Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “MITRAL VALVE”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,693 records · Page 94Linked to original sources
PubMed2002

A neonate with mitral stenosis due to accessory mitral valve, ventricular septal defect, and patent ductus arteriosus: changes in echocardiographical findings during the neonatal period.

A female neonate with mitral stenosis due to accessory mitral valve with ventricular septal defect and patent ductus arteriosus is described. She was referred to our hospital because of neonatal asphyxia. Asphyxia was improved by ventilator support, but rapid deterioration of respiration with pulmonary congestion and hemorrhage appeared 8 days after birth. Echocardiography revealed an accessory mitral valve attached to the anterior mitral leaflet with a perimembranous ventricular septal defect and patent ductus arteriosus. Although there were no echocardiographical findings indicating mitral stenosis on admission, the mitral stenosis blood flow patterns were detected by color and pulsed Doppler examination performed on the eighth day after admission. Transaortic resection of accessory mitral valve tissue was performed with patch closure of the ventricular septal defect and ligation of the ductus arteriosus 35 days after birth. After operation, pulmonary congestion and hemorrhage were improved. Postoperative echocardiography showed complete resection of the accessory mitral valve and no mitral insufficiency. We concluded that the combination of the accessory mitral valve and left-to-right shunt due to ventricular septal defect or patent ducturs arteriosus might have led to a critical hemodynamic condition due to relative mitral stenosis in the neonatal period with the decrease in pulmonary vascular resistance.

Cardiac Surgical Procedures↗
PubMed2002

Five years of less invasive mitral valve surgery: from experimental to routine approach.

BACKGROUND: In the last five years, mitral valve surgery has changed fundamentally. This study reviews our experience in less invasive mitral valve surgery (LIMS) during that time. METHODS: LIMS was performed in 449 patients (age 59 +/- 14 years, 237 female) via a right lateral minithoracotomy. The operations included 42 "redo" procedures. After initially experiencing a high number of complications, we have modified and simplified the procedure. After using the Port- Access? Technique (PAT) in the earlier stages of our series, in the last 226 patients the aorta was clamped directly using the transthoracic clamping (Chitwood) technique (TTC). In our most recent cases, PAT was only employed in redo procedures. In 336 patients, the procedure was completed with robotic assistance, and in 23 of these we used the da Vinci telemanipulation system. RESULTS: The mitral valve was repaired in 327 patients and replaced in 122 patients. In 100 patients, additional surgical procedures (TVR n = 13, ASD closure n = 16, left atrial ablation n = 65, left atrial reduction plasty n = 6) were performed. Bypass and clamp time, including times for both additional and redo procedures, were 124 +/- 44 min. and 65 +/- 29 min. in the overall series. Complications, which were mainly neurological, were fewer in the TTC group than in the PAT group (n = 4 vs. n = 17; p <0.04). Hospital mortality was 3.1% and 5.2%, respectively, for the two groups. There were no additional costs associated with using the TTC technique compared to conventional procedures. Mean survival rate was 96.3% at a mean follow-up of 727 +/- 451 days (95% CI, 677 to 779). CONCLUSIONS: Less invasive mitral valve surgery enables the patient to avoid the surgical trauma associated with sternotomy. It has developed into a reliable technique with reproducible results for primary, redo, and additional procedures. LIMS has become the standard approach for mitral valve operations at our institution.

Cardiac Surgical Procedures↗
PubMed1981

Is it important to preserve the chordae tendinae and papillary muscles during mitral valve replacement?

