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PubMed2004

Surgery of congenital mitral valve disease.

Congenital malformations of the mitral valve are numerous and can be confusing. The functional expression is an insufficiency, a stenosis or a combined lesion. The anatomic classification is replaced by a functional approach. Anatomy and functional manifestations are analyzed by echocardiography pre-, intra- and postoperatively. Conservative surgery is the goal but is not always possible. Surgery of mitral valve insufficiency has a better prognosis than stenosis. The most difficult malformations are parachute and hammock mitral valves. When the mitral lesion is associated with another cardiac defect, the trend is to treat all the lesions in the same operation.

Cardiac Surgical Procedures↗
PubMed2002

ECG-gated multi-detector row CT for assessment of mitral valve disease: initial experience.

Our objective was to evaluate applicability and image quality of contrast-enhanced, retrospectively ECG-gated multi-detector row CT (MDCT) for visualization of anatomical details of the mitral valve and its apparatus, and to determine the value of MDCT for diagnosing abnormal findings of the mitral valve. Twenty consecutive patients with mitral valve disease underwent MDCT preoperatively. Two readers assessed visibility of the mitral valve annulus, mitral valve leaflets, tendinous cords, and papillary muscles by using a four-point Likert grading scale. Abnormal mitral valve findings [thickening of the mitral valve leaflets, presence of mitral annulus calcification (MAC), and calcification of the valvular leaflets] were compared with preoperative echocardiography and intraoperative findings. Visibility of the mitral valve annulus and mitral valve leaflets was good or excellent in 15 patients (75%) and in 19 patients (95%) for papillary muscles. The MDCT yielded a 95-100% agreement compared with echocardiography and surgery with regard to the assessment of mitral valve leaflet thickening and the presence of calcifications of the mitral valve annulus or mitral valve leaflets. Intermodality agreement between MDCT and echocardiography was excellent with regard to classification of mitral valve leaflet thickness (kappa=1.00) and good regarding classification of MAC thickness (kappa=0.73). Contrast-enhanced, retrospectively ECG-gated MDCT allows good to excellent visualization of anatomical details of the mitral valve and its apparatus, and demonstrates good agreement with echocardiography and surgery in diagnosing mitral valve abnormalities.

Contrast Media↗
PubMed2003

Repair versus replacement for degenerative mitral valve disease with coexisting ischemic heart disease.

OBJECTIVE: We sought to compare mitral valve repair and replacement as treatments for degenerative mitral valve disease with coexisting ischemic heart disease. Specifically, we sought to (1) identify differences between patients undergoing repair and replacement, (2) determine whether the choice of mitral valve procedure affected survival after adjusting for those differences, and (3) discover which patients were predicted to benefit from mitral valve repair and which from replacement. METHODS: From 1973 to 1999, 679 patients (mean age, 67 +/- 9.1 years; 73% men) with degenerative mitral valve and ischemic heart diseases underwent combined coronary artery bypass grafting and either mitral valve repair (66%) or replacement (34%). Factors associated with repair and replacement were used for multivariable propensity matching. Risk factors for death were identified by means of multivariable, multiphase hazard-function analysis. RESULTS: Patients more likely to undergo repair had isolated posterior chordal rupture (P <.0001) or more recent date of operation (P <.0001); those more likely to undergo replacement were older (P =.0003) or had bileaflet prolapse (P <.0001). Unadjusted survival at 30 days and 1, 5, and 10 years was 97%, 92%, 79%, and 59% after repair and 94%, 88%, 70%, and 37% after replacement. After adjusting for comorbid factors, the extent and effect of ischemic heart disease, and propensity score, the survival benefit of repair became evident after 2 years (P =.01). Eighty-nine percent of patients were predicted to benefit from repair. CONCLUSIONS: In patients with degenerative mitral valve and ischemic heart diseases, mitral valve repair confers a survival advantage over replacement that becomes evident about 2 years after the operation.

Aged↗
PubMed1991

Site-related difference in the prevalence of mitral valve prolapse. Relation to the prevalence and severity of mitral regurgitation.

