Mobilization of the posterior leaflet of the mitral valve for resection of a left ventricular tumor producing carbohydrate antigen 19-9

2003 ◽  
Vol 51 (9) ◽  
pp. 466-468
Author(s):  
Takashi Yamauchi ◽  
Tetsuo Sakakibara ◽  
Hiroshi Takano ◽  
Hironobu Fujimura ◽  
Hitoshi Suhara
Keyword(s):  
Mitral Valve ◽  
Carbohydrate Antigen ◽  
Left Ventricular ◽  
Posterior Leaflet ◽  
Left Ventricular Tumor

scholarly journals The role of three dimensional transeosephageal echocardiography in predicting the effect of cardiac resynchronization therapy on mitral regurgitation in patients with low ejection fraction heart fail

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Demirtola ◽  
TS Tan ◽  
A Mammadli ◽  
IM Akbulut ◽  
I Dincer
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Functional Mitral Regurgitation ◽  
Posterior Leaflet ◽  
Resynchronization Therapy ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Purpose Cardiac resynchronization therapy (CRT) has  a positive effect on the improvement of functional mitral regurgitation in patients with low ejection heart failure. However geometric changes in the mitral valve apparatus, subvalvular structures and their contribution to  the improvement of mitral regurgitation after CRT have not  been clearly defined. The aim of our study was to evaluate the geometric parameters of mitral valve apparatus measured with 3Dimensional (3D) transesophageal echocardiography (TEE) before CRT implantation and to determine the parameters predicting the improvement of mitral regurgitation after CRT. Methods Thirty patients with moderate or severe mitral regurgitation with low EF heart failure planned for CRT implantation and had an indication for TEE were included in the study. Effective regurgitant orifice (ERO) and regurgitant volume (RV) measurements were performed before CRT implantation. Detailed quantitative measurements of mitral valve were done from recorded images by 3D TEE. ERO, RV measurements were repeated to evaluate mitral regurgitation at the end of 3rd month. Results There were no significant changes in left ventricular EF and left ventricular diameters at the end of 3rd month, whereas ERO and RV values were decreased. A statistically significant difference was found in  posterior leaflet angle between mitral regurgitation responder and non-responder groups.  (28,93 ± 8,41 vs 41,25 ± 10,90, p = 0,006). Conclusion Heart failure patients with moderate or severe functional mitral regurgitation who underwent CRT implantation were found to have lower posterior leaflet angle measured by 3D TEE in the patient group whose mitral regurgitation improved after CRT. Abstract Figure.

Abstract 15426: Comparison of Multimodality Imaging in Mitral Leaflet Lengths in Patients Undergoing Surgical Myectomy: A Prospective Study in Hypertrophic Obstructive Cardiomyopathy Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Agostina M Fava ◽  
Anand Mehta ◽  
Barbara Bittel ◽  
Andrew Bauer ◽  
Zoran B Popovic ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Multimodality Imaging ◽  
Imaging Techniques ◽  
Ventricular Outflow Tract ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Posterior Leaflet ◽  
Anterior Leaflet ◽  
Average Deviation ◽  
Basal Septum

Introduction: In hypertrophic obstructive cardiomyopathy (HOCM), mitral valve (MV) leaflets in often contribute to left ventricular outflow tract obstruction (LVOTO). Hence, MV assessment is crucial during surgical planning. 2 or 3-dimensional transesophageal echocardiography (2D or 3D TEE) & cardiac magnetic resonance (CMR) are used to measure MV length. Hypothesis: We sought to compare MV leaflet lengths using intraoperative TEE [2D, zoom 3D, automatic quantification of mitral valve (AMVQ)], & preoperative CMR. Methods: We prospectively studied 50 HOCM patients (59±12 years, 46% men, basal septum 18±5 mm, LVOT gradient 87 ±56 mmHg) undergoing surgical relief of LVOTO. We compared MV leaflet length on a) long-axis 2DTEE b) 3DTEE using multiplanar reconstruction c) AMVQ, EchoPAC, General Electric & d) CMR. Results: Mean anterior leaflet lengths (mm) were as follows: 2D TEE (3.3 ±0.3), 3DTEE (2.9±0.5), CMR (3.1±0.4), & AMVQ (2.9±0.5). Mean posterior leaflet lengths were 1.7±0.3, 1.7±0.4, & 1.7±0.2 & 1.9±0.4 mm, respectively. Assuming 3DTEE as the gold standard, the closest correlation for anterior leaflet was with CMR (average overestimation by CMR of 0.5 mm [root mean square deviation or RMSE% 17]), intermediate correlation with 2DTEE (average deviation of 0.6 mm [RMSE%:21]) & no correlation with AMVQ (deviation of 0.7mm [RMSE% 24]), Fig 1A-C & 2A-C. No correlation was found for posterior leaflet,Fig 1D-F & 2D-F. Conclusions: There are significant differences in measuring MV lengths using different imaging techniques. In HOCM patients undergoing surgery, precise measurement of MV leaflet lengths is crucial & extrapolation from one technique to other is not recommended.

