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At least 1,621 records · Page 90Linked to original sources
PubMed1994

Outcome of mitral valve repair in patients with preoperative atrial fibrillation. Should the maze procedure be combined with mitral valvuloplasty?

To examine late outcome of mitral valve repair in patients with preoperative atrial fibrillation, we reviewed the cases of 323 consecutive patients who underwent mitral valvuloplasty for mitral regurgitation from 1980 to 1991; average age of 215 men and 108 women was 64 years (range 14 to 88 years), and 224 patients (70%) were in New York Heart Association class III or IV before operation. The main indications for operation were severe mitral regurgitation (76%), coronary artery disease with associated mitral regurgitation (15%), and aortic valve disease (6%). At the time of mitral valve repair, coronary artery bypass grafting was done in 35% of patients, aortic valve replacement was done in 7%, and multiple other procedures were done in 10%. For all patients, the 30-day mortality rate was 2.5% (70% confidence limits 1.6% to 3.4%) and survivorships at 3 and 5 years were 81% and 76%, respectively. Before operation, 216 patients were in sinus rhythm and 97 patients had atrial fibrillation; in the latter group, 11 had recent onset of atrial fibrillation within 3 months preceding mitral valve repair. Comparing patients with preoperative atrial fibrillation to those with sinus rhythm, we found no significant difference in operative mortality (3% versus 1.9%) or 5-year survivorship (74.3% +/- 6.3% versus 76.9% +/- 4.0%). At late follow-up, atrial fibrillation was present in 5% of patients with preoperative sinus rhythm, 80% of patients with preoperative chronic atrial fibrillation, and 0% of patients with preoperative recent onset atrial fibrillation (p < 0.01). The left atrial size by echocardiography was larger in patients with preoperative atrial fibrillation compared with that in those with sinus rhythm (59 +/- 1.4 mm versus 50.9 +/- 0.7 mm; p < 0.05). There was, however, only a weak correlation between preoperative left atrial size and late atrial fibrillation. Further, age, gender, and associated coronary artery disease did not correlate with presence of atrial fibrillation at late follow-up. Prevalence of late thromboembolic events was similar in patients with preoperative sinus rhythm compared with that in those with atrial fibrillation. These data suggest that mitral valve repair should be done before or soon after the onset of atrial fibrillation to maximize the chance of postoperative sinus rhythm and avoid long-term anticoagulation with warfarin. However, the early and late results of mitral valve repair in patients with chronic atrial fibrillation are good, and concomitant operation for supraventricular arrhythmia must have negligible morbidity and no adverse effect on operative mortality.

Adolescent↗
PubMed1985

Surgical treatment of double-orifice mitral valve in atrioventricular canal defects. Experience in 25 patients.

Double-orifice mitral valve is an uncommon but surgically important condition. The experience in 25 cases of double-orifice mitral valve associated with atrioventricular canal defects was reviewed. This constituted 4.3% of the 581 cases of atrioventricular canal defects operated upon between 1961 and July, 1984. The combined mitral orifice area ranged from 85% to 91% of normal in those patients whose valves were sized intraoperatively. Ten associated cardiac defects were repaired in six patients. Of 23 patients having cleft mitral valve, 21 had partial closure of the cleft. There was one operative death (4.0%), which occurred early in the series in a patient in whom the tissue bridge was severed and massive mitral regurgitation resulted. In the remaining 24 patients the tissue bridge was left intact, and all survived operation. No patient had clinically significant mitral stenosis during a follow-up of 1 to 14 years (mean 4.9 years). Two patients (8%) developed progressive mitral regurgitation and required mitral valve replacement 3 and 11 years postoperatively. One of these patients died and a second death occurred suddenly 2 years following operation. All survivors are in Functional Class I or II. The noncleft orifice of a double-orifice mitral valve usually is competent and rarely requires closure. The cleft, because it constitutes a type of parachute (single papillary muscle) valve, should be closed partially so as to relieve valve incompetence without causing undue stenosis. The incidence of late development of mitral regurgitation is similar to that of atrioventricular canal without double-orifice mitral valve. Repair of atrioventricular canal associated with double-orifice mitral valve can be achieved with a low operative mortality and excellent late results.

Adolescent↗
PubMed2006

Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation.

