Double orifice mitral valve (DOMV) without mitral regurgitation or mitral stenosis are asymptomatic. Physical findings may only exist if mitral regurgitation or mitral stenosis are present.. The severity of symptoms depends on the degree of left atrial hypertension. Dyspnea, nocturnal cough, and tachypnea occur, related to pulmonary venous congestion and increased lung stiffness. Frequent respiratory infections and wheezing occur, secondary to pulmonary congestion, increased fluid exudation, and airway narrowing. Poor feeding, failure to thrive, fatigue and sweating occur because of heart failure and reduced cardiac output. On occasion, a child with double orifice mitral valve presents with acute pulmonary edema or generalized edema. Hemoptysis and syncope can occur in older patients with double orifice mitral valve.. Double orifice mitral valve is detected in one of 3 ways. As an associated lesion with other congenital heart defects, especially in the presence of atrioventricular (AV) septal ...
BURCHELL, Richard K. and SCHOEMAN, Johan. Advances in the understanding of the pathogenesis, progression and diagnosis of myxomatous mitral valve disease in dogs. J. S. Afr. Vet. Assoc. [online]. 2014, vol.85, n.1, pp.01-05. ISSN 2224-9435.. A number of key questions remain unanswered in the pathogenesis of myxomatous mitral valve disease (MMVD). As MMVD typically afflicts small-breed dogs, a genetic basis has been implied. In addition, the fact that not all dogs within a risk group develop MMVD is still unexplained. Research into the pathogenesis of MMVD typically falls under three categorical divisions, namely genetic factors, mechanical factors of the valve and systemic factors. Genetic studies have implicated certain loci in the pathogenesis of MMVD. Of particular interest is the insulin-like growth factor (IGF)-1 locus, as IGF-1 is also associated with growth. The mechanical structure and function of the mitral valve have also received much attention in recent years. What has emerged is the ...
BURCHELL, Richard K. y SCHOEMAN, Johan. Medical management of myxomatous mitral valve disease: An evidence-based veterinary medicine approach. J. S. Afr. Vet. Assoc. [online]. 2014, vol.85, n.1, pp.01-07. ISSN 2224-9435. http://dx.doi.org/10.4102/jsava.v85i1.1095.. Myxomatous mitral valve disease (MMVD) is the most common heart disease of dogs. The current management of MMVD in dogs is mostly pharmacological, and the recommendations for treatment are based on a number of veterinary studies. Notwithstanding the current consensus regarding the medical management of MMVD, there remains active debate as to which drugs are the most effective. In order to understand how recommendations are constructed in the pharmacological management of diseases, the veterinarian needs to understand the concept of evidence-based veterinary medicine, and how the findings of these studies can be applied in their own practices. This review summarises the current veterinary literature and explains how the consensus ...
Your blood is supposed to follow a one-way path through your heart. It flows in through the top chamber (the left atrium), down to the bottom chamber (the left ventricle), and then out to your body. Your mitral valve separates these two chambers and keeps the blood from flowing backward. In mitral valve regurgitation, your mitral valve does not work as it should and allows blood to flow backward into your upper heart chamber.. Mitral valve regurgitation can happen suddenly (acute) or, more commonly, gradually over time (chronic). Acute mitral valve regurgitation is often caused by damage to the heart, perhaps from a heart attack or a heart infection called endocarditis. There are many possible reasons you can develop chronic mitral valve regurgitation, including mitral valve prolapse, rheumatic heart disease and untreated high blood pressure. If you have mitral valve regurgitation, you may notice that you feel very tired and that you have a hard time catching your breath when you exercise or ...
Devices and methods are provided for diagnosing and repairing mitral valve defects such as mitral valve regurgitation. According to an exemplary method, mitral valve function is visualized by transesophageal echocardiography. A catheter is inserted along the venous system of the patient through the atrium into the mitral valve. A suction tip grasps the leaflets of the mitral valve to immobilize and juxtapose the leaflets at a point simulating a stitch, and the mitral valve is again observed to confirm that fastening at that point will repair the prolapse or other defect. The mitral valve leaflets are then via a fastening such as a staple or shape memory rivet. The fastener may be inserted by a stapling assembly in the venous catheter tip, or by a separate stapler that is inserted along an arterial path from the opposite direction and guided along a transcardiac rail to the immobilized point. Upon completion of the repair process, the mitral valve is once again visualized by transesophageal
TY - JOUR. T1 - Long-term results of suture annuloplasty for degenerative mitral valve disease. T2 - A propensity-matched analysis. AU - Garatti, Andrea. AU - Canziani, Alberto. AU - Parolari, Alessandro. AU - Castelvecchio, Serenella. AU - Guazzi, Marco. AU - Daprati, Andrea. AU - Farah, Ali Abu. AU - Grimaldi, Francesco. AU - Tripepi, Sonia. AU - Menicanti, Lorenzo. PY - 2018/1/1. Y1 - 2018/1/1. N2 - Aims Ring annuloplasty is the gold standard of surgical repair in degenerative mitral valve disease. However, prosthetic annuloplasty has some drawbacks and potential hazards. Suture annuloplasty theoretically is able to preserve annular leaflet dynamics and left ventricular performance, but experience is limited. The aim of the study was to review the early and long-term outcome of the posterior double-suture annuloplasty (DSA) technique for degenerative mitral valve repair. Methods From January 2002 to December 2008, 400 patients underwent primary mitral valve repair for degenerative disease ...
