scholarly journals Prognostic Value of Late Gadolinium Enhancement in Postoperative Morbidity following Mitral Valve Surgery in Rheumatic Mitral Stenosis

2019 ◽  
Vol 28 (04) ◽  
pp. 237-244
Author(s):  
Teuku Muhammad Haykal Putra ◽  
Renan Sukmawan ◽  
Elen Elen ◽  
Celly A. Atmadikoesoemah ◽  
Dwita Rian Desandri ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Late Gadolinium Enhancement ◽  
Mitral Valve ◽  
Myocardial Fibrosis ◽  
Mitral Stenosis ◽  
Postoperative Morbidity ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Gadolinium Enhancement ◽  
Rheumatic Mitral Stenosis

Myocardial fibrosis in rheumatic mitral stenosis (MS) is caused by chronic inflammatory process. Its occurrence may lead to hemodynamic problems, especially after cardiac surgery. Myocardial fibrosis predicts worse morbidity after cardiac surgery, notably in coronary heart disease and aortic valve abnormalities. However, this issue has not been explored yet among patients with rheumatic MS.The aim of the study was to investigate prognostic impact of myocardial fibrosis to postoperative morbidity after mitral valve surgery in patients with rheumatic MS.This is a prospectively enrolled observational study of 47 consecutive rheumatic MS patients. All patients had preoperative evaluation with cardiac magnetic resonance imaging (CMR) including late gadolinium enhancement (LGE) protocol for left ventricular myocardial fibrosis assessment prior to mitral valve surgery. All patients were followed during hospitalization period. Postoperative morbidities were defined as stroke, renal failure, and prolonged mechanical ventilation.This study involved 33 women (70.2%) and 14 men (29.8%) with a mean age of 46 ± 10 years. Preoperative myocardial fibrosis was identified in 43 patients (91.5%). Estimated fibrosis volume ranged from 0% to 12.8% (median 2.8%). Postoperative morbidities occurred in 11 patients (23.4%). Significant mean difference of myocardial fibrosis volume was observed between patients with and without morbidity after mitral valve surgery (5.97 ± 4.16% and 3.12 ± 2.62%, p = 0.04). This significant association was allegedly influenced by different postoperative hemodynamic changes between the two groups.More extensive myocardial fibrosis is associated with postoperative morbiditiy after mitral valve surgery in patients with rheumatic MS.

scholarly journals Left Ventricular Dimension after Mitral Valve Surgery in Rheumatic Mitral Stenosis: the Impact of Myocardial Fibrosis

2020 ◽  
Author(s):  
Teuku Muhammad Haykal Putra ◽  
Renan Sukmawan ◽  
Dwita Rian Desandri ◽  
Celly A. Atmadikoesoemah ◽  
Elen Elen ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Myocardial Fibrosis ◽  
Mitral Stenosis ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
P Value ◽  
Rheumatic Mitral Stenosis ◽  
Dimensional Parameters ◽  
The Impact

Background: Patients with rheumatic mitral stenosis (MS) experience changes in left ventricular (LV) dimensions after mitral valve surgery. We sought to investigate changes in LV dimensional parameters after mitral valve surgery and find out whether the same changes occurred in different extents of myocardial fibrosis. Methods: This prospective observational study comprised 43 patients with rheumatic MS planned for mitral valve surgery between October 2017 and April 2018 in National Cardiovascular Center Harapan Kita (NCCHK) Jakarta. All the patients underwent cardiac magnetic resonance imaging based on the late gadolinium enhancement (LGE) protocol for myocardial fibrosis assessment prior to surgery. The patients were classified according to the estimated fibrosis volume considered to influence hemodynamic performance (myocardial fibrosis <5% and myocardial fibrosis ≥5%). Serial transthoracic echocardiographic examinations before and after surgery were performed to detect changes in LV dimensional parameters. Results: This study consisted of 31 (72.1%) women and 12 (27.9%) men at a mean age of 46±9 years. The LGE protocol revealed myocardial fibrosis of less than 5% in 32 (74.4%) patients. A significant increase was detected in the LV end-diastolic diameter postoperatively, specifically in the patients with myocardial fibrosis of less than 5% (44.0±4.8 mm vs 46.6±5.6 mm; P value=0.027). A similar significant increase was not found in the other group (45.0±6.6 mm vs 46.7±6.9 mm; P value=0.256). Other changes in echocardiographic parameters showed similar patterns in both groups. Conclusion: Our patients with rheumatic MS who had myocardial fibrosis of less than 5% demonstrated better improvements in terms of increased preload. Myocardial fibrosis of less than 5% is associated with more favorable improvements in LV geometry.

