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PubMed1999

[Radionuclide diagnosis of tricuspid regurgitation as a method of estimating the significance of tricuspid insufficiency with concurrent mitral valve disease].

UNLABELLED: A mitral valve replacement without simultaneous correction of a concomitant tricuspid regurgitation aggravates remote postoperative results. Nowadays diagnostics of a degree of tricuspid regurgitation bases on semi-quantitative methods, which are not unequivocal criteria of a significant tricuspid insufficiency. The aim of the study was to investigate diagnostic usefulness of a radioisotopic method of determination significant tricuspid insufficiency. The study group consisted of 35 patients with rheumatic mitral valve disease and tricuspid regurgitation (30 females, 5 males) at a mean age of 55 years qualified for operative treatment. Physical and noninvasive examinations were performed in all patients: chest X-ray (relative heart volume--RHV) and echocardiographicy (tricuspid regurgitation and right ventricle pressure). Final determination of a significant tricuspid insufficiency based on intraoperative diagnosis. The radioisotopic method relies on first pass technique with a determination of a tricuspid regurgitation index (TRI) and a right ventricular ejection fraction. Intraoperatively the patients were divided into two groups: with significant tricuspid regurgitation--21 patients and without--14 patients. Statistically significant differences, considering clinical and echocardiographic assessment between the two groups were noticed. The TRI index did not differentiate two groups. Noninvasive parameters that could affect diagnosis of significant tricuspid regurgitation were proved by a logistic regression analysis. Among them the TRI Index could have a separate value. CONCLUSIONS: Presented radioisotopic method of determination a degree of tricuspid regurgitation with the new TRI Index is of value in diagnosing significant tricuspid insufficiency when assessed with other noninvasive parameters. Estimation of a clinical usefulness of the method needs further investigation and bigger study group.

Adult↗
PubMed2002

Surgical treatment of partial atrioventricular septal defect: functional analysis of the mitral valve in the postoperative period.

OBJECTIVE: To study mitral valve function in the postoperative period after correction of the partial form of atrioventricular septal defect. METHODS: Fifty patients underwent surgical correction of the partial form of atrioventricular septal defect. Their mean age was 11.8 years and 62% of the patients were males. Preoperative echocardiography showed moderate and severe mitral insufficiency in 44% of the patients. The mitral valve cleft was sutured in 45 (90%) patients (group II - GII). Echocardiographies were performed in the early postoperative period, and 6 and 12 months after hospital discharge. RESULTS: The patients who had some type of arrhythmia in the postoperative period had ostium primum atrial septal defect of a larger size (2.74 x 2.08 cm). All 5 patients in group I (GI), who did not undergo closure of the cleft, had a competent mitral valve or mild mitral insufficiency in the preoperative period. One of these patients began to have moderate mitral insufficiency in the postoperative period. On the other hand, in GII, 88.8% and 82.2% of the patients had competent mitral valve or mild mitral insufficiency in the early and late postoperative periods, respectively. CONCLUSION: The mitral valve cleft was repaired in 90% of cases. Echocardiography revealed competent mitral valve or mild mitral insufficiency in 88.8% and 82.2% of GII patients in the early and late postoperative periods, respectively.

Adolescent↗
PubMed1982

Two-dimensional echocardiographic evaluation of mitral valve calcification. Sensitivity and specificity.

The effectiveness of two-dimensional echocardiography in assessing mitral valve calcification was compared to radiography of the surgically excised valves in 43 patients affected by rheumatic disease of the mitral valve. Mitral valve calcification was graded as absent or present if single thin or multiple dense conglomerate echoes defined the valvular orifice in short axis view, provided the sensitivity of the instrumentation was adequately optimized. The radiograph of the excised valve was similarly graded. The interobserver reproducibility for both two-dimensional echocardiography and radiography was 100 percent. There were 14 true positives, 19 true negatives, 10 false positives and no false negatives, thus giving, for two-dimensional echocardiography, a sensitivity of 100 percent and a specificity of 65 per cent. It is concluded that two-dimensional echocardiography is an extremely sensitive method for assessing mitral valve calcification, and is prospectively useful also in planning reconstruction versus replacement in mitral valve surgery. Nevertheless, the consistent number of false positives affecting two-dimensional echocardiography represents a definite limit to the specificity of the technique.