It was a very good discussion on minimally invasive Mitral valve surgery. Everyone is talking about a right sided mini thoracotomy. For the Mitral valve, we forget that the Mitral valve is a left sided structure and the Left Atrium is a posterior structure. We, particularly in India have been used to approaching the Mitral through the left side for a Closed Mitral Valvotomy. Now we can accomplish arterial and venous return through excellent groin cannulation available today. Since most of the Mitral valve patients are relatively young, the concern for atherosclerosis emboli should be minimal. When one does the procedure through the left side, the Mitral valve is closer to the surgeon and the surgery can be accomplished through routine instruments. One does not need knot tiers and knot pushers. From the right side, the Mitral valve is at a fair distance from the incision and one loses the tactile sensation. Advantages of approaching the Mitral valve through the left side are 1. Easy and secure ...
The mitral valve lies between the left atrium and the left ventricle and has two leaflets, the anterior and the posterior. In the figures below, the anterior leaflet is colored green and the posterior leaflet is colored blue. The corresponding video clips show the motion of the valve through the cardiac cycle, but the leaflets are not colored. The images in the left column show the mitral valve directly visualized from the left ventricle, where the chordae tendinae of the subvalvular apparatus can be appreciated. The middle images are taken using transthoracic echocardiography in a 2 chamber, long axis view of the mitral valve. The images on the right are taken of the anterior and posterior leaflets in a short axis view of the heart taken at the level of the mitral valve annulus using transthoracic echocardiography. Applications such as color flow echocardiography allow for the visualization of flow through the mitral valve. Other anatomical features of the mitral valve that can be visualized ...
IMR continues to be a clinical challenge, and the best surgical treatment for this ever-increasing patient population remains to be defined. Alfieri edge-to-edge mitral repair along with mitral ring annuloplasty partially eliminates ischemic and functional mitral regurgitation.10,12 However, no large series of patients with IMR treated with this technique has been reported, and the efficacy of Alfieri repair without ring annuloplasty is unknown. This acute ovine experiment revealed that the Alfieri repair did not prevent acute IMR. Furthermore, it did not alter the annular, subvalvular, and leaflet geometric distortions associated with acute ischemia.. Acute posterolateral ischemia in sheep results in annular dilatation and larger SL annular diameter,18 similar to that reported here. However, the mitral CC diameter increase, has not been observed previously and may be because of the acute, open-chest nature of this experiment. Interestingly, the annular geometric changes during ischemia did not ...
A device effects the mitral valve annulus geometry of a heart. The device includes a first anchor configured to be positioned within and anchored to the coronary sinus of the heart adjacent the mitral valve annulus within the heart and a second anchor configured to be positioned within the coronary sinus of the heart proximal to the first anchor and adjacent the mitral valve annulus within the heart. The second anchor, when deployed, anchors against distal movement and is moveable in a proximal direction. The device further includes a connecting member having a fixed length permanently attached to the first and second anchors. As a result, when the first and second anchors are within the coronary sinus with the first anchor anchored in the coronary sinus, the second anchor may be displaced proximally to effect the geometry of the mitral valve annulus and released to maintain the effect on the mitral valve geometry.
12 patients who had atrial flutter without clinical, echocardiographic or angiographic evidence of aortic insufficiency were studied with simultaneous echo- and phonocardiograms. In patients with high-grade atrioventricular (AV) block, the mitral valve opened and closed with each flutter wave. Of seven patients, two had persistent and five had intermittent early mitral valve closure before QRS inscription. In five patients (three with 2:1 AV block) the mitral valve closed on time. In one patient with a mitral valve prosthesis, echocardiography and cinefluorography demonstrated closure during mid-diastole, with reopening in late diastole after a flutter wave. Final valve closure occurred before the onset of the QRS, and each closure was associated with a click. Simultaneous phonocardiographic analysis in these patients demonstrated that the first heart sound intensity was inversely related to the degree of mitral valve preclosure. This relationship was independent of the length of the RR ...