To evaluate the importance of preserving chordae tendinae and papillary muscles to left ventricular function after mitral valve replacement, 12 dogs had Carpentier-Edwards or Björk-Shiley mitral valves inserted. Cardiopulmonary bypass, systemic hypothermia at 25 degrees C and cold cardioplegia were used. The period of anoxic arrest was 30 minutes. In six dogs, mitral valve replacement was performed after complete excision of the mitral valve. In the other six dogs the anterior leaflet was partially excised but all chordae tendinae and papillary muscles were left intact. Hemodynamic measurements, including left ventricular function following volume loading, were made preoperatively and postoperatively. Left ventricular angiograms were obtained postoperatively in all dogs. Preoperatively there was no significant difference in the left ventricular function curves in the two groups, but postoperatively the curves showed significant differences. In the group with preserved chordae tendinae, left ventricular function improved with volume loading to a left ventricular end-diastolic pressure of 20 mm Hg while in the group with divided chordae tendinae, function improved more slowly and ceased to improve after loading to an end-diastolic pressure of 15 mm Hg. The mean left ventricular ejection fraction following mitral valve replacement with preserved papillary muscles was 0.62 +/- 0.01 and with divided papillary muscles was 0.45 +/- 0.05 (P less than 0.05). The authors conclude that it is important to preserve chordae tendinae and papillary muscles when carrying out mitral valve replacement.

Animals↗
PubMed1993

Interstitial cells from the atrial and ventricular sides of the bovine mitral valve respond differently to denuding endocardial injury.

The mitral valve has atrial and ventricular sides, each lined by endocardial cells. The valve stroma contains alpha smooth muscle actin positive interstitial cells, collagen, glycosaminoglycans, and elastic tissue. To eliminate the effect of endocardium on wound repair in bovine mitral valve organ culture, the endocardium was removed from both sides of the valve. At 6 days, organ cultures of these preparations revealed surface cells on the ventricular side but not in the atrial side. Ventricular surface cells were negative for Factor VIII-related antigen, and positive for alpha smooth muscle actin. Immunoperoxidase staining for proliferating cell nuclear antigen/cyclin, a marker for cell proliferation, revealed a positive labeling index of (mean +/- standard deviation) 0.08 +/- 0.16% for interstitial cells from the atrial side and 0.14 +/- 0.19% for ventricular side interstitial cells in uncultured preparations (not significant), and 0.44 +/- 0.69% for atrial side interstitial cells and 2.25 +/- 1.64% for ventricular side interstitial cells in the cultured preparations (significant, P < 0.0006). The results suggest that in organ culture, interstitial cells from the ventricular side of the mitral valve respond to a denuding endocardial injury by proliferating and migrating onto the adjacent surface whereas interstitial cells from the atrial side do not. This difference in the response to injury of interstitial cells from the atrial and ventricular sides of the valve may reflect differences in phenotype or may be due to effects of extracellular matrix on interstitial cell behavior. The latter is possible because of differences in the extracellular matrix of the atrial and ventricular sides of the valve.

Actins↗
PubMed1990

Mitral valve repair: results and the decision-making process in reconstruction. Report of 275 cases.

From January 1975 to June 1988, 275 patients underwent mitral valve repair for mitral regurgitation, pure (148 patients) or associated with mitral stenosis (127 patients). Patients with pure mitral stenosis were excluded from this study. The cause of mitral regurgitation was rheumatic in 180 patients (aged 28.6 +/- 1.2 years, mean +/- standard error of the mean) and degenerative in 84 patients (aged 54.7 +/- 1.5 years). Fifty-nine percent of the patients were in New York Heart Association classes III and IV before the operation. Intraoperative assessment of the mitral valve led us to identify four major mechanisms of mitral regurgitation: (1) restriction of leaflet motion by fibrosis (group I, 63 patients); (2) enhancement of leaflet motion by leaflet and chordal extension and prolapse (group II, 139 patients), (3) combination of both (group III, 64 patients); and (4) isolated dilatation of the anulus (group IV, 10 patients). One hundred sixty-one patients had isolated mitral disease and 114 had associated aortic or tricuspid valve disease, or both. The hospital mortality rate was 4.0%. Follow-up was 96% complete and totaled 1247.47 patient-years. At 13 years' follow-up, the survival rate was 93.0% +/- 6.8% in group I, 90.0% +/- 6.0% in group II, and 96.6% +/- 4.6% in group III. Freedom from reoperation was 78.1% +/- 21.0%, 83.2% +/- 18.9%, and 79.6% +/- 16.2%, respectively. Freedom from embolism was 94.7% for the whole series. In patients with isolated mitral valve repair, the cumulative morbidity was significantly higher in groups I (6.3 +/- 2.0%/pt-yr) and III 6.3% +/- 1.7%/pt-yr) than in group II (2.5% +/- 0.9%/pt-yr, p less than 0.05). Multivariate analysis identified age and associated tricuspid valve disease as significant predictors of reoperation (p less than 0.01 for both factors). These results suggest that conservative surgery should be used with caution in group I and III patients. In contrast, indications for mitral valve repair should be extended in group II patients. This observation has important clinical implications since, in Western countries, valve prolapse tends to be a major cause of mitral regurgitation.

