Management in Mitral Valve Replacement with Pulmonary Hypertension and Thyroid Storm: A Case Report

2021 ◽  
Vol 15 (7) ◽  
pp. 1982-1986
Author(s):  
Satrio Adi Wicaksono ◽  
Mohammad Sudrajat ◽  
Mochamad . ◽  
Pradana Bayu Rakhmatjati ◽  
Sulistiyati Bayu Utami ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Vascular Resistance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Thyroid Storm ◽  
Ventricular Ejection Fraction ◽  
Life Threatening

Introduction: We reported a case of patient after mitral valve replacement (MVR) with pulmonary hypertension (PH) and thyroid storm that is rare, but life-threatening condition. Case Illustration: A 57-year-old-male with a subclinical hyperthyroidism underwent MVR due to severe mitral regurgitation (MR) and high possibility for PH. He showed atrial fibrillation with normal left ventricular ejection fraction (LVEF). In the intensive care unit (ICU), four hours postoperatively, he developed thyroid storm with heart rate of 226 times/min, temperature 39oC, and thyroid function showed low TSH (<0.05 uIU/mL), high fT4 (25.4 pmol/L), and high T3 (3.3 nmol/L). He was administered with propranolol, propylthiouracil, hydrocortisone, and lugol. Discussion: Trauma of cardiac surgery might trigger thyroid storm in this patient. The post-operative period represented a high-risk time for PH patients, moreover with thyroid storm. Therapy for thyroid storm was multimodal, including anti-thyroid, beta blockers, iodine, and glucocorticoid. Hemodynamic goals were avoidance of elevation in pulmonary vascular resistance (PVR), avoidance of myocardial depressants and maintenance of systemic vascular resistance (SVR), myocardial contractility and preload. Conclusion: Thyroid storm and PH complicating MVR was rare, but life-threatening. Comprehensive management could decrease morbidity and mortality of thyroid storm. Keywords: mitral valve replacement surgery; pulmonary hypertension; thyroid storm

scholarly journals Early Clinical Results After Stentless Mitral Valve Implantation and Comparison With Conventional Valve Repair or Replacement

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Thomas Walther ◽  
Claudia Walther ◽  
Volkmar Falk ◽  
Anno Diegeler ◽  
Ralf Krakor ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Maximum Flow ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Papillary Muscles ◽  
Valve Repair ◽  
Promising Alternative ◽  
Ventricular Ejection Fraction

Background —A new quadricusp stentless mitral bioprosthetic valve (QMV) is evaluated and compared with current standards. Methods and Results —Since August 1997, 67 patients were prospectively evaluated: 23 patients received a QMV, 23 had mitral valve repair (MVR), and 21 received conventional mitral valve replacement (MVP). Patient age was 69±8, 64±10, and 62±9 years for QMV, MVR, and MVP treatment, respectively. The underlying pathology was mitral stenosis, incompetence, and mixed disease in a corresponding 8, 9, and 6 patients for QMV, 1, 22, and 0 patients for MVR, and 2, 12, and 7 patients for MVP. The papillary muscles were sufficient in all QMV cases to suspend the valve. Cross-clamp time was 59±19 minutes for QMV implantation. In-hospital mortality for QMV, MVR, and MVP was 1, 0, and 0 patients, respectively, and thoracotomy had to be performed again in 1, 1, and 2 patients, respectively (these outcomes were not valve related). At baseline transthoracic echocardiography, respective maximum flow velocities were 1.6, 1.4, and 1.7 m/s, and valve orifice area was 2.6, 3.5, and 3.4 cm 2 . Mild transvalvular reflux was seen in 8, 7, and 2 patients; moderate reflux, in 1, 1, and 1 patients. Left ventricular ejection fraction was 52%, 54%, and 51% in the respective treatment groups. At follow-up, hemodynamic parameters had further improved in all groups. Conclusions —One year after clinical implantation, the QMV appears to function well and has no additional risks compared with MVR or MVP. The subvalvular apparatus is preserved by suspending the QMV at the papillary muscles; this arrangement is hemodynamically advantageous. Echocardiography reveals an excellent valve performance that resembles native mitral valve morphology and hemodynamic function. The QMV is a promising alternative for biological mitral valve replacement.

