ECHOCARDIOGRAPHY PREDICTORS OF SUCCESSFUL MITRAL VALVE REPAIR IN DEGENERATIVE MITRAL VALVE REGURGITATION

2015 ◽  
pp. 77-82
Author(s):  
Ba Minh Du Le ◽  
Anh Vu Nguyen ◽  
Duc Phu Bui
Keyword(s):  
Mitral Valve ◽  
Transesophageal Echocardiography ◽  
Success Rate ◽  
Mitral Valve Repair ◽  
Transthoracic Echocardiography ◽  
Mitral Valve Prolapse ◽  
Posterior Leaflet ◽  
Valve Repair ◽  
Mitral Repair ◽  
Fibroelastic Deficiency

Background and aim of the study: Mitral repair is now as the treatement of choice in patients suffering mitral regurgitation due to mitral valve prolapse or flail. However, mitral valve repair demands the mitral valve morphology being feasible for repair. The study aims at evaluating transthoracic and transesophageal echocardiographic features in consecutive patients with mitral valve prolapse or flail undergoing surgical repair at Hue Central Hospital. The correlation between preoperative and intraoperative echocardiographic features and surgical findings in these patients. These echocardiographic data may predict the surgical outcome. Methods: From December 2010 to January 2013, 73 patients (37 men, 36 women; average age 37.5) were recruited into the study. All patients had degenerative mitral valve disease causing important regurgitation and underwent systematic preoperative transthoracic echocardiography, preoperative and intraoperative transesophageal echocardiography for delineation of six segments (scallops) of anterior and posterior leaflets. Results: Among 73 patients, 64 patients were in fibroelastic deficiency (87.7%) and 9 patients suffered Barlow disease (12.3%). Mitral valve repair was performed in 52 patients (71.2%) and mitral replacement was performed in 21 patients (28.8%). All 52 mitral valve repair (81.3%) and 12 mitral valve replacement (18.7%) was performed in fibroelastic deficiency patients. All 9 Barlow patients must undergo mitral valve replacement (100%). A prolapse or flail of mitral valve in 73 patients was documented by transthoracic and transesophageal echocardiography and confirmed on surgical inspection. Accuracy of transthoracic echocardiography was (89.0%) and accuracy of transesophageal echocardiography was (91.8%) in identifying mitral valve segments prolapse or flail. Success rate of mitral valve repair was (98.0%) in prolapse of 1 or 2 segments, but was low (36.0%) in prolapse > 3 segments. Success rate of mitral valve repair was (96.6%) in prolapse of posterior leaflet, but was (63.6%) in prolapse anterior leaflet or bileaflet. Conclusion: - Mitral valve repair was favorable in fibroelastic deficiency patients, but difficult in Barlow patients. - Accuracy of transthoracic and transesophageal echocardiography was high in identifying mitral valve segments prolapse or flail. - Success rate of mitral valve repair was high in prolapse of 1 or 2 segments. - Success rate of mitral valve repair was high in in prolapse of posterior leaflet. Key words: Mitral repair, echocardiography, degenerative, Barlow, fibroelastic deficiency, prolapse, flail

scholarly journals A randomized surgical trial of mitral valve repair with leaflet resection versus leaflet preservation on functional mitral stenosis – primary results of the CAMRA CardioLink-2 trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Chan ◽  
C.D Mazer ◽  
T Mesana ◽  
B.E De Varennes ◽  
A.J Gregory ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Mitral Stenosis ◽  
Peak Exercise ◽  
Funding Source ◽  
Posterior Leaflet ◽  
Valve Repair ◽  
Mitral Repair ◽  
The Mean ◽  
Leaflet Prolapse

