Severe hemolytic anemia and acute renal failure after mitral valve repair associated with non-endothelialization of artificial chordae tendinae: case report

Abstract Background Mechanical hemolytic anemia and acute renal failure are rare complications of mitral valve repair. Case presentation We report a unique case of severe hemolytic anemia and severe acute renal failure after mitral valve repair using artificial chordae tendinae. Conservative therapy including plasmapheresis and blood transfusion was not effective. The major cause of the mechanical hemolysis was mild mitral regurgitation originating from the centre of the valve and striking the annuloplasty ring. The hemolytic anemia resolved gradually after the replacement of mitral valve. The new artificial chordae tendinae was found to be completely non-endothelialized in the surgery. Non-endothelialization of artificial chordae tendinae may also play a role in the genesis of mechanical anemia. Conclusions The major cause of the mechanical hemolysis was mild mitral regurgitation originating from the centre of the valve and striking the annuloplasty ring. Non-endothelialization of foreign materials might be another mechanism of hemolysis after mitral repair.

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Severe Hemolytic Anemia and Acute Renal Failure After Mitral Valve Repair Associated With Non-endothelialization of Artificial Chordae Tendinae: Case Report

10.21203/rs.3.rs-921534/v1 ◽

2021 ◽

Author(s):

Jing Li ◽

Qun-Jun Duan

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Hemolytic Anemia ◽

Mitral Valve Repair ◽

Rare Complication ◽

Valve Repair ◽

Annuloplasty Ring ◽

Artificial Chordae

Abstract Background: Mechanical hemolytic anemia and acute renal failure are rare complication sof mitral valve repair.Case presentation: We report a unique case of severe hemolytic anemia and severe acute renal failure after mitral valve repair using artificial chordae tendinae. Conservative therapy including plasmapheresis and blood transfusion was not effective. The major cause of the mechanical hemolysis was mild mitral regurgitation originating from the centre of the valve and striking the annuloplasty ring. The hemolytic anemia resolved gradually after the replacement of mitral valve. The new artificial chordae tendinae was found to be completely non-endothelialized in the surgery. Non-endothelialization of artificial chordae tendinae may also play a role in the genesis of mechanical anemia. Conclusions: The major cause of the mechanical hemolysis was mild mitral regurgitation originating from the centre of the valve and striking the annuloplasty ring. Non-endothelialization of foreign materials might be another mechanism of hemolysis after mitral repair.

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

Kosuyolu Heart Journal ◽

10.51645/khj.2021.m133 ◽

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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Microinvasive Mitral Valve Surgery: A New Frontier to Tackle Mitral Regurgitation

10.22541/au.163251877.73709582/v1 ◽

2021 ◽

Author(s):

Solomon Seifu ◽

Eduardo de Marchena

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Repair System ◽

Valve Repair ◽

Mitral Repair ◽

New Frontier ◽

Clinical Benefits

Microinvasive, catheter-based mitral valve repair of severe mitral regurgitation utilizes less invasive approaches with less procedural morbidity and mortality. The procedural steps and clinical benefits of the transcatheter transapical mitral valve annuloplasty (AMEND mitral repair implant) and transcatheter transapical chordal repair systems (Neochord DS 1000 device and Harpoon Mitral Valve Repair System) are reviewed in this manuscript.

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Optimizing P2 Neochordal Length and Stability in Mitral Valve Repair With Use of a Polypropylene Loop

Texas Heart Institute Journal ◽

10.14503/thij-18-6913 ◽

2020 ◽

Vol 47 (3) ◽

pp. 207-209

Author(s):

Anil Ozen ◽

Ertekin Utku Unal ◽

Hamdi Mehmet Ozbek ◽

Gorkem Yigit ◽

Hakki Zafer Iscan

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Severe Mitral Regurgitation ◽

Posterior Leaflet ◽

Valve Repair ◽

Chordae Tendineae ◽

Optimal Length ◽

Precise Method ◽

Artificial Chordae

Determining the optimal length of artificial chordae tendineae and then effectively securing them is a major challenge in mitral valve repair. Our technique for measuring and stabilizing neochordae involves tying a polypropylene suture loop onto the annuloplasty ring. We used this method in 4 patients who had moderate-to-severe mitral regurgitation from degenerative posterior leaflet (P2) prolapse and flail chordae. Results of intraoperative saline tests and postoperative transesophageal echocardiography revealed only mild insufficiency. One month postoperatively, echocardiograms showed trivial regurgitation in all 4 patients. We think that this simple, precise method for adjusting and stabilizing artificial chordae will be advantageous in mitral valve repair.

