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Journal of the American College of... Jan 2010The appropriateness and timing of mitral valve surgery in patients with advanced heart failure and severe mitral regurgitation remains controversial. Recent surgical... (Review)
Review
The appropriateness and timing of mitral valve surgery in patients with advanced heart failure and severe mitral regurgitation remains controversial. Recent surgical results provide evidence for beneficial effects on left ventricular remodeling and functional capacity. Given the absence of randomized trials comparing the outcomes of mitral valve surgery to medical therapy, however, clinical decision making regarding surgery for these fragile patients poses a dilemma to thoughtful clinicians. This paper reviews the pathophysiology of mitral regurgitation in heart failure and proposes an integrated approach to management.
Topics: Heart Failure; Humans; Mitral Valve; Mitral Valve Insufficiency; Ventricular Remodeling
PubMed: 20117430
DOI: 10.1016/j.jacc.2009.08.059 -
Journal of Cardiovascular Translational... Aug 2022Current in vitro models of the left heart establish the pressure difference required to close the mitral valve by sealing and pressurizing the ventricular side of the...
Current in vitro models of the left heart establish the pressure difference required to close the mitral valve by sealing and pressurizing the ventricular side of the valve, limiting important access to the subvalvular apparatus. This paper describes and evaluates a system that establishes physiological pressure differences across the valve using vacuum on the atrial side. The subvalvular apparatus is open to atmospheric pressure and accessible by tools and sensors, establishing a novel technique for experimentation on atrioventricular valves. Porcine mitral valves were excised and closed by vacuum within the atrial chamber. Images were used to document and analyze closure of the leaflets. Papillary muscle force and regurgitant flow rate were measured to be 4.07 N at 120 mmHg and approximately 12.1 ml/s respectively, both of which are within clinically relevant ranges. The relative ease of these measurements demonstrates the usefulness of improved ventricular access at peak pressure/force closure.
Topics: Swine; Animals; Mitral Valve; Chordae Tendineae; Mitral Valve Insufficiency; Vacuum; Papillary Muscles
PubMed: 34993757
DOI: 10.1007/s12265-021-10199-5 -
International Journal For Numerical... Nov 2019We present a coupled left atrium-mitral valve model based on computed tomography scans with fibre-reinforced hyperelastic materials. Fluid-structure interaction is...
We present a coupled left atrium-mitral valve model based on computed tomography scans with fibre-reinforced hyperelastic materials. Fluid-structure interaction is realised by using an immersed boundary-finite element framework. Effects of pathological conditions, eg, mitral valve regurgitation and atrial fibrillation, and geometric and structural variations, namely, uniform vs non-uniform atrial wall thickness and rule-based vs atlas-based fibre architectures, on the system are investigated. We show that in the case of atrial fibrillation, pulmonary venous flow reversal at late diastole disappears, and the filling waves at the left atrial appendage orifice during systole have reduced magnitude. In the case of mitral regurgitation, a higher atrial pressure and disturbed flows are seen, especially during systole, when a large regurgitant jet can be found with the suppressed pulmonary venous flow. We also show that both the rule-based and atlas-based fibre defining methods lead to similar flow fields and atrial wall deformations. However, the changes in wall thickness from non-uniform to uniform tend to underestimate the atrial deformation. Using a uniform but thickened wall also lowers the overall strain level. The flow velocity within the left atrial appendage, which is important in terms of appendage thrombosis, increases with the thickness of the left atrial wall. Energy analysis shows that the kinetic and dissipation energies of the flow within the left atrium are altered differently by atrial fibrillation and mitral valve regurgitation, providing a useful indication of the atrial performance in pathological situations.