Adult↗
PubMed1980

Echocardiographic diagnosis of mitral valve aneurysm.

Cases of mitral valve aneurysm determined during the patient's lifetime have not yet been described in literature. Using a mechanical sector scanner we were able to diagnose a mitral valve aneurysm in a 22-yr-old man suffering from rheumatic aortic steno-insufficiency. The real-time, cross-sectional image showed an aneurysm which was limited to the proximal part of the anterior mitral leaflet. During diastole the reflow of blood from the insufficient aorta determined an enlargement of the aneurysm towards the left atrial cavity. Bacterial vegetation which protruded from the aortic valvular surface and which was responsible for abnormal echoes in the M-mode in the left outflow tract was also detected. The patient died of irreversible cardiac insufficiency caused by the infectious endocarditis, and upon autopsy the echocardiographic diagnosis was confirmed.

Adult↗
PubMed1995

Histopathologic studies of innervation of normal and prolapsed human mitral valves.

We evaluated the distribution of the nerves in valve tissue of humans to clarify the relationship between mitral valve prolapse and autonomic nerve dysfunction. We studied 15 autopsy specimens of normal mitral valve, 10 prolapsed mitral valves, five each of normal tricuspid, aortic, and pulmonary valves, and three prolapsed mitral valves obtained at cardiac surgery. Immunohistochemical studies utilized the avidinbiotin peroxidase complex (ABC) method and several nerve-related antigens: 1) S-100 protein, glial fibrillary acidic protein (GFAP), and neurofilament protein (NFP) as markers of glial and Schwann cells of the nervous system; 2) choline acetyltransferase (ChAT) to identify cholinergic nerve endings; 3) neuropeptide Y (NPY), a neuropeptide that is distributed in accordance with sympathetic nerves; and 4) calcitonin gene-related peptide (CGRP), a neuropeptide that is distributed in accordance with afferent nerves. Distribution of adrenergic nerve fibers was also examined by fluorescence method. Morphology of nerve endings of the normal mitral valve was studied by electron microscopy. In normal valves, distributions of S-100 protein, GFAP, and NFP immunoreactivities were clearly visible along the subendocardial site on the coaptation aspect of the base-to-body portion of each valve, regardless of the kind of valve. In contrast, there was only a scanty distribution of these reactivities on the physiologic coaptation area of the tip. In prolapsed mitral valves, there was no distribution of S-100-positive protein or other nerve-related antigens in areas of the valve with myxomatous degeneration. Distribution of CGRP, ChAT, and NPY immunoreactivities, and adrenergic fluorescence, were the same as those of the nerve-related antigens in both normal and prolapsed mitral valves. Electron microscopic study of the atrial aspect of normal mitral valves revealed numerous small axons with aggregations of small clear vesicles, indicating cholinergic features. The results suggest that the subendocardial site on the atrial aspect at the middle portion of the mitral valve is rich in nerve endings, including the afferent nerves, and that mechanical stimuli from this area caused by abnormal coaptation in mitral valve prolapse may produce an improper circuit in autonomic nerve function between the central and mitral valve nervous systems.

Adult↗
PubMed1979

Psychiatric implications of the mitral valve prolapse syndrome (MVPS).

The mitral valve prolapse syndrome (MVPS) is an infrequent outcome of mitral valve prolapse, a common and usually benign structural abnormality. Psychiatric patients often present with symptoms indistinguishable from MVPS, knowledge of which is thus essential for differential diagnosis. Even when prolapse of the mitral valve is detected, the symptoms may be variously determined by both physical and emotional factors. Four illustrative case histories are presented.

Adult↗
PubMed1988

Floppy mitral valve chordae tendineae: histopathologic alterations.

