Congenital Mitral Valve Regurgitation in Adult Patients

2011 ◽  
Vol 14 (2) ◽  
pp. 114 ◽  
Author(s):  
ShengLi Jiang ◽  
ChangQing Gao ◽  
BoJun Li ◽  
ChongLei Ren ◽  
Yao Wang ◽  
...  
Keyword(s):  
New York ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Heart Association ◽  
Mitral Valve Regurgitation ◽  
Atrioventricular Septal Defect ◽  
Functional Class ◽  
Valve Regurgitation ◽  
Valve Repair ◽  
New York Heart Association

Objective: Congenital mitral valve regurgitation (MVR) is a rare disease found in adults. We report on our 5-year surgical experience with congenital MVR in adults.Methods: We reviewed the data for 48 consecutive patients (26 men), aged >18 years (median, 42 years; range, 18-78 years) who underwent operations for severe congenital MVR between June 2005 and May 2010. Patients with atrioventricular septal defect were excluded.Results: Congenital MVR was preoperatively diagnosed in 28 cases (58%). The lesions consisted of annular dilation (100%), valvular cleft (58%), prolapsed leaflet (40%), papillary muscle abnormality (5%), commissure fusion (2%), and leaflet deficiency (2%). Mitral valve repair was performed in 42 cases (88%) by means of Carpentier techniques. The other 6 patients underwent mitral valve replacement; one of these patients died of ventricular fibrillation 2 days after surgery. There were no other hospital deaths or late mortality. At the last follow-up (median, 38 months; range, 2-50 months), all 47 patients were in New York Heart Association functional class I or II. Echocardiography evaluations for the 42 patients who underwent the repairs revealed that 32 (76%) of the patients had no or trivial MVR and 10 patients (24%) had mild MVR. No patient underwent reoperation.Conclusion: Congenital MVR is rare and often misdiagnosed in adults. Mitral valve repair is feasible in the majority of patients, with excellent immediate and medium-term results.

scholarly journals MitraClip After Failed Surgical Mitral Valve Repair—An International Multicenter Study

2021 ◽  
Author(s):  
Zouhair Rahhab ◽  
David Scott Lim ◽  
Stephen H. Little ◽  
Maurizio Taramasso ◽  
Shingo Kuwata ◽  
...  
Keyword(s):  
New York ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Heart Association ◽  
York Heart Association Class ◽  
Valve Repair ◽  
Association Class ◽  
New York Heart Association ◽  
Technical Challenges ◽  
International Multicenter

Background Recurrence of mitral regurgitation (MR) after surgical mitral valve repair (SMVR) varies and may require reoperation. Redo mitral valve surgery can be technically challenging and is associated with increased risk of mortality and morbidity. We aimed to assess the feasibility and safety of MitraClip as a treatment strategy after failed SMVR and identify procedure modifications to overcome technical challenges. Methods and Results This international multicenter observational retrospective study collected information for all patients from 16 high‐volume hospitals who were treated with MitraClip after failed SMVR from October 29, 2009, until August 1, 2017. Data were anonymously collected. Technical and device success were recorded per modified Mitral Valve Academic Research Consortium criteria. Overall, 104 consecutive patients were included. Median Society of Thoracic Surgeons score was 4.5% and median age was 73 years. At baseline, the majority of patients (82%) were in New York Heart Association class ≥III and MR was moderate or higher in 86% of patients. The cause of MR pre‐SMVR was degenerative in 50%, functional in 35%, mixed in 8%, and missing/unknown in 8% of patients. The median time between SMVR and MitraClip was 5.3 (1.9–9.7) years. Technical and device success were 90% and 89%, respectively. Additional/modified imaging was applied in 21% of cases. An MR reduction of ≥1 grade was achieved in 94% of patients and residual MR was moderate or less in 90% of patients. In‐hospital all‐cause mortality was 2%, and 86% of patients were in New York Heart Association class ≤II. Conclusions MitraClip is a safe and less invasive treatment option for patients with recurrent MR after failed SMVR. Additional/modified imaging may help overcome technical challenges during leaflet grasping.

scholarly journals Very Long-Term Results (More Than 20 Years) of Valve Repair With Carpentier’s Techniques in Nonrheumatic Mitral Valve Insufficiency

