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PubMed1994

[Disorders of the hemostasis system in patients with mitral valve prolapse].

Mitral prolapse is frequently encountered in association with other manifestations of mesenchymal dysplasia (skin hyperelastosis, joint hypermobility, dislocations, etc.) and occasional bleedings. Of 35 cases reported, 17 had petechiae and ecchymoses, 1 had hematuria, the rest suffered from bleedings: nasal (22 cases), profuse menstrual (19 cases), long-term extraction and cut bleedings (9 cases), gastrointestinal (3 cases). Hemorrhages of different sites often occurred in combination. Hemostatic investigations revealed: platelet aggregation dysfunction, Willebrand syndrome, end coagulation disturbances, lack or anomalies of factors VII, X and II (14, 17, 12 and 4 patients, respectively).

Adolescent↗
PubMed2002

Mitral valve relpair and revascularization for ischemic mitral regurgitation: predictors of operative mortality and survival.

BACKGROUND AND AIMS OF THE STUDY: Surgery for ischemic mitral regurgitation (IMR) is required in 4-5% of patients subjected to coronary artery surgery, and may be challenging. The study aim was to determine outcome following mitral valve repair and myocardial revascularization for moderate-to-severe IMR. METHODS: A total of 102 patients (mean age 68+/-7 years) underwent mitral valve repair for IMR between 1998 and 2001 at the authors' unit. Among patients, 28 had acute and 74 chronic mitral regurgitation (MR). Valve repair was achieved with an annuloplasty ring in all 102 patients, while 99 underwent concomitant myocardial revascularization. Preoperatively, 69 patients had MR grade III-IV, 62 had CCS angina class III-IV, 59 were in NYHA class II-IV, 81 had impaired left ventricular function, and 10 were in cardiogenic shock. Follow up was 100% complete (mean 14+/-7 months; range: 0-38 months). RESULTS: Overall operative mortality was 8.8% (n = 9) (17.8% for acute IMR, 5.4% for chronic, p = 0.048). On multiple logistic regression analysis, cardiogenic shock (p = 0.028) was the only significant risk factor for operative death. There were 11 late deaths. Kaplan-Meier survival at one and three years was 82+/-4% and 79+/-4%, respectively. On Cox proportional hazards regression model, preoperative left ventricular end-systolic diameter (LVESD) >4.5 cm (p = 0.01) and NYHA class III-IV (p = 0.02) were independent adverse predictors of survival. Three patients required reoperation. Kaplan-Meier three-year freedom from reoperation was 97+/-2%. CONCLUSION: Surgery for IMR carries a considerable, but acceptable, operative risk and provides satisfactory freedom from reoperation and mid-term survival. Cardiogenic shock before surgery is the major determinant of an unfavorable in-hospital outcome. LVESD >4.5 cm and poor preoperative NYHA status limit the probability of late survival. The study results support early surgical intervention for IMR, before ventricular dilatation occurs.

Aged↗
PubMed2002

[The first clinical experience and technical peculiarities of mitral valve homograft implantation].

INTRODUCTION: Surgical interventions because of mitral valve disease have been ascribed since 1951. Many changes within mitral valve replacement have passed including closed and open mitral commissurotomy, mitral valve repair operations implantation of mechanical, biological heart valve and finally use of mitral valve homograft. Despite changes in chirurgical tactics and medico-technical environment, mitral valve homograft implantation remains one of the most complex surgical interventions. Surgical and technical details of mitral valve homograft implantation are discussed. OBJECTIVE: to estimate technical difficulties and anatomical positioning of mitral valve homograft considering a spectrum of indications of mitral valve replacement. CASE REPORT: 62-year-old woman 26 years ago underwent mitral valve replacement with Starr-Edwards mitral valve prosthesis, because of rheumatic heart disease by homograft. Due to malfunction of the mitral valve prosthesis, and progressive left ventricular failure patient was reoperated on 26(th) of February 2002. Fresh antibiotic preserved mitral valve homograft was implanted. Surgical techniques were guided using left ventricle size measurement indicated by echocardiography. RESULTS: The technique described by Acar/Carpentier was used except of mitral valve annuloplasty ring implantation. Peri- and early postoperative period was free of homograft related complications. The left ventricle function was improving and the heart size decreased dramatically during first postoperative week. CONCLUSION: The most important peculiarities for mitral valve homograft implantation are echocardiography data and intraoperative left ventricle measurements. Homograft implantation techniques are rather demanding therefore indications for mitral valve replacement have to be selected carefully and should be based on the presence of severe mitral valve dysfunction in order to achieve best hemodynamic results and prevent patient from anticoagulation therapy.

