Transthoracic echocardiography in patients undergoing mitral valve repair: comparison of new transthoracic 3D techniques to 2D transoesophageal echocardiography in the localization of mitral valve prolapse

2018 ◽  
Vol 34 (7) ◽  
pp. 1099-1107 ◽  
Author(s):  
Paola Gripari ◽  
Massimo Mapelli ◽  
Ilaria Bellacosa ◽  
Concetta Piazzese ◽  
Maria Milo ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Transthoracic Echocardiography ◽  
Mitral Valve Prolapse ◽  
Transoesophageal Echocardiography ◽  
Valve Repair

ECHOCARDIOGRAPHY PREDICTORS OF SUCCESSFUL MITRAL VALVE REPAIR IN DEGENERATIVE MITRAL VALVE REGURGITATION

2015 ◽  
pp. 77-82
Author(s):  
Ba Minh Du Le ◽  
Anh Vu Nguyen ◽  
Duc Phu Bui
Keyword(s):  
Mitral Valve ◽  
Transesophageal Echocardiography ◽  
Success Rate ◽  
Mitral Valve Repair ◽  
Transthoracic Echocardiography ◽  
Mitral Valve Prolapse ◽  
Posterior Leaflet ◽  
Valve Repair ◽  
Mitral Repair ◽  
Fibroelastic Deficiency

Background and aim of the study: Mitral repair is now as the treatement of choice in patients suffering mitral regurgitation due to mitral valve prolapse or flail. However, mitral valve repair demands the mitral valve morphology being feasible for repair. The study aims at evaluating transthoracic and transesophageal echocardiographic features in consecutive patients with mitral valve prolapse or flail undergoing surgical repair at Hue Central Hospital. The correlation between preoperative and intraoperative echocardiographic features and surgical findings in these patients. These echocardiographic data may predict the surgical outcome. Methods: From December 2010 to January 2013, 73 patients (37 men, 36 women; average age 37.5) were recruited into the study. All patients had degenerative mitral valve disease causing important regurgitation and underwent systematic preoperative transthoracic echocardiography, preoperative and intraoperative transesophageal echocardiography for delineation of six segments (scallops) of anterior and posterior leaflets. Results: Among 73 patients, 64 patients were in fibroelastic deficiency (87.7%) and 9 patients suffered Barlow disease (12.3%). Mitral valve repair was performed in 52 patients (71.2%) and mitral replacement was performed in 21 patients (28.8%). All 52 mitral valve repair (81.3%) and 12 mitral valve replacement (18.7%) was performed in fibroelastic deficiency patients. All 9 Barlow patients must undergo mitral valve replacement (100%). A prolapse or flail of mitral valve in 73 patients was documented by transthoracic and transesophageal echocardiography and confirmed on surgical inspection. Accuracy of transthoracic echocardiography was (89.0%) and accuracy of transesophageal echocardiography was (91.8%) in identifying mitral valve segments prolapse or flail. Success rate of mitral valve repair was (98.0%) in prolapse of 1 or 2 segments, but was low (36.0%) in prolapse > 3 segments. Success rate of mitral valve repair was (96.6%) in prolapse of posterior leaflet, but was (63.6%) in prolapse anterior leaflet or bileaflet. Conclusion: - Mitral valve repair was favorable in fibroelastic deficiency patients, but difficult in Barlow patients. - Accuracy of transthoracic and transesophageal echocardiography was high in identifying mitral valve segments prolapse or flail. - Success rate of mitral valve repair was high in prolapse of 1 or 2 segments. - Success rate of mitral valve repair was high in in prolapse of posterior leaflet. Key words: Mitral repair, echocardiography, degenerative, Barlow, fibroelastic deficiency, prolapse, flail

scholarly journals Preoperative determination of artificial chordae tendineae length by transoesophageal echocardiography in totally endoscopic mitral valve repair

2020 ◽  
Vol 31 (1) ◽  
pp. 20-27
Author(s):  
Antonios Pitsis ◽  
Nikolaos Tsotsolis ◽  
Efstratios Theofilogiannakos ◽  
Harisios Boudoulas ◽  
Konstantinos Dean Boudoulas
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Mitral Valve Prolapse ◽  
Transoesophageal Echocardiography ◽  
Stereoscopic Vision ◽  
Valve Repair ◽  
Chordae Tendineae ◽  
Artificial Chordae

