MODERN PRINCIPLES OF DIAGNOSIS AND SURGICAL TREATMENT OF ISCHEMIC MITRAL INSUFFICIENCY

2021 ◽  
pp. 011-015
Author(s):  
Rashad Mahmudov
Keyword(s):  
Heart Disease ◽  
Surgical Treatment ◽  
Mitral Valve ◽  
Ischemic Heart Disease ◽  
Myocardial Revascularization ◽  
Mitral Valve Insufficiency ◽  
Mitral Insufficiency ◽  
Valve Insufficiency ◽  
Severe Degree ◽  
Preoperative Examination

The purpose of the study is to evaluate and analyze the results of surgical treatment of patients with ischemic mitral insufficiency. Material and methods. The results of the examination and surgical treatment of 35 patients with ischemic mitral insufficiency are analyzed. In the operative period, in order to identify the degree of mitral insufficiency and the valvular apparatus, an echocardiography was performed, where the diameter of the fibrous ring, the interpapillary distance, the annulopapillary distance, the area of the cusp tension, and the depth of the coaptation of the valves were determined. Results. A preoperative examination proved the presence of mitral valve insufficiency with regurgitation of varying degrees. 15 patients underwent myocardial revascularization, 20 patients underwent myocardial revascularization + various options for correction of ischemic mitral insufficiency. After the operation, a significant improvement in the spatial-geometric correlation of the LV and mitral valve by reducing the tension forces acting on the valves and in the group of patients undergoing myocardial revascularization + various options for the correction of ischemic mitral insufficiency as the elimination of regurgitation. Conclusion. In patients with ischemic heart disease after echocardiographic studies, having determined the degree of mitral insufficiency with its moderate and severe degree, it is necessary to have a surgical correction of the mitral valve in its apparatus; the use of myocardial revascularization + various options for the correction of ischemic mitral insufficiency gives more tantalizing results than isolated myocardial revascularization.

scholarly journals Surgical treatment of the ischemic heart disease with lowered contractility of left ventricle and mitral valve insufficiency

2020 ◽  
Vol 87 (9-10) ◽  
pp. 22-26
Author(s):  
S. A. Rudenko ◽  
A. V. Rudenko ◽  
Yu. V. Kaschenko ◽  
V. P. Zakharova
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Left Ventricle ◽  
Ischemic Heart Disease ◽  
Mitral Valve Insufficiency ◽  
Ischemic Heart ◽  
Cardiac Insufficiency ◽  
Mitral Insufficiency ◽  
Valve Insufficiency ◽  
The Impact

Objective. To determine the impact of the mitral valve insufficiency in patients, suffering ischemic heart disease with lowered contractility of left ventricle and methods of its treatment. Materials and methods. During 01.01.2015-31.12.2018 yrs period in the Amosov National Institute of Cardiovascular Surgery there were conducted 2267 consecutive operations of coronary shunting, of them 190 (8.4%) - in patients, suffering the ischemic heart disease with lowered contractility of left ventricle. Reduction of the output fraction of left ventricle down to 35% and lower have served as criterion of inclusion of the patients into the Group. There were 170 (89.5%) men and 20 (10.5%) women. The patients’ age have constituted 29 - 83 yrs old, (61.1 ± 8.9) yrs old at average. Results. In 47.9% of the patients the lowering of the left ventricle contractility after myocardial infarction was followed by occurrence of regurgitation on a mitral valve. At the same time it was noted, that the regurgitation value have had correlated with degree of the left ventricle contractility lowered: in reduction of values of the left ventricle output fracture down to 25% and lower a moderate regurgitation on a mitral valve was registered up to 2 times, a significant one - in 2.5 times, and the pronounced one - in 1.5 times more frequently, than in values of the left ventricle output fracture, exceeding 25%. Occurrence of a mitral insufficiency in 18.7% patients was caused by direct damage of valvular apparatus, while in 81.3% patients the consequences of the heart cavities were present in disorder of contractile function of myocardium. Presence of postinfarction mitral insufficiency enhances the risk of an acute cardiac insufficiency in 1.7 times and necessitates intraoperative correction in values of the regurgitation fraction over 30%. Conclusion. The own data obtained witness, that noncorrected mitral insufficiency in the ischemic heart disease worsens significantly the postoperative period course after performance of coronary shunting, enhancing rate of an acute cardiac, respiratory and renal insufficiency. Thus, taking into account a negative impact of concomitant mitral valve insufficiency on efficacy of surgical interventions in the lowered contractility of left ventricle the need emerges to perform complex reconstructive intervention in patients, suffering ischemic heart disease with lowered contractility of left ventricle.

scholarly journals Mitral Valve Disease in Thyroid Storm

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A941-A942
Author(s):  
Sandra Rocio Rivera Menjura ◽  
Lia G Moyano Rivas ◽  
Camila Parraguez Gamboa ◽  
Cristobal Balmaceda ◽  
Juan P Peralta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Invasive Mechanical Ventilation ◽  
Mitral Valve Insufficiency ◽  
Left Ventricular ◽  
Thyroid Storm ◽  
Multiple Infections ◽  
Mitral Insufficiency ◽  
Type I ◽  
Valve Insufficiency

