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TY - JOUR. T1 - The impact of intraoperative residual mild regurgitation after repair of degenerative mitral regurgitation. AU - Imielski, Bartlomiej. AU - Malaisrie, S. Chris. AU - Pham, Duc Thinh. AU - Kruse, Jane. AU - Andrei, Adin Cristian. AU - Liu, Menghan. AU - Cox, James L.. AU - McCarthy, Patrick M.. PY - 2019/1/1. Y1 - 2019/1/1. N2 - Objectives: During degenerative mitral repair, surgeons must decide if further repair is warranted for residual mild mitral regurgitation. We examined the incidence of mild mitral regurgitation, late echocardiographic and clinical outcomes, and influence of surgical experience in decision making. Methods: From April 2004 to June 2018, 1155 of 1195 patients with pure degenerative disease underwent repair (97% repair rate). Propensity score matching was performed between patients with trace/no mitral regurgitation and patients with mild residual mitral regurgitation. Late echocardiographic outcome and freedom from reoperation were compared using ...

Coronary Atherosclerosis & Mitral Valve Insufficiency & Thickening of the Mitral Valve Leaflets Symptom Checker: Possible causes include Mitral Valve Prolapse. Check the full list of possible causes and conditions now! Talk to our Chatbot to narrow down your search.

The outcome in functional mitral regurgitation after aortic valve replacement is unclear. A frail 82-year-old woman with severe aortic valve regurgitation and mild to moderate functional mitral valve regurgitation (NYHA functional class III) was referred to our clinic. In consideration of her frail condition, aortic valve replacement without mitral surgery was performed. She had hemodynamic instability and difficulty to wean off cardiopulmonary bypass caused by severe functional mitral valve regurgitation with left ventricular dilatation. A central Alfieri edge-to-edge stitch was placed between the anatomical middle of the two leaflets of the mitral valve after reinstitution of cardiopulmonary bypass. This eliminated the mitral regurgitation, which enabled successful separation from cardiopulmonary bypass.

Mitral valve insufficiency (MI) is inadequate closure of the valve that separates the left atrium from the left ventricle. This disorder can be due to backward movement of the valve (prolapsing), thickening of the valve, gradual (chronic) degeneration of the valve, bacterial infection of the valve, narrowing of the opening in the valve or dysfunction of the muscles or chords controlling the valve. Chronic degeneration of the valve is the most common cause of MI in dogs and cats.. This inability to close the mitral valve completely causes regurgitation (backward flow) of blood into the left atrium of the heart. This regurgitation increases the amount of blood that the left atrium has to pump, which may lead to volume overloading. As a means of compensation, the left atrium may dilate (expand). This is a condition known as left atrial enlargement. In later stages of disease, the left ventricle and veins of the lungs are generally enlarged as well.. Signs of MI include coughing, increased heart ...

Concomitant mitral valve surgery in patients with moderate ischemic mitral regurgitation undergoing coronary artery bypass grafting

Cardiosurgery: Mitral valve insufficiency (prolapse) | Prosthetic (replacement) of mitral valve (minimally invasive). Treatment in Tuebingen, Germany ✈ Find the best medical programs at BookingHealth - ✔Compare the prices ✔Online booking.

Mitral valve insufficiency (prolapse) | Prosthetic (replacement) of mitral valve (minimally invasive). Cardiosurgery: Treatment abroad ✈. Clinics on BookingHealth.com - booking treatment online!

Echocardiography is currently the technique of choice to assess the etiology and severity of mitral regurgitation (MR). Multiple 2D and Doppler parameters are assessed in an integrated fashion and the proximal flow convergent zone of the mitral regurgitation jet is used to calculate effective regurgitant orifice area and regurgitant volume. These measurements have been shown to have important prognostic information. In the last two years, the development of transesophageal imaging with 3D capability has allowed a better visualization of mitral leaflet pathology. Color Doppler 3D studies have shown that 2D methods generally underestimate mitral regurgitant volume. Magnetic resonance techniques have recently been developed to quantitate flow and calculate regurgitant volumes.. The purpose of this study is to evaluate newer methods of quantitating mitral regurgitation severity using real-time 3D echocardiography (RT3DE) and cardiac magnetic resonance imaging (CMR). Although RT3DE measurements have ...

Veterinarian Dr.Jan answers your questions and gives expert pet advice about natural remedies for dogs with mitral valve insufficiencies.

TY - JOUR. T1 - Myocardial contractile state in dogs with chronic mitral regurgitation. T2 - Echocardiographic approach to the peak systolic pressure/end-systolic area relationship. AU - Dávila-Román, Víctor G.. AU - Creswell, Lawrence L.. AU - Rosenbloom, Michael. AU - Pérez, Julio E.. PY - 1993/7. Y1 - 1993/7. N2 - Analysis of the pressure-dimension relationship provides a sensitive index of myocardial contractility, but widespread application of this method is limited because it requires invasive measurement techniques. The recent development of two-dimensional echocardiographic automatic boundary detection permits accurate and reproducible on-line measurement of ventricular cavity areas that can be combined with ventricular pressure measurements to derive instantaneous pressure-area relationships. In anesthetized closed-chest dogs with chronic mitral regurgitation, the slope of the ventricular pressure-area relationship was determined by obtaining baseline measurements (at baseline and ...

