High Mitral Annulus Calcium Score in Pre-Operative Chest Computerized Tomography and Adverse Outcomes in Mitral Valve Surgery

Abstract Aims We aimed to assess the prevalence of mitral annulus disjunction (MAD) and to explore the association with aortic disease and mitral valve surgery in patients with Marfan syndrome (MFS) and Loeys–Dietz syndrome (LDS). Methods and results We included consecutive MFS patients fulfilling Revised Ghent Criteria and LDS patients fulfilling Loeys–Dietz Revised Nosology. MAD was identified by echocardiography and was quantified as the longitudinal distance from the ventricular myocardium to the hinge point of the posterior mitral leaflet. Aortic events were defined as aortic dissection or prophylactic aortic surgery. We recorded the need of mitral valve surgery including mitral valve repair or replacement. We included 168 patients (103 with MFS and 65 with LDS). The prevalence of MAD was 41%. MAD was present in all age groups. Aortic events occurred in 112 (67%) patients (27 with dissections and 85 with prophylactic surgical interventions). Patients with MAD were younger at aortic event than those without MAD (log rank = 0.02) Patients with aortic events had greater MAD distance in posterolateral wall [8 (7–10) mm vs. 7 (6–8) mm, P = 0.04]. Mitral events occurred more frequently in patients with MAD (P < 0.001). Conclusion MAD was highly prevalent in patients with MFS and LDS. MAD was a marker of severe disease including aortic events at younger age and need of mitral valve surgery. Screening patients with MFS an LDS for MAD may provide prognostic information and may be relevant in planning surgical intervention. Detection of MAD in patients with MFS and LDS may infer closer clinical follow-up from younger age.

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Mitral valve surgery in patients with extensive calcification of the mitral annulus

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(03)00081-3 ◽

2003 ◽

Vol 126 (3) ◽

pp. 777-781 ◽

Cited By ~ 102

Author(s):

Christopher M Feindel ◽

Zafar Tufail ◽

Tirone E David ◽

Joan Ivanov ◽

Susan Armstrong

Keyword(s):

Mitral Valve ◽

Mitral Annulus ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Extensive Calcification

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Morphometric study of the human mitral annulus: Guide for mitral valve surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492313513596 ◽

2013 ◽

Vol 22 (7) ◽

pp. 787-793 ◽

Cited By ~ 3

Author(s):

Masataka Eto ◽

Shigeki Morita ◽

Yutaka Nakashima ◽

Yousuke Nishimura ◽

Ryuji Tominaga

Keyword(s):

Mitral Valve ◽

Mitral Annulus ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Morphometric Study

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Mitral annulus disjunction is associated with adverse outcome in patients with Marfan syndrome and Loeys-Dietz syndrome

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.419 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

M Chivulescu ◽

K Krohg-Sorensen ◽

E Scheirlynk ◽

B Lindberg ◽

LA Dejgaard ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Prolapse ◽

Aortic Surgery ◽

Severe Disease ◽

Mitral Annulus ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Public Institution ◽

Common Finding ◽

Hinge Point

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority Background Mitral valve prolapse is a common finding in patients with Marfan (MFS) and Loeys-Dietz syndromes (LDS). Mitral annulus disjunction (MAD) is an atrial displacement of the hinge point of the mitral valve that frequently coexists with mitral valve prolapse, but its clinical relevance in connective tissue disorders is unknown. Purpose To explore the association between MAD and severity of mitral valve and aortic disease in patients with MFS and LDS. Methods We included consecutive MFS patients and LDS patients fulfilling established diagnostic criteria. MAD was identified by echocardiography and defined as the distance from the ventricular myocardium to the hinge point of the posterior mitral leaflet (Figure, panel A). Aortic surgery was defined as emergency surgery for aortic dissection or prophylactic aortic surgery for aortic aneurysm. We recorded the need of mitral valve surgery including mitral valve repair or replacement. Results We included 168 patients of whom 103 (61%) had MFS and 65 (39%) had LDS. We identified MAD in 69 (41%) patients. Aortic surgery was performed in 112 (67%) patients (27 dissections and 85 prophylactic interventions). Patients with MAD were younger at the time of aortic surgery than those without MAD (p log rank = 0.02) (Figure, panel B). Patients needing aortic surgery had greater MAD distance (8 [7-10] mm vs. 7 [6-8] mm, p = 0.04). Mitral valve surgery was performed in 12 (7%) patients, more frequently in patients with MAD than in those without (16% vs. 1%, p < 0.001, p log rank < 0.001) (Figure, panel C). Conclusion MAD was frequent and detected in 41% of patients with MFS and LDS. MAD was associated with a more severe disease phenotype including aortic surgery at younger age and frequent need for mitral valve surgery. Screening patients with MFS and LDS for MAD may provide prognostic information and may be relevant in planning surgical interventions. Abstract Figure