Echocardiography↗
PubMed2001

Mitral valve endocarditis following balloon mitral valvotomy.

The case of a patient who developed fungal valve endocarditis due to Candida albicans following balloon mitral valvotomy is presented. The patient did not have any obvious predisposing factors which led to the development of fungal endocarditis.

Candida albicans↗
PubMed1997

Mid-term results of mitral valve replacement combined with chordae tendineae replacement in patients with mitral stenosis.

BACKGROUND AND AIMS OF THE STUDY: Although many studies have found that preservation of the continuity between the mitral annulus and the papillary muscles during mitral valve replacement improves postoperative left ventricular performance in patients with mitral regurgitation, much less research has been done in this respect in patients with mitral stenosis. We reviewed our experience with mitral valve replacement combined with chordae tendineae replacement in 29 patients with mitral disease, 26 of whom had mitral stenosis. METHODS: During mitral valve replacement, continuity between the papillary muscle and annulus was restored with expanded polytetrafluoroethylene (ePTFE) mattress sutures, which were threaded into the compact portion of each papillary muscle and placed at the 2, 4, 8 and 10 o'clock positions in the mitral annulus. Postoperatively, the patients were followed by echocardiographic assessment and exercise (stress) radionuclide angiography testing. The stress test results were compared with those in patients who had undergone traditional mitral valve replacement, and also those in normal people. RESULTS: There were no hospital deaths, complications, or cardiac deaths or events during a median follow up of two-and-a-half years. Echocardiography showed no postoperative cardiac dilatation. The stress tests found no significant differences between the ejection fraction in mitral stenosis patients who underwent conventional mitral valve replacement and in those who had valve replacement combined with ePTFE chordae tendineae replacement. CONCLUSIONS: A direct advantage of chordae-preserving mitral valve replacement over conventional replacement with respect to postoperative global left ventricular performance in patients with mitral valve stenosis has not been demonstrated. However, postoperative regional left ventricular contraction in patients with mitral stenosis has been observed to be better among those who have undergone the chordae-preserving procedure. Additional investigations are needed to elucidate the effects of this procedure in mitral stenosis, but we believe that the technique improves left ventricular performance and may decrease the risk of left ventricular rupture.

Adult↗
PubMed1998

Predictors of left atrial thrombus and spontaneous echo contrast in rheumatic valve disease before and after mitral valve replacement.

In this study we aimed to analyze, with reference to mitral regurgitation (MR), the incidence and predictors of left atrial (LA) thrombus and spontaneous echo contrast in patients with rheumatic valve disease before and after mitral valve replacement. The incidence of LA thrombus is known to be less in patients with MR. The impact of mitral valve replacement on this beneficial effect has not been studied in detail. The study included 169 consecutive patients (59 men and 110 women, average age 40 +/- 13 years) with rheumatic mitral valve disease who underwent transesophageal echocardiographic examination 1 to 3 days before and within 7 days (mean 4.0 +/- 1.3) after mitral valve replacement using mechanical prostheses in a single institution. The preoperative incidence of echocardiographic LA spontaneous echo contrast (SEC) was 1.1%, 30%, and 54%, and the incidence of thrombus was 1.1%, 13%, and 17% in the groups with MR, combined mitral stenosis + MR, and isolated mitral stenosis, respectively. In the MR group, SEC and thrombus incidence increased significantly after surgery. The independent predictors for postoperative thrombus development were atrial fibrillation, postoperative SEC, and preoperative thrombus. Thrombus recurred after surgery in 64% of 14 patients who had surgical thrombectomy. The presence of postoperative MR was associated with decreased risk of postoperative SEC and thrombus development. The interaction between MR and SEC and thrombus both before and after surgery provides further support for the protective effect of MR against LA thrombus formation.

Adult↗
PubMed1987

Importance of the mitral complex in left ventricular contraction--an analysis of the results of mitral valve replacement with preservation of the posterior mitral complex.

