Recurrence of left ventricular pseudoaneurysm after multiple mitral valve replacements

Left ventricular pseudoaneurysm (LVPA) formation is a potentially lethal complication of myocardial infarction (MI] and mitral valve (MV) replacement that requires prompt diagnosis and treatment. A female patient who had been complaining of exertional dyspnea underwent a two-dimensional transthoracic echocardiogram (TTE) which revealed a functioning mechanical MV with severe paravalvular leak, severe tricuspid regurgitation (TR) and severely elevated pulmonary artery systolic pressure. Moreover, echo-lucent space at the postero-lateral portion of the left ventricle near the MV was seen, suggestive of a large LVPA. Transesophageal echocardiography (TEE) and Computed Tomography (CT) angiography confirmed these findings. Afterwards, the patient had a surgical repair for the LVPA along with mitral and tricuspid valve (TV) replacement. Three months later, the patient presented with symptoms of congestive heart failure. The LVPA had recurred at the same location of the previous pseudoaneurysm and given the high risk for reoperating on the patient, close monitoring and medical management was deemed as a better option.

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The Carpentier-Edwards classic and physio annuloplasty rings in repair of degenerative mitral valve disease: A retrospective study

10.21203/rs.3.rs-23128/v1 ◽

2020 ◽

Author(s):

Abubakari Ibn Sidiki ◽

Alexandr Georgievich Faybushevich ◽

Alexandr Nikolaevich Lishchuk ◽

Alexey Nikolaevich Koltunov

Keyword(s):

Mitral Valve ◽

Cox Regression ◽

Systolic Pressure ◽

Left Ventricular ◽

Functional Class ◽

Pulmonary Artery Systolic Pressure ◽

Tricuspid Valve Repair ◽

Cox Regression Analysis ◽

Barlow’S Disease ◽

Fibroelastic Deficiency

Abstract BackgroundPhysio ring (SR) is considered an improved version of the Classic rigid ring (RR). Today, SR is more widely used in mitral valve (MV) repair. We sought to compare the long-term outcomes of repair with RR and SR in degenerative mitral valve disease.MethodsIn a computerized registry of our institution, 306 patients had isolated MV repair with either RR (139 patients) or SR (167 patients) ring between 2005 and 2015. Fifteen of them had concomitant tricuspid valve repair. Ninety-two (30.1%) had Barlow’s disease and 214 (69.9%) had fibroelastic deficiency. The patients had similar demographic and echocardiographic characteristics.ResultsThere were 4 (1.3%) operative mortalities. Mean follow-up time was 107.4 ± 13.2 months. Left ventricular end diastolic and end systolic diameters significantly improved in both groups but not between groups. Survival at 10 years was 84.6% (93.1% in RR and 91.5% in SR; p = 0.177) and 10-year freedom from recurrent MR ≥ 2 + was 74.5% (88.2% in RR and 86.3% in SR; p = 0.110). Reoperations for repair failure were 8 in RR and 6 in SR. By Cox regression analysis, Barlow’s disease, preoperative MR = 4 + and chordal shortening were predictors of repair failure. Old age (≥ 70 years), NYHA functional class IV and pulmonary artery systolic pressure (≥ 40 mmHg) were predictors of poor survival by univariate analysis.ConclusionLong-term outcomes of repair for degenerative MV disease with the Classic and Physio rings are comparable. Artificial chordal implantation should be used instead of chordal shortening for diseased chordae.

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P1523 Impact of different techniques for mitral valve repair on left ventricular function: a 2D/3D echocardiographic analysis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.946 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Cimino ◽

L I Birtolo ◽

V Maestrini ◽

F De Leo ◽

M Vinciguerra ◽

...

Keyword(s):