The paper by Feldman et al. (1) in this issue of the Journalis the first published report about a new percutaneous mitral valve technology, the edge-to-edge Evalve clip (Evalve Inc., Menlo Park, California). This is an important step into a new era of catheter-based valve procedures and one that will be compared and contrasted with the ongoing excellent surgical results obtained with mitral valve repair of the myxomatous regurgitant mitral valve. The investigators, who are among the leading cardiac interventionalists in the country, have performed a carefully thought out phase I U.S. Food and Drug Administration safety trial of 27 low-risk patients with myxomatous valve disease, a group of patients for whom surgical repair of the mitral valve is safe and effective. They have clearly documented the safety of this procedure, and have also documented that there is a significant learning curve as it relates to fluoroscopy time, echocardiography time, and anesthesia time. The investigators have been ...
Mitral valve surgery can repair or replace your hearts mitral valve. The new valve may be mechanical or made of animal tissue, often from a pig. Your doctor will talk with you before surgery about which type of valve is best for you.. The mitral valve opens and closes to keep blood flowing in the proper direction through your heart. When the mitral valve does not close properly (mitral valve regurgitation) or is very tight and narrow (mitral valve stenosis), blood does not flow through the heart the right way.. You will be asleep during the surgery. The doctor will make a cut (incision) in the skin over your breastbone (sternum). Then the doctor will cut through your sternum to reach your heart.. The doctor will connect you to a heart-lung bypass machine, which is used to add oxygen to your blood and move the blood through your body. This machine will allow the doctor to stop your heartbeat while he or she works on your heart.. While your heartbeat is stopped, the doctor will repair or replace ...
It can be reasonably argued that the very dawn of cardiac surgery began with a mitral valve repair. On May 20, 1923, Dr Elliot Carr Cutler (Fig. 35-1) performed the worlds first successful mitral valve repair at the Peter Bent Brigham Hospital in Boston, Massachusetts.1 Dr Cutler carried out a transventricular mitral valve commissurotomy with a neurosurgical tenotomy knife on a critically ill 12-year-old girl. His choice of instrument was likely influenced by Dr Harvey Cushing who was surgeon-in-chief at the time. A new era in surgery was introduced as well as the reality of mitral valve repair.2 Cutler had worked assiduously on this problem in the Surgical Research Laboratories of Harvard Medical School before turning his attention to this critically ill patient. Subsequent attempts at this operation using a device to cut out a segment of the diseased mitral valve resulted in several deaths from massive mitral regurgitation and Cutler eventually abandoned the procedure.3 Of Cutlers ...
The purpose of this study is to determine whether the addition of surgical ablation to planned mitral valve surgery for patients with persistent or longstanding persistent AF (within 6 months prior to randomization) reduces the incidence of postoperative heart arrhythmia compared to mitral valve repair with medication therapy alone. This is a randomized, multi-center trial which will enroll 260 subjects who will be randomized in a 1:1 fashion to: (a) mitral valve surgery plus surgical ablation or (b) mitral valve surgery without ablation (control group). All patients will undergo ligation or excision of the left atrial appendage. Patients assigned to the ablation group will be further randomized (1:1) to one of two lesion sets: (1) pulmonary vein isolation only or (2) biatrial Maze lesions. The target population for this trial consists of adult patients with mitral valve disease requiring surgical intervention and persistent or longstanding persistent atrial fibrillation. All patients who meet ...
TY - JOUR. T1 - Left atrial isolation for the treatment of atrial fibrillation due to mitral valve disease. Hemodynamic evaluation. AU - Graffigna, A.. AU - Ressia, L.. AU - Pagani, F.. AU - Minzioni, G.. AU - Vigano, M.. PY - 1993. Y1 - 1993. N2 - Ablation of atrial fibrillation secondary to mitral valve disease is frequently impossible after isolated mitral valve surgery. In order to improve sinus rhythm recovery in such patients, patients with rheumatic mitral valve disease and chronic atrial fibrillation underwent surgical electrophysiological isolation of the left atrium at the time of surgery. The left atrium is left free to fibrillate, beat or stand still, while the right atrium recovers its sinus activation and warrants a regular ventricular rate. Apart from this advantage, we tested the hypothesis that the recovery of right atrial booster function could significantly improve cardiac output. From May 1989 to July 1993 184 patients with mitral with or without other valve disease ...
Our study shows that: 1) the mitral leaflet coaptation decreased proportionally in patients with FMR related to the bilateral PM displacement, despite increased total leaflet area to compensate for the increased mitral annular area and mitral leaflet tethering; 2) annular area was significantly smaller and leaflet-to-annular area ratio was significantly larger in patients with global LV remodeling who have nonsignificant FMR compared with the patients with significant FMR; and 3) the indexes of coaptation were related to MR severity.. FMR is produced by a complex combination of pathophysiological processes where distorted and spherical LV geometry leads to tethering of the chordae and therefore incomplete leaflet coaptation (8,10,21). In this condition, patients with mitral leaflet tethering have been shown to have larger mitral leaflet area than the control subjects (10). Similarly, Dal-Bianco et al. (22) demonstrated that mechanical stresses imposed by PM tethering increased MV leaflet area ...