The importance of the mitral complex in left ventricular contraction was studied in seventy-five patients who underwent mitral valve replacement (MVR) with preservation of the posterior mitral complex (modified MVR:mMVR), and in one hundred and twenty-two patients who had conventional mitral valve replacement (cMVR). Mechanical heart valves (Medtronic Hall or St. Jude Medical valves) were used in MVR. Patients after mMVR showed lower left atrial pressures, higher left ventricular stroke work indexes, and better left ventricular function curve using less catecholamines than those after cMVR during the initial 24 hours following cardiopulmonary bypass. M-mode echocardiographic analysis revealed that the sequential apex-to-base contraction of the ventricular wall was better preserved after mMVR than after cMVR. This tendency was more prominent in mitral regurgitation (MR) than in mitral stenosis (MS) patients. Echocardiographic analysis revealed that the posterior mid left ventricular segment began to contract and reached maximal contraction earlier than the basal segment in patients before and after mMVR. After cMVR, this tendency was less noticeable, and the contraction processed and peaked almost simultaneously in all segments. The mitral complex plays an important role in left ventricular contraction, and modified MVR can be said to be an excellent procedure for preserving left ventricular function.

Cardiopulmonary Bypass↗
PubMed1993

Contribution of mitral valve reserve capacity to sustained symptomatic improvement after balloon valvulotomy in mitral stenosis: implications for restenosis.

OBJECTIVES: To explain the discrepancy between the symptomatic status of patients and the hemodynamically calculated mitral valve area during long-term follow-up after mitral balloon valvulotomy, mitral valve orifice variability after dobutamine infusion was investigated in two groups of patients. BACKGROUND: A significant increase in aortic valve area with increased aortic transvalvular flow has been reported in patients with calcific aortic stenosis after aortic balloon valvulotomy. A similar phenomenon with regard to the mitral valve has not been studied in detail. METHODS: Group 1 comprised 10 patients (mean age 33 +/- 9 years) with untreated mitral stenosis. Group 2 comprised 29 consecutive patients (mean age 32 +/- 7 years) who underwent successful percutaneous mitral balloon valvulotomy 13 +/- 2 months before the study. RESULTS: After dobutamine infusion, heart rate and cardiac index increased significantly in both groups. The mean pulmonary artery pressure, mitral valve gradient and pulmonary capillary pressure remained unchanged in Group 2 but increased significantly in Group 1. The mean mitral valve area was significantly larger in Group 2 after dobutamine infusion than at baseline (1.9 +/- 0.5 vs. 2.4 +/- 0.6 cm2, p < 0.0001) but was unchanged in Group 1 (1.2 +/- 0.2 vs. 1.3 +/- 0.3 cm2, p = NS). The mean mitral valve area in seven patients in Group 2 (24%) was < or = 1.5 cm2 before dobutamine infusion (1.3 +/- 0.4 cm2), which was defined as restenosis. In five of these seven patients who had minimal or no symptoms, the mitral valve area increased significantly after dobutamine infusion (1.3 +/- 0.1 vs. 1.9 +/- 0.1 cm2). In the other two patients who were symptomatic, the mitral valve area did not change after dobutamine infusion. These two patients were identified as having "true" restenosis, and redilation of the mitral valve was performed in both. CONCLUSIONS: In patients who underwent mitral balloon valvulotomy, increased mitral valve reserve capacity contributed to symptomatic improvement on long-term follow-up. Dobutamine infusion may be helpful in detecting clinically significant restenosis.

Adult↗
PubMed1997

Multiple-leaflet mitral valve as a rare cause of congenital mitral insufficiency.

A rare case of congenital mitral insufficiency characterized by six well-demarcated leaflets of mitral valve and annular dilatation is reported. At operation, the mitral valve was successfully repaired by resection of the posterior median leaflet with subsequent annular plication, closure of unusual valvular tissue divisions, and ring annuloplasty.

Child↗
PubMed2000

[Mitral valve prolapse in children].

