Abstract 14338: Prevalence, Associations and Outcomes of Double Orifice and Parachute Mitral Valve

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
uzoma obiaka ◽  
Anna Chow ◽  
Jen Lie Yau ◽  
Valeria Matto Morina ◽  
Shubhika Srivastava
Keyword(s):  
Mitral Valve ◽  
Age At Diagnosis ◽  
Text Search ◽  
Associated Lesions ◽  
Significant Difference ◽  
Parachute Mitral Valve ◽  
Valve Function ◽  
Echocardiographic Images ◽  
Double Orifice

Background: The incidence of congenital mitral valve disease is 0.4%; Double Orifice Mitral Valve (DOMV) and Parachute Mitral Valve (PMV) are two morphologic pathologies that may result in mitral valve dysfunction. The objectives of this study are 1) To describe valve function and progression and 2) To define factors contributing to disease progression. Methods: Retrospective database review. Fyler codes for DOMV, PMV and text search was performed. Echocardiographic images, echo reports, and chart review were used to identify mitral regurgitation (MR), mitral stenosis (MS), morphology, and associated lesions. Results: 39 patients with DOMV and 76 patients with PMV were identified. In the DOMV cohort, 51% were male, median age at diagnosis was 0.17 years (IQR 0.01, 3.88); median follow-up of 5.92 years (IQR 0.46, 10.22). In the PMV cohort, 44% were male, median age at diagnosis at was 0.01 years (IQR 0, 0.34); median follow-up of 2.56 years (IQR 0.25, 9.55). 41% of DOMV and 23% of patients with PMV had normal valve function at initial visit. DOMV was associated with MR (p=0.04), and PMV with MS (p<0.0001). 23% of patients in the PMV cohort had progressive MS compared to 5% of patients in the DOMV cohort (p<0.0001). There was no significant difference in MR progression between both groups (p=0.02). Papillary muscle (PM) morphology was evaluated in 37 (excluding canals) of 76 patients in the PMV cohort. 5 had true PMV (single PM), 32 had variant PMV with two PM groups of which 62.5% had dominant posterior medial PM. 67% of those with posterior medial PM dominance had progressive MS irrespective of association with Shone’s complex. The anterolateral PM muscle group dominant PMV were not associated with Shone’s complex and progressive MS. Conclusion: DOMV are more likely to have MR while PMV are more likely to have MS. DOMV has non progressive MR and MS. Posterior medial PM dominance in PMV is more likely to have progressive MS.

scholarly journals The Long-Term Follow-Up of Patients with Cystine Stones: A Single-Center Experience for 13 Years

2021 ◽  
Vol 10 (7) ◽  
pp. 1336
Author(s):  
Toshifumi Takahashi ◽  
Shinya Somiya ◽  
Katsuhiro Ito ◽  
Toru Kanno ◽  
Yoshihito Higashi ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Median Number ◽  
Small Sample ◽  
Age At Diagnosis ◽  
Surgical Interventions ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Cystine Stones

Introduction: Cystine stone development is relatively uncommon among patients with urolithiasis, and most studies have reported only on small sample sizes and short follow-up periods. We evaluated clinical courses and treatment outcomes of patients with cystine stones with long-term follow-up at our center. Methods: We retrospectively analyzed 22 patients diagnosed with cystine stones between January 1989 and May 2019. Results: The median follow-up was 160 (range 6–340) months, and the median patient age at diagnosis was 46 (range 12–82) years. All patients underwent surgical interventions at the first visit (4 extracorporeal shockwave lithotripsy, 5 ureteroscopy, and 13 percutaneous nephrolithotripsy). The median number of stone events and surgical interventions per year was 0.45 (range 0–2.6) and 0.19 (range 0–1.3) after initial surgical intervention. The median time to stone events and surgical intervention was 2 years and 3.25 years, respectively. There was a significant difference in time to stone events and second surgical intervention when patients were divided at 50 years of age at diagnosis (p = 0.02, 0.04, respectively). Conclusions: Only age at a diagnosis under 50 was significantly associated with recurrent stone events and intervention. Adequate follow-up and treatment are needed to manage patients with cystine stones safely.

