Mitral Valve Fenestration as a Rare Cause of Congenital Mitral Insufficiency Successfully Repaired

Background and Aim: We aimed to identify risk factors for recurrent mitral regurgitation in two surgical treatment groups: isolated coronary artery bypass grafting (CABG) and CABG combined with mitral valve (MV) repair in patients with moderate ischemic mitral regurgitation (IMR). Methods: A single-centre, prospective, randomised study, which included 76 patients with ICM and moderate mitral regurgitation (MR). Study included two groups: isolated CABG and CABG with MV repair (MVR). Isolated annuloplasty was used to correct mitral insufficiency in the CABG + MVR group. Results: Isolated CABG or CABG combined with MVR in patients with ICM does not lead to a statistically significant decreasing of MR in the long-term period compared to baseline values. However, in one year after surgery, the degree of MR after combined surgery is lower than the initial values. The identification of predictors of the progression of IMR in ICM made it possible to determine the threshold values for the effectiveness of MVR, and the assessment of echocardiographic predictors for annuloplasty helps to choose the right surgical tactic of patients. Conclusions: Coronary revascularization with surgical of IMR in patients with ICM does not increase the number of complications in the early postoperative period compared to the group of isolated CABG. In patients with ICM and moderate MR after isolated CABG, the progression of MR (MR of the 3rd degree, initially 0%, after 12 months 31%, after 36 months 71%; p <0.001) was observed even with an initially moderate expansion of the fibrous ring of the MV.

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The surgical treatment of congenital mitral insufficiency. Morphology of mitral valve in the view of mitral valvuloplasty.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.19.1355 ◽

1990 ◽

Vol 19 (6) ◽

pp. 1355-1356

Author(s):

H. Ohno

Keyword(s):

Surgical Treatment ◽

Mitral Valve ◽

Mitral Insufficiency ◽

Mitral Valvuloplasty

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Subaortic stenosis and mitral dysplasia in three Black Russian Terrier puppies

Veterinární Medicína ◽

10.17221/5630-vetmed ◽

2012 ◽

Vol 50 (No. 7) ◽

pp. 321-326

Author(s):

J. Pikula ◽

J. Pikulova ◽

H. Bandouchova ◽

P. Kohout ◽

K. Najman ◽

...

Keyword(s):

Mitral Valve ◽

Aortic Stenosis ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Subaortic Stenosis ◽

Maximum Pressure ◽

Mitral Insufficiency ◽

Left Ventricular Outflow

A combined congenital heart defect of aortic stenosis and mitral dysplasia was diagnosed in three Black Russian Terrier puppies two months old. The aortic stenosis component included both fixed and dynamic obstructions. The fixed obstruction was subvalvularly located at the entrance to the left ventricular outflow tract. The dynamic obstruction was caused by the septal leaflet of the mitral valve protruding into the left ventricular outflow tract. Mitral dysplasia resulted in mitral insufficiency leading to regurgitation through the mitral valve closer to the septal side. The maximum pressure gradient across the aortic valve amounting to 103 mmHg measured in one puppy was consistent with the most severe grade of stenosis. The diagnosis was confirmed by autopsy in all three puppies that were males and originated in one litter, so genetic influences are supposed.

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OP33 Treatment Of Mitral Insufficiency And Multicriteria Decision-Making

International Journal of Technology Assessment in Health Care ◽

10.1017/s026646231900103x ◽

2019 ◽

Vol 35 (S1) ◽

pp. 8-8

Author(s):

François Désy ◽

Mireille Goetghebeur ◽

Maria Vutcovici Nicolae ◽

Laurie Lambert ◽

Michèle de Guise

Keyword(s):