Abstract OBJECTIVES Artificial chordae tendineae are widely used for surgical repair in patients with mitral regurgitation due to floppy mitral valve/mitral valve prolapse. Expanded polytetrafluoroethylene has been used to construct these artificial chordae; however, the determination of the optimal length of the chordae prior to surgery has been an issue. For this reason, such a method was developed and the results of its use are presented. METHODS Forty-seven consecutive patients with significant mitral regurgitation due to floppy mitral valve/mitral valve prolapse who underwent totally endoscopic mitral valve surgery were studied. The chordae length was predetermined using transoesophageal echocardiography. The length between the top of the fibrous body of the papillary muscle and the coaptation line of the 2 leaflets of the mitral valve was measured and used to define the length of the chordae to be used for repair. Then under stereoscopic vision, a total endoscopic mitral valve repair was performed. RESULTS The predicted mean length of chordal loops was 19.76 ± 0.71 mm (median 20, range 16–28) and the actual mean length of chordal loops used was 19.68 ± 0.74 mm (median 20, range 16–26) demonstrating an excellent correlation between the two (r = 0.959). The mean number of chordae loops used per patient was 5.12 ± 0.62 (median 4, range 2–12). All patients at the time of discharge had no or trivial mitral regurgitation on transoesophageal echocardiography. CONCLUSIONS The chordae length used for mitral valve repair can be determined prior to surgery using transoesophageal echocardiography with a high degree of accuracy. Further, total endoscopic repair in this group of patients provides excellent results. For these reasons, it is expected that this method will replace most traditional approaches to cardiac surgeries in the years to come.

P6489Preoperative determination of artificial chordae length by transesophageal echocardiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Pitsis ◽  
N Tsotsolis ◽  
E Theofilogiannakos ◽  
H Boudoulas ◽  
K Boudoulas
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Pearson Correlation ◽  
Transoesophageal Echocardiography ◽  
Valve Repair ◽  
Bottom Part ◽  
Artificial Chordae ◽  
The Mean

Abstract The use of artificial chordae is one of the main techniques used in mitral valve repair to treat prolapsing leaflets, especially in anterior and bileaflet prolapse. With the use of PTFE sutures to replace elongated or ruptured chords mitral valve repair rates have significantly improved. The main difficulty with this technique is to determine the optimal length of the artificial chordae. Intraoperative transoesophageal echocardiography (TOE) is mandatory in mitral valve repair in order to determine the type of lesion of the mitral valve but also to evaluate the quality of the repair. We examined the accuracy of preoperative prediction of artificial chordae length by the preoperativeTOE. Patients and methods Twenty-one consecutive patients (7 females) underwent mitral valve repair with artificial chordae for significant mitral valve prolapse in our department during the last year. The median age of the patients was 62 y. (range 25 - 87) and the mean EuroSCORE II 3,36% (SD 4,61%). During the prep TOE we determined the predicted length of the required replacement chordae for the repair using mainly the 4 chamber view to calculate the distance between the tip of the papillary muscle and the coaptation point of the two leaflets and we subtracted 5mm which is the minimum of the desired coaptation length (top right part of the Figure). All the patients underwent totally endoscopic mitral repair through a 3 cm right periareolar incision. 14,3% of the patients had anterior leaflet (AML) prolapse, 23,8% bileaflet and 61,9% posterior (PML). The appropriate length of the required chordae was measured intraoperatively. Results We used on average 3 loops of artificial chordae size 23,3 mm (SD 1,15mm) to treat the AML prolapse, 5 loops size 23,2 mm (SD 2,28mm) to treat the bileaflet prolapse and 2,23 loops size 18mm (SD 2mm) to treat the PML prolapse (bottom part of the figure). The predicted size of the artificial chordae had a positive correlation to the length used (Pearson correlation, p<0,001) as demonstrated in the top left part of the Figure. An annuloplasty band was implanted to all the patients. All the patients had no mitral regurgitation in the postoperative TOE. The mean valve area was 3,54cm2 (SD 0,57) and the mean peak gradient 5,6 mmHg (SD 1,82). There was no mortality. Chordae length predicted by echo Conclusion The length of artificial chordae can be predetermined with great accuracy with the use of TOE, making TOE an important tool not only for the determination of the mitral lesion and quality of the repair but also for the planning of the operation.

scholarly journals Very Long-Term Survival and Durability of Mitral Valve Repair for Mitral Valve Prolapse

Circulation ◽  
2001 ◽  
Vol 104 (suppl_1) ◽  
Author(s):  
Dania Mohty ◽  
Thomas A. Orszulak ◽  
Hartzell V. Schaff ◽  
Jean-Francois Avierinos ◽  
Jamil A. Tajik ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Mitral Valve Prolapse ◽  
Reoperation Rate ◽  
Surgical Correction ◽  
Valve Repair ◽  
Term Survival ◽  
Long Term Survival ◽  
Leaflet Prolapse

