-
European Journal of Pediatrics Jan 2022Mitral valve diseases are relatively rare in the paediatric population; however, they can cause considerable mortality and morbidity worldwide. Acquired causes are a... (Review)
Review
Mitral valve diseases are relatively rare in the paediatric population; however, they can cause considerable mortality and morbidity worldwide. Acquired causes are a major contributor to cardiovascular disease burden in the paediatric population. Diseases can be detected before birth, at birth, or when the child is older and presents with symptoms of advanced heart failure. Definitive management consists of surgical intervention, with mitral valve replacement being the gold standard.Conclusion: Repair has been gaining popularity; however, its outcomes require further study. Percutaneous mitral balloon valvuloplasty is an emerging technique which holds promise as a bridge to surgical treatment. The effect of these interventions on quality of life must be emphasised and requires further study. What is Known: • The epidemiology of mitral valve disease in the paediatric population - predominant causes include rheumatic disease and congenital defects. • Mitral valve repair and replacement are the standard treatment methods for paediatric mitral valve disease. What is New: • Emergence of percutaneous mitral valve interventions and their potential as bridge-to-surgery or definitive treatment in high-risk surgical candidates. • Recent evidence comparing mitral valve repair and replacement in the paediatric population demonstrates increasing popularity of repair techniques.
Topics: Child; Heart Valve Diseases; Humans; Infant, Newborn; Mitral Valve; Mitral Valve Insufficiency; Quality of Life; Rheumatic Heart Disease; Treatment Outcome
PubMed: 34309707
DOI: 10.1007/s00431-021-04208-7 -
The Journal of Thoracic and... Nov 2022
Topics: Cardiac Surgical Procedures; Chordae Tendineae; Humans; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome; Ventricular Function, Left
PubMed: 33726905
DOI: 10.1016/j.jtcvs.2021.02.052 -
Methodist DeBakey Cardiovascular Journal 2023Mitral regurgitation is the most common form of valvular heart disease. The anatomy and pathophysiology of mitral valve regurgitation are very complex, and dedicated...
Mitral regurgitation is the most common form of valvular heart disease. The anatomy and pathophysiology of mitral valve regurgitation are very complex, and dedicated devices are required for transcatheter mitral valve replacement in patients with a high or prohibitive surgical risk. In the United States, all transcatheter mitral valve replacement devices are still being studied and are not yet approved for commercial use. Early feasibility studies have demonstrated good technical success and short-term outcomes, but larger samples and longer-term outcomes still need to be assessed. Furthermore, significant advances in device technology, delivery systems, and implantation techniques are essential to avoid left ventricular outflow tract obstruction, and valvular and paravalvular regurgitation as well as ensuring good anchoring of the prosthesis.
Topics: Humans; Mitral Valve; Heart Valve Prosthesis Implantation; Cardiac Catheterization; Treatment Outcome; Mitral Valve Insufficiency; Heart Valve Prosthesis
PubMed: 37213879
DOI: 10.14797/mdcvj.1231 -
Heart, Lung & Circulation May 2022Problematic mitral regurgitation (MR) may develop following lung transplantation (LTx). There is limited information on the management of MR in LTx patients, as such we...
BACKGROUND
Problematic mitral regurgitation (MR) may develop following lung transplantation (LTx). There is limited information on the management of MR in LTx patients, as such we sought to evaluate our centre's experience.
METHODS
From 2000 to 2019, 1,054 patients underwent LTx at our centre (896 bilateral, 158 single). We identified patients in whom significant MR developed at any point post-LTx. The aetiology of MR, management and outcome were retrospectively analysed.
RESULTS
Eight (8) patients developed severe MR post-LTx, six following bilateral LTx and two following single LTx. Lung transplantation indications included interstitial lung disease (n=5), chronic obstructive pulmonary disease (n=2) and pulmonary arterial hypertension (n=1). Severe MR occurred intraoperatively (n=1), postoperative day 1 (n=1) with the remaining six cases between 80 and 263 days post-LTx. The aetiology was noted to be due to severe left ventricular dysfunction following unmasking of a chronically pulmonary hypertension-related under-preloaded left ventricle in one case, and in the remaining seven patients causes included myxomatous degeneration, ischaemic MR, and functional MR due to annular dilatation. In the patient with intraoperative severe MR, the MR became mild with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and in the remaining seven patients a variety of procedures were used, including mitral valve repair, valve replacement and transcatheter edge-to-edge mitral valve repair. All patients survived the mitral procedure. Two (2) deaths occurred at 12.9 years (stroke) and 5 years (cancer) from mitral valve surgery.
CONCLUSIONS
Development of significant mitral valve regurgitation is a rare but morbid complication after lung transplantation. This may represent the progressive natural history of pre-existing degenerative mitral valve disease and rarely, early after transplantation may be related to changes in ventricular geometry. Management of severe MR can follow the same management approach as in the non-transplant community, with the expectation of similarly good results.
