Acquired submitral aneurysms may be associated with mitral paravalvular leaks

Acquired submitral aneurysm after mitral valve replacement is caused by weakness of the annular tissues induced by inflammation, scarring, and ischemia from surgical trauma. The asynchronous stretch of the annulus caused by the submitral aneurysm may cause recurrent paravalvular leaks. In patients with acquired submitral aneurysms and paravalvular leaks, ideal solution is a repeat surgery to address both the aneurysm and the leak. However, when patients are at high risk for repeat surgeries on cardiopulmonary bypass through sternotomy, transcatheter closure of these paravalvar leaks may offer an alternative solution. Four such procedures in three patients are detailed in this report.

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Postoperative Nesiritide Use following High-Risk Mitral Valve Replacement

The Heart Surgery Forum ◽

10.1532/hsf98.20033008 ◽

2004 ◽

Vol 7 (3) ◽

pp. E189-E190 ◽

Cited By ~ 9

Author(s):

John W. C. Entwistle, III ◽

David E. McLoughlin ◽

Kourosh Baghelai

Keyword(s):

High Risk ◽

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement

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Transcatheter Closure of Left Ventricular Pseudoaneurysm After Mitral Valve Replacement

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2019.12.019 ◽

2020 ◽

Vol 110 (2) ◽

pp. e123-e125

Author(s):

Ahmet Arnaz ◽

Serdar Akansel ◽

Yusuf Yalcinbas ◽

Arda Saygili ◽

Tayyar Sarioglu

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Transcatheter Closure ◽

Left Ventricular ◽

Left Ventricular Pseudoaneurysm

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Successful Management of Massive Pulmonary Embolism Occurring during Cardiopulmonary Bypass for Mitral Valve Replacement

CHEST Journal ◽

10.1378/chest.73.2.236 ◽

1978 ◽

Vol 73 (2) ◽

pp. 236-238 ◽

Cited By ~ 3

Author(s):

Joseph C. Cleveland ◽

Ira M. Lebenson ◽

Jack W. Friedman

Keyword(s):

Pulmonary Embolism ◽

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Massive Pulmonary Embolism ◽

Successful Management

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Cardiac surgery in patients with heparin induced thombocytopenia (HIT II)

Acta chirurgica iugoslavica ◽

10.2298/aci0901047j ◽

2009 ◽

Vol 56 (1) ◽

pp. 47-52

Author(s):

M.D. Jovic ◽

D.G. Nezic ◽

B.M. Calija ◽

D.S. Nenadic ◽

A.M. Knezevic ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Anticoagulant Therapy ◽

Anticoagulation Therapy ◽

Thrombin Inhibitors ◽

Postoperative Treatment ◽

Per Oral

Heparin-induced thrombocytopenia (HIT) might be lifethreatening in patients undergoing open heart surgery, due to thromboembolic events, thrombocytopenia and bleeding. If cardiac surgery with cardiopulmonary bypass (CPB) is necessary, anticoagulation therapy will be based on usage of danaparoid or direct thrombin inhibitors. Female patient was switched from per oral anticoagulant therapy to low molecular heparin therapy preparing for reredo mitral valve replacement due to endocarditis and artificial valve thrombosis. In next 10 days, thrombocytopenia was obvious (Tr 302 000 mm3 to 11 000 mm3) , and diagnoses of HIT were done. Anticoagulant therapy was continued with danaparoid, 750 IU/12 h sc. During the surgery, reredo mitral valve replacement and aortocoronary bypass on anterior descending coronary artery, blood salvage technique with rhirudin( intravenous bolus 0,4 mg/kg, in CPB prajming solution 0,4mg/kg and continuous infusion during CPB 0,15 mg/kg/h ) during cardiopulmonary bypass was used. Active coagulation time and +++ were monitored, without any sign of micro thrombosis in circuit. Postoperatively, per oral anticoagulation therapy was initiated with prolonged postoperative treatment due to basic disease, endocarditis. Patient was discharged from hospital on 21-st postoperative day without any complication.

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Mitral surgical redo versus transapical transcatheter mitral valve implantation

PLoS ONE ◽

10.1371/journal.pone.0256569 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0256569

Author(s):

Alina Zubarevich ◽

Marcin Szczechowicz ◽

Arian Arjomandi Rad ◽

Robert Vardanyan ◽

Philipp Marx ◽

...

Keyword(s):

High Risk ◽

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Left Ventricular ◽

High Risk Patients ◽

Transcatheter Mitral Valve Replacement ◽

Risk Patients ◽

The Mean ◽

Similar Survival

Background Transcatheter methods have been rapidly evolving to provide an alternative less invasive therapeutic option, mainly because redo patients often present with multiple comorbidities and high operative risk. We sought to evaluate and compare our experience with transapical transcatheter mitral valve replacement (TA-TMVR) to conventional redo mitral valve replacement in patients presenting with degenerated biological mitral valve prostheses or failed valve annuloplasty. Methods and material Between March 2012 and November 2020, 74 consecutive high-risk patients underwent surgical redo mitral valve replacement (n = 33) or TA-TMVR (n = 41) at our institution. All patients presented with a history of a surgical mitral valve procedure. All transcatheter procedures were performed using the SAPIEN XT/3™ prostheses. Data collection was prospectively according to MVARC criteria. Results The mean logistic EuroSCORE-II of the whole cohort was 19.9±16.7%, and the median STS-score was 11.1±12.5%. The mean age in the SMVR group was 63.7±12.8 years and in the TMVR group 73.6±9.7 years. Patients undergoing TA-TMVR presented with significantly higher risk scores. Echocardiography at follow up showed no obstruction of the left ventricular outflow tract, no paravalvular leakage and excellent transvalvular gradients in both groups (3.9±1.2 mmHg and 4.2±0.8 mmHg in the surgical and transcatheter arm respectively). There was no difference in postoperative major adverse events between the groups with no strokes in the whole cohort. Both methods showed similar survival rates at one year and a 30-day mortality of 15.2% and 9.8% in SAVR and TMVR group, respectively. Despite using contrast dye in the transcatheter group, the rate of postoperative acute kidney failure was similar between the groups. Conclusion Despite several contraindications for surgery, we showed the non-inferiority of TA-TMVR compared to conventional surgical redo procedures in high-risk patients. With its excellent hemodynamic and similar survival rate, TA-TMVR offers a feasible alternative to the conventional surgical redo procedure in selected patients.

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Left ventricular outflow tract obstruction after transcatheter mitral valve replacement: the importance of preprocedural planning and prevention

MOJ Clinical & Medical Case Reports ◽

10.15406/mojcr.2021.11.00395 ◽

2021 ◽

Vol 11 (4) ◽

pp. 116-119

Author(s):

Muhammad Abdulbasit

Keyword(s):

High Risk ◽

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Transcatheter Mitral Valve Replacement ◽

Left Ventricular Outflow

Given the prevalence of mitral valve pathology in high-risk patients, transcatheter mitral valve replacement (TMVR) is becoming an attractive treatment modality. A known complication of TMVR is left ventricular outflow tract obstruction (LVOT) due to the prosthetic mitral valve and native anterior mitral valve leaflet encroaching into the LVOT. This is a serious complication which can lead to decreased cardiac output and death. Preprocedural planning with various imaging modalities (multi-detector cardiac CT and echocardiography) can predict those at high risk of LVOT obstruct. To increase awareness and to prevent this complication from occurring in the future, we present a case of LVOT obstruction after TMVR.

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