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JACC. Cardiovascular Interventions Jan 2021
Topics: Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Insufficiency; Shock, Cardiogenic; Treatment Outcome
PubMed: 33069649
DOI: 10.1016/j.jcin.2020.09.030 -
JACC. Cardiovascular Interventions Oct 2020
Topics: Cardiac Surgical Procedures; Humans; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 33011143
DOI: 10.1016/j.jcin.2020.07.023 -
JACC. Cardiovascular Imaging Apr 2021
Topics: Heart Valve Prosthesis Implantation; Humans; Mitral Valve Insufficiency; Predictive Value of Tests
PubMed: 33832659
DOI: 10.1016/j.jcmg.2021.03.001 -
Methodist DeBakey Cardiovascular Journal 2010The prevalence of valvular heart disease is increasing along with the life span of the population. In assessing individuals with valve disease, echocardiography is the... (Review)
Review
The prevalence of valvular heart disease is increasing along with the life span of the population. In assessing individuals with valve disease, echocardiography is the primary imaging modality used by clinicians both for initial assessment and for longitudinal evaluation. Information regarding valve morphology and function, cardiac chamber size, wall thickness, ventricular function, and estimates of pulmonary artery pressures can be readily obtained and integrated to formulate an assessment of valve disease severity. In some instances, body habitus or the presence of coexisting lung disease may result in suboptimal acoustic windows on echocardiography, which may lead to technically difficult studies. Additionally, in some patients, information from clinical history and physical examination or other diagnostic tests may be discordant with echocardiographic findings. In these instances, there is a significant clinical role for cardiovascular magnetic resonance (CMR). The diagnostic capabilities of CMR have increased substantially over the past 20 years due to hardware and software advances. Today, CMR has a number of unique advantages over other imaging modalities - primarily, it provides a view of the entire heart without limitations from inadequate imaging windows or body habitus. Furthermore, CMR can obtain imaging data in any imaging plane prescribed by the scan operator, which makes it ideal for accurate investigation of all cardiac valves - aortic, mitral, pulmonic, and tricuspid. In addition, CMR for valve assessment is noninvasive, free of ionizing radiation, and in most instances does not require contrast administration. Since a comprehensive review of the role of CMR in all valve lesions is beyond the scope of this article, we will focus on the most common valvular indication for performance of clinical CMR techniques and an overview of selected validation and reproducibility studies. The objectives of a comprehensive CMR study for evaluating mitral insufficiency are threefold: 1) to provide insight into the mechanism of mitral insufficiency, and 3) to discern the consequences of the lesions including the effects on left ventricular (LV) volume, LV systolic function, and left atrial volumes. In most instances this information can be obtained without the need for intravenous contrast agents (gadolinium). Therefore, CMR can be performed even in patients with severe renal failure.
Topics: Atrial Function; Contrast Media; Humans; Magnetic Resonance Imaging, Cine; Mitral Valve; Mitral Valve Insufficiency; Predictive Value of Tests; Reproducibility of Results; Severity of Illness Index; Ventricular Function, Left
PubMed: 20360653
DOI: 10.14797/mdcj-6-1-15 -
Journal of Cardiothoracic and Vascular... May 2023The objective of this study was to develop a mathematical model for mitral annular dilatation simulation and determine its effects on the individualized mitral valve...
OBJECTIVES
The objective of this study was to develop a mathematical model for mitral annular dilatation simulation and determine its effects on the individualized mitral valve (MV) coaptation reserve index (CRI).
DESIGN
A retrospective analysis of intraoperative transesophageal 3-dimensionalechocardiographic MV datasets was performed. A mathematical model was created to assess the mitral CRI for each leaflet segment (A1-P1, A2-P2, A3-P3). Mitral CRI was defined as the ratio between the coaptation reserve (measured coaptation length along the closure line) and an individualized correction factor. Indexing was chosen to correct for MV sphericity and area of largest valve opening. Mathematical models were created to simulate progressive mitral annular dilatation and to predict the effect on the individual mitral CRI.
SETTING
At a single-center academic hospital.
PARTICIPANTS
Twenty-five patients with normally functioning MVs undergoing cardiac surgery.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Direct measurement of leaflet coaptation along the closure line showed the lowest amount of coaptation (reserve) near the commissures (A1-P1 0.21 ± 0.05 cm and A3-P3 0.22 ± 0.06 cm), and the highest amount of coaptation (reserve) at region A2 to P2 0.25 ± 0.06 cm. After indexing, the A2-to-P2 region was the area with the lowest CRI in the majority of patients, and also the area with the least resistance to mitral regurgitation (MR) occurrence after simulation of progressive annular dilation.
CONCLUSIONS
Quantification and indexing of mitral coaptation reserve along the closure line are feasible. Indexing and mathematical simulation of progressive annular dilatation consistently showed that indexed coaptation reserve was lowest in the A2-to-P2 region. These results may explain why this area is prone to lose coaptation and is often affected in MR.
