scholarly journals Surgical management of biatrial myxoma: case report

2021 ◽  
Vol 25 (4) ◽  
pp. 118
Author(s):  
T. A. Simonyan ◽  
I. I. Scopin ◽  
I. M. Tsiskaridze ◽  
I. Yu. Farulova ◽  
E. A. Babajanyan
Keyword(s):  
Mitral Valve ◽  
Surgical Management ◽  
Tricuspid Valve ◽  
Conflict Of Interest ◽  
Right Atrium ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Support Ring ◽  
Ventricular Ejection Fraction ◽  
Left And Right

<p>Heart tumours account for approximately 0.2 % of all tumours: of these, approximately 75 % of all primary heart tumours are benign and 50 % of them are myxomas. Further, myxomas make up 0.0017 % of the general population of patients with cardiovascular disease. Biatrial myxomas, i.e. tumours in both the left and right atria, can be in the form of a ‘butterfly’ or a ‘dumbbell’, and account for &lt; 1 % of all cardiac myxomas. Here we describe the successful surgical management of a rare case of a large biatrial myxoma and concomitant atrioventricular valve insufficiency. Briefly, 2D transthoracic echocardiography findings included an end-diastolic volume of 90 ml, an end-systolic volume of 40 ml and a left ventricular ejection fraction of 55 % (according to Simpson). The fibrous ring of the mitral valve measured 36 mm with a regurgitation degree of 2 while the fibrous ring of the tricuspid valve was 42 mm in size and the regurgitation grade was 3. Lesion size in the cavity of the left and right atrium were 73 × 38 mm and 80 × 42 mm, respectively. These neoplasia were surgically removed under peripheral cardiopulmonary bypass, hypothermia and cold cardioplegia (Custodiol). The myxomas were accessed through the right atrium, according to Giradon and were resected without defragmentation. Next, mitral valve plasty using a soft support ring and annuloplasty of the tricuspid valve were performed according to de Vega. The duration of artificial circulation was 150 minutes and that of myocardial ischaemia was 100 minutes. The patient was extubated 11 hours after surgery, spent 22 hours in the intensive care unit and was discharged on the 14th day after surgery. Surgical resection of biatrial myxomas before the development of serious irreversible or life-threatening complications can provide rapid symptomatic relief in congestive heart failure.</p><p>Received 30 May 2021. Revised 22 August 2021. Accepted 23 August 2021.</p><p><strong>Funding: </strong>The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Literature review: T.A. Simonyan<br /> Drafting the article: T.A. Simonyan, I.M. Tsiskaridze<br /> Critical revision of the article: T.A. Simonyan, I.Yu. Farulova, E.A. Babajanyan<br /> Surgical treatment: I.I. Scopin, I.M. Tsiskaridze<br /> Final approval of the version to be published: T.A. Simonyan, I.I. Scopin, I.M. Tsiskaridze, I.Yu. Farulova, E.A. Babajanyan</p>

scholarly journals MIDA mortality risk score in patients undergoing percutaneous edge-to-edge mitral repair

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Kavsur ◽  
C Iliadis ◽  
C Metze ◽  
M Spieker ◽  
V Tiyerili ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Risk Score ◽  
Patient Selection ◽  
Mortality Risk ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Valve Repair ◽  
Ventricular Ejection Fraction