BACKGROUND: For patients with ischemic mitral regurgitation (MR), it is not clear whether adjunctive mitral valve (MV) repair at the time of coronary artery bypass graft surgery (CABG) is beneficial. We sought to test the hypothesis that MV repair with CABG is superior to CABG alone in improving MR without increasing operative or long-term mortality. METHODS AND RESULTS: A total of 107 consecutive patients with moderate or severe ischemic MR, as determined by preoperative echocardiography, underwent CABG with concomitant MV repair (repair group, n=50) or CABG only (CABG group, n=57). Degree of MR was graded as none, mild, moderate, or severe by the proximal isovelocity surface area method. The groups were similar with respect to age, gender, baseline New York Heart Association class, ejection fraction, and number of bypass grafts. The repair group had a higher percentage of patients with atrial fibrillation or severe MR than the CABG group. The operative mortality was significantly higher for the repair group (12%) than the CABG group (2%), whereas the 5-year actuarial survival rate of the 2 groups was similar (88%+/-5% versus 87%+/-6%). On multivariate logistic regression analysis, older age, higher New York Heart Association class, and atrial fibrillation were independent predictors of operative mortality (P<0.05). Among patients with severe MR, ischemic MR was improved in all patients of the repair group and in 67% of patients in the CABG group (P<0.001), whereas improvement rates in patients with moderate MR were similar in the 2 groups (75% versus 67%, P=NS). CONCLUSIONS: Although MV repair appears to be more effective at reducing ischemic functional MR, CABG alone may be a preferable treatment option for patients with moderate MR and high operative risk factors such as old age or atrial fibrillation.

Aged↗
PubMed1990

Two siblings with Tel Hashomer camptodactyly and mitral valve prolapse.

A brother and sister with Tel Hashomer camptodactyly and mitral valve prolapse are described. Mitral valve prolapse is heterogenous, but appears to occur more frequently in individuals with connective tissue disorders. The presence of mitral valve prolapse as a component manifestation of Tel Hashomer camptodactyly suggests that abnormal connective tissue is a pleiotropic effect of the mutant allele.

Abnormalities, Multiple↗
PubMed1986

[Clinical problems in mitral valve prolapse: an echocardiographic review].

Several unsolved problems in the echocardiographic diagnosis of mitral valve prolapse were reviewed. At present, two-dimensional echocardiography is the most reliable method for assessing mitral valve prolapse. However, basic knowledge on the anatomical orientation of the mitral annulus, hitherto not sufficiently studied, is indispensable before making adequate echocardiographic diagnosis. The annulus is not like a geometrical plane and occupies certain millimeters' width between the left atrium and the ventricle. Therefore, assuming the left atrial margin of the annulus as the reference, many unmistakable prolapse with mitral regurgitation are overlooked, while assuming the left ventricular margins as the reference, some false positive diagnoses will be inevitable. Consulting several autopsy specimens, the author noticed that the central fibrous body, the site of the anterior mitral valve insertion to the interventricular septum, forms the most inferior part of the mitral annulus. This fact could explain a higher sensitivity of the apical four-chamber view for detecting anterior mitral valve prolapse reported by several investigators, and also more frequent over-diagnosis according to our experience. Although the author prefers the left ventricular margin of the mitral annulus defined by the long-axis view as the reference for echocardiographic diagnosis of mitral prolapse, further investigation should be made in relation to the clinical significance of this abnormality diagnosed by echocardiography.

Echocardiography↗
PubMed1992

Conservative surgery of the mitral valve: a report of the first 100 cases from one unit and one surgeon.

