scholarly journals Possibilities of Echocardiography at the Stages of Surgical Treatment of the Patient with the Mitral Valve Posterior Leaflet Prolapse Resulted in Mitral Insufficiency and Atrial Fibrillation (A Case Report)

2017 ◽  
pp. 103-113
Author(s):  
M. V. Kadyrova ◽  
N. N. Askerova ◽  
Yu. A. Stepanova ◽  
N. V. Zhemerov ◽  
E. S. Malyshenko ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Plastic Surgery ◽  
Mitral Insufficiency ◽  
Posterior Leaflet ◽  
Support Ring ◽  
Leaflet Prolapse

The mitral valve prolapse is characterized by the degeneration of the valve leaflets, accompanied by their thickening, increasing surface area and flexibility. The mitral valves leaflets bulge (prolapse) beyond the plane of the atrioventricular ring into the left atrium during ventricular systole and lose the ability to close tightly, leading to the mitral regurgitation. Acute chord rupture of the mitral valve posterior leaflet is a rare but important cause of severe mitral regurgitation and the development of acute or progressive chronic heart failure. Acute mitral insufficiency, accompanied by hemodynamic disorders, requires an urgent valve plastic surgery or valve prosthetics. The mitral valve plastic surgery gives a number of undeniable advantages over prosthetics, providing the best hemodynamic parameters, saving the patient from lifelong receiving of anticoagulant drugs. Detailed qualified echocardiographic evaluation of all structures of the mitral valve (fibrous ring, MV leaflets by segments, overlapping structures, structure of the chordal apparatus, papillary muscles) provides the necessary information for the mitral valve reconstructive plastic surgery with the choice of the method that is most optimal for a certain patient at the preoperative stage. We report herein a clinical observation of the patient with a diagnosis: acquired heart disease, the mitral valve posterior leaflet prolapse with mitral insufficiency Grade 3. Chronic heart failure IIA. II FC. Atrial fibrillation. The patient underwent multicomponent mitral valve reconstruction with the creation of a neochord and the fibrous ring plastic on the duplicate of a PTFE strip (soft support ring), pairwise isolation of the pulmonary vein entrance and right cavotricuspid isthmus.

Butterfly technique in mitral valve repair

2020 ◽  
Vol 28 (7) ◽  
pp. 413-415
Author(s):  
Tohru Asai
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Systolic Anterior Motion ◽  
Posterior Leaflet ◽  
Valve Repair ◽  
Free Margin ◽  
Leaflet Prolapse

Degenerative mitral regurgitation due to posterior leaflet prolapse is often associated with tissue redundancy in the leaflet height and free margin of the prolapsing segment. The butterfly technique has been introduced for focal resection to precisely control the leaflet height without annular plication. This technique is indicated for a high prolapsing leaflet, greater than 20 mm. With intraoperative measurement of leaflet heights and ink dot marking as a depth indicator, the butterfly technique can be safely performed in most high posterior leaflet prolapse cases, without increasing the risk of systolic anterior motion.

scholarly journals The role of three dimensional transeosephageal echocardiography in predicting the effect of cardiac resynchronization therapy on mitral regurgitation in patients with low ejection fraction heart fail

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Demirtola ◽  
TS Tan ◽  
A Mammadli ◽  
IM Akbulut ◽  
I Dincer
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Functional Mitral Regurgitation ◽  
Posterior Leaflet ◽  
Resynchronization Therapy ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Purpose Cardiac resynchronization therapy (CRT) has  a positive effect on the improvement of functional mitral regurgitation in patients with low ejection heart failure. However geometric changes in the mitral valve apparatus, subvalvular structures and their contribution to  the improvement of mitral regurgitation after CRT have not  been clearly defined. The aim of our study was to evaluate the geometric parameters of mitral valve apparatus measured with 3Dimensional (3D) transesophageal echocardiography (TEE) before CRT implantation and to determine the parameters predicting the improvement of mitral regurgitation after CRT. Methods Thirty patients with moderate or severe mitral regurgitation with low EF heart failure planned for CRT implantation and had an indication for TEE were included in the study. Effective regurgitant orifice (ERO) and regurgitant volume (RV) measurements were performed before CRT implantation. Detailed quantitative measurements of mitral valve were done from recorded images by 3D TEE. ERO, RV measurements were repeated to evaluate mitral regurgitation at the end of 3rd month. Results There were no significant changes in left ventricular EF and left ventricular diameters at the end of 3rd month, whereas ERO and RV values were decreased. A statistically significant difference was found in  posterior leaflet angle between mitral regurgitation responder and non-responder groups.  (28,93 ± 8,41 vs 41,25 ± 10,90, p = 0,006). Conclusion Heart failure patients with moderate or severe functional mitral regurgitation who underwent CRT implantation were found to have lower posterior leaflet angle measured by 3D TEE in the patient group whose mitral regurgitation improved after CRT. Abstract Figure.

