Mastering Mitral Leaflets Coaptation After Valve Repair with Adjustable Mitral Annuloplasty Ring

Abstract Background:Surgical repair of rheumatic mitral valve disease is technically more demanding however, mitral repair is preferred over mechanical valve implantation if possible. İn this case report we presented the case of functional mitral stenosis after surgical mitral valve repair and annuloplasty ring implantation for rheumatic mitral regurgitation. Case Report:A 64-year-old female patient was admitted to our clinic with progressively worsening shortness of breath (New York Heart Association-Classification II-III), 6 months after surgical mitral valve repair and annuloplasty ring implantation for rheumatic mitral regurgitation. The 28/13 mmHg gradient was observed in the mitral valve annuloplasty ring in transthoracic echocardiography. TEE findings showed that motions of the mitral valve leaflet were fine, but in the mitral annuloplasty ring there was an extreme constriction and increased gradient.Conclusion:The development of mitral stenosis following mitral valve surgery is a condition associated with multiple mechanisms that are poorly understood. Mitral valve repair can be difficult and low success rate, especially in rheumatic mitral valve patients. The defect in the surgical technique and the application of restrictive small annuloplasty causes an increased gradient, leading to the development of severe functional mitral stenosis, especially when accompanied by a slight increase in pannus tissue.

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Use of Pledgeted Sutures in Mitral Annuloplasty

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000060 ◽

2014 ◽

Vol 9 (2) ◽

pp. 148-149

Author(s):

Mohammed Hassan ◽

Jimmy Windsor ◽

Tomas Salerno ◽

Marco Ricci

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Annuloplasty Ring ◽

Mitral Annuloplasty ◽

Suture Placement

Annuloplasty ring or band dehiscence is a possible complication of mitral valve repair surgery. It may be due to increased tension on the annuloplasty sutures, especially in ischemic mitral pathology in which a circumferential ring is used. Herein, we describe a technique for alternative suture placement in mitral annuloplasty using pledgeted sutures that may reduce the risk for ring or band dehiscence.

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First-in-man implantation of a trans-catheter aortic valve in a mitral annuloplasty ring: novel treatment modality for failed mitral valve repair

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2010.09.021 ◽

2011 ◽

Vol 39 (6) ◽

pp. 1054-1056 ◽

Cited By ~ 57

Author(s):

Arend de Weger ◽

See H. Ewe ◽

Victoria Delgado ◽

Jeroen J. Bax

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Mitral Valve Repair ◽

Treatment Modality ◽

Valve Repair ◽

Annuloplasty Ring ◽

Mitral Annuloplasty ◽

Novel Treatment

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P1409 Sizing of mitral annuloplasty rings using three-dimensional transoesophageal echocardiography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.842 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

K Yoshitani ◽

T Fujii ◽

S Ito ◽

A Shimokawa ◽

Y Ohnishi

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Three Dimensional ◽

Transoesophageal Echocardiography ◽

Ring Size ◽

Valve Repair ◽

Annuloplasty Ring ◽

Mitral Annuloplasty ◽

Systolic Phase

Abstract Funding Acknowledgements Department funding Background Mitral valve repair is preferred to valve replacement in cases of degenerative mitral regurgitation (MR) due to the lower risk of valve-related complications and operative mortality. In mitral valve repair, annuloplasty is associated with better clinical outcomes. Sizing of the annuloplasty ring with a ring sizer, which should be performed in the end-systolic phase, is performed in diastole during hyperkalaemia cardioplegic arrest. Three-dimensional transoesophageal echocardiography (3D-TEE) allows measurement of the mitral valve while the heart is beating, which is beneficial since the mitral valve size changes throughout the cardiac cycle. Purpose To investigate whether 3D-TEE measurements of the mitral valve are effective for preventing recurrent mitral regurgitation (MR) in patients who undergo mitral valve repair for degenerative MR. Methods This study retrospectively reviewed 139 patients who underwent mitral annuloplasty for degenerative MR. After 47 patients were excluded, 92 patients were analysed. The inter-commissural (IC) distance and anterior leaflet height of the A2 segment of the mitral valve were measured by 3D-TEE at the end-systolic phase. The annuloplasty ring size and type were selected by surgeons using specific ring sizers. We investigated the association of the IC distance with the size of implanted annulus ring and differences between the size of implanted annulus ring and the IC distance. We also compared the IC distance, the A2 height, and the ratio of A2 height to IC distance between patients with and without recurrent mild-to-moderate MR for 36 months. Results There was a significant correlation between the size of the mitral annuloplasty ring and the IC distance (R²=0.7023, p < 0.001). The variety between implanted annulus ring size and IC distance measured by 3D-TEE was shown in Figure1. Eight cases had mild or greater recurrent MR. There was a significant difference in the ratio of A2 height to IC distance between patients with and without recurrent MR (p = 0.006). The A2 height was greater in patients with recurrent MR, but this difference was not significant (p = 0.059). Conclusions There was a significant correlation between the size of the mitral annuloplasty ring and the IC distance. Our results demonstrated a higher ratio of A2 height to IC distance in patients with recurrent MR. Abstract P1409 Figure1

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Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezab178 ◽

2021 ◽

Author(s):

Arian Arjomandi Rad ◽

Vinci Naruka ◽

Robert Vardanyan ◽

Alessandro Viviano ◽

Mohammad Yousuf Salmasi ◽

...