Double-Outlet Right Ventricle with Supravalvular Mitral Ring and Parachute Mitral Valve

1997 ◽  
Vol 5 (4) ◽  
pp. 247-249
Author(s):  
Fatih İslamoğlu ◽  
Yüksel Atay ◽  
İlker Alat ◽  
Osman Saribülbül ◽  
E Alp Alayunt
Keyword(s):  
Mitral Valve ◽  
Right Ventricle ◽  
Septal Defect ◽  
Superior Vena ◽  
Vena Cava ◽  
Double Outlet Right Ventricle ◽  
Parachute Mitral Valve ◽  
Valve Opening ◽  
Polytetrafluoroethylene Patch

A 3-year-old female presented with double-outlet right ventricle associated with supravalvular mitral ring, parachute mitral valve, left persistent superior vena cava, and atrial septal defect. The supra-annular mitral valve ring was resected. Only one papillary muscle of the mitral valve could be detected and this was minimally divided to achieve adequate valve opening. An intraventricular tunnel repair technique using a polytetrafluoroethylene patch was carried out to repair the double-outlet right ventricle, which had a subaortic ventricular septal defect. The follow-up results at 2 years are excellent.

scholarly journals 870 Surgical Outcomes of Primary and Two-Stage Atrioventricular Septal Defect (AVSD) Repair: A Single Institution Experience

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J J Kwong ◽  
C C Hew ◽  
M Haranal
Keyword(s):  
Surgical Outcomes ◽  
Septal Defect ◽  
Atrioventricular Septal Defect ◽  
Two Stage ◽  
Palliative Procedure ◽  
Complete Repair ◽  
Significant Difference ◽  
Valve Insufficiency ◽  
Valve Function

Abstract Objective To examine the surgical outcomes of primary and two-stage repair of complete atrioventricular septal defect(AVSD). Method This retrospective study included 74 patients who underwent operation for balanced complete AVSD between January 2015 and December 2018 in National Heart Centre Kuala Lumpur. Patient demographics, types of procedure, post-op complications and follow-up atrioventricular (AV) valve function were analysed. Results Twenty-one patients (median age: 3 months(2.28-4.32months)), weight: 3.10kg( 2.7-3.82kg)) had Pulmonary Artery Banding (PAB) prior to complete AVSD repair. The post-banding weight of patients rose from 3.1kg to 6.4kg prior to complete repair. The rate of ventilator dependence decreased from 19.8 to 4.8%. There was no worsening of post-banding left AV valve insufficiency (5%) before the complete repair. There was no statistically significant difference in the outcomes after complete AVSD repair in both groups (mortality p = 0.133, morbidities p = 0.471). There was a trend towards higher left AV valve insufficiency in the PAB group over time (at discharge, 10 vs 12%; at 3-months, 12 vs 6%; at 1-year, 14 vs 11%). Similarly, the PAB group also demonstrated a trend towards higher rates of major post- operative complications (33 vs 21%) and in-hospital mortality (9.5 vs 1.9%). Conclusions PAB remained as an effective palliative procedure for patients who are not suitable for primary AVSD repair at the time of presentation. However, it is associated with a higher incidence of left AV valve insufficiency at follow up.

scholarly journals Does mitral valve repair matter in infants with ventricular septal defect combined with mitral regurgitation?