Children with ventricular septal defect (VSD) often demonstrate failure to thrive (Ff1). Such patients usually have reduced systemic cardiac output which has been postulated as a cause for their growth retardation. This study was conducted to ascertain the mechanism of the reduced cardiac output in children with VSD and FT11 and also in a porcine model of VSD. Forward stroke volume was reduced in VSD-FIT children, 31±8 ml/m2, compared to normal children, 49±15 ml/m2 (P , 0.05), but was not reduced in children with VSD and normal growth and development (41±16 ml/m2). Forward stroke volume was also reduced in swine with VSD compared to controls. Contractility assessed by mean velocity of circumferential shortening (Vd) corrected for afterload was similar in normals and VSD-FTI children. Contractile performance was also similar in normal and VSD swine. Afterload assessed as systolic stress was similar in FIT-VSD children and normal subjects. Preload assessed as end-diastolic stress was ...

Children with ventricular septal defect (VSD) often demonstrate failure to thrive (Ff1). Such patients usually have reduced systemic cardiac output which has been postulated as a cause for their growth retardation. This study was conducted to ascertain the mechanism of the reduced cardiac output in children with VSD and FT11 and also in a porcine model of VSD. Forward stroke volume was reduced in VSD-FIT children, 31±8 ml/m2, compared to normal children, 49±15 ml/m2 (P , 0.05), but was not reduced in children with VSD and normal growth and development (41±16 ml/m2). Forward stroke volume was also reduced in swine with VSD compared to controls. Contractility assessed by mean velocity of circumferential shortening (Vd) corrected for afterload was similar in normals and VSD-FTI children. Contractile performance was also similar in normal and VSD swine. Afterload assessed as systolic stress was similar in FIT-VSD children and normal subjects. Preload assessed as end-diastolic stress was ...

BACKGROUND AND AIM OF THE STUDY: Leaflet curvature is a primary determinant of leaflet stress, but no quantitative in-vivo leaflet curvature data exist. Chronic ischemic mitral regurgitation (CIMR) is associated with remodeling of the valvular-ventri

Chronic ischemic mitral regurgitation (cIMR) remains a vexing problem for a large number of patients and their respective clinicians. It is estimated that ≈2 million Americans experience cIMR, and this number is likely to increase with an aging general population and improved survival rates for myocardial infarction.1 Despite the large number of patients with this disease, relatively few patients are referred for surgical therapy. This is reflected in the fact that the largest surgical series to date consist of only a few hundred patients operated on over a several-year interval.2,3. Article see p 2720. One important reason for the small number of cIMR surgical referrals is the lack of evidence of a survival benefit associated with surgery,4 despite observed improvements in heart failure symptoms and left ventricular (LV) dimensions.5 Improvements in reverse LV remodeling and functional status have also been demonstrated in patients with idiopathic dilated cardiomyopathy who undergo a ...

BACKGROUND: The American Society of Echocardiography (ASE) guidelines suggest the use of several echocardiographic methods to assess mitral regurgitation severity using an integrated approach, without guidance as to the weighting of each parameter. The purpose of this multicenter prospective study was to evaluate the recommended echocardiographic parameters against a reference modality and develop and validate a weighting for each echocardiographic measure of mitral regurgitation severity. METHODS: This study included 112 patients who underwent evaluation with echocardiography and magnetic resonance imaging (MRI). Echocardiographic parameters recommended by the ASE were included and compared with MRI-derived regurgitant volume (MRI-RV). RESULTS: Echocardiographic parameters that correlated best with MRI-RV were proximal isovelocity surface area (PISA) radius (r = 0.65, P | .0001), PISA-derived effective regurgitant orifice area (r = 0.65, P | .0001), left ventricular end-diastolic volume (r = 0.56, P |

In recent years, transcatheter mitral valve repair using the MitraClip (Abbott Vascular, Abbott Park, Illinois) has become a prevalent approach to treat significant mitral regurgitation (MR) in patients deemed inoperable or at high surgical risk (1-3). The technique emulates the surgical edge-to-edge suture (4) by using 1 or more transseptally introduced clips to approximate the mitral leaflets at the origin of the regurgitant jet. Although the reduction in MR severity achieved by MitraClip implantation has been shown to persist in the majority of patients, recurrence of significant MR has been reported (2,3,5).. Different mechanisms may account for MR recurrence. On the one hand, progression of the underlying disease that originally gave rise to (functional or degenerative) MR may lead to recurrent regurgitation despite initially successful MitraClip therapy. On the other hand, loss of leaflet insertion (LLI) into the clip imperatively causes a relapse of MR. LLI may be the consequence of ...

Ischemic mitral regurgitation (IMR) is associated with decreased quality of life and long-term survival. Although extensive mechanistic research has been conducted, the optimal management of IMR remains elusive. Clinical studies in the past often included MR of multiple etiologies, including degenerative or nonischemic origin and IMR grouped into the same category, leading to confusion and incorrect conclusions regarding the natural history and true long-term impact of IMR. It is important to distinguish IMR from mitral regurgitation resulting from nonischemic etiologies. Mitral regurgitation is often associated with coronary artery disease without a direct cause-and-effect relationship. Given the prevalence of coronary artery disease, the association of myocardial infarction and nonischemic mitral regurgitation is a common clinical association. IMR must be distinguished from mitral insufficiency caused by degenerative, rheumatic, congenital, and infectious etiologies, as well as that arising ...

