scholarly journals Denervation of Pulmonary Arteries in Patients with Mitral Valve Defects Complicated by Atrial Fibrillation and Pulmonary Hypertension

2019 ◽  
Vol 11 (4) ◽  
pp. 95
Author(s):  
N.A. Trofimov ◽  
A.P. Medvedev ◽  
A.V. Nikolsky ◽  
V.A. Kichigin ◽  
S.S. Zhamlikhanova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Hypertension ◽  
Mitral Valve ◽  
Pulmonary Arteries

scholarly journals Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

Kardiologiia ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 35-42 ◽  
Author(s):  
N. A. Trofimov ◽  
A. P. Medvedev ◽  
V. Y. Babokin ◽  
I. P. Efimova ◽  
V. A. Kichigin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Hypertension ◽  
Surgical Treatment ◽  
Mitral Valve ◽  
Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Pulmonary Trunk ◽  
Long Term Results ◽  
Reverse Remodeling ◽  
High Ph

Objective Investigate the influence of the sympathetic denervation of the pulmonary trunk and the orifices of the pulmonary arteries on the degree of pulmonary hypertension (PH) and outcomes of the surgical treatment of atrial fibrillation (AF) in patients with mitral valve defects, complicated AF, and high PH.Material and methods We analyzed the surgical treatment of 140 patients with mitral valve defect, concomitant AF, and high PH – pulmonary artery systolic pressure (PASP) gradient more than 40 mm Hg. The group of interest included 51 patients (46 patients with severe mitral stenosis and five patients with grade 4 mitral valve regurgitation). All patients underwent mitral valve correction (47 valve replacement surgeries and 4 valve-sparing interventions), biatrial Maze IV procedure, and additionally, denervation of the pulmonary trunk and the orifices of the pulmonary arteries. The control group included 89 patients diagnosed with mitral valve defect, AF, and PH with PASP > 40 mm Hg. However, unlike in patients of interest, denervation of the pulmonary arteries was not performed.Results Circular radiofrequency denervation of the pulmonary trunk and the orifices of the pulmonary arteries using a clamp-destructor is an effective and safe method, significantly reduces secondary PH (p=0.018), promotes reverse remodeling of the heart chambers, left atrium in particular (p=0.01), and improves outcomes of the Maze IV procedure (p=0.022) by restoring sinus rhythm in patients with mitral valve defects, complicated AF, and high PH.Conclusion This technique must be studied further involving a more significant number of patients, analyzing long-term results, and using this technique in patients with non-valvular causes of secondary PH.

scholarly journals Dynamics of echocardiography parameters after circular PADN procedure in patients with mitral valve defects, atrial fibrillation, and high pulmonary hypertension

2019 ◽  
Vol 34 (3) ◽  
pp. 129-143
Author(s):  
N. A. Trofimov ◽  
A. P. Medvedev ◽  
V. E. Babokin ◽  
A. G. Dragunov ◽  
V. A. Kichigin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Hypertension ◽  
Surgical Treatment ◽  
Mitral Valve ◽  
Mitral Valve Disease ◽  
Pulmonary Arteries ◽  
Surgical Correction ◽  
Valve Disease ◽  
Severe Pulmonary Hypertension ◽  
Radiofrequency Denervation

Aim. To analyze the dynamics of echocardiographic parameters after surgical treatment of severe pulmonary hypertension in patients with mitral valve disease and atrial fibrillation.Material and Methods. Data of surgical treatment in 202 patients with mitral valve disease complicated by severe pulmonary hypertension with blood pressure more than 40 mm Hg and atrial fibrillation were analyzed. Surgical intervention in these patients consisted in surgical correction of mitral dysfunction with artificial prosthetic valve or valve-preserving intervention (group 1, n = 62). In patients of group 2 (n = 89), correction of mitral valve defect was also performed as well as the Maze IV procedure for concomitant atrial fibrillation using bipolar radiofrequency ablator AtriCure. Patients of group 3 (n = 51) underwent integrated surgery, which consisted in the elimination of mitral valve defect, surgical correction of atrial fibrillation by Maze IV procedure, as well as circular radiofrequency denervation of the trunk and mouth of the pulmonary arteries (pulmonary artery denervation (PADN)).Conclusions. The circular PADN procedure was effective and safe, significantly reduced the level of pulmonary hypertension in the postoperative period (p = 0.018), and promoted reverse remodeling of the heart cavities. Integrated surgical correction in patients with mitral dysfunction, atrial fibrillation, and severe pulmonary hypertension may significantly reduce the phenomenon of heart failure (p = 0.023). Further analysis of the effectiveness of radiofrequency denervation of pulmonary arteries with the study of a larger number of patients, analysis of long-term results, as well as determining the possibility of this technique in patients with non-valvular forms of pulmonary hypertension are required. 

PADN procedure in patients with mitral valve disease, atrial fibrillation and high pulmonary hypertension

2019 ◽  
Vol 12 (5) ◽  
pp. 450
Author(s):  
N. A. Trofimov ◽  
A. P. Medvedev ◽  
V. E. Babokin ◽  
A. G. Dragunov ◽  
I. P. Efimova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Hypertension ◽  
Mitral Valve ◽  
Mitral Valve Disease ◽  
Valve Disease

scholarly journals "Portrait" of patients with pulmonary hypertension, associated with mitral valve diseases before cardiac surgery

2021 ◽  
Vol 10 (2) ◽  
pp. 83-88
Author(s):  
Yu. E. Teplova ◽  
I. N. Lyapina ◽  
V. A. Shaleva ◽  
O. K. Kuzmina ◽  
A. V. Evtushenko ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Mitral Valve ◽  
Left Ventricle ◽  
Right Ventricle ◽  
Rheumatic Heart Disease ◽  
Systolic Function ◽  
The Right ◽  
Rheumatic Heart

Aim. To study “the portrait” of patients with acquired mitral valve (MV) heart disease of various origins and pulmonary hypertension hospitalized for surgical correction of the defect.Methods. The study included 97 patients with acquired diseases of mitral valve and pulmonary hypertension. The assessment of demographic, clinical and anamnestic data, indicators of transthoracic echocardiography, quality of life before the correction of MV defect was carried out.Results. The studied cohort is mostly represented by female patients (n = 70; 72.2%). The most common cause of mitral valve disease was rheumatic heart disease (n = 40; 41.2%). Overweight, hypertension (n = 76; 78.4%) and atrial fibrillation (n = 62; 63.9%) were the most common comorbidities. The mean pressure level in the pulmonary artery according to echocardiography was 35.5 (29.0; 40.0) mm Hg, with no significant difference among the patients, regardless the mitral defect etiology. Less pronounced remodeling of the left ventricle was noted in patients with rheumatic heart disease, which is caused by a lesion of the MV by the type of stenosis in contrast to patients with connective tissue dysplasia syndrome or against the background of detachment of MV chords with MV damage in the form of its insufficiency. There were no significant differences in the systolic function of the right ventricle depending on the etiology of MV defect.Conclusion. The “portrait” of a patient with pulmonary hypertension associated with an acquired mitral valve defect before its correction is the predominance of female, overweight, with II or III functional class of chronic heart failure, more frequent rheumatic genesis of MV defect, the presence of concomitant pathology in the form of hypertension and persistent atrial fibrillation, and increased size of the left atrium and left ventricle, reduced systolic function of the right ventricle according to the data of Echocardiography. 

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