scholarly journals Atrial fibrillation and early clinical outcomes after mitral valve surgery in patients with rheumatic vs. non-rheumatic mitral stenosis

Heart Views ◽  
2012 ◽  
Vol 13 (4) ◽  
pp. 136 ◽  
Author(s):  
SJ Mirhosseini ◽  
Sadegh Ali-Hassan-Sayegh ◽  
Mehdi Hadadzadeh ◽  
S. M. Y Mostafavi Pour Manshadi ◽  
Nafiseh Naderi
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Clinical Outcomes ◽  
Mitral Stenosis ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Rheumatic Mitral Stenosis ◽  
Early Clinical Outcomes

scholarly journals Improvement of exercise capacity after early phase II cardiac rehabilitation in patients who undergo rheumatic mitral valve surgery

2020 ◽  
Author(s):  
Ade Meidian Ambari ◽  
Budhi Setianto ◽  
Anwar Santoso ◽  
Basuni Radi ◽  
Bambang Dwiputra ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Cardiac Rehabilitation ◽  
Exercise Capacity ◽  
Phase Ii ◽  
Mitral Stenosis ◽  
Early Phase ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Rheumatic Mitral Stenosis ◽  
Rheumatic Heart

Background: Rheumatic heart disease still become a major concern in developing countries. Recent studies showed the benefits of early phase II cardiac rehabilitation (CR) on improving the exercise capacity but the evidence in patients after rheumatic mitral valve surgery due to rheumatic heart disease is limited. This study aims to investigate the effects of early phase II CR program on increasing exercise capacity in the rheumatic mitral valve surgery patients. Methods: This is a cohort retrospective study. A review of medical records identified 254 patients who underwent early phase II CR after rheumatic mitral valve  surgery between July 2009 – June 2019. Effects of CR was assessed by 6 Minutes Walking Distance (6MWD) pre and post early phase II CR and peak oxygen uptake (VO2 peak) calculated by Cahallin formula. In this study, we observed and analyzed the increasing of 6MWD and VO2 peak. Results: Our findings showed that 6MWD and VO2 peak increased significantly in these patients after early phase II CR program (p = 0.001). Mean of 6MWD increased from 316.3 ± 71.7 meters to 378.6 ± 60.3 meters and VO2 peak increased from 7.7 ±2.4 mL/kg/min to 8.9 ± 2.2 mL/kg/min. The mean difference of 6MWD was 62.3 meters and VO2 peak was 1.2 mL/kg/min. There was a strong correlation between VO2 peak and 6MWD (r = 71%; R2 = 51%; p = 0.001). Conclusion: Early phase II CR in patients with Rheumatic Mitral Stenosis after mitral valve surgery improved the exercise capacity. Based on 6MWD, we can predict the value of VO2 peak patients with rheumatic mitral stenosis surgery patients.   Keywords: Cardiac rehabilitation, rheumatic mitral stenosis, 6MWD, VO2 peak

scholarly journals Robotics in cardiac surgery

2018 ◽  
Vol 100 (Supplement 7) ◽  
pp. 22-33 ◽  
Author(s):  
AH Sepehripour ◽  
G Garas ◽  
T Athanasiou ◽  
R Casula
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Mitral Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Coronary Artery Revascularisation

A summary of its uses in mitral valve surgery and coronary artery revascularisation

Abstract 14956: Improved Operative Efficiency for Minimally Invasive Mitral Valve Surgery at a Low-volume Center

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Monica Fowler ◽  
Jeffrey B MacLeod ◽  
christie aguiar ◽  
Alexandra M Yip ◽  
zlatko pozeg ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
High Volume ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Entire Study ◽  
Invasive Approach ◽  
Low Volume ◽  
Skin To Skin

