Should pre-operative left atrial volume receive more consideration in patients with degenerative mitral valve disease undergoing mitral valve surgery?

2017 ◽  
Vol 227 ◽  
pp. 106-113 ◽  
Author(s):  
Giuseppe Di Gioia ◽  
Simona Mega ◽  
Antonio Nenna ◽  
Cosimo Marco Campanale ◽  
Iginio Colaiori ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Disease ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Disease ◽  
Atrial Volume

scholarly journals Variation of Left Atrial Function in Different Stages of Mitral Regurgitation and Its Association With Guidelines-Based Surgical Indication

2020 ◽  
Vol 23 (6) ◽  
pp. E746-E751
Author(s):  
Fengming Bai ◽  
Lingfei Cun ◽  
Bo Li
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Atrial Function ◽  
Left Atrial Function ◽  
Atrial Volume ◽  
Current Guidelines

Purpose: The current guidelines associate indications for surgery in mitral regurgitation (MR) with left ventricle size and function. However, there is not enough emphasis in current guidelines on left atrial function, which is thought to be an important factor predicting adverse outcomes in MR. The aim of this study was to investigate the left atrial function at different stages of mitral regurgitation and its value in predicting the indications of mitral valve surgery. Methods: This was a retrospective study with 163 consecutive chronic primary MR patients who underwent color doppler echocardiography at the Guangxi Zhuang Autonomous Region Second People's Hospital between January 2016 and June 2018. All patients were in sinus rhythm, classified into three groups, according the degree of mitral regurgitation. Comparison was made with 30 control patients. Using Simpson’s methods, we recorded maximal left atrial volume, left atrial volume before active contraction and minimal left atrial volume, from which left atrial expansion index, left atrial passive emptying fraction, left atrial active emptying fraction, and the total left atrial emptying fraction were derived. Results: Left atrial volume was expanded and left atrial emptying fraction was reduced in the mitral regurgitation group. By multivariate analysis, left atrial passive emptying fraction and left atrial active emptying fraction were independent predictors of mitral regurgitation requiring surgery. Using receiver-operating characteristic analysis, left atrial passive emptying fraction <97.4% demonstrated 98% sensitivity and 67% specificity for predicting the presence of surgical indication (area under the curve: 0.91; P < .001). Conclusion: During mitral regurgitation, left atrial volume increases and functions decrease. The left atrial passive emptying fraction can be used as an additional tool to predict the indications of mitral valve surgery.

scholarly journals Mitral prolapsing volume is associated with increased cardiac dimensions in patients with mitral annular disjunction

2021 ◽  
Author(s):  
P. Luyten ◽  
S. Heuts ◽  
E. Cheriex ◽  
J. R. Olsthoorn ◽  
H. J. G. M. Crijns ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Disease ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Valve Disease ◽  
Control Group ◽  
Additional Parameter ◽  
Atrial Volume ◽  
Volume Shift

Abstract Introduction In patients with mitral annular disjunction (MAD), it can be difficult to assess the severity of mitral regurgitation (MR), as they present with a prolapsing volume (i.e. volume resulting from mitral valve prolapse, blood volume shift) rather than a regurgitant jet. The influence of the mitral prolapsing volume (MPV) on cardiac dimensions is unknown. We hypothesised that the severity of MR is underestimated in these patients. Our aim was to measure MPV and to investigate its influence on cardiac dimensions in patients with MAD. Methods We retrospectively included 131 consecutive patients with MAD from our institution’s echocardiographic database. Transthoracic echocardiography was used to assess MPV. Additionally, we established a control group of 617 consecutive patients with degenerative mitral valve disease and performed propensity score matching. Results Median MPV in the MAD group was 12 ml. MPV was an independent predictor for left ventricular end-diastolic (LVEDD) and end-systolic diameter (LVESD) and left atrial volume (all p < 0.001). In patients with large prolapsing volumes (> 15 ml), LVEDD (56 ± 6 mm vs 51 ± 6 mm, p < 0.001), LVESD [38 mm (34–41) vs 34 mm (31–39), p < 0.01] and left atrial volume [105 ml (86–159) vs 101 ml (66–123), p = 0.04] were significantly increased compared to matched patients with degenerative mitral valve disease and similarly assessed severity of MR. Conclusion Due to a volume shift based on the MPV rather than an actual regurgitant jet, MR severity cannot be assessed adequately in MAD patients. Increased MPV induces ventricular and atrial enlargement. These findings warrant future studies to focus on MPV as an additional parameter for assessment of the severity of MR in MAD patients.

