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 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.

scholarly journals Association of Transcatheter Mitral Valve Repair With Quality of Life Outcomes at 30 Days and 1 Year

2018 ◽  
Vol 3 (12) ◽  
pp. 1151 ◽  
Author(s):  
Suzanne V. Arnold ◽  
Zhuokai Li ◽  
Sreekanth Vemulapalli ◽  
Suzanne J. Baron ◽  
Michael J. Mack ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Life Outcomes ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Quality Of Life Outcomes

scholarly journals pH of exudate test in the physiological quality of crambe seeds

2016 ◽  
Vol 46 (6) ◽  
pp. 1014-1018 ◽  
Author(s):  
Charline Zaratin Alves ◽  
Lennis Afraire Rodrigues ◽  
Carlos Henrique Queiroz Rego ◽  
Josué Bispo da Silva
Keyword(s):  
Pearson Correlation ◽  
Raw Material ◽  
Mean Values ◽  
Tukey Test ◽  
Physiological Quality ◽  
The Subject ◽  
The Mean ◽  
C 30

ABSTRACT: Crambe is a rapeseed with high oil content and can be used as a winter cover or as a source of raw material for the production of biodiesel, however espite the growing interest in the culture, research on the subject is still incipient, especially concerning the seed production and analysis technology. The purpose of this study is to evaluate the physiological quality of crambe seeds, 'FMS Brilhante' cultivar, by testing the pH of exudate. Five seed lots were submitted to the determination of water content and the tests of germination and vigor (first count, emergence and tetrazolium). In the conduction of pH exudate test, temperatures (25 and 30oC), and periods of seed imbibition in water (15, 30 and 45 minutes) were tested. The experiment was conducted in a completely randomized manner, with four replicates, and the mean values were compared by the Tukey test at 5% probability; Pearson correlation between the pH of the exudate and initial tests was also made. Testing the pH of exudate is promising for separating lots of crambe seeds and the following combinations of 25°C/30 minutes or 30°C/45 minutes can be used.

scholarly journals Optimizing P2 Neochordal Length and Stability in Mitral Valve Repair With Use of a Polypropylene Loop

2020 ◽  
Vol 47 (3) ◽  
pp. 207-209
Author(s):  
Anil Ozen ◽  
Ertekin Utku Unal ◽  
Hamdi Mehmet Ozbek ◽  
Gorkem Yigit ◽  
Hakki Zafer Iscan
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Severe Mitral Regurgitation ◽  
Posterior Leaflet ◽  
Valve Repair ◽  
Chordae Tendineae ◽  
Optimal Length ◽  
Precise Method ◽  
Artificial Chordae

Determining the optimal length of artificial chordae tendineae and then effectively securing them is a major challenge in mitral valve repair. Our technique for measuring and stabilizing neochordae involves tying a polypropylene suture loop onto the annuloplasty ring. We used this method in 4 patients who had moderate-to-severe mitral regurgitation from degenerative posterior leaflet (P2) prolapse and flail chordae. Results of intraoperative saline tests and postoperative transesophageal echocardiography revealed only mild insufficiency. One month postoperatively, echocardiograms showed trivial regurgitation in all 4 patients. We think that this simple, precise method for adjusting and stabilizing artificial chordae will be advantageous in mitral valve repair.

The use of artificial chordae in mitral valve repair

2017 ◽  
Vol 32 (4) ◽  
pp. 250-258 ◽  
Author(s):  
Li Wei ◽  
Lihong Jiang ◽  
Yaxiong Li
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Artificial Chordae

scholarly journals A 20-year experience with mitral valve repair with artificial chordae in 608 patients

2008 ◽  
Vol 135 (6) ◽  
pp. 1280-1287.e1 ◽  
Author(s):  
Loris Salvador ◽  
Salvatore Mirone ◽  
Roberto Bianchini ◽  
Tommaso Regesta ◽  
Fabio Patelli ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Artificial Chordae

Idiopathic Acute Mitral Regurgitation Due to Chordal Rupture in Infants: Surgical Management and Results

2019 ◽  
Vol 10 (1) ◽  
pp. 37-41
Author(s):  
Kosuke Yoshizawa ◽  
Keiichi Fujiwara ◽  
Nobuhisa Ohno ◽  
Kentaro Watanabe ◽  
Hisanori Sakazaki
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Surgical Intervention ◽  
Valve Repair ◽  
Aortic Cross Clamp Time ◽  
Aortic Cross Clamp ◽  
Acute Mitral Regurgitation ◽  
Artificial Chordae

Objective: Emergency surgical treatment is required for idiopathic acute mitral regurgitation due to chordae rupture in infants. Nevertheless, mitral valve repair for such a patient population still remains challenging. We report our experience with mitral valve repair for idiopathic acute mitral regurgitation due to chordae rupture in infants. Methods: From 2005 to 2017, six infants (four boys) were diagnosed with acute mitral regurgitation due to chordae rupture and underwent mitral valve repair. The median age, mean body weight, and median follow-up period were 5.5 months (range: 4-9 months), 6.8 kg (range: 5.5-8.0 kg), and 6.4 years (range: 6 months to 10 years), respectively. Results: In all cases, surgical intervention was performed within 24 hours of admission. Artificial chordae reconstruction and paracommissural edge-to-edge repair were utilized in three and four cases, respectively, while Kay’s annuloplasty was performed in all cases. Mean cardiopulmonary bypass time and aortic cross-clamp time were 117 minutes (range: 70-143 minutes) and 73 minutes (range: 35-108 minutes), respectively. No early or late deaths and reoperations had occurred during the follow-up period. Moreover, postoperative mitral regurgitation was significantly reduced, while no chronologic progression of mitral regurgitation was observed. Conclusions: The combination of various techniques, such as artificial chordae reconstruction, paracomissural edge-to-edge repair, and Kay’s annuloplasty, can be a promising surgical option for idiopathic acute mitral regurgitation due to chordae rupture in infants.

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