Abstract Background The gold standard treatment for mitral valve regurgitation due to prolapse involves surgery with annuloplasty and either leaflet resection or leaflet preservation, with placement of artificial neochordae. It has been suggested that leaflet resection may be prone to functional mitral stenosis, whereby a patient may have a higher mitral gradient at peak exercise compared to a leaflet preservation strategy. Although both techniques are widely used, there has been no prospective randomized study conducted to compare these two techniques, particularly in regard to functional mitral stenosis. Methods A total of 104 patients with posterior leaflet prolapse were randomized to undergo mitral repair with either leaflet resection (N=54) or leaflet preservation (N=50) at 7 specialized Canadian cardiac centers. Patient age, proportion of female patients, and mean Society of Thoracic Surgeons risk score was 63.9±10.4 years, 19%, and 1.4% for those who underwent leaflet resection, and 66.3±10.8 years, 16%, and 1.9% for those who underwent leaflet preservation, respectively. The primary endpoint was the mean trans-mitral repair gradient at peak exercise 12-months after repair. Results Baseline characteristics were similar between the groups. At 12-months, the mean trans-mitral repair gradient at peak exercise in patients who underwent leaflet resection and preservation was 9.1±5.2 and 8.3±3.3 mmHg (P=0.4), respectively. The two groups had similar mean mitral valve gradient at rest (3.2±1.9 mmHg following resection and 3.1±1.1 mmHg following leaflet preservation, P=0.7). There was no between-group difference for the 6-minute walk distance (451±147 m and 481±95 m for the resection and preservation groups, respectively, P=0.3). Conclusion We report the first prospective surgical randomized trial to evaluate commonly used mitral valve repair strategies for posterior leaflet prolapse. Leaflet resection and leaflet preservation both yield acceptable results with no difference in postoperative valve gradient and functional status 12-months after surgical mitral valve repair. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Heart and Stroke Foundation of Canada

Robot-Assisted Mitral Valve Repair with Posterior Leaflet Extension for Rheumatic Disease

2017 ◽  
Vol 12 (1) ◽  
pp. 60-63
Author(s):  
Burak Onan ◽  
Unal Aydin ◽  
Zeynep Kahraman ◽  
Korhan Erkanli ◽  
Ihsan Bakir
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Mitral Valve Insufficiency ◽  
Posterior Leaflet ◽  
Valve Repair ◽  
Mitral Repair ◽  
Autologous Pericardial Patch ◽  
Valve Insufficiency ◽  
Robot Assistance ◽  
Mitral Disease

Mitral valve repair has been one of the widely used applications of robotic surgery. Patients with rheumatic mitral disease usually present at an early age with thickening, retraction, or fusion of the leaflets and subvalvular apparatus. Robotic mitral repair can be feasible among this group of patients, rather than replacement. Herein, we describe a young woman who presented with rheumatic mitral valve insufficiency. A complex mitral repair with posterior leaflet extension with an autologous pericardial patch was successfully conducted using robot assistance.

scholarly journals 503 Unlocking the mystery of haemolytic anaemia after mitral valve repair

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Sotananusak ◽  
T Yingchoncharoen ◽  
S Chaiyaroj ◽  
T Limpijankit
Keyword(s):  
Mitral Valve ◽  
Transesophageal Echocardiography ◽  
Hemolytic Anemia ◽  
Mitral Valve Repair ◽  
Transthoracic Echocardiography ◽  
Complete Blood Count ◽  
Valve Surgery ◽  
Paravalvular Leak ◽  
Valve Repair ◽  
Surgery Patient