Mitral Valve ◽

Ejection Fraction ◽

Systolic Pressure ◽

Surgical Techniques ◽

Left Ventricular ◽

Pulmonary Artery Systolic Pressure ◽

P Value ◽

Lv Volumes ◽

And Function

Abstract Funding Acknowledgements None Aim Different surgical techniques are available for mitral valve (MV) repair in patients with degenerative severe mitral regurgitation (MR). Leaflet resection (LR) and neochordoplasty (NP), both including ring annuloplasty (RA), are the most frequently performed techniques for posterior mitral leaflet prolapse/flail repair. Despite NP technique is supposed to preserve LV physiology more than LR, it is unclear which technique provides the best haemodynamic pattern. In the present study, the results of the two different surgical techniques in terms of left ventricular (LV) dimension and function are investigated. Methods 23 consecutive patients who underwent MV surgical repair were enrolled. All patients underwent, before surgery and after 8 ± 2 months, 2D and 3D echocardiography with automatic (Heart Model, Philips) assessment of LV volumes and ejection fraction (EF), left atrial (LA) volume, right ventricular (RV) dimension and function, pulmonary artery systolic pressure (PASP), MR, tricuspid regurgitation (TR) and MVPG quantification. MR was corrected using 1) NP with polytetrafluoroethylene sutures and 2) triangular LR, both with RA. Patients were divided in 2 groups according to the surgical technique. Results: techniques were able to successfully correct MR. There were no significant differences in baseline echocardiogram and demographic characteristics between the two groups. There were no significant differences in terms of post-surgical MVPG between the two groups. In all patients a trend in reduction in LV dimension at follow-up was observed, but it was statistically significant only in NP patients (pre-surgical EDV 150 ± 41 VS post-surgical EDV 100 ± 27 ml, p = 0.03). Conclusions Both MV repair techniques showed a successful MV repair and an improvement in LV volumes at follow-up, especially in NP group. Further perspective studies are necessary to demonstrate the hypothesis of more physiological haemodynamic pattern associated with NP techniques. Echo parameters pre VS post MV Repair Parameter pre post p value LVEDV RN (ml) 150 ± 41 100 ± 27 0.03 LVESV RN (ml) 58 ± 20 46 ± 14 NS LVEF RN (%) 58 ± 8 55 ± 7 NS LVEDV RR (ml) 160 ± 58 118 ± 31 NS LVESV RR (ml) 62 ±11 51 ±13 NS LVEF RR (%) 59 ± 8 57 ± 4 NS EDV: end-diastolic volume, ESV: end-systolic volume, EF: ejection fraction, RN = Ring + Neochordae; RR= Ring + Resect.

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Novel full-flow valves, impact on early mitral post-replacement period: a non-randomised controlled cohort trial

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2021-28-3-46-60 ◽

2021 ◽

Vol 28 (3) ◽

pp. 46-60

Author(s):

V. S. Perekopskaya ◽

N. A. Morova ◽

V. N. Tsekhanovich

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Heart Defects ◽

Classical Model ◽

Systolic Pressure ◽

Mechanical Valve ◽

Left Ventricular ◽

Pulmonary Artery Systolic Pressure ◽

The Novel ◽

Valve Model

Background. Among cardiovascular diseases, valve pathology of various aetiology comprises a primary factor of chronic heart failure. Mitral valve diseases afflict over half of all patients with acquired heart defects. Today’s long-term outcomes of mitral valve replacement are not quite satisfactory, which urges the invention of novel vales. Such a modern artificial valve is the nationally developed bivalve full-flow MedInzh-ST prothesis.Objectives. Assessment of advantages of the novel MedInzh-ST full-flow mechanical valve vs. MedInzh-2 model in analyses of short-term postoperative outcomes.Methods. Over a five-year period, 116 patients underwent indicated mitral replacement with MedInzh valves. The full-flow MedInzh-ST was implanted in 55 patients, and MedInzh-2 — in 61. All patients had transthoracic echocardiography for structural and functional heart and implant control prior to surgery and discharge from hospital. Clinical and echocardiographic analyses were performed in the early postoperative period.Results. The choice of valve model had no effect on the rates of postoperative complications and hospital mortality. All lethal cases were not associated with the valve malfunction. All patients with predominant mitral stenosis revealed the reliably lower peak and mean transmitral pressure gradient and pulmonary artery systolic pressure, irrespective of the valve model. The novel full-flow valve implantation significantly more often associated with a reduced right ventricle size. All patients with predominant insufficiency were observed to reduce mitral regurgitation and the left ventricular size upon defect correction. Patients with full-flow protheses significantly more often had a reduced end-systolic dimension.Conclusion. The MedInzh-ST full-flow mechanical valve satisfies the modern requirements for efficacy and safety. Mitral stenosis correction with full-flow valves is shown to exert a greater effect on reverse right ventricular remodelling compared to the classical model.

