scholarly journals Surgical considerations for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism

2021 ◽  
Author(s):  
Toshihiko Shibata ◽  
Yosuke Takahashi ◽  
Hiromichi Fujii ◽  
Akimasa Morisaki ◽  
Yukio Abe
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Chronic Atrial Fibrillation ◽  
Mitral Annulus ◽  
Valve Disease ◽  
Functional Mitral Regurgitation ◽  
Functional Tricuspid Regurgitation ◽  
Giant Left Atrium ◽  
Artificial Chordae ◽  
The Right

AbstractAtrial functional mitral regurgitation is a hot research topic in the field of mitral valve disease. Atrial functional mitral regurgitation is distinctly different from ventricular functional mitral regurgitation. The surgical indications for atrial functional mitral regurgitation have not been well established because of the small amount of evidence gathered to date. Mitral annular plication with an artificial ring is an essential surgical procedure because dilatation of the mitral valve annulus is a main factor underlying this pathology. Most of these cases can be treated by mitral annuloplasty alone. However, additional procedures, such as application of artificial chordae to the anterior leaflet for pseudo-prolapse, and posterior leaflet augmentation with a pericardial patch, are required in advanced cases with a giant left atrium and extremely enlarged mitral annulus. Chronic atrial fibrillation causes enlargement of the right and left atria. This pathology is a bilateral atrioventricular valve disease (dual-valve disease). Therefore, the conventional guidelines of single-valve disease should not be applied. Although atrial functional tricuspid regurgitation is underappreciated, tricuspid annuloplasty should be considered for most patients to prevent future regurgitation. In addition to the mitral and tricuspid valve procedure, integrated surgical management, including plication of the atrium and left appendage closure, is required. This review summarizes the current considerations of surgical treatment for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism.

scholarly journals Mitral annulus dynamics in myxomatous mitral valve disease

2021 ◽  
Vol 31 (1) ◽  
pp. 66-75
Author(s):  
Maria-Magdalena Gurzun ◽  
Monica Rosca ◽  
Andreea Calin ◽  
Carmen Beladan ◽  
Marinela Serban ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Mitral Valve Disease ◽  
Current Trend ◽  
Mitral Annulus ◽  
Valve Disease ◽  
Valve Repair ◽  
Functional Changes ◽  
Different Types

Myxomatous mitral valve disease (MVD) is a common disorder in which the entire mitral valve apparatus seems to be involved. Mitral valve repair is nowadays the method of choice for the correction of mitral regurgitation but the optimal shape and flexibility of the annuloplasty ring remain controversial. Considering that myxomatous MVD covers a wide spectrum from limited fi bro-elastic deficiency to extensive Barlow disease, we presume that the mitral annulus morphological and functional changes are likely different in different types of myxomatous MVD. We analyze the 3-dimensional geometry and the dynamics of the mitral annulus in 110 patients with significant mitral regurgitation due to different types of myxomatous mitral valve disease and 40 normal subjects using 3D transesophageal echocardiography. The mitral annulus differs in patients with limited MVD, extensive MVD and in normal controls in terms of size, shape, and dynamics. Patients with limited MVD have larger, flatter, dysfunctional and more mobile mitral annulus compared to normal, while patients with extensive MVD have even larger, fl atter and more dysfunctional mitral annulus, with reduced mobility. The non-planar dynamics has different patterns during systole, according to the extension of MV disease. Our data may be important for the appropriate choose of annuloplasty mitral annulus in mitral valve repair, the current trend being to choose the ring according to the underlying pathology.

scholarly journals Future Technology

2018 ◽  
Vol 23 (1) ◽  
pp. 123-133 ◽  
Author(s):  
Kelly Kohorst ◽  
Mias Pretorius
Keyword(s):  
Clinical Trials ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Minimally Invasive ◽  
Mitral Valve Disease ◽  
Open Heart Surgery ◽  
Mitral Annulus ◽  
Valve Disease ◽  
Mitral Valves ◽  
Transcatheter Mitral Valve Replacement

