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PubMed1985

[Frequency, localization and extent of local wall function disorders of the left ventricle in patients with rheumatic mitral valve diseases].

In 59 patients with rheumatic mitral valve disease, local wall motion was assessed by analysing the diastolic and systolic left ventricular silhouette from biplane angiograms with a quantitative radial axes model using 90 radii in each projection. The left ventricle was dissected into 4 segments in the RAO and 2 segments in the LAO projection and a mean radii shortening for each segment was calculated. 27 patients had pure severe mitral stenosis (MS), 10 patients mitral insufficiency (MI) and 22 patients combined mitral valve disease (MSMI). A mean radii shortening less than 25% was diagnosed as wall motion abnormality. In 78% of all patients wall motion abnormalities could be detected in at least one segment. 32% of patients with MS, 27% of patients with MI and 33% of patients with MSMI had wall motion abnormality of the anteroapical wall. In only 8% of patients with MS and in no patients with MI and MSMI was the posterobasal segment disturbed. The anterobasal and diaphragmal wall motion showed wall motion abnormality in 16% and the septal and the posterolateral area in 17% of all patients. 78% of all patients had at least one diseased segment; motion abnormalities of the anteroapical wall (seg. 2) occurred most often whereas the posterobasal area (seg. 4) was diseased in only 4% of all patients. Ejection fraction was severely impaired (less than 55%) in 7 patients only (5 of these patients had MS) with wall motion abnormalities in more than 4 segments. There was no correlation between the extent of valve disease and occurrence and extent of wall motion abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Repair of chordae tendineae for rheumatic mitral valve disease. A twenty-year experience.

Sixty-two patients with rheumatic mitral valve disease (mean age 42.2 +/- 10.2 years) underwent repair of chordae tendineae between June 1974 and May 1994. Chordal shortening was done in 38 patients, fenestration in 17, resection of secondary chordae in 3, replacement in 2, and transposition in 2. In 41 patients, mitral commissurotomy was also done. Ring annuloplasty was done in all patients. The mean follow-up was 10.2 years (range 2 months to 20 years). The completeness of follow-up during the closing interval (January to July 1994) was 100%. Hospital mortality occurred in four patients (6.5%) and nine patients died during the late follow-up. The actuarial survival curve at 20 years was 65.8% +/- 10%. Six patients with mitral valve dysfunction (restenosis 4, insufficiency 2) and one with aortic valve dysfunction (structural deterioration of bioprosthesis) underwent reoperation. The actuarial curve of freedom from reoperation at 20 years for mitral valve dysfunction was 73.1% +/- 10.5%. In the 49 surviving patients, a Doppler echographic study during the closing interval showed a mean mitral valve area of 1.9 +/- 0.3 cm2. In the 43 patients with a repaired native valve, absent or trivial mitral regurgitation was documented in 35 and mild or moderate regurgitation in 8. In conclusion, repair of chordae tendineae in rheumatic mitral valve disease when feasible is a stable and safe procedure with a low prevalence of reoperation. However, the type of reconstructive operation and experience of the surgical team are major considerations in successful repair of the mitral valve.

Adult↗
PubMedDate not supplied

Minimally invasive mitral valve repair with and without robotic technology in the elderly.

An increasing number of elderly persons require mitral valve surgery, primarily for mitral regurgitation. Minimally invasive mitral valve repair, including robotic surgery, has been shown to be feasible and safe in the general population. Minimally invasive cardiac surgery is especially beneficial in the elderly because it decreases trauma and speeds recovery. The authors conducted a retrospective review of 123 cases of minimally invasive mitral valve repair in elderly patients aged 70 years and older and five robotic mitral valve repairs using the da Vinci surgical system (Intuitive Surgical, Inc., Sunnyvale, CA) in one octogenarian. The authors review their 9 years of experience with minimally invasive mitral valve repair in the elderly and compare and contrast other forms of surgery in the elderly, including robotic mitral valve repair.