Topics: Atrial Fibrillation; Blood Flow Velocity; Finite Element Analysis; Heart Atria; Humans; Mitral Valve; Models, Cardiovascular; Tomography, X-Ray Computed
PubMed: 31454470
DOI: 10.1002/cnm.3254 -
EuroIntervention : Journal of EuroPCR... Sep 2014Mitral regurgitation is a common valvular heart disease and its prevalence is expected to increase with population ageing. Percutaneous techniques for the treatment of... (Review)
Review
Mitral regurgitation is a common valvular heart disease and its prevalence is expected to increase with population ageing. Percutaneous techniques for the treatment of mitral regurgitation are emerging as an alternative therapeutic option. However, the mitral valve is a complex structure, and a comprehensive understanding of the anatomy of the mitral valve apparatus and its surrounding structures is crucial for a correct selection of patients and the success of transcatheter mitral valve interventions.
Topics: Chordae Tendineae; Endovascular Procedures; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Papillary Muscles
PubMed: 25256321
DOI: 10.4244/EIJV10SUA15 -
Journal of the American College of... Aug 2020
Topics: Arrhythmias, Cardiac; Humans; Mitral Valve; Mitral Valve Prolapse; Rome
PubMed: 32762898
DOI: 10.1016/j.jacc.2020.06.048 -
Arquivos Brasileiros de Cardiologia Sep 2021
Topics: Cardiac Surgical Procedures; Humans; Mitral Valve; Mitral Valve Insufficiency
PubMed: 34550226
DOI: 10.36660/abc.20210067 -
The Journal of Invasive Cardiology Apr 2021A 36-year-old woman with a history of redo mitral valve replacement (bileaflet mechanical mitral valve prosthesis) in 2002 for prosthetic mitral valve endocarditis...
A 36-year-old woman with a history of redo mitral valve replacement (bileaflet mechanical mitral valve prosthesis) in 2002 for prosthetic mitral valve endocarditis presented to the emergency department with a history of recurrent palpitations. A transthoracic echocardiogram was performed and falsely indicated a diagnosis of prosthetic mitral valve thrombosis. However, review of the echocardiogram by an experienced echocardiologist revised the diagnosis to microbubbles formation phenomenon with mechanical mitral prosthesis. Frame-by-frame analysis or reducing the frame rate of the recorded echocardiographic loop is vital to demonstrate the growing or dissipation of microbubbles and hence to avoid inadvertent thrombolytic therapy or surgical intervention.
Topics: Adult; Female; Heart Valve Prosthesis; Humans; Microbubbles; Mitral Valve; Thrombolytic Therapy; Thrombosis
PubMed: 33794483
DOI: No ID Found -
JACC. Cardiovascular Imaging Dec 2021
Topics: Echocardiography; Humans; Mitral Valve; Mitral Valve Insufficiency; Predictive Value of Tests; Unsupervised Machine Learning
PubMed: 34419406
DOI: 10.1016/j.jcmg.2021.06.023 -
Journal of Medicine and Life 2009Congenital heart diseases are broadly defined as those cardiac anomalies that are present at birth. By their very nature, such defects have their origin in embryonic...
Congenital heart diseases are broadly defined as those cardiac anomalies that are present at birth. By their very nature, such defects have their origin in embryonic development. Congenital mitral valve regurgitation is a rare disease occurring in infancy or childhood. In up to 60% of cases, congenital anomalies of the mitral valve occur in association with other cardiac lesions, and often more than one component of the mitral apparatus is involved. The true incidence of congenital mitral valve regurgitation (MVR) is difficult to determine accurately (0.21-0.42% from total mitral valve regurgitations); isolated congenital mitral regurgitation is uncommon. The Carpentier classification of congenital mitral valve disease is the most commonly used nomenclature based on a functional analysis of the mitral valve leaflet. The contemporary anatomic classification has the advantage of minimizing observer variability in the diagnosis and it offers a much better liaison between the cardiologist and surgeon.
Topics: Cardiac Surgical Procedures; Cardiology; Echocardiography; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Humans; Interprofessional Relations; Mitral Valve; Mitral Valve Insufficiency
PubMed: 20108755
DOI: No ID Found -
Anatolian Journal of Cardiology Apr 2021
Topics: Atrial Fibrillation; Cardiac Surgical Procedures; Catheter Ablation; Cryosurgery; Humans; Mitral Valve; Robotic Surgical Procedures
PubMed: 33830049
DOI: 10.14744/AnatolJCardiol.2020.92744