May 2, 2017 /Press Release/ -- Patients can maximize chances of high-quality mitral valve repair through referral to surgeons with large annual repair rates. Surgeons who perform more than 25 mitral valve operations a year are more likely to perform repairs that are durable, and their patients are more likely to be alive a year after the operation, than when operations are performed by lower-volume surgeons, an Icahn School of Medicine at Mount Sinai study has found.. The results of the study will be presented at the American Association for Thoracic Surgery Centennial meeting on Tuesday, May 2, in Boston and published online simultaneously in the Journal of the American College of Cardiology. The study is the first to highlight that patients operated on by higher volume mitral surgeons experienced lower one year mortality and rates of reoperations compared to those operated by low volume mitral surgeons.. Mitral valve repair is the recommended treatment for patients with severe degenerative ...
CAD occurs when the arteries that supply blood to the heart become blocked as a result of plaque buildup. In severe cases, CAD can cause chest pain, shortness of breath, and heart attack. CABG is one treatment option for people with CAD. During a CABG procedure, a healthy artery or vein from another part of the body is connected to the blocked coronary artery. Blood flow is then routed around the blockage to the heart.. After a heart attack, some people may have a leak in the mitral valve of the heart. This condition is known as ischemic mitral regurgitation (IMR) and is associated with poor health outcomes, including worsening heart failure. In people with severe mitral valve leakage, the CABG procedure and a mitral valve repair procedure are routinely performed together; however, in people with only moderate valve leakage, there is no consensus in the medical community as to whether the mitral valve repair procedure is beneficial at the time of CABG. The purpose of this study is to determine ...
The normal mitral valve permits one-way blood flow from the left atrium to the left ventricle in an efficient, nearly frictionless fashion.1 Although even a normal competent valve may allow a trivial amount of reversed flow, more than a trace of mitral regurgitation is considered pathologic.2 Mild-to-moderate mitral regurgitation is tolerated indefinitely as long as it does not worsen. However, severe mitral regurgitation causes left ventricular remodeling reduced forward cardiac output, neurohumoral activation, left ventricular damage, heart failure, and ultimately death.3 The natural history of mitral regurgitation depends intimately on its etiology, the severity of left ventricular volume overload as well as its contractile performance, and the appearance of overlapping clinical conditions secondary to reversal flow, such as atrial fibrillation and pulmonary hypertension.4 In this setting, myxomatous degeneration of the mitral valve, a very common pathologic substrate of mitral valve ...
The complexity of structural heart disease interventions such as edge-to edge mitral valve repair requires integration of multiple highly technical imaging modalities. Real time imaging with...
Patients with myelodysplastic syndrome (MDS) most commonly have refractory anemia accompanied by various degrees of granulocytopenia and thrombocytopenia. At the time of cardiac surgery, both major infections and bleeding are severe complications in patients with pancytopenia due to MDS. However, there were very few patients with MDS who had undergone open-heart surgery. We reported a case of mitral valve replacement in a patient with MDS. A 68-year-old man with valvular heart disease and MDS, with a platelet count of 1.9 ~104/mm3, underwent successful mitral valve replacement. The mitral valve was replaced by an SJM25A prosthesis after resection of left atrial thrombosis using cardiopulmonary bypass. Platelets were transfused after the bypass. Perioperative hemorrhage was moderate and postoperative course was uneventful. We evaluated platelet function by Sonoclot coagulation and a platelet function analyzer. We did not need a large amount of transfusion of red blood cells and platelets, and ...
Since reduction annuloplasty alone for ischemic mitral regurgitation (MR) cannot prevent late recurrence of MR or improve survival for those with left ventricular (LV) dysfunction, and the surgical approach to this etiology is still controversial, we conducted a study to assess the efficacy of the additional papillary muscle approximation (PMA) procedure for ischemic MR by comparing the different subtypes of PMA. We studied 45 patients who underwent mitral annuloplasty and papillary muscle approximation (PMA) for ischemic MR between 2003 and 2012. Papillary muscles were approximated entirely (cPMA: complete PMA, n = 32) through an LV incision or partially from the tips to mid-parts (iPMA: incomplete PMA, n = 13) through the mitral and aortic valves. Twenty-three patients with cPMA also underwent LV plasty (LVP). We assessed the outcomes after PMA by comparing cPMA and iPMA. The baseline MR grade, NYHA class, LV end-diastolic diameter, and LV ejection fraction (LVEF) were 2.8 ± 1.0, 3.2 ± 0.6, 67 ± 6
Methods and results Consecutive patients treated with MitraClip from October 2008 to December 2015 were analysed. Primary outcomes of interest were cardiovascular and non-cardiovascular mortality, rehospitalisation for heart failure and major adverse events at 30 days and 90 days. A total of 269 patients were included. Of these, 115 patients were early discharged (ED group). Rates of ED increased from 25.9% for the biennium 2008-2009 to 59.1% in 2014-2015 (p,0.001 for trend). In a penalised logistic regression model, male gender (OR=2.13, 95% CI 1.17 to 3.95) and procedural year (OR=2.13, 95% CI 1.51 to 3.11) were associated with higher probability of ED. Conversely, atrial fibrillation (OR=0.48, 95% CI 0.27 to 0.85), any Mitral Valve Academic Research Consortium bleeding (OR=0.07, 95% CI 0.01 to 0.60), log-transformed N-terminal pro-brain natriuretic peptide levels (OR=0.79, 95% CI 0.63 to 0.99) and postimplant MR grade (OR=0.60, 95% CI 0.37 to 0.94) conferred a lower likelihood of ED. In ...