Percutaneous mitral valve repair using the MitraClip (Abbott Vascular, Santa Clara, California) is a promising technique to treat symptomatic severe mitral regurgitation (MR) in patients at high or prohibitive surgical risk. Large observational registries of patients treated with this device for predominantly secondary MR show symptomatic relief and improvement of hemodynamics at rest (1,2). Comparative data on exercise hemodynamics before versus after percutaneous mitral valve repair therapy are currently lacking, although such data are most relevant in secondary MR. First, secondary MR is characteristically dynamic and sensitive to changes in ventricular geometry and loading conditions (3). It remains unclear whether, besides a reduction in resting MR, percutaneous mitral valve repair therapy is effective in reducing secondary MR during exercise. Second, mitral valve area is typically reduced following the procedure (4). It remains to be determined whether such mild iatrogenic stenosis might ...

TY - JOUR. T1 - Prognostic impact of moderate or severe mitral regurgitation (MR) irrespective of concomitant comorbidities: A retrospective matched cohort study. AU - Prakesh, Roshan. AU - Horsfall, Matthew. AU - Markwick, Andrew. AU - Pumar, Marsus. AU - Lee, Leong. AU - Sinhal, Ajay. AU - Joseph, Majo. AU - Chew, Derek. PY - 2014. Y1 - 2014. N2 - Objective: We sought to objectively quantify the independent impact of significant mitral regurgitation (MR) on prognosis in patients with multiple comorbidities and ascertain the extent to which median survival is affected by increasing comorbidities. Methods: This was a retrospective matched cohort study using a clinical-echocardiography reporting database linked to a clinical and administrative database in an Australian tertiary hospital. We identified our study cohort (patients with significant MR) and control cohort (without MR) on transthoracic echocardiographies performed between 2005 and 2010. The main outcome measures were mortality and ...

Systematic overestimation of the MV SV or underestimation of ISVS R could cause the traditional PISA method to appear to underestimate continuity-based MR EROA. Identifying orifice location is often challenging, allowing both underestimation and overestimation of ISVS R. However, because flow must converge along the leaflets ventricular surface, the orifice cannot be behind this surface. Importantly, our theoretical predictions of expected ISVS R with elongation and leaflet tenting agreed closely with our empiric R measurements, and our control series PISA EROA agreed well with their corresponding continuity EROAs, validating our measurement technique and supporting the absence of systematic errors in our ISVS R measurements.. The major potential source of overestimation of MV SV is mitral annular diameter. Our mean diameter was 3.3 cm. Mihalatos et al. (13) reported that the MV orifice becomes circular and its diameter increases progressively with MR severity. They found mean end-systolic and ...

Mitral reguritation is a relatively common finding in coronary heart disease. In this series of 127 patients, selected with a view to coronary or left ventricular surgery on the basis of severity of symptoms, the incidence was 39 (31%). Mitral regurgitation is significantly more common in patients with a history or electrocardiographic evidence of previous myocardial infarction. Clinically it may present as a pan- or late systolic or even a mid-systolic, ejection type murmur at the apex or at the left sternal edge; but in 39 per cent of the patients with angiographic mitral regurgitation no murmur was present. Angiographically important mitral regurgitation (grades 2-4/4) was usually associated with a systolic murmur; this finding was independent of ejection fractions. Left ventricular enlargement clinically or radiographically is likely to accompany mitral regurgitation but left atrial enlargement (electrocardiographically or on chest x-ray) is a more reliable pointer to mitral regurgitation ...

TY - JOUR. T1 - Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy. AU - Rossi, Andrea. AU - Dini, Frank L.. AU - Faggiano, Pompilio. AU - Agricola, Eustachio. AU - Cicoira, Mariantonietta. AU - Frattini, Silvia. AU - Simioniuc, Anca. AU - Gullace, Mariangela. AU - Ghio, Stefano. AU - Enriquez-Sarano, Maurice. AU - Temporelli, Pier Luigi. PY - 2011/10. Y1 - 2011/10. N2 - Background: Functional mitral regurgitation (FMR) is a common finding in patients with heart failure (HF), but its effect on outcome is still uncertain, mainly because in previous studies sample sizes were relatively small and semiquantitative methods for FMR grading were used. Objective: To evaluate the prognostic value of FMR in patients with HF. Methods and results: Patients with HF due to ischaemic and non-ischaemic dilated cardiomyopathy (DCM) were retrospectively recruited. The ...

BACKGROUND: The aim of this study was to develop and validate an automated method for extracting forward stroke volume (FSV) using indicator dilution theory directly from dynamic positron emission tomography (PET) studies for two different tracers and scanners.. METHODS: 35 subjects underwent a dynamic (11)C-acetate PET scan on a Siemens Biograph TruePoint-64 PET/CT (scanner I). In addition, 10 subjects underwent both dynamic (15)O-water PET and (11)C-acetate PET scans on a GE Discovery-ST PET/CT (scanner II). The left ventricular (LV)-aortic time-activity curve (TAC) was extracted automatically from PET data using cluster analysis. The first-pass peak was isolated by automatic extrapolation of the downslope of the TAC. FSV was calculated as the injected dose divided by the product of heart rate and the area under the curve of the first-pass peak. Gold standard FSV was measured using phase-contrast cardiovascular magnetic resonance (CMR).. RESULTS: FSVPET correlated highly with FSVCMR (r = 0.87, ...