Abstract Background Recent studies indicate that careful patient selection is key for the percutaneous edge-to-edge repair via MitraClip procedure. The MIDA Score represents a useful tool for patient selection and is validated in patients with degenerative mitral regurgitation (MR). Aim We here assessed the potential benefit of the MIDA Score for patients with functional or degenerative MR undergoing edge-to-edge mitral valve repair via the MitraClip procedure. Methods In the present study, we retrospectively included 520 patients from three Heart Centers undergoing MitraClip implantation for MR. All parameters of the MIDA Score were available in these patients, consisting of the 7 variables age, symptoms, atrial fibrillation, left atrial diameter, right ventricular systolic pressure, left-ventricular end-systolic diameter, left ventricular ejection fraction. According to the median MIDA-Score of 9 points, patients were stratified in to a high and a low MIDA Score group and association with all-cause mortality was evaluated. Moreover, MR was assessed in echocardiographic controls in 370 patients at discharge, 279 patients at 3-months and 222 patients at 12 months after MitraClip implantation. Results During 2-years follow-up after MitraClip implantation, 69 of 291 (24%) patients with a high MIDA Score and 25 of 229 (11%) patients with a low MIDA Score died. Kaplan-Meier analysis and log rank test showed inferior rates of death in patients with a low score (p&lt;0.001) and multivariate cox regression revealed an odds ratio of 0.54 (0.31–0.95; p=0.032) regarding 2-year survival in this group. Moreover, one point increase in the MIDA Score was associated with a 1.18-fold increase in the risk for mortality (1.02–1.36; p=0.025). Comparing patients with a high MIDA Score and patients with a low score, post-procedural residual moderate/severe MR tended to be more frequent in patients with a high MIDA Score at discharge (53% vs 43%; p=0.061), 3-months (50% vs 40%; p=0.091) and significantly at 12-months follow-up (52% vs 37%; p=0.029). Conclusion The MIDA Mortality Risk Score remained its predictive ability in patients with degenerative or function MR undergoing transcatheter edge-to-edge mitral valve repair. Moreover, a high MIDA score was associated with a higher frequency of post-procedural residual moderate/severe MR, indicating a lower effectiveness of this procedure in these patients. Funding Acknowledgement Type of funding source: None

scholarly journals Early Clinical Results After Stentless Mitral Valve Implantation and Comparison With Conventional Valve Repair or Replacement

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Thomas Walther ◽  
Claudia Walther ◽  
Volkmar Falk ◽  
Anno Diegeler ◽  
Ralf Krakor ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Maximum Flow ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Papillary Muscles ◽  
Valve Repair ◽  
Promising Alternative ◽  
Ventricular Ejection Fraction

Background —A new quadricusp stentless mitral bioprosthetic valve (QMV) is evaluated and compared with current standards. Methods and Results —Since August 1997, 67 patients were prospectively evaluated: 23 patients received a QMV, 23 had mitral valve repair (MVR), and 21 received conventional mitral valve replacement (MVP). Patient age was 69±8, 64±10, and 62±9 years for QMV, MVR, and MVP treatment, respectively. The underlying pathology was mitral stenosis, incompetence, and mixed disease in a corresponding 8, 9, and 6 patients for QMV, 1, 22, and 0 patients for MVR, and 2, 12, and 7 patients for MVP. The papillary muscles were sufficient in all QMV cases to suspend the valve. Cross-clamp time was 59±19 minutes for QMV implantation. In-hospital mortality for QMV, MVR, and MVP was 1, 0, and 0 patients, respectively, and thoracotomy had to be performed again in 1, 1, and 2 patients, respectively (these outcomes were not valve related). At baseline transthoracic echocardiography, respective maximum flow velocities were 1.6, 1.4, and 1.7 m/s, and valve orifice area was 2.6, 3.5, and 3.4 cm 2 . Mild transvalvular reflux was seen in 8, 7, and 2 patients; moderate reflux, in 1, 1, and 1 patients. Left ventricular ejection fraction was 52%, 54%, and 51% in the respective treatment groups. At follow-up, hemodynamic parameters had further improved in all groups. Conclusions —One year after clinical implantation, the QMV appears to function well and has no additional risks compared with MVR or MVP. The subvalvular apparatus is preserved by suspending the QMV at the papillary muscles; this arrangement is hemodynamically advantageous. Echocardiography reveals an excellent valve performance that resembles native mitral valve morphology and hemodynamic function. The QMV is a promising alternative for biological mitral valve replacement.

scholarly journals Single versus bilateral chordo-papillary apparatus preservation in mitral valve replacement: a hemodynamic study

2020 ◽  
Vol 2 (2) ◽  
pp. 62-69
Author(s):  
Mostafa Alaaeldin Abdelfatah Shalaby ◽  
Haytham Mohamed Abd el.Moaty ◽  
Mohamed Hossiny Mahmoud ◽  
Mohamed S H Abdallah
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Ventricular Geometry ◽  
Ventricular Ejection Fraction ◽  
Group Iii ◽  
Group I ◽  
Single Versus