2018 ◽  
Vol 11 (2) ◽  
pp. 85-92
Author(s):  
Yuriy Yu Kulyabin ◽  
Ilya A Soynov ◽  
Alexey V Zubritskiy ◽  
Alexey V Voitov ◽  
Nataliya R Nichay ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ventricular Septal Defect ◽  
Postoperative Period ◽  
Septal Defect ◽  
Early Postoperative Period ◽  
Valve Repair ◽  
Significant Difference

OBJECTIVES: This study aimed to assess mitral valve function after repair of ventricular septal defect (VSD) combined with mitral regurgitation (MR) in the mid-term follow-up period, to evaluate the clinical utility of simultaneous mitral valve repair (MVR). METHODS: From June 2005 to March 2014, 60 patients with VSD and MR underwent surgical treatment. After performing propensity score analysis (1:1) for the entire sample, 46 patients were selected and divided into 2 groups: those with VSD closure and MVR - 23 patients and those with VSD closure without mitral valve intervention - 23 patients. The follow-up period - 32 (28;40) months. RESULTS: There was no postoperative mortality in either group. There was no significant difference in the duration of the postoperative period between groups. Mean cardiopulmonary bypass time and aortic cross-clamping time were significantly longer in the 'VSD + MVR' group (cardiopulmonary bypass, P=0.023; aortic cross-clamp, P< 0.001). There was no significant difference in regurgitation area (P=0.30) and MR grade (P= 0.76) between groups postoperatively. There was no significant difference in freedom from MR ≥ 2+ between groups (log-rank test, P= 0.28). The only significant risk factor for recurrent MR ≥ 2+ during the follow-up period was mild residual MR in the early postoperative period ( P=0.037). CONCLUSIONS: In infants with VSD combined with MR, simultaneous MVR has no benefits simultaneous MVR provided no advantage over that of isolated VSD closure. We found that the presence of mild residual MR in the early postoperative period predisposes the development of MR ≥ 2+ in follow-up period.

P365Does papillary muscle ablation affect mitral valve function: a single centre experience

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Stassen ◽  
D Dilling ◽  
J Vijgen ◽  
J Schurmans ◽  
P Koopman
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Delayed Enhancement ◽  
Papillary Muscles ◽  
Premature Ventricular Contractions ◽  
Valve Function ◽  
History Of ◽  
Study Population ◽  
The Impact

Abstract Introduction Ventricular arrhythmias from papillary muscles (PMs) often require extensive catheter ablation (CA). Not much is known about the mitral valve (MV) function after these extensive catheter ablations. Purpose The goal of this study was to determine the impact of papillary muscle CA on MV function.  Methods We retrospectively examined echocardiographic measurements in 21 patients with frequent premature ventricular contractions (PVCs) originating from the mitral PMs who underwent CA, dating from October 2012 till November 2018. We assessed MV function at baseline, 6 month and last follow-up. Degree of mitral regurgitation (MR) was graded as mild (ERO &lt;0,2 cm2, regurgitation volume (RV) &lt;30ml), moderate (ERO 0,2-0,4cm2, RV 30-59ml) or severe (ERO ≥0,4cm2, RV  ≥60ml). Significant MR was defined as a 2+ change. Results Mean age of the study population was 59,7 (27-80)years, 52,4% was female. 2 patients were known with ischemic heart disease. There was a family history of sudden cardiac death in 3 patients. Main symptoms at presentation were palpitations (66,7%), fatigue (33,3%), dyspnea (33,3%, all NYHA 2), dizziness (28,6%), angina pectoris (14,3%) and syncope (4,8%). Beta blocker (71,4%), flecaïnide (23,8%), amiodarone (9,5%), sotalol (4,8%) and propafenon (4,8%) were the most frequent medical therapies before CA. Mean burden of PVC before ablation was 15 574 (2000-39700)/24h. In 28,6% non sustained VT was documented, 1 patient suffered a sustained episode of VT.  After ablation, mean burden of PVC was reduced to 1331 (0-14200)/24h. Redo ablation was necessary in 28,6% of patients. PVCs orginated from the anterolateral PM in 33,3% and from the posteromedial PM in 66,7%. Mean troponin release was 9.4 ± 5.3 µg/l, mean troponin hs (since 2016) was 1591.0 ±658.6ng/ml. CMR was done in 14/21 (66,7%) patients before CA. In 5 out of 14 patients (35,7%), delayed enhancement at the papillary muscles was noticed. In 5 patients without delayed enhancement, CMR was repeated after CA. In all these 5 patients, delayed enhancement was noticed at the level of the papillary muscles.  At baseline, 15/21 had mild, 5/21 moderate and  1/21 severe MR. There was no significant chance in MR at 6m follow-up with 15/21 having mild and  6/21 moderate MR (p 0.58) with 1 patient having a significant MR 2+ change. At last follow-up (23.7 ± 22.6 months) there was also no significant chance in MR with 15/21 having mild and 6/21 moderate MR (p 0.58) without a significant MR 2+ change.  Complications occurred in 1 patient (transient AV blok). No patients died during follow up.  Conclusions Although PM ablation was associated with time extensive ablation, significant troponine release and documented delayed enhancement on post ablation MRI, there was no risk of additional valvular dysfunction after CA in this study. Larger studies will be necessary to confirm these findings.