Catheter-based percutaneous edge-to-edge repair using the MitraClip device (Abbott Vascular; Abbott Park, IL, USA) is a well-established, effective, and safe procedure that can be utilized in...

A Clinical Evaluation of the Safety and Effectiveness of the MitraClip® System for the Treatment of Functional Mitral Regurgitation in Symptomatic Heart Failure Subjects (COAPT) Scottsdale/Phoenix, Ariz. The purpose of the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) Trial is to confirm the safety and effectiveness of the MitraClip System for the treatment of moderate-to-severe or severe functional mitral regurgitation (FMR) in Symptomatic Heart Failure Subjects who are treated per standard of care and who have been determined by the sites local heart team as not appropriate for mitral valve surgery. This randomized controlled trial will provide the opportunity to strengthen or add labeling claims regarding safety and clinical benefits of the MitraClip System for symptomatic heart failure patients with moderate-to-severe or severe functional mitral regurgitation.. Approximately 610 subjects will ...

TY - JOUR. T1 - Dynamic change in mitral regurgitant orifice area. T2 - comparison of color doppler echocardiographic and electromagnetic flowmeter-based methods in a chronic animal model. AU - Shiota, Takahiro. AU - Jones, Michael. AU - Teien, Dag E.. AU - Yamada, Izumi. AU - Passafini, Arnaldo. AU - Ge, Shuping. AU - Sahn, David J.. N1 - Funding Information: Doppler echocardiographie quantitative evaluation of valvular regurgitant lesions has been attempted using a number of methods, none of which has achieved general clinical utilization (1-5). Imaging of the proximo! flow convergence region in the left ventricle for flow accelerating retrograde across the mitral valve has been reported (6-8) to 4-useful for identifying the site of regurgitation and for grading its severity. The flow convergence phenomenon has been used experimentally and clinically for quantifying the regurgitant flow volume and flow rate using a variety of assumptions, most commonly that of a hemispheric isovelocity flow ...

The most complete and elaborate follow-up for mitral repair in contemporary literature is probably the series of Flameng and associates4 who report a series of 242 consecutive mitral repairs with serial follow-up echocardiography done at 6 month intervals. They found a freedom from moderate or severe mitral regurgitation of 71% at 7 years and found that new recurrent mitral regurgitation appeared at a rate of 3.7% per year (Figure 2). The data of Flameng and colleagues4 suggest that durability of many mitral repairs is limited; the linear recurrence rate implies that recurrent mitral regurgitation is likely a reflection of progression of underlying valve disease. This hypothesis is supported by data from mitral re-operations after previous repair, as the previous repairs are found to be intact in two-thirds of patients, with recurrent regurgitation usually due to new valve lesions (chordal rupture, fibrosis, calcification, leaflet perforation)5. Technical failure can be a major cause of ...

There is controversy as to the best timing for surgery. Patients presenting with acute severe mitral regurgitation are generally critically ill and require urgent surgery. However, in patients with chronic mitral regurgitation, the timing is more uncertain.. In the past, cardiologists recommended waiting until severe symptoms developed before proceeding to surgery. However, waiting often was associated with a bad outcome, and left ventricular function did not respond well to the sudden change in afterload imposed by putting an artificial valve in a patient who had severe regurgitation. Now, many recommend operating as soon as significant symptoms develop. Some, in fact, even recommend that these patients not be treated with medication so as not to mask symptoms and that surgery be done as soon as any symptom presents.. However, replacement of a native valve with a prosthetic one is not a cure for the patient, but rather a shift to a new set of problems associated with the prosthetic valve. Newer ...

BACKGROUND: Functional mitral regurgitation (MR) is common in patients with heart failure and left ventricular (LV) dysfunction, and its severity may vary over time, depending primarily on the loading conditions. Because dynamic changes in the severity of functional MR may affect forward stroke volume, we hypothesized that exercise-induced changes in MR severity influence the stroke volume response of patients with LV dysfunction to exercise, and hence their exercise capacity. METHODS AND RESULTS: Heart failure patients (n=25; mean age 53+/-12 years) with LV dysfunction underwent dynamic bicycle exercise at steady-state levels of 30%, 60%, and 90% of predetermined peak VO2. During each exercise level, right heart pressures, cardiac output, VO2, and MR severity were measured simultaneously. During exercise, MR severity, as evaluated by the ratio of MR jet over left atrium area, increased from 15+/-8% to 33+/-15%. Peak VO2, exercise-induced changes in stroke volume, and those in capillary wedge ...