Background: It has been postulated that disruption of the mitral valve apparatus at the time of mitral valve replacement (MVR) is a risk factor for postoperative ventricular dysfunction. The aim of this study was to evaluate the effect of single versus bilateral chordo-papillary preservation on the left ventricular function in comparison to no preservation. Methods: This study was conducted from 2015 to 2018 on sixty patients who had MVR. The patients were classified into group I included 20 patients who underwent MVR with complete excision of the subvalvular chordae and tips of papillary muscles, group II: included 20 patients who underwent MVR with preservation of posterior chordo-papillary apparatus, and group III: included 20 patients who underwent MVR with preservation of both posterior and anterior chordo-papillary apparatus. Results: There were 20 males (33.3%), and the mean age was 48.76± 8.91 years. Patients in group III were significantly older (37.15 ±4.92, 39.8 ± 5.49, and 57.25 ± 6.93 years in groups I, II, and III, respectively; p< 0.001). The left ventricular end-diastolic (5.40 ±0.34, 4.96 ± 0.43, and 4.44 ± 0.55 mm in group I, II and III, respectively, p<0.001) and end-systolic diameter (4.33 ±0.48, 3.58 ±0.43 and 3.20 ±0.43 mm in group I, II and III; respectively, p<0.001) were significantly reduced in partial and complete preservation groups after 6 months. Left ventricular ejection fraction improved in the bilateral preservation and partial preservation groups after 6 months (45.32 ±9.78, 56.79 ±10.14, and 56.60 ±11.68 % in groups I, II and III respectively, p<0.001). Mechanical ventilation was significantly longer in group I (24.10 ± 6.6, 16.80 ± 5.97, and 15.80 ± 5.24 hours in groups I, II and III, respectively, p<0.001) and the duration of ICU stay was significantly longer in group I (78.65 ± 15.32, 65.40 ± 14.21, and 60.20 ± 12.58 hours in groups I, II and III, respectively, p<0.001). Conclusion: Preservation of the annulo-papillary continuity may preserve left ventricular geometry and performance. Total preservation of chordae could be superior to partial preservation with better left ventricular remodeling and improvement in the left ventricular functions.

Atrial function discriminates paroxysmal AF patients with HFpEF from those without HFpEF: subanalysis from AF-RISK study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
V Artola ◽  
B Santema ◽  
R De With ◽  
B Nguyen ◽  
D Linz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Atrial Function ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Left And Right ◽  
Right Atria

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie. Grant support from the Dutch Heart Foundation [NHS2010B233] Background. Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) are two cardiovascular conditions that often coexist. Overlapping symptoms, biomarker profile, and echocardiographic changes hinder the diagnosis of underlying HFpEF in patients with AF and suggest that both conditions might reflect similar remodelling processes in the heart. Purpose. To assess cardiac remodelling in AF patients with versus without concomitant HFpEF by transthoracic echocardiography, focusing on atrial dimension and strain. Methods. We selected 120 patients included in AF-RISK, a prospective, observational, multicentre study aiming to identify a risk profile to guide atrial fibrillation therapy study. Patients had paroxysmal AF diagnosed within three years before inclusion, had a left ventricular ejection fraction (LVEF) ≥50% and were in sinus rhythm at the moment of performing echocardiography and blood sampling. Patients were matched by nearest neighbour by age and sex with a 1:1 ratio and were classified into two groups: 1) AF with HFpEF (n = 60) and 2) AF without HFpEF (n = 60). The diagnosis of HFpEF was based on the 2016 ESC heart failure guidelines, including symptoms and signs of heart failure, N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥125pg/ml, and one of the following echocardiographic measures: left atrium volume index (LAVI) &gt;34ml/m2, left ventricular mass index ≥115g/m2 for men and ≥95g/m2 for women, average E/e’ ≥13cm/s and average e’ &lt;9cm/s. Measurements of reservoir, conduit and contraction strain of both atria were performed in apical four-chamber by echocardiography (GE, EchoPac BT12). Associations of clinical and echocardiographic characteristics were tested for collinearity by multivariable logistic regression analyses. LAVI, LV mass index and NT-proBNP were excluded from multivariable analysis since these markers were part of the HFpEF diagnostic criteria. Results. Patients with paroxysmal AF and concomitant HFpEF had more often hypertension (72% vs. 45%, P = 0.005), had more impaired strain phases of both the left and right atria (figure 1), had comparable LVEF and global longitudinal strain (GLS) (P = 0.168 and P = 0.212, respectively). In a model adjusted for the number of comorbidities and sex, LA contraction decrease was associated with presence of HFpEF (odds ratio per 1% LA contraction-percent was 0.94, 95% confidence interval 0.87–0.99, P = 0.042). LA contraction was not explained by LAVI in patients with concomitant HFpEF (Spearman’s rho= -0.07, P = 0.08). Conclusion. Our results show that atrial function may differentiate paroxysmal AF patients with HFpEF from those without HFpEF. In patients with paroxysmal AF, more impaired strain phases of the left and right atria were associated with concomitant HFpEF, whereas ventricular function, reflected by LVEF and GLS, did not differ. Abstract Figure. Strain distribution of both atria

