The Effect of Depth of Anaesthesia on the Severity of Mitral Insufficiency by Transesophageal Echocardiography

Abstract Background The assessment of mitral regurgitation (MR) is complex and complicated by the dynamic nature of this valvular abnormality. Intraoperative transesophageal echocardiography (TEE) is a well-established tool that is used to assess the mitral regurgitation (MR) before and after mitral valve reconstruction. Objectives This study conducted in the National Heart Institute in Cairo aimed at assessing the effect of depth of anaesthesia guided by bispectral index on the severity of mitral insufficiency as measured by transesophageal echocardiography. Patients and Methods This study was conducted in the National Heart Institute in Cairo. The study was conducted for a period of about six months after the approval from Ethical committee. Informed oral consent for every patient was obtained. Prospective observational cross-sectional study with a random sample of 20 patients at National Heart Institute. A sample size of at least 15 data pairs achieves 80% power to reject the null hypothesis of zero effect size when the population effect size is 0.80 and the significance level (alpha) is 0.05 using a two-sided paired ttest. Adult patients undergoing elective cardiac surgery in National Heart Institute. Results The MR severity decreased at a deeper anaesthesia at low BIS than at a shallower anaesthesia at high BIS in patients with organic MR. Eight patients out of twenty patients (40% with organic MR) showed a + 1 grade of improvement in MR grade, by semi-quantitively measuring maximal JA and VC width. Improvement in mitral regurge severity thought to be secondary to unloading effect of general anaesthesia on left ventricle causing a decrease in afterload, preload, and left ventricular dimensions. This study demonstrated that, a comparison between deep anaesthesia and shallow anaesthesia using BIS showed there is a significant reduction in multiple parameters of MR severity assessment secondary to unloading effect of general anaesthesia on left ventricle caused by a decrease in both afterload and preload. Conclusion This reduction in MR severity appeared to be significant enough to modify intraoperative decisions regarding valve surgery by underestimation of valve severity. Thus, strong consideration should be given to thorough preoperative assessment of MR severity, rather than relying on intraoperative findings.

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P1689 Mitral valve prolapse secondary to ischemic cardiomyopathy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1052 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

G Babur Guler ◽

A Kilicgedik ◽

H Zencirkiran Agus ◽

G Kahveci

Keyword(s):

Myocardial Infarction ◽

Mitral Valve ◽

Left Ventricle ◽

Mitral Regurgitation ◽

Transesophageal Echocardiography ◽

Papillary Muscle ◽

Mitral Valve Prolapse ◽

Systolic Function ◽

Systolic Pulmonary Artery Pressure ◽

Mitral Prolapse

Abstract Introduction Mitral valve prolapse is the most common form of degenerative mitral valve disease. However, ischemic mitral valve prolapse is a rare cause of mitral regurgitation. The mechanism was initially thought to be papillary muscle dysfunction, but more complex mechanisms were suggested recently. Purpose Try to understand the pathophysiology of ischemic mitral valve prolapse on a case example. Case Report A 42-year-old male with a history of inferoposterior myocardial infarction was admitted from outpatient clinic due to NYHA class 3 heart failure symptoms. On physical examination, a 4/6 holosystolic murmur was heard in the apex. He had a permanent pacemaker implanted for sick sinus syndrome. Transthoracic echocardiography showed 1-global dysfunction of the left ventricle (posterior segment akinetic and thinned), 2- prolapse of the posterior mitral leaflet (suspicion of ruptured chordae) 3-severe mitral regurgitation (with anterior eccentric jet), 4- moderate tricuspid regurgitation and high systolic pulmonary artery pressure (65 mmHg), 5- pacemaker lead in the right heart chambers. 6- normal right ventricular systolic function. Transesophageal echocardiography showed P2 scallop prolapse and chordae were intact, there were no redundant or myxamous components of the leaflets. It was observed that the posteromedial papillary muscle was elongated and did not contract. We commented that these echocardiographic findings represented ischemic mitral valve prolapse. Other echo findings in favour of this hypothesis were the posteromedial papillary muscle prolongation in systole and reduced the free strain of papillary muscle in the the apical long axis view. The patient underwent mitral ring anuloplasty and surgical neocord implantation. Surgery also reported the aetiology as ischemic mitral prolapse secondary to chordal extension in accordance with echocardiography. Conclusion(s): Ischemic mitral prolapse is a complex pathology involving multiple components of the mitral valve apparatus as left ventricle, papillary muscle, chordae, annulus, leaflets. The diagnostic criteria for ischemic mitral valve prolapse and its management are not defined. The presence of myocardial infarction and the exclusion of other possible valve pathologies with transesophageal echocardiography are important steps in the diagnosis. Abstract P1689 Figure.