Actuarial Analysis↗
PubMed1979

Altered collagen composition in a prolapsing mitral valve with ruptured chordae tendineae.

A patient presented with mitral valve prolapse, ruptured chordae tendineae, severe mitral regurgitation and congestive heart failure. Pathologic studies demonstrated myxomatous changes of both mitral leaflets. Collagen analysis of the valve and of the chordae tendineae revealed the presence of type I collagen in normal quantities and a striking absence of type III and AB collagens. The altered collagen in this patient's mitral valve probably contributed to the development of his mitral valve disorder.

Chordae Tendineae↗
PubMed1980

Surgical treatment for chest pain in mitral valve prolapse.

The case of a 40-year-old woman with mitral valve prolapse and severe atypical chest pain is presented. The diagnosis was confirmed by phonocardiographic, echocardiographic, and angiocardiographic studies. The electrocardiogram revealed an ischemic pattern of ST-T on the anterior and inferior wall. Coronary angiographic studies showed normal coronary arteries. The patient's long-standing, prolonged, disabling atypical chest pain could not be relieved with medical therapy, despite the administration of beta-adrenergic blocking agents, calcium antagonists, and short-acting nitrites during a 30-month period. Thus, the prolapsed mitral valve was replaced with a Hancock xenograft. After 12 months the patient is totally free of symptoms, without any treatment and with a normal ECG. This excellent surgical result could be explained on the basis of the valvular theory of chest pain in mitral valve prolapse, suggesting that pain is promoted probably by a regional imbalance between oxygen availability and consumption, because of the excessive papillary muscular stretching produced by the prolapse. To our knowledge, this is the first published report of successful surgical treatment of chest pain in mitral valve prolapse.

Adult↗
PubMed1994

[A case of perforated mitral valve aneurysm following aortic valve replacement associated with infective endocarditis].

A case of perforated mitral valve aneurysm following aortic valve replacement associated with infective endocarditis was reported. The patient was a 29-year-old man, who was suffering from high fever, Osler's nodules and headache. A brain abscess was recognized in a computed tomography and 3rd grade aortic regurgitation was recognized in echocardiogram and aortography. Hematological studies suggested the inflammation and gram-positive cocci was incubated from his arterial blood. Then infective endocarditis with aortic regurgitation was diagnosed. AVR was performed following 8 weeks treatment with antibiotics, when he had negative CRP and his blood culture. After the operation, he was received the intravenous antibiotic therapy for 6 weeks and oral antibiotic drugs was given following his hospital discharge. At 6 months after AVR, mitral valve aneurysm was recognized in his echocardiogram. At 30 months after AVR, the perforation of it was revealed and mitral valve replacement was performed with his negative blood culture. The patient was discharged 28th day after MVR. There has been no active inflammation from his first hospital discharge and following days, the mitral valve aneurysm and the perforation was caused by weakened tissue of the anterior mitral leaflet due to sibilant inflammatory change.

Adult↗
PubMed1991

[Continuity from normal to prolapsed mitral valves: two-dimensional and color Doppler echocardiographic investigations].