Introduction: When implementing a minimally invasive cardiac surgery program, increased surgical times may serve as a deterrent. Results demonstrating parity in operative times between minimally invasive (MIMVR) and conventional mitral valve replacement/repair (CMVR) have been limited to high-volume centers. The purpose of this study was to examine operative efficiency for MIMVR in a low-volume center. Methods: All patients having undergone non-emergent, isolated MIMVR or CMVR at the New Brunswick Heart Centre from 2011-2017 were considered. Detailed peri-operative data, including cross clamp (XC), cardiopulmonary bypass (CPB), skin-to-skin (SS) and total operative (TO) times, were collected. Patients were assigned to one of 3 eras: 2011-2013, 2014-2015, 2016-2017. Unadjusted comparisons were made between MIMVR and CMVR over the entire study period and within each era. Results: A total of 168 patients were included (MIMVR: 64; CMVR: 104). There was an increase in the number of MIMVR cases over time (2011-2013: 19; 2014-2015: 17; 2016-2017: 28). Patients undergoing MIMVR were less likely to be ≥70years (29.7% vs. 47.1%, p=0.04) and to have had NYHA-IV symptoms (17.2% vs. 41.3%, p=0.002), previous cardiac surgery (4.7% vs. 23.1%, p=0.003) or urgent presentation (12.5% vs. 35.6%, p=0.002). Intra-operatively, MIMVR patients were more likely to have undergone a mitral valve repair (65.1% vs. 29.1%, p<0.0001). No differences were noted in rates of in-hospital mortality (0.0% vs. 5.1%, p=0.29). Median operative times were uniformly longer among MIMVR patients between 2011-2013. However, in 2014-2015 and 2016-2017, these times improved to the point where no significant differences in operative efficiency were noted (Figure). Conclusions: Improved operative efficiency may be safely achieved for MIMVR in a low-volume center. The results of this study should encourage low-volume centers to adopt a minimally invasive approach to isolated mitral valve surgery.

scholarly journals Dexmedetomidine Improves Lung Function by Promoting Inflammation Resolution in Patients Undergoing Totally Thoracoscopic Cardiac Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Junji Cui ◽  
Mintai Gao ◽  
Hongqian Huang ◽  
Xiaoyan Huang ◽  
Qingshi Zeng
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Pulmonary Function ◽  
Inflammatory Cytokines ◽  
Chest Radiography ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Arterial Blood ◽  
Extubation Time ◽  
Thoracoscopic Technique

Objective. Totally thoracoscopic cardiac surgery under cardiopulmonary bypass combined with one-lung ventilation has been identified as the trend in cardiac surgery. The aim of this study was to examine the effects of the selective α2 adrenergic receptor agonist dexmedetomidine on the pulmonary function of patients who underwent mitral valve surgery using the totally thoracoscopic technique. Methods. Fifty-seven patients who underwent thoracoscopic mitral valve surgery between July 2019 and December 2019 were selected. The patients were randomly divided into the control (Con) group (n=28) and the dexmedetomidine (DEX) group (n=29) using the random number table method. Arterial blood gas analyses were performed, and the oxygenation (PaO2/FiO2) and respiratory indexes (P(A-a)O/PaO2) were calculated 5 min after tracheal intubation (T1), 2 h after operation (T2), 6 h after operation (T3), and 24 h after operation (T4). Moreover, the serum cytokines interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and intercellular adhesion molecule-1 (ICAM-1) were detected using the enzyme-linked immunosorbent method at all time points. Chest radiography was performed 24 h after surgery. Peripheral blood samples were collected before and after the operation for a complete hemogram. Additionally, the procalcitonin concentration was measured and recorded when the patients were transported to the intensive care unit (ICU). The postoperative extubation time, length of ICU stay, and pulmonary infection rate were also recorded. Results. Inflammatory reaction after surgery was evident. However, the inflammatory cytokines IL-6, TNF-α, and ICAM-1 in the DEX group were lower than those in the Con group after surgery (T2 to T4; P<0.05). Neutrophil counts and procalcitonin concentration were higher in the Con group than in the DEX group (P<0.05). In addition, in the DEX group, pulmonary exudation on chest radiography was lower, and pulmonary function, as shown by an increase in oxidation index and decrease in the respiratory index, improved after surgery (P<0.05). Moreover, the duration of mechanical ventilation in the Con group was 3.4 h longer than that in the DEX group. Conclusion. Dexmedetomidine has a protective effect on pulmonary function in patients undergoing mitral valve surgery using a totally video-assisted thoracoscopic technique, which may be related to a reduction in the concentration of inflammatory cytokines in the early perioperative period.

