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1.
Mymensingh Med J ; 30(1): 164-170, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33397869

RESUMO

Standard mitral valve replacement in patients with chronic mitral valve regurgitation and mitral valve stenosis consistently results in a decrease in early postoperative left ventricular ejection performance. Some studies showed that preservation of mitral valve leaflet and subvalvular apparatus can reduce postoperative left ventricular dysfunction. On the basis of the concept, this randomized clinical trial comparing mitral valve replacement with preservation of mitral subvalvular apparatus and conventional mitral valve replacement performed in National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, in the period of July 2010 to December 2011. We included 60 patients of mitral regurgitation and mitral stenosis, among them 30 patients underwent mitral valve replacement with preservation of mitral subvalvular apparatus (Group A) and 30 patients underwent conventional mitral valve replacement (Group B). There was no significant difference between two groups in terms of peri-operative variables. But there was significant higher incidence of Low cardiac output (LOS) syndrome [36.7% vs. 6.9% (p<0.05)] and congestive heart failure in Group B than Group A. The duration of ICU stay was also significantly higher in conventional mitral valve replacement group [113.23±11.30 hours vs. 96.23±20.02 (p=0.001)]. Additionally, there was significantly less fall of left ventricular ejection fraction in preservation of mitral subvalvular apparatus group [preop 65.27±5.45, at discharge 54.31±3.78, after 3 months 58.28±5.20 (p<0.0001)] than conventional group [preop 66.43±4.58, at discharge 46.43±3.87, after 3 months 46.55±3.63 (p<0.0001)]. In this study left ventricular ejection fraction was used as measure of left ventricular function. We postulate that, this relative preservation of left ventricular ejection fraction was likely the result of preservation of mitral subvalvular apparatus.


Assuntos
Baixo Débito Cardíaco , Implante de Prótese de Valva Cardíaca , Bangladesh , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Incidência , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
2.
Cardiovasc Pathol ; 50: 107277, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32882373

RESUMO

Mitral valve is a complex cardiac structure composed of several components to work in synchrony to allow blood flow into left ventricle during diastole and not to allow blood flow into left atrium during systole. Accessory mitral valve tissue (AMVT) was defined as existence of any additional part and parcel of valvular structure which has an attachment to normal mitral valve apparatus in left-sided cardiac chambers. AMVT may present itself in different clinical circumstances ranging from a silent clinical course to thromboembolic events, heart failure, left ventricular outflow tract obstruction, and severe arrhythmia. This article reviews the clinical perspectives of AMVT in terms of symptoms, diagnosis, and treatment, providing a new anatomical classification regarding the location of AMVT. Briefly type I refers to AMVT having attachments on the supra leaflets level, type II refers to attachments on the mitral leaflets, and type III refers to attachment below the mitral leaflets. Increased awareness and widespread use of echocardiographic techniques would increase recognition of AMVT in patients with heart murmurs but otherwise healthy and in those with left ventricular outflow tract obstruction or tissue which causes subaortic stenosis and with unexplained cerebrovascular events.


Assuntos
Cardiopatias Congênitas , Valva Mitral/anormalidades , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/terapia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Tromboembolia/etiologia , Obstrução do Fluxo Ventricular Externo/etiologia
3.
Clinics (Sao Paulo) ; 75: e2428, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33263628