Pathologic studies of floppy or myxomatous mitral valves have focused primarily on changes in the valve cusps, with little attention given to the chordae tendineae. In a systematic study of the histopathology of floppy mitral valve chordae tendineae, 128 nonruptured chordae from 8 severely regurgitant floppy mitral valves were compared to 152 chordae from 10 normal control mitral valves and to 152 chordae from 8 control mitral valves with severe regurgitation due to ischemic heart disease. Collagen alterations were observed in 2% of normal mitral valve chordae and 3% of control regurgitant mitral valve chordae compared to 38% of floppy mitral valve chordae. Moderate or severe acid mucopolysaccharide accumulation was observed in 2% of normal mitral valve chordae and 3% of control regurgitant mitral valve chordae compared to 39% of floppy mitral valve chordae. Nonuniform histopathologic alterations, rare in normal and control regurgitant mitral valve chordae tendineae, were frequent in floppy mitral valve chordae tendineae (p less than 0.001). Histopathologic alterations provide the basis for abnormal physical properties previously demonstrated in floppy mitral valve chordae tendineae and may predispose to chordal elongation and rupture.

Aged↗
PubMed1985

Prostaglandin E1. A new therapy for refractory right heart failure and pulmonary hypertension after mitral valve replacement.

Patients undergoing mitral valve replacement, particularly those with severe pulmonary hypertension and/or congestive heart failure, may develop life-threatening right heart failure in the immediate postbypass period. We have observed that such patients have intense pulmonary vasoconstriction. The markedly increased pulmonary impedance may aggravate the right heart failure and prevent recovery of right ventricular function in this setting. Therefore, we studied the effects of high-dose prostaglandin E1 (30 to 150 ng/kg/min), a potent pulmonary vasodilator, in combination with massive infusion of norepinephrine (up to 1 microgram/kg/min) into the left atrium in five consecutive patients with refractory right heart failure and pulmonary hypertension after mitral valve replacement. This pharmacologic approach takes advantage of the pulmonary vasodilating effects of prostaglandin E1, while offsetting associated systemic vasodilation and resulting hypotension. All five patients had rapid pulmonary vasodilator responses followed by marked improvement in right ventricular function. All survived the operation and none had right ventricular infarction or chronic right heart failure postoperatively.

Adult↗
PubMed1987

Mitral valve prolapse in children.

Mitral valve prolapse is extremely common in children. It is diagnosed by the presence of a nonejection click with or without an associated murmur. In isolated mitral valve prolapse, the prognosis is excellent, but regular office visits are necessary for cardiac status review and infective endocarditis prophylaxis. Patients with significant dysrhythmias represent a small subset with an unknown long-term prognosis.

Arrhythmias, Cardiac↗
PubMed2000

Successful percutaneous balloon mitral valvuloplasty using left ventricular pressure as a guide to cross the mitral valve--a case report.

Percutaneous balloon mitral valvuloplasty (PBMV) provides an effective alternative to surgery in a selective group of patients with symptomatic mitral stenosis. The Inoue balloon technique involves transseptal catheterization followed by catheter manipulation to cross the mitral valve. The authors describe a case of successful percutaneous balloon mitral valvuloplasty in a patient with severe mitral stenosis and pulmonary hypertension. Left ventricular systolic pressure was used as a guide to locate and to advance the balloon catheter across the mitral valve. This technique to cross the mitral valve has not been reported in the literature.

Adult↗
PubMed1989

[Pathoetiological aspects of mitral valve prolapse].

Myxomatous lesion of the mitral valve, a major pathological factor in mitral valve prolapse (MVP), was analyzed in 33 cases with idiopathic MVP, 34 with secondary MVP, 30 with hypertension, 11 with right ventricular hypertrophy, and 28 control subjects. Area of the myxomatous lesion expressed as a percent area in the cross-section of each valve leaflet was obtained in each zone. With the increasing age, the % area increased particularly in the posterior leaflet and the area expanded from the rough zone to the basal zone. Compared with other conditions, the mitral valve in idiopathic MVP had extensive myxomatous lesion of 50% or more in the % area. Histologically, this area showed diffusely distributed lesion from the fibrosa to the ventricularis, disappeared collagen fibers, and disrupted elastic fibers irregularly located. Electron-microscopically, these disruption or disappearance were replaced by young mesenchymal cells. It was concluded that the increase in a myxomatous lesion is the essential pathological finding in idiopathic MVP, but this lesion may be developed secondarily in other conditions, though not so extensive.

