The Dilemma of Reducing Functional Mitral Regurgitation Versus Development of Mitral Stenosis

2012 ◽  
pp. 307-331
Author(s):  
Ali Vazir ◽  
Olaf Franzen ◽  
Neil Eric Moat ◽  
Susanna Price
Keyword(s):  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Functional Mitral Regurgitation

scholarly journals Does Stringent Restrictive Annuloplasty for Functional Mitral Regurgitation Cause Functional Mitral Stenosis and Pulmonary Hypertension?

Circulation ◽  
2011 ◽  
Vol 124 (11_suppl_1) ◽  
pp. S97-S106 ◽  
Author(s):  
S. Kainuma ◽  
K. Taniguchi ◽  
T. Daimon ◽  
T. Sakaguchi ◽  
T. Funatsu ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Functional Mitral Regurgitation

scholarly journals Predictors and Clinical Impact of Functional Mitral Stenosis Induced by Restrictive Annuloplasty for Ischemic and Functional Mitral Regurgitation

2017 ◽  
Vol 81 (12) ◽  
pp. 1832-1838 ◽  
Author(s):  
Satoshi Kainuma ◽  
Kazuhiro Taniguchi ◽  
Koichi Toda ◽  
Toshihiro Funatsu ◽  
Haruhiko Kondoh ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Clinical Impact ◽  
Functional Mitral Regurgitation

scholarly journals P760 Stress echocardiography testing of a novel trans annular mitral bridge implantation for mitral regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Benesova ◽  
V A Subramanian ◽  
S Cerny
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Arterial Pressure ◽  
Mitral Stenosis ◽  
Functional Mitral Regurgitation ◽  
Peak Exercise ◽  
Valve Repair ◽  
Ergometer Exercise ◽  
Valve Area

Abstract Objectives Indirect reduction of septal- lateral diameter (SLD) by circumferential cinching of the annulus with ring annuloplasty (RA) is the standard part of mitral valve repair surgery. Direct SLD reduction without circumferential annular cinching by a novel trans-annular Mitral Bridge with an infra-annular curvature has been used for functional mitral regurgitation (FMR) as a sole procedure and for mitral valve prolapse (MVP)as a part of valve repair. The aim of this study was to assess the functional and hemodynamic outcomes at rest and exercise at 2 yr. follow up in the patients with this novel type of annuloplasty. Methods 30 of 34 patients with FMR who had trans annular Mitral Bridge as the sole treatment of their MR and 5 of 8 patients with MVP in a prospective trial underwent at 2yr F/U bicycle ergometer exercise echocardiography on a special semi-recumbent bicycle. Mitral regurgitation, mitral peak and mean gradient, mitral valve area, systolic pulmonary arterial pressure, systolic function of the left ventricle were assessed at rest and peak exercise. Results Mitral regurgitation was 0.3 ± 0.5 at rest and 0.4 ± 0.5 at peak exercise (p = 0.264). The resting mean mitral gradient was 2.3 ± 0.9 mmHg and peak 4.6 ± 1.9 mmHg (p <.0001) and valve area was at rest 3.5 ± 0.7cm2 and at peak 3.9 ± 0.9 cm2 (p = 0.026). Pulmonary systolic arterial pressure was 25.8 ± 17 at rest and 36.9 ± 21.8 at peak exercise (P = 0.012). LVEF was 60,4± 10.5 at rest and at peak 66,4± 12.5 (p <.0001). Conclusion Trans annular Mitral Bridge as a alternative to standard annuloplasty ring is effective. At 2 yr follow up there was only trace mitral regurgitation and no mitral stenosis. The stress test verified the durability of the mitral repair both in FMR and MVP. There was no mitral stenosis and no mitral regurgitation at exercise. The raise of the mean mitral gradient was statistically important, but the values remained within the normal range. The raise of gradients is in correlation with the presence of cardiac reserve and increased LVEF. There were no signs of pulmonary hypertension caused by the stress. Abstract P760 Figure. Mitral Bridge

Role of Closed Mitral Commissurotomy for Mitral Stenosis: Mid- and Long-term Surgical Outcome of 36 Patients

2005 ◽  
Vol 8 (1) ◽  
pp. 55 ◽  
Author(s):  
Azman Ates ◽  
Yahya �nl� ◽  
Ibrahim Yekeler ◽  
Bilgehan Erkut ◽  
Yavuz Balci ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Operating Time ◽  
Term Survival ◽  
Long Term Outcome ◽  
Mitral Commissurotomy ◽  
Closed Mitral Commissurotomy