scholarly journals Late gadolinium enhancement predicts adverse clinical outcome in patients with mitral valve prolapse/mitral annulus disjunction

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
S Figliozzi ◽  
G Georgiopoulos ◽  
GD Aquaro ◽  
K Bauer ◽  
L Monti ◽  
...  
Keyword(s):  
Heart Disease ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Mitral Valve ◽  
Clinical Outcome ◽  
Myocardial Fibrosis ◽  
Mitral Valve Prolapse ◽  
Mitral Annulus ◽  
Gadolinium Enhancement ◽  
Unexplained Syncope

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Mitral vAlve prolapse and disjunction by cardiac maGnetIC resonance (MA-GIC) registry Backgroung Mitral valve prolapse (MVP) is 2-3% prevalent in the general population with good prognosis. However, some patients develop complex ventricular arrhythmias (CVAs), sudden cardiac death (SCD), or severe mitral regurgitation (MR). Previous studies suggested that bi-leaflet involvement, mitral annulus disjunction (MAD), and myocardial fibrosis (MF) are associated with adverse outcome. Notwithstanding, these findings were limited to autopsic series or single-centre studies involving highly selected patients. Moreover, MF has been scantly investigated as predictor of clinical outcome. Purpose To investigate the prognostic significance of MF in an international multicentre study of MVP patients studied by cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE).  Methods From October 2007 to June 2020 patients undergoing LGE-CMR were screened in 14 European centres. Inclusion criteria were: i) age &gt; 18 years; ii) full clinical history and cardiac rhythm monitoring at baseline; iii) MVP (leaflet displacement ≥ 2 mm beyond the annulus). Exclusion criteria were: i) ischemic heart disease; ii) primary cardiomyopathy; iii) inflammatory heart disease; iv) congenital heart diseases; v) moderate-to-severe valvular heart disease. CVAs at the study outset was defined as one of the following: i) ventricular ectopic beats &gt;10000/24h; ii) ≥ 1 episode of non-sustained ventricular tachycardia (VT); iii) sustained VT; iv) aborted SCD. Primary end-point was a composite of SCD, unexplained syncope, and mitral valve repair/replacement. Secondary end-point was a composite of SCD and unexplained syncope.  Results Four-hundred-fifty-eight MVP patients were eventually included (46 ± 16 years old, 51% males) of whom 68% had MAD. LGE was detected in 103 (22%) of subjects with mid-wall pattern (46%) in left ventricular (LV) lateral wall (66%) as the most prevalent feature. At baseline, 37% of LGE-positive patients vs. 18% of LGE-negative individuals had CVAs (P &lt; 0.001). SVT and/or aborted SCD were more prevalent in LGE-positive than in LGE-negative patients (9% vs 2%, P &lt; 0.001). By multivariable Cox-regression analysis, LGE presence or extent were strong independent predictors of the primary (HR = 4.02, P = 0.003 and HR = 4.76 per 10% increase, P = 0.032, respectively) and secondary (HR = 5.39, P = 0.008 and HR = 8.78 per 10% increase, P = 0.012, respectively) endpoints after correction for major confounders including LV volumes, left atrial size and MAD presence. Conlusion Myocardial fibrosis by LGE is the strongest independent predictor of clinical outcome in MVP. In contrast, MAD per se does not harbinger worse prognosis.

scholarly journals Pulmonary Function Changes Before and After Mitral Valve Surgery in Severe Mitral Stenosis

2018 ◽  
Vol 02 (02) ◽  
pp. 079-083
Author(s):  
Manoj Kumar Sahu ◽  
Mayank Yadav ◽  
Milind Padmakar Hote ◽  
Sarvesh Pal Singh ◽  
Shiv Kumar Choudhary
Keyword(s):  
Mitral Valve ◽  
Pulmonary Function ◽  
Mitral Stenosis ◽  
Pulmonary Function Tests ◽  
Nyha Class ◽  
Forced Expiratory Volume ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Female Ratio ◽  
Expiratory Flow