A minimally invasive mitral valve replacement is a procedure to replace a poorly working mitral valve with an artificial valve. The mitral valve helps blood flow through the heart and out to the body. Your doctor will use an artificial valve to replace your poorly working mitral valve.
The mitral valve is a complex structure regulating forward flow of blood between the left atrium and left ventricle (LV). Multiple disease processes can affect its proper function, and when these diseases cause severe mitral regurgitation (MR), optimal treatment is repair of the native valve. The mitral valve (MV) is a dynamic structure with multiple components that have complex interactions. Computational modeling through finite element (FE) analysis is a valuable tool to delineate the biomechanical properties of the mitral valve and understand its diseases and their repairs. In this review, we present an overview of relevant mitral valve diseases, and describe the evolution of FE models of surgical valve repair techniques.. ...
The heart has four valves that regulate blood flow through the heart. The mitral valve is the heart valve located between the left atrium, or upper chamber of the heart, and left ventricle, or lower chamber of the heart. After the left atrium fills with blood the mitral valve opens to allow the blood to flow down into the left ventricle. When the heart pumps and the left ventricle contracts, the mitral valve closes and blood flows outward through the aortic valve (the exit valve of the heart) and into the circulation of the body.. If the mitral valve does not close properly, blood flows backwards into the left atrium. This back flow is called "regurgitation." Small amounts of regurgitation are well tolerated, but if the amount increases over time, symptoms such as breathlessness and weakness can result. The heart muscle grows larger due to increased work load and becomes a less efficient pump.. Medicines or heart valve surgery may be recommended as treatment.. ...
Poncelet, Alain. Recurrence of mitral valve regurgitation after mitral valve repair in degenerative valve disease.. In: Circulation, Vol. 108, no.17, p. 125e-125 (2003 ...
The choice of prosthesis for mitral valve replacement still remains controversial. This study assessed mortality, bleeding events and reoperation in patients who underwent mitral valve replacement surgery with biological or mechanical substitutes. A total of 352 patients who underwent mitral valve replacement surgery between 1990 and 2008 with 5 to 23 years of follow-up were retrospectively evaluated in a cohort study. The 5, 10, 15 and 20 year survival rates after surgery using a mechanical substitute were 87.7%, 74.2%, 69.3% and 69.3%, respectively, while after surgery with a biological substitute, they were 87.6%, 71.0%, 64.2% and 56.6%, respectively. There was no significant difference between the two groups (p = 0.38). In the multivariate analysis, the factors associated with death were age, bleeding events and renal failure. The probabilities of remaining free of reoperation at 5, 10, 15 and 20 years after surgery using a mechanical substitute were 94.4%, 92.7%, 92.7% and 92.7%; after surgery with
In vitro studies have demonstrated that shear forces ,3000 dynes/cm2are associated with significant red cell destruction (24). A recent report by Garcia et al. provided new insights into the pathophysiology of mitral prosthetic hemolysis (8). Using fluid dynamic simulation models, they showed that rapid acceleration, fragmentation and collision jets were associated with high shear stress and may therefore produce hemolysis, whereas free and slow deceleration jets were not. However, their study included only 3 patients with hemolytic anemia after mitral valve repair.. This study was therefore conducted to determine the hydrodynamic mechanisms involved in the occurrence of hemolysis after mitral valve repair as assessed by serial two-dimensional and color flow Doppler echocardiography. We found that clinically significant hemolysis in patients after mitral valve repair is associated with distinct patterns of regurgitant flow that have been shown (8)to be associated with high shear stress: ...
Percutaneous mitral valve repair (MVR) is used to treat mitral regurgitation (MR; depicted in the image below). Percutaneous procedures used to treat valvular heart disease were first developed decades ago; the first pulmonic balloon valvuloplasty was reported in 1982 and was quickly followed by applications to the aortic and mitral valves.
