A Concept for a Novel Procedure for Mitral Valve Repair by Percutaneous Annuloplasty

2008 ◽  
Author(s):  
Toufic Azar ◽  
Sumitra Rajagopalan ◽  
Renzo Cecere ◽  
Joszef Kovecses ◽  
Jorge Angeles
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Mitral Valve Regurgitation ◽  
The United States ◽  
Valve Repair ◽  
Operative Trauma ◽  
Idiopathic Cardiomyopathy

Mitral valve regurgitation [1] (MVR) is a functional heart disease in which the valve does not close completely and causes blood to leak back into the left atrium. This condition increases the workload on the heart, and if left untreated, can lead to irreversible heart damage, cardiac arrhythmia, and congestive heart failure. Annually, in the United States, more than 50 000 patients undergo mitral valve repair. The causes of MR can be either primary, due to an anatomical change of the valve apparatus, or secondary to ischemic heart disease and idiopathic cardiomyopathy. Currently, the intervention requires an open heart surgery with cardiopulmonary bypass. Under such conditions, the patient is subjected to intra and post-operative trauma that can result in a mortality increase and that can prevent high risk individuals from undergoing the repair. A non-invasive percutaneous method would greatly reduce risks associated with a conventional surgery while increasing the potential candidates for repair. Introduced in this paper is a concept for a novel procedure that relies on a robotically-guided compliant catheter, fitted with an anchoring mechanism, intended to reshape the mitral-valve annulus to dimensions suitable for the effective support of the valve leaflets.

scholarly journals Design of a Catheter-Based Device for Performing Percutaneous Chordal-Cutting Procedures

2009 ◽  
Vol 3 (2) ◽  
Author(s):  
A. H. Slocum ◽  
W. R. Bosworth ◽  
A. Mazumdar ◽  
M. A. Saez ◽  
M. L. Culpepper ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Design Process ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Mitral Valve Regurgitation ◽  
The United States ◽  
Functional Requirements ◽  
Device Design ◽  
Design Concepts ◽  
Rapid Design

In this paper we detail the rapid design, fabrication and testing of a percutaneous catheterbased device that is envisioned to enable externally controlled manipulation and cutting of specific chordae tendinae within the heart. The importance of this work is that it (a) provides a means that surgeons may use to alleviate problems associated with some forms of mitral valve regurgitation and (b) demonstrates how a deterministic design process may be used to drive design innovation in medical devices while lowering development cost/time/resources. In the United States alone, approximately 500,000 people develop ischemic or functional MR per year. A chordal cutting procedure and device could allow many patients, who would otherwise be unable to survive open-heart surgery, to undergo a potentially life-saving operation at reduced risk. The design process has enabled us to generate a solution to this problem in a relatively short time. A deterministic design process was used to generate several design concepts and then evaluate and compare each concept based on a set of functional requirements. A final concept to be alpha prototyped was then chosen, optimized, and fabricated. The design process made it possible to make rapid progress during the project and to achieve a device design that worked the first time. This approach is important to medical device design as it reduces engineering effort, cost, and the amount of time spent in iterative design cycles. An overview of the design process will be presented and discussed within the context of a specific case study–the rapid design/fabrication of a chordal cutting device. Experimental results will be used to assess: (i) The performance of the catheter in maneuvering into the heart and grasping various structures. (ii) The effectiveness of the catheter's RF ablation tip at cutting chordae inside of a heart. In the first experiment, the catheter was guided to the basal chordae under direct visualization, which showed that the catheter is capable of successfully grasping a chord. During the second experiment, ultrasound was shown to be a viable method of visualizing the catheter within the heart. During this experiment, once contact between the chord and RF ablator tip was confirmed, the chord was successfully ablated. We will also discuss experiments that are currently underway to visualize the catheter utilizing a Trans-Esophageal Echo probe, as well as imaging the mitral valve from the apex of the heart with a laparoscope so that video of the basal chord being grasped and cut can be acquired on a heart whose anatomical structures are intact. A brief synopsis will then be given of how the design process has been used in research and educational collaborations between MIT and local hospitals.

scholarly journals Mitral Valve Repair in Rheumatic Disease: Early Results

2004 ◽  
Vol 3 (3) ◽  
pp. 65
Author(s):  
S Pradhan ◽  
B Koirala ◽  
R Koirala ◽  
J Sharma ◽  
A Acharya ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Heart Surgery ◽  
Common Iliac Artery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Valve Repair ◽  
Left Common Iliac Artery ◽  
Early Results ◽  
Associated Lesions

Mitral valve repair is an accepted method of treating severe mitral valve disease due to rheumatic fever, Valve repair confers fewer complications and better survival as compared to mitral valve replacement. Since commencing open-heart surgery at SGNHC, 49 mitral valve repair operations have been performed here. There were 25 male and 24 female patients. The average age was 28.7 years (5 - 68 years). All were symptomatic with significant dyspnoea and palpitation. Other symptoms were hemoptysis in eight, peripheral embolism in one and CNS embolism in four. Associated lesions included ASD in three, an ASD and constrictive pericarditis in one and a pseudoaneurysm of the left common iliac artery with PDA in the fifth. One patient had undergone CMV nine years before presentation.

scholarly journals Infective endocarditis and pregnancy

2019 ◽  
pp. 61-66
Author(s):  
S. O. Siromakha ◽  
A. O. Rusnak ◽  
O. F. Luchinets ◽  
A.O. Ogorodnyk ◽  
T. A. Malysheva ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Infective Endocarditis ◽  
Mitral Valve ◽  
Pregnant Women ◽  
Perinatal Mortality ◽  
Mitral Valve Repair ◽  
Multidisciplinary Team ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Valve Repair