To investigate the continuity between the normal and prolapsed mitral valves (MVP), two-dimensional echocardiography (2DE) and color Doppler echocardiography (CDE) were performed in 508 healthy boys aged 12 to 13 years old. The distance from the plane of the mitral annulus to the coaptation of the mitral valve "c", the maximum distance between the anterior leaflet and a straight line connecting the anterior mitral annulus and the coaptation of the mitral valve "d", and the maximum distance between the posterior mitral leaflet and the straight line connecting the posterior mitral annulus and the coaptation of the mitral valve "e" were measured in the parasternal long-axis view. The locations of the anterior and posterior mitral annuli were determined to be the hing point of the anterior leaflet on the left ventricular side and the junction of the posterior leaflet on the ventricular side, respectively. Mitral regurgitation (MR) was evaluated by CDE in the parasternal long-axis view. The ratio of the duration of regurgitation to ejection time (DT/ET) was measured by M-mode CDE in the subjects with and without MVP. The values of "c" ranged from +10 mm to -3 mm, and those of "d" from +5 mm to -4 mm (minus denotes prolapse into the left atrium). Approximately normal distributions were demonstrated with the parameters "c" and "d". The value of "e" could not be measured because of a poor image of the posterior leaflet. The incidence of MVP varied from 2.5 to 13.5% depending on the criterion for applied MVP. Fifty-nine of the 487 healthy subjects turned out to have MR (12%). Coaptation of the mitral valve deviated from the posterior commissure significantly to the left atrium more in the subjects with MR than in those without MR (2.46 +/- 1.93 vs 3.41 +/- 1.84, p < 0.01). The DT/ET ratio of the MR subjects with MVP tended to be higher than that of the boys without MVP. The presence of continuity between the normal and prolapsed mitral valves suggests that MVP may be a multifactorial disorder of the valve. Associated asymptomatic MR may be related not only to the severity of MVP but also to other factors, especially in MR of normal healthy subjects.

Adolescent↗
PubMed1984

Observations on structure and function of the equine mitral valve.

The anatomy of the equine mitral valve and certain variations observed in 60 adult horses are described. The functional role of this valve, sited between the left atrium and the high pressure-generating left ventricle, is discussed in relation to its anatomical structure. A method of examining the left side of the heart post mortem is described.

Animals↗
PubMed1996

Results of represervation of the chordae tendineae during redo mitral valve replacement.

BACKGROUND: Previous studies have shown that preservation of the chordae tendineae improves early and late postoperative left ventricular function after mitral valve replacement. This report describes the results of represervation of the chordae tendineae during redo mitral valve replacement in patients who had their chordae tendineae preserved during their initial operation. METHODS: Fifty-four patients undergoing reoperative mitral valve replacement with preservation of their chordal annular attachments (chordae group) were compared with 187 patients who had redo mitral valve replacement without preservation of the chordae (nonchordae group). The interval between the initial operation and the reoperation was 8.7 +/- 4.4 years in the chordae group and 8.6 +/- 4.9 years in the nonchordae group (p = 0.315). Seventy-three patients underwent aortic valve replacement during their redo mitral valve replacement compared with 168 patients who had mitral valve replacement alone. There were 15 patients who had their chordal attachments represerved during redo double-valve replacement. RESULTS: In the chordae group, intraoperative assessment revealed excellent chordal connection between the preserved papillary muscles and the mitral annulus in all patients. One patient had adhesions between the preserved chordae and the stent of the tissue valve. The chordal attachments were preserved during insertion of the second valve in all patients. The incidence of low output syndrome and operative mortality in the chordae group was 16.7% and 7.4%, respectively. In the nonchordae group, the incidence of low output syndrome was 27.3% (p = 0.112 compared with the chordae group) and the operative mortality was 13.4% (p = 0.236 compared with the chordae group). In patients with double-valve replacement, represervation of the chordae was associated with a reduction in low output syndrome (0% versus 24%; p = 0.034) and mortality (6.7% versus 15.5%; p = 0.374). CONCLUSIONS: Preservation of the chordal attachments between the papillary muscles and the mitral annulus can be accomplished during reoperative mitral valve replacement. Represervation of the chordae tendineae may reduce postoperative low output syndrome, especially in high-risk patients undergoing redo double-valve replacement.