Circulation ◽  
2001 ◽  
Vol 104 (suppl_1) ◽  
Author(s):  
E. Braunberger ◽  
A. Deloche ◽  
A. Berrebi ◽  
A. Fayssoil ◽  
J.A Celestin ◽  
...  
Keyword(s):  
New York ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Heart Association ◽  
Mitral Valve Insufficiency ◽  
Functional Class ◽  
Long Term Results ◽  
Valve Repair

Background Mitral valve repair is considered the gold standard in surgery of degenerative mitral valve insufficiency (MVI), but the long-term results (>20 years) are unknown. Methods and Results We reviewed the first 162 consecutive patients who underwent mitral valve repair between 1970 and 1984 for MVI due to nonrheumatic disease. The cause of MVI was degenerative in 146 patients (90%) and bacterial endocarditis in 16 patients (10%). MVI was isolated or, in 18 cases, associated with tricuspid insufficiency. The mean age of the 162 patients (104 men and 58 women) was 56±10 years (age range 22 to 77 years). New York Heart Association functional class was I, II, III, and IV in 2%, 39%, 52%, and 7% of patients, respectively. The mean cardiothoracic ratio was 0.58±0.07 (0.4 to 0.8), and 72 (45%) patients had atrial fibrillation. Valve analysis showed that the main mechanism of MVI was type II Carpentier’s functional classification in 152 patients. The leaflet prolapse involved the posterior leaflet in 93 patients, the anterior leaflet in 28 patients, and both leaflets in 31 patients. Surgical technique included a Carpentier’s ring annuloplasty in all cases, a valve resection in 126 patients, and shortening or transposition of chordae in 49 patients. During the first postoperative month, there were 3 deaths (1.9%) and 3 reoperations (2 valve replacements and 1 repeat repair [1.9%]). Six patients were lost to follow-up. The remaining 151 patients with mitral valve repair were followed during a median of 17 years (range 1 to 29 years; 2273 patient-years). The 20-year Kaplan-Meier survival rate was 48% (95% CI 40% to 57%), which is similar to the survival rate for a normal population with the same age structure. The 20-year rates were 19.3% (95% CI 11% to 27%) for cardiac death and 26% (95% CI 17% to 35%) for cardiac morbidity/mortality (including death from a cardiac cause, stroke, and reoperation). During the 20 years of follow-up, 7 patients were underwent surgery at 3, 7, 7, 8, 8, 10, or 12 years after the initial operation. Valve replacement was carried out in 5 patients, and repeat repair was carried out in 2 patients. At the end of the study, 65 patients remained alive (median follow-up 19 years). Their median age was 76 years (age range 41 to 95 years). All except 1 were in New York Heart Association functional class I/II. Conclusions Mitral valve repair using Carpentier’s technique in patients with nonrheumatic MVI provides excellent long-term results with a mortality rate similar to that of the general population and a very low incidence of reoperation.

scholarly journals Sequential Venous Percutaneous Transluminal Angioplasty and Balloon Dilatation of the Interatrial Septum during Percutaneous Edge-to-Edge Mitral Valve Repair

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Rezo Jorbenadze ◽  
Johannes Patzelt ◽  
Meinrad Gawaz ◽  
Peter Seizer ◽  
Harald F. Langer
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Percutaneous Transluminal Angioplasty ◽  
Balloon Dilatation ◽  
Mitral Valve Regurgitation ◽  
Interatrial Septum ◽  
Transluminal Angioplasty ◽  
Valve Regurgitation ◽  
Valve Repair ◽  
Percutaneous Transluminal

Percutaneous edge-to-edge mitral valve repair (PMVR) is widely used for selected, high-risk patients with severe mitral valve regurgitation (MR). This report describes a case of 81-year-old woman presenting with severe and highly symptomatic mitral valve regurgitation (MR) caused by a flail of the posterior mitral valve leaflet (PML). PMVR turned out to be challenging in this patient because of a stenosis and tortuosity of both iliac veins as well as sclerosis of the interatrial septum, precluding the vascular and left atrial access by standard methods, respectively. We managed to achieve atrial access by venous percutaneous transluminal angioplasty (PTA) and balloon dilatation of the interatrial septum. Subsequently, we could advance the MitraClip® system to the left atrium, and deployment of the clip in the central segment of the mitral valve leaflets (A2/P2) resulted in a significant reduction of MR.

