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PubMedDate not supplied

SAM-systolic anterior motion of the anterior mitral valve leaflet post-surgical mitral valve repair.

Systolic anterior motion (SAM) is a postoperative complication experienced by patients undergoing mitral valve repair. The incidence of SAM after mitral valve repair ranges from 5 to 10%. Early recognition of the signs and symptoms of SAM is imperative to the management of these patients. This article presents the pathophysiology of mitral valve dysfunction to give the practitioner a clear understanding of the dynamics of SAM. This article's main focus is the detection and management of SAM and the most current treatment modalities. A case study is used to illustrate the complex management necessary for the patient with SAM.

Aged↗
PubMed2002

[Myocardial revascularization combined with mitral valve surgery in case of ischemic mitral valve insufficiency].

BACKGROUND: The aim of the study was to evaluate the possibility of mitral valve surgery in patients with mitral valve insufficiency and short time outcomes following mitral valve correction combined with coronary artery bypass grafting. METHODS: Thirty one combined coronary artery bypass grafting with mitral valve correction procedures were performed from 1994 to 2002. Mean age was 65.4+/-6 years. 29 pts were in NYHA IV-V functional class. 84% of pts were with impaired left ventricle function. RESULTS: Mitral valve replacement was performed in 16 patients and correction of mitral valve in 15 cases. Mitral valve replacement was performed in cases with significant lesions of the papillary muscles. The mean of 3.05+/-1.8 graft per patient was performed and total coronary revascularisation for 84% of patients. Hospital mortality was 32.2% (10/31). CONCLUSION: In cases of coronary artery bypass grafting for patients with moderate and significant mitral insufficiency after myocardial infarction, mitral valve correction must be performed.

Aged↗
PubMed2003

Minimally invasive mitral valve repair suggests earlier operations for mitral valve disease.

OBJECTIVE: We began minimally invasive mitral valve surgery in August, 1996, to reduce hospital costs, to improve patient recovery, cosmetic appearance, and to decrease trauma, yet maintain the same quality of surgery. To validate this approach we reviewed our entire experience through May 2002. METHODS: From August 1996 to May 2002, we performed 413 minimally invasive mitral valve operations including 51 mitral valve replacements and 362 mitral valve repairs. Excluding 4 robotically assisted repairs, we evaluated 358 patients, using the mitral valve repairs as the basis for this retrospective survey. These operations were performed through a 6- to 8-cm minimally invasive incision, beginning with parasternal and, most recently, lower ministernotomy (181 patients). The mitral valve reparative techniques include repair of 94 prolapsed anterior leaflets, posterior leaflet resection, leaflet advancement, commissuroplasty, Polytetrafluoroethylene (PTFE; Gore-Tex, W. L. Gore & Associates, Inc, Flagstaff, Ariz) chordal placement, and ring annuloplasty. Cannulation sites varied but primarily utilized a miniaturized system of 24F catheters in both the inferior and superior venae cavae with assisted venous suction. The Cosgrove ring was used in 95% of the patients undergoing this procedure. RESULTS: The operative mortality was 0/358. Perioperative morbidity included a 26% incidence of new atrial fibrillation, 2% incidence of pacemaker implantation, 0.5% incidence of deep sternal wound infection, and 1.9% incidence of stroke after an operation. There were 10 arterial and 3 venous complications. The mean length of stay was 6 days and 208 patients stayed < or =5 days. Only 25% of the patients underwent homologous blood transfusion. The mean follow-up was 36 months with 1.4% lost to follow-up. There were 12 late deaths and a survival at 5 years of 95%. There were 21 valves requiring reoperation for structural valve failure of 5.8%. The probability of freedom from reoperation at 5 years was 92%. CONCLUSION: This study documents the safety of minimally invasive mitral valve repair surgery in 358 patients. It also documents a low incidence of homologous blood use, requirement for post-hospital rehabilitation, and general morbidity.

Adolescent↗
PubMed2001

Percutaneous balloon mitral valvuloplasty in comparison with open mitral valve commissurotomy for mitral stenosis during pregnancy.

OBJECTIVES: We sought to compare the maternal and fetal outcomes of patients with severe mitral stenosis submitted to percutaneous balloon dilation versus open mitral valve commissurotomy (MVC) during pregnancy. BACKGROUND: Heart failure in patients with mitral stenosis complicating pregnancy is a common problem in developing countries. Since 1984, percutaneous dilation of the mitral valve using a balloon catheter has become a therapeutic alternative to open heart surgery. Although the efficacy of percutaneous mitral valve balloon dilation is well established, its results have never before been compared with the results of commissurotomy during pregnancy. METHODS: We compared the clinical and obstetric complications in 45 women who were treated with percutaneous mitral valve balloon dilation (group I, n = 21; from 1990 to 1995) or open MVC (group II, n = 24; from 1985 to 1990) for severe heart failure due to mitral stenosis during pregnancy. RESULTS: In our study, percutaneous balloon dilation of the mitral valve had a success rate of 95% (Gorlin formula) and 90.5% (echocardiographic "pressure half-time" method), as demonstrated by the final mitral valve area achieved. This improvement was followed by a marked decrease in the mitral valve gradient, left atrial pressure and mean pulmonary artery pressure. Patients in both groups had similar improvements in symptoms. Patients who underwent percutaneous balloon dilation had significantly fewer fetal complications, with a reduction in fetal and neonatal mortality (1 death in group I vs. 8 in group II, p = 0.025). CONCLUSIONS: Percutaneous balloon mitral valvuloplasty is safe and effective and appears to be preferable for the fetus, compared with open MVC during pregnancy.