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An Assessment of Left Ventricular Systolic Function with the Use of a Continuous Doppler Imaging in Dogs with Spontaneous Mitral Regurgitation. A Preliminary Study

Bulletin of the Veterinary Institute in Pulawy ◽

10.2478/v10213-012-0070-9 ◽

2012 ◽

Vol 56 (3) ◽

pp. 399-402 ◽

Cited By ~ 3

Author(s):

Urszula Pasławska ◽

Agnieszka Noszczyk-Nowak ◽

Józef Nicpoń

Keyword(s):

Left Ventricle ◽

Mitral Regurgitation ◽

Systolic Function ◽

Pressure Rise ◽

Left Ventricular ◽

Valvular Disease ◽

Cardiac Insufficiency ◽

Doppler Imaging ◽

Mitral Insufficiency ◽

Continuous Doppler

Abstract The aim of this study was to evaluate systolic function of left ventricle in dogs with spontaneous mitral regurgitation by estimating the rate of pressure rise in the left ventricle (dP/dt). Ninety-three dogs of different breed and sex, with chronic degenerative valvular disease were examined. All dogs had echocardiography examination with dP/dt estimation assessed from mitral regurgitant jet using continuous Doppler-echocardiography. The dogs were divided into four classes of heart failure according to NYHA class. Results: dogs in NYHA I dP/dt = 2,142 ±1,309, SF=33.6±10.5, EF=66.58± 14; NYHA II dP/dt = 3,062 ±1,798, SF=42 ±10, EF=76.5 ±11.5; NYHA III dP/dt = 3,483 ±2,136, SF=44.2 ±21, EF=75.7 ±13; NYHA IV dP/dt = 4,496 ±1,797, SF=40.6 ±6, EF=70.4 ±16. Dogs with chronic cardiac insufficiency and mitral insufficiency due to chronic degenerative valvular disease had no echocardiograhic evidence of left ventricular systolic dysfunction assessed from mitral regurgitant jet dP/dt.

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Abstract 3051: Percutaneous Repair of Functional Mitral Regurgitation Using CARILLON ™ Mitral Contour System. Acute Transesophageal Echocardiography Results from AMADEUS ™ Trial

Circulation ◽

10.1161/circ.118.suppl_18.s_808-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Tomasz Siminiak ◽

Uta C Hoppe ◽

Joachim Schofer ◽

Michael Haude ◽

Jean-Paul Herrman ◽

...

Keyword(s):

Mitral Regurgitation ◽

Transesophageal Echocardiography ◽

Left Ventricular ◽

Functional Mitral Regurgitation ◽

Mitral Insufficiency ◽

Clinical Value ◽

Vena Contracta ◽

Percutaneous Repair ◽

Number Of Patients ◽

Impact Phase

Left ventricular dilatation with subsequent mitral insufficiency exacerbates heart failure. New techniques for percutaneous repair of Functional Mitral Regurgitation (FMR) are being developed to minimize the high procedural risk of conventional cardiac surgery therapies. To evaluate the feasibility and procedural safety of percutaneous mitral valve repair with CARILLON ™ Mitral Contour System ™ (Cardiac Dimensions® Inc.) in FMR patients AMADEUS ™ trial has been designed. Patients with FMR of both ischemic and non-ischemic origin were enrolled to this multicenter phase I trial. The device is implanted into the coronary venous system and applies tension to the mitral ring in order to improve coaptation of the leaflets. Transesophageal echocardiography (TEE) was used to assess the MR changes. Acute procedural data, obtained in the cath lab immediately before and after the procedure, are reported. Percutaneous mitral annuloplasty in patients with FMR and dilated cardiomyopathy resulted in acute MR reduction (grade 3.0±0.6 to 2.0±0.8, p<0.0001) and permanent device implantation in 30 out of 43 attempts. Additional measurements in final 20 implanted patients showed reductions in vena contracta (0.69±0.29 cm to 0.46±0.26 cm, p<0.0001), effective regurgitant orifice area (0.33±0.17 cm 2 to 0.19±0.08 cm 2 , p<0.0001), regurgitant volume (40±20 ml to 24±11 ml, p= 0.0005), and jet area/left atrial area (45±13% to 32±12%, p<0.0001). Coronary arteries were crossed in 36 patients (84%), but arterial compromise contributed to lack of implantation in 6 patients (14%). All unsuccessful implants were recaptured and removed in these patients without procedural complications. Permanent implantation of the device is safely achievable in the majority of eligible patients resulting in acute MR reduction. Arteries are crossed in most patients and without significant impact. Phase two trials including long term clinical observations on larger number of patients are needed to asses the clinical value of the technique.

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Assay Methods and Standard Preparations for Plasmin, Plasminogen and Urokinase in Purified Systems, 1967-1968

Thrombosis and Haemostasis ◽

10.1055/s-0038-1653535 ◽

1969 ◽

Vol 21 (02) ◽

pp. 259-272 ◽

Cited By ~ 74

Author(s):

A. J Johnson ◽

D. L Kline ◽

Norma Alkjaersig

Keyword(s):

Heart Institute ◽

Thrombolytic Agents ◽

National Heart ◽

Assay Methods

SummaryTo facilitate communication between investigators, the Committee on Thrombolytic Agents of the National Heart Institute suggests standardized reagents and assay methods for the measurement of standard preparations of plasmin, plasminogen, and urokinase with use of casein, fibrin and synthetic esters as substrates.