scholarly journals P1412 A new light to improve the view of the anatomical details during micro-invasive trans-ventricular repair of degenerative prolapse of mitral valve

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Vairo ◽  
M Marro ◽  
G Speziali ◽  
M Rinaldi ◽  
S Salizzoni
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Coming Out ◽  
Left Ventricular ◽  
Posterior Leaflet ◽  
Valve Repair ◽  
High Definition ◽  
Definition Of ◽  
Leaflet Prolapse

Abstract BACKGROUND Mitral valve repair is the preferred surgical treatment for severe mitral regurgitation due to degenerative leaflet prolapse. Within the growing era of transcatheter treatments for valvular heart disease, an innovative micro-invasive trans-ventricular beating-heart procedure was developed. Three-dimensional (3D) transoesophageal echocardiographic guidance is crucial to assist the operator in instrument navigation and chords positioning. 3D ultrasound technology is constantly evolving and a special light, that can be mobilized within the 3D images, has recently been invented. This light allows to illuminate the structures from different points of view and increase the definition of the anatomical details. PURPOSE To show the advantages of this new 3D image analysis technology, described above, through a sequence of intra-procedural images of a mitral valve repair by trans-ventricular polytetrafluoroethylene (ePTFE) chords implantation. METHODS The procedure is performed using a device that is introduced through a posterolateral ventriculotomy and it is advanced towards the mitral valve under real-time 3D transoesophageal guidance. The prolapsing segment, in this case central part of posterior leaflet (Fig. 1 A, B and C), is grasped with the jaw of the instrument (J in Fig. 1D), then the chords are implanted, tensioned and secured outside the ventricle. Figure 1A shows the pre-operative image of posterior leaflet prolapse with flail (P2 segment) and the light illuminates the valve from above. The broken chords (arrow in Fig. 1A) can be recognized with high definition. The light can also be placed on the valve plane (Fig. 1B) or below (Fig. 1C). When illumination occurs from the left ventricular side, the coaptation loss due to the P2 flail is highlighted (arrow in Fig. 1C). After placement, tensioning and securing the chords outside the ventricle, the prolapse disappears and the correct coaptation is re-established (Fig. 1E). The coaptation deficit is no longer visible, even with the light placed below the valve and it is possible to see the light coming out of the aortic valve (Ao), opened in systole, with mitral valve closed (Fig. 1F). RESULTS At the end of the procedure the residual mitral regurgitation was trivial and no loss of coaptation can be evidenced even with the light placed in the left ventricle (Fig. 1F). CONCLUSIONS This new light allows to improve the anatomical definition of 3D echocardiographic images, allows better visualization of the coaptation defects and can be used as a further verification of the result especially in cases of micro-invasive mitral repair. Abstract P1412 Figure 1

Anomalous mitral arcade leading to congenital mitral insufficiency with an associated anomaly of the tricuspid valve

1992 ◽  
Vol 2 (4) ◽  
pp. 357-358 ◽  
Author(s):  
Jyoti V. Mandke ◽  
Vikas R. Dharnidharka ◽  
Vasundhara P. Sanzgiri
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Tricuspid Valve ◽  
Acute Onset ◽  
Mitral Insufficiency

SummaryA 21-day-old girl presented with congestive heart failure of acute onset and Doppler evidence of mitral regurgitation, which subsequently proved fatal. Necropsy revealed an anomalous arcade lesion of the mitral valve. The tendinous cords of the tricuspid valve were also abnormal, a finding, to the best of our knowledge, not reported before.

scholarly journals The role of three-dimensional transesophageal echocardiography in predicting the effect of cardiac resynchronization therapy on mitral regurgitation in patients with low ejection fraction heart failure

2021 ◽  
Author(s):  
Ayse Demirtola ◽  
Turkan Tan ◽  
Anar Mammadli ◽  
irem Muge Akbulut ◽  
Demet Gerede ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Functional Mitral Regurgitation ◽  
Posterior Leaflet ◽  
Resynchronization Therapy