scholarly journals P770 Does intraoperative transesophageal match postoperative echocardiography in mitral valve surgery?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Alves ◽  
V Marinho ◽  
C Branco ◽  
A R Ramalho ◽  
M J Maldonado ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Systolic Pulmonary Artery Pressure ◽  
Flow Profile ◽  
Strongly Correlated ◽  
Functional Area ◽  
Global Improvement ◽  
Ventricular Ejection Fraction

Abstract BACKGROUND Intraoperative transesophageal echocardiography (iTEE) has an important role in mitral valve (MV) surgery, but may have dissimilar parameters from postoperative echocardiography (post-TTE). We aimed to evaluate iTTE Doppler flow profile and compare with the post-TTE in MV surgery. METHODS We conducted a prospective, observational study of 126 patients that underwent MVsurgery during 2 years. iTEE evaluated mean pressure gradient (MPG) and functional area. Patients were re-evaluated with TTE, 72 hours after surgery (post-TTE). iTEE and post-TTE Doppler values were compared and correlated. Preoperative TTE (pre-TTE) parameters were also determined. RESULTS The mean age was 59 ± 18 years and 55% were female. The prevalence of severe mitral regurgitation (MR) was 77.6% and severe mitral stenosis (MS) 23.7%. Globally, mitral valve repair was performed in 71%cases (83% for MR and 15% for MS) and replacement in 29% (64% for MR and 46% for MS). Left ventricular ejection fraction (LVEF), systolic pulmonary artery pressure (sPAP), tricuspid annular plane systolic excursion (TAPSE) assessed in pre-TTE and post-TTE, as also MPG and functional area in post-TTE and iTEE are depicted on table 1. There was a higher numerical difference in iTEE vs post-TTE MPG values in mechanical valves (n = 5) (3.5 ± 1.2 to 5.2 ± 1.6, difference of 1.65 ± 2.4mmHg), than in biological valves (n = 17) (3.1 ± 1.1 to 3.9 ± 1.5, difference of 0.8 ± 1.7mmHg). Globally, iTEE-derived MPG and functional area were strongly correlated with their post-TTE values (r2 0.7 and 0.8,p &lt; 0.001). CONCLUSIONS iTEE Doppler parameters were strongly correlated with postoperative TTE parameters, with minimal differences: postoperative MPG were +0.4 ± 1mmHg higher in MV repair and +1.0 ± 1.8mmHg in MV replacement. There was a global improvement in sPAP. Our study demonstrates the usefulness of iTEE and its importance in stablishing possible reference values for postoperative follow-up. MR MS pre-TTE post-TTE P value pre-TTE post-TTE P value LVEF (± SD,%) 57 ± 9 52 ± 10 &lt;0.001 58 ± 6 56 ± 7 &lt;0.001 sPAP (± SD,mmHg) 42 ± 17 33 ± 9 &lt;0.001 47 ± 18 35 ± 6 &lt;0.001 TAPSE (± SD,mm) 18 ± 2 14 ± 3 &lt;0.001 18 ± 2 14 ± 3 &lt;0.001 MV repair MV replacement iTEE post-TTE P value iTEE post-TTE P value MPG (± SD, mmHg) 2.8 ± 1.5 3.1 ± 1.4 0.084 3.2 ± 1.4 4.2 ± 1.6 0.016 Functional Area (± SD, cm2) 2.8 ± 0.6 2.8 ± 0.7 0.665 2.8 ± 0.6 2.7 ± 0.8 0.653

scholarly journals Formula to Correct Left Ventricular Ejection Fraction in Patients with Mitral Valve Regurgitation

2019 ◽  
Vol 87 (3) ◽  
pp. 223-226
Author(s):  
Hugo Villarroel Abrego ◽  
Raúl Garillo ◽  
Hilda Peralta-Rosado ◽  
Elaine Nuñez ◽  
Juan Carlos González Suero
Keyword(s):  
Mitral Valve ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Mitral Valve Regurgitation ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Valve Regurgitation ◽  
Ventricular Ejection Fraction
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