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Giant Left Ventricular Pseudoaneurysm as a Complication After Mitral Valve Replacement Surgery

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2014.06.080 ◽

2014 ◽

Vol 98 (4) ◽

pp. 1480 ◽

Cited By ~ 3

Author(s):

Stefan Baumann ◽

Matthias Renker ◽

James V. Spearman ◽

Richard R. Bayer ◽

U. Joseph Schoepf ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Left Ventricular ◽

Left Ventricular Pseudoaneurysm ◽

Replacement Surgery ◽

Valve Replacement Surgery

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Doubly committed subarterial ventricular septal defect with prolapsed right coronary cusp with moderate aortic regurgitation

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v10i4.34561 ◽

2017 ◽

Vol 10 (4) ◽

pp. 240

Author(s):

Redoy Ranjan ◽

Asit Baran Adhikary ◽

Mohammad Rashal Chowdhury ◽

Md. Kabiruzzaman ◽

Md. Mushfiqur Rahman

Keyword(s):

Ventricular Septal Defect ◽

Aortic Regurgitation ◽

Septal Defect ◽

Systolic Pressure ◽

Failure To Thrive ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Pulmonary Artery Systolic Pressure ◽

Coronary Cusp ◽

Right Coronary Cusp

<p>A 4 year old girl was presented with the respiratory tract infection, breathlessness after taking meal, failure to thrive, abnormal movement of the chest on left side overlying the area of heart and systolic murmur. She developed these symptoms gradually for the last 3.5 years. Echocardiography revealed doubly committed subarterial ventricular septal defect with moderate aortic regurgitation. The size of the ventricular septal defect was 7 x 9 mm at the left ventricular outflow tract. The right coronary cusp of the aortic valve was prolapsed. Left atrium and left ventricle were dilated. The pulmonary artery systolic pressure was 35 mm Hg. The ventricular septal defect was closed with the standard surgical procedure using cardiopulmonary bypass followed by aortotomy and right atriotomy. Immediate post-operative period of this case was uneventful and the patient was discharged on 9<sup>th</sup> post-operative day. Follow-up echocardiography showed no residual ventricular septal defect or aortic regurgitation and the ventricular function was good.</p>

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Left Ventricular Pseudoaneurysm Repair after Mitral Valve Re-replacement for Prosthetic Valve Endocarditis

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.47.166 ◽

2018 ◽

Vol 47 (4) ◽

pp. 166-169

Author(s):

Daisuke Yano ◽

Fumiaki Kuwabara ◽

Shinji Yamada ◽

Shinichi Ashida ◽

Yuichi Hirate

Keyword(s):

Mitral Valve ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Left Ventricular ◽

Left Ventricular Pseudoaneurysm

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Visualization and Hemo-Dynamic Evaluation of Edge-to-Edge Mitral Valve Repair Within Reanimated Swine Hearts

Journal of Medical Devices ◽

10.1115/1.3136430 ◽

2009 ◽

Vol 3 (2) ◽

Author(s):

M. G. Bateman ◽

J. L. Quill ◽

J. St. Louis ◽

P. A. Iaizzo

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Imaging Modality ◽

Systolic Pressure ◽

Left Ventricular ◽

Lv Function ◽

Valve Repair ◽

Regurgitant Fraction ◽

Orifice Area ◽

Leaflet Coaptation

This project aims to investigate the performance of edge-to-edge mitral valve repair (MVR) within reanimated swine hearts. Direct imaging and hemodynamic data of the mitral valve during normal cardiac function (Normal), after an induced prolapse (Prolapse), and post surgical repair (E2E) was obtained. Isolated swine hearts (n=6) were reanimated using a clear Krebs–Henseleit buffer. Mitral prolapse, and regurgitation, in the P2 region was induced by cutting chordae tendinae of the posterior leaflet. An edge-to-edge MVR procedure was performed, suturing the prolapsed P2 region to the A2 region of the anterior leaflet. The mitral valve was imaged using endoscopic cameras in the left atrium and ventricle allowing verification of stitch placement and leaflet coaptation. Analysis of the endoscopic images provided measures of annulus area, orifice area, and regurgitant area. Echocardiography, the standard clinical imaging modality, was used to determine the hemodynamic performance of the valve. Additionally, ECG and left chamber pressures were recorded at a sample rate of 5 kHz. Prolapse of the P2 region was consistently created, and edge-to-edge repair of the mitral leaflet showed full leaflet coaptation. The annulus area of the valve was tracked throughout the procedure and did not show significant variation. The orifice area, defined as the area of the annulus that does not contain leaflets, normalized to the corresponding annulus area for Normal, Prolapse and E2E were: 41±13%, 44±14% and 21±13%, p=0.02. The regurgitant area, normalized to the corresponding annulus area, increased from 2±2% for Normal to 8±3% for the Prolapse and then decreased to 1±1% for the E2E group. The regurgitant fraction, normalized against the maximum observed, for Normal, Prolapse and E2E was 10±6%, 57±26% and 13±13%, p<0.01. Over the course of the experiment the left ventricular (LV) systolic pressure and negative dP/dt reduced from 95 to 54 mm Hg and 743 to 402 mm Hg/s, respectively. Our results show that orifice area was significantly smaller after MVR when compared to Normal and Prolapse periods. There was no significant change in regurgitant area and regurgitant fraction from the Normal to repaired valve as compared to a significant increase in regurgitant area and regurgitant fraction during Prolapse. Low gradients were observed for all three groups, with no indications for symptomatic stenosis. The reduction of LV function was caused by global ischemia and the progressive onset of edema. In this acute assessment of edge-to-edge repair of P2 prolapse, repair does not affect annulus area, decreases orifice area, and successfully eliminates regurgitant area with no evidence of mitral stenosis.