Abstract Introduction: The cardiovascular effects that thyroid gland causes are widely studied. In fact, there is a known correlation between Graves’ Disease and mitral valve damage. We present the case of a patient admitted with thyroid storm and heart failure associated with severe structural damage of the mitral valve papillary muscle. Case Report: 24 year old woman with hyperthyroidism diagnosed 12 years ago, treated irregularly with thiamazole and propranolol, leaving treatment a year ago, presents dyspnea, class III functional capacity, diarrhea and logic dysphagia of a month of evolution. Heart rate over 170 bpm, respiratory rate 48 rpm and blood pressure 143/84 mmHg. Physical exam positive for exophthalmos, grade III goiter, crackles in both lung bases, pretibial myxedema and fulfilling criteria for a thyroid storm (65 points in Burch-Wartofsky Point Scale). First Lab Results: TSH<0.005µU/mL, free T4>7.7ng/dl and TRAB 37.8UI/L. Chest ray: Global cardiomegaly and pulmonary edema. EKG: Narrow complex supraventricular tachycardia. Thyroid ultrasound: Intrathoracic goiter. Transesophageal echocardiogram: Severe mitral insufficiency (Carpentier Type I and IIIB), right cavities and left ventricular enlargement, preserved right ventricular function and severe pulmonary hypertension (PSAP 71-76 mmHg). First treated with thiamazole, hydrocortisone IV, cholestyramine and sedation, falling time after into ventilatory failure and developing delirium, requiring invasive mechanical ventilation. Tested positive for COVID- 19. Starts preparation with Lugol and undergoes Total Thyroidectomy. After surgery develops severe hypocalcemia secondary to transitory hypoparathyroidism. During hospitalization presents multiple infections including pneumonia (Pseudomonas Aeruginosa), lung aspergillosis, bacteriuria (Enteroccocus Faecium) and candiduria (Candida Albicans and Glabrata), each one treated with multiple antibiotics and vasoactive drugs. Once stable, mitral valve replacement is realized, after which, the patient progresses favorably being discharged with programmed ambulatory controls. Conclusion: We report a case of a patient who was presented with positive thyroid storm criteria associated with heart failure and severe mitral valve insufficiency. The case gets complicated as multiple infections take place, including COVID-19. Fortunately, because of the early and aggressive multidisciplinary management, the patient evolved favorably, overcoming the life-threatening conditions she went through. Key Words: Thyroid storm, mitral valve insufficiency, heart failure. Bibliography: Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007 Oct 9;116(15):1725-35. doi: 10.1161/CIRCULATIONAHA.106.678326. Erratum in: Circulation. 2008 Jan 22;117(3):e18. PMID: 17923583.

scholarly journals Surgical treatment of mitral valve insufficiency by valve repair

2002 ◽  
Vol 17 (4) ◽  
Author(s):  
Henrique Murad ◽  
Eliane Carvalho Gomes ◽  
Adriana Alves Pinheiro ◽  
José Augusto de Azevedo ◽  
Mauro Paes Leme de Sá ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Mitral Valve ◽  
Mitral Valve Insufficiency ◽  
Valve Repair ◽  
Valve Insufficiency

scholarly journals Diagnosis of mitral insufficiency using impedance cardiography technique ICG

2019 ◽  
Vol 7 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Souhir Chabchoub ◽  
Sofienne Mansouri ◽  
Ridha B. Salah
Keyword(s):  
Mitral Valve ◽  
Heart Valves ◽  
Impedance Cardiography ◽  
Characteristic Parameter ◽  
Mitral Valve Insufficiency ◽  
Mitral Insufficiency ◽  
Hemodynamic Parameters ◽  
Control Subjects ◽  
Impedance Cardiogram ◽  
Valve Insufficiency

Abstract Impedance cardiography (ICG) is a non-invasive tool for assessing the hemodynamic parameters. It has been used for diagnosing several cardiovascular diseases, such as heart failure, cardio-myopathy, and valvular diseases. Particularly, the valvular heart disease is characterized by the damage in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary valves. The mitral valve insufficiency and the aortic valve stenos are the most frequent valve diseases in the world. In this paper, we propose to diagnosis the mitral valve insufficiency using the impedance cardiography technique. The study group consisted of 40 subjects (20 control subjects and 20 patients with mitral insufficiency). A parameter “I” is calculated from the impedance cardiogram waveform and it is used to differentiate control subjects from patients with mitral insufficiency. The parameter “I” was related significantly to the abnormalities of the impedance cardiogram waveform. For patients with mitral insufficiency, “I” was higher than for the healthy subjects with a difference ratio of 89% (p<0.001). To improve the diagnosis, we determined the stroke volume, cardiac output, and other hemodynamic parameters for the two groups of subjects. Finally, we concluded that we could identify, easily, patients with mitral insufficiency based on the abnormalities of the impedance cardiogram tracings and a characteristic parameter “I”.

A Complex Mitral Valve Reconstruction: A Case Report

2005 ◽  
Vol 6 (2) ◽  
pp. 27
Author(s):  
Dimitrios Buklas ◽  
Massimo Massetti ◽  
Eric Saloux ◽  
Eugenio Neri ◽  
Olivier LePage ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Surgical Techniques ◽  
Mitral Valve Insufficiency ◽  
Left Ventricular ◽  
Mitral Valve Reconstruction ◽  
Mitral Repair ◽  
Valve Reconstruction ◽  
Valve Insufficiency ◽  
Valve Function ◽  
Valvular Function

Several techniques are currently in use for mitral valve reconstruction. We report a mitral repair case in which the use of a combination of different surgical techniques resulted in the necessary correction. A 47-year-old woman underwent surgical intervention to treat severe mitral valve insufficiency due to A1/A2/A3 and P2 prolapsed valve tissue. A combination of quadrangular resection, sliding leaflet, single chordal transposition, "flip-over" leaflet, and ring annuloplasty techniques were applied, and postsurgical correct valve function was documented by results of a left ventricular saline filling test and transesophageal echocardiography control. Complex mitral valve repairing techniques can be combined to reestablish valvular function.

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