Purpose: To evaluate long-term survival and valve-related complications as well as prognostic factors for mid- and long-term outcome after closed mitral commissurotomy, covering a follow-up period of 14 years. Material and Methods: Between 1989 and 2003, 36 patients (28 women and 8 men, mean age 28.8 6.1 years) underwent closed mitral commissurotomy at our institution. The majority of patients were in New York Heart Association (NYHA) functional class IIB, III, or IV. Indication for closed mitral commissurotomy was mitral stenosis. Closed mitral commissurotomy was undertaken with a Tubbs dilator in all cases. Median operating time was 2.5 hours 30 minutes. Results: After closed mitral commissurotomy, the mitral valve areas of these patients were increased substantially, from 0.9 to 2.11 cm2. No further operation after initial closed mitral commissurotomy was required in 86% of the patients (n = 31), and NYHA functional classification was improved in 94% (n = 34). Postoperative complications and operative mortality were not seen. Follow-up revealed restenosis in 8.5% (n = 3) of the patients, minimal mitral regurgitation in 22.2% (n = 8), and grade 3 mitral regurgitation in 5.5% (n = 2) patients. No early mortality occurred in closed mitral commissurotomy patients. Reoperation was essential for 5 patients following closed mitral commissurotomy; 2 procedures were open mitral commissurotomies and 3 were mitral valve replacements. No mortality occurred in these patients. Conclusions: The mitral valve area was significantly increased and the mean mitral valve gradient was reduced in patients after closed mitral commissurotomy. Closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients.

A Novel Technique for Functional Mitral Regurgitation Therapy: Mitral Annular Remodeling

2006 ◽  
Vol 9 (6) ◽  
pp. E888-E892 ◽  
Author(s):  
Keiji Kamohara ◽  
Michael Banbury ◽  
Anthony Calabro ◽  
Zoran B. Popović ◽  
Aniq Darr ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Novel Technique

Surgical Technique: Papillary Muscle Sling for Functional Mitral Regurgitation during Minimally Invasive Valve Surgery

2013 ◽  
Vol 16 (5) ◽  
pp. E295-E297 ◽  
Author(s):  
Joseph Lamelas ◽  
Christos Mihos ◽  
Orlando Santana
Keyword(s):  
Mitral Regurgitation ◽  
Minimally Invasive ◽  
Median Sternotomy ◽  
Rational Approach ◽  
Functional Mitral Regurgitation ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Mitral Annuloplasty ◽  
Technical Details ◽  
Mitral Apparatus

In patients with functional mitral regurgitation, the placement of a sling encircling both papillary muscles in conjunction with mitral annuloplasty appears to be a rational approach for surgical correction, because it addresses both the mitral valve and the deformities of the subvalvular mitral apparatus. Reports in the literature that describe the utilization of this technique are few, and mainly involve a median sternotomy approach. The purpose of this communication is to describe the technical details of performing this procedure via a minimally invasive approach.

Mitral Annular Remodeling to Treat Functional Mitral Regurgitation: A Pilot Acute Study in a Canine Model

2010 ◽  
Vol 13 (4) ◽  
pp. E247-E250 ◽  
Author(s):  
Hideyuki Fumoto ◽  
Tohru Takaseya ◽  
Akira Shiose ◽  
Roberto M. Saraiva ◽  
Yoko Arakawa ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Canine Model ◽  
Functional Mitral Regurgitation ◽  
Acute Study

Percutaneous Mitral Annuloplasty for Treatment of Functional Mitral Regurgitation

2009 ◽  
Vol 5 (1) ◽  
pp. 67
Author(s):  
Lutz Buellesfeld ◽  
Lazar Mandinov ◽  
Eberhard Grube ◽  
◽  
◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Coronary Sinus ◽  
Standard Of Care ◽  
Mitral Annulus ◽  
Functional Mitral Regurgitation ◽  
Invasive Treatment ◽  
Large Variability ◽  
Mitral Annuloplasty ◽  
Number Of Patients ◽  
Anatomical Relationship

Functional mitral regurgitation affects a substantial proportion of patients with congestive heart failure due to myocardial infarction or dilated cardiomyopathy. Functional mitral regurgitation greatly increases morbidity and mortality. Surgical annuloplasty is the standard of care for symptomatic patients with moderate or severe functional mitral regurgitation; however, a large number of patients are refused surgery. Several percutaneous approaches have been developed to address the need for less invasive treatment of mitral annulus dilatation. Devices using coronary sinus to cinch the mitral annulus are relatively easy to use; however, a number of factors may limit their clinical application, such as suboptimal anatomical relationship between the coronary sinus and mitral annulus, risk of coronary artery compression, large variability in the coronary venous anatomy and conflict with other therapies such as ablation or cardiac resynchronisation. Direct mitral annuloplasty is anticipated to be more effective than the coronary sinus approaches; however, it has yet to prove its safety and efficacy in carefully designed clinical trials. The best candidates and the best timing for each percutaneous mitral annuloplasty therapy, whether direct or indirect, have yet to be identified.

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