RESUMO

OBJECTIVES: The aim of this study was to analyze mitral annulus (MA) dynamics using cardiac magnetic resonance (CMR) in patients with degenerative mitral insufficiency who underwent mitral valve repair (MVR). METHODS: Mitral valve imaging was performed by CMR in twenty-nine patients with degenerative mitral insufficiency who underwent MVR between July 2014 and August 2016, with quadrangular resection of the posterior leaflet without ring annuloplasty. They were prospectively followed up from the preoperative period up to 2 years postoperatively. RESULTS: We observed a significant reduction in all measurements of the MA after surgery. The mean systolic circumference of the MA was reduced from 13.28±1.95 cm to 11.50±1.59 cm, and the diastolic circumference was reduced from 12.51±2.01 cm to 10.66±2.09 cm in the immediate postoperative period, measures that remained stable 2 years after MVR (p<0.001). The mean maximum area of the MA was significantly reduced from 14.34±4.03 to 10.45±3.17 cm2 when comparing the immediate postoperative period and the 2 year follow-up (p<0.001). The same occurred with the mean minimum area of the MA, which was reduced from 12.53±3.68 cm2 to 9.23±2.84 cm2 in the same period, and this reduction was greater in the antero-posterior diameter than in the mid-lateral diameter. The mobility of the MA was preserved after surgery, ranging between 19.6% and 25.7% at 2-year follow-up. CONCLUSION: We observed a significant reduction in the MA size after MVR, with preservation of the MA mobility at the 2-year follow-up.


Assuntos
Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Diástole , Seguimentos , Humanos , Espectroscopia de Ressonância Magnética , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Resultado do Tratamento
4.
Open Heart ; 7(2)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33154146

RESUMO

OBJECTIVE: The World Heart Federation (WHF) criteria incorporate a Doppler-based system to differentiate between 'physiological' and 'pathological' mitral regurgitation (MR)-a sole criterion sufficient for the diagnosis of WHF 'borderline' rheumatic heart disease (RHD). We have identified that interscallop separations (ISS) of the posterior mitral valve (MV) leaflet, can give rise to pathological MR in an otherwise-normal MV. We aimed to establish and compare the prevalence of ISS-related MR among South African children at high and low risk for RHD. METHODS: A prospective cross-sectional echocardiographic study of 759 school children (aged 13-18) was performed. Cases with MR≥1.5 cm underwent a second comprehensive study to determine the prevalence of RHD according to the WHF guideline and establish the underlying mechanism of MR. RESULTS: Of 400 high-risk children, two met criteria for 'definite RHD' (5 per 1000 (95% CI 1.4 to 18.0); p=0.5) and 11 for 'borderline RHD' (27.5 per 1000 (95% CI 15.4 to 48.6)). Of 359 low-risk children, 14 met criteria for borderline RHD (39 per 1000 (95% CI 23.4 to 64.4)). Comprehensive echocardiography identified an underlying ISS as the mechanism of isolated pathological MR in 10 (83.3%) high-risk children and 11 low-risk children (78.5%; p>0.99). CONCLUSIONS: ISS are a ubiquitous finding among South African schoolchildren from all risk profiles and are regularly identified as the underlying mechanism of WHF pathological MR in borderline RHD cases. A detailed MV assessment with an emphasis on ascertaining the underlying mechanism of dysfunction could reduce the reported numbers of screened cases misclassified as borderline RHD.


Assuntos
Ecocardiografia Doppler , Insuficiência da Valva Mitral/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Cardiopatia Reumática/diagnóstico por imagem , Adolescente , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Insuficiência da Valva Mitral/epidemiologia , Variações Dependentes do Observador , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Reprodutibilidade dos Testes , Cardiopatia Reumática/epidemiologia , Medição de Risco , Fatores de Risco , África do Sul
5.
J Vis Exp ; (164)2020 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-33191942

RESUMO

Traditionally, it was believed that the right side of the heart has a minor role in circulation; however, more and more data suggest that right ventricular (RV) function has strong diagnostic and prognostic power in various cardiovascular disorders. Due to its complex morphology and function, assessment of the RV by conventional two-dimensional echocardiography is limited: the everyday clinical practice usually relies on simple linear dimensions and functional measures. Three-dimensional (3D) echocardiography overcame these limitations by providing volumetric quantification of the RV free of geometrical assumptions. Here, we offer a step-by-step guide to obtain and analyze 3D echocardiographic data of the RV using the leading commercially available software. We will quantify 3D RV volumes and ejection fraction. Several technical aspects may help to improve the quality of RV acquisition and analysis as well, which we present in a practical manner. We review the current opportunities and the limiting factors of this method and also highlight the potential applications of 3D RV assessment in current clinical practice.


