MRI to Evaluate Left Atrial and Ventricular Reverse Remodeling After Restrictive Mitral Annuloplasty in Dilated Cardiomyopathy

Background— Data on reverse remodeling of the left atrium (LA) and left ventricle (LV) after restrictive annuloplasty in patients with dilated cardiomyopathy are scarce, and follow-up studies are performed with echocardiography. Methods and Results— Twenty patients with dilated cardiomyopathy and severe mitral regurgitation selected for restrictive mitral annuloplasty underwent serial MRI studies (within 1 week before surgery, and 2 months [n =18] and 1 year [n =13] after surgery). Early mortality was 10%; all patients were free from endocarditis and thromboembolism. New York Heart Association class improved from 3.2±0.4 to 1.2±0.9. Only 1 patient developed recurrent severe mitral regurgitation during follow-up and it was re-repaired. LA end-systolic volumes decreased significantly over time (from 165±48 mL to 109±23 mL to 111±28 mL; P <0.01), as did LA end-diastolic volumes (from 92±32 mL to 71±22 mL to 75±17 mL; P =0.01). LV end-diastolic volumes decreased significantly (from 244±56 mL to 184±54 mL to 195±67 mL; P <0.01), whereas end-systolic volumes did not change significantly. LV ejection fraction increased significantly (from 35±8% to 46±13% to 46±15%; P <0.01) and LV mass decreased significantly (from 150±43 grams to 132±39 grams to 136±33 grams; P =0.02). Conclusion— Restrictive annuloplasty in patients with dilated cardiomyopathy yielded excellent clinical results associated with significant LA and LV reverse remodeling over time as demonstrated by MRI.

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Reconstructive surgery for Ebstein anomaly: three decades of experience

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz022 ◽

2019 ◽

Vol 56 (2) ◽

pp. 385-392

Author(s):

Kevin M Veen ◽

Mostafa M Mokhles ◽

Jolien W Roos-Hesselink ◽

Bas R Rebel ◽

Johanna J M Takkenberg ◽

...

Keyword(s):

New York ◽

Tricuspid Regurgitation ◽

Survival Data ◽

Heart Association ◽

Reoperation Rate ◽

Ebstein Anomaly ◽

Mortality And Morbidity ◽

Cone Repair ◽

Over Time

AbstractOBJECTIVESSince 1988, our centre employs vertical plication repair with deattachment and reattachment of the tricuspid valve for Ebstein anomaly. This study describes the characteristics and long-term outcomes of our single-centre cohort.METHODSData from all patients operated on between 1988 and 2016 were retrospectively collected. Kaplan–Meier analyses were done for survival data and mixed models were used to analyse longitudinally collected clinical and echocardiography data.RESULTSThirty-six patients (mean age: 25.4 ± 15.9 years, 36% male) were operated on using the Carpentier–Chauvaud 21 (58%) or Cone repair 15 (42%). One patient (3%) died in hospital. Two late deaths were observed, yielding a survival of 97 ± 3% at 25 years. Reoperation was performed in 6 patients after a mean follow-up of 14.1 ± 10.3 years, resulting in a freedom of reoperation of 80 ± 8% at 25 years. During follow-up, predicted probability of being in New York Heart Association III/IV did not exceed 10%. Modelling longitudinal evolution of tricuspid regurgitation showed no major changes over time. Additionally, a rigid ring repair was associated with a higher probability of tricuspid regurgitation, especially after the first years after the operation. A full Cone repair was associated with less progression of tricuspid regurgitation over time.CONCLUSIONSRepair of Ebstein abnomaly is associated with low mortality and morbidity, acceptable reoperation rate and excellent valve function over time, especially in patients with completed Cone repair. Therefore, we conclude that in our centre, repair of Ebstein abnomaly is a durable technique to treat patients.

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Restrictive Mitral Annuloplasty With or Without Surgical Ventricular Restoration in Ischemic Dilated Cardiomyopathy With Severe Mitral Regurgitation

Circulation ◽

10.1161/circulationaha.110.010330 ◽

2011 ◽

Vol 124 (11_suppl_1) ◽

pp. S107-S114 ◽

Cited By ~ 4

Author(s):

Y. Shudo ◽

K. Taniguchi ◽

K. Takeda ◽

T. Sakaguchi ◽

T. Funatsu ◽

...

Keyword(s):

Mitral Regurgitation ◽

Dilated Cardiomyopathy ◽

Severe Mitral Regurgitation ◽

Surgical Ventricular Restoration ◽

Mitral Annuloplasty ◽

Ventricular Restoration

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Thyroid Status, Cardiac Function, and Mortality in Patients With Idiopathic Dilated Cardiomyopathy

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2014-4159 ◽

2015 ◽

Vol 100 (8) ◽

pp. 3210-3218 ◽

Cited By ~ 25

Author(s):

Wenyao Wang ◽

Haixia Guan ◽

A. Martin Gerdes ◽

Giorgio Iervasi ◽

Yuejin Yang ◽

...