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MEASURING HEALTHCARE SERVICE QUALITY FOR INPATIENT AT THE NATIONAL HEART INSTITUTE AT BACHMAI HOSPITAL IN VIETNAM

International Journal of Public Health and Clinical Sciences ◽

10.32827/ijphcs.6.3.143 ◽

2019 ◽

Vol 6 (3) ◽

Keyword(s):

Service Quality ◽

Healthcare Service ◽

Heart Institute ◽

National Heart

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Extended Myectomy for Hypertrophic Obstructive Cardiomyopathy

The Heart Surgery Forum ◽

10.1532/hsf98.20111185 ◽

2012 ◽

Vol 15 (5) ◽

pp. 251

Author(s):

Changqing Gao ◽

Chonglei Ren ◽

Cangsong Xiao ◽

Yang Wu ◽

Gang Wang ◽

...

Keyword(s):

Mitral Valve ◽

Left Ventricle ◽

Mitral Regurgitation ◽

Surgical Procedures ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Systolic Anterior Motion ◽

Anterior Leaflet ◽

Septal Myectomy ◽

The Mean

Background: The purpose of this study was to summarize our experience of extended ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods: Thirty-eight patients (26 men, 12 women) with HOCM underwent extended ventricular septal myectomy. The mean age was 36.3 years (range, 18-64 years). Diagnosis was made by echocardiography. The mean (mean � SE) systolic gradient between the left ventricle (LV) and the aorta was 89.3 � 31.1 mm Hg (range, 50-184 mm Hg) according to echocardiographic assessments before the operations. Moderate or severe systolic anterior motion (SAM) of the anterior leaflet of the mitral valve was found in 38 cases, and mitral regurgitation was present in 29 cases. Extended ventricular septal myectomy was performed in all 38 cases. The results of the surgical procedures were evaluated intraoperatively with transesophageal echocardiography (TEE) and with transthoracic echocardiography (TTE) at 1 to 2 weeks after the operation. All patients were followed up with TTE after their operation.Results: All patients were discharged without complications. The TEE evaluations showed that the mean systolic gradient between the LV and the aorta decreased from 94.8 � 35.6 mm Hg preoperatively to 13.6 � 10.8 mm Hg postoperatively (P = .0000) and that the mean thickness of the ventricular septum decreased from 28.3 � 7.9 mm to 11.8 � 3.2 mm (P = .0000). Mitral regurgitation and SAM were significantly reduced or eliminated. During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only, and syncope was abolished. TTE examinations showed that the postoperative pressure gradient either remained the same or diminished.Conclusions: Extended ventricular septal myectomy is mostly an effective method for patients with HOCM, and good surgical exposure and thorough excision of the hypertrophic septum are of paramount importance for a successful surgery.

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The Results of the Use of Angiotensin Receptor Inhibitors and Neprilisin in Secondary Functional Mitral Regurgitation in Outpatient Practice

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1462 ◽

2020 ◽

Vol 75 (5) ◽

pp. 514-522

Author(s):

Alexey S. Ryazanov ◽

Konstantin I. Kapitonov ◽

Mariya V. Makarovskaya ◽

Alexey A. Kudryavtsev

Keyword(s):

Heart Failure ◽

Left Ventricle ◽

Mitral Regurgitation ◽

Effective Area ◽

Left Ventricular ◽

Functional Mitral Regurgitation ◽

Angiotensin Receptor ◽

Optimal Drug ◽

Patients With Heart Failure ◽

Valsartan Group

Background. Morbidity and mortality in patients with functional mitral regurgitation (FMR) remains high, however, no pharmacological therapy has been proven to be effective.Aimsto study the effect of sacubitrile/valsartan and valsartan on functional mitral regurgitation in chronic heart failure.Methods.This double-blind study randomly assigned sacubitrile/valsartan or valsartan in addition to standard drug therapy for heart failure among 100 patients with heart failure with chronic FMR (secondary to left ventricular (LV) dysfunction). The primary endpoint was a change in the effective area of the regurgitation hole during the 12-month follow-up. Secondary endpoints included changes in the volume of regurgitation, the final systolic volume of the left ventricle, the final diastolic volume of the left ventricle, and the area of incomplete closure of the mitral valves.Results.The decrease in the effective area of the regurgitation hole was significantly more pronounced in the sacubitrile/valsartan group than in the valsartan group (0.070.066against0.030.058sm2; p=0.018)in the treatment efficacy analysis, which included 100patients (100%). The regurgitation volume also significantly decreased in the sacubitrile/valsartan group compared to the valsartan group (mean difference:8.4ml; 95%CI, from 13.2 until 1.9;р=0.21). There were no significant differences between the groups regarding changes in the area ofincomplete closure of the mitral valves and LV volumes, with the exception of the index of the final LV diastolic volume (p=0.07).Conclusion.Among patients with secondary FMR, sacubitril/valsartan reduced MR more than valsartan. Thus, angiotensin receptor inhibitors and neprilysin can be considered for optimal drug treatment of patients with heart failure and FMR.

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