In this study, 431 consecutive patients with mitral valve prolapse (MVP) diagnosed by two-dimensional echocardiography were employed to further investigate the site-related difference in the prevalence of MVP. Following echocardiographic determination of the site and severity of MVP, a pulsed-Doppler technique was further performed to assess the existence and severity of mitral regurgitation (MR) in all patients. These patients were then classified by age in 10-year groups with patients older than 60 years being enrolled in one group. The younger groups accounted for a large number of the patients with MVP in our study, with the number of patients being reduced with age. In addition, female patients tended to predominate up until the 50s, but not in the 50 and older groups. The prevalence of MVP at the centro-medial site of the anterior mitral leaflet (AML) predominated in all age groups, gradually decreasing with age, except for a peak in the 40s, before continuing to decline in the 50 and older groups. On the other hand, the prevalence of MVP at the lateral site of the AML and at the posterior mitral leaflet (PML) increased with age. In the 50 and older age groups, the prevalence of MVP at these sites increased steeply with age. However, the prevalence of MVP at both the lateral site of the AML and PML did not significantly increase with age. The trend shown above was not significantly different for gender. The number of patients with MR increased with age independent of the site of MVP. However, the prevalence and severity of MR associated with MVP at the lateral site of the AML and/or at the PML were significantly greater than at the other sites up until the 50s (p less than 0.05). When patients were older than 50 years, this significant site-related difference in the prevalence of MR was not observed because of the higher prevalence of MR in the older patients in this study. Forty-one patients could be followed for 2 to almost 5 years. Three of the 41 patients were observed to have MVP at the centro-medial site of the AML in the initial examination, but the site of MVP had extended to the lateral side of the AML in the final examination. Two patients with MVP at all 3 sites of the AML demonstrated an increase in the severity of MVP. However, there were no newly documented cases of MR among those patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1986

A comparative in vitro study of the closing characteristics of Björk-Shiley and Bicer-Val tilting disc mitral valve prostheses.

The replacement of mitral valves has become a relatively common procedure in cardiac surgery. Information concerning losses due to backflow through the valve may be used to assess and compare the physical characteristics of commercially available prostheses. A simple apparatus based on an artificial ventricle was used to measure closing volume, leakage volume, total volume, leakage rate and closing time on a beat by beat basis for Björk-Shiley and Bicer Val prosthetic mitral valves. The Björk-Shiley valve opened to 60 degrees and displayed a smaller closing volume than the Bicer Val, which opened to 75 degrees; and the Björk-Shiley displayed higher leakage than the Bicer Val, thus reducing its advantage in terms of closing volume. Overall, the Bicer-Val showed about 1 ml greater reflux per beat than the Björk-Shiley. Study of a Bicer-Val, modified to have an opening angle of 80 degrees, confirmed that valve closing volume was a function of opening angle.

Cardiac Output↗
PubMed2001

Mitral valve replacement and repair. Report of 5 patients with systemic lupus erythematosus.

Severe mitral valve regurgitation due to systemic lupus erythematosus is a rare cause of valvular heart disease, necessitating valve surgery. Currently, there are 36 case reports in the world medical literature of mitral valve replacement or repair in patients who have lupus. The current trend in mitral valve surgery is toward anatomic valve repair. In patients who have systemic lupus erythematosus, however, valve repair often leads to repeat surgery and valve replacement. We report the cases of 5 patients with lupus and severe mitral valve regurgitation who underwent mitral valve surgery. In 3 of these patients, replacement with a mechanical prosthetic mitral valve was performed with good long-term results. In the other 2 patients, mitral valve repair was performed, but only 1 of the repairs was successful. The 2nd patient required subsequent replacement with a mechanical valve. To our knowledge, this report of 5 patients is the largest series of mitral valve surgery in patients with lupus. These results, along with a review of the literature, suggest the superiority of mechanical prosthetic valve replacement to repair in patients who have systemic lupus erythematosus.

Adult↗
PubMed1984

Aortic and mitral valve incompetence: long-term follow-up (10 to 19 years) of patients treated with the Starr-Edwards prosthesis.