The presence and severity of MR associated with myocardial infarction has been shown to be an important prognostic factor in ischemic heart disease.1-4 Lamas et al1 reported that the 3-year survival rate after myocardial infarction was significantly lower in patients with than without residual MR (71% versus 88%), and mortality risk has been shown to be directly related to the severity of ischemic MR.2 Because revascularization alone may not resolve ischemic MR,20 MV repair together with CABG may be preferable to CABG alone, but only if correction of MR can be performed safely. We have shown here that for patients with severe MR, MV repair was superior to CABG alone in reducing ischemic MR and LV size, without increasing operative or long-term mortality rates. In patients with moderate MR, however, the operative mortality rate of the combination of CABG and MV repair was significantly higher than that of CABG alone, whereas the MR improvement rates were similar in the 2 procedures. Even if MV ...

Learn about the 2 types of mitral regurgitation: primary mitral regurgitation (degenerative MR) and functional mitral regurgitation (secondary MR).

We sought to evaluate the geometric changes of the mitral leaflets, local and global LV remodeling in patients with left ventricular dysfunction and varying degrees of Functional mitral regurgitation (FMR). Functional mitral regurgitation (FMR) occurs as a consequence of systolic left ventricular (LV) dysfunction caused by ischemic or nonischemic cardiomyopathy. Mitral valve repair in ischemic MR is one of the most controversial topic in surgery and proper repairing requires an understanding of its mechanisms, as the exact mechanism of FMR are not well defined. 136 consecutive patients mean age of 55 with systolic LV dysfunction and FMR underwent complete echocardiography and after assessing MR severity, LV volumes, Ejection Fraction, LV sphericity index, C-Septal distance, Mitral valve annulus, Interpapillary distance, Tenting distance and Tenting area were obtained. There was significant association between MR severity and echocardiogarphic indices (all p values | 0.001). Severe MR occurred more

Mitral surgery was ultimately performed in 265 patients, involving valve repair in 240 patients (90.6%) and valve replacement in 25 patients (mechanical: n = 18, bioprosthesis: n = 7). Forty patients (15.1%) underwent concomitant coronary bypass surgery and 7 had a Maze procedure. As expected, patients who underwent surgery after diagnosis versus those who remained medically managed, had larger RVol (89 ± 37 ml vs. 43 ± 32 ml, p , 0.001) and LA index (63 ± 25 ml/m2vs. 46 ± 23 ml/m2, p , 0.001). During total follow-up (including pre- and post-operative period), 80 patients died (survival: 85 ± 1.8% 5 years after diagnosis), and 26 patients died after mitral surgery (survival: 91 ± 2.0% 5 years after surgery). New onset AF occurred in 26 patients and heart failure in 15 patients. There was no difference in post-operative outcome after stratification by pre-operative LA index ≥60 or ,60 ml/m2(5-year post-operative mortality: 9.1 ± 2.0% vs. 8.7 ± 2.8%, p = 0.98; and cardiovascular events: ...

Mitral Incompetence, Mitral regurgitation (MR),mitral insufficiency, Aetiology of Mitral Incompetence,Examination and Treatment for Mitral Incompetence

450 patients with , 70% stenosis in ≥1 epicardial coronary artery (75% men, median age 63 years, median LV ejection fraction (EF) 22 %, median ESVi 106ml, median scar % of 29% ) underwent delayed hyperenhancement-MRI (Siemens 1.5-T scanner, Erlangen, Germany) between 2002-2006. CMR evaluation included long and short axis assessment of LV and RV function on balanced steady state free precession images along with assessment of LV and RV myocardial scar (on phase-sensitive inversion recovery DHE-CMR sequence ~ 10-20 minutes after injection of 0.2 mmol/kg of Gadolinium dimenglumine). Scar was identified as regions of interest , 2 SD above normal myocardium. Cox proportional hazards survival modeling, using a primary end-point of all-cause mortality, was used to risk-adjust comparisons. MR severity was determined by echocardiography and assessed by width of the vena contracta. Cox proportional hazards survival modeling, using a primary end-point of all-cause mortality, was used to risk-adjust ...

In the studies, 327 of 351 patients completed 12 months of follow-up. Patients were elderly (76 ± 11 years), with 70% having functional MR and 60% having prior cardiac surgery. The mitral valve device reduced MR to ≤2+ in 86% of patients at discharge (n = 325; p < 0.0001). Major adverse events at 30 days included death in 4.8%, myocardial infarction in 1.1%, and stroke in 2.6%. At 12 months, MR was ≤2+ in 84% of patients (n = 225; p < 0.0001). From baseline to 12 months, left ventricular (LV) end-diastolic volume improved from 161 ± 56 ml to 143 ± 53 ml (n = 203; p < 0.0001), and LV end-systolic volume improved from 87 ± 47 ml to 79 ± 44 ml (n = 202; p < 0.0001). New York Heart Association functional class improved from 82% in class III/IV at baseline to 83% in class I/II at 12 months (n = 234; p < 0.0001). The 36-item Short Form Health Survey physical and mental quality-of-life scores improved from baseline to 12 months (n = 191; p < 0.0001). The annual hospitalization rate for heart ...