Assuntos
Ecocardiografia Tridimensional/métodos , Função Ventricular Direita , Humanos , Valva Mitral/diagnóstico por imagem , Software
8.
Kyobu Geka ; 73(11): 944-946, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130720

RESUMO

We report a case of surgical treatment of mitral valve stenosis due to severe calcification on the glutaraldehyde-treated autologous pericardium. A 39-year-old woman presented with progressive dyspnea. She had undergone mitral valve repair by leaflet augmentation with a glutaraldehyde-treated autologous pericardium for mitral regurgitation 3 years before. Transthoracic echocardiography showed mitral valve stenosis with limited movement of the anterior leaflet. At redo surgery, severe calcification was observed of the glutaraldehyde-treated autologous pericardium patch on the anterior mitral leaflet. Mitral valve replacement was performed successfully, and she was discharged on postoperative day 14.


Assuntos
Insuficiência da Valva Mitral , Valva Mitral , Adulto , Feminino , Glutaral , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Pericárdio/cirurgia , Pericárdio/transplante , Resultado do Tratamento
9.
Kyobu Geka ; 73(11): 947-949, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130721

RESUMO

A 76-year-old woman was admitted to our hospital complaining of dyspnea on effort. Echocardiography showed severe mitral regurgitation. Her medical history indicated that she was allergic to metal, and skin patch tests were positive for nickel, cobalt, platinum, manganese, iridium, chromium, and zinc. Valvuloplasty involved triangular resection of P2 and mitral valve annuloplasty with a metal-free, 29 mm Tailor Flexible Ring. The sternum was closed using polyester non-absorbable sutures instead of surgical steel wire. Her postoperative course was uneventful and she was discharged on postoperative day 21. Nine months later, she is well and free of allergic symptoms.


Assuntos
Hipersensibilidade , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Idoso , Ecocardiografia , Feminino , Humanos , Hipersensibilidade/etiologia , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia
10.
Kyobu Geka ; 73(11): 950-953, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130722

RESUMO

A 33-year-old man presenting with fever, fatigue, and delirium was diagnosed with infectious endocarditis(IE). He had already undergone surgery for IE twice;initial valve repair 4 years ago and mitral valve replacement(MVR) 1 year later. He has refractory atopic dermatitis, which was considered to be the cause of his repeated IE. Initially, antibiotics were administered but the infection was not controlled. Therefore, we decided to perform the 3rd surgery. MVR was performed, and using bovine pericardium, we covered valve cuff and suture felts to separete these parts from blood stream. Postoperative echocardiography showed good prosthetic valve motion without transvalvular regurgitation or paravalvular leak. He was discharged on the 39th postoperative day and has been doing well for 2 years since.


Assuntos
Endocardite , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral , Adulto , Animais , Bovinos , Endocardite/cirurgia , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Pericárdio , Suturas
11.
Pol Merkur Lekarski ; 48(287): 335-338, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33130794

RESUMO

Mitral valve prolapse (MVP) is diagnosed by auscultation and echocardiography in about 2-3% of the general population and takes rather a benign course. However, in some patients, ventricular arrhythmia and sudden cardiac death (SCD) occur, which is linked to mitral annular disjunction (MAD). MAD is defined as distinct separation of the mitral valve annulus-left atrial wall continuum and the basal region of the posterolateral left ventricular (LV) myocardium. MAD results in disturbed inferior-posterior LV wall and posteromedial papillary muscle stretch giving rise to local fibrosis presenting in cardiac magnetic resonance (CMR) as late gadolinium enhancement (LGE) and posing a substrate for malignant arrhythmia. Multidetector-row computed tomography (MDCT) in MAD patients is still rarely used. A CASE REPORT: Mitral valve prolapse (MVP) is diagnosed by auscultation and echocardiography in about 2-3% of the general population and takes rather a benign course. However, in some patients, ventricular arrhythmia and sudden cardiac death (SCD) occur, which is linked to mitral annular disjunction (MAD). MAD is defined as distinct separation of the mitral valve annulus-left atrial wall continuum and the basal region of the posterolateral left ventricular (LV) myocardium. MAD results in disturbed inferior-posterior LV wall and posteromedial papillary muscle stretch giving rise to local fibrosis presenting in cardiac magnetic resonance (CMR) as late gadolinium enhancement (LGE) and posing a substrate for malignant arrhythmia. Multidetector-row computed tomography (MDCT) in MAD patients is still rarely used.