Mitral regurgitation is the most common valvular disease and significant (moderate/severe) mitral regurgitation is found in 2.3% of the population older than 65 years. New transcatheter minimally invasive technologies are being developed to address mitral valve disease in patients deemed too high a risk for conventional open-heart surgery. There are several features of the mitral valve (saddle-shaped noncalcified annulus with irregular leaflet geometry) that make a transcatheter approach to repair or replacing the valve more challenging compared with the aortic valve. Several devices are under investigation for transcatheter mitral valve replacement, and also for mitral valve repair targeting the mitral valve leaflets, chordae tendinae, and mitral annulus. The MitraClip device is the only Food and Drug Administration–approved device to treat mitral regurgitation by targeting the mitral leaflets. There are eight minimally invasive devices being studied in humans that target the mitral annulus, and at least two devices being studied in animal models. There are 5 devices in clinical trials for minimally invasive approaches targeting the chordae tendinae. More than 10 different transcatheter mitral valves are in various stages of development and clinical trials. These transcatheter mitral valves can be delivered either through a transseptal, transapical, transaortic, or left atriotomy approach. It seems likely that transcatheter treatment approaches to mitral valve disease will become more common, at least in the sick and elderly patient population.

Mitral Valve Surgery

2019 ◽  
pp. 30-40
Author(s):  
Sohail K. Mahboobi
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Disease Process ◽  
Mitral Annulus ◽  
Developed Countries ◽  
Pathological Process ◽  
Mitral Valve Surgery ◽  
Functional Mitral Regurgitation ◽  
Chordae Tendineae ◽  
Mitral Disease

The mitral valve consists of the mitral annulus, anterior and posterior mitral leaflets, anterolateral and posteromedial papillary muscles attached to mitral leaflets with chordae tendineae, and the left ventricle. Any condition or pathological process involving one or more of these components will affect proper functioning of the valve. A degenerative mitral valve disease process is commonly followed by functional mitral regurgitation. Rheumatic heart disease involving the mitral valve is not common in developed countries but is the most common cause of mitral disease in developing countries. A surgical procedure involving the mitral valve requires a thorough understanding of the physiology of a normally functioning valve as well as the mechanism of pathological processes affecting the valve. Mitral regurgitation is more common than mitral stenosis, and mitral valve repair is a preferable technique over replacement of the valve due to less chance of endocarditis, no thrombolytic therapy requirement, and maintenance of normal physiology of the valve. Anesthesiologists providing care for these patients in the operating room play a pivotal role in successful mitral valve procedures by determining the primary mechanism of the pathology, recommending if the valve is repairable, and evaluating the success of the surgical intervention.

P6491Predictive effect of mitral annular size on persistent mitral valve dysfunction after transcatheter edge-to-edge mitral valve repair for functional mitral regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kitamura ◽  
T Schmidt ◽  
D Schewel ◽  
H Alessandrini ◽  
K.-H Kuck ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
The Other ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Ventricular Ejection Fraction ◽  
The Mean ◽  
Predictive Effect

