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PubMed2004

Beating mitral valve replacement for a patient with porcelain aorta.

Beating mitral valve replacement was performed for mitral valve stenosis in a patient with a porcelain aorta after aortic valve replacement. The 77-year-old patient had developed heart failure several times. A chest computed tomographic scan revealed severe calcification on the ascending aorta and aortic arch. A cardiopulmonary bypass was established by bicaval drainage and aortic return after epiaortic echographic evaluation of the ascending aorta. The mitral valve was successfully replaced under a beating heart.

Aged↗

PubMed1998

Techniques and results of direct-access minimally invasive mitral valve surgery: a paradigm for the future.

OBJECTIVES: Our objective was to determine whether direct-access minimally invasive mitral valve surgery can improve recovery and cost while maintaining the efficacy of conventional surgery. METHODS: Minimally invasive mitral valve operations were performed on 106 patients, 58% male, average age 58.1 years, with good ventricular function. Ninety underwent repair of a regurgitant, myxomatous valve, and 16 underwent mitral valvuloplasty for prematurely calcified mitral stenosis. The valve was approached with standard instruments through a 5- to 8-cm right parasternal incision. Eighty-five had open femoral artery-femoral vein cannulation, but this technique has recently been replaced by direct cannulation of the aorta and percutaneous cannulation of the femoral vein for most patients. RESULTS: There were no operative deaths. The mean mitral regurgitation score (0-4) decreased from 3.7 to 0.7 after the operation. Although ischemic and bypass times were increased, postoperative recovery was accelerated. Ventilatory support time, intensive care unit stay, hospital stay, need for rehabilitation, and return to "normal activities" all improved. Hospital charges, pain medications, and blood transfusions were also reduced. New atrial fibrillation contributed significantly to increased length of stay and charges. There were no deep wound infections. Other complications included re-exploration for bleeding (n = 1), transient ischemic attacks (n = 2), stroke (n = 1), femoral artery injury (n = 5), pseudoaneurysm (n = 2), and antegrade dissection of the ascending aorta (n = 1). Two patients died and 1 required reoperation during a mean follow-up of 8.8 months. CONCLUSIONS: Direct-access minimally invasive mitral valve surgery can accelerate recovery, decrease charges, and decrease pain, while maintaining overall surgical efficacy. It has become our standard approach for isolated primary mitral valve operations.

Adult↗

PubMed2002

[Noncompaction of the left ventricular myocardium. Case report and review of the literature].

Left ventricular non-compaction is an unclassified cardiomyopathy characterized by an excessively prominent trabecular meshwork due to an arrest in myocardial morphogenesis. We report on a 51-year-old female patient with abnormal myocardial trabeculations associated with a congenital mitral valve stenosis post commissurotomy at the age of 14. In the present case report, clinical manifestation of the disorder included impaired left ventricular systolic function and atrial fibrillation. Noncompaction was diagnosed by echocardiography and levocardiography. In addition, a review of the literature on this rare disorder is presented.

Adolescent↗

PubMed1993

Partial kidney transplantation: a successful kidney transplantation in a child with severe cardiac failure by surgical mass reduction of an adult donor kidney.

We report on a trial of partial kidney transplantation performed on a low body weight child with impaired cardiac function due to mitral valve stenosis and uremic cardiomyopathy. The weight of the donated kidney was successfully reduced by one-third using bench surgery in order to obtain sufficient graft perfusion and function. Our procedure is justified when a graft is too large to be adequately perfused in a recipient suffering from cardiac failure.

Adult↗

PubMed1998

[A case of aortic prosthetic valve endocarditis with aortic root aneurysm].