Operative Results of Mitral Valve Repair and Replacement in Chronic Ischaemic Mitral Valve Regurgitation

2018 ◽  
Vol 27 ◽  
pp. S514
Author(s):  
Damian Gimpel ◽  
Levi Bassin ◽  
Peter Grant ◽  
Zakir Akhunji ◽  
Beatrix Weiss ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Mitral Valve Regurgitation ◽  
Valve Regurgitation ◽  
Valve Repair ◽  
Operative Results

scholarly journals Site-Level Variability in 30-Day Patient Outcomes After Transcatheter Mitral Valve Repair in the United States

2020 ◽  
Vol 13 (12) ◽  
Author(s):  
Ali O. Malik ◽  
Adnan K. Chhatriwalla ◽  
John Saxon ◽  
Vittal Hejjaji ◽  
Amanda Stebbins ◽  
...  
Keyword(s):  
Health Status ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Odds Ratio ◽  
Mitral Valve Regurgitation ◽  
Valve Regurgitation ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Baseline Health ◽  
Baseline Health Status

Background: Clinical trials have demonstrated health status benefit of transcatheter mitral valve repair (TMVr) with MitraClip in patients with mitral valve regurgitation. Real-world site-level variability in health status outcomes for TMVr, and factors associated with this variability, are unknown. Methods: All patients undergoing TMVr procedure with MitraClip between November 2013 and March 2019 in the Transcatheter Valve Therapy Registry were included. Health status was measured at baseline and 30 days with the Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary (OS) score. Site-level variability in 30-day change in KCCQ-OS was examined by calculating the median odds ratio from a hierarchical logistic regression model, with ≥20-point improvement as the dependent variable. To define the extent to which patient characteristics, procedural characteristics (residual mitral valve regurgitation, periprocedural bleeding), site volume, and patients’ baseline health status accounted for variability in outcomes, the proportion of variability ( R 2 ) explained by sequentially adding these variables to the model was quantified. Results: Across 339 sites, 12 415 patients (mean age 79.0±9.5 years, 46.1%. females, 89.5% White) completed baseline and 30-day health status assessments. Mean KCCQ-OS score was 43.0±24.4 at baseline and 67.0±24.9 at 30-day follow-up. Across sites, the proportion of patients achieving a ≥20-point improvement in KCCQ-OS ranged from 12.5% to 100% and the adjusted median odds ratio was 1.58 (95% CI, 1.46–1.69). The greatest contribution to the variability in health status outcomes was from patients’ baseline KCCQ-OS score ( R 2 =25%) with <1% of the variability explained by patient and procedural characteristics, and annual site volume. Conclusions: There is moderate variation across sites in their patients’ achievement of health status benefits from TMVr, with patient’s baseline health status accounting for the largest proportion of this variation. This underscores the importance of patient selection in supporting more consistent health status benefit from TMVr.

Successful MitraClipTM implantation in a 15-year-old patient with multiple prior cardiac surgeries

2012 ◽  
Vol 23 (4) ◽  
pp. 620-622 ◽  
Author(s):  
Matthias Gorenflo ◽  
Hugo A. Katus ◽  
Raffi Bekeredjian
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Clinical Improvement ◽  
Mitral Valve Repair ◽  
Aortic Valve Stenosis ◽  
Mitral Valve Regurgitation ◽  
Male Adolescent ◽  
Valve Regurgitation ◽  
Valve Repair

AbstractPercutaneous edge-to-edge mitral valve repair using the MitraClipTM has not been used in children. The patient in this reported case was a 15-year-old male adolescent who presented postnatally with severe aortic valve stenosis and dysplasia of the mitral valve. The boy underwent surgical valvuloplasty at the age of 3 months and an aortoventriculoplasty with three re-operations. At the age of 15 years, he developed severe mitral valve regurgitation. Owing to high surgical risks, a MitraClipTM was implanted with a reduction of mitral regurgitation from grade 4+ to 2+, translating into a rapid clinical improvement.

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