Topics: Humans; Lung Transplantation; Mitral Valve; Mitral Valve Insufficiency; Retrospective Studies; Treatment Outcome
PubMed: 34838453
DOI: 10.1016/j.hlc.2021.10.010 -
Annals of Thoracic and Cardiovascular... Oct 2022Our aim was to evaluate the development of new significant mitral regurgitation and long-term survival after mitral repair surgery in functional mitral regurgitation. (Observational Study)
Observational Study
PURPOSE
Our aim was to evaluate the development of new significant mitral regurgitation and long-term survival after mitral repair surgery in functional mitral regurgitation.
METHODS
A retrospective observational analysis of the recurrence of functional mitral regurgitation (ischemic and nonischemic) and global mortality during follow-up of 176 patients who underwent mitral repair surgery between 1999 and 2018 in our center was conducted.
RESULTS
The etiology of functional mitral regurgitation was ischemic in 55.7% of cases. After surgery, mitral regurgitation was 0-I in 92.3% of cases. We conducted a long-term clinical follow-up of a mean 42.2 months and an echocardiographic follow-up of a mean 41.8 months. We observed mitral regurgitation of at least grade II in 52 patients (36.9%). Survival at 1, 3, and 5 years was 78.8%, 66.7%, and 52.3%, respectively. Predictive factors for global mortality were age (hazard ratio = 1.038, p = 0.01) and a depressed preoperative ejection fraction. After a competing risk analysis, we found the only predictive factor for the recurrence of mitral regurgitation in our series to be age (sub-hazard ratio = 1.03, 95% confidence interval = 1.01-1.06, p = 0.016).
CONCLUSION
Repair surgery for functional mitral regurgitation shows age as the only independent predictor of recurrence. Age and depressed ejection fraction were predictors of mortality.
Topics: Humans; Mitral Valve Insufficiency; Mitral Valve; Retrospective Studies; Treatment Outcome; Prognosis
PubMed: 35851568
DOI: 10.5761/atcs.oa.22-00051 -
Journal of Cardiothoracic and Vascular... Jul 2022
Topics: Humans; Mitral Valve Insufficiency
PubMed: 35370075
DOI: 10.1053/j.jvca.2022.02.035 -
The Journal of Invasive Cardiology Jan 2023Valve embolization is a catastrophic complication of mitral valve-in-valve and valve-in-ring procedures and occurs due to inadequate ventricular positioning,...
Valve embolization is a catastrophic complication of mitral valve-in-valve and valve-in-ring procedures and occurs due to inadequate ventricular positioning, undersizing, or insufficient anchoring. Emergent cardiac surgery to retrieve the embolized valve is usually required for overt embolization. In the situation described herein, a decision was made to attempt to deploy a second valve at a proper depth to anchor the embolized valve and prevent further migration. This case highlights the technique of deploying a second valve to anchor the embolized valve if valve migration has occurred with minimal movement.
Topics: Humans; Mitral Valve; Heart Valve Prosthesis; Embolism; Heart Ventricles; Mitral Valve Insufficiency; Heart Valve Prosthesis Implantation
PubMed: 36588095
DOI: 10.25270/jic/22.00124 -
European Journal of Heart Failure Aug 2021
Topics: Heart Failure; Humans; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Registries
PubMed: 33929075
DOI: 10.1002/ejhf.2203 -
Journal of the American College of... Aug 2022
Topics: Humans; Ischemia; Mitral Valve; Mitral Valve Insufficiency; Myocardial Ischemia; Ventricular Remodeling
PubMed: 35902174
DOI: 10.1016/j.jacc.2022.05.023 -
Journal of Cardiac Surgery Dec 2022Mitral valve apparatus is complex and involves the mitral annulus, the leaflets, the chordae tendinae, the papillary muscles as well as the left atrial and ventricular... (Review)
Review
BACKGROUND
Mitral valve apparatus is complex and involves the mitral annulus, the leaflets, the chordae tendinae, the papillary muscles as well as the left atrial and ventricular myocardium. Secondary mitral regurgitation is a consequence of regional or global left ventricle remodeling due to an acute myocardial infarction (75% of cases) or idiopathic dilated cardiomyopathy (25% of cases). It is associated with an increase in mortality and poor outcome. There is a potential survival benefit deriving from the reduction in the degree of severity of mitral regurgitation. So the correction of the valve defect can change the clinical course and prognosis of the patient. The rationale for mitral valve treatment depends on the mitral regurgitation mechanism. Therefore, it is essential to identify and understand the pathophysiology of mitral valve regurgitation.
AIM OF THE STUDY
The aim of this review is to describe the crucial role of transthoracic and trans-esophageal echocardiography, in particular with three-dimensional echocardiography, for the assessment of the severity of secondary mitral regurgitation, anatomy, and hemodynamic changes in the left ventricle. Moreover, the concept that the mitral valve has no organic lesions has been abandoned. The echocardiography must allow a complete anatomical and functional evaluation of each component of the mitral valve complex, also useful to the surgeon in choosing the best surgical approach to repair the valve.
CONCLUSIONS
Echocardiography is the first-line imaging modality for a better selection of patients, according to geometrical modifications of mitral apparatus and left ventricle viability, especially in preoperative phase.
Topics: Humans; Mitral Valve Insufficiency; Echocardiography; Mitral Valve; Myocardial Infarction; Echocardiography, Transesophageal
PubMed: 35998280
DOI: 10.1111/jocs.16863