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Minimally Invasive Mitral Valve Surgery for Mitral Valve Infective Endocarditis

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1604206 ◽

2017 ◽

Vol 66 (07) ◽

pp. 525-529 ◽

Cited By ~ 3

Author(s):

Joerg Seeburger ◽

Jens Garbade ◽

Uta Schon ◽

Martin Misfeld ◽

Friedrich Mohr ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Minimally Invasive ◽

Mitral Annulus ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Mitral Leaflet ◽

Minimally Invasive Approach ◽

Invasive Approach

Background The feasibility of minimally invasive mitral valve (MV) surgery in infective endocarditis (IE) has not been reported in detail. We assessed the safety, efficacy, and durability of the minimally invasive approach through a right anterolateral minithoracotomy for surgical treatment of MV IE. Methods A review of the Leipzig Heart Center database revealed 92 eligible patients operated on between 2002 and 2013. All patients had undergone minimally invasive surgery for IE. The indication for surgery was isolated IE of the MV in all patients. Baseline and intraoperative data, as well as clinical outcomes and short-term follow-up were analyzed retrospectively. Results The patients' mean age was 60.9 ± 15.3 years, the logistic EuroSCORE II was 19.6 ± 19.1%, and 64.1% (59) were male. MV repair was feasible in 23.9% (22/92) of patients. Repair techniques included annuloplasty ring implantation, anterior mitral leaflet resection, posterior mitral leaflet resection, and implantation of neochordae. MV replacement was performed in 69 patients (75%), a mitral annulus patch in 1 patient, and concomitant tricuspid valve surgery for tricuspid regurgitation in 5 patients. Bacteriological analysis showed staphylococcus infection in 45.5%, streptococcus in 36.4%, enterococcus in 13.6%, and others in 4.5%. The 30-day-mortality rate was 9.8% (9 patients). The 1-year follow-up showed a 1-year survival rate of 77.7 ± 4.4% and freedom from reoperation within 1 year due to reendocarditis of 93.3 ± 2.1%. Conclusions The minimally invasive approach is suitable for the treatment of IE of the MV. It is a good technique in IE in selected patients.

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Myocardial Performance Index as Predictor of Adverse Outcomes Following Mitral Valve Surgery

European Heart Journal - Cardiovascular Imaging ◽

10.1053/euje.4.2.134 ◽

2003 ◽

Vol 4 (2) ◽

pp. 128-134 ◽

Cited By ~ 7

Author(s):

M. Al-Mukhaini ◽

S. Argentin ◽

J.-F. Morin ◽

C. Benny ◽

D. Cusson ◽

...

Keyword(s):

Mitral Valve ◽

Performance Index ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Adverse Outcomes ◽

Myocardial Performance Index ◽

Myocardial Performance

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Atrial Approach in Mitral Valve Surgery: Are There Differences in the Incidence of Clinically Relevant Adverse Effects? A Propensity Analysis.

10.21203/rs.3.rs-1014098/v1 ◽

2021 ◽

Author(s):

Carlos Obando ◽

Javier D Garzón ◽

Lina M Ramirez ◽

Andrea C Castillo ◽

Albert F Guerrero ◽

...

Keyword(s):

Mitral Valve ◽

Left Atrial ◽

Pacemaker Implantation ◽

Heart Rhythm ◽

Mitral Valve Surgery ◽

Permanent Pacemaker ◽

Valve Surgery ◽

Adverse Outcomes ◽

Cerebrovascular Events ◽

Heart Rhythm Disorders

Abstract Background: The lack of evidence with respect to complications with mitral valve approaches leaves the choice of exposure to the surgeon’s preference, basing it on individual experience, speed, ease, and quality of exposure. Methods: Analysis of patients undergoing mitral valve surgery by either a superior transseptal approach or a left-atrial approach between 2006 and 2018. We included first time elective mitral valve procedures, isolated or combined, without a history of rhythm disturbances. We used propensity score matching based on 26 perioperative variables. Primary endpoint was to determine the association between the superior transeptal approach and clinically significant adverse outcomes including arrhythmias, need for permanent pacemaker, cerebrovascular events, and mortalityResults: 652 patients met the inclusion criteria, 391 received the left atrial approach and 261 superior transseptal. After matching, 96 patients were compared with 69, respectively. The distribution of the preoperative and perioperative variables was similar. There was no difference in the incidence of supraventricular tachyarrhythmias and the need for treatment. The incidence of nodal rhythm (p = 0.008) and length of stay in intensive care (p = 0.04) were higher in the superior transseptal group, however the need for permanent pacemaker implantation was the same. Likewise, there was no difference in the need for anticoagulation due to arrhythmia, the incidence of cerebrovascular events or mortality in the postoperative period, and in the long-term follow-up.Conclusion: We did not find an association with permanent heart rhythm disorders or any other significant adverse clinical outcome, therefore we consider that the superior transeptal approach is useful and safe for mitral valve exposure.

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