Aortic Valve↗
PubMed1991

The flail mitral valve: echocardiographic findings by precordial and transesophageal imaging and Doppler color flow mapping.

To determine the echocardiographic and Doppler characteristics of mitral regurgitation associated with a flail mitral valve, precordial and transesophageal echocardiography with pulsed wave and Doppler color flow mapping was performed in 17 patients with a flail mitral valve leaflet due to ruptured chordae tendineae (Group I) and 22 patients with moderate or severe mitral regurgitation due to other causes (Group II). Echocardiograms were performed before or during cardiac surgery; cardiac catheterization was also performed in 28 patients (72%). Mitral valve disease was confirmed at cardiac surgery in all patients. By echocardiography, the presence of a flail mitral valve leaflet was defined by the presence of abnormal mitral leaflet coaptation or ruptured chordae. Using these criteria, transesophageal imaging showed a trend toward greater sensitivity and specificity than precordial imaging in the diagnosis of flail mitral valve leaflet. By Doppler color flow mapping, a flail mitral valve leaflet was also characterized by an eccentric, peripheral, circular mitral regurgitant jet that closely adhered to the walls of the left atrium. The direction of flow of the eccentric jet in the left atrium distinguished a flail anterior from a flail posterior leaflet. By transesophageal echocardiography with Doppler color flow mapping, the ratio of mitral regurgitant jet arc length to radius of curvature was significantly higher in Group I than Group II patients (5.0 +/- 2.3 versus 0.7 +/- 0.6, p less than 0.001); all of the Group I patients and none of the Group II patients had a ratio greater than 2.5.(ABSTRACT TRUNCATED AT 250 WORDS)

Chordae Tendineae↗
PubMed1992

[Intra-atrial implantation of mitral valve prosthesis in 2 patients with active infective endocarditis complicated by mitral annular destruction].

This is a report of two patients with extensive destruction of the mitral annulus due to active infective endocarditis. Patient 1 was a 66-year-old female and the patient 2 was a 59-year-old male. In both patients medical therapy had failed to control endocarditis and emergency mitral valve replacements were carried out. At the operation special surgical techniques were necessitated, since insertion of artificial valves in the annulus was impossible because of the lack of the annular tissue due to destruction and excision. On the posterior commissure side, mitral valve prosthesis were sutured to the left atrial wall just above the anatomical mitral ring. Furthermore, in patient 2, a bovine pericardium collar attached to the prosthetic valve was sutured to the left atrial wall to secure fixation of the prosthetic valve. The postoperative courses were uneventful in both patients. This technique seems to be useful in patients with mitral annular destruction.

Aged↗
PubMed1999

Mitral valve repair. Quadrangular resection of the posterior leaflet in patients with myxomatous degeneration.

OBJECTIVE: To analyze the immediate and late results of mitral valve repair with quadrangular resection of the posterior leaflet without the use of a prosthetic ring annuloplasty. METHODS: Using this technique, 118 patients with mitral valve prolapse who underwent mitral repair from January '84 through December '96 were studied. Age ranged from 30 to 86 (mean = 59.1 +/- 11.8) years and 62.7% were males. An associated surgery was performed in 22% of the patients, and coronary artery bypass graft was the most frequently performed surgery (15 patients--12.7%). In 20 (16.9%) patients other associated techniques of mitral valve repair were used and shortening of elongated chordae tendineae was the most frequent one (6 patients). RESULTS: Immediate mortality was 0.9% (one patient). Long-term rates for thromboembolism, endocarditis, reoperation and death in the late postoperative period were 0.4%, 0.4%, 1.7% and 2.2% patients/year, respectively. The actuarial curve of survival was 83.8 +/- 8.6% over 12 years; survival free from re-operation was 91.8 +/- 4.3%, free from endocarditis was 99.2 +/- 0.8% and free from thromboembolism was 99.2 +/- 0.8%. In the late postoperative period, 93.8% of the patients were in functional class 1 (NYHA), with a complete follow-up in 89.7% of the patients. CONCLUSION: Patients with mitral valve prolapse who undergo mitral valve repair using this technique have a satisfactory prognosis over 12 years.