Abstract Objective This study was undertaken to assess the pulmonary functions in the patients with predominant severe mitral stenosis before corrective mitral valve surgery, then to reassess the same 6 months after surgery and compare them. Patients and Methods Fifty consecutive patients with predominant severe mitral stenosis undergoing mitral valve replacement surgery were included in this prospective observational study. This study was conducted from July 2016 till January 2018 after obtaining approval from the institute's ethics committee and written consent from all the participants. All the patients were evaluated clinically and divided according to New York Heart Association (NYHA) class symptomatology. Computed spirometric pulmonary function tests (PFTs) such as forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, forced expiratory flow (FEF) 25–75%, peak expiratory flow rate (PEFR), and maximum voluntary ventilation (MVV) were performed on each patient 1 day before and 6 months after surgery. Results Fifty study patients were analyzed, mean age was 38.4 ± 10.76 years (15–56 years), and male-to-female ratio was 1:1.38 (21 males and 29 females). NYHA class symptoms improved significantly in most of our patients after surgery (p < 0.01). PFTs such as FVC, FEV1, FEV1/FVC ratio, FEF 25–75%, and MVV showed significant improvement 6 months after surgery (p < 0.01). Though PEFR also improved compared with preoperative values, it was not significant statistically (p < 0.07). Conclusion This study showed that the lung functions are impaired in patients with severe mitral stenosis and improved significantly 6 months after surgery, which does not correlate well with the betterment of NYHA class.

Abstract 16798: Evidence of Abnormal T1 Mapping in Arrhythmic Mitral Valve Prolapse Without Significant Mitral Regurgitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Brian B Agbor-Etang ◽  
Lisa J Lim ◽  
Karen G Ordovas ◽  
Francesca N Delling
Keyword(s):  
Late Gadolinium Enhancement ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Myocardial Fibrosis ◽  
Mitral Valve Prolapse ◽  
Ventricular Arrhythmias ◽  
T1 Mapping ◽  
Diffuse Myocardial Fibrosis ◽  
Diffuse Fibrosis ◽  
Gadolinium Enhancement

Background: Prior cardiac magnetic resonance (CMR) studies have reported abnormal T1 mapping, reflective of diffuse myocardial fibrosis, in patients with mitral valve prolapse (MVP) and ventricular arrhythmias. However, T1 mapping was derived from conventional Look-Locker sequences and/or obtained in selected MVP patients with severe mitral regurgitation (MR) and a clinical indication for CMR. Hypothesis: We hypothesize that extracellular volume (ECV) fraction, a marker of diffuse fibrosis derived from research-based, MOLLI T1 mapping sequences, is increased in MVP subjects with ventricular arrhythmias, even in the absence of significant MR. Methods: We performed CMRs in 10 consecutive, randomly selected MVP patients identified through our echocardiographic database, age/gender matched to 10 controls free of significant cardiac disease. All 10 MVPs underwent ambulatory EKG monitoring. CMR images were acquired using a GE 3.0T Discovery MR750w scanner. Global ECV fraction was calculated using pre- and 10 minutes post-contrast T1 times after administration of 0.1 mmol/kg of gadobutrol (Gadavist). Late gadolinium enhancement (LGE) was also obtained. MR fraction was quantified by velocity encoded CMR. Mild MR was defined as MR fraction < 16%. Results: MVP patients had significantly higher ECV fraction compared to controls (mean ECV (%) 32 ± 4 vs 20 ± 6, p = 0.0002), with 5/10 demonstrating non-sustained VT on ambulatory EKG monitoring. The majority (9/10 or 90%) of MVPs had mild or no MR (MR fraction < 16%), and 1/10 or 10% had moderate MR (MR fraction 18%). Only one individual in the MVP group had late gadolinium enhancement (LGE) in the papillary muscles. Conclusion: MVP with ventricular arrhythmias is associated with increased global ECV reflective of diffuse myocardial fibrosis, even in the absence of significant MR or LGE. Our preliminary findings highlight for the first time a primary interstitial derangement in MVP. Larger studies are needed to understand the mechanisms and prognostic significance of primary diffuse fibrosis in MVP.

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