Results Average peak E wave velocity was 1.05±0.26 m/s, and was significantly higher in grade 4+ than grade 3+ (1.20±0.28 vs 0.98±0.21 m/s, p,0.001). Peak E wave velocity was associated with quantitative MR severity, as well as clinical characteristics of advanced MR (higher brain natriuretic peptide, larger LV and left atrium, higher tricuspid regurgitation pressure gradient and dilated inferior vena cava). During a median follow-up of 4.3 years, 66 (35%) patients developed cardiovascular events. Multivariate Cox proportional hazards analysis showed that peak E wave velocity was an independent predictor of cardiovascular events (adjusted HR 1.245 (95% CI 1.126 to 1.378) per 0.1 m/s, p,0.001). ...

In the last recent years a new percutaneous procedure, the MitraClip, has been validated for the treatment of mitral regurgitation. MitraClip procedure is a promising alternative for patients unsuitable for surgery as it reduces the risk of death related to surgery ensuring a similar result. Few data are present in literature about the variation of hemodynamic parameters and ventricular coupling after Mitraclip implantation. Hemodynamic data of 18 patients enrolled for MitraClip procedure were retrospectively reviewed and analyzed. Echocardiographic measurements were obtained the day before the procedure (T0) and 21 ± 3 days after the procedure (T1), including evaluation of Ejection Fraction, mitral valve regurgitation severity and mechanism, forward Stroke Volume, left atrial volume, estimated systolic pulmonary pressure, non invasive echocardiographic estimation of single beat ventricular elastance (Es(sb)), arterial elastance (Ea) measured as systolic pressure • 0.9/ Stroke Volume, ventricular

Background: In heart failure (HF) patients the severity of mitral regurgitation (MR) at rest has a well established prognostic value and its increase during exercise further adds to an increased risk. Our goal was to define the relationship between the degree of exercise MR severity with cardiopulmonary and echocardiographic related phenotypes in a cohort of HF patients. Methods: 71 HF reduced ejection fraction patients (mean age 67±11; male 72%; ischemic etiology 61%; NYHA class I, II, III and IV 13%, 36%, 39% and 12%, mean ejection fraction 33±9%) underwent cardiopulmonary exercise test (CPET) on tiltable cycle-ergometer combined with echocardiography at rest and during exercise. The population was divided into two groups according to the degree of functional peak MR: no to mild/moderate MR (no MR, MR1+ and MR2+) vs moderate/severe MR (MR3+ and MR4+). Results: A good correlation (ρ coefficient= 0.49) was found between the degree of dynamic MR and PASP at peak exercise. Despite similar ...

A combination of left ventricular volumetric quantification and phase-contrast imaging performed at level of ascending aorta, however, allows accurate and reproducible assessment of mitral regurgitation. In the presence of regurgitation, the difference in cardiac output between the left ventricle and ascending aorta yields the regurgitation volume. Regurgitation fraction is calculated by normalizing the regurgitation volume to the left ventricular stroke volume. Use of regurgitation fraction should be recommended as this parameter has the advantage to be relatively insensitive to concomitant other valve abnormalities. Regurgitation fraction limits for mitral and aortic regurgitations have been estimated by using cardiac MRI: mild ≤ 15%; moderate 16-25%; moderate-severe 26-48%; severe , 48%.. ...

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 ...

TY - JOUR. T1 - Papillary muscle relocation and mitral annuloplasty in ischemic mitral valve regurgitation: Midterm results. AU - Fattouch, Khalil. AU - Guccione, Francesco. AU - Dioguardi, Pietro. AU - Castrovinci, Sebastiano. AU - Murana, Giacomo. AU - Nasso, Giuseppe. AU - Fattouch, Khalil. AU - Speziale, Giuseppe. AU - Guccione, Francesco. AU - Dioguardi, Pietro. PY - 2014. Y1 - 2014. N2 - Objectives The surgical approach for ischemic mitral regurgitation remains unclear. Many studies are in favor of adding the subvalvular procedure to mitral annuloplasty to reduce recurrent mitral regurgitation. This study reports the clinical and echocardiographic outcomes of papillary muscle relocation combined with mitral annuloplasty.Methods From 2003, 115 patients with severe ischemic mitral regurgitation who underwent papillary muscle relocation plus nonrestrictive mitral annuloplasty and coronary artery bypass grafting were retrospective analyzed. Patients mean age was 52 ± 12.8 years, New York ...

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 ...

Proximal Isovelocity Surface Area (PISA) method is based on the continuity equation. When a flow passes through a narrow orifice, as it approaches the narrowest region, there is a flow convergence and flow acceleration. PISA is the surface area of the hemisphere at the aliasing region of the flow convergence. PISA increases as the flow increases and also with lower aliasing velocity. To reduce errors in measurement, smaller aliasing velocity has to be set, to get higher PISA measurement with lower chance for errors.. Regurgitant flow rate can be calculated as:. 2 Pi r2 x Valiasing. Radius is measured from the orifice to point of colour change. If the flow convergence is not a true hemisphere, the angle subtended by the flow convergence at the orifice has to be measured and divided by 180 to get a correction factor. Good correlation between angiographic estimates of regurgitant flow and PISA based estimates have been reported.. ...