Abstract Background In patients with functional mitral regurgitation (FMR), deformation of the mitral valve (MV) apparatus leads to deteriorating coaptation of both leaflets. The MV geometry is essential to predict procedural success of using the MitraClip™ for FMR patients. Persistent such mitral regurgitation (MR) and post-procedural mitral stenosis (MS) are parameters for an increasing mortality rate after MitraClip implantation. The anterior-to-posterior mitral annulus diameter (MAD) is simple to evaluate with a high reproducibility rate. However, the predictive effect has not been determined to date. Purpose We evaluated the predictive effect of baseline anterior-to-posterior MAD on persistent MV dysfunctions after MitraClip™ implantation. Methods We investigated the prevalence of procedural failure (MR at discharge > grade 2+) and post-procedural MS (mean transmitral gradient (mTMG) at discharge ≥6 mmHg) in a patient cohort with FMR (n=190), who underwent MitraClip™ implantation. We measured the MV apparatus geometry on mid-systole using transoesophageal echocardiography before the index procedure. The MAD was stratified by interquartile ranges (IQR) in the comparison. (≤34 mm, 35 to 37 mm, 38 to 40 mm, and ≥41 mm, respectively) Results The mean age was 75±9 years, and 63 patients (33%) were female. The mean left ventricular ejection fraction was 34±14%. Moderate-to-severe (3+) or severe MR (4+) were documented in all patients before the procedure. Transthoracic echocardiography at discharge revealed residual MR (>2+) in 10 patients (5%) and post-procedural MS in 13 patients (7%), in which one patient presented with both residual MR and MS. After stratification by the IQRs of MAD, there were significant differences in body weight (p<0.001), height (p<0.001), and body surface area (p<0.001), but no significant differences in the other baseline characteristics. Notably, significant differences in the prevalence of procedural failure (p=0.004) and post-procedural MS (p=0.022) were observed among the groups. (Figure) Specifically, in the cohort with the 4th IQR (MAD ≥41 mm, n=44), procedural failure was observed in 7 patients (16%), although the prevalence was only 2% in the other IQR groups. Moreover, the cohorts with the 1st and 2nd IQR presented with higher prevalence of post-procedural MS (6 of 46 patients (13%) in the 1st IQR group, and 6 of 51 (12%) in the 2nd IQR group) than those with the 3rd and 4th IQRs. (1 of 49 patients (2%) in the 3rd IQR, and none of 44 patients in the 4th IQR) Figure 1 Conclusion In this analysis we showed that the mitral annulus size affected MV dysfunction after MitraClip™. Anterior-to-posterior MAD was useful to predict the procedural result. For FMR candidates with dilated mitral annulus larger than 40 mm, new-generation MitraClip-XTR™ system or other therapeutic concept such as annuloplasty may be reasonable to obtain satisfactory MV function.

scholarly journals Giant left atrium in undersized mitral ring annuloplasty

2016 ◽  
Vol 86 (1-2) ◽  
Author(s):  
Nicole Bertin ◽  
Aniello Pappalardo ◽  
Alessandro Minati ◽  
Gabriella Forti ◽  
Serena Favretto ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Left Atrium ◽  
Mitral Valve Disease ◽  
Volume Overload ◽  
Valve Disease ◽  
Severe Mitral Regurgitation ◽  
Unique Case ◽  
Ring Annuloplasty ◽  
Giant Left Atrium

<p>Enlargement of left atrium occurs in patients with longstanding mitral valve disease due to chronic pressure and volume overload and occasionally left atrium reaches a massive enlargement, condition known as giant left atrium. It is most commonly associated with rheumatic mitral valve disease, both stenosis and regurgitation. This unique case deals with a 70-year-old woman who developed a giant left atrium due to a severe mitral regurgitation from complete prolapse of both mitral leaflets, as a consequence of previous undersized mitral ring annuloplasty. </p>

scholarly journals P1710 Reverse right ventricular remodeling using right ventricular strain and strain rate after mitral clip implantation in functional mitral regurgitation, an echocardiographic study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H Abdo Naeim ◽  
O Amoudi ◽  
I H Alharbi ◽  
ABEER Mahmood ◽  
A Elasfar ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Right Ventricular ◽  
Strain Rate ◽  
Functional Mitral Regurgitation ◽  
Reverse Remodeling ◽  
Systolic Pulmonary Artery Pressure ◽  
Strain And Strain Rate ◽  
The Right