OBJECTIVE: To report the first 100 mitral valve repairs performed in a unit with an aggressive approach to conservative mitral valve surgery. DESIGN: Case notes were reviewed retrospectively and patients invited for clinical examination and cross sectional and Doppler echocardiography. SETTING: Tertiary cardiothoracic referral centre. PATIENTS: Between December 1985 and April 1991 mitral valve repair was carried out on 100 patients (66 males). Patients with pure mitral stenosis were excluded. Sixty seven had degenerative and 15 rheumatic mitral valve disease. Median age was 66 (range 12 to 79) years, with an interquartile range of 59 to 71 years. INTERVENTIONS: Operative procedures included annuloplasty ring in 97, resection of the posterior leaflet in 67, resection of endocarditic portion of posterior leaflet in four, commissurotomy in six, and correction of anterior leaflet abnormalities in seven. Thirty nine concomitant cardiac procedures were performed in 32 patients. Six operations were emergencies, and three of these required concomitant procedures. MAIN OUTCOME MEASURES: Mortality, operative failure rate, patients' functional state and degree of residual mitral regurgitation, incidence of thromboembolism, and endocarditis. RESULTS: Follow up ranged from one to 59 months, median 14 months, and an interquartile range of four to 23.5 months. Early mortality was 1%, late mortality 5%, and there was a 2% reoperation rate. Eighty four patients had moderate to severe mitral regurgitation preoperatively. At follow up mitral regurgitation was absent or mild in 78. Eighty six patients were in New York Heart Association (NYHA) class I-II at follow up compared with 80 in NYHA class III-IV preoperatively. There were no thromboembolic events. CONCLUSION: This study shows that satisfactory results can be obtained with mitral valve repair in a fairly elderly population with a high incidence of concomitant cardiac disorders. We suggest that these encouraging results will lead to earlier mitral valve repair in mitral regurgitation.

Adolescent↗
PubMed1994

Treatment of hypertrophic cardiomyopathy by mitral valve repair and septal myectomy.

This report describes surgical treatment consisting of mitral valve repair and septal myectomy in a young patient with a combination of hypertrophic cardiomyopathy and intrinsic mitral valve disease. The posterior mitral valve leaflet was elongated and was subject to systolic anterior motion, creating left ventricular outflow tract obstruction. With the described treatment, it was possible to avoid mitral valve replacement in this patient.

Adult↗
PubMed1991

Morphologic comparison of patients with mitral valve prolapse who died suddenly with patients who died from severe valvular dysfunction or other conditions.

Clinical and necropsy findings are described in 56 patients with mitral valve prolapse: 15 patients, aged 16 to 69 years (mean 39), died suddenly and mitral valve prolapse was the only cardiac condition found at necropsy (hereafter called isolated mitral valve prolapse); the remaining 41 patients had other conditions that were capable of being fatal. Of the latter 41 patients, 7, aged 17 to 59 years (mean 45), had associated congenital heart disease, and 34 patients, aged 17 to 70 years (mean 52), had no associated congenital cardiac abnormalities. Compared with the 34 patients without associated congenital heart disease and with nonmitral valve prolapse conditions capable in themselves of being fatal, the 15 patients who died suddenly with isolated mitral valve prolapse were younger (mean age 39 +/- 17 versus 52 +/- 15 years; p = 0.01), more often women (67% versus 26%; p = 0.008) and had a lower frequency of mitral regurgitation (7% versus 38%; p = 0.02). The 15 patients dying suddenly with isolated mitral valve prolapse also were less likely to have evidence of ruptured chordae tendineae (29% versus 67%; p = 0.04). The frequency of increased heart weight (67% versus 59%), a dilated mitral valve anulus (80% versus 81%), a dilated tricuspid valve anulus (17% versus 17%), an elongated anterior mitral leaflet (86% versus 54%), an elongated posterior mitral leaflet (79% versus 77%) and fibrous endocardial plaque under the posterior mitral leaflet (73% versus 63%) was similar between the two groups. The severity of the prolapse (mild 20% versus 11%; moderate 27% versus 58%; severe 53% versus 32%) also was similar between the two groups. Thus, persons with mitral valve prolapse dying suddenly without another recognized condition tend to be relatively young women without mitral regurgitation.

Adolescent↗
PubMed2000

Improved assessment of mitral valve stenosis by volumetric real-time three-dimensional echocardiography.