Adult↗
PubMed1994

Mitral valve replacement with the Biocor stentless mitral valve: early results.

Chordal preservation during mitral valve replacement is thought to greatly preserve left ventricular function. Recently a stentless mitral valve (Biocor) became available for clinical use. It is a porcine mitral valve with the entire chordal apparatus, the sewing ring being reinforced by a bovine pericardial ring and the chordae being sutured together onto two pericardial patches. During a six months period, seven patients undergoing mitral valve replacement for mitral insufficiency (four cases), mitral stenosis (two cases) or mixed lesions (one case) received a stentless mitral valve. Their mean age was 66.3 +/- 4.8. The valve was implanted by suturing the pericardial patches onto the papillary muscles and the sewing ring onto the mitral annulus. Echocardiography control immediately after surgery showed good valve function. Three valves failed after a period of seven days, seven and 12 months respectively. The valve lesions were similar and consistent with an excessive tension on the chordae and on the valvular tissue. There were tears along the posterior annulus and at the level of the commissures, often accompanied by chordal rupture. Histology and scanning electron microscopy showed good integration of the prosthesis with the patients own tissues. There were areas of overgrowing tissue without endothelial cells especially in the area of papillary muscle -pericardial patch interaction. The remaining four patients continue to do well after a mean follow up of two years. The apparent excessive tension on the valve tissues leading to the premature failure of the prosthesis could be due to the variability in the distance between mitral annulus and papillary muscles.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

[Mitral valve replacement for congenital parachute mitral valve].

A one-year-old boy was admitted with refractory congestive biventricular heart failure for medical treatment. On echocardiogram and cardiac catheterization revealed severe mitral stenosis from parachute deformity with pulmonary hypertension. During the operation, a single round orifice of 7 mm in diameter was detected in the mitral valve and adhered chordae were attached to a large single papillary muscle which was located at the posteromedial portion of the left ventricle. An isolated muscle band which was not attached to the mitral valve was observed at the anterolateral wall of the left ventricle. The mitral valve was replaced with 16 mm Carbo-Medicus prosthesis. Postoperative catheterization revealed residual pulmonary hypertension which was responsive to Imidarine infusion. He was discharged from the hospital without any sequelae, and has been on regimen including anticoaglant and vasodilator.

Heart Valve Prosthesis↗
PubMed1985

Primary (spontaneous) chordal rupture: relation to myxomatous valve disease and mitral valve prolapse.

The excised valves of 152 consecutive patients who underwent isolated primary mitral valve replacement between May 1979 and July 1983 were studied to determine the cause of primary (spontaneous) rupture of the chordae tendineae and estimate the prevalence of floppy mitral valve with underlying myxomatous disease. Of these 152 patients, 72 had nonrheumatic disease; 42 (28% of the total group) had a floppy valve, and 39 of these valves had microscopic changes of myxomatous disease. Primary chordal rupture had occurred in 31 patients, including 29 with myxomatous disease. Seven of these patients had prior documentation of mitral valve prolapse and an additional 20 patients had a long-standing murmur. Ischemic mitral regurgitation (22 patients) accounted for the majority of the remaining 30 patients with nonrheumatic disease. Therefore, approximately half of all isolated mitral valve replacements in this institution are now performed for nonrheumatic disease, the majority for a floppy valve in which myxomatous disease was the underlying abnormality. Primary chordal rupture almost invariably occurs as a complication of myxomatous disease, and mitral valve prolapse may be a common precursor.

Adult↗
PubMed1996

Mitral valve repair for mitral regurgitation utilizing intraoperative transesophageal echocardiography--late results.

Ninety consecutive patients underwent mitral valve repair for mitral regurgitation (MR) utilizing intraoperative transesophageal echocardiography (TEE). Fifty-nine males and 31 females between the ages of 31 and 88 with a mean age of 67.9 years were evaluated. Preoperative TEE demonstrated pathology involving the posterior leaflet in 28 patients, anterior leaflet in 21 patients, both leaflets in 19 patients, annular dilatation in 19 patients, and restricted leaflet in three patients. Surgical procedures attempted included quadrangle resection of posterior leaflet pathology (40), Duran "flip over" operation (13), or Goretex suture for anterior leaflet pathology (20), and ring alone for central/ischemic mitral regurgitation (20). TEE immediately following repair showed either no regurgitation or a trace in 78 patients (86%). Time elapsed since repair ranged from one month to 55 months, with a mean of 29 months. Long-range evaluation of mitral valve competence was done by clinical examination and transthoracic or transesophageal echocardiography. Three patients died postoperatively. Fifty-six of 87 patients (64%) had either no or trivial MR within the first year of follow-up. Ring alone for annular dilatation and Goretex suture for anterior leaflet prolapse had the highest incidence of progression of MR. Among the 65 patients followed over one year, 42 (64%) continue to have either none or trivial MR. Three patients had worsening MR requiring mitral valve replacement. Quadrangle resection for posterior leaflet repair and Duran "flip over" operation for anterior leaflet pathology had the highest success rate in long-term follow-up.

Adult↗