Background Mitral regurgitation (MR) due to mitral valve prolapse (MVP) is often treatable by surgical repair. However, the very long-term (>10-year) durability of repair in both anterior leaflet prolapse (AL-MVP) and posterior leaflet prolapse (PL-MVP) is unknown. Methods and Results In 917 patients (aged 65±13 years, 68% male), surgical correction of severe isolated MR due to MVP (679 repairs and 238 replacements [MVRs]) was performed between 1980 and 1995. Survival after repair was better than survival after MVR for both PL-MVP (at 15 years, 41±5% versus 31±6%, respectively; P =0.0003) and AL-MVP (at 14 years, 42±8% versus 31±5%, respectively; P =0.003). In multivariate analysis adjusting for predictors of survival, repair was independently associated with lower mortality in PL-MVP (adjusted risk ratio [RR] 0.61, 95% CI 0.44 to 0.85; P =0.0034) and in AL-MVP (adjusted RR 0.67, 95% CI 0.47 to 0.96; P =0.028). The reoperation rate was not different after repair or MVR overall (at 19 years, 20±5% for repair versus 23±5% for MVR; P =0.4) or separately in PL-MVP ( P =0.3) or AL-MVP ( P =0.3). However, the reoperation rate was higher after repair of AL-MVP than after repair of PL-MVP (at 15 years, 28±7% versus 11±3%, respectively; P =0.0006). From the 1980s to the 1990s, the RR of reoperation after repair of AL-MVP versus PL-MVP did not change (RR 2.5 versus 2.7, respectively; P =0.58), but the absolute rate of reoperation decreased similarly in PL-MVP and AL-MVP (at 10 years, from 10±3% to 5±2% and from 24±6% to 10±2%, respectively; P =0.04). Conclusions In severe MR due to MVP, mitral valve repair compared with MVR provides improved very long-term survival after surgery for both AL-MVP and PL-MVP. Reoperation is similarly required after repair or replacement but is more frequent after repair of AL-MVP. Recent improvement in long-term durability of repair suggests that it should be the preferred mode of surgical correction of MVP whether it affects anterior or posterior leaflets and is an additional incentive for early surgery of severe MR due to MVP.

Effect of mitral valve repair for mitral valve prolapse on regression of left ventricular mass

1992 ◽  
Vol 70 (13) ◽  
pp. 1216-1217 ◽  
Author(s):  
Marc D. Tischler ◽  
Kyle A. Cooper ◽  
Robert W. Battle ◽  
Bruce J. Leavitt
Keyword(s):  
Mitral Valve ◽  
Left Ventricular Mass ◽  
Mitral Valve Repair ◽  
Mitral Valve Prolapse ◽  
Left Ventricular ◽  
Valve Repair ◽  
Ventricular Mass

Post-repair coaptation length and durability of mitral valve repair for posterior mitral valve prolapse

2013 ◽  
Vol 62 (4) ◽  
pp. 221-227 ◽  
Author(s):  
Tomoya Uchimuro ◽  
Minoru Tabata ◽  
Kiyomi Saito ◽  
Kentaro Shibayama ◽  
Hiroyuki Watanabe ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Mitral Valve Prolapse ◽  
Valve Repair

Mitral-Valve Repair for Mitral-Valve Prolapse

2009 ◽  
Vol 361 (23) ◽  
pp. 2261-2269 ◽  
Author(s):  
Subodh Verma ◽  
Thierry G. Mesana
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Mitral Valve Prolapse ◽  
Valve Repair

The Percutaneous Mitral Valve Repair Procedure – The Role of Echocardiographic Guidance

2011 ◽  
Vol 7 (3) ◽  
pp. 177 ◽  
Author(s):  
Martin Swaans ◽  
Ben van den Branden ◽  
Marco Post ◽  
Jan van der Heyden ◽  
◽  
...  
Keyword(s):  
Mitral Valve ◽  
Real Time ◽  
Mitral Valve Repair ◽  
Three Dimensional ◽  
Transoesophageal Echocardiography ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair ◽  
Repair Procedure ◽  
Additional Value

Percutaneous mitral valve repair is a sophisticated procedure which requires a unique collaboration between the interventionalist and echocardiographer since it is mainly driven by real-time transoesophageal echocardiography (TEE). Fluoroscopy plays a lesser role. We will review the role of echocardiography during the different procedural steps and the additional value of three-dimensional (3D TEE).

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