Aged↗
PubMed1975

[Mitral valve surgery: 10 years follow-up of 501 patients (author's transl)].

The results of mitral surgery between 1961 and 1971 are presented. Pure or predominant mitral stenosis outnumbered combined mitral valve disease and mitral incompetence by two to one. Surgical treatment comprised 291 closed mitral commissurotomies, 145 open reconstructions and 81 replacements of the mitral valve. One month mortality was 2,4% for commissurotomy, 4,8% for reconstruction, and 25% for replacement. Early mortality of the latter operation decreased to 7% since 1971. For patients with no more than slight preoperative symptoms life expectany remained unaffected for 10 years after closed commissurotomy. For patients with significant preoperative limitation or symptoms at rest 5 and 10 years life expectancy after successful surgery was 93 and 79% resp. for commissurotomy, 94 and 73% for reconstruction and 79 and 53% resp. for mitral valve replacement. In spite of a higher rate of reoperations and late deterioration of valve function the reparative operations deserve preference to the replacement of the mitral valve whenever feasible.

Adult↗
PubMed1975

Simultaneous echocardiographic phonocardiographic recordings at rest and during amyl nitrite administration in patients with mitral valve prolapse.

Simultaneous electrocardiograms, phonocardiograms, and echocardiograms were recorded in 21 patients with mitral valve prolapse. Four patients with holosystolic mitral valve prolapse on echocardiogram had smaller resting end-diastolic volumes than the remaining 17 patients with late systolic echocardiopraphy prolapse (p greater than 0.01). Thirteen of the 17 patients with late systolic prolapse had phonocardiograhically recorded auscultatory phenomena. The initial vibrations of the auscultatory phenomena occurred after the onset of echocardiographic prolapse, but prior to maximal echocardiographic mitral valve prolapse. Amyl nitrite was administered to all patients. Three of the 17 patients with late systolic prolapse developed holosystolic prolapse, while the remaining 14 retained the late systolic prolapse pattern during amyl nitrite inhalation. In these 14 patients, the onset of mitral prolapse occurred earlier in systole due to decrease in the duration of systole prior to onset of mitral valve prolapse (p greater than 0.001). This corresponded with the occurrence of auscultatory phenomena earlier in systole. Twelve patients had left ventricular volumes recorded during amyl nitrite inhalation and all showed a decrease in left ventricular volumes (greater than) 0.001). These findings confirm the temporal relationship of mitral valve prolapse and onset of auscultatory phenomena in these patients. It suggests that the movement of auscultatory phenomena earlier in systole during amyl nitrite inhalation is related to earlier prolapse of the mitral valve, and that a decrease in ventricular valume is a tenable explanation for the earlier onset of prolapse.

Administration, Intranasal↗
PubMed1984

[A study on prolapse of the mitral valve in autopsy-proved papillary muscle dysfunction].

Echocardiographic studies have recently documented high incidence of mitral valve prolapse in cases with papillary muscle dysfunction (PMD). However, any pathologic evidence has not been yet described. To evaluate the incidence and the degree of morphologic prolapse of the mitral valve, we examined 76 cases of mitral regurgitation which were pathologically proved to have PMD among 3,000 consecutive autopsy cases over 60 years of age. The morphologic evidence of "mitral valve prolapse" was defined as overshooting of the mitral leaflet into the left atrium beyond the degree of normal hooding. Papillary muscle dysfunction was classified into three types; Type A due to old myocardial infarction, Type B due to acute myocardial infarction, and Type C induced by other factors such as cardiomyopathies. The following results were obtained: Morphologic "mitral valve prolapse" was found in 19 among the 76 cases (25%) of PMD, but marked "prolapse" was found in only one case. The incidence of morphologic "prolapse" did not show any difference among the types of PMD (cf. Fig. 1). The site of "prolapse" was mainly in the region of posteromedial commissure of the mitral valve. Echocardiographic study of 39 cases with PMD showed mitral valve prolapse in only two cases who belonged to the eight cases having morphologic "mitral valve prolapse". This study suggests that prolapse formation of the mitral valve secondary to PMD can be differentiated morphologically from those following primary myxomatous degeneration of the mitral leaflets as observed in cases with MVP.