Mitral regurgitation (MR) is a disorder of the heart characterized by failure of the mitral valve to close properly during systole leading to blood leakage from the left ventricle to the left atrium during systole. Individuals with acute mitral regurgitation may present with significant hemodynamic instability due to the sudden drop in cardiac output, leading to acute pulmonary edema, hypotension and possible cardiogenic shock. Individuals with chronic compensated mitral regurgitation may be asymptomatic, with a normal exercise tolerance and no evidence of heart failure, or may present with fatigue, dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea.[1] The management of MR includes afterload reduction with careful monitoring of fluid status, management of the underlying disease (CAD, mitral valve prolapse, rheumatic heart disease), and early surgical intervention in severe cases. Ultimately, the management of MR depends on the anatomy of the mitral valve, the acuteness of the ...

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 - Thoracoscopic Versus Open Mitral Valve Repair. T2 - A Propensity Score Analysis of Early Outcomes. AU - Suri, Rakesh M.. AU - Schaff, Hartzell V.. AU - Meyer, Steven R.. AU - Hargrove, W. Clark. PY - 2009/10/1. Y1 - 2009/10/1. N2 - Background: The very low risk of mitral valve repair performed through median sternotomy must be reproducible when using a port-access approach to justify early repair employing minimally invasive platforms. We compared the outcomes of mitral valve repair performed through port access using thoracoscopic assistance (port) versus median sternotomy (open). Methods: The early results after mitral valve repair performed by two different surgeons at two separate institutions were analyzed. Between January 1999 and December 2006, isolated mitral valve repair was performed with a port approach in 350 patients and an open approach in 365 patients. Results: The mean age was similar between the two groups; however, port patients were more frequently female (148 ...

Normal mitral valve function depends upon the maintenance of the proper spatial relationships between the papillary muscles, the chordae tendinae, and the mitral valve leaflets throughout the cardiac cycle. Papillary muscle dysfunction may occur as a result of (1) ischemia or infarction of a papillary muscle, (2) ventricular dilatation (including aneurysm), (3) rupture of a papillary muscle, (4) inflammatory disease of a papillary muscle, and (5) interventricular conduction disturbances.. Papillary muscle dysfunction results in mitral regurgitation and an apical systolic murmur. The characteristics of the murmur vary depending upon the etiology of the papillary muscle dysfunction. In the case of ...

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.

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

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 ...

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 ...

MitraClip therapy is a transcatheter mitral valve repair procedure for select U.S. patients with degenerative mitral regurgitation at high risk for surgery. See Important Safety Information on MitraClip.com/HCP.

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 ...

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 ...

A female patient in whom idiopathic rheumatoid polyarthritis was diagnosed at the age of 8 years required surgery for severe mitral valve insufficiency 16 years later. Intraoperative analysis revealed a fibrotic endocarditis involving mainly the posterior leaflet. Granulomatous vegetations as well as a large thrombus which filled the left ventricular apex and simulated endomyocardial fibrosis were noted. Valve repair was achieved using an anterior leaflet augmentation with a patch of mitral homograft associated with a prosthetic ring annuloplasty. Postoperatively, a severe pericardial effusion required surgical drainage. Eight years later, the patient had no cardiac symptoms and echocardiography confirmed a normally functioning mitral valve.

Hello, Im 29 years old, I have leaky mitral valve which was found when I was two years old, Ive always had check up every 2 years and everything always ok, had few little flutters but was once in...

Our main hypothesis is that inhalation of milrinone can reduce the elevated pulmonary arterial pressure due to severe mitral valve regurgitation without compromising systemic hemodynamics. Therefore, the effects of a brief inhaled milrinone (IH) on pulmonary artery pressure are determined and compared to those of intravenous milrinone (IV) in severe mitral regurgitation patients undergoing mitral valve surgery ...

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.. ...

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 ...

The Mitral Valve Repair Reference Center at Mount Sinai now offers patients the highest percentages of mitral valve repair anywhere in the world., Patients with mitral regurgitation due to fibroelastic deficiency have a lack of connective tissue as the pathological mechanism that triggers leaflet and chordal thinning and eventual chordal rupture.

TY - JOUR. T1 - Automatic quantification of aortic regurgitation using 3D full volume color doppler echocardiography. T2 - a validation study with cardiac magnetic resonance imaging. AU - Choi, Jaehuk. AU - Hong, Geu Ru. AU - Kim, Minji. AU - Cho, In Jeong. AU - Shim, Chi Young. AU - Chang, Hyuk Jae. AU - Mancina, Joel. AU - Ha, Jong Won. AU - Chung, Namsik. PY - 2015/10/24. Y1 - 2015/10/24. N2 - Recent advances in real-time three-dimensional (3D) echocardiography provide the automated measurement of mitral inflow and aortic stroke volume without the need to assume the geometry of the heart. The aim of this study is to explore the ability of 3D full volume color Doppler echocardiography (FVCDE) to quantify aortic regurgitation (AR). Thirty-two patients with more than a moderate degree of AR were enrolled. AR volume was measured by (1) two-dimensional-CDE, using the proximal isovelocity surface area (PISA) and (2) real-time 3D-FVCDE with (3) phase-contrast cardiac magnetic resonance imaging ...