Keyword(s):

New York ◽

Dilated Cardiomyopathy ◽

Thyroid Function ◽

Thyroid Dysfunction ◽

Heart Association ◽

Idiopathic Dilated Cardiomyopathy ◽

Risk Of Mortality ◽

Low T3 ◽

New York Heart Association

Context: Previous studies claiming a relationship between thyroid dysfunction and poor prognosis of heart failure (HF) had a major limitation in that they included patients with different etiologies. Objective: With complete information of thyroid function profile from 458 consecutive patients with idiopathic dilated cardiomyopathy, we tested the hypothesis that thyroid status can independently influence mortality in patients with HF. Design, Patients, and Outcome Measure: The original cohort consisted of 572 consecutive patients with idiopathic dilated cardiomyopathy, and 458 patients remained at the end of follow-up. All patients took thyroid function tests and other regular examinations in hospital. The risk of mortality was evaluated based on free T3, TSH, and the whole thyroid function profile, respectively. Results: The most frequent thyroid dysfunction was subclinical hypothyroidism (n = 41), followed by subclinical hyperthyroidism (n = 35), low-T3 syndrome (n = 17), and hypothyroidism (n = 12). Logistic analysis showed log-TSH and free T3 as independent predictors of exacerbated cardiac function (New York Heart Association stages III–IV vs New York Heart Association stages I–II). During the follow-up (17 ± 8 mo), 111 cumulative deaths occurred. Hypothyroidism was the strongest predictor of mortality [hazard ratio (HR) 4.189; 95% confidence interval (CI) 2.118–8.283)], followed by low-T3 syndrome (HR 3.147; 95% CI 1.558–6.355) and subclinical hypothyroidism (HR 2.869; 95% CI 1.817–4.532). Subclinical hyperthyroidism showed no significant impact. Conclusions: We found a clear association between thyroid dysfunction and increased risk of mortality in idiopathic dilated cardiomyopathy with HF. These results suggest that monitoring thyroid function in HF patients is necessary, and further studies on the treatment of HF with thyroid dysfunction are needed.

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Outcomes after the MitraClip Procedure in Patients at Very High Risk for Conventional Mitral Valve Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000571 ◽

2018 ◽

Vol 13 (6) ◽

pp. 433-437

Author(s):

Joshua L. Manghelli ◽

Daniel I. Carter ◽

Ali J. Khiabani ◽

Hersh S. Maniar ◽

Ralph J. Damiano ◽

...

Keyword(s):

New York ◽

High Risk ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Heart Association ◽

Mitral Valve Surgery ◽

Risk Of Mortality ◽

New York Heart Association ◽

Predicted Risk

Objective Approximately 50% of patients with severe symptomatic mitral regurgitation are deemed too high risk for surgery. The MitraClip procedure is a viable option for this population. Our goal was to assess outcomes and survival of patients who underwent the MitraClip procedure at an institution where mitral valve surgery is routinely performed. Methods A retrospective study of patients undergoing the MitraClip procedure was performed. Baseline characteristics, perioperative outcomes, and follow-up echocardiographic and clinical outcomes were examined. Primary end point was survival. Secondary end points included technical failure (residual 3/4+ mitral regurgitation), reoperation, New York Heart Association symptoms, 30-day mortality, and other clinical outcomes. Predictors of mortality were determined using multivariable regression analysis. Results Fifty consecutive patients underwent the MitraClip procedure during the 4-year period. The average age was 83, the Society of Thoracic Surgeons predicted risk of mortality mean was 9.4%, 88% (44/50) had New York Heart Association III/IV symptoms, 86% (43/50) had 4+ mitral regurgitation, and 72% (36/50) had degenerative mitral disease etiology. Echocardiographic data (median [interquartile range] follow-up = 43 [26–392]) showed that 86% (43/50) of patients had 2+ or less mitral regurgitation. Sixty percent (24/40) had New York Heart Association I/II symptoms at last follow-up. Predictors of mortality were higher Society of Thoracic Surgeons predicted risk of mortality ( P = 0.042, hazard ratio = 1.098) and previous cardiac surgery ( P = 0.013, hazard ratio = 3.848). Survival at 1 and 2 years was 75% and 63%, respectively. Conclusions Many patients with mitral valve regurgitation who are high risk for open surgery can be treated with the MitraClip procedure. In our study, most patients (86%) had a technically successful operation and postoperative outcomes including survival were acceptable.

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Does Coronary Artery Bypass Grafting Alone Correct Moderate Ischemic Mitral Regurgitation?

Circulation ◽

10.1161/circ.104.suppl_1.i-68 ◽

2001 ◽

Vol 104 (suppl_1) ◽

Author(s):

Lishan Aklog ◽

Farzan Filsoufi ◽

Kathryn Q. Flores ◽

Raymond H. Chen ◽

Lawrence H. Cohn ◽

...

