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Journal of Cardiothoracic Surgery Feb 2020Mitral annular calcification (MAC) occurs represents a challenge to surgeons during mitral valve (MV) surgery with increased perioperative risk. (Review)
Review
Surgical mitral valve replacement using direct implantation of Sapien 3 valve in a patients with severe mitral annular calcification without adjunctive techniques, a case report.
BACKGROUND
Mitral annular calcification (MAC) occurs represents a challenge to surgeons during mitral valve (MV) surgery with increased perioperative risk.
CASE PRESENTATION
We describe a challenging case of an elderly female patient with multiple comorbidities who presented with symptoms and signs of heart failure with a previous history of mechanical aortic valve replacement 15 years prior to presentation. Echocardiogram showed severe mitral stenosis and regurgitation with severe calcification of the mitral annulus. Given her high-risk profile and unavailability of suitable percutaneous therapeutic options we decided to replace her mitral valve with Sapien 3 valve under direct exposure. The case describes the technical details for the valve implantation and demonstrates the viability of this option in high risk surgical patients without the need for adjunct techniques like predilatation, additional supporting sutures or patches with a review of the literature on open surgical implantation of Sapien 3 valve.
CONCLUSION
Direct open surgical implantation of Sapien 3 valve can be implanted safely in patients with severe MAC, without predilatation and without the use of other adjunctive techniques like fixation sutures or patches.
Topics: Aged; Calcinosis; Echocardiography; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Stenosis
PubMed: 32093723
DOI: 10.1186/s13019-020-1083-8 -
Journal of Medical Case Reports May 2021Among cardiac causes for postpartum maternal collapse, severe mitral stenosis is not listed as a potential cause in current literature. We report a rare case of severe...
BACKGROUND
Among cardiac causes for postpartum maternal collapse, severe mitral stenosis is not listed as a potential cause in current literature. We report a rare case of severe mitral stenosis that presented with severe hypoxia and maternal decompensation in early postpartum period for the first time. A 30-year-old para 2, abortus 1, Ethiopian woman developed severe hypoxia and rapid deterioration on her sixth postoperative day after cesarean delivery for fetal bradycardia with a good fetal outcome. She was put on a mechanical ventilator when she developed respiratory failure. Initially, a diagnosis of pulmonary embolus was considered. After admission to the intensive care unit, severe mitral stenosis was diagnosed with the help of echocardiography. She was managed successfully for congestive heart failure and discharged from the intensive care unit with improvement.
CONCLUSION
The possibility of mitral stenosis, as a differential diagnosis, should be considered whenever a case of postpartum maternal collapse is encountered. We recommend a routine immediate echocardiography in any patient that experiences postpartum collapse, especially in the presence of a known trigger for heart failure such as long hours of labor, bleeding, anemia, hypotension, and infection.
Topics: Adult; Cesarean Section; Female; Heart Failure; Humans; Mitral Valve Stenosis; Postpartum Period; Pregnancy; Pregnancy Complications, Cardiovascular
PubMed: 33941257
DOI: 10.1186/s13256-021-02806-5 -
BMC Surgery May 2022Percutaneous balloon mitral valvotomy is a common therapeutic approach for rheumatic mitral stenosis. Avulsion of the papillary muscle is a rare but serious complication...
BACKGROUND
Percutaneous balloon mitral valvotomy is a common therapeutic approach for rheumatic mitral stenosis. Avulsion of the papillary muscle is a rare but serious complication of balloon mitral valvotomy. The papillary muscles are derived from the trabecular layer of the developing ventricular walls. When subjected to a force, avulsion of papillary muscle from the trabecular layer may occur.
CASE PRESENTATION
In this case report, we describe a patient with rheumatic mitral stenosis, who experienced avulsion of the mitral papillary muscle from the left ventricular wall after undergoing balloon mitral valvotomy. Papillary muscle alvusion resulted in severe mitral regurgitation, which was finally treated by mitral valve replacement.
CONCLUSION
We successfully diagnosed avulsion of the papillary muscle following balloon mitral valvotomy. Three-dimensional transthoracic echocardiography provides more information on mitral apparatus structure than two-dimensional transthoracic echocardiography.
Topics: Catheterization; Echocardiography; Echocardiography, Three-Dimensional; Humans; Mitral Valve Stenosis; Papillary Muscles
PubMed: 35597976
DOI: 10.1186/s12893-022-01636-6 -
Thorax Sep 1962
Topics: Humans; Mitral Valve Stenosis
PubMed: 13889286
DOI: 10.1136/thx.17.3.271 -
Multimedia Manual of Cardiothoracic... Jun 2020In this video tutorial we present our technique for hybrid surgical Melody® valve implantation in the left atrio-ventricular valve (henceforth referred to as mitral...
