Anatomy of Mitral Valve Complex as Revealed by Non-Invasive Imaging: Pathological, Surgical and Interventional Implications

Knowledge of mitral valve (MV) anatomy has been accrued from anatomic specimens derived by cadavers, or from direct inspection during open heart surgery. However, today two-dimensional and three-dimensional transthoracic (2D/3D TTE) and transesophageal echocardiography (2D/3D TEE), computed tomography (CT) and cardiac magnetic resonance (CMR) provide images of the beating heart of unprecedented quality in both two and three-dimensional format. Indeed, over the last few years these non-invasive imaging techniques have been used for describing dynamic cardiac anatomy. Differently from the “dead” anatomy of anatomic specimens and the “static” anatomy observed during surgery, they have the unique ability of showing “dynamic” images from beating hearts. The “dynamic” anatomy gives us a better awareness, as any single anatomic arrangement corresponds perfectly to a specific function. Understanding normal anatomical aspects of MV apparatus is of a paramount importance for a correct interpretation of the wide spectrum of patho-morphological MV diseases. This review illustrates the anatomy of MV as revealed by non-invasive imaging describing physiological, pathological, surgical and interventional implications related to specific anatomical features of the MV complex.

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Mitochondrial Reconstructions Based on Serial Thick Sections and HVEM

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100115055 ◽

1975 ◽

Vol 33 ◽

pp. 286-287

Author(s):

Jerome J. Paulin

Keyword(s):

Imaging Techniques ◽

Three Dimensional ◽

Posterior Pole ◽

Dimensional Structure ◽

Stereo Imaging ◽

Thin Sections ◽

Anatomical Features ◽

The Past ◽

Cellular Components ◽

Mitochondrial Reticulum

Within the past decade it has become apparent that HVEM offers the biologist a means to explore the three-dimensional structure of cells and/or organelles. Stereo-imaging of thick sections (e.g. 0.25-10 μm) not only reveals anatomical features of cellular components, but also reduces errors of interpretation associated with overlap of structures seen in thick sections. Concomitant with stereo-imaging techniques conventional serial Sectioning methods developed with thin sections have been adopted to serial thick sections (≥ 0.25 μm). Three-dimensional reconstructions of the chondriome of several species of trypanosomatid flagellates have been made from tracings of mitochondrial profiles on cellulose acetate sheets. The sheets are flooded with acetone, gluing them together, and the model sawed from the composite and redrawn.The extensive mitochondrial reticulum can be seen in consecutive thick sections of (0.25 μm thick) Crithidia fasciculata (Figs. 1-2). Profiles of the mitochondrion are distinguishable from the anterior apex of the cell (small arrow, Fig. 1) to the posterior pole (small arrow, Fig. 2).

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Jugular bulb temperature compared with non-invasive temperatures and cerebral arteriovenous oxygen saturation differences during open heart surgery

Pediatric Anesthesia ◽

10.1046/j.1460-9592.1999.00326.x ◽

1999 ◽

Vol 9 (2) ◽

pp. 123 ◽

Cited By ~ 12

Author(s):

KERSTIN SANDSTRÖM

Keyword(s):

Oxygen Saturation ◽

Heart Surgery ◽

Open Heart Surgery ◽

Jugular Bulb ◽

Open Heart ◽

Non Invasive

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Mitral valve disease and open heart surgery in osteogenesis imperfecta tarda.

Heart ◽

10.1136/hrt.35.1.103 ◽

1973 ◽

Vol 35 (1) ◽

pp. 103-106 ◽

Cited By ~ 44

Author(s):

S J Wood ◽

J Thomas ◽

M V Braimbridge

Keyword(s):

Mitral Valve ◽

Osteogenesis Imperfecta ◽

Mitral Valve Disease ◽

Heart Surgery ◽

Open Heart Surgery ◽

Valve Disease ◽

Open Heart

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Early results of a real-world series with two transapical transcatheter mitral valve replacement devices

Clinical Research in Cardiology ◽

10.1007/s00392-020-01757-z ◽

2020 ◽

Author(s):

S. Ludwig ◽

D. Kalbacher ◽

N. Schofer ◽

A. Schäfer ◽

B. Koell ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Surgery ◽

Open Heart Surgery ◽

Functional Improvement ◽

Study Cohort ◽

Early Results ◽

Transcatheter Mitral Valve Replacement

Abstract Aims Transcatheter mitral valve replacement (TMVR) with dedicated devices promises to fill the treatment gap between open-heart surgery and edge-to-edge repair for patients with severe mitral regurgitation (MR). We herein present a single-centre experience of a TMVR series with two transapical devices. Methods and results A total of 11 patients were treated with the Tendyne™ (N = 7) or the Tiara™ TMVR systems (N = 4) from 2016 to 2020 either as compassionate-use procedures or as commercial implants. Clinical and echocardiographic data were collected at baseline, discharge and follow-up and are presented in accordance with the Mitral Valve Academic Research Consortium (MVARC) definitions. The study cohort [age 77 years (73, 84); 27.3% male] presented with primary (N = 4), secondary (N = 5) or mixed (N = 2) MR etiology. Patients were symptomatic (all NYHA III/IV) and at high surgical risk [logEuroSCORE II 8.1% (4.0, 17.4)]. Rates of impaired RV function (72.7%), severe pulmonary hypertension (27.3%), moderate or severe tricuspid regurgitation (63.6%) and prior aortic valve replacement (63.6%) were high. Severe mitral annulus calcification was present in two patients. Technical success was achieved in all patients. In 90.9% (N = 10) MR was completely eliminated (i.e. no or trace MR). Procedural and 30-day mortality were 0.0%. At follow-up NYHA class was I/II in the majority of patients. Overall mortality after 3 and 6 months was 10.0% and 22.2%. Conclusions TMVR was performed successfully in these selected patients with complete elimination of MR in the majority of patients. Short-term mortality was low and most patients experienced persisting functional improvement. Graphic abstract