Keyword(s):

Pooled Analysis ◽

Ring Size ◽

Inclusion Criteria ◽

Valve Repair ◽

Annuloplasty Ring ◽

Mitral Annuloplasty ◽

Ring Annuloplasty ◽

Cochrane Database ◽

Significant Difference ◽

Systematic Database

Abstract OBJECTIVES Mitral and tricuspid ring annuloplasty dehiscence with consequent recurrent valve regurgitation is a rare but challenging procedural failure. The incidence and predisposing risk factors for annuloplasty ring dehiscence include technical and pathological ones. METHODS A systematic database search with pooled analysis was conducted of original articles that only included dehiscence rate of mitral and tricuspid ring in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to November 2020. The outcomes included were dehiscence rate in mitral and tricuspid, type of ring implanted, dehiscence rate by pathology and by ring size and shape. RESULTS Our search yielded 821 relevant studies. Thirty-three studies met the inclusion criteria with a total of 10 340 patients (6543 mitral, 1414 tricuspid) of which 87 (mitral) and 30 (tricuspid) had dehiscence. Overall, dehiscence rate was 1.43%, diagnosed at a median of 4.5 ± 1.0 months postoperatively. A significant difference in mitral dehiscence rate was found by ring type (semi-rigid 1.86%, rigid 2.32%; flexible 0.43%; P < 0.001). There was no significant difference in rate of dehiscence by ring size (P = 0.067) and shape in mitral (P = 0.281) but there was higher dehiscence rate in ischaemic compared to non-ischaemic mitral regurgitation (3.91% vs 1.63%; P = 0.022). Among tricuspid studies, 9 of 10 studies did not report any dehiscence. CONCLUSIONS Although rigid, semi-rigid and flexible annuloplasty rings provide acceptable valve repair outcomes, mitral annuloplasty ring dehiscence is clinically more common among rigid rings. Understanding the multifactorial nature of ring dehiscence will help in identifying the patients at high risk and improve their clinical outcomes.

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Postoperative annular dynamics assessed with RT3D-Transesophageal Echocardiography after mitral valve repair: comparison between two semi-rigid mitral annuloplasty devices

10.26226/morressier.57108e2fd462b80290b49824 ◽

2016 ◽

Author(s):

Annemie Bauters

Keyword(s):

Mitral Valve ◽

Transesophageal Echocardiography ◽

Mitral Valve Repair ◽

Valve Repair ◽

Mitral Annuloplasty

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Preliminary experience in mitral valve repair using theCosgrove?Edwards annuloplasty ring

Interactive Cardiovascular and Thoracic Surgery ◽

10.1016/s1569-9293(03)00056-2 ◽

2003 ◽

Vol 2 (3) ◽

pp. 256-261 ◽

Cited By ~ 2

Author(s):

G GATTI ◽

P PUGLIESE

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Annuloplasty Ring

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Transapical 29-mm Edwards SAPIEN-XT Aortic Valve in a 34-mm Mitral Annuloplasty Ring

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e31826d5cd0 ◽

2012 ◽

Vol 7 (4) ◽

pp. 290-294 ◽

Cited By ~ 10

Author(s):

Gry Dahle ◽

Arnt E. Fiane ◽

Kjell-Arne Rein

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Severe Congestive Heart Failure ◽

Cardiac Resynchronization ◽

Bench Test ◽

Valve Repair ◽

Mitral Annuloplasty ◽

Edwards Sapien ◽

Transcatheter Valve ◽

The Given

A 71-year-old woman with severe congestive heart failure and failed mitral valve repair was referred for surgery. Because of her low ejection fraction, a valve-in-ring procedure was suggested. There was a great difference in the given size for the 34-mm Carpentier-Edwards-Physio-Ring and the biggest available transcatheter valve of 29 mm from Edwards. Therefore, we did a “bench test.” We expanded a 29-mm Edwards SAPIEN-XT aortic valve in a 34-mm Carpentier-Edwards-Physio-Ring. It fitted well and turned out circular with good coaptation of the leaflets. Thereafter, a successful transapical mitral valve-in-ring implantation on cardiopulmonary bypass was performed, and additional leads for cardiac resynchronization was placed.

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