In this video tutorial we present our technique for hybrid surgical Melody® valve implantation in the left atrio-ventricular valve (henceforth referred to as mitral valve) position in children. The key steps, including valve preparation, implantation, and balloon dilatation, are depicted. We discuss the short-term outcome, we red-flag potential complications, and we hypothesize medium-term outcomes, including late balloon dilatation.
Topics: Bioprosthesis; Echocardiography; Female; Heart Septal Defects; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Infant; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Stenosis; Postoperative Complications; Prognosis; Prosthesis Design; Reoperation; Treatment Outcome
PubMed: 32544312
DOI: 10.1510/mmcts.2020.034 -
Journal of the American College of... Aug 1990Mitral valve areas determined by Doppler pressure half-time were compared with areas obtained by planimetry in two groups of patients with mitral stenosis: 24 patients...
Mitral valve areas determined by Doppler pressure half-time were compared with areas obtained by planimetry in two groups of patients with mitral stenosis: 24 patients without aortic regurgitation and 32 patients with more than grade 1 aortic regurgitation. The severity of aortic regurgitation was assessed by color flow mapping; 17 patients had grade 2, 10 had grade 3 and 5 had grade 4 aortic regurgitation. Regression equations for pressure half-time area versus planimetry mitral valve area were calculated separately for the aortic regurgitation (r = 0.88) and the nonaortic regurgitation group (r = 0.86); analysis of covariance revealed a significant (p less than 0.001) difference between the two groups leading to overestimation of planimetry area by the pressure half-time method in the aortic regurgitation group. The mitral valve areas in the group without regurgitation were best calculated with the expression 239/T1/2 (r = 0.77) as compared with a best fit of 195/T1/2 (r = 0.85) for the aortic regurgitation group. To elucidate the mechanisms affecting pressure half-time in aortic regurgitation, an in vitro model of mitral inflow in the presence of varying regurgitant volumes and different ventricular chamber compliances was used. Aortic regurgitation shortened directly measured pressure half-time proportional to the regurgitant fraction but an increase in left ventricular compliance could offset this effect. Finally, in a mathematic model of mitral inflow the competing effects of aortic regurgitation and chamber compliance could be confirmed. In conclusion, aortic regurgitation results clinically in a significant net shortening of pressure half-time leading to mitral valve area overestimation. However, the effect is moderate and individually unpredictable because of changes in chamber compliance.
Topics: Adult; Aged; Aortic Valve Insufficiency; Compliance; Computer Simulation; Echocardiography, Doppler; Female; Heart Ventricles; Humans; Male; Middle Aged; Mitral Valve Stenosis; Models, Cardiovascular; Pressure
PubMed: 2373818
DOI: 10.1016/0735-1097(90)90592-d -
Brazilian Journal of Cardiovascular... Apr 2021Coronary artery to left atrial fistula is rare in patients with mitral stenosis. We report an interesting case of a patient with concomitant mitral valve stenosis and...
Coronary artery to left atrial fistula is rare in patients with mitral stenosis. We report an interesting case of a patient with concomitant mitral valve stenosis and coronary fistulae, originating from the left circumflex artery and drained into the left atrium with two terminal orifices.
Topics: Coronary Vessels; Fistula; Heart Atria; Humans; Hypertension, Pulmonary; Mitral Valve Stenosis
PubMed: 34048204
DOI: 10.21470/1678-9741-2019-0297 -
Journal of the American College of... Jul 1986The clinical data, echocardiographic findings, operative anatomy and postoperative follow-up were assessed in 14 patients who had surgery for membranous supravalvular...