Aged↗
PubMed1995

[Mitral valve repair for infectious endocarditis].

Fourteen patients with mitral regurgitation resulting from infectious endocarditis underwent mitral valve repair between December 1988 and July 1994. There were nine males and five females aged from 14 to 70 years (mean 40.2 +/- 19.7 years). Three patients had active endocarditis. Time between the onset of endocarditis symptoms and surgery ranged from 1 to 24 months (mean 8.3 months). Bacterial findings were Streptococcus in eight patients, Staphylococcus in one, and unknown in five. All macroscopically infected tissue was excised in patients with active endocarditis. Carpentier's reconstructive techniques were mainly used. There were no hospital deaths. Mean follow-up was 29 months and complete. Thirteen patients were in New York Heart Association functional class I and one in class II. There were no late deaths, reoperations, recurrent endocarditis, thromboembolic events, or other valve-related morbidity. We conclude that mitral valve repair is an attractive procedure in patients with mitral regurgitation resulting from infectious endocarditis.

Adolescent↗
PubMed2003

Long-term results of mitral valve replacement: biological xenograft versus mechanical valves.

We studied 279 patients who underwent mitral valve replacement at the Department of Thoracic and Cardiovascular Surgery, Hyogo College of Medicine, between November 1973 and December 1998. The patients were divided into two groups based on the type of replacement valve (154 patients in the biological xenograft group and 125 patients in the mechanical valve group), and the long-term results were compared. Clinically satisfactory results were obtained in both the biological xenograft group and the mechanical valve group according to the surgical results, long-term survival, and incidence of prosthetic valve endocarditis. At 15 years, fewer patients in the mechanical valve group than in the biological xenograft group were free of bleeding events (92.5 +/- 3.7% vs 100% P < 0.05). At 15 years, the biological xenograft group was lower than the mechanical valve group with respect to freedom from thromboembolism (72.2 +/- 4.6% vs 93.5 +/- 3.6% P < 0.01), freedom from valve failure (22.0 +/- 5.2% vs 87.0 +/- 4.1% P < 0.005) and freedom from cardiac events (16.5 +/- 3.9% vs 47.2 +/- 14.5% P < 0.01). Though it has previously been suggested that biological xenografts used in mitral valve replacement do not need anticoagulation, the current study suggests the need for anticoagulation with the use of biological xenografts. Mechanical valves require close monitoring of anticoagulation, but their use has decreased the incidence of valve failure and thromboembolism, as compared with the use of biological xenografts. Therefore, mechanical valves are currently the preferred choice for mitral valve replacement. We believe that biological xenografts are indicated only for the older patient (> or =65 years).

Adult↗
PubMed1996

Long-term changes in left ventricular performance following mitral valve replacement for pure rheumatic mitral regurgitation.

Our data indicate that MVR, with or without chordal preservation, for pure severe MR in symptomatic younger rheumatic patients with a good preoperative ejection fraction results in normalization of LV size and performance by 1 year. Normalization of LV performance was only achieved at 1 year after surgery, and it is therefore essential to extend the assessment of LV function to at least 1 year postoperatively.

Adolescent↗
PubMed1995

In situ mitral valve stabilization with glutaraldehyde.