OBJECTIVES: This study was performed to determine the feasibility, accuracy and reproducibility of real-time volumetric three-dimensional echocardiography (3-D echo) for the estimation of mitral valve area in patients with mitral valve stenosis. BACKGROUND: Planimetry of the mitral valve area (MVA) by two-dimensional echocardiography (2-D echo) requires a favorable parasternal acoustic window and depends on operator skill. Transthoracic volumetric 3-D echo allows reconstruction of multiple 2-D planes in any desired orientation and is not limited to parasternal acquisition, and could thus enhance the accuracy and feasibility of calculating MVA. METHODS: In 48 patients with mitral stenosis (40 women; mean age 61 +/- 13 years) MVA was determined by planimetry using volumetric 3-D echo and compared with measurements obtained by 2-D echo and Doppler pressure half-time (PHT). All measurements were performed by two independent observers. Volumetric data were acquired from an apical view. RESULTS: Although 2-D echo allowed planimetry of the mitral valve in 43 of 48 patients (89%), calculation of the MVA was possible in all patients when 3-D echo was used. Mitral valve area by 3-D echo correlated well with MVA by 2-D echo (r = 0.93, mean difference, 0.09 +/- 0.14 cm2) and by PHT (r = 0.87, mean difference, 0.16 +/- 0.19 cm2). Interobserver variability was significantly less for 3-D echo than for 2-D echo (SD 0.08cm2 versus SD 0.23cm2, p < 0.001). Furthermore, it was much easier and faster to define the image plane with the smallest orifice area when 3-D echo was used. CONCLUSIONS: Transthoracic real-time volumetric 3-D echo provides accurate and highly reproducible measurements of mitral valve area and can easily be performed from an apical approach.

Cardiac Volume↗
PubMed2003

Mitral valve repair--early and medium-term results.

BACKGROUND: Mitral valve repair is the treatment of choice in patients with mitral insufficiency. Mechanical valves, even when functioning perfectly, are less efficient hemodynamically than a native mitral valve and also have attendant morbidity from thrombolism, anticoagulant-related hemorrhage, and endocarditis. Long-term data have confirmed the durability of mitral repair. METHODS: Mitral valve repair was performed on 89 consecutive patients (20 patients in ischemic group) between Nov. 1997 and Jan. 2002, In all patients, posterior annuloplasty with Capentier ring (30) or polytetrafluoroethylene Teflon strip (59) was performed. The repair technique included quadrangular resection, artificial chordae replacement, chordal transfer, and chordal shortening. RESULTS: There were 5 early deaths (4 deaths in the ischemic group), 9 major complications (5 complications in the ischemic group). Mean follow-up in the entire patient series was 25.18 months. There was one late death and one thromboembolic cerebral episode. Two patients required reoperation after mitral repair. There was a significant improvement in New York Heart Association functional class and grade of mitral regurgitation. CONCLUSIONS: The results of our study confirm that mitral valve repair results in acceptable operative mortality rate, excellent early and medium-term results and incidence of post operative complications.

Adolescent↗
PubMed1995

Percutaneous balloon dilatation of the mitral valve in critically ill young patients with intractable heart failure.

OBJECTIVE: To assess the outcome of percutaneous balloon dilatation of the mitral valve in critically ill young patients with intractable heart failure. DESIGN: Retrospective analysis of all such patients presenting over a period of 4 years. PATIENTS: Of 432 consecutive patients undergoing percutaneous balloon dilatation of the mitral valve, 12 (mean age 29 years) with intractable heart failure were identified. Nine had severe pulmonary oedema and three had pulmonary oedema with severe right heart failure and hypotension. Three patients were pregnant and three required mechanical; ventilatory support. PROCEDURE: Percutaneous balloon dilatation of the mitral valve was performed using the Inoue balloon technique. The procedure was shortened by excluding full right study, cardiac output measurement, and left ventriculography. The mitral valve morphology and mitral valve area were determined before and after percutaneous balloon dilatation using cross sectional Doppler echocardiography. RESULTS: The procedure was technically successful in all patients. The mean (SD) echocardiographic value of the mitral valve area increased from 0.7 (0.1) to 1.4 (0.2) cm2 with a concomitant reduction in pulmonary artery systolic pressure (Doppler) from 81 (17) to 50 (7) mm Hg. There was a significant clinical improvement in all patients. The mean (range) fluoroscopy time for the procedure was 6.9 (1.7-14.1) min. During follow up (mean 10 months) nine patients were in New York Heart Association (NYHA) functional class I, one was in class II, one under NYHA elective mitral valve replacement, and one, who refused elective surgery, died suddenly at home. CONCLUSION: Percutaneous balloon dilatation of the mitral valve can be performed as a life saving procedure in critically ill patients with mitral stenosis, as even a modest increase in valve area in these patients produces gratifying clinical improvement.