Purpose: Cardiac resynchronization therapy (CRT) has a positive effect on the improvement of functional mitral regurgitation in patients with heart failure with reduced ejection fraction. However geometric changes in the mitral valve apparatus, subvalvular structures and their contribution to the improvement of mitral regurgitation after CRT have not been clearly defined. The aim of our study was to evaluate the geometric parameters of mitral valve apparatus measured with 3Dimensional (3D) transesophageal echocardiography (TEE) before CRT implantation and to determine the parameters predicting the improvement of mitral regurgitation after CRT. Methods: In this prospective study thirty patients with moderate or severe mitral regurgitation with low EF heart failure planned for CRT implantation and had an indication for TEE were included. Effective regurgitant orifice (ERO) and regurgitant volume (RV) measurements were performed before CRT implantation. Detailed quantitative measurements of mitral valve were done from recorded images by 3D TEE. ERO, RV measurements were repeated to evaluate mitral regurgitation at the end of 3rd month. Results: There were no significant changes in left ventricular EF and left ventricular diameters at third month follow-up, whereas ERO and RV values were decreased. posterior leaflet angle was found higher in non-responder group compared to responder group. (28,93 ± 8,41 vs 41,25 ± 10,90, p = 0,006). Conclusion: Heart failure patients with moderate or severe functional mitral regurgitation who underwent CRT implantation were found lower posterior leaflet angle which was measured by 3D TEE in the patient group whose mitral regurgitation improved after CRT.

scholarly journals P627 Step by step valve destruction in infective endocarditis with no apparent vegetations

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Skafar ◽  
A Ovsenik ◽  
J Toplisek ◽  
B Berlot ◽  
M Bervar
Keyword(s):  
Heart Failure ◽  
Staphylococcus Aureus ◽  
Congestive Heart Failure ◽  
Infective Endocarditis ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Antibiotic Therapy ◽  
Systolic Dysfunction ◽  
Illustrative Case ◽  
Posterior Leaflet

Abstract Background Infective endocarditis can present without evident vegetation, diagnosis is challenging and prognosis very poor. We present an illustrative case where natural evolution of the mitral valve destruction with no evident vegetations was followed with frequent consecutive transthoracic (TTE) and transesophageal echocardiography (TOE). Case presentation 71-year old male with known dilated cardiomyopathy presented with dyspnoea, ankle swelling and severe kidney failure with hyperkalemia. During short hospitalization he was recompensated with haemodialysis, parenteral diuretics and inotropes. TTE showed dilated left ventricle with severe systolic dysfunction and no evidence of valvular disease. Few days after discharge he was readmitted with malaise and febrile state with no obvious site of infection. Blood cultures were positive for Staphylococcus aureus and antibiotic therapy was initiated immediately. Weekly TTEs and TOEs were performed (Figure 1, column A-D): Week 1: TTE was performed due to congestive heart failure. There was no suspicion on disease and TTE showed no obvious mitral valve pathology. Week 3: Second TTE showed only light thickening of posterior mitral leaflet with mild mitral regurgitation. Week 4: Follow-up TOE was performed showing posterior leaflet discontinuity with small eccentric regurgitation jet and no vegetation. Week 6: Symptoms of congestive heart failure persisted despite antibiotic treatment. A progressive destruction of posterior leaflet with evident perforation of P1 scallop and consequent severe mitral regurgitation. Patient was referred for urgent mitral valve replacement. Conclusions Staphylococcus aureus is a destructive pathogen and can cause severe destruction of native valve even without obvious vegetations. This case presents echocardiographic features of natural course of infective endocarditis on mitral valve. Despite antibiotic therapy progressive valve destruction is possible. Abstract P627 Figure.

scholarly journals Contrasting Effects of Pharmacological, Procedural, and Surgical Interventions on Proportionate and Disproportionate Functional Mitral Regurgitation in Chronic Heart Failure

Circulation ◽  
2019 ◽  
Vol 140 (9) ◽  
pp. 779-789 ◽  
Author(s):  
Milton Packer ◽  
Paul A. Grayburn
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Cardiac Resynchronization ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Lv Volumes

