Adult Obstructive Cor Triatriatum with Severe Mitral Regurgitation: A Case Report

Adult cor triatriatum sinister associated with severe mitral regurgitation is extremely rare. As these obstructive cor triatriatum feature hemodynamics that mimic mitral stenosis, a pressure load is theoretically generated only on the left atrial proximal chamber, and therefore the left ventricle is less likely to suffer volume loading. Here, we report a surgical case with such rare hemodynamics. A 22-year-old man with obstructive cor triatriatum and severe mitral regurgitation received an anomalous membrane excision and mitral annuloplasty. An abnormal membrane with an orifice 7 mm in size was completely resected while a grossly dilated mitral annulus was repaired via annuloplasty ring. Mitral regurgitation was controlled well, and the postoperative course was uneventful. Even with obstructive cor triatriatum, severe mitral annular dilatation and subsequent left ventricular dilatation may occur, causing the progressive heart failure encountered in this case.

Idiopathic Bradycardia in Unicuspid Unicommissural Aortic Valve Complicated with Infective Endocarditis and Aortic Root Abscess: A Case Report

Unicuspid aortic valves are among the rarest congenital malformations. They are classified as either acommissural or unicommissural, with the unicommissural being presented in early adulthood. Unicuspid valves share many similarities with bicuspid valves, namely increased rates of valve degeneration and calcification, making them prone to secondary aortic stenosis, regurgitation, or both. Among other similarities are the increased risk of aortic root dilatation, dissection, and left ventricular dilatation. We report our case of a 23-year-old male with unicuspid unicommissural aortic valve with aortic root and left ventricular dilatation. He successfully underwent Wheat procedure.

Midterm results of mitral valve repair for atrial functional mitral regurgitation: a retrospective study

Background Annular dilation by left atrial remodeling is considered the main cause of atrial function mitral regurgitation. Although acceptable outcomes have been obtained using mitral ring annuloplasty alone for atrial functional mitral regurgitation, data assessing outcomes of this procedure are limited. Therefore, we aimed to assess midterm outcomes of mitral valve repair in patients with atrial functional mitral regurgitation. Methods We retrospectively studied 40 patients (mean age: 69 ± 9 years) who had atrial fibrillation that persisted for > 1 year, preserved left ventricular ejection fraction of > 40%, and mitral valve repair for atrial functional mitral regurgitation. The mean clinical follow-up duration was 42 ± 24 months. Results Mitral ring annuloplasty was performed for all patients. Additional repair including anterior mitral leaflet neochordoplasty was performed for 22 patients. Concomitant procedures included maze procedure in 20 patients and tricuspid ring annuloplasty in 31 patients. Follow-up echocardiography showed significant decreases in left atrial dimensions and left ventricular end-diastolic dimensions. Recurrent mitral regurgitation due to ring detachment or leaflet tethering was observed in five patients and was seen more frequently among those with preoperative left ventricular dilatation. Three patients without tricuspid ring annuloplasty or sinus rhythm recovery by maze procedure developed significant tricuspid regurgitation. Five patients who underwent the maze procedure showed sinus rhythm recovery. Rates of freedom from re-admission for heart failure at 1 and 5 years after surgery were 95 and 86%, respectively. Conclusions Mitral valve repair is not sufficient to prevent recurrent atrial functional mitral regurgitation in patients with preoperative left ventricular dilatation. Tricuspid ring annuloplasty may be required for long-term prevention of significant tricuspid regurgitation.

Midterm results of mitral valve repair for atrial functional mitral regurgitation: A retrospective study

Background: Annular dilation by left atrial remodeling is considered the main cause of atrial function mitral regurgitation. Although acceptable outcomes have been obtained using mitral ring annuloplasty alone for atrial functional mitral regurgitation, data assessing outcomes of this procedure are limited. Therefore, we aimed to assess midterm outcomes of mitral valve repair in patients with atrial functional mitral regurgitation.Methods: We retrospectively studied 40 patients (mean age: 69 ± 9 years) who had atrial fibrillation that persisted for >1 year, preserved left ventricular ejection fraction of >40%, and mitral valve repair for atrial functional mitral regurgitation. The mean clinical follow-up duration was 42 ± 24 months.Results: Mitral ring annuloplasty was performed for all patients. Additional repair including anterior mitral leaflet neochordoplasty was performed for 22 patients. Concomitant procedures included maze procedure in 20 patients and tricuspid ring annuloplasty in 31 patients. Follow-up echocardiography showed significant decreases in left atrial dimensions and left ventricular end-diastolic dimensions. Recurrent mitral regurgitation due to ring detachment or leaflet tethering was observed in five patients and was seen more frequently among those with preoperative left ventricular dilatation. Three patients without tricuspid ring annuloplasty or sinus rhythm recovery by maze procedure developed significant tricuspid regurgitation. Five patients who underwent the maze procedure showed sinus rhythm recovery. Rates of freedom from re-admission for heart failure at 1 and 5 years after surgery were 95% and 86%, respectively.Conclusions: Mitral valve repair is not sufficient to prevent recurrent atrial functional mitral regurgitation in patients with preoperative left ventricular dilatation. Tricuspid ring annuloplasty may be required for long-term prevention of significant tricuspid regurgitation.

The Value of NT-proBNP the Follow - up of Children with Dilated Cardiomyopathy

Objectives: To survery the plasma NT-proBNP concentration, the correlation between NT-proBNP concentration and the New York Pediatric Heart Failure Index (NYU PHFI) in children with dilated cardiomyopathy. Comment on the association of NT-proBNP with the level of left ventricular dilatation and systolic function in the follow - up of children with dilated cardiomyopathy. Method: Prospective, descriptive study. Results: At the time of diagnosis, 32 out of 33 patients (97%) had an NTproBNP level higher than 97,5th percentile. The log NT-proBNP was significantly positively correlated with PHFI (r = 0.84; P <0.001). The log NT-proBNP wasalso positively correlated with LVED (r = 0.519; p <0.001), was negatively correlated with LVEF (r = -0.736; p <0.001) and LVFS (r = - 0.737; p <0.001. The initial levels of serum NT-proBNP were not different from three progressed groups. However, at 3 months after diagnosis, the NT-proBNP of the improved group was significantly different from each other. Conclusion: NT-proBNP is an excellentbiomarker used to diagnose and assess cardiac insufficiency inthe follow – up of children with dilated cardiomyopathy.