The long-term course (mean 15 years) of 336 patients with valvular incompetence who underwent Starr-Edwards ball valve implantation between 1962 and 1971 was reviewed. Eighteen patients (10%) with aortic valve replacement and 24 (16%) with mitral valve replacement died early postoperatively. Mortality remained high (31%) in the first 3 years after aortic valve replacement; it was highest (13%) in the first year after mitral valve replacement and then approached the normal rate. The most common mode of death was sudden death after aortic and cardiac failure after mitral valve replacement. At follow-up, 76% of survivors had improved symptomatically. Three instances of primary valve malfunction occurred. The probability of freedom from thromboembolism at 15 years postoperatively was 56% for aortic valve replacement and 52% for mitral valve replacement. The Starr-Edwards valve prosthesis is durable over prolonged follow-up period, but thromboembolism remains a persistent problem. Survival may be normal for patients surviving the early postoperative years.

Adolescent↗
PubMedDate not supplied

Echographic method for the estimation of cardiac output from mitral-valve area, heart rate, and diastolic-filling period in conditions of mitral stenosis: correlation with cardiac catheterization.

An orifice equation for the non-invasive measurement of mitral-valve area is demonstrated. It is shown that by combining this expression with the assumption of mitral-valve area invariance an orifice equation for the non-invasive assessment of cardiac output in conditions of mitral stenosis using simple echographically measureable variables can be developed. This equation is V = (21)-1 R X A X T2, where V = cardiac output in ml, R = heart frequency, A = mitral-valve area in cm2 and T = diastolic-filling period in sec X min-1. These results suggest that when mitral-valve area is accurately measured at one point in time, cardiac output may be measured at subsequent times at a clinically useful level from a knowledge of the echographically measurable variables of heart rate and diastolic-filling period.

Cardiac Catheterization↗
PubMed1978

Determination of mitral valve area by cross-sectional echocardiography.

Cross-sectional echocardiograms of the mitral valve orifice were recorded in 37 patients with mitral stenosis. Twenty-seven had pure mitral stenosis, and 10 had associated mitral regurgitation. Mitral valve area in patients with pure mitral stenosis measured from cross-sectional echocardiography was highly correlated (r = 0.89) with that calculated with the Gorlin formula using the pressure gradient and Fick cardiac output. With mitral regurgitation, mitral valve area by cross-sectional echocardiography correlated well (r = 0.90) with that calculated from the pressure gradient and cineangiographic stroke output. In two cases, direct pathologic measurements of mitral valve area agreed exactly with the cross-sectional echocardiographic measurement. Correlation between the mitral E-F slope and mitral valve area by cross-sectional echocardiography (r = 0.56) and catheterization (r = 0.49) was less reliable. Cross-sectional echocardiographic measurement of the mitral valve area correlates well with catheterization in patients with pure mitral stenosis and those with associated regurgitation.

Adult↗
PubMedDate not supplied

Left atrial reduction and mitral valve replacement in a 5-year-old girl with severe mitral regurgitation and giant left atrium.

Giant left atrium associated with mitral valve disease has been implicated in the morbidity following mitral valve repair or replacement. Various methods including left atrial plication have been described to reduce the size of left atrium. Herein we describe our technique of left atrial reduction in a 5-year-old girl with severe mitral regurgitation and giant left atrium. She underwent mitral valve replacement and circumferential left atrial reduction with successful outcome.

Anastomosis, Surgical↗
PubMed1993

[A case report of mitral valve aneurysm].

A case of aneurysm of the mitral valve associated with aortic valve regurgitation is presented. The patient was 45-years-old female who complained of palpitation and underwent both aortic and mitral valve replacement. We could not detect the aneurysm by the transthoracic echocardiography because of it's small size (14 mm in diameter). The transesophageal echocardiography showed the aneurysm of the anterior mitral valve leaflet toward the left atrium clearly. This report describes that transesophageal echocardiography appears to be available for accurate diagnosis of the mitral valve disease, especially for the mitral valve aneurysm.

Aortic Valve↗
PubMed2005

Is mitral valve surgery safe in octogenarians?