scholarly journals A study to assess the impact of left atrial size reduction in outcome of the patients undergoing mitral valve surgery for mitral valve disease with left atrial enlargement in a tertiary care hospital

2021 ◽  
Vol 8 (2) ◽  
pp. 536
Author(s):  
Raghavendra K. H. ◽  
Chandra A.
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Disease ◽  
Left Atrial ◽  
Mitral Valve Surgery ◽  
Functional Class ◽  
Valve Surgery ◽  
Valve Disease ◽  
Left Atrial Size ◽  
Atrial Size ◽  
The Impact

Background: Rheumatic mitral valve disease (mitral stenosis or regurgitation) remains the common heart disease in developing countries. Mitral valve is involved in 99% of cases. The prognostic implication of LA (left atrium) size has also been shown in high-risk subgroups, such as patients with acute myocardial infarction, atrial arrhythmia, LV dysfunction, or dilated cardiomyopathy, and patients undergoing valve replacement for aortic stenosis and mitral regurgitations. Objective of the study was to study the impact of left atrial size reduction in patients undergoing mitral valve surgery for mitral valve disease with left atrial enlargement on clinical outcome and echocardiographic parameters.Methods: A prospective study was done at department of cardiovascular and thoracic surgery, Sri Venkateshwara institute of medical sciences, Tirupati from June 2012 and June 2013.The study population consisted of patients with rheumatic mitral valve disease with or without tricuspid valve disease with left atrial size enlargement who underwent mitral valve surgery alone and mitral valve surgery with left atrial reduction. Twenty consecutive subjects were taken in each group during the study period. Results: The age range is 21 to 61 years. There means age is 39.7±10.3 years. in the study group. Following MVR significant improvement in the NYHA (New York Heart Association) functional class was noted in all the patients. The decrease in RVSP, LA size, and TR was noted in all the patients.Conclusions: It seems reasonable to suggest that patients who undergo LA reduction along with MVR have significant improvement in clinical outcome and NYHA functional class with less thromboembolic complications during long term follow up.

scholarly journals Totally endoscopic mitral valve surgery: early experience in 188 patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yi Chen ◽  
Ling-chen Huang ◽  
Dao-zhong Chen ◽  
Liang-wan Chen ◽  
Zi-he Zheng ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Disease ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Disease ◽  
Endoscopic Technique ◽  
Venous Cannula ◽  
Defect Repair

Abstract Introduction Totally endoscopic technique has been widely used in cardiac surgery, and minimally invasive totally endoscopic mitral valve surgery has been developed as an alternative to median sternotomy for many patients with mitral valve disease. In this study, we describe our experience about a modified minimally invasive totally endoscopic mitral valve surgery and reported the preliminary results of totally endoscopic mitral valve surgery. The aim of this retrospective study is to evaluate the results of totally endoscopic technique in mitral valve surgery. Material and methods We retrospectively reviewed the profiles of 188 patients who were treated for mitral valve disease by modified totally endoscopic mitral valve surgery at our institution between January 2019 and December 2020. The procedure was performed under endoscopic right minithoracotomy and with femoro-femoral cannulation using the single two-stage venous cannula. Results A total of 188 patients underwent total endoscopic mitral valve surgery. Fifty-six patients had concomitant tricuspid valvuloplasty, 11 patients underwent concomitant ablation of atrial fibrillation and atrial septal defect repair was performed in three patients. Only one patient postoperatively died of multi-organ failure. Two patients were converted to median sternotomy. Except for one patient underwent operation to stop the bleeding from the incision site, no other serious complications nor reintervention occurred during the follow-up period. Conclusions The modified totally endoscopic mitral valve surgery performed at our institution is technically feasible and safe with the same efficacy as reported studies.

Surgical Management of Mitral Valve Disease

2015 ◽  
pp. 713-727
Author(s):  
Robin Varghese
Keyword(s):  
Mitral Valve ◽  
Surgical Management ◽  
Mitral Valve Disease ◽  
Surgical Techniques ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Disease ◽  
Mitral Valve Stenosis ◽  
Complications Of Surgery ◽  
Future Direction

Surgery for the mitral valve has increased over the last decade, with a focus on an increasing number of valve repairs for degenerative mitral valve disease. This chapter discusses the surgical management of mitral valve disease with a focus on the pathology of mitral valve stenosis and regurgitation. With an examination into the pathophysiology of the lesions. Subsequently a discussion regarding the various surgical techniques for mitral valve surgery followed by the major and minor complications of surgery are reviewed to provide the Intensivist with an overview of possible complications. Finally a look at the future direction of the field is briefly examined.

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