Mitral valve prolapse (MVP) is an abnormal movement of one or two of mitral leaflets into the left atrium during ventricular systole. Etiopathogenesis is still not fully understood. Clinical presentation of MVP could be asymptomatic. Chest pain, palpitation and syncope are typical for mitral valve prolapse syndrome. On physical examination most patients have midsystolic click and/or systolic murmur which is often misdiagnosed as an innocent murmur. Arrhythmia and mitral regurgitation are the most often seen complications of MVP and their number increases with patients age. Most children with MVP do not need any treatment. In those with mitral regurgitation prophylaxis against endocarditis is obligatory. The use of echocardiography increased the number of patients with diagnosed mitral valve prolapse diagnosed.

Child↗
PubMed1983

Progressive extreme biatrial enlargement following mitral valve replacement.

Patients with mitral valve disease and extreme enlargement of the left atrium usually exhibit significant decrease in chamber size following corrective mitral valve surgery. We describe a patient in whom extreme right and left atrial enlargement developed, and progressed following mitral valve replacement, with no evidence of prosthetic valve malfunction or tricuspid valve disease.

Aged↗
PubMed2000

Permanent left ventricular pacing from the great cardiac vein of a patient with artificial tricuspid and mitral valves--a case report.

Transvenous placement of a right ventricular pacemaker lead through the artificial tricuspid valve is a known contraindication, and in this situation, epicardial pacemaker implantation is the procedure of choice. However, permanent pacemaker implantation is a subject for debate when the use of the epicardial route is impossible. This report describes alternate transvenous routes for a pacemaker lead in a patient with an artificial tricuspid valve and mitral valve in whom the epicardial lead and pacemaker generator must be removed because of resistant infection.

Cardiac Pacing, Artificial↗
PubMed2005

Mitral stenosis after mitral valve repair using the duran flexible annuloplasty ring for degenerative mitral regurgitation.

The case is presented of a 47-year-old woman who had undergone mitral valve repair using the Duran annuloplasty ring four years earlier, and who was diagnosed with mitral stenosis owing to fibrous tissue overgrowth. In this patient, dense whitish fibrous tissue covered the annuloplasty ring and extended onto both leaflets of the mitral valve, narrowing its orifice and rendering the leaflets stiff and immobile. The pannus covering the mitral valve could not be stripped off without damaging the leaflets, making mitral valve replacement necessary. Mitral valve replacement with a St. Jude Medical mechanical heart valve prosthesis was successfully performed, and no major perioperative complications were encountered.

Female↗
PubMed1996

[A case of valve thrombosis of CarboMedics prosthesis four years after mitral valve replacement: relationship of anticoagulant therapy to coagulation and fibrinolysis activating factors].

A 50-year-old man experienced acute heart failure four years after initial mitral valve replacement (MVR) for left atrial thrombosis using a CarboMedics prosthesis, despite satisfactory coagulation control with warfarin. After initial MVR, late cardiac tamponade occurred twice and left circumflex branch stenosis was treated with percutaneous transluminal coronary angioplasty (PTCA). Re-MVR with an Edwards-TEKNA valve was performed after echocardiography and cineradiography showed mitral valve thrombosis, with thrombi on both mitral valve leaflets and covering most of the left atrial wall. Post-surgery progress was favorable with warfarin and dipyridamole therapy. After six weeks cardiac catheter revealed complete right external iliac artery occlusion. Cardiac dysfunction and atrial flutter apparently accelerated thrombosis after a common cold activated coagulation. Cardiac tamponade, circumflex branch stenosis, and right external iliac artery occlusion occurred despite satisfactory coagulation control by warfarin. Warfarin suppresses some coagulation factors but cannot always correct hypercoagulability. Two months after re-MVR, coagulation tests showed normal TT, F1 + 2, and D-Dimer but an increase in TAT, suggesting involvement of additional coagulation factors. After artificial valve replacement, therapy should achieve a PT-INR level of 3.0-4.5, with close follow-up using other indices of fibrinolysis and coagulation activity in addition to TT.

Acute Disease↗
PubMed1977

[Surgical treatment of obstructive cardiomyopathies by mitral valve replacement].

The authors present a series of 10 cases of OCM which were treated by replacement of the mitral valve. Mitral incompetence was present in all patients, and was major or massive in 7 of them. Direct surgery to the mitral valve area has demonstrated pathological lesions in the mitral valve mechanism in 7 patients. A formal indication for mitral valve replacement in the surgical treatment of cases of OCM therefore exists when there is major mitral incompetence, intraventricular conduction defect, cardiac failure, or failure of previous myotomy.

Adult↗