The clinical data, echocardiographic findings, operative anatomy and postoperative follow-up were assessed in 14 patients who had surgery for membranous supravalvular mitral stenosis between 1978 and 1985. The patients ranged in age from 6 weeks to 13 years at the time of operation, and 8 of the 14 had associated mitral valve abnormalities. Other associated lesions included ventricular septal defect (n = 7), coarctation of the aorta (n = 5), left superior vena cava (n = 6), subaortic stenosis (n = 3) and atrial septal defect (n = 1). Twelve of the 14 patients had successful removal of the supravalvular membrane, which was usually adherent to the valve, and 2 patients with associated mitral valve abnormalities underwent mitral valve replacement. There were no operative deaths. Review of preoperative two-dimensional echocardiograms, which were available in 11 patients, revealed two types of membranous supravalvular mitral stenosis in 10 patients. In four of these patients, the membrane was only evident after repeated stop action viewing from a single subcostal or parasternal location. The membrane was never seen in one patient. Eleven patients had follow-up in excess of 1 year, and there was one late death. Eight of the remaining 10 patients are asymptomatic, and 7 have no clinical evidence of residual mitral obstruction. Failure to recognize membranous supravalvular mitral stenosis can result in undue delay of cardiac surgery with resultant cardiopulmonary deterioration. Patients with evidence of left ventricular inflow obstruction should have extensive echocardiographic evaluation in an effort to detect membranous supravalvular mitral stenosis, which may be amenable to surgical repair.
Topics: Adolescent; Child; Child, Preschool; Diagnosis, Differential; Echocardiography; Follow-Up Studies; Heart Defects, Congenital; Humans; Infant; Mitral Valve Stenosis
PubMed: 3711511
DOI: 10.1016/s0735-1097(86)80107-3 -
Methodist DeBakey Cardiovascular Journal 2023A 56-year-old man with no significant past medical history presented with exertional shortness of breath. Echocardiogram, cardiac magnetic resonance, and computed...
A 56-year-old man with no significant past medical history presented with exertional shortness of breath. Echocardiogram, cardiac magnetic resonance, and computed tomography showed mitral stenosis and a left atrial thrombus. Left atrial thrombus formation is a well-known complication of severe mitral stenosis that can lead to systemic thromboembolism. The patient underwent mitral valve replacement, left atrial thrombus resection, and left atrial appendage closure that resulted in significant improvement in breathing.
Topics: Male; Humans; Middle Aged; Mitral Valve Stenosis; Atrial Fibrillation; Heart; Thromboembolism; Thrombosis
PubMed: 37636318
DOI: 10.14797/mdcvj.1272 -
The Israel Medical Association Journal... Oct 2012Understanding the mechanism and the main components involved in rheumatic mitral regurgitation (MR) associated with dominant pliable mitral stenosis (MS) may improve our... (Comparative Study)
Comparative Study
Mild rheumatic mitral regurgitation in the presence of dominant stenotic pliable valve: an echocardiographic structural valve analysis in patients undergoing balloon valvuloplasty.
BACKGROUND
Understanding the mechanism and the main components involved in rheumatic mitral regurgitation (MR) associated with dominant pliable mitral stenosis (MS) may improve our ability to repair some mixed rheumatic mitral valve pathologies.
OBJECTIVES
To assess mitral valve structural components in pure mitral stenosis versus mitral stenosis associated with mild regurgitation
METHODS
Using two-dimensional echocardiography, we performed mitral valve structural analysis in two groups of patients prior to balloon mitral valvuloplasty (BMV). The first group, consisting of 13 females and 2 males (mean age 39 +/- 5 years), suffered from pure pliable mitral stenosis (PPMS), while the second group, with 22 females and 2 males (mean age 44 +/- 5 years), had mixed mitral valve disease (MMVD) characterized by mild MR in the presence of dominant pliable MS. All echocardiographic measurements relating to the mechanism of MR were undertaken during the systolic phase.
RESULTS
The mean Wilkins scores of the PPMS and MMVD groups were 7 +/- 1 and 8 +/- 1 respectively (P = 0.004). No significant differences were found between the MMVD group and the PPMS group regarding annular circumference (15.5 +/- 1.4 cm vs. 15.4 +/- 1.6cm, P = 0.84), annular diameter (36 +/- 4 mm vs. 38 +/- 5 mm, P = 0.18), and chordae tendinae length directed to the anterior mitral leaflet (AML) (10 +/- 2 mm vs. 11 +/- 2 mm, P = 0.137). However, anterior vs. posterior mitral leaflet length during systole was significantly lower in the MMVD than in the PPMS group (2.2 +/- 0.5 vs. 2.8 +/- 0.4, P = 0.02), whereas the AML thickness at the co-aptation point was greater in the MMVD than in the PPMS group (7 +/- 1 vs. 5 +/- 1 mm, P = 0.0004).
CONCLUSIONS
In rheumatic valves, thickening and shortening of the AML are the main factors determining the appearance of mild MR in the presence of dominant pliable MS.
Topics: Adult; Balloon Valvuloplasty; Echocardiography; Female; Follow-Up Studies; Humans; Male; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Stenosis; Retrospective Studies; Severity of Illness Index
PubMed: 23193785
DOI: No ID Found