Clinical trial enrollment and follow-up visit rates among survivors of childhood cancer.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 22-22
Author(s):  
Kelley Kennedy Hutchins ◽  
Sureyya Savasan ◽  
Ronald Thomas ◽  
Laura Strathdee ◽  
Jeffrey Warren Taub
Keyword(s):  
Clinical Trial ◽  
Cancer Treatment ◽  
Childhood Cancer ◽  
Survival Rates ◽  
Age At Diagnosis ◽  
Treatment Center ◽  
Increased Risk ◽  
Significant Difference

22 Background: Childhood cancer treatment outcomes have improved substantially with five-year overall survival rates reaching greater than 80%. However, survivors are at increased risk of long-term complications, and long-term follow-up (LTFU) is critical. Distance from a cancer treatment center and increased time from completion of therapy have been associated with decreased LTFU rates. We studied whether lack of enrollment in a therapeutic clinical trial may be an additional barrier to receiving LTFU care. Methods: We conducted a retrospective review of 353 patient records at the Children’s Hospital of Michigan enrolled in our Children’s Oncology Group (COG) registry between 1/1/05-12/31/10. All patients were ≤ 25 years of age at diagnosis.Sixty-seven patients were excluded (died prior to follow-up, n = 61; still on therapy, n = 5; insufficient information, n = 1). A total of 286 patient charts were available for analysis after exclusion. One hundred sixty-two (57%) patients were enrolled in a therapeutic clinical trial, and 124 (43%) were enrolled in a biology study alone due to lack of an open therapeutic clinical trial at the time of diagnosis. One hundred eighty-six (65%) patients were < 10 years of age at diagnosis. Results: Follow-up rates at one-, two- and five-years following completion of therapy for patients enrolled in a therapeutic clinical trial were 94.5%, 91.9% and 74%, respectively, compared to 82.9% (p = 0.002), 74% (p < 0.001) and 66% (p = 0.029) for patients not enrolled. The follow-up rate at five-years for patients who were < 10 years of age was 77.5% compared to 70.7% (p = 0.007) for patients > 10 years. There was no significant difference at one- or two-years based on age at diagnosis. Conclusions: Our findings demonstrate that patients enrolled in a therapeutic clinical trial have significantly superior LTFU rates compared to patients enrolled in biology studies alone. Younger age at diagnosis demonstrated a superior rate at five-years of follow-up. Our findings suggest that additional resources/strategies must be utilized to ensure better LTFU for patients not enrolled in therapeutic clinical trials.