OBJECTIVE: To evaluate the outcomes of mitral valve surgery in octogenarians. METHODS: Data were collected prospectively from January 1996 to March 2004 at two surgical centers. Of 1386 consecutive patients with mitral valve surgery, 58 (4.2%) were aged > or = 80 years. Survival data were analyzed using Cox proportional hazards modeling and Kaplan-Meier actuarial log rank statistics. RESULTS: Octogenarians were similar to younger patients for the presence of pre-operative hypertension, hyperlipidemia, diabetes mellitus, and smoking history. Octogenarians had a higher incidence of cerebrovascular disease (19.0 versus 7.8%, P = 0.003), urgent in-hospital surgery (55.2 versus 28.6%, P < 0.001), and presence of ischemic disease requiring combined mitral valve plus revascularization surgery (72.4 versus 41.0%, P < 0.001). Mitral valve repair was performed in a similar proportion of octogenarians and younger patients (44.8 versus 45.6%). Thirty-day mortality for octogenarians was significantly higher than younger patients (15.5 versus 5.6%, P = 0.002), and actuarial survival of octogenarians was significantly decreased (P = 0.009). However, 52.3% of the octogenarians were alive at 7-years following surgery. Independent predictors of mortality from multivariate risk adjusted modeling of the entire cohort were: emergency surgery (hazards ratio [HR] = 2.94, P < 0.001), combined mitral valve plus revascularization surgery (HR = 2.27, P < 0.001), mitral valve replacement (HR = 1.85, P < 0.01), and age > or = 80 years (HR = 1.80, P = 0.02). CONCLUSIONS: Octogenarians undergoing mitral valve surgery have significantly greater incidence of urgent surgery, ischemic disease requiring combined revascularization surgery, and have decreased rates of survival. While caution is required when operating on these higher risk elderly patients, overall 52.3% of the octogenarians are alive at 7-years following surgery, which is greater than the survival of octogenarians in the community. The greatest survival benefit within octogenarians occurred when mitral valve repair was possible over replacement. Further study will more clearly define subgroups of octogenarians with potentially greater benefit from mitral valve surgery.

Adolescent↗
PubMed1986

[Mitral valve prolapse: surgical approaches].

Surgical approaches currently used for the complication of mitral valve prolapse; i.e., for mitral regurgitation (MR), are either replacement or repair of the mitral valve. Recently, the latter has proved to be superior in view of the late results, and should be recommended thereafter. Repair of the mitral valve in cases without MR has been attempted in some Repair of the mitral valve in cases without MR has been attempted in some institutions. The results had benefit to relieve the prolapse, but symptoms and signs were not always abolished completely.

Adult↗
PubMed1983

A diastolic mid-echo in torn chordae tendineae of the mitral valve.

Echocardiographic studies were performed on 3 patients with torn chordae tendineae of the mitral valve proven by open heart surgery or during autopsy. Mitral regurgitation was noted after episodes of bacterial endocarditis in 3 patients; one had had rheumatic valvular disease before the episode. Conventional M-mode echocardiograms showed coarse diastolic fluttering of the mitral valve, multiple mitral valve echoes in systole, and diastolic mid-echoes between both anterior and posterior leaflets. The last pattern was found in all 3 patients. There was only one patient with an unusual systolic echo in the left atrium. Two-dimensional echocardiograms from 2 patients revealed an abnormal echo in the left ventricle in diastole which moved into the left atrium in systole, slightly beyond the closure line of the mitral valve. This moving abnormal echo observed in two-dimensional echograms presumably originated from torn chordae tendineae and was consistent with the diastolic mid-echo noted in M-mode echograms. Thus, the diastolic mid-echo of the mitral valve by M-mode echocardiography is an important finding in the diagnosis of torn chordae tendineae of the mitral valve, and two-dimensional echocardiography can identify the movement of torn chorda itself.

Adult↗
PubMed1980

Afterload reduction and cardiac output in patients after mitral valve surgery.

