scholarly journals Remodeling of the left heart in patients with rheumatic mitral valve disease after mitral valve replacement with preservation of subvalvular structures

2020 ◽  
Vol 4 (Issue 2) ◽  
pp. 40
Author(s):  
Dinara Toktosunova ◽  
Murat Djundubaev ◽  
Elmira Seytahunova ◽  
Irina Akhmedova
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Case Histories ◽  
Systolic Volume ◽  
Replacement Surgery ◽  
End Systolic Volume ◽  
Valve Replacement Surgery

Objectives: to evaluate the advantage of preserving the subvalvular structures of the mitral valve from both leaflets compared with the preservation of the subvalvular structures only from the posterior valve during mitral valve replacement surgery (MVR). Methods: A retrospective analysis of case histories of 41 patients with isolated rheumatic lesions of the mitral valve who underwent MVR, which were divided into 2 groups: with complete preservation of subvalvular structures (n = 24) and preservation of only the posterior leaflet (n = 17), was performed. Results: In the group with complete preservation of the chordal-papillary apparatus, there was a significant decrease in the end-systolic volume (p<0.05) and a slight increase in the ejection fraction of the left ventricle in the immediate postoperative period compared with the group with the preservation of the chordal-papillary apparatus only from the posterior cusp, where end-systolic volume decreased slightly (p&qt;0.05) and the ejection fraction of the left ventricle remained at the same levels. Conclusion: Our preliminary results of the study indicate better remodeling and optimization of the geometry of the left ventricle when assessing the closest postoperative parameters in a group of patients with preservation of chordo-papillary structures of both leaflets, both the anterior and the posterior leaflets.

Randomized Trial of Partial Versus Complete Chordal Preservation Methods of Mitral Valve Replacement

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Kwok L. Yun ◽  
Colleen F. Sintek ◽  
D. Craig Miller ◽  
Gregg T. Schuyler ◽  
Alden D. Fletcher ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Ejection Fraction ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Wall Stress ◽  
Posterior Leaflet ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
End Systolic Volume ◽  
Fractional Shortening

Background —The merits of retaining the subvalvular apparatus during mitral valve replacement for chronic mitral regurgitation have been demonstrated in numerous clinical and laboratory investigations. In this preliminary report, we analyzed the early effects of complete versus partial chordal preservation on left ventricular mechanics. Methods and Results —Fifty patients undergoing isolated surgical correction of mitral insufficiency were prospectively randomized to either total or partial chordal-sparing mitral valve replacement. Of the first 19 patients studied, 8 had preservation of the posterior leaflet only, and 11 had complete preservation of all chordal structures. A comparison group consisted of 6 patients who had primary mitral valve repair. Echocardiography was performed preoperatively and at discharge from the hospital to determine dimensions, wall stress, and ejection fraction. Preservation of the posterior leaflet only resulted in a reduction in end-diastolic volume, an increase in end-systolic volume ( P =0.058), a rising trend in end-systolic stress, a decrease in long-axis fractional shortening, and a fall in ejection fraction from 0.68±0.16 to 0.46±0.19 ( P =0.001). Although patients who had preservation of all chordal structures also had decreased end-diastolic volume, long-axis fractional shortening, and ejection fraction (0.60±0.13 to 0.52±0.07, P =0.01), end-systolic stress fell and end-systolic volume decreased instead of increased. Compared with the posterior leaflet preservation group, those in the group with completely preserved chordal structures had a larger decline in end-diastolic volume and smaller decreases in long-axis fractional shortening and ejection fraction. Changes in end-systolic volume and stress were also statistically different between the 2 cohorts. No differences were detected between the group with total preserved chordal structures and the mitral repair group in any of the measured parameters. Conclusions —Compared with posterior chordal preservation only, complete retention of the subvalvular apparatus during mitral valve replacement resulted in improved ejection performance and smaller chamber volumes due to reduced systolic wall stress. These hemodynamic advantages are comparable to those observed with primary mitral reconstruction.

RELATIONSHIP OF PREOPERATIVE RIGHT VENTRICULAR FUNCTION AND OUTCOME AFTER MITRAL VALVE REPLACEMENT SURGERY – A PROSPECTIVE OBSERVATIONAL STUDY

2020 ◽  
pp. 43-46
Author(s):  
Debashis Karmokar ◽  
Pinaki Majumdar ◽  
Manjushree Ray ◽  
Asim Kumar Kundu
Keyword(s):  
Mitral Valve ◽  
Right Ventricular ◽  
Ventricular Function ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Right Ventricular Function ◽  
Low Cardiac Output Syndrome ◽  
Replacement Surgery ◽  
Grade 3 ◽  
Valve Replacement Surgery

Objective:Right ventricular dysfunction constitutes a major risk factor for patients suffering from degenerative mitral valve disease. The objective of this study was to assess right ventricular function by echocardiography and to detect role of right ventricular functions in prediction of outcome following mitral valve replacement operation in patients with rheumatic heart disease involving mitral valve. Methods:Transthoracic 3D echocardiography was done in 52 patients posted for mitral valve replacement surgery. Right ventricular function was analyzed by measuring fractional area change (FAC) of right ventricle, tethering distance and, tricuspid annular plane systolic excursion (TAPSE). Tricuspid regurgitation was graded 0 to 4. Based on echocardiographic ndings of right ventricle, patients were allocated in two groups; Group A (normal right ventricular function) and Group B (poor right ventricular function). After surgery, incidence of complications such as; low cardiac output syndrome, refractory arrhythmia and, sepsis were compared in two group. Results: Incidence of postoperative complication such as low cardiac output syndrome and sepsis was signicantly more in patients with poor right ventricular function. Right ventricular variables, FAC <35%, TAPSE <17 mm and tethering distance > 8 mm are independent predictors of postoperative complications. Tricuspid valve was repaired in patients with grade 3 and 4 regurgitation. Therefore cardiopulmonary bypass time was signicantly more in patients with grade 3 and 4 TR (84.42±69.77 min) (p<0.01). Duration of intensive care support was also signicantly more in patients with poor right ventricular function (p<0.001) Conclusion: To predict possible complications and outcome following mitral valve replacement surgery, right ventricular functions should be thoroughly assessed by 3D echocardiography

Giant Left Ventricular Pseudoaneurysm as a Complication After Mitral Valve Replacement Surgery

2014 ◽  
Vol 98 (4) ◽  
pp. 1480 ◽  
Author(s):  
Stefan Baumann ◽  
Matthias Renker ◽  
James V. Spearman ◽  
Richard R. Bayer ◽  
U. Joseph Schoepf ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Pseudoaneurysm ◽  
Replacement Surgery ◽  
Valve Replacement Surgery

scholarly journals Role of per-operative milrinone on pulmonary hypertension having mitral valve replacement.

2021 ◽  
Vol 28 (01) ◽  
pp. 120-124
Author(s):  
Shahbaz Ahmad Khilji ◽  
Shuja Tahir ◽  
Shahid Abbas
Keyword(s):  
Pulmonary Hypertension ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Nyha Class ◽  
Control Group ◽  
Study Group ◽  
Replacement Surgery ◽  
Valve Replacement Surgery

Objective: To determine the role of perioperative milrinone on pulmonary hypertension in patients with mitral valve disease undergoing mitral valve replacement surgery. Study Design: Randomized Control Trial. Setting: Department of Cardiac Surgery, Faisalabad Institute of Cardiology, Faisalabad. Period: June 2019 to June 2020. Material & Methods: A total of 80 patients with mitral valve disease who underwent mitral valve replacement were included. The patients were divided into a control group of 40, who were not administered milrinone, and a study group of 40 who received milrinone perioperatively. TVPG, LVEF and NYHA class were recorded preoperatively and postoperatively and were compared. Results: In the study group, postoperative LVEFs and NYHA class were not statistically significant in both groups while postoperative TVPG was significantly lower in study group as compare to control group and is statistically significant (P<0.001). Conclusion: Our study concludes that milrinone can be used as an effective therapy to reduce pulmonary pressure in patients with pulmonary hypertension undergoing mitral valve replacement surgery.

scholarly journals Effects of Controling of Post Operative Hypergycemia (Stress Induced Hyperglycemia) in Adult Non-Diabetic Patients Undergoing Mitral Valve Replacement Surgery Under Cardiopulmonary Bypass

2019 ◽  
Vol 34 (1) ◽  
pp. 44-51
Author(s):  
Md Armane Wadud ◽  
Syed Tanvir Ahmed ◽  
Shahnoor Aziz ◽  
Ibrahim Khalilullah ◽  
CM Shaheen Kabir
Keyword(s):  
Blood Glucose ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Postoperative Morbidity ◽  
Replacement Surgery ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Group B ◽  
Valve Replacement Surgery

Objectives: The objective of this study was to see whether there is an association between high blood glucose levels after operation under CPB and post operative morbidity and mortality. Methodology: This cohort study was carried out in the Department of Cardiac Surgery at National Institute of Cardiovascular DiseaseS (NICVD), Sher-e-Bangla Nagar, Dhaka from January, 2012 to December, 2013 for a period of twenty four (24) months. A total number of 110 patients who underwent MVR operation with CPB were enrolled in this study as per inclusion and exclusion criteria. Patients were divided into two groups according to their post operative blood glucose levels, recorded with in first 60 hrs after mitral valve replacement surgery under cardiopulmonay bypass. Patients having blood glucose level of less than 10.1 mmol/L (unexposed) and patients having blood lactate level of 10.1 mmol/L or more (exposed) were grouped. Post operative variables were observed and recorded during the hospital course of the patient. Result: A total number of 110 patients were enrolled in this study. Blood glucose levels lower than or equal to10 mmol/L after MVR were present in 55(50%) patients (Group A) Blood glucose levels higher than 10 mmol/L after MVR were present in 55(50%) patients. Postoperative morbidity was higher in this group ( Group B) than in the patients who had peak blood glucose levels of less than or equal to 10 mmol/L MVR (p 0.001). Postoperative ICU stay was prolonged in patients with elevated levels of blood glucose after MVR under CPB compared with of patients with lower blood glucose levels (p 0.001). Other common morbidities are neurological complication (p 0.04), renal dysfunction (p 0.01) , wound infection (p 0.04), post-operative hospital stay ( p0.004). also higher in group B patient, as well as mortality. Conclusions: Blood glucose concentration of 10.1 mmol/ L or higher after MVR under CPB is an important issues related to postoperative morbidity and mortality. Bangladesh Heart Journal 2019; 34(1) : 44-51

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