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Idiopathic Acute Mitral Regurgitation Due to Chordal Rupture in Infants: Surgical Management and Results

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118809076 ◽

2019 ◽

Vol 10 (1) ◽

pp. 37-41

Author(s):

Kosuke Yoshizawa ◽

Keiichi Fujiwara ◽

Nobuhisa Ohno ◽

Kentaro Watanabe ◽

Hisanori Sakazaki

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Surgical Intervention ◽

Valve Repair ◽

Aortic Cross Clamp Time ◽

Aortic Cross Clamp ◽

Acute Mitral Regurgitation ◽

Artificial Chordae

Objective: Emergency surgical treatment is required for idiopathic acute mitral regurgitation due to chordae rupture in infants. Nevertheless, mitral valve repair for such a patient population still remains challenging. We report our experience with mitral valve repair for idiopathic acute mitral regurgitation due to chordae rupture in infants. Methods: From 2005 to 2017, six infants (four boys) were diagnosed with acute mitral regurgitation due to chordae rupture and underwent mitral valve repair. The median age, mean body weight, and median follow-up period were 5.5 months (range: 4-9 months), 6.8 kg (range: 5.5-8.0 kg), and 6.4 years (range: 6 months to 10 years), respectively. Results: In all cases, surgical intervention was performed within 24 hours of admission. Artificial chordae reconstruction and paracommissural edge-to-edge repair were utilized in three and four cases, respectively, while Kay’s annuloplasty was performed in all cases. Mean cardiopulmonary bypass time and aortic cross-clamp time were 117 minutes (range: 70-143 minutes) and 73 minutes (range: 35-108 minutes), respectively. No early or late deaths and reoperations had occurred during the follow-up period. Moreover, postoperative mitral regurgitation was significantly reduced, while no chronologic progression of mitral regurgitation was observed. Conclusions: The combination of various techniques, such as artificial chordae reconstruction, paracomissural edge-to-edge repair, and Kay’s annuloplasty, can be a promising surgical option for idiopathic acute mitral regurgitation due to chordae rupture in infants.

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Haemolysis and acute renal failure after mitral valve repair

Acta Cardiologica ◽

10.1080/ac.68.2.2967277 ◽

2013 ◽

Vol 68 (2) ◽

pp. 189-191 ◽

Cited By ~ 1

Author(s):

Els Viaene ◽

Pascal Schroeyers ◽

Karl Dujardin

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair

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Coming undone: a case of annuloplasty ring suture degeneration post mitral valve repair leading to recurrent severe MR

Echo Research and Practice ◽

10.1530/erp-19-0058 ◽

2020 ◽

Vol 7 (1) ◽

pp. K7-K10

Author(s):

Patrick Savage ◽

Michael Connolly

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Progressive Disease ◽

List Type ◽

Valve Repair ◽

Annuloplasty Ring ◽

2D And 3D ◽

Learning Points

Summary Mitral valve repair is the gold standard treatment for degenerative mitral valve disease with superior perioperative and long-term morbidity and mortality outcomes vs mitral valve replacement. The 10 year survival freedom from redo valve repair varies from 72 to 90%. Often, failure of valve repair necessitating redo surgery is directly related to disease progression; however, rarely it can be attributed to technical complications such as annuloplasty dehiscence, leaflet suture rupture, incorrect artificial chord length or incorrect annuloplasty position. We report one such case of severe mitral regurgitation secondary to a degenerative annuloplasty ring suture occurring 1 year post valve repair. Learning points: Differentiation of causative pathology involved in recurrent mitral regurgitation following repair has important implications for patient outcomes. In the hands of an experienced practitioner echocardiography – in particular, integrated 2D- and 3D echocardiography – is a powerful tool for differentiating between progressive disease and procedural failure.

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Long-Term Results of Mitral Valve Repair for Severe Mitral Regurgitation in Infants: Fate of Artificial Chordae

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2012.03.064 ◽

2012 ◽

Vol 94 (2) ◽

pp. 581-586 ◽

Cited By ~ 14

Author(s):

Takashi Murashita ◽

Takaya Hoashi ◽

Koji Kagisaki ◽

Kenichi Kurosaki ◽

Isao Shiraishi ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Long Term Results ◽

Severe Mitral Regurgitation ◽

Valve Repair ◽

Artificial Chordae

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Repair Options for Mitral Regurgitation

European Cardiology Review ◽

10.15420/ecr.2011.7.2.131 ◽

2011 ◽

Vol 7 (2) ◽

pp. 131

Author(s):

Ottavio Alfieri ◽

Michele De Bonis ◽

◽

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Surgical Techniques ◽

Long Term Results ◽

Functional Mitral Regurgitation ◽

Valve Repair ◽

Term Survival ◽

Mitral Repair

Mitral valve repair is the treatment of choice for severe degenerative mitral regurgitation providing better freedom from cardiac events, quality of life and long-term survival compared with mitral valve replacement. Increasing numbers of asymptomatic patients are therefore referred for mitral repair. With refinements of the surgical techniques, long-term results have further improved in the last decade. Certainly experience is crucial in determining the likelihood of success and patients with a mitral valve deemed reparable should be referred to centers with high volume and extensive experience in this field. In this article the current role of mitral valve repair in degenerative mitral regurgitation (MR) will be outlined. Moreover some important concepts regarding indication and techniques of mitral repair in the more challenging setting of secondary (functional) mitral regurgitation will be presented and discussed.

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Early Period Mitral Stenosis After Mitral Annuloplasty: Functional or Real Stenosis?

10.21203/rs.3.rs-141458/v1 ◽

2021 ◽

Author(s):

Serkan Asil ◽

Veysel Özgür Barış ◽

Suat Görmel ◽

Murat Çelik ◽

Uygar Çağdaş Yüksel

Keyword(s):

Case Report ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Mitral Stenosis ◽

Early Period ◽

Valve Repair ◽

Mitral Valve Leaflet ◽

Annuloplasty Ring ◽

Mitral Annuloplasty

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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