Reversal of Left Ventricular Functions in Chronic Mitral Regurgitation after Mitral Valve Replacement

2016 ◽  
Vol 19 (4) ◽  
pp. 160
Author(s):  
Montaser Elsawy Abd elaziz ◽  
Islam Moheb Ibrahim
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
The Mean ◽  
Ventricular Functions

<strong>Background:</strong> Mitral valve regurgitation leads to deterioration of left ventricular functions if not treated early. We aimed to study the effect of mitral valve replacement on normalization of ejection fraction, remodeling of left ventricular dimensions, and left atrial reduction in patients with chronic mitral regurgitation.<br /><strong>Methods:</strong> Between December 2012 and August 2014, <br />45 patients with chronic mitral regurgitation underwent isolated mitral valve replacement. None of the patients had any other severe valvular or concomitant disease or severe coronary heart  disease. The patients were evaluated by echocardiography (preoperative, 1-week, and 1-year postoperative). The results were statistically analyzed by paired t test.<br /><strong>Results:</strong> Forty-five patients who underwent mitral valve replacement in our hospital were included in  the study. The group comprised 20 men and 25 women; the mean age was 31.8 ± 6.76 years. The mean  left ventricular ejection fraction was 61.09 ± 7.6 and decreased significantly to 59.04 ± 6.65 and 59.67 ± 6.56, 1-week and 1-year postoperative follow up, respectively. The left atrium showed significant reduction in size (4 ± 0.54 cm) at 1-year postoperative follow up, from (4.51 ± 0.57 cm) one-week postoperative, and from (5.55 ± 0.88 cm) preoperatively. The mean left ventricular end systolic diameter significantly decreased from 4.06 ± 0.65 cm preoperatively to 3.4 ± 0.4 cm, 1-week postoperative (P = .01), and also decreased significantly to 3.45 ± 0.51 cm at 1-year follow up postoperatively, but was higher than that at 1-week follow up. Also, the mean left ventricular end diastolic diameter decreased  significantly during periods of follow up (P &lt; .001).<br /><strong>Conclusion:</strong> Reversal of left ventricular functions and reduction of left-sided chamber dimensions are possible if early mitral valve replacement is considered in chronic mitral regurgitation before worsening of the condition.<br /><br />

Mitral valve replacement for isolated mitral regurgitation: Analysis of clinical course and late postoperative left ventricular ejection fraction

1981 ◽  
Vol 48 (4) ◽  
pp. 647-654 ◽  
Author(s):  
Harry R. Phillips ◽  
Frederick H. Levine ◽  
Jane E. Carter ◽  
Charles A. Boucher ◽  
Mary D. Osbakken ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricular Ejection Fraction ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Clinical Course ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Transaortic Edge-To-Edge Repair for Functional Mitral Regurgitation during Aortic Valve Replacement: A 13-Year Experience

2016 ◽  
Vol 11 (6) ◽  
pp. 425-429 ◽  
Author(s):  
Christos G. Mihos ◽  
Maiteder Larrauri-Reyes ◽  
Judy Hung ◽  
Orlando Santana
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
The Mean

Objective The study evaluated the feasibility of a transaortic edge-to-edge mitral valve repair (Alfieri stitch) for moderate or greater (≥2+) functional mitral regurgitation (MR) in high-risk patients undergoing aortic valve replacement. Methods We retrospectively evaluated 40 consecutive patients who underwent aortic valve replacement combined with a transaortic edge-to-edge mitral valve repair for 2+ or greater functional MR, between February 2002 and April 2015. The MR was graded semiquantitatively as 0 (trace/none), mild moderate (2+), or moderate to severe (3–4+). Results Thirty-two patients had aortic stenosis, and eight had aortic regurgitation. The mean ± standard deviation (SD) age was 77.5 ± 5 years, 34 (85%) were male, and the mean ± SD EuroSCORE II was 14.3% ± 12.9. At a median follow-up of 1 month (interquartile range, 0.75–10), there were significant improvements in preoperative versus postoperative median MR grade (3+ vs 1+, P < 0.001), mean left ventricular ejection fraction (34% vs 41%, P = 0.018), left ventricular end-diastolic diameter (54 vs 49 mm, P = 0.005), and pulmonary artery systolic pressure (49 vs 35 mm Hg, P < 0.001). Persistent 3 to 4+ MR occurred in two patients (5%). In 12 patients with at least 6-month follow-up (mean ± SD, 18 ± 11 months), a sustained improvement in all echocardiographic parameters was observed, with persistent 3 to 4+ MR occurring in one patient (8.3%). Actuarial survival at 1, 3, and 4.5 years was 82% ± 6, 71% ± 8, and 65% ± 10, respectively. Conclusions A transaortic edge-to-edge repair for 2+ or greater functional MR can be safely performed during aortic valve replacement and is associated with improvements in MR grade, left ventricular remodeling, and pulmonary hemodynamics.