Topics: Humans; Mitral Valve; Mitral Valve Insufficiency; Dilatation; Retrospective Studies; Computer Simulation; Echocardiography, Three-Dimensional
PubMed: 36509635
DOI: 10.1053/j.jvca.2022.11.009 -
Archives Des Maladies Du Coeur Et Des... Dec 2007Mitral regurgitation (MR) is a serious complication of coronary heart disease. The functional form is the most frequent, often presenting with a dynamic character. The... (Review)
Review
Mitral regurgitation (MR) is a serious complication of coronary heart disease. The functional form is the most frequent, often presenting with a dynamic character. The presence, and in particular the severity of MR and its dynamic character have a major impact on the medium and long term prognosis. The mechanisms responsible for MR are complex and occur in a state of disequilibrium between traction forces and closing forces, for which the significance is partly affected by the presence of asynchrony in left ventricular contraction. The therapeutic management of these patients is difficult. In cases of proven asynchrony, implantation of a biventricular pacemaker is justified. A mitral surgical procedure may be envisaged in cases of severe MR where bypass surgery is planned. In cases of moderate MR at rest, an evaluation of its dynamic character on effort can assist with the decision to undertake combined surgery. Mitral regurgitation (MR) is a common and serious complication of ischemic heart disease. Three general forms are distinguished: MR related to acute rupture of the mitral pillar, ischemic MR and functional MR.
Topics: Cardiac Pacing, Artificial; Heart Rupture; Humans; Mitral Valve Insufficiency; Papillary Muscles; Ultrasonography
PubMed: 18223522
DOI: No ID Found -
Clinical Cardiology Jul 1994This two-part article examines the histologic and morphologic basis for stenotic and purely regurgitant mitral valves. In Part I, conditions producing mitral valve... (Review)
Review
This two-part article examines the histologic and morphologic basis for stenotic and purely regurgitant mitral valves. In Part I, conditions producing mitral valve stenosis were reviewed. In over 99% of stenotic mitral valves, the etiology is rheumatic disease. Other rare causes of mitral stenosis include congenitally malformed valves, active infective endocarditis, massive annular calcium, and metabolic or enzymatic abnormalities. In Part II, conditions producing pure mitral regurgitation are discussed. In contrast to the few causes of mitral stenosis, the causes of pure (no element of stenosis) mitral regurgitation are multiple. Some of the conditions producing pure regurgitation include floppy mitral valves, infective endocarditis, papillary muscle dysfunction, rheumatic disease, and ruptured chordae tendineae.
Topics: Cardiomyopathies; Humans; Mitral Valve Insufficiency; Mitral Valve Prolapse; Mitral Valve Stenosis; Papillary Muscles
PubMed: 8088026
DOI: 10.1002/clc.4960170710 -
EuroIntervention : Journal of EuroPCR... Dec 2021An independent panel of experts reviewed all investigator-reported cases of mitral valve leaflet adverse events (LAE) after MitraClip NTR/XTR in the EXPAND study.
BACKGROUND
An independent panel of experts reviewed all investigator-reported cases of mitral valve leaflet adverse events (LAE) after MitraClip NTR/XTR in the EXPAND study.
AIMS
We aimed to report the findings of the expert panel and standardise definitions for LAE.
METHODS
Standard definitions for different types of LAE were formulated and events adjudicated after detailed review by the expert panel.
RESULTS
Enrolling centres reported LAE in 35 cases, 11 leaflet injuries (9 tears, 2 perforations) and 24 single leaflet device attachment (SLDA). The panel confirmed LAE in 20 cases (2.0% incidence), 18 patients had SLDA and 4 had leaflet injury (2 cases had both SLDA and injury). Leaflet injury occurred during device implant and resulted in surgical valve replacement or death. SLDA-alone events were identified during implant (n=2), pre-discharge (n=7) or at 30 days of follow-up (n=7) and were resolved (≤2+ residual MR) with additional clips in 75% of cases.
CONCLUSIONS
Mitral valve repair with MitraClip NTR/XTR is safe. The rate of LAE is lower than previously reported using older-generation devices. The proposed definitions and findings will help to differentiate leaflet injury from inadequate leaflet insertion and SLDA and provide guidance for consistent diagnosis of LAE post MitraClip implantation.
Topics: Cardiac Surgical Procedures; Humans; Incidence; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 34031024
DOI: 10.4244/EIJ-D-21-00012 -
The Journal of Thoracic and... Jul 2020
Review
Topics: Consensus; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Insufficiency; Quality of Health Care
PubMed: 32389460
DOI: 10.1016/j.jtcvs.2020.03.059 -
Canadian Journal of Veterinary Research... Apr 2020There is evidence that perfusing the heart with a heart and lung machine is less injurious than cross-clamping the aorta and administering cardioplegia during cardiac...
There is evidence that perfusing the heart with a heart and lung machine is less injurious than cross-clamping the aorta and administering cardioplegia during cardiac surgery. Although mitral valve replacement has been carried out without aortic cross-clamping and cardioplegia, it has been stated that cross-clamping is necessary in order to maintain visualization and a motionless surgical field for mitral valve repair. The purpose of this study was to determine the surgical feasibility of mitral valve repair without cross-clamping the aorta and using cardioplegia. Our hypothesis was that a completely bloodless and motion-free field would not be necessary to carry out mitral valve repair with annuloplasty and synthetic chordae tendineae sutures. Papillary muscles, chordae tendineae, annulus, and mitral valve leaflets were all readily visualized. Chordae tendineae sutures were used and annuloplasty was conducted without visual obstruction or motion interference. Our results show that mitral valve repair is feasible without cross-clamping the aorta and using cardioplegia.
Topics: Animals; Cardiovascular Surgical Procedures; Dog Diseases; Dogs; Mitral Valve Insufficiency; Pilot Projects
PubMed: 32255912
DOI: No ID Found