Keyword(s):

New York ◽

Mitral Regurgitation ◽

Preoperative Diagnosis ◽

Artery Bypass ◽

Heart Association ◽

Ischemic Mitral Regurgitation ◽

Optimal Management ◽

Mitral Annuloplasty ◽

New York Heart Association ◽

Moderate Ischemic Mitral Regurgitation

Background The optimal management of moderate (3+ on a scale of 0 to 4+) ischemic mitral regurgitation (MR) remains controversial. Some advocate CABG alone, whereas others favor concomitant mitral annuloplasty. To clarify the optimal management of these patients, we evaluated the early impact of isolated CABG on moderate ischemic MR. Methods and Results Between January 1992 and August 1999, 136 patients (54% male, mean age 70.5 years, mean New York Heart Association class 2.7, mean ejection fraction 38.1%) with a preoperative diagnosis of moderate ischemic MR, without leaflet prolapse or pathology, underwent isolated CABG. Thirty-eight (28%) of 136 patients had intraoperative transesophageal echocardiography (TEE) before CABG, and 68 (50%) had postoperative transthoracic echocardiography (TTE) within 6 weeks of surgery. The subgroups of patients undergoing intraoperative TEE and postoperative TTE had preoperative characteristics similar to the overall group. The 30-day operative mortality was 2.9% ( \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(\frac{4}{136}\) \end{document} ). Intraoperative TEE downgraded the severity of MR to mild or less (0 to 2+) in 89% ( \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(\frac{34}{38}\) \end{document} ). On postoperative TTE, 40% ( \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(\frac{27}{68}\) \end{document} ) continued to have at least moderate MR (3 to 4+), 51% ( \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(\frac{35}{68}\) \end{document} ) improved somewhat to mild (2+) MR, and only 9% ( \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(\frac{6}{68}\) \end{document} ) had resolution of their MR (0 to 1+). The mean preoperative, intraoperative, and postoperative MR grades were 3.0±0.0, 1.4±1.0, and 2.3±0.8, respectively ( P <0.001). Conclusions CABG alone for moderate ischemic MR leaves many patients with significant residual MR and may not be the optimal therapy for most patients. Intraoperative TEE may significantly underestimate the severity of ischemic MR. A preoperative diagnosis of moderate MR may warrant concomitant mitral annuloplasty.

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218: It There Still a Role for Undersized Mitral Annuloplasty for Mitral Regurgitation in End-Stage Dilated Cardiomyopathy: Single Centre Long Term Follow-Up

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2008.11.848 ◽

2009 ◽

Vol 28 (2) ◽

pp. S142

Author(s):

G. Bruschi ◽

T. Colombo ◽

S. Trunfio ◽

E. Ribera ◽

C. Russo ◽

...

Keyword(s):

Mitral Regurgitation ◽

Dilated Cardiomyopathy ◽

Single Centre ◽

Mitral Annuloplasty ◽

Long Term Follow Up ◽

End Stage

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Severe mitral regurgitation from Libman–Sacks endocarditis treated with MitraClip: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab361 ◽

2021 ◽

Vol 5 (10) ◽

Author(s):

Wong Ningyan ◽

Ignasius Aditya Jappar ◽

Ewe See Hooi ◽

Yeo Khung Keong

Keyword(s):

New York ◽

Mitral Regurgitation ◽

Heart Association ◽

Class Ii ◽

Left Ventricular ◽

Functional Class ◽

Left Ventricular Ejection ◽

Severe Mitral Regurgitation ◽

Nyha Functional Class ◽

New York Heart Association

Abstract Background Systemic lupus erythematosus (SLE) valvulopathy can manifest as a spectrum of pathologies and treatment of severe valvular dysfunction thus far has been surgical. However, surgery in patients with SLE is frequently associated with high morbidity and mortality due to the presence of significant co-morbidities. Case summary We report the case of a 41-year-old woman with SLE and anti-phospholipid syndrome with extensive co-morbidities including lupus nephritis, pancytopaenia, cerebrovascular accident, and severe airway obstruction from ipsilateral lung collapse and bronchiectasis. She had severe mitral regurgitation (MR) from Libman–Sacks endocarditis and in recent months developed heart failure with progressive exertional dyspnoea from New York Heart Association (NYHA) functional Class from New York Heart Association (NYHA) functional class II to III. In addition, there was progressive left ventricular dilatation and reduction in left ventricular ejection fraction. In view of the high surgical risk, she underwent transcatheter edge-to-edge repair (TEER) of the mitral valve with the MitraClip system. At 1-month follow-up, she was back to NYHA functional Class II with mild MR. Discussion Our case demonstrates that in select patient with suitable anatomy, TEER is a potential treatment option for severe MR from SLE valvulopathy.

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