Echocardiography Diagnosis of a Stenotic Double Orifice Parachute Mitral Valve with a Single Papillary Muscle

2000 ◽  
Vol 17 (4) ◽  
pp. 349-352 ◽  
Author(s):  
DILEK YESILBURSA ◽  
ANDREW MILLER ◽  
NAVIN C. NANDA ◽  
OSMAN MUKHTAR ◽  
WEN YING HUANG ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Parachute Mitral Valve ◽  
Double Orifice

Correction of Traumatic Tricuspid Insufficiency Using the Double Orifice Technique

2005 ◽  
Vol 13 (3) ◽  
pp. 238-240 ◽  
Author(s):  
Guo-Hua Luo ◽  
Wei-Guo Ma ◽  
Han-Song Sun ◽  
Jian-Ping Xu ◽  
Li-Zhong Sun ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Tricuspid Insufficiency ◽  
Ring Annuloplasty ◽  
Repeat Operation ◽  
Valve Function ◽  
Tricuspid Incompetence ◽  
Traumatic Tricuspid Regurgitation ◽  
Anterior Papillary Muscle ◽  
Double Orifice

Traumatic tricuspid insufficiency is an uncommon clinical condition and surgical procedures vary. In this paper we report our experience in treating traumatic tricuspid insufficiency using the double orifice technique. From January 2000 to September 2003, 10 patients with traumatic tricuspid regurgitation were admitted to our hospital, 5 of whom were corrected using the double orifice technique. There were 4 males and 1 female with ages ranging from 31 to 52 years. Preoperative transthoracic echocardiography (TTE) detected severe tricuspid regurgitation in 4 patients and moderate tricuspid regurgitation in 1 patient. At surgery, tear of the tricuspid anterior papillary muscle was found in 2 cases and anterior chordal rupture in 3 cases. The valves were successfully repaired using the double orifice technique in combination with ring annuloplasty. There was no repeat operation, no operative complications or deaths. Before discharge, TTE detected normal tricuspid valve function in 2 cases and tiny regurgitation in 3 cases. After a follow up of 8 to 36 months, TTE demonstrated normal valve function in 1 patient and tiny regurgitation in 4 patients. The double orifice technique appears to be a simple but effective method of repairing traumatic tricuspid incompetence. Satisfactory clinical outcomes can be produced in carefully selected patients.

Parannular Elliptical Posterior Resection: A Low-Impact Reparative Technique for Mitral Valve Prolapse

2015 ◽  
Vol 10 (4) ◽  
pp. 252-257
Author(s):  
Uberto Da Col ◽  
Simone Perticoni ◽  
Enrico Ramoni
Keyword(s):  
New York ◽  
Mitral Valve ◽  
Heart Association ◽  
Safe Alternative ◽  
Mitral Prolapse ◽  
Association Class ◽  
New York Heart Association ◽  
Valve Function ◽  
The Impact

Objective Although effective, Carpentier technique for mitral regurgitation presents two “Achille's heel”: the resection of the whole prolapsing section of posterior mitral leaflet (PML) including chordae tendinae and the annular distortion due to plication. An alternative technique of limited PML resection, which preserves mitral anatomy decreasing the impact on valve function, and 9-year outcome are presented. Methods Since April 2005 till March 2014, of 205 patients affected by mitral prolapse scheduled for repair (mitral valve repair), 54 patients have been included in the study. The rationale of the new technique was to limit PML resection to achieve a fair reduction of the prolapsing scallop(s) height, to avoid leaflet and annular distortion, and to spare the coaptation surface and other substantial structures. According to the observation that the posterior smooth zone of PML is quite free from chordal insertions, an elliptical slice of tissue was resected from this area. Annuloplasty and neochordal insertion when indicated completed the procedure. Results Up to 9 years of follow-up was 98% complete. One inhospital death, two late noncardiac deaths, one redo operation due to endocarditis were reported. On late follow-up, 92% patients were on New York Heart Association class I. Late echocardiography showed stability of repair (regurgitation grade of ≤1 in 92% of patients). Nearly two third of valves preserved good PML mobility. Conclusions The parannular elliptical posterior leaflet resection, providing excellent stable midterm results, seems to be a safe alternative method for repair of PML prolapse. It avoids distortion and weakening of annulus and leaflet, and it allows restoring a proper coaptation surface and maintains a satisfactory PML motion.

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