Abstract Hemolytic anemia is an uncommon complication after mitral valve repair. All possible causes should be excluded before making a diagnosis. Echocardiography is an important tool. Transthoracic echocardiography may underestimate the severity and direction of regurgitation jets. Transesophageal echocardiography is the helpful imaging modality helping identify an accurate mechanism. A 55-year-old female with a history of mitral valve repair 5 years earlier presented with shortness of breath for 2 months. She noticed that she had intermittent jaundice and dark urine for 5 months but these symptoms were worsening and persistent for 2 months. She had no fever and abdominal pain. She did not take any medication. The physical examination revealed mark pale conjunctiva and icteric sclera. The apex of heart was palpated at 6th intercostal space lateral to the midclavicular line. The pan-systolic murmur was audible along the mitral valve area. The lung was clear and no pedal edema. Her complete blood count showed hematocrit of 13% with fragmented red blood cell and polychromasia in a blood smear. The level of aspartate transaminase, direct bilirubin, and lactate dehydrogenase was elevated with low haptoglobin level. A chest X-ray showed cardiomegaly without pulmonary edema. The diagnosis of autoimmune hemolytic anemia was made but her symptom was not improved after corticosteroid treatment. Transthoracic echocardiography cannot explain the cause of hemolytic anemia, so the transesophageal echocardiography was performed. The echocardiography revealed severe mitral regurgitation and paravalvular leak. The turbulent flow was seen across the mitral annuloplasty ring. She underwent mitral valve replacement to treat her symptoms. After an operation, her symptoms were significantly improved without any jaundice. The hemolytic anemia was resolved. This case demonstrated an important role of transesophageal echocardiography, especially in post heart valve surgery patient. Although hemolytic anemia after mitral valve surgery is rare, it should be considered in every hemolytic anemia patient without other explainable causes. An accurate diagnosis is a crucial role in treatment. Abstract 503 Figure.

scholarly journals Transcatheter echo guided mitral valve repair with neochord implantation for posterior leaflet disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Mahia ◽  
J Cobiella ◽  
D Enriquez ◽  
M Carnero ◽  
L Maroto ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Transesophageal Echocardiography ◽  
Real Time ◽  
Mitral Valve Repair ◽  
Type A ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Posterior Leaflet ◽  
Valve Repair ◽  
3D Transesophageal Echocardiography

Abstract Background/Introduction Transapical off-pump mitral valve repair with NeoChord implantation (TOP-MINI) has become applied for patients presenting with severe mitral regurgitation (MR) due to posterior leaflet (PML) prolapse or flail. The procedure is performed under real-time 2D- and 3D-transesophageal echocardiography for both implantation and neochordae tension adjustment allowing real-time monitoring of hemodynamic recovery. Purpose This prospective study sought to evaluate acute safety and efficacy of this innovative, minimally invasive, transcatheter mitral valve repair approach. Methods 33 symptomatic patients patients with severe MR secondary to PML flail/prolapse (March 2017-Dec 2019) were included. Patients were stratified on the basis of the preoperative 3D transesophageal echocardiography assessment of MV morphology: type A, isolated central PML prolapse/flail (25 patients); type B, posterior multisegment prolapse/flail (3 patients); type C and D, anterior or bileaflet prolapse/flail or paracommissural prolapse/flail or any type of disease with the presence of significant leaflet/annular calcifications (5 patients). Type A was considered the more favorable morphology. Results Median age was 67.7±13.4 y. Median EuroSCORE-II 2.7%±1.91. Procedural success was achieved in 28 patients (84,9%). 5 patients, 2 type A and 3 type D, underwent conversion to open surgery for immediate failure. The median number of chords implanted was 3.1±0.6. 1 high-risk patient considered inoperable because of severe comorbidities and extensive annular calcifications died before discharge. Postoperative length of stay was 4.25±1 days. At 12.3±4.9 months median follow-up, MR≤moderate was present in 25 (90%). Overall 1-year survival was 100%. Freedom from reintervention was 97% for overall population. Transthoracic echocardiography at 1 year revealed ventricular reverse remodeling, with a significant decrease in indexed left ventricular end- end-systolic volumes (25.3±6.4 to 21.6±8.2 mL/m2, P<0.001). 92.9% were in New York Heart Association class I. Conclusions TOP-MINI procedure is a feasible, low-risk technique that allows safely repair degenerative mitral valve failure secondary to prolapse/flail valvular and its efficacy is maintained up to 1-year. Funding Acknowledgement Type of funding source: None

Sign in / Sign up

Export Citation Format

Share Document