Abstract Funding Acknowledgements none OnBehalf none Background Chronic mitral regurgitation (MR) leads to right ventricular dysfunction because of volume and pressure overload over a long time. Mitral valve repair with a mitral clip will reduce the (MR) but how much its effect on the right ventricle. Aim The aim of the present study is to assess the impact of Mitral Valve Clipping on right ventricular (RV) remodeling (RV strain and strain rate) at med term after Mitral Clip implantation in high-risk surgical patients with severe functional mitral regurgitation (MR). Methods Study population included 62 patients with severe functional MR. All the patients underwent full echocardiographic evaluation before MV clip, and at 12-month follow-up. RV systolic function was assessed using tissue Doppler and TAPSE. Using Tom-Tec software the RV endocardium is traced in the apical 4 chamber view to get the RV strain and strain rate. RV after load was evaluated using systolic pulmonary artery pressure. Results In our cohort, 62 patients had percutaneous mitral valve clip and completed at least 12 months of follow-up. The average age was 60.56 years, 24.19 were females, 50% were diabetic, 46.77 were hypertensive, 12.90 had ESRD and 11.29 % had anemia. Coronary artery disease (CAD) was present in 59.41 %, prior CABG in 11.67% and prior PCI in 35.48%. All parameters value was compared pre MV clip and 12 ± 4.6 months after MV clip. The RV longitudinal strain was -12.4 ± 2.6% and improved to -14.6 ± 3.1% (P 0.005) (Figure A and B). The RV strain rate was -1.1 ± 0.41 and improved to -1.3 ± 0.57 (P 0.004) (Figure C and D). The tricuspid annulus plane systolic excursion (TAPSE) was 1.76 ±0.57 mm, and improved to 1.82 ±0.63 mm (P 0.4). The systolic velocity at the tricuspid annulus was 9.50 ±2.33cm/sec and improved to 9.64 ±2.72 cm/sec (P 0.269). The systolic pulmonary artery pressure (SPAP) was 50.49 ±13.92 and improved to 42.33 (P 0.036). Conclusion Mitral Clip implantation induces a significant reverse remodeling of RV. It produces significant improvement in the hemodynamics of the right side indicated by the significant reduction in SPAP and a significant increase in longitudinal RV strain and strain rate. Those changes could be a direct reflection of the concomitant reduction in LV filling pressure produced by the significant reverse remodeling of the LV caused by Mitral Clipping. Abstract P1710 Figure.

Minimally Invasive Mitral Valve Annuloplasty with Realignment of Both Papillary Muscles for Correction of Type IIIb Functional Mitral Regurgitation

2017 ◽  
Vol 12 (5) ◽  
pp. 329-332 ◽  
Author(s):  
Evaldas Girdauskas ◽  
Lenard Conradi ◽  
Eva Karolina Harmel ◽  
Hermann Reichenspurner
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Minimally Invasive ◽  
Papillary Muscle ◽  
Mitral Annulus ◽  
Functional Mitral Regurgitation ◽  
High Recurrence Rate ◽  
Papillary Muscles ◽  
Type Iiib

Objective Pathophysiological background of type IIIb functional mitral regurgitation (FMR) is a progressively increasing distance between papillary muscle tips and mitral annular plane. Standard surgical treatment of such FMR by means of undersized mitral annuloplasty is associated with a high recurrence rate. Methods We propose a modified subannular maneuver to correct type IIIb FMR while combining undersized annuloplasty with a controlled realignment of both papillary muscles, thereby fixing the distance between mitral annular plane and papillary muscle tips. The differences of this subannular maneuver as compared with the previously published techniques are the following: (1) controlled realignment of both papillary muscles, (2) fixation of the papillary muscles to mitral annulus distance on an annuloplasty ring, and (3) application in a three-dimensional endoscopic minithoracotomy setting. Results We describe a surgical technique of minimally invasive mitral valve repair performed due to severe type IIIb FMR, which includes a modified subannular maneuver to realign both papillary muscles. Preliminary results of the first 10 patients who underwent this procedure at our institution are presented. There was no in-hospital mortality and follow-up echocardiography (mean ± SD echocardiographic follow-up = 10 ± 6 months) demonstrated stable functional results. Conclusions Our initial experience indicates that adding of this subannular maneuver to the standard annuloplasty and thereby fixing the distance between papillary muscles and mitral annular plane have a potential to improve results of surgical FMR treatment.

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