scholarly journals Single versus bilateral chordo-papillary apparatus preservation in mitral valve replacement: a hemodynamic study

2020 ◽  
Vol 2 (2) ◽  
pp. 62-69
Author(s):  
Mostafa Alaaeldin Abdelfatah Shalaby ◽  
Haytham Mohamed Abd el.Moaty ◽  
Mohamed Hossiny Mahmoud ◽  
Mohamed S H Abdallah
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Ventricular Geometry ◽  
Ventricular Ejection Fraction ◽  
Group Iii ◽  
Group I ◽  
Single Versus

Background: It has been postulated that disruption of the mitral valve apparatus at the time of mitral valve replacement (MVR) is a risk factor for postoperative ventricular dysfunction. The aim of this study was to evaluate the effect of single versus bilateral chordo-papillary preservation on the left ventricular function in comparison to no preservation. Methods: This study was conducted from 2015 to 2018 on sixty patients who had MVR. The patients were classified into group I included 20 patients who underwent MVR with complete excision of the subvalvular chordae and tips of papillary muscles, group II: included 20 patients who underwent MVR with preservation of posterior chordo-papillary apparatus, and group III: included 20 patients who underwent MVR with preservation of both posterior and anterior chordo-papillary apparatus. Results: There were 20 males (33.3%), and the mean age was 48.76± 8.91 years. Patients in group III were significantly older (37.15 ±4.92, 39.8 ± 5.49, and 57.25 ± 6.93 years in groups I, II, and III, respectively; p< 0.001). The left ventricular end-diastolic (5.40 ±0.34, 4.96 ± 0.43, and 4.44 ± 0.55 mm in group I, II and III, respectively, p<0.001) and end-systolic diameter (4.33 ±0.48, 3.58 ±0.43 and 3.20 ±0.43 mm in group I, II and III; respectively, p<0.001) were significantly reduced in partial and complete preservation groups after 6 months. Left ventricular ejection fraction improved in the bilateral preservation and partial preservation groups after 6 months (45.32 ±9.78, 56.79 ±10.14, and 56.60 ±11.68 % in groups I, II and III respectively, p<0.001). Mechanical ventilation was significantly longer in group I (24.10 ± 6.6, 16.80 ± 5.97, and 15.80 ± 5.24 hours in groups I, II and III, respectively, p<0.001) and the duration of ICU stay was significantly longer in group I (78.65 ± 15.32, 65.40 ± 14.21, and 60.20 ± 12.58 hours in groups I, II and III, respectively, p<0.001). Conclusion: Preservation of the annulo-papillary continuity may preserve left ventricular geometry and performance. Total preservation of chordae could be superior to partial preservation with better left ventricular remodeling and improvement in the left ventricular functions.

scholarly journals Creation of artificial chords during mitral valve replacement in patients with rheumatic heart disease

2012 ◽  
Vol 93 (3) ◽  
pp. 479-484
Author(s):  
I V Abdul’yanov ◽  
M N Mukharyamov ◽  
R K Dzhordzhikiya ◽  
I I Vagizov
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Contractile Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Ventricular Geometry ◽  
Control Group ◽  
Ventricular Ejection Fraction

Aim. To evaluate the effectiveness and safety of the use of artificial chords using polytetrafluoroethylene sutures during mitral valve replacement in patients with rheumatism. Methods. The study included 134 patients operated on for isolated rheumatic mitral valve disease. Immediate (10 days) and long-term (24 months) results were evaluated in the three groups of patients, depending on the method of valve replacement: creation of prosthetic chords using polytetrafluoroethylene sutures (37 patients), preservation of native chords (67 patients), total excision of the subvalvular apparatus (control group, 30 patients). Results. 24 months after surgery in the group of prosthetic chords and the group of preserved native chords recorded was a significant decrease in the pulmonary artery pressure, the left atrial size and a reduction in the end-diastolic left ventricular size. In the control group of patients reported was a reduction in left ventricular ejection fraction in long-term follow up. Conclusion. The use of polytetrafluoroethylene sutures in order to create new chords demonstrated their safety and effectiveness in preserving the physiological left ventricular geometry; artificial chords, as well as the preserved native chords, have a positive effect on the left ventricular contractile function in the remote postoperative period.