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Case report of simultaneous transcatheter mitral valve-in-valve implantation and percutaneous closure of two paravalvular leaks

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz123 ◽

2019 ◽

Vol 3 (3) ◽

Author(s):

Masahiko Asami ◽

Thomas Pilgrim ◽

Stephan Windecker ◽

Fabien Praz

Keyword(s):

Mitral Valve ◽

Heart Surgery ◽

Open Heart Surgery ◽

Transoesophageal Echocardiography ◽

Paravalvular Leak ◽

Open Heart ◽

Surgical Risk ◽

Significant Difference ◽

Valve In Valve ◽

Valve Implantation

Abstract Background Concomitant structural degeneration of surgical mitral bioprostheses and paravalvular leak (PVL) is rare but potentially fatal. Data pertaining to simultaneous transcatheter mitral valve implantation (TMVI) and percutaneous PVL closure are limited, and the optimal treatment strategy remains undetermined. We report a case of simultaneous TMVI and double percutaneous PVL closure in a patient with a degenerated bioprosthetic mitral valve and associated medial and lateral PVLs. Case summary A 75-year-old woman who underwent combined aortic (Edwards Perimount Magna 19 mm) and mitral (Edwards Perimount Magna 25 mm) surgical valve replacement 6 years ago was referred for treatment of new-onset orthopnoea and severely reduced exercise capacity. Transoesophageal echocardiography revealed severe mitral stenosis and concomitant moderate to severe mitral regurgitation, originating from two PVLs located medial and lateral from the surgical bioprosthesis. Due to high surgical risk, we performed successful transseptal mitral valve-in-valve (ViV) implantation combined with the closure of two PVLs during the same procedure. Discussion Although surgery should be considered as a first-line treatment in this setting, most patients have extremely high or prohibitive surgical risk inherent to repeat open heart surgery. Mitral ViV implantation appears a reasonable treatment option for patients with failed mitral bioprostheses. Furthermore, a recent study of percutaneous PVL closure showed no significant difference in long-term all-cause mortality compared with redo open-heart surgery. Simultaneous TMVI and percutaneous PVL closure appears feasible in selected high-risk patients.

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Non Invasive Transcutaneous Carbondioxide Monitoring in Adult Open Heart Surgery

Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society ◽

10.5222/gkdad.2013.118 ◽

2013 ◽

Vol 19 (3) ◽

pp. 118-122

Author(s):

Perihan Ucar ◽

Gulcin Gazioglu ◽

Ozcan Erdemli ◽

Omer Faruk Cicek ◽

Asli Demir

Keyword(s):

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart ◽

Non Invasive

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Open heart surgery with mitral valve replacement - ordeal of an undiagnosed haemophilia patient.

Clinical & Laboratory Haematology ◽

10.1046/j.1365-2257.2003.00498.x ◽

2003 ◽

Vol 25 (2) ◽

pp. 131-133 ◽

Cited By ~ 6

Author(s):

K. Ghosh ◽

M. Madkaikar ◽

F. Jijina ◽

S. Gandhi ◽

S. Shetty ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart

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Robotic mitral valve surgery: how soon will we be moving away from open heart surgery?

Future Cardiology ◽

10.2217/fca.12.61 ◽

2012 ◽

Vol 8 (6) ◽

pp. 797-799

Author(s):

Saina Attaran ◽

Jon Anderson ◽

Prakash Punjabi

Keyword(s):

Mitral Valve ◽

Heart Surgery ◽

Open Heart Surgery ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Open Heart

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Simulation Based Design and Evaluation of a Transcatheter Mitral Heart Valve Frame

Journal of Medical Devices ◽

10.1115/1.4007182 ◽

2012 ◽

Vol 6 (3) ◽

Cited By ~ 3

Author(s):

Melissa Young ◽

Ahmet Erdemir ◽

Samantha Stucke ◽

Ryan Klatte ◽

Brian Davis ◽

...

Keyword(s):

Mitral Valve ◽

Heart Surgery ◽

Large Diameter ◽

Open Heart Surgery ◽

Element Analysis ◽

Mechanical Fracture ◽

Simulation Based Design ◽

Simulation Based ◽

Desirable Feature ◽

Computational Modeling And Simulation

In certain populations, open heart surgery to replace a diseased mitral valve is not an option, leaving percutaneous delivery a viable alternative. However, a surgical transcatheter based delivery of a metallic support frame incorporating a tissue derived valve puts considerable constraints on device specifications. Expansion to a large diameter from the catheter diameter without mechanical fracture involves advanced device design and appropriate material processing and selection. In this study, a new frame concept is presented with a desirable feature that incorporates wings that protrude during expansion to establish adequate fixation. Expansion characteristics of the design in relation to annulus fixation were quantified through finite element analysis predictions of the frame wing span and angles. Computational modeling and simulation was used to identify many favorable design features for the transcatheter mitral valve frame and obtain desired expansion diameters (35–45 mm), acceptable radial stiffness (2.7 N/mm), and ensure limited risk of failure based on predicted plastic deformations.

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