Assuntos
Prolapso da Valva Mitral , Valva Mitral , Meios de Contraste , Gadolínio , Humanos , Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/diagnóstico por imagem , Músculos Papilares
12.
Open Heart ; 7(2)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33046594

RESUMO

OBJECTIVE: Minimally invasive surgery is increasingly adopted as an alternative to conventional sternotomy for mitral valve pathology in many centres worldwide. A systematic safety analysis based on a comprehensive list of pre-specified 30-day complications defined by the Mitral Valve Academic Consortium (MVARC) criteria is lacking. The aim of the current study was to systematically analyse the safety of minimally invasive mitral valve surgery in our centre based on the MVARC definitions. METHODS: All consecutive patients undergoing minimally invasive mitral valve surgery through right mini-thoracotomy in our institution within 10 years were studied retrospectively. The primary outcome was a composite of 30-day major complications based on MVARC definitions. RESULTS: 745 patients underwent minimally invasive mitral valve surgery (507 repair, 238 replacement), with a mean age of 62.9±12.3 years. The repair was successful in 95.8%. Overall 30-day mortality was 1.2% and stroke rate 0.3%. Freedom from any 30-day major complications was 87.2%, and independent predictors were left ventricular ejection fraction <50% (OR 1.78; 95% CI 1.02 to 3.02) and estimated glomerular filtration rate <60 mL/min/1.73 m2 (OR 1.98; 95% CI 1.17 to 3.26). CONCLUSIONS: Minimally invasive mitral valve surgery is a safe technique and is associated with low 30-day mortality and stroke rate.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Valva Mitral/cirurgia , Toracotomia , Idoso , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/instrumentação , Anuloplastia da Valva Mitral/mortalidade , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Toracotomia/efeitos adversos , Toracotomia/mortalidade , Fatores de Tempo , Resultado do Tratamento
13.
Open Heart ; 7(2)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33020254

RESUMO

Disseminating the practice of minimally invasive mitral surgery (mini-MVS) can be challenging, despite its original case reports a few decades ago. The penetration of this technology into clinical practice has been limited to centres of excellence, and mitral surgery in most general cardiothoracic centres remains to be conducted via sternotomy access as a first line. The process for the uptake of mini-MVS requires clearer guidance and standardisation for the processes involved in its implementation. In this statement, a consensus agreement is outlined that describes the benefits of mini-MVS, including reduced postoperative bleeding, reduced wound infection, enhanced recovery and patient satisfaction. Technical considerations require specific attention and can be introduced through simulation and/or use in conventional cases. Either endoballoon or aortic cross clamping is recommended, as well as femoral or central aortic cannulation, with the use of appropriate adjuncts and instruments. A coordinated team-based approach that encourages ownership of the programme by the team members is critical. A designated proctor is also recommended. The organisation of structured training and simulation, as well as planning the initial cases, is an important step to consider. The importance of pre-empting complications and dealing with adverse events is described, including re-exploration, conversion to sternotomy, unilateral pulmonary oedema and phrenic nerve injury. Accounting for both institutional and team considerations can effectively facilitate the introduction of a mini-MVS service. This involves simulation, team-based training, visits to specialist centres and involvement of a designated proctor to oversee the initial cases.