Two distinct pathways can lead to functional mitral regurgitation (MR) in patients with chronic heart failure and a reduced ejection fraction. When remodeling and enlargement of the left ventricle (LV) cause annular dilatation and tethering of the mitral valve leaflets, there is a linear relationship between LV end-diastolic volume and the effective regurgitant orifice area of the mitral valve. These patients, designated as having proportionate MR, respond favorably to treatments that lead to reversal of LV remodeling and a decrease in LV volumes (eg, neurohormonal antagonists and LV assist devices), but they may not benefit from interventions that are directed only at the mitral valve leaflets (eg, transcatheter mitral valve repair). In contrast, when ventricular dyssynchrony causes functional MR attributable to unequal contraction of the papillary muscles, the magnitude of regurgitation is greater than that predicted by LV volumes. These patients, designated as having severe but disproportionate MR, respond favorably to treatments that are directed to the mitral valve leaflets or their supporting structures (eg, cardiac resynchronization or transcatheter mitral valve repair), but they may derive little benefit from interventions that act only to reduce LV cavity size (eg, pharmacological treatments). This novel conceptual framework reflects the important interplay between LV geometry and mitral valve function in determining the clinical presentation of patients, and it allows characterization of the determinants of functional MR to guide the most appropriate therapy in the clinical setting.

scholarly journals Is there the phenotype of chronic heart failure with “intermediate” left ventricular ejection fraction? Additional echocardiographic criteria for left ventricular systolic dysfunction in patients with chronic heart failure of ischemic origin with ejection fraction in the “gray area”

2021 ◽  
Vol 23 (3) ◽  
pp. 322-330
Author(s):  
V. V. Syvolap ◽  
V. A. Lysenko
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Gray Area

Patients with chronic heart failure (CHF) with left ventricular ejection fraction (LV EF) in the range of 40–55 % form a separate group with “intermediate” or “moderately reduced” LV EF. Since there are a number of additional criteria in echocardiography other than EF for determining LV systolic function (TEI, MAPSE, systolic velocity of the fibrous ring of the mitral valve (S’), E/e’, dP/dt mitral regurgitation, etc.), their use may be helpful in the final identification of systolic dysfunction in CHF patients with LV EF within the “gray area”. The aim of the work – to find out the possibility of using ultrasound parameters of LV systolic function as additional diagnostic criteria for systolic dysfunction and to develop an algorithm for its diagnosis in CHF patients with LV EF within the “gray zone” (40–55 %). Materials and methods. The study included 79 patients (men – n = 49; women – n = 30) with CHF of ischemic origin with LV EF from 40 % to 55 % (main group) who were divided into two subgroups: the first subgroup (n = 40) – patients with LV EF within the “gray area 45–55 %”, the second subgroup (n = 39) – patients with LV EF less than 45 %. The comparison group – 90 patients with coronary heart disease without signs of CHF (men – n = 40, 44.5 %; women – n = 50, 55.5 %). The patient groups were age-, sex-, height-, weight-, body surface area-matched. Doppler echocardiographic examination was performed on the device Esaote MyLab Eight (Italy). Results. According to our results, 90 % (71/79) of CHF patients with reduced LV EF had mitral regurgitation. Additional examination of the systolic index dP/dT of less than 1200 mm Hg/s on the flow of mitral regurgitation allowed to classify CHF patients from the “gray area” (LV EF 40–55 %) to the CHF phenotype with reduced LV EF, and that was almost half of patients – 50.6 % (40/79). Cut off points were established for Myocardial Performance Index TEI of the LV >0.56 r. u., the right ventricle >0.51 r. u., decrease in systolic dP/dT ≤1000 mm Hg/s, systolic velocity of the medial (S med ≤7 cm/s) and the lateral (S lat ≤7 cm/s) fibrous ring of the mitral valve, the amplitude of the medial (MAPSE med ≤11.7 mm) and the lateral (MAPSE lat ≤11.1 mm) fibrous ring of the mitral valve. Conclusions. The cohort of CHF patients with “intermediate” LV EF is a heterogeneous group, which includes patients according to one formal criterion – LV EF in the range of 40–55 %. LV EF is a surrogate marker, insufficient for the final determination of the CHF phenotype. Additional criteria for systolic dysfunction include ventricular TEI, dP/dT mitral regurgitation, systolic velocity (S), and amplitude (MAPSE) of the medial and lateral fibrous ring of the mitral valve. In the presence of two or more additional ultrasound criteria for systolic LV dysfunction, CHF patients with LV EF within 40–55 % should be considered as patients with reduced LV EF.

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