Patrick Perier trained and graduated in heart and vascular surgery at the Hôpital Broussais in Paris, under the supervision of Alain Carpentier who became his mentor. He was appointed staff surgeon at the time of the early phases of development of mitral valve repair and was the first to compare the long-term results of mitral valve repair and mitral valve replacement. Dr Perier is currently staff surgeon at the Herz und Gefäss Klinik in Bad Neustadt, Germany. He initiated mitral valve reconstruction in Germany and has further developed techniques of mitral valve repair, with a specific interest in dealing with the prolapse of the posterior leaflet. During the last 10 years he has concentrated on developing video-assisted mitral valve surgery with increasing enthusiasm. Today more than 1100 patients have had minimally invasive reconstruction of the 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 MitraClip device is a small clip that treats mitral regurgitation. It allows your mitral valve to close more completely, helping to restore normal blood flow through your heart.. Transcatheter Mitral Valve Repair (TMVR) is a new treatment option for high risk patients with severe mitral regurgitation due to a primary structural cause of mitral valve leak.. In 2013, the FDA approved a device called Mitraclip, a small clip that is attached to your mitral valve. We access the mitral valve with a thin tube (called a catheter) that is guided through a vein in your leg to reach your heart. Once placed, the clip closes the leaky valve.. More than 25,000 patients have been treated worldwide and have seen improvement in heart failure related symptoms. The UVM Health Network started offering this treatment option in January 2017. It is for patients deemed appropriate by our heart team, including a cardiac surgeon, heart failure specialist, and interventional cardiologist. We very recently treated a ...

Traditionally, in patients with mitral regurgitation (MR) a successful mitral valve repair is considered when residual MR by post-pump transesophageal echocardiography (TEE) is less than moderate or absent. Little is known about the prognostic value of less than moderate (mild or mild-to-moderate) residual MR for the early outcome of patients treated with mitral valve repair. Eligible for this study were patients undergoing isolated mitral valve repair. Patients with moderate or severe residual MR after valve repair were excluded. The primary endpoint of the study was the composite of death or need of reintervention. A total of 98 patients (54 with no residual MR-Group 1, and 44 with less than moderate residual MR-Group 2) were analyzed. Of these, 72% presented with New York Heart Association (NYHA) 3/4, and 38% were women. The primary endpoint of the study occurred in 3 (5.5%) patients in Group 1 and 6 (13.6%) patients in Group 2 MR (P = 0.31). There was a trend toward a higher incidence of use of

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 ...

I turned down a stent recommendation and started the Esselstyn diet 100%. 1 month later I am walking 1 hr. on the treadmill 3.5 mph with no angina. Lost 10 lbs. A1c6.6 down to A1c 5.7 Ldl down from 117 to 93 Cholesteral down form 173 to 142 with no medication. I expect these numbers will continue down.. I am told I have mild Mitral valve insufficiency (not enough blood flow to the heart) and moderate tricuspid valve insufficiency. Can this get better with a great diet? Can it a least stay the same or will it continue to get worse over time ...

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 ...

Superiority of mitral valve repair was seen across all subgroups analyzed.. These data support current recommendations and substantiate the contention that, when feasible, MV repair should be the preferred treatment of severe degenerative MR and should remain a central condition of treatment algorithms and quality measure of valve centers, the authors conclude.. Not Shocking at All. Vanoverschelde believes there are entrenched referral patterns that he hopes can change with these new data.. Many times a cardiologist refers just to the surgeon he knows and this might not be the right approach, he said. Even if [the patient] needs to travel a lot of miles, it is better to get a MV repair than a MV replacement. So if you do not have a surgeon capable of repairing a valve in your institution, then hopefully this kind of paper will make cardiologists think about sending their patients to another institution for a MV repair rather than having an MV replacement, because 20 years down the road, ...

Valtech Cardio Ltd., a medical device company that develops solutions for mitral valve repair and replacement, announced today that two patients diagnosed with severe mitral regurgitation (MR) have been treated successfully with the Transfemoral Cardioband™ Annuloplasty System.. The Cardioband device replaces the need for open-heart surgery for MR patients. The device is implanted without stopping the patients heart from beating and without putting the patient on a cardiac bypass machine. Another advantage is that the size of the Cardioband can be adjusted while the heart is beating to optimize the results of the repair. Importantly, the form and clinical function of the Cardioband closely replicates that of the annuloplasty rings that are today the standard-of-care in surgery.. The first patients were treated at the San Raffaele Hospital, Milan, Italy. They were selected by the heart team led by Prof. Ottavio Alfieri , Head of the Division of Cardiac Surgery and Prof. Antonio Colombo , Head ...

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 ...

MitraClip (mitral clip) is a novel, percutaneous method of heart treatment that is targeted for patients who have been denied surgery to fix mitral valve regurgitation. MitraClip was first implanted in 2003, and in 2013 became the FDAs first commercially approved alternative to mitral valve regurgitation surgery. Open-heart surgery is the standard method of treatment for patients with mitral valve regurgitation, however it is very invasive and not a feasible option for all patients. The risk of complications and mortality greatly increase in patients with other health conditions like liver disease, previous chest surgeries, and age above 75, which is why they are often denied surgery. The implantation of MitraClip via catheter does not involve open-heart surgery, but mimics the surgical method of edge-to-edge valve repair. The mitral valve leaflets are clipped together with the device instead of being sutured together, making this procedure much less invasive but still effective for improving ...

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.