Infective endocarditis in pregnant women is a threatening disease that leads to significant maternal and perinatal losses. Methods for caring for such patients have not yet been standardized, and literature sources provide single descriptions of case reports. Objectives. To reduce maternal and perinatal mortality and disability, as well as to provide optimal management and delivery strategy for pregnant women with infective endocarditis. Materials and methods.This paper presents the experience of treating three cases of IE in pregnant women (n-2) and parturient (n-1) by specialists of a national multidisciplinary team. In all three cases, cardiology, cardiac surgery and perinatal tactics were personalized in accordance with the recommendations of the European Society of Cardiologists and the experience of the team members. Parturient with acute IE and septic clot of right ventricle underwent urgent cardiac surgery. Another pregnant was provided with conservative support by a multidisciplinary team due to the absence of indications for immediate surgery (she underwent aortic valve replacement and mitral valve repair in 11 days after in-term labour). The third one underwent cardiac surgery (mitral valve repair) with fetus in utero at 21 weeks of pregnancy after 11 weeks of de-escalation therapy by antibiotics. Results. In all cases, the immediate maternal and perinatal results were good. Follow-up for two cases we could observe (33 and 18 months after surgery) are good. Conclusions. Treatment tactic for pregnant women with acute IE that require heart surgery is always a compromise between the treatment and rehabilitation of a deep-preterm baby and the intra-operative risks to the fetus. Risk of intervention for mother and fetus can be minimized by a highly professional multidisciplinary team with wide experience in open-heart surgery, competent preparation of women for surgical treatment, conducting intraoperative fetal monitoring, as well as using special parameters of artificial circulation and anesthesia. Primary and secondary prevention of infectious complications in pregnant women at risk of IE is a powerful tool to reduce maternal, perinatal mortality and disability.

scholarly journals Sequential Venous Percutaneous Transluminal Angioplasty and Balloon Dilatation of the Interatrial Septum during Percutaneous Edge-to-Edge Mitral Valve Repair

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Rezo Jorbenadze ◽  
Johannes Patzelt ◽  
Meinrad Gawaz ◽  
Peter Seizer ◽  
Harald F. Langer
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Percutaneous Transluminal Angioplasty ◽  
Balloon Dilatation ◽  
Mitral Valve Regurgitation ◽  
Interatrial Septum ◽  
Transluminal Angioplasty ◽  
Valve Regurgitation ◽  
Valve Repair ◽  
Percutaneous Transluminal

Percutaneous edge-to-edge mitral valve repair (PMVR) is widely used for selected, high-risk patients with severe mitral valve regurgitation (MR). This report describes a case of 81-year-old woman presenting with severe and highly symptomatic mitral valve regurgitation (MR) caused by a flail of the posterior mitral valve leaflet (PML). PMVR turned out to be challenging in this patient because of a stenosis and tortuosity of both iliac veins as well as sclerosis of the interatrial septum, precluding the vascular and left atrial access by standard methods, respectively. We managed to achieve atrial access by venous percutaneous transluminal angioplasty (PTA) and balloon dilatation of the interatrial septum. Subsequently, we could advance the MitraClip® system to the left atrium, and deployment of the clip in the central segment of the mitral valve leaflets (A2/P2) resulted in a significant reduction of MR.

R15 Long-term Outcome Following Mitral Valve Repair in Rheumatic Heart Disease

2021 ◽  
Vol 30 ◽  
pp. S21-S22
Author(s):  
K.F.L. Lee ◽  
O.J.O.J. Lee ◽  
T.L.D. Chan ◽  
K.L.C. Ho ◽  
W.K.T. Au
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Rheumatic Heart Disease ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Rheumatic Heart

Early and Mid-term Results of Mitral Valve Repair in Patients with Degenerative Mitral Regurgitation

2021 ◽  
Author(s):  
Hasan Erdem ◽  
Emre Selçuk
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Survival Rates ◽  
Mitral Valve Regurgitation ◽  
Valve Repair ◽  
Repair Rate ◽  
Mitral Repair ◽  
Mid Term Results

Objectives: In this study, we present the mid-term results of patients who underwent valve repair due to degenerative mitral valve regurgitation in the first five years of our mitral valve repair program. Patients and Methods: In this retrospective study, all patients who were operated for degenerative mitral regurgitation by a single surgical team between 2013 and 2017 were investigated. We determined early and mid-term cumulative survival rates, repair failure and freedom from reoperation. In addition, as a specific subgroup, the results of patients under 18 years of age after mitral valve repair were investigated Results: Mitral repair was performed in 121 of 153 degenerative mitral regurgitation patients during the study period. The overall repair rate was 79%. Mitral valve repair rate increased significantly over years. The Median follow-up time was 63 (range 10-92) months. Early mortality was 2.5% (n=3 patients). During the follow-up period, moderate-to-severe mitral regurgitation was observed in 14 (11.8%) patients, mitral valve reoperation was required in 7 (5.9%) patients. Valve repair was performed in 4 of 7 patients under the age of 18. There was no pediatric case requiring reoperation during the follow-up period (median 46 months). Conclusion: Mid-term results of mitral valve repair in degenerative mitral valve patients are satisfactory. The success rate of repair increases in line with surgical experience.

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