Thirteen patients who had mitral valve surgery were studied within 3 hours after operation. The patients were divided into 2 groups: group A with initial low cardiac index (1.70 +/- 0.25), elevated left atrial pressure (16.5 +/- 6.7) and high peripheral vascular resistance (2623 +/- 789); group B with initial normal cardiac index (3.71 +/- 0.54), normal left atrial pressure (13 +/- 3.5) and normal peripheral vascular resistance (1223 +/- 303). In both groups the mean arterial pressure was elevated (98 +/- 8.8, 96 +/0 15.8). An infusion of nitroprusside to reduce the mean arterial pressure to either 80 mmHg or 10% below the initial value had different effects in each group. In group A, cardiac index (CI) increased by 23%, left atrial pressure (LAP) decreased by 20%, pulmonary artery pressure (PAP) by 35%, and peripheral vascular resistance (PRV) by 32%. In group B, CI decreased by 8%, LAP by 32%, PAP by 30% and PVR by 13%. When LAP returned to initial values after an infusion of blood with continued infusion of nitroprusside, CI increased in both groups (27%, 11%) and the PVR remained lower (40%, 29%). The study demonstrates the favorable effect on cardiac output of vasodilator therapy on patients with elevated blood pressure, impaired by left ventricular function and high LAP, after surgery on mitral valve. The optimal effect is achieved by keeping the LAP within normal limits.

Adolescent↗
PubMed1995

Mitral valve aneurysm and infective endocarditis: report of four cases.

From March 1992 to March 1994, four cases of mitral valve aneurysm were diagnosed at National Taiwan University Hospital. Mitral valve infective endocarditis was documented in three patients, while aortic valve infective endocarditis was found in the other. The diagnosis of mitral valve aneurysm was based on characteristic echocardiographic findings. The mitral valve aneurysms in these four cases were all visualized by transesophageal but not transthoracic echocardiography. At the time of diagnosis, three patients with a history of mitral valve endocarditis had perforated mitral valve aneurysms and severe mitral regurgitation. Although not found before surgery, the remaining patient with a history of aortic valve endocarditis was noted to have an unperforated mitral valve aneurysm one month after aortic valve replacement. All three patients with severe mitral regurgitation underwent mitral valve replacement and the patient with an unperforated mitral valve aneurysm was managed conservatively and obtained a stable clinical condition. In conclusion, mitral valve aneurysm usually appears to be associated with infective endocarditis and transesophageal echocardiography is more helpful in the diagnosis of mitral valve aneurysm than transthoracic echocardiography. Furthermore, unperforated mitral valve aneurysms may be managed conservatively with careful follow-up.

Adult↗
PubMed1998

Homograft replacement of mitral valve in children.

BACKGROUND: Recent reports have demonstrated successful early outcomes using mitral valve homografts in adults. We report our early results after homograft mitral valve replacement in 4 children with previous atrioventricular septal defects, previous placement of a prosthetic valve, and rheumatic valvular disease. METHODS: Between May 1996 and June 1997, 4 children (ages 5, 11, 13, and 15 years) underwent mitral valve replacement with cryopreserved mitral valve homografts at our institution. Preoperative echocardiography confirmed moderately severe to severe mitral regurgitation, stenosis, or both in all 4 patients. RESULTS: Successful homograft valve replacement was achieved in all 4 patients. Based on symptoms, physical examinations, and echocardiographic follow-up, all four homograft mitral valves are functioning well with normal hemodynamics. None of these patients are receiving warfarin. Follow-up has been limited to 10 months. CONCLUSIONS: In children requiring mitral valve replacement, the use of mitral valve homografts offers advantages over prosthetic valves, such as the avoidance of complications associated with thrombosis and anticoagulation. Homograft mitral valve replacement is technically feasible in children with congenital and rheumatic heart disease and previous prosthetic valves.

Adolescent↗
PubMed1996

In vivo validation of a fluid dynamics model of mitral valve M-mode echocardiogram.

A fluid dynamics model of mitral valve motion during diastolic filling of the left heart is described. Given a pulsed Doppler velocity pattern in the mitral annulus, the radius of circular mitral orifice, the length of leaflets and the end-systolic left ventricular volume, the numerical model predicts the time course of the mitral leaflets during diastole: the mitral valve M-mode echocardiogram. Results obtained by computer simulation have been validated with in vivo data. It is shown that mitral valve flow is essentially a fluid dynamics process of floating mitral valve leaflets with blood flow due to the atrioventricular pressure gradient. In addition, a partial opening of the mitral valve as the initial boundary condition is required to simulate the overshooting of the leaflets during early peak filling. Some back flow is a condition for perfect closing of the native mitral valve. The higher the unsteady character of mitral flow, the less efficient is the opening and closing processes of the mitral valve.

Computer Simulation↗