Adult↗
PubMed1984

Role of chordae tendineae in mitral valve opening: two-dimensional echocardiographic evidence.

Study of 16 normal and 33 flail mitral valves provides evidence of the active participation of chordae tendineae in mitral valve opening. The normal valves have straight chordae at all phases of opening. During isovolumic relaxation and progressive opening phases, the smooth configuration of the mid-anterior mitral leaflet is broken by a sharp outward "tenting." This tenting is localized at chordal insertions, reflecting significant tension at these points. Flail mitral valves allow comparison of opening motion between mitral segments with normal chordal attachment and flail segments without chordal support. Posterior flail leaflets demonstrate delay in initiation of opening motion relative to the normal anterior leaflet. The most dramatic examples of this delay reveal a maximal opening excursion of the anterior leaflet before the flail posterior leaflet initiates opening motion. The untethered free margins of opening flail anterior leaflets produce the appearance of the flail segment trailing the body of the anterior leaflet with a sharp break in leaflet contour between the supported and unsupported segments. These configurational expressions of mitral valve opening are inconsistent with a passive hemogenic mechanism. They support an active myogenic process mediated through direct traction on the valve by the chordae tendineae.

Chordae Tendineae↗
PubMed1994

Anatomic basis for mitral valve modelling.

The increasing popularity of mitral valve repair and current interest in replacement with a mitral homograft or heterograft warrant a new look at the normal functional anatomy of the system. We conducted a detailed review of the anatomic structure of both the intact and excised mitral apparatus of porcine and human species. The following intact structural dimensions were measured: total annular length, anterior and posterior annular length. Excised measurements included: total annular length, anterior and posterior annular lengths, leaflet edge lengths, leaflet heights, and anterolateral and posteromedial commissural heights. Leaflet area was calculated from planimetric measurements. Chordal lengths were measured and distribution recorded. The majority of leaflet measurements were not statistically different between groups. For both groups, the measured annular length increased significantly upon valve excision. In both groups, the posterior leaflet area was significantly larger than the anterior leaflet area, and the area of each leaflet alone was significantly greater than the calculated orifice area. Chordal length was not significantly different between groups, however, distribution varied slightly with the ratio of origins to insertions being 8:1 (porcine) and 5:1 (human). The results are consistent with previous studies of the human mitral valve. This study showed little difference between human and porcine data, and the porcine valve was identified as an appropriate model for further investigation of the mitral valve system.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Mitral valve surgery in the patient with left ventricular dysfunction.

Mitral regurgitation (MR) is a frequent complication of end-stage cardiomyopathy. Historically, these patients were managed either medically or with mitral valve replacement, both associated with poor outcomes. We studied 125 patients with cardiomyopathy and severe MR who were managed with mitral reconstruction. One hundred twenty-five patients with 4+ MR, left ventricular ejection fractions from 8% to 24% (mean 14%), and New York Heart Association class III or IV symptoms were prospectively studied. All patients underwent mitral valve repair with an undersized flexible annuloplasty ring. There was one intraoperative death and five 30-day mortalities. Intraoperative echocardiography showed mild to trivial MR in seven patients, and no residual MR in the majority of patients. There were 26 late deaths; three of these patients had progression of the disease and underwent transplantation. One- and 2-year actuarial survival has been 80% and 70%, respectively. New York Heart Association class has improved for all the patients from a preoperative mean of 3.2 +/- 0.2 to 1.8 +/- 0.4 postoperatively. At 24-month follow-up, all patients showed an improvement of ejection fraction, cardiac output, and end-diastolic volumes, along with a reduction in sphericity index and regurgitant volume. Mitral valve repair with an undersized flexible annuloplasty ring is a safe and effective approach to correct MR in cardiomyopathy patients. All observed changes contribute to reverse remodeling and the restoration of the normal left ventricular geometric relationship. Mitral reconstruction offers a new treatment strategy for patients with MR and end-stage heart failure.

Cardiac Surgical Procedures↗
PubMed1998

Mitral valve replacement in sickle cell disease.

Cardiac dysfunction, including mitral valve regurgitation and congestive heart failure, can occur in patients with sickle cell disease. However, major surgery poses a greater risk in this population. This paper reports on the management of a patient with sickle cell disease who underwent successful replacement of the mitral valve.

Adult↗