Mitral valve repair in the young rheumatic patient carries a high reoperation rate due to progression of the disease. In an attempt to halt or at least slow down this process, the possibility of fixing in situ the valve tissues with glutaraldehyde was explored. Six weanling sheep underwent tanning of their anterior mitral leaflet for two minutes with 0.5% buffered glutaraldehyde. The non-treated posterior mitral leaflet served as control. The animals were sacrificed at varying intervals between 2.5 and 6 months. At sacrifice, Doppler echocardiography and hemodynamic studies were done. The leaflets were subjected to histopathologic examination and calcium and glutaraldehyde contents were estimated. Glutaraldehyde treatment of the anterior leaflet caused thickening of the cusp and chordae associated with partial devitalization of its core tissue, partial loss of endothelium and intense fibrocellular reaction with abundant elastic fibers without altering its functional integrity. It did not induce calcification. There were no detectable levels of glutaraldehyde at explantation. The posterior mitral leaflets were normal. Although the absence of calcification and partial viability of the tissue are encouraging, it does not necessarily follow that this treatment would arrest progression of the underlying disease. This process may have clinical application in the future, but it is not yet recommended.

Animals↗
PubMed1992

Modified preservation of all annular-papillary continuity in replacement of the calcified mitral valve.

The technique described here is a modification of the mitral valve replacement with preservation of chordae tendineae for calcified mitral stenosis. After commissurotomy, the middle portion of the anterior leaflet is excised to get two parts with accessible chordal insertion. Each thickened and calcified segment is debrided by means of an ultrasonic tool and then attached to the mural leaflet. Finally mitral valve replacement is carried out. This procedure will extend surgical indication of chordae-sparing methods in mitral valve replacement for mitral stenosis.

Calcinosis↗
PubMed2003

Mitral valve repair and replacement in northern New England.

BACKGROUND: The etiology of mitral valvular disease has changed in the last 20 years, and new techniques for the diagnosis and repair of mitral valves have been advanced. A retrospective regional study was conducted to identify changes in patient and disease characteristics and in population-based rates for mitral valve repair and replacement in northern New England. METHODS: Data from 1648 patients were collected from 5 clinical centers in Maine, New Hampshire, and Vermont between January 1, 1990, and December 31, 1999. U.S. Census data were used to calculate population-based rates. RESULTS: Total mitral valve procedures increased 2.4 times, from 8.7 to 20.6 cases/100,000/year (p(trend) = 0.004). Primary procedures increased from 6.7 to 16.9 cases/100,000/year (p(trend) = 0.014). Primary mitral valve repair procedures increased 3.7 times, from 2.4 to 8.9 cases/100,000/year (p(trend) = 0.012), whereas mitral valve replacement increased only 1.9 times, from 4.3 to 8.0 cases/100,000/year (p(trend) = 0.016). Repeat mitral valve operations did not change significantly (p(trend) = 0.810). During this period, there was a significant increase of the percentage of octogenarians (p(trend) = 0.016) and of patients with ejection fractions <40% (p(trend) = 0.012). There was a decrease in the percentage of patients with mitral stenosis (p(trend) = 0.024). CONCLUSION: In an era of a change in the etiology of mitral valvular disease and new techniques for diagnosis and repair of mitral valvular disease, regional data demonstrate substantial increased rates of mitral repair and replacement and expanded indications of older age and poorer left ventricular function.

Aged↗
PubMed1999

Functional evaluation of the medtronic stentless porcine xenograft mitral valve in sheep.

