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

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.

scholarly journals P1409 Sizing of mitral annuloplasty rings using three-dimensional transoesophageal echocardiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Yoshitani ◽  
T Fujii ◽  
S Ito ◽  
A Shimokawa ◽  
Y Ohnishi
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Three Dimensional ◽  
Transoesophageal Echocardiography ◽  
Ring Size ◽  
Valve Repair ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty ◽  
Systolic Phase

Abstract Funding Acknowledgements Department funding Background Mitral valve repair is preferred to valve replacement in cases of degenerative mitral regurgitation (MR) due to the lower risk of valve-related complications and operative mortality. In mitral valve repair, annuloplasty is associated with better clinical outcomes. Sizing of the annuloplasty ring with a ring sizer, which should be performed in the end-systolic phase, is performed in diastole during hyperkalaemia cardioplegic arrest. Three-dimensional transoesophageal echocardiography (3D-TEE) allows measurement of the mitral valve while the heart is beating, which is beneficial since the mitral valve size changes throughout the cardiac cycle. Purpose To investigate whether 3D-TEE measurements of the mitral valve are effective for preventing recurrent mitral regurgitation (MR) in patients who undergo mitral valve repair for degenerative MR. Methods This study retrospectively reviewed 139 patients who underwent mitral annuloplasty for degenerative MR. After 47 patients were excluded, 92 patients were analysed. The inter-commissural (IC) distance and anterior leaflet height of the A2 segment of the mitral valve were measured by 3D-TEE at the end-systolic phase. The annuloplasty ring size and type were selected by surgeons using specific ring sizers. We investigated the association of the IC distance with the size of implanted annulus ring and differences between the size of implanted annulus ring and the IC distance. We also compared the IC distance, the A2 height, and the ratio of A2 height to IC distance between patients with and without recurrent mild-to-moderate MR for 36 months. Results There was a significant correlation between the size of the mitral annuloplasty ring and the IC distance (R²=0.7023, p < 0.001). The variety between implanted annulus ring size and IC distance measured by 3D-TEE was shown in Figure1. Eight cases had mild or greater recurrent MR. There was a significant difference in the ratio of A2 height to IC distance between patients with and without recurrent MR (p = 0.006). The A2 height was greater in patients with recurrent MR, but this difference was not significant (p = 0.059). Conclusions There was a significant correlation between the size of the mitral annuloplasty ring and the IC distance. Our results demonstrated a higher ratio of A2 height to IC distance in patients with recurrent MR. Abstract P1409 Figure1

scholarly journals Successful mitral valve-in-ring repair of mitral annuloplasty ring dehiscence causing severe mitral regurgitation—a case report

2021 ◽  
Author(s):  
Harish Sharma ◽  
Adnan Nadir ◽  
Richard P Steeds ◽  
Sagar N Doshi
Keyword(s):  
Case Report ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Transesophageal Echocardiography ◽  
Severe Mitral Regurgitation ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty ◽  
Case Summary ◽  
Valve Implantation ◽  
Two Jets

Abstract Background Annuloplasty failure caused by ring dehiscence can lead to trans-ring and para-ring mitral regurgitation. Transcatheter treatments are available for patients at prohibitive risk of surgery. In patients unsuitable for edge-to-edge repair, valve-in-ring transcatheter mitral valve implantation has been described to treat trans-ring or para-ring jets but not both concurrently. Case summary A 78-year-old male presented with severe mitral regurgitation due to dehiscence of a 34 mm Edwards Physio II mitral annuloplasty ring. Transesophageal echocardiography showed two jets of regurgitation; trans-ring and para- ring. Repair was successfully undertaken with a valve-in-ring procedure (29 mm S3 Edwards Lifesciences). Discussion Patients with failure of mitral valve annuloplasty with trans-ring and para-ring regurgitation can be safely and effectively treated by valve-in-ring transcatheter mitral valve implantation.

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

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.

Simple Suture Mitral Annuloplasty with Left Ventriculotomy

2008 ◽  
Vol 16 (6) ◽  
pp. 495-496
Author(s):  
Mohammad H Mandegar ◽  
Mohammad A Yousefnia ◽  
Farideh Roshanali
Keyword(s):  
Surgical Treatment ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Ventricular Aneurysm ◽  
Valve Repair ◽  
Mitral Annuloplasty

Surgical treatment of mitral regurgitation, especially when compounded by ventricular aneurysm, remains a challenge. Several procedures have been developed to repair the mitral valve and reduce regurgitation. We describe a technique of intraventricular annuloplasty which is much less time-consuming than mitral valve repair through a left atriotomy. This procedure is considered technically easy and useful.

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

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jing Li ◽  
Qun-Jun Duan
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Hemolytic Anemia ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Annuloplasty Ring ◽  
Mitral Repair ◽  
Artificial Chordae

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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