scholarly journals Case of trileaflet mitral valve: an important differential for non-classical intracavitary gradient in suspected hypertrophic cardiomyopathy

2019 ◽  
Vol 12 (6) ◽  
pp. e229106
Author(s):  
Joseph Barker ◽  
Neil Silverwood ◽  
Robert Gerber
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Mitral Valve ◽  
Left Ventricular ◽  
Congenital Deformity ◽  
Disease Course ◽  
Posterior Leaflet ◽  
Exertional Dyspnoea ◽  
Mitral Valves ◽  
Left Ventricular Outflow ◽  
Very High

There are nine published reports of trileaflet mitral valves globally. As such their implication on health outcomes and associations with other disease is uncertain. This case describes a 62-year-old man presenting with exertional dyspnoea and hypertension. It describes an early misdiagnosis of hypertrophic cardiomyopathy and highlights that clinicians should be alerted in cases of very high left ventricular outflow gradients in the presence of eccentric mitral regurgitation (MR). Here the MR was caused by a rare congenital deformity whereby a deep cleft in the posterior leaflet resulted in a tricuspid appearance. We present the natural disease course of a trileaflet mitral valve and without intervention over 13 years from symptom onset to the development of severe MR.

scholarly journals P1412 A new light to improve the view of the anatomical details during micro-invasive trans-ventricular repair of degenerative prolapse of mitral valve

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Vairo ◽  
M Marro ◽  
G Speziali ◽  
M Rinaldi ◽  
S Salizzoni
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Coming Out ◽  
Left Ventricular ◽  
Posterior Leaflet ◽  
Valve Repair ◽  
High Definition ◽  
Definition Of ◽  
Leaflet Prolapse

Abstract BACKGROUND Mitral valve repair is the preferred surgical treatment for severe mitral regurgitation due to degenerative leaflet prolapse. Within the growing era of transcatheter treatments for valvular heart disease, an innovative micro-invasive trans-ventricular beating-heart procedure was developed. Three-dimensional (3D) transoesophageal echocardiographic guidance is crucial to assist the operator in instrument navigation and chords positioning. 3D ultrasound technology is constantly evolving and a special light, that can be mobilized within the 3D images, has recently been invented. This light allows to illuminate the structures from different points of view and increase the definition of the anatomical details. PURPOSE To show the advantages of this new 3D image analysis technology, described above, through a sequence of intra-procedural images of a mitral valve repair by trans-ventricular polytetrafluoroethylene (ePTFE) chords implantation. METHODS The procedure is performed using a device that is introduced through a posterolateral ventriculotomy and it is advanced towards the mitral valve under real-time 3D transoesophageal guidance. The prolapsing segment, in this case central part of posterior leaflet (Fig. 1 A, B and C), is grasped with the jaw of the instrument (J in Fig. 1D), then the chords are implanted, tensioned and secured outside the ventricle. Figure 1A shows the pre-operative image of posterior leaflet prolapse with flail (P2 segment) and the light illuminates the valve from above. The broken chords (arrow in Fig. 1A) can be recognized with high definition. The light can also be placed on the valve plane (Fig. 1B) or below (Fig. 1C). When illumination occurs from the left ventricular side, the coaptation loss due to the P2 flail is highlighted (arrow in Fig. 1C). After placement, tensioning and securing the chords outside the ventricle, the prolapse disappears and the correct coaptation is re-established (Fig. 1E). The coaptation deficit is no longer visible, even with the light placed below the valve and it is possible to see the light coming out of the aortic valve (Ao), opened in systole, with mitral valve closed (Fig. 1F). RESULTS At the end of the procedure the residual mitral regurgitation was trivial and no loss of coaptation can be evidenced even with the light placed in the left ventricle (Fig. 1F). CONCLUSIONS This new light allows to improve the anatomical definition of 3D echocardiographic images, allows better visualization of the coaptation defects and can be used as a further verification of the result especially in cases of micro-invasive mitral repair. Abstract P1412 Figure 1

scholarly journals The role of three-dimensional transesophageal echocardiography in predicting the effect of cardiac resynchronization therapy on mitral regurgitation in patients with low ejection fraction heart failure