BACKGROUND: Recently, renewed interest in allograft and stentless "freehand" bileaflet xenograft mitral valve replacement has arisen. The variability of human papillary tip anatomy and scarcity of donors limit allograft availability, making xenograft mitral valves an attractive alternative; however, these valves require new surgical implantation techniques, and assessment of their hemodynamics and functional geometry is lacking. METHODS: Seven sheep underwent implantation of a new stentless, glutaraldehyde-preserved porcine mitral valve (Physiological Mitral Valve [PMV], Medtronic) and were studied acutely under open-chest conditions. A new method of retrograde cardioplegia was developed. Hemodynamic valve function was assessed by epicardial Doppler echocardiography. 3D motion of miniature radiopaque markers sutured to the valve leaflets, annulus, and papillary tips was measured. Six other sheep with implanted markers served as controls. RESULTS: Both papillary muscle tips avulsed in the first animal, leaving 6 other animals. Mitral regurgitation was not observed in any xenograft valve. The peak and mean transvalvular gradients were 4.6+/-1.8 mm Hg and 2.6+/-1.5 mm Hg, respectively. The average mitral valve area was 5.7+/-1.6 cm(2). Valve closure in the xenograft group occurred later (30+/-11 ms, P<0. 015) and at higher left-ventricular pressure (61+/-9 mm Hg, P<0.001) than in the control group; furthermore, leaflet coaptation was displaced more apically (5.6+/-2.2 mm, P<0.001) and septally (5. 8+/-1.5 mm, P<0.001), and the anterolateral papillary tip underwent greater septal-lateral displacement (2.7+/-1.5 mm, P<0.001). Annular contraction during the cardiac cycle was similar in the 2 groups (xenograft 9.2+/-4.5% versus control 10.6+/-4.5% [mean+/-SD; 2-factor ANOVA model]). CONCLUSIONS: Successful freehand stentless porcine mitral valve implantation is feasible in sheep and was associated with excellent early postoperative hemodynamics. Physiological mitral valve annular contraction and functional leaflet closure mechanics were preserved. Long-term valve durability, calcification, and hemodynamic performance remain to be determined in models.

Animals↗
PubMed1989

Right thoracotomy, femorofemoral bypass, and deep hypothermia for re-replacement of the mitral valve.

Ten patients underwent mitral valve re-replacement for the third to sixth time through a right thoracotomy using one-lung anesthesia, femorofemoral bypass, profound systemic hypothermia, and low-flow perfusion without aortic cross-clamping or cardioplegia. The indications for this approach were previous mediastinitis, severe right ventricular hypertension with multiple previous sternotomies, intact coronary artery bypass graft, or previous aortic valve replacement. There was 1 operative death, which was due to end-stage pulmonary hypertension and intractable right heart failure. Blood loss was minimal, and there was no major postoperative morbidity in the 9 surviving patients except for supraventricular arrhythmias.

Adult↗
PubMed1990

Artificial mitral valve chordae: experimental and clinical experience.

Failure of mitral valve reconstructive procedures often may be ascribed to severe or progressive alterations of subvalvar apparatus. Expanded polytetrafluoroethylene sutures were used to replace anterior leaflet mitral valve chordae in 8 animals (hypertensive dogs and growing sheep). After the positive results obtained during a 13-month follow-up, 5-0 sutures of the same material were introduced in clinical practice to replace mitral valve chordae. Twelve patients had two to six anterior leaflet chordae replaced for degenerative or rheumatic disease. In 3 patients, the intraoperative result was not acceptable and a prosthetic valve was inserted during the same operation. One case of late failure has been recorded so far (18 months after the procedure), owing to rupture of a natural chorda shortened at operation. Since that event, we have implanted supportive artificial chordae in case of diffuse alteration of natural chordae. The remaining patients show satisfactory hemodynamic results, and no valve-related events have been recognized up to 30 months after operation. We suggest use of 5-0 polytetrafluoroethylene sutures in replacing anterior leaflet chordae in degenerative, rheumatic, and congenital mitral valve diseases.

Adult↗
PubMed2000

[Right thoracotomy for reoperative mitral valve replacement].

We report a case of 67-year-old male who underwent reoperative mitral valve replacement through the right thoracotomy. He had undergone primary double valve replacement with mechanical valve for aortic valve and tissue valve for mitral valve respectively, and tricuspid annular plasty 11 years ago. The second operation was performed through the right thoracotomy under moderately hypothermic cardiopulmonary bypass. The mechanical valve was replaced via right side of left atrium approach under ventricular fibrilation at 25 centigrade of bladder temperature. He recovered well without any major complications.

Aged↗