Assuntos
Procedimentos Cirúrgicos Cardíacos/normas , Cardiologia/normas , Doenças das Valvas Cardíacas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Valva Mitral/cirurgia , Medicina Estatal/normas , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Consenso , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Equipe de Assistência ao Paciente , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Desenvolvimento de Programas , Resultado do Tratamento , Reino Unido
14.
EuroIntervention ; 16(10): 803-807, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33046435

RESUMO

Percutaneous mitral valve leaflet repair has revolutionised the treatment of heart failure patients with secondary mitral regurgitation. It also offers a valuable alternative to surgery for high-risk patients with degenerative disease. More than one device is now available for leaflet repair, broadening the indications and improving outcomes, as well as complicating the decision-making algorithms. In the last two years, several trials and registries have enriched the evidence around these procedures, although many questions remain open. Two major clinical trials have provided opposing evidence, confirming that this field of cardiovascular medicine remains controversial. Probably, the challenge remains with the human factor: achieving optimal outcomes remains a challenge, highly dependent on patient selection, timing and procedural details. Operator-dependent factors are emerging as a key element, not unexpectedly, to achieve procedural excellence. Besides large randomised controlled trials, a great deal of knowledge is emerging from real-world registries. This review focuses on what we can learn from registries and single-centre experiences as a complement to the large randomised trials.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Insuficiência Cardíaca , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Previsões , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia , Resultado do Tratamento
15.
Clin Nucl Med ; 45(12): 973-974, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33031244

RESUMO

Cardiac valvular involvement in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is very rare. We report the case of a patient seen in 2019, followed for ANCA-associated vasculitis for 15 years, who had a first relapse with cardiac valvular involvement in 2012, and who underwent a second histologically proven vasculitis relapse involving mitral periprosthetic endocardium. PET/CT imaging showed an intense and focal FDG activity of paramitral bioprosthesis leak site. Mitral bioprosthesis was replaced, and the patient improved with steroids and rituximab. Through this exceptional case, we suggest that FDG PET/CT could be of interest in the follow-up of ANCA-associated vasculitis with cardiac valvular involvement.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva
16.
Int Heart J ; 61(5): 970-978, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32999196

RESUMO

The mechanism of systolic annular expansion in mitral valve prolapse (MVP) is not clarified. Since annular expansion is systolic outward shift of MV leaflet/chorda tissue complex at superior and outer ends, annular expansion could be related to inward (superior) shift of the complex at another inferior and inner end of the papillary muscle (PM) tip and/or systolic lengthening of the tissue complex, especially MV leaflets.MV annulus systolic expansion, PMs' systolic superior shift, and MV leaflets' systolic lengthening were evaluated by echocardiography with a speckle tracking analysis in 25 normal subjects, 25 subjects with holo-systolic MVP and 20 subjects with late-systolic MVP.PMs' superior shift, MV leaflets' lengthening, MV annular area at the onset of systole and subsequent MV annulus expansion were significantly greater in late-systolic MVP than in holo-systolic MVP (4.6 ± 1.6 versus 1.5 ± 0.7 mm/m2, 2.5 ± 1.4 versus 0.6 ± 2.0 mm/m2, 6.8 ± 2.5 versus 5.7 ± 1.0 cm2/m2 and 1.6 ± 0.8 versus 0.1 ± 0.5 cm2/m2, P < 0.001, respectively). Multivariate analysis identified MV leaflets' lengthening and PMs' superior shift as independent factors associated with MV annular expansion.Conclusions: These results suggest that systolic MV annular expansion in MVP is related to abnormal MV leaflets' lengthening and PMs' superior shift.