Adult↗
PubMed2002

Minimal access mitral valve replacement.

Minimally invasive mitral valve surgery has recently been advocated as an alternative to the conventional median sternotomy approach. It has several documented advantages and requires a close relationship betweeen the surgeons, anaesthetist and perfusionist for a successful outcome. This article demonstrates our surgical technique for replacement of the mitral valve. The various aspects of the specialised equipment used are also described.

Anesthesia, General↗
PubMed1989

Mitral valve prolapse:--the facts.

Mitral Valve Prolapse does not cause chest pain or other symptoms and is extremely unlikely to give rise to complications. In practice it is difficult to differentiate a 'prolapsing' valve from one that is 'normal' no matter what methods are used. Since diagnosing 'heart disease' is itself a well known cause of ill health, the most stringent criteria must be adopted before the mitral valve is labelled as being abnormal. The need for the diagnosis at all is, in most cases, doubtful.

Electrocardiography↗
PubMed2000

[Extensions of mitral valve repair techniques: surgery for endocarditis and valvular tumors].

Mitral valve repair has demonstrated its superiority over valve replacement. Mitral valve repair constitutes the optimal therapeutic option in case of degenerative dystrophic, rheumatic, congenital or ischemic mitral valve disease. These surgical techniques can also be successfully and advantageously applied in case of bacterial endocarditis or tumoral valvular disease. We report a case of staphylococcal endocarditis and another case of posterior leaflet fibroelastoma to show the place of conservative mitral surgery in these unusual indications.

Adult↗
PubMed2000

Three-dimensional echocardiographic assessment of annular shape changes in the normal and regurgitant mitral valve.

OBJECTIVES: To compare mitral annular shape and motion throughout the cardiac cycle in patients with normal hearts versus those with functional mitral regurgitation (FMR). BACKGROUND: The causes of mitral regurgitation without valvular disease are unclear, but the condition is associated with changes in annular shape and dynamics. Three-dimensional (3D) imaging provides a more comprehensive view of annular structure and allows accurate reconstructions at high spatial and temporal resolution. METHODS: Nine normal subjects and 8 patients with FMR undergoing surgery underwent rotationally scanned transesophageal echocardiography. At every video frame of 1 sinus beat, the mitral annulus was manually traced and reconstructed in 3D by Fourier series. Annular projected area, nonplanarity, eccentricity, perimeter length, and interpeak and intervalley spans were determined at 10 time points in systole and 10 points in diastole. RESULTS: The mitral annulus in patients with FMR had a larger area, perimeter, and interpeak span than in normal subjects (P <.001 for all). At mid-systole in normal annuli, area and perimeter reach a minimum, nonplanarity is greatest, and projected shape is least circular. These cyclic variations were not significant in patients with FMR. Annular area change closely paralleled perimeter change in all patients (mean r = 0.96 +/- 0.07). CONCLUSIONS: FMR is associated with annular dilation and reduced cyclic variation in annular shape and area. Normal mitral valve function may depend on normal annular 3D shape and dimensions as well as annular plasticity. These observations may have implications for design and selection of mitral annular prostheses.

Adult↗
PubMed1980

Mitral valve systolic click syndrome.

Mitral valve prolapse, although usually a benign condition, can cause incapacitating chest pain or refractory arrhythmias. Among patients undergoing cardiac catheterization for evaluation of chest pain, 50 who were found to have mitral valve prolapse were analyzed. Three patients had neither a click nor a murmur. Echocardiography was diagnostic in 46 patients; two patients had no evidence of prolapse, and two patients had tests that were technically inadequate. Only 15 of the patients demonstrated a normal electrocardiogram.

Adult↗