Mitral Valve ◽

Literature Review ◽

Health System ◽

Advisory Committee ◽

Scientific Evidence ◽

Multicriteria Decision Making ◽

Clinical Excellence ◽

Expert Committee ◽

Mitral Insufficiency ◽

Health Technologies

IntroductionControversy regarding the efficacy of transcatheter mitral valve repair with a clip (TMVRc) in reducing the mitral regurgitation is related to the lack of solid scientific evidence. Worldwide, refusal or conditional acceptance for implementation of TMVRc, reflect ongoing uncertainty. We sought to apply a systematic multicriteria framework to ensure a fair and reasonable decision regarding the use of TMVRc in Quebec.MethodsThe framework included the following domains: context, quality of evidence concerning safety, efficacy and effectiveness, unmet patient needs, expected volume of patients, and impact on the health system including costs. Each domain within the framework was examined by a review of the literature and through consultations with a scientific advisory committee, a TMVRc clinical expert committee, TMVRc clinical teams, industry representatives and the Institut national d'excellence en santé et en services sociaux (INESSS) clinical excellence committee.ResultsThe literature review indicated that uncertainty about the efficacy and effectiveness of TMVRc persists, particularly in the real world context, and this view was supported by scientific experts. The TMVRc clinical teams provided insight into the burden of mitral insufficiency on patients and the health system and their belief in the promise of TMVRc. They also highlighted the challenges of patient selection and organizational issues related to the introduction of TMVRc within their institutions. The advisory committee stressed the need for further evaluation prior to wide diffusion.ConclusionsUsing a multicriteria framework facilitated a more standardized and transparent approach to our literature review and consultations as well as to the development of the proposed recommendations. This was especially important in the context of an evaluation of a promising new approach to treat mitral valve disease with many important uncertainties. This multi-criteria approach will facilitate a more standardized process for deliberation on how new health technologies should be implemented into the Quebec health system.

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Mitral valve repair for ischemic mitral insufficiency: an increased early postoperative risk for the elderly

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2015.11840 ◽

2015 ◽

Vol 23 (3) ◽

pp. 606-607

Author(s):

Evren Özçınar

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

The Elderly ◽

Mitral Insufficiency ◽

Valve Repair ◽

Postoperative Risk

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Mitral valve repair for ischemic mitral insufficiency: an increased early postoperative risk for the elderly

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2015.10645 ◽

2015 ◽

Vol 23 (2) ◽

pp. 239-244

Author(s):

Cem Arıtürk

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

The Elderly ◽

Mitral Insufficiency ◽

Valve Repair ◽

Postoperative Risk

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Surgical treatment of acute episodes of rheumatic fever

Cardiology in the Young ◽

10.1017/s1047951100000986 ◽

1992 ◽

Vol 2 (3) ◽

pp. 244-246

Author(s):

Pablo Maria Alberto Pomerantzeff ◽

Rachel Snitcowsky ◽

Isabelle Vianna Trevisan ◽

Miguel Barbero Marcial ◽

Geraldo Verginelli ◽

...

Keyword(s):

Surgical Treatment ◽

Mitral Valve ◽

Good Condition ◽

Aortic Insufficiency ◽

Mitral Insufficiency ◽

Inflammatory Condition ◽

History Of ◽

Laboratory Examinations ◽

High Doses

AbstractEight patients, four males and four females, age five to 13 years old (average: 11 years) have undergone surgery in the acute phase of rheumaticfever. The patients presented a history of rheumatic activity characterized by the presence of migratory arthritis and carditis. All patients had severe acute mitral insufficiency, while one of them had associated aortic insufficiency. Laboratory examinations revealed the presence of an acute inflammatory condition. All patients had acute heart failure and were treated initially with high doses of diuretics, peripheral vasopressor and vasodilator amines, together with cardiotonic drugs, without improvement. Surgical treatment was indicated after a period of observation between 24 hours and five days. In five patients, the Doppler echocardiogram revealed rupture and elongation of tendinous cords. Two of them had acute dilatation of the mitral ring, and one had isolated acute dilatation of the mitral ring. Five patients underwent valvar replacement and, in three, valvar repair was carried out. Two patients, who were in cardiogenic shock at the time of their referral, died in the operating room following replacement of the mitral valve. All patients who underwent repair of the mitral valve were in good condition at the last follow-up, six to 27 months after surgery.

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