scholarly journals Bileaflet versus Posterior-Leaflet-Only Preservation in Mitral Valve Replacement

2014 ◽  
Vol 41 (2) ◽  
pp. 165-169 ◽  
Author(s):  
Ahmet Coskun Ozdemir ◽  
Bilgin Emrecan ◽  
Ahmet Baltalarli
Keyword(s):  
Mitral Valve ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Posterior Leaflet ◽  
Ventricular Ejection Fraction

In the present study of mitral valve replacement, we investigated whether complete preservation of both leaflets (that is, the subvalvular apparatus) is superior to preservation of the posterior leaflet alone. Seventy patients who underwent mitral valve replacement in our clinic were divided into 2 groups: MVR-B (n=16), in whom both leaflets were preserved, and MVR-P (n=54), in whom only the posterior leaflet was preserved. The preoperative and postoperative clinical and echocardiographic findings were evaluated retrospectively. No signs of left ventricular outflow tract obstruction were observed in either group. In the MVR-B group, no decrease was observed in left ventricular ejection fraction during the postoperative period, whereas a significant reduction was observed in the MVR-P group (P=0.003). No differences were found between the 2 groups in their need for inotropic agents or intra-aortic balloon pump support, or in cross-clamp time, duration of intensive care unit or hospital stays, postoperative development of new atrial fibrillation, or mortality rates. Bileaflet preservation prevented the decrease in left ventricular ejection fraction that usually followed preservation of the posterior leaflet alone. However, posterior leaflet preservation alone yielded excellent results in terms of decreased left ventricular diameter. Bileaflet preservation should be the method of choice to prevent further decreases in ejection fraction and to avoid death in patients who present with substantially impaired left ventricular function.

Reversal of Left Ventricular Functions in Chronic Mitral Regurgitation after Mitral Valve Replacement

2016 ◽  
Vol 19 (4) ◽  
pp. 160
Author(s):  
Montaser Elsawy Abd elaziz ◽  
Islam Moheb Ibrahim
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
The Mean ◽  
Ventricular Functions

<strong>Background:</strong> Mitral valve regurgitation leads to deterioration of left ventricular functions if not treated early. We aimed to study the effect of mitral valve replacement on normalization of ejection fraction, remodeling of left ventricular dimensions, and left atrial reduction in patients with chronic mitral regurgitation.<br /><strong>Methods:</strong> Between December 2012 and August 2014, <br />45 patients with chronic mitral regurgitation underwent isolated mitral valve replacement. None of the patients had any other severe valvular or concomitant disease or severe coronary heart  disease. The patients were evaluated by echocardiography (preoperative, 1-week, and 1-year postoperative). The results were statistically analyzed by paired t test.<br /><strong>Results:</strong> Forty-five patients who underwent mitral valve replacement in our hospital were included in  the study. The group comprised 20 men and 25 women; the mean age was 31.8 ± 6.76 years. The mean  left ventricular ejection fraction was 61.09 ± 7.6 and decreased significantly to 59.04 ± 6.65 and 59.67 ± 6.56, 1-week and 1-year postoperative follow up, respectively. The left atrium showed significant reduction in size (4 ± 0.54 cm) at 1-year postoperative follow up, from (4.51 ± 0.57 cm) one-week postoperative, and from (5.55 ± 0.88 cm) preoperatively. The mean left ventricular end systolic diameter significantly decreased from 4.06 ± 0.65 cm preoperatively to 3.4 ± 0.4 cm, 1-week postoperative (P = .01), and also decreased significantly to 3.45 ± 0.51 cm at 1-year follow up postoperatively, but was higher than that at 1-week follow up. Also, the mean left ventricular end diastolic diameter decreased  significantly during periods of follow up (P &lt; .001).<br /><strong>Conclusion:</strong> Reversal of left ventricular functions and reduction of left-sided chamber dimensions are possible if early mitral valve replacement is considered in chronic mitral regurgitation before worsening of the condition.<br /><br />

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