We successfully performed coronary artery bypass grafting and mitral valve replacement in a 72-year-old man who had undergone a left pneumonectomy 13 years previously due to a malignant mass. The patient was admitted to our clinic with symptoms of dyspnoea, palpitations, chest pain and fatigue. He was diagnosed with mitral valve disease and two-vessel coronary artery disease, as seen from echocardiography and catheterisation studies. Conventional cardiopulmonary bypass grafting was performed following sternotomy. The patient's heart was completely displaced to the left hemithorax. Saphenous vein grafts were harvested. Distal anastomoses were performed with the use of the on-pump beating heart technique without cross clamping. Afterwards a cross clamping was placed and a left atriotomy was performed. The mitral valve was severely calcific. A mitral valve replacement was performed using number 27 mechanical valve after the valve had been excised. The patient's postoperative course was uneventful
By Allareddy, V Ward, M M; Ely, J W; Allareddy, V; Levett, J Aim. Heart valve replacement surgeries account for 20% of all cardiac procedures. In-hospital mortality rates are approximately 6% for aortic valve replacements and 10% for mitral valve replacements. The objectives of the study are to provide nationally representative estimates of complications following aortic and mitral valve replacements and to quantify the impact of different types of complications on in-hospital outcomes. Methods. The Nationwide Inpatient Sample was analyzed for years 2000-2003. The effect of complications on in-hospital mortality, length of stay (LOS), and hospital charges were examined using bivariate and multivariable logistic and linear regression analyses. The confounding effects of age, sex, primary diagnosis, type of valve replacement, type of admission, comorbid conditions, and hospital characteristics were adjusted. Results. A total of 43 909 patients underwent aortic valve replacement as the primary ...
The Mitral Valve Repair Reference Center at Mount Sinai now offers patients the highest percentages of mitral valve repair anywhere in the world., Refer a patient to the mitral valve repair program at The Mount Sinai Hospital.
The Mitral Valve Repair Reference Center at Mount Sinai now offers patients the highest percentages of mitral valve repair anywhere in the world., The mitral valve has two leaflets, the antierior leaflet and the posterior leaflet.
22. Reynolds, C.A., Brown, D.C., Rush, J.E., Fox, P.R., Nguyenba, T.P., Lehmkuhl, L.B., Gordon, S.G., Kellihan, H.B., Stepien, R.L, Lefbom, B.K., Meier, C.K.,Oyama, M.A. (2012). Prediction of first onset of congestive heart failure in dogs with degenerative mitral valve disease: The PREDICT cohort study. J. Vet. Cardiol. 14, 1, 193-202. http://dx.doi.org/10.1016/j.jvc.2012.01.008CrossrefGoogle Scholar ...
In order to investigate the functional effects of mitral valve surgery, echocardiograms showing left ventricular dimension were recorded and digitised in 14 normal subjects and 129 patients after mitral valve surgery. Measurements were made of peak rate of increase of dimension (dD/dt) and duration of rapid filling, studies on left ventriculograms in 36 patients having shown close correlation between these values and changes in cavity volume. In 14 patients with mitral stenosis, peak dD/dt was reduced to 7-2 +/ 1-5 cm/s, and filling period prolonged to 330 +/- 65 ms, compared with normal (16-0 +/- 3-2 cm/s, and 160 +/- 50 ms, respectively), and after mitral valvotomy, these values improved significantly (10-4 +/- 2-7 cm/s and 245 +/- 55 ms). Characteristic abnormalities were found in 67 patients with mitral prostheses. Values for the Björk-Shiley (10-5 +/- 4-2 cm/s and 180 +/- 80 ms) and Hancock (10-3 +/- 3-7 cm/s, 245 +/- 80 ms) values were similar, and both superior to the Starr-Edwards (7-4 ...
TY - JOUR. T1 - Multicenter evaluation of high-risk mitral valve operations. T2 - Implications for novel transcatheter valve therapies. AU - Lapar, Damien J.. AU - Isbell, James M.. AU - Crosby, Ivan K.. AU - Kern, John. AU - Lim, D. Scott. AU - Fonner, Edwin. AU - Speir, Alan M.. AU - Rich, Jeffrey B.. AU - Kron, Irving L.. AU - Ailawadi, Gorav. PY - 2014/12/1. Y1 - 2014/12/1. N2 - Results Of 2,440 isolated mitral operations, 29% (n = 698) were HR per REALISM criteria. Median STS Predicted Risk of Mortality (PROM) for HR patients was 6.6% compared with 1.6% for non-HR patients (p , 0.001). The HR patients more commonly underwent MV replacement as well as urgent (30% vs 19%, p , 0.001) operations. High-risk patients incurred higher morbidity and mortality (7% vs 1.6%) with longer intensive care unit (48 vs 41 hours) and hospital stays (7 vs 6 days, all p , 0.001). Among REALISM criteria, STS PROM 12% or greater and high-risk STS criteria were the only criteria associated with ...