A 72-year-old male who underwent patch closure of atrial septal defect and aortic valve replacement (AVR) 10 years ago was diagnosed as aortic prosthetic valve endocarditis for recurrent fever, coexisting paravalvular leakage and aortic root aneurysm by transthoracic and transesophageal echocardiography. Operative findings showed mechanical prosthesis was dehiscenced in part and limited subannular aneurysm that was healed macroscopically. The hole of the aneurysm was closed by direct suture. Re-AVR, mitral valve replacement and tricuspid annuloplasty for complicating mitral valve stenosis and regurgitation and tricuspid valve regurgitation was performed. The patient is now doing well for one year after the reoperation.

Aged↗

PubMed1984

Mitral valve disease.

Mitral stenosis is a progressive lesion carrying a relatively high risk of sudden incapacitation from systemic embolus or the onset of atrial fibrillation. Since the condition is likely to be significant when diagnosed, it is not compatible with single-crew professional operations and requires careful supervision. The presence of mild mitral regurgitation where the aetiology has been shown not to be due to chordal rupture, papillary muscle dysfunction secondary to coronary artery disease, rheumatic mitral valve disease, or Marfan's disease, where left atrial and left ventricular dimensions are shown to be normal on the echocardiogram, and where follow-up over at least a year has shown no progression of disease, may be consistent with full certification. Regular cardiological review with echocardiography and exercise electrocardiography is required. Any departure from these guidelines may lead to restriction of flying status to multi-crew operations, or denial.

Adult↗

PubMed1985

The effect of low-dose intravenous nitroglycerin on pulmonary hypertension immediately after replacement of a stenotic mitral valve.

The postoperative effect of infusion of nitroglycerin on pulmonary vasomotor dynamics was studied in 28 patients undergoing valve replacement for mitral valve stenosis. A 30% reduction in mean pulmonary arterial pressure (38.74 +/- 8.3 to 26.92 +/- 7.72 mm Hg, p less than .001) and a 48.4% reduction in pulmonary vascular resistance index (12.08 +/- 4.19 to 5.61 +/- 1.61 U/m2, p less than .001) were observed after nitroglycerin. While pulmonary driving pressure (mean pulmonary arterial pressure minus left atrial pressure) dropped by 50.8%, cardiac and stroke volume indexes increased by 25.5% and 24.2%, respectively. The ratio pulmonary/systemic vascular resistance decreased from 34.14% to 20.9% (p less than .001). There were no significant changes in mean systemic arterial pressure (86.89 +/- 13.5 to 83.5 +/- 9.3 mm Hg, p = NS) or heart rate (97.43 +/- 20.45 to 99.36 +/- 20.9 beats/min, p = NS); left and right atrial pressures decreased by 19.5% and 9.5%, respectively. Systemic vascular resistance index decreased by 18.8%. We conclude that low-dose infusion of nitroglycerin reduces the pulmonary vascular resistance in patients with pulmonary hypertension, and consequently results in improvement in immediate postoperative hemodynamics after replacement of a stenotic mitral valve.

Adolescent↗

PubMed1986

[Determination of stenotic mitral valve area using Doppler echocardiography. A comparison with hemodynamic studies].

In order to assess the reliability of Doppler echocardiography in the determination of mitral valve area (MVA) 21 consecutive patients (pts) affected by rheumatic disease and mitral valve stenosis (MS) were analyzed by continuous wave doppler echocardiography (CWD). Cardiac catheterization (cath) was performed within 24 hours from echocardiographic examination. MVA by CWD was calculated with a computerized system from the "pressure half-time" (T1/2) using the equation: 220/T1/2 in cm2. MVA was calculated from cath data by applying the modified Gorlin formula. MVA determined by CWD ranged from 0.9 to 2.8 cm2 (mean 1.39 +/- 0.55). MVA determined by Gorlin formula ranged from 0.5 to 2.8 cm2 (mean 1.31 +/- 0.63). The correlation between CWD and cath was good (r = 0.93, SEE = 0.19 cm2, P less than 0.001). In conclusion this study indicates that CWD is quite accurate in estimation of MVA and can reliably discriminate the "critical" size of the orifice. CWD has the advantage of allowing MVA determination in patients with associated mitral regurgitation.

Adolescent↗

PubMed1956