Actuarial Analysis↗
PubMedDate not supplied

The mitral valve prolapse--panic disorder connection.

Whether mitral valve prolapse (MVP) is more common in patients with panic disorder (PD) and agoraphobia with panic attacks (AgP) than in the normal population is controversial. A related issue is whether the presence of MVP in such patients has any clinical or biological significance. Echocardiograms were performed on 36 patients with PD/AgP and 22 normal controls. MVP was found to be more common in PD/AgP patients than in normal controls. However, MVP in the patients was mild and not associated with thickened mitral leaflets or small left ventricular size. Moderate or severe prolapse was uncommon in both groups. Patients with MVP had trends to higher heart rate and prolonged QTc interval on EKG, and reported more respiratory difficulty during panic attacks compared to patients without MVP. Lactate infusion did not affect patients with MVP differently than patients without MVP. The authors conclude that MVP is more common in patients with PD or AgP than in normal controls, but is of doubtful clinical significance.

Adult↗
PubMed1996

Echocardiographic study of mitral valve prolapse in dachshunds.

In this prospective echocardiographic study, we investigated the occurrence of mitral valve prolapse (MVP) in 60 dachshunds: 30 with mitral regurgitation (MR), 15 age-matched and 15 3-year-old controls without heart murmurs. To assess the MVP, video recorded sequences from the right parasternal long axis 4-chamber view were blindly evaluated by three observers. Of the 30 dogs with MR, 12 (40%) had severe MVP, 10 (33%) had mild MVP, and eight (27%) had a normal mitral valve. The clinical status of the dogs with MR correlated significantly with the severity of MVP, and these dogs had significantly worse MVP than age-matched controls, among which seven (47%) had mild MVP and eight (53%) had a normal mitral valve ( P < 0.01). In the group of 15 young dachshunds without heart murmurs, seven (47%) had mild MVP and eight (53%) had a normal mitral valve. The degree of MVP correlated significantly with the occurrence of arrhythmias, particularly severe sinus arrhythmia. We conclude that dachshunds with MR have a higher prevalence of MVP than controls, and that the severity of MVP is correlated with clinical status. The dogs with MVP and marked sinus arrhythmia might have autonomic dysfunction, analogous to findings in humans. Whether young dachshunds with MVP are predisposed to MR later in life must await the results of a longitudinal study.

Animals↗
PubMed2002

Intraoperative transesophageal echocardiography accurately predicts mitral valve anatomy and suitability for repair.

Mitral valve (MV) repair is the procedure of choice for MV prolapse or flail. However, valve repair is more technically demanding and requires a precise definition of MV morphology to determine the timing, complexity, and feasibility of repair. We prospectively examined 170 consecutive patients with MV prolapse or flail referred for MV repair. The MV valve was systematically assessed by intraoperative transesophageal echocardiography. MV anatomy was independently assessed at the time of operation. Accuracy of transesophageal echocardiography in identifying MV segments ranged from 90% to 97%, and was best for the middle segment/scallop of either anterior or posterior leaflet. MV repair was successful in 91% of patients. Success rate was the lowest (78%) in the presence of extensive bileaflet disease involving at least 2 segments of each leaflet. Independent predictors of unsuccessful repair were central jet of mitral regurgitation, calcification or severe dilatation of the mitral annulus, and extensive leaflet disease with involvement of at least 3 segments.

Adult↗