The ACC/AHA 1998 guidelines for the management of patients with valvular heart disease do not provide recommendations for patients who have undergone a mitral valve repair and neither do the ACCP guidelines of 2004. The European Society of Cardiology do provide guidelines for these patients, stating that there are no randomized controlled trials to support the safety of omitting warfarin after mitral repair. They recommend 3 months of warfarin at a target INR of 2.5 or 3.0 if there are additional risk factors. They acknowledge that this is based on expert consensus and acknowledge that many surgeons do not follow this guideline. Vaughan et al in a survey of UK surgeons found that 64% of consultants used warfarin post mitral repair, thus demonstrating that there is much variation in the anticoagulation management of patients post mitral repair in the UK. Of the large series of patients with mitral valve repair, Carpentier et al have provided the longest follow up. They reported their long term ...
No survival difference was observed between use of mechanical and bioprosthetic mitral valves in patients aged 50-69 years matched by propensity score (actuarial 15-year survival 57.5% [95% confidence interval (CI) 50.5-64.4%] vs. 59.9% [95% CI 54.8-65.0%], hazard ratio [HR] 0.95 [95% CI 0.79-1.15]), or in a subgroup analysis of age by decade. Among patients matched by propensity score, mechanical versus bioprosthetic mitral valve replacement was associated with higher 15-year incidence of stroke (14.0% [95% CI 9.5-18.6%] vs. 6.8% [95% CI 4.5-8.8%], HR 1.62 [95% CI 1.10-2.39]) and bleeding events (14.9% [95% CI 11.0-18.8%] vs. 9.0% [95% CI 6.4-11.5%], HR 1.50 [95% CI 1.05-2.16]), but a lower incidence of reoperation (5.0% [95% CI 3.1-6.9%] vs. 11.1% [95% CI 7.6-14.6%], HR 0.59 [95% CI 0.37-0.94]).. ...
A method and apparatus for reducing mitral regurgitation. The apparatus is inserted into the coronary sinus of a patient in the vicinity of the posterior leaflet of the mitral valve, the apparatus being adapted to straighten the natural curvature of at least a portion of the coronary sinus in the vicinity of the posterior leaflet of the mitral valve, whereby to move the posterior annulus anteriorly and thereby improve leaflet coaptation and reduce mitral regurgitation.
TY - JOUR. T1 - Direct endoscopy-guided mitral valve repair in the beating heart. T2 - An acute animal study. AU - Horai, Tetsuya. AU - Fukamachi, Kiyotaka. AU - Fumoto, Hideyuki. AU - Takaseya, Tohru. AU - Shiose, Akira. AU - Arakawa, Yoko. AU - Rao, Santosh. AU - Dessoffy, Raymond. AU - Mihaljevic, Tomislav. PY - 2011/3/1. Y1 - 2011/3/1. N2 - Objective: The purpose of this study was to develop a new method for minimally invasive mitral valve repair under direct endoscopic visualization in the beating heart. Methods: Fiberoptic cardioscopy of the left heart was conducted in 12 calves. Systemic perfusion was maintained by cardiopulmonary bypass through a median sternotomy. A clear solution (Ringers lactate) was temporarily administered via the pulmonary artery to flush out the pulmonary vasculature, and additional perfusion of the left heart chambers enhanced visualization of the intracardiac anatomy. The endoscope, with an open-ended transparent flexible outer sheath, was inserted through the ...
TY - CHAP. T1 - Reoperations for mitral valve disease. T2 - Surgical approaches and techniques. AU - Schaff, Hartzell V. AU - Arghami, Arman. PY - 2012/6/1. Y1 - 2012/6/1. N2 - Approximately 10% of all adult cardiac operations involve redo thoracotomy, and clinically significant hemorrhage occurs in up to 8% of patients with a resultant increase in operative morbidity and mortality (Ann Thorac Surg 68: 2215-9, 1999). Indeed, in some reports, prior cardiac surgery increases the operative risk of mitral valve (MV) surgery almost twofold (J Am Coll Cardiol 37: 885-92, 2001; J Thorac Cardiovasc Surg 131: 547-57, 2006). Reoperation for MV disease is necessary for a wide variety of problems, such as failure of a previously placed prosthesis, development of a paravalvular leak, endocarditis, or newly diagnosed valve disease in a patient with prior aortic valve replacement or coronary artery bypass. Careful attention to the planning and execution of the operation can minimize surgical risks, and this ...
David H. Adams, MD is the Marie-Josée and Henry R. Kravis Professor and Chairman of the Department of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai (ISMMS) and the Cardiac Surgeon-in-Chief of the Mount Sinai Health System. He is also President of the Mitral Foundation, a not-for-profit organization dedicated to promoting best practice standards in mitral valve disease.. Dr. Adams is a recognized leader in the field of heart valve surgery and mitral valve reconstruction. As the Program Director of the Mitral Valve Repair Reference Center at The Mount Sinai Hospital, he has set national benchmarks with greater than 99 percent degenerative mitral valve repair rates. Concurrently, he runs one of the largest and most respected valve programs in the United States with a team that now performs over 400 mitral valve operations per year.. He is a co-author with Professor Alain Carpentier, of the internationally acclaimed, and widest selling valve textbook Carpentiers ...