scholarly journals Bileaflet versus Posterior-Leaflet-Only Preservation in Mitral Valve Replacement

2014 ◽  
Vol 41 (2) ◽  
pp. 165-169 ◽  
Author(s):  
Ahmet Coskun Ozdemir ◽  
Bilgin Emrecan ◽  
Ahmet Baltalarli
Keyword(s):  
Mitral Valve ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Posterior Leaflet ◽  
Ventricular Ejection Fraction

In the present study of mitral valve replacement, we investigated whether complete preservation of both leaflets (that is, the subvalvular apparatus) is superior to preservation of the posterior leaflet alone. Seventy patients who underwent mitral valve replacement in our clinic were divided into 2 groups: MVR-B (n=16), in whom both leaflets were preserved, and MVR-P (n=54), in whom only the posterior leaflet was preserved. The preoperative and postoperative clinical and echocardiographic findings were evaluated retrospectively. No signs of left ventricular outflow tract obstruction were observed in either group. In the MVR-B group, no decrease was observed in left ventricular ejection fraction during the postoperative period, whereas a significant reduction was observed in the MVR-P group (P=0.003). No differences were found between the 2 groups in their need for inotropic agents or intra-aortic balloon pump support, or in cross-clamp time, duration of intensive care unit or hospital stays, postoperative development of new atrial fibrillation, or mortality rates. Bileaflet preservation prevented the decrease in left ventricular ejection fraction that usually followed preservation of the posterior leaflet alone. However, posterior leaflet preservation alone yielded excellent results in terms of decreased left ventricular diameter. Bileaflet preservation should be the method of choice to prevent further decreases in ejection fraction and to avoid death in patients who present with substantially impaired left ventricular function.

scholarly journals Preservation of Posterior Mitral Leaflet in Mitral Valve Replacement: Effect on Left Ventricular Geometry with Immediate Outcome.

2018 ◽  
Vol 11 (1) ◽  
pp. 39-41
Author(s):  
AKM Manzurul Alam ◽  
Monzil Ahmed ◽  
Istiaq Ahmed ◽  
Mamun Hossain ◽  
Mohashin Reza ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Ejection Fraction ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Geometry ◽  
Posterior Mitral Leaflet ◽  
Group A ◽  
Group B

Bcakground: Preservation of the posterior mitral leaflet and subvalvular structures during mitral valve replacement (MVR) preserve left ventricular geometry and function. We evaluated the effect of preservation of subvalvular structures during mitral valve replacement on LV ejection fraction (LVEF).Methods: Total 60 patients were taken and then grouped into group A and group B. Group A include patients of MVR with preservation of posterior leaflet and subvalvular structure, Group B without preservation of subvalvular structures. All patients were evaluated before operation, at discharge, and at 3 months follow-up. Left ventricular function was assessed by ventricular ejection fraction (LVEF).Results: Preoperative LV ejection fraction was 58.3±11.0% and 56.6±8.4% in Group A and Group B respectively. Post-operative mean LVEF at discharge was found 44.2±5.1% in group A and 37.3±4.8% in group B. Observation at three months follow-up showed that mean LVEF was 49.0±4.7% in group A and 39.6±4.7% in group B.Conclusion: Left ventricular function is better maintained when MVR is done preserving posterior leaflet and subvalvular structure.Cardiovasc. j. 2018; 11(1): 39-41

Minimally Invasive Transaortic Repair of the Mitral Valve

2011 ◽  
Vol 14 (4) ◽  
pp. 232 ◽  
Author(s):  
Orlando Santana ◽  
Joseph Lamelas
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Operative Mortality ◽  
The Mean ◽  
Transaortic Approach

<p><b>Objective:</b> We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement.</p><p><b>Methods:</b> From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve.</p><p><b>Results:</b> There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation.</p><p><b>Conclusion:</b> Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.</p>

scholarly journals Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Benito Gonzalez ◽  
X Freixa ◽  
C Godino ◽  
M Taramasso ◽  
R Estevez-Loureiro ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
One Year ◽  
The Impact

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None

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