2021 ◽  
Author(s):  
Ayse Demirtola ◽  
Turkan Tan ◽  
Anar Mammadli ◽  
irem Muge Akbulut ◽  
Demet Gerede ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Functional Mitral Regurgitation ◽  
Posterior Leaflet ◽  
Resynchronization Therapy

Purpose: Cardiac resynchronization therapy (CRT) has a positive effect on the improvement of functional mitral regurgitation in patients with heart failure with reduced ejection fraction. However geometric changes in the mitral valve apparatus, subvalvular structures and their contribution to the improvement of mitral regurgitation after CRT have not been clearly defined. The aim of our study was to evaluate the geometric parameters of mitral valve apparatus measured with 3Dimensional (3D) transesophageal echocardiography (TEE) before CRT implantation and to determine the parameters predicting the improvement of mitral regurgitation after CRT. Methods: In this prospective study thirty patients with moderate or severe mitral regurgitation with low EF heart failure planned for CRT implantation and had an indication for TEE were included. Effective regurgitant orifice (ERO) and regurgitant volume (RV) measurements were performed before CRT implantation. Detailed quantitative measurements of mitral valve were done from recorded images by 3D TEE. ERO, RV measurements were repeated to evaluate mitral regurgitation at the end of 3rd month. Results: There were no significant changes in left ventricular EF and left ventricular diameters at third month follow-up, whereas ERO and RV values were decreased. posterior leaflet angle was found higher in non-responder group compared to responder group. (28,93 ± 8,41 vs 41,25 ± 10,90, p = 0,006). Conclusion: Heart failure patients with moderate or severe functional mitral regurgitation who underwent CRT implantation were found lower posterior leaflet angle which was measured by 3D TEE in the patient group whose mitral regurgitation improved after CRT.

Effect of Chordal Preservation on Left Ventricular Function

2005 ◽  
Vol 13 (3) ◽  
pp. 233-237 ◽  
Author(s):  
Nagarajan Muthialu ◽  
Shashi K Varma ◽  
Sundar Ramanathan ◽  
Chandrasekar Padmanabhan ◽  
K Madhusudana Rao ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Survival Benefit ◽  
Left Ventricular ◽  
Cardiac Performance ◽  
Left Ventricular Geometry ◽  
Posterior Leaflet ◽  
Ventricular Geometry ◽  
And Function ◽  
Fractional Shortening

Chordopapillary apparatus preservation was compared with valve-excising mitral valve replacement in a retrospective analysis of 360 patients, of whom 98 had total or partial chordal preservation and 262 had the conventional operation. No significant differences were seen in age, sex, pathology, crossclamp or cardiopulmonary bypass times between the 3 groups. Left ventricular fractional shortening decreased significantly in patients whose valves had been excised completely, whereas it remained unchanged in patients with either partial or total chordal conservation. There was a survival benefit for patients undergoing leaflet preservation (92% vs. 80% for conventional excision at 5 years; p = 0.001). Chordal preservation during valve replacement for mitral valve disease improves survival, enhances functional status, preserves left ventricular geometry and function, and improves overall cardiac performance. Preservation of the posterior leaflet alone offers excellent results that are comparable to those of patients with total chordal preservation.

scholarly journals Transcatheter echo guided mitral valve repair with neochord implantation for posterior leaflet disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Mahia ◽  
J Cobiella ◽  
D Enriquez ◽  
M Carnero ◽  
L Maroto ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Transesophageal Echocardiography ◽  
Real Time ◽  
Mitral Valve Repair ◽  
Type A ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Posterior Leaflet ◽  
Valve Repair ◽  
3D Transesophageal Echocardiography

Abstract Background/Introduction Transapical off-pump mitral valve repair with NeoChord implantation (TOP-MINI) has become applied for patients presenting with severe mitral regurgitation (MR) due to posterior leaflet (PML) prolapse or flail. The procedure is performed under real-time 2D- and 3D-transesophageal echocardiography for both implantation and neochordae tension adjustment allowing real-time monitoring of hemodynamic recovery. Purpose This prospective study sought to evaluate acute safety and efficacy of this innovative, minimally invasive, transcatheter mitral valve repair approach. Methods 33 symptomatic patients patients with severe MR secondary to PML flail/prolapse (March 2017-Dec 2019) were included. Patients were stratified on the basis of the preoperative 3D transesophageal echocardiography assessment of MV morphology: type A, isolated central PML prolapse/flail (25 patients); type B, posterior multisegment prolapse/flail (3 patients); type C and D, anterior or bileaflet prolapse/flail or paracommissural prolapse/flail or any type of disease with the presence of significant leaflet/annular calcifications (5