Figure 2 Post-Operative Inflammation Versus Infective Endocarditis in Prosthetic Mitral Valves. (A) A 48-year-old man had undergone bileaflet mechanical mitral valve replacement (27-mm Sorin Bicarbon [Sorin, Milan, Italy]) 1 month previously to treat rheumatic mitral stenosis. Oblique coronal fused PET/CTA view of the mitral valve shows mild, homogeneous FDG uptake (SUVmax 2.2) at the perivalvular suture (arrows). (B) A 69-year-old woman had recurrent mechanical mitral valve infective endocarditis (valve implantation 11 years previously) and persistently positive blood cultures for Staphylococcus epidermidis. Echocardiography demonstrated vegetations, but no periprosthetic complications to explain the relapse. Fused PET/CTA image at the mitral plane shows intense, focal FDG uptake (SUVmax 13.2) over a large residual perivalvular calcification, findings suggestive of a periprosthetic abscess (arrowhead). The PET/CTA findings were confirmed during surgery, and the abscess was successfully removed. ...
and Abbott expects to enroll the first patient in the U.S. pivotal trial in the coming months. Abbott is a global leader in the treatment of MR with the MitraClip® device, which has been on the market in the EU since 2008 and in the U.S. since 2013. More than 60,000 patients have been treated with this first-of-its-kind therapy, a catheter-based, minimally invasive device that is delivered to the heart through a blood vessel in the leg.. By securing a portion of the leaflets of the mitral valve with a clip, the heart can pump blood more efficiently throughout the body, thereby relieving the symptoms of severe MR and improving patient quality of life.2 For MR patients who are not candidates for traditional open-heart surgery or a minimally invasive mitral valve repair, Tendyne may offer a new valve replacement treatment option. "Tendyne was specifically designed to address the functional, degenerative and mixed causes of mitral regurgitation that cannot be addressed through minimally invasive ...
I recently was told I had a heart murmur-possibly two; mitral valve and I think aortic valve. My Echocardiogram results show: the aortic valve leaflets are mildly thickened; the mitral valve leaflet...
MitraClip Mitral Valve Repair System. from the Abbott website MedPage Today reported promising results in a study yesterday involving noninvasive mitral valve repair. Some clinicians feel the results could be much better if the patient population were different. A new device called the MitraClip is getting significant publicity after initial results of the Everest II study were recently released. The…
I HAD A HEART ATTACK THIS PAST DECEMBER AND RECOVERED NICELY UNTIL MID FEBRUARY WHEN I DEVELOPED CONGESTIVE HEART FAILURE, ATRIAL FIBRILLATION AND DAMAGED MITRAL VALVE. ON JULY 22ND. I HAD A FULL COX 111 MAZING PROCEDURE AND MITRAL VALVE REPLACEMENT. SO FAR SO GOOD ON THE FIBRILLATION BUT SOME DAYS I JUST DONT HAVE THE SPUNK TO DO MY LITTLE BIT OF WALKING AND BREATHING EXERCISES. I AM ON OXYGEN 24/7 WHICH HAS ME DEPRESSED ALTHOUGH IM TOLD THIS IS JUST TEMPORARY. MY CHEST IS HEAVILY BRUISED BUT MY SCAR IS HEALING VERY WELL. MOST OF THE TIME I HAVE PAIN IN THE INCISION AND ALSO INSIDE MY CHEST. I DONT KNOW EXACTLY WHAT TO EXPECT AND I GUESS I AM BEING IMPATIENT. HAS ANYONE HAD MAZING AND HOW LONG WERE YOU OUT OF COMMISSION? AND THE MITRAL VALVE REPLACEMENT, ALSO. ID SURE APPRECIATE SOME FEEDBACK IF YOU COULD GIVE IT TO ME. I AM A 61 YEAR OLD GUY IN GOOD HEALTH OTHERWISE. ...
in Echocardiography (2011). OBJECTIVES: Intraoperative three-dimensional (3D) transesophageal echocardiography (TEE) has been suggested to be a valuable technique for the evaluation of the mechanisms of ischemic mitral regurgitation ... [more ▼]. OBJECTIVES: Intraoperative three-dimensional (3D) transesophageal echocardiography (TEE) has been suggested to be a valuable technique for the evaluation of the mechanisms of ischemic mitral regurgitation (IMR). Studies comparing multiplane two-dimensional (2D) with 3D TEE reconstruction of the mitral valve using the new mitral valve quantification (MVQ) software are lacking. We undertook a prospective comparison between multiplane 2D and 3D TEE for the assessment of IMR. METHODS: We evaluated echocardiographically 45 patients with IMR who underwent mitral valve surgery in our institution. 2D and 3D TEE examinations followed by a 3D offline assessment of the mitral valve apparatus were performed in all patients. Offline analysis of mitral valve ...