Assuntos
Ecocardiografia/métodos , Prolapso da Valva Mitral/fisiopatologia , Valva Mitral/fisiopatologia , Músculos Papilares/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/diagnóstico por imagem , Músculos Papilares/diagnóstico por imagem , Estudos Retrospectivos , Sístole
17.
Asian Cardiovasc Thorac Ann ; 28(7): 427-430, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33023305

RESUMO

Based on current guidelines, 15% to 20% of patients undergoing mitral valve repair for regurgitation develop left ventricular dysfunction (ejection fraction < 50%-55%) despite a normal baseline. Two schools of thought have been debated: preexisting myocardial disease or suboptimal intraoperative myocardial protection. In our view, they could be reconciled. It is well recognized that left ventricular ejection fraction with a standard cut off at 50%-55% has limited sensitivity in detecting early systolic impairment in mitral regurgitation patients. Mitral regurgitation also leads to mitochondrial oxidative stress, thus rendering the myocardium more susceptible to ischemia-reperfusion injury and precipitating postoperative cardiac dysfunction. The fall in left ventricular ejection fraction early after mitral valve repair was shown to be caused by the reduction in both myocardial contractility and left ventricular stroke volume. To mitigate the risk to myocardial reperfusion injury, appropriate cardioplegia volume and distribution and well-defined surgical repair processes are equally important. We use transesophageal echocardiography-guided cardioplegia delivery, imaging the intramyocardial flow and ensuring adequate protection of the subendocardium during mitral valve repair. Mild aortic regurgitation on a beating heart often leads to left ventricular dilatation with diminished cardioplegia flow in the myocardium, thus requiring direct ostia cardioplegia. Systematic transesophageal echocardiography assessment before surgery is essential for establishing the mitral regurgitation mechanisms and translating them into precise surgical repair strategies. The benefits of transesophageal echocardiography-guided cardioplegia delivery warrant further clinical trials in order to evolve into part of a high surgical standard.


Assuntos
Ecocardiografia Transesofagiana , Parada Cardíaca Induzida , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Disfunção Ventricular Esquerda/prevenção & controle , Ecocardiografia Transesofagiana/efeitos adversos , Parada Cardíaca Induzida/efeitos adversos , Hemodinâmica , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Traumatismo por Reperfusão Miocárdica/diagnóstico por imagem , Traumatismo por Reperfusão Miocárdica/etiologia , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Fatores de Risco , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
18.
Asian Cardiovasc Thorac Ann ; 28(7): 381-383, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33023307
20.
Surg Technol Int ; 37: 185-190, 2020 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-32944920

RESUMO

The risk of recurrent mitral regurgitation after surgical mitral valve repair for ischemic functional mitral regurgitation is 28 % at 10 years. Also, an increasing number of patients with degenerated mitral bioprostheses are seen in daily clinical practice due to a dramatic shift from mechanical to biological bioprostheses over the past few decades. Therefore, it can be anticipated that there will be growing need for therapy options to treat high-risk patients in case of recurrent mitral regurgitation subsequent to surgical mitral valve repair or replacement. Interventional therapy for failing surgical mitral valve replacement and repair is an appealing option in patients who are ineligible for redo surgery. The efficacy and safety of transcatheter mitral valve replacement have been reported in patients with failing mitral rings or degenerated mitral bioprostheses. However, crucial limitations remain, including possible device malpositioning, left ventricular outflow tract obstruction and postprocedural mitral regurgitation. Partially, these complications can be explained by the most frequently used transcatheter heart valves, which are balloon-expanding bioprostheses intended for transcatheter aortic valve implantation that cannot be repositioned. Currently, frequently used approaches for transcatheter mitral valve replacement include retrograde transapical and antegrade transseptal techniques, most often with the use of transcatheter heart valves from the Sapien family (Edwards Lifesciences Inc., Irvine, CA, USA) followed by the mechanical expandable Lotus valve (Boston Scientific, Marlborough, MS, USA). Anecdotal reports have described the application of self-expandable transcatheter heart valves (Centera; Edwards) or dedicated transcatheter mitral valve replacement devices. In this report, we give an overview of current interventional techniques, available evidence and reported outcomes for transcatheter mitral valve replacement for degenerated bioprosthetic valves and failed annuloplasty rings.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Bioprótese , Cateterismo Cardíaco , Humanos , Valva Mitral/diagnóstico por imagem , Anuloplastia da Valva Mitral , Desenho de Prótese , Falha de Prótese , Resultado do Tratamento
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