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Normal Fluctuations in Pulmonary Artery Pressures and Cardiac Output in Patients with Severe Left Ventricular Dysfunction

European Journal of Cardiovascular Nursing ◽

10.1016/s1474-51510200013-0 ◽

2002 ◽

Vol 1 (2) ◽

pp. 131-137 ◽

Cited By ~ 1

Author(s):

Debra K. Moser ◽

Susan K. Frazier ◽

Mary A. Woo ◽

Linda K. Daley

Keyword(s):

Cardiac Output ◽

Pulmonary Artery ◽

Pulmonary Capillary Wedge Pressure ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Systolic Pressure ◽

Left Ventricular ◽

Pulmonary Artery Systolic Pressure ◽

Pulmonary Capillary ◽

Normal Fluctuations

Background: One barrier to accurate interpretation of changes in hemodynamic pressures and cardiac output is lack of data about what constitutes a normal fluctuation. Few investigators have examined normal fluctuations in these parameters and none have done so in patients with left ventricular dysfunction. Aims: To describe normal fluctuations in pulmonary artery pressures and cardiac output in patients with left ventricular dysfunction. Methods: Hemodynamically stable advanced heart failure patients ( N=39; 55±6 years old; 62% male) with left ventricular dysfunction (mean ejection fraction 22±5%) were studied. Cardiac output and pulmonary artery pressures were measured every 15 min for 2 h. Results: Mean±standard deviation fluctuations were as follows: pulmonary artery systolic pressure=7±4 mmHg; pulmonary artery diastolic pressure=6±3 mmHg; pulmonary capillary wedge pressure=5±3 mmHg; cardiac output=0.7±0.3 l/min. The coefficient of variation for fluctuations in pulmonary artery systolic pressure was 6.7%, in pulmonary artery diastolic pressure was 9.3%, in pulmonary capillary wedge pressure was 9.2%, and in cardiac output was 7.2%. Conclusions: Values that vary <8% for pulmonary artery systolic pressure, <11% for pulmonary artery diastolic pressure, <12% for pulmonary capillary wedge pressure, and <9% for cardiac output from baseline represent normal fluctuations in these parameters in patients with left ventricular dysfunction.

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A tensed Tendyne

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa109 ◽

2020 ◽

Vol 58 (3) ◽

pp. 651-653 ◽

Cited By ~ 1

Author(s):

Daniel Grinberg ◽

Matteo Pozzi ◽

Chloé Bernard ◽

Jean-Francois Obadia

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Paravalvular Leak ◽

Main Challenge ◽

Low Profile ◽

Transcatheter Mitral Valve Replacement ◽

Left Ventricular Outflow

Abstract We report a case of prosthesis dislodgement after transcatheter mitral valve replacement in an 85-year-old woman with chronic ischaemic heart failure. Two weeks after an initial successful implantation, she presented with a paravalvular leak associated with left ventricular outflow tract obstruction. Tether re-tensioning was performed and resolved the situation, but resulted in a deformation of the apical attachment zone into the left ventricle. Unfortunately, the patient finally expired from severe endocarditis. Proper anchoring is the main challenge for transcatheter mitral valve replacement techniques. Dislodgement of the prosthesis after transcatheter mitral valve replacement is an infrequent complication of the Tendyne® procedure. This case emphasizes the importance of assessing the quality of the myocardium at the implantation zone of the apical pad, and of prosthesis oversizing, especially if low-profile valves are chosen. .

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