Mitral Annulus and Left Ventricular Posterior Wall Motion in Mitral Valve Replaced Patients

1989 ◽  
Vol 19 (4) ◽  
pp. 677
Author(s):  
Chong Hun Park ◽  
Young Lee
Keyword(s):  
Mitral Valve ◽  
Wall Motion ◽  
Posterior Wall ◽  
Mitral Annulus ◽  
Left Ventricular

scholarly journals Immediate outcomes of treatment of severe mitral annular calcification

2021 ◽  
Vol 23 (2) ◽  
pp. 52-59
Author(s):  
R. M. Muratov ◽  
M. N. Sorcomov ◽  
A. S. Sachkov ◽  
S. I. Babenko ◽  
A. M. Sleptsova ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Annulus Fibrosus ◽  
Posterior Wall ◽  
Mitral Annulus ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Calcium Deposition ◽  
Mitral Annular Calcification ◽  
Valve Function ◽  
Annular Calcification

Mitral annular calcification (MAC) is a chronic degenerative process involving the fibrous part of the mitral complex, characterized by calcium deposition and loss of valve function. MAC prevalence is 8–10%, but despite this, the clinical significance of MAC is underestimated. Currently, there are reports that complete decalcification leads to improved long-term outcomes in patients with severe MAC. An analysis of the immediate outcomes of mitral valve surgery in patients with severely calcified mitral annulus with decalcification was performed. The calcified annulus fibrosus underwent complete decalcification in all cases. Calcium deposits were removed in a single block, in 6 cases it was reconstructed with a xeno-pericardial patch; in 2 cases the annulus fibrosus was sutured. There were 2 cases of in-hospital mortality, caused by acute heart failure on day 8 in 1 patient and pulmonary embolism on day 30 after operation in the second patient. There were no complications associated with coronary artery injury and left ventricular posterior wall rupture. Experience in the treatment of severe mitral valve calcification with extensive annulus fibrosus decalcification and subsequent reconstruction is possible and gives satisfactory results.

scholarly journals Myxomatous Mitral Valve Disease with Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical and Functional Significance of the Coincidence

2021 ◽  
Vol 8 (2) ◽  
pp. 9
Author(s):  
Nina C. Wunderlich ◽  
Siew Yen Ho ◽  
Nir Flint ◽  
Robert J. Siegel
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Disease ◽  
Morphological Changes ◽  
Morphological Characteristics ◽  
Mitral Annulus ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Valve Disease ◽  
Left Ventricular Myocardium ◽  
Basal Portion

The morphological changes that occur in myxomatous mitral valve disease (MMVD) involve various components, ultimately leading to the impairment of mitral valve (MV) function. In this context, intrinsic mitral annular abnormalities are increasingly recognized, such as a mitral annular disjunction (MAD), a specific anatomical abnormality whereby there is a distinct separation between the mitral annulus and the left atrial wall and the basal portion of the posterolateral left ventricular myocardium. In recent years, several studies have suggested that MAD contributes to myxomatous degeneration of the mitral leaflets, and there is growing evidence that MAD is associated with ventricular arrhythmias and sudden cardiac death. In this review, the morphological characteristics of MAD and imaging tools for diagnosis will be described, and the clinical and functional aspects of the coincidence of MAD and myxomatous MVP will be discussed.

Coordinate-Free Analysis of Mitral Valve Dynamics in Normal and Ischemic Hearts

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Paul Dagum ◽  
Tomasz A. Timek ◽  
G. Randall Green ◽  
David Lai ◽  
George T. Daughters ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Color Doppler ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Free System ◽  
Ring Annuloplasty ◽  
3D Geometry ◽  
Valve Function ◽  
Valve Dynamics ◽  
Radiopaque Markers

Background —The purpose of this investigation was to study mitral valve 3D geometry and dynamics by using a coordinate-free system in normal and ischemic hearts to gain mechanistic insight into normal valve function, valve dysfunction during ischemic mitral regurgitation (IMR), and the treatment effects of ring annuloplasty. Methods and Results —Radiopaque markers were implanted in sheep: 9 in the ventricle, 1 on each papillary tip, 8 around the mitral annulus, and 1 on each leaflet edge midpoint. One group served as a control (n=7); all others underwent flexible Tailor partial (n=5) or Duran complete (n=6) ring annuloplasty. After an 8±2-day recovery, 3D marker coordinates were measured with biplane videofluoroscopy before and during posterolateral left ventricular ischemia, and MR was assessed by color Doppler echocardiography. Papillary to annular distances remained constant throughout the cardiac cycle in normal hearts, during ischemia, and after ring annuloplasty with either type of ring. Papillary to leaflet edge distances similarly remained constant throughout ejection. During ischemia, however, the absolute distances from the papillary tips to the annulus changed in a manner consistent with leaflet tethering, and IMR was observed. In contrast, during ischemia in either ring group, those distances did not change from preischemia, and no IMR was observed. Conclusions —This analysis uncovered a simple pattern of relatively constant intracardiac distances that describes the 3D geometry and dynamics of the papillary tips and leaflet edges from the dynamic mitral annulus. Ischemia perturbed the papillary-annular distances, and IMR occurred. Either type of ring annuloplasty prevented such changes, preserved papillary-annular distances, and prevented IMR.

scholarly journals P1754 Regional left ventricular longitudinal myocardial dysfunction in mitral valve prolapse could be primary

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Barbier ◽  
O A Annoh ◽  
G Liu ◽  
M Scorsin ◽  
S Moriggia ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Myocardial Dysfunction ◽  
Stroke Volume Index ◽  
Volume Overload ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Volume Index ◽  
Maximum Strain

Abstract Background Regional left ventricular dysfunction in patients with mitral valve prolapse (MVP) and normal ejection fraction has been described by different Authors, and recent data point to a dysfunction (prevalently longitudinal strain) of the myocardium of the LV base secondary to dilatation of the mitral annulus. Purpose To investigate degree and extent of regional LV dysfunction and its mechanisms in patients with MVP, severe regurgitation and normal global systolic function, compared to patients with equivalent degree of regurgitation but functional etiology (FMR). Methods Speckle-tracking echocardiography was performed in 30 controls (N), and in severe primary (MVP, n= 50) or functional (FMR, n= 20) mitral regurgitation, to measure global, regional and segmental longitudinal peak systolic strain (LPSS, %), and time delay of peak maximum strain (TTPd, ms, calculated as time to peak maximum strain - time of aortic valve closure). Maximum and minimum mitral annulus diameters and area were measured with 3D echo. We also evaluated as recommended: LV end-diastolic volume index (EDVi, ml/m2), ejection fraction (EF, %), and left atrial end-systolic volume index (LAESVi, ml/m2) with 2D echo; LV stroke volume index, and non-invasive pulmonary systolic (PSP, mmHg) and diastolic pressures (PDP), mmHg) with Doppler echo. Results Age, heart rate, BSA and systolic blood pressure were similar between groups. Atrial fibrillation was present in 34% of MVP and 71% of FMR patients. LV EF was normal in MVP and reduced in FMR (43 ± 14 % vs N, p<.001). LV EDVi (MVP: 77 ± 20 ml/m2; FMR: 107 ± 35, both p<.001 vs N) and LAESVi (MVP: 91 ± 26 ml/m2; FMR: 80 ± 30, both p<.001 vs N) were similarly increased (volume overload) in MVP and FMR, as were PSP (MVP: 42 ± 23 ml/m2; FMR: 52 ± 25, both p<.001 vs N) and PDP (MVP: 16 ± 6 ml/m2; MVP: 15 ± 5, both p<.001 vs N). In FMR, LPSS was reduced globally (-12.8 ± 3.3, p<.001 vs N and MVP) and similarly at LV base, papillary and apical levels. In contrast, in MVP global (-19.4 ± 3.7%) and apical (-23.4 ± 4.5%) LPSS were normal, whereas LV base (-12.3 ± 5.8%, p=.003 vs N) and papillary (-17.1 ± 4%, p=.024 vs N) LPSS were reduced; further, LPSS reduction was localized to the anterior (-16 ± 4, p=.028 vs N), lateral (-17 ± 5, p=.006 vs N) and posterior (-16 ± 6, p=.007 vs N) segments, and was associated with an increased TTPd in the same segments in MVP but not in FMR patients. At multivariate analysis, degree and localisation of regional myocardial dysfunction in patients with MVP was not related to the prolapsing scallop, dimension of the mitral annulus, degree of volume overload or pulmonary pressures, or stroke volume index. Conclusions In patients with MVP, severe regurgitation and normal EF, there is a specific dysfunction pattern of regional LV longitudinal function which appears to be primary and not dependent on the degree of preload increase, mitral annulus dilatation, or localization of the prolapsing scallop.

scholarly journals New Self-Expanding Transcatheter Valve for Off-Pump Transatrial Mitral Valve-In-Ring Implantation

Cardiology ◽  
2015 ◽  
Vol 132 (4) ◽  
pp. 221-227
Author(s):  
Liang Ma ◽  
Zipu Yu ◽  
Christoph Huber ◽  
Chengchen Li ◽  
Linfeng Qian ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Annulus ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Annuloplasty Ring ◽  
Left Thoracotomy ◽  
Off Pump ◽  
Custom Made ◽  
Transcatheter Valve ◽  
Annulus Diameter

Objectives: To validate a self-expanding transcatheter valve for off-pump transatrial mitral valve-in-ring (VIR) implantation via a left thoracotomy. Methods: Mitral valve annuloplasty was performed via sternotomy during cardiopulmonary bypass on 9 pigs. After successful weaning from extracorporal circulation, the custom-made, self-expanding transcatheter VIR device was deployed under fluoroscopic guidance within the annuloplasty ring via a left thoracotomy. Hemodynamic data before and after the implantation were recorded. Mitral annulus diameter and valve area were measured by echocardiography. Transvalvular and left-ventricular outflow-tract pressure gradient were measured invasively. Results: Eight successful implantations were performed. Implantation failed in 1 pig because of difficulty with technical delivery of the sheath. Mean transatrial procedure time was 12.6 ± 1.7 min. Hemodynamic status during transatrial implantation was stable, and differences were not statistically significant. Mean mitral annulus diameter and mean mitral orifice area were 2.32 ± 0.2 and 3.84 ± 0.55 cm2, respectively. Mild regurgitation was detected in 7 animals and moderate regurgitation in 1. Mean gradients were 6.1 ± 5.0 mm Hg across the device. Postmortem examination confirmed adequate positioning of devices within the annuloplasty ring. Conclusions: This custom-made transcatheter device allows for safe and reproducible off-pump transatrial mitral VIR implantations. Transatrial access is a promising route to facilitate VIR implantations. Our custom-made stent-valve may be suitable for VIR procedures.

scholarly journals Long-axis fractional shortening and mitral annulus motion in dogs

2016 ◽  
Vol 37 (5) ◽  
pp. 3115 ◽  
Author(s):  
Marlos Gonçalves Sousa ◽  
Fabio Nelson Gava ◽  
Jorge Cardoso da Silva Filho ◽  
Sheila Nogueira Saraiva da Silva ◽  
Rafael Rodrigues Camacho ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Disease ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Cardiac Contraction ◽  
Valve Disease ◽  
Strain And Strain Rate ◽  
Echocardiographic Parameters ◽  
Myocardial Fibers ◽  
Fractional Shortening

Ventricular systolic dynamics involves the contraction of transverse and longitudinal myocardial fibers. Unfortunately, only the activity of the transverse myocardial fibers is foreseen by the standard systolic echocardiographic parameters. Although strain and strain rate have been used to assess the radial, circumferential and longitudinal planes of cardiac contraction, such analysis requires advanced equipment which is not always available in veterinary medicine. On the contrary, some unusual parameters may be recorded via standard methodology, allowing for the specific evaluation of left ventricular longitudinal contractility. In this study, the longitudinal contractile activity was evaluated using the long-axis fractional shortening and the mitral annulus motion, which were compared with several standard echocardiographic parameters in 14 beagles, including seven with asymptomatic mitral valve disease. The long-axis fractional shortening was positively correlated with both the mitral annulus motion and the end-diastolic left-ventricular diameter. Also, a significant correlation was found to exist between the mitral annulus motion and the left-ventricular end-diastolic diameter, which is likely supportive of its preload dependency. Even though no difference was documented in either mitral annulus motion or long-axis fractional shortening between healthy dogs and dogs with mitral valve disease, the latter only included animals with minimal cardiac remodeling, with no overt compromise of systolic function. Since it is possible to obtain these two parameters with any echocardiographic equipment, their inclusion in the routine exam would probably add information regarding the activity of the longitudinal myocardial fibers, whose functional deterioration supposedly occurs prior to the impairment of transverse fibers.

Excision of a left atrial myxoma with mitral and tricuspid valve repair

2020 ◽  
Keyword(s):  
Mitral Valve ◽  
Left Atrial ◽  
Ventricular Dysfunction ◽  
Mitral Annulus ◽  
Pulmonary Artery Hypertension ◽  
Left Ventricular ◽  
Atrial Myxoma ◽  
Tricuspid Valve Repair ◽  
Left Atrial Myxoma ◽  
Common Benign Tumor

A left atrial myxoma is the most common benign tumor of the heart, but it is still uncommon, with a reported prevalence of 0.03% in the general population. In developing countries, patients may present late with a stroke or with pulmonary artery hypertension and ventricular dysfunction. We may need to address the mitral and tricuspid valves in such cases. This video tutorial illustrates the technical aspects of myxoma excision along with modified De Vega tricuspid annuloplasty. The mitral valve was structurally normal and free from tumor; therefore, it was not touched in the first place but had to be repaired because there was severe regurgitation after the tumor was excised. The presence of left ventricular dysfunction can indicate a dilated mitral annulus and the need to repair the mitral valve.

scholarly journals Utilization of intra-aortic balloon pump to allow MitraClip procedure in patients with non-coapting mitral valve leaflets: a case series

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Ran Eliaz ◽  
Anna Turyan ◽  
Ronen Beeri ◽  
Mony Shuvy
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Multiorgan Failure ◽  
Case Series ◽  
Transoesophageal Echocardiography ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Left Ventricular Remodelling ◽  
Intra Aortic Balloon Pump ◽  
Annular Dilatation

Abstract Background The MitraClip (MC) procedure was designed for high-risk surgical patients with severe mitral regurgitation (MR). Some patients do not meet the required anatomical criteria due to advanced left ventricular remodelling and mitral annular dilatation leading to leaflet tethering and insufficient coaptation surface. Theoretically, ‘temporary remodelling’ of the mitral valve apparatus by pharmacological and/or mechanical support using intra-aortic balloon pump (IABP) could improve leaflets coaptation. Case summary We report a case series of four patients with severe MR and non-coapting leaflets who underwent MC implantation. Sufficient coaptation was achieved only after insertion of IABP. The first patient presented with worsening heart failure and severe MR after a non-reperfused posterior wall myocardial infarction (MI), underwent a successful procedure with good results. The second patient presented with worsening heart failure secondary to rheumatic MR, and underwent MC procedure with good results after the insertion of IABP. The third patient developed worsening heart failure and severe MR 2 months after an acute inferior-lateral MI, and underwent a successful procedure. The fourth patient presented with respiratory failure, the patient underwent the procedure, but unfortunately died a few days following the procedure from multiorgan failure. In each case, the insertion of the IABP decreased annular mitral diameter and increased the coaptation surface as assessed by transoesophageal echocardiography. Discussion For patients suffering from symptomatic severe MR who are not suitable candidates for MC procedure, IABP system enabled us to overcome mitral leaflet gap and complete the MC procedure successfully.

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