scholarly journals The dilatation factor of left atrium in remote period after the mitral valve prosthesis

2019 ◽  
Vol 86 (11-12) ◽  
pp. 9-12
Author(s):  
K. V. Pukas ◽  
V. V. Lazoryshynets
Keyword(s):  
Mitral Valve ◽  
Left Atrium ◽  
Posterior Wall ◽  
Valve Prosthesis ◽  
Thromboembolic Complications ◽  
Mitral Valve Prosthesis ◽  
Constant Form ◽  
Left Atrium Size ◽  
Contractility Of The Heart

Objective. Studying of the morphometry indices and contractility of the heart left compartments in the left atrium reduction after prosthesis of a mitral valve. Materials and methods. Into the investigation 634 consequently operated patients with isolated mitral failure were included, who were surgically treated in Amosov National Institute of Cardiovascular Surgery from the 1st of January to the 1st of January 2007 yr. In all the patients the mitral valve prosthesis was performed. In the left atrium dilatation in 49 (7.7%) patients additionally its reduction was done, using paraanular plication of posterior wall of left atrium with the aim to achieve its size lesser than 5,0 cm. Results. Of 49 patients, suffering constant form of atrial fibrillation, thromboembolic complications have occurred in 3 (6.1%) while performance of paraanular plasty of left atrium with simultaneous elimination of its auricle. All thromboembolic complications were nonsevere, and a left atrium size did not exceeded 5.5 sm. Conclusion. The left atrium reduction and elimination of its auricle in the left-sided atriomegaly constitutes a significant element of the result improvement in the mitral valve prosthesis in late period of follow-up.

Redo tricuspid valve operation in patients with 1st-generation mitral prostheses

2018 ◽  
Vol 26 (7) ◽  
pp. 524-528
Author(s):  
Simon CY Chow ◽  
Alex PW Lee ◽  
Anthony MH Ho ◽  
Herman HM Chan ◽  
Malcolm J Underwood ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Tricuspid Valve ◽  
First Generation ◽  
Right Heart Failure ◽  
Valve Prosthesis ◽  
Normal Functioning ◽  
Mitral Valve Prosthesis ◽  
Mechanical Prostheses ◽  
Valve Operation

Background In patients with remarkably enlarged cardiac chambers and history of implantation of older types of mitral valve prosthesis, the considerations for reoperative tricuspid valve surgery are not limited to the risks of sternal reentry but also include the dilemma of whether to carry out prophylactic replacement of the normal functioning but outdated prosthesis or leave it in situ. Methods We reviewed our surgical strategy and postoperative 5-year follow-up findings in two patients who underwent redo tricuspid surgery 3 to 4 decades after mechanical mitral valve replacement. Both patients presented with significant symptoms of progressive right heart failure due to severe tricuspid regurgitation, despite optimal medical therapy. Results We found the beating-heart approach to be an effective and safe method for redo tricuspid surgery. Both first-generation mitral mechanical prostheses were not replaced and have remained well functional upon the patients’ postoperative 5-year follow-up, respectively. Conclusion For patients with normal functioning first-generation mechanical mitral prostheses, whether to prophylactically replace the prosthesis should be based on an individualized risk-benefit analysis.

scholarly journals Preservation of the left ventricle contractility while performing of the combined mitral-aortal failure correction

2020 ◽  
Vol 87 (11-12) ◽  
pp. 10-14
Author(s):  
A. A. Bolshak ◽  
V. Zh. Boukarim ◽  
K. E. Vakulenko ◽  
R. M. Vitovskiy ◽  
Yu. V. Bakhovska ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Left Ventricular Ejection ◽  
Valve Prosthesis ◽  
Posterior Flap ◽  
Mitral Valve Prosthesis ◽  
Group A ◽  
Group B

Objective. The studying of possibilities of procedures, directed on preservation of left ventricle while doing a mitral valve prosthesis in operative correction of combined mitral-aortal failure. Materials and methods. In the analysis the results of surgical treatment of 340 patients, suffering combined mitral-aortal failure and a left-sided ventriculomegaly, who were operated in N. M. Amosov National Institute of Cardio-Vascular Surgery NAMS of Ukraine, were included. In all the patients a mitral valve prosthesis in combination with the aortal failure correction (prosthesis) was performed. In 83 patients the mitral valve prosthesis with complete preservation of posterior flap (Group A) was conducted, in 97 - with translocation of chords with papillar muscles of anterior flap in combination with posterior flap (Group B), in 160 - without preservation of the undervalvular apparatus (Group C). Definitely-systolic index of left ventricle in Groups A, B and C have constituted (87.4 ± 10.5), (88.4 ± 11.1) and (89.4 ± 11.5) ml/m2 accordingly; left ventricular ejection fraction have constituted 0.51 ± 0.03, 0.5 ± 0.03 and 0.51 ± 0.03 accordingly. Results. In Group A on a hospital stage 2 (2.5%) patients died, in Group B - 2 (2.1%) patients, and in Group C - 5 (3.1%). Definitely-systolic index of left ventricle on the tenth-eleventh postoperative day in Groups A, B and C have constituted (74.3 ± 9.8), (69.4 ± 8.2) and (76.4 ± 9.2) ml/m2 accordingly, while in late follow-up period - (55.4 ± 8.4), (49.4 ± 7.2) and (62.4 ± 7.2) ml/m2 accordingly. The left ventricle ejection fraction on the tenth-eleventh postoperative day in Groups A, B and C have constituted 0.54 ± 0.03, 0.55 ± 0.03 and 0.53 ± 0.03 accordingly, and in late follow-up period - 0.55 ± 0.03, 0.57 ± 0.03 and 0.54 ± 0.03 accordingly. Conclusion. In the left-sided ventriculomegaly and combined mitral-aortal failure the a maximal preservation of undervalvular structures of mitral valve, while its prosthesis performance, constitutes a serious component, which leads to improvement of morphometric indices of left ventricle on hospital stage and in follow-up period as well.

scholarly journals The valve-preserving operations on a chordo-papillary continuum in a mitral valve prosthesis

2020 ◽  
Vol 87 (1-2) ◽  
pp. 8-10
Author(s):  
K. V. Pukas ◽  
V. V. Lazoryshynets
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Contractile Function ◽  
Valve Prosthesis ◽  
Complete Excision ◽  
Posterior Flap ◽  
Mitral Valve Prosthesis ◽  
Anterior Flap ◽  
Late Postoperative Period

Objective. Studying of morphometric indices and contractility of left ventricle in various variants of preservation of chordo-papillary continuum in late period after the mitral valve prosthesis. Materials and methods. Analysis in 634 patients with isolated mitral valve failure, who were surgically treated from Sept. 1 2005 till Jan. 1 2007, was conducted. While the mitral valve prosthesis the chordo-papillary continuum was conducted, using preservation of the mitral valve posterior flap (41 patients) and simultaneous translocations of chordo-papillary muscles of anterior flap and preservation of posterior flap of a mitral valve (57 patients). Results. While comparing morphometric indices of left ventricle in left ventriculomegaly on a hospital stage and in late postoperative period when complete excision of a mitral valve in its prosthesis was performed, and when posterior flap was preserved, and simultaneously the posterior and anterior mitral valve flaps the improvement of the indices was observed, as well as normalization of a contractile function of left ventricle if a subvalvular space is preserved. Conclusion. Preservation of chordo-papillary continuum while performing the mitral valve prosthesis improves morphometric indices and contractility of left ventricle on a hospital stage and in late follow-up period.

scholarly journals Triangular plasty of left atrium in a left-sided atriomegaly

2020 ◽  
Vol 87 (5-6) ◽  
pp. 26-29
Author(s):  
V. Zh. Boukarim ◽  
A. A. Bolshak ◽  
V. V. Popov
Keyword(s):  
Mitral Valve ◽  
Left Atrium ◽  
Blood Circulation ◽  
Cardiovascular Surgery ◽  
Main Group ◽  
Control Group ◽  
Thromboembolic Complications ◽  
The Brain ◽  
Left Atrium Diameter

Objective. Studying possibilities of the triangular plasty of left atrium procedure, performed while prosthesis of a mitral valve. Materials and metods. Into the main group 137 patients, suffering isolated mitral failure, complicated by left atriomegaly (diameter of left atrium ≥ 6.0 cм), to whom surgical treatment was performed in Amosov National Institute of Cardiovascular Surgery from 01.10.2010 to 01.01.2019 yr, were included. In all the patients a prosthesis of a mitral valve, preserving native structures of a mitral valve with reduction of the left atrium cavity, using procedure of the left atrium triangular plasty, was performed. Into a control group were included 57 patients, in whom a mitral valve correction without a left atrium reduction was performed only for a mitral valve failure and a left-sided atriomegaly (diameter of left atrium was ≥ 6.0 cm). Results. Of 137 patients of the main group on the hospital stage 3 (2.2%) have died. Dynamics of echocardiographic indices of the left atrium diameter on different stages was following: (65.5 ± 3.8) mm preoperatively, (51.5 ± 2.1) mm postoperatively, (52.5 ± 2.2) mm in a remote follow-up period, in a remote follow-up period in (5.1 ± 0.4) years at average, thromboembolic complications (the transient disorders of the brain blood circulation) were noted in (1.6%) of 125 patients. Of 57 patients of a control group on the hospital stage 2 (3.5%) have died. Dynamics of echocardiographic indices, concerning diameter of the left atrium on various stages was following: (66.7 ± 2.7) mm preoperatively, (63.5 ± 2.3) mm postoperatively, (71.5 ± 2.4) mm in the remote follow-up period. In the remote follow-up period in (7.1 ± 0.4) years, thromboembolic complications were noted in 7 (14.6%) of 48 patients. Conclusion. The procedure of triangular plasty of left atrium constitutes an obligatory stage while performing correction of a mitral failure in presence of a left-sided atriomegaly (diameter of left atrium ≥ 6.0 cm). The procedure is miniinvasive and effective, leads to significant improvement of the left atrium morphometry and is accompanied by low risk of the complications occurrence and hospital mortality. The data accumulated and estimation of remote results of the procedure permits her to occupy a significant place among other methods of atrioplasty.

scholarly journals P1458 Recurrent endocarditis on mitral valve prosthesis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Suma ◽  
C Spaziani ◽  
T Manca ◽  
A Ramelli ◽  
A Vezzani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Staphylococcus Aureus ◽  
Mitral Valve ◽  
Antibiotic Therapy ◽  
Blood Cultures ◽  
Valve Prosthesis ◽  
Mitral Valve Prosthesis ◽  
Mitral Prosthesis ◽  
History Of

Abstract Patient Presentation and initial work up A 72 years old man with history of hypertension was admitted to our hospital due to acute pulmonary oedema. He had no fever at that time and he had an history of known mitral valve prolapse but with no reported mitral valve regurgitation (MR). Transthoracic Echocardiogram (TTE) was performed and it showed a severe MR. Transesophageal echocardiogram (TOE) showed prolapse of the posterior leaflet of the mitral valve with suspicion of cordal rupture and the presence of an aneurysm of the anterior mitral valve leaflet with perforation of it (panel A and B). Diagnosis and Management Diagnosis of severe MR as the result of previous endocarditis was made. Blood cultures were negative, as well as there were no signs of active endocarditis. However, since there were heart failure and signs of uncontrolled infection, the patient underwent surgical mitral valve replacement (MVR) with bioprosthesis. Moreover, it was started antibiotic therapy with vancomycin, rifampin and ceftriaxone, which was continued for two weeks and then stopped since the microbiological culture of the valve was negative. Follow-up After two months he was re-admitted to the hospital due to a new onset of breathlessness. TTE showed a dehiscence of the mitral prosthetic valve in the inferolateral zone with rocking movement, subvalvular pseudoaneurysm and moderate paravalvular leak (panel C and D). Blood cultures were positive for Staphylococcus Aureus. Consequently, the patient underwent a new surgical MVR. Furthermore, six weeks of antibiotic therapy were carried out with daptomycin and rifampin. However, after another three months, he was admitted once again to the hospital for heart failure with a new evidence of abruption of the mitral prosthesis, again in the inferolateral region and, this time, with the evidence of a vegetation on the atrial side of the prosthesis (panel E and F). Again, blood cultures were positive for Staphylococcus Aureus, and the patient underwent the third surgical intervention of MVR. Another six weeks of antibiotic therapy with daptomycin and rifampin were performed. The patient was then discharged and he is now strictly followed clinically. Conclusion In conclusion, we reported the case of a recurrent relapse of endocarditis on mitral valve prosthesis due to Staphylococcus Aureus infection. Interestingly, the mitral prosthesis was involved always in the same zone (inferolateral area) with abruption of the prosthesis and significant paravalvular regurgitation. At the second relapse there was also a vegetation on it and both times blood cultures were positive. Moreover, antibiotic therapy was conducted for six weeks both times, but the recurrence of endocarditis showed us that he was a sensitive patient and that in cases of relapses like this it should be performed a more careful clinical follow up, involving frequent laboratory tests and clinical and echocardiographic evaluations. Abstract P1458 Figure.

scholarly journals The impact of preservation of the subvalvular structures on intracardiac hemodynamics in mitral valve prosthesis surgery

2012 ◽  
Vol 18 (5) ◽  
pp. 467-469
Author(s):  
Zh. N. Nurbay ◽  
V. K. Novikov ◽  
M. L. Gordeev
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Prosthesis ◽  
Left Heart ◽  
Mitral Valve Prosthesis ◽  
Design And Methods ◽  
The Impact ◽  
Positive Effect

Background. Nowadays, progress has occurred in mitral valve surgery; however, the frequency of performance of mitral valve prosthesis with preservation of subvalvular structures still yields to «standard» mitral valve prosthesis with removal of subvalvular structures. Design and methods. The results of checkup and treatment of 185 patients in whom mitral valve prosthesis was performed are presented. A comparative analysis of two different groups of patients was made: a group of patients with the preserved subvalvular structures (120 patients) and a group of patients with the removed subvalvular structures (65 patients). Results. Echocardiography showed a positive effect of preservation of the subvalvular structures in mitral valve prosthesis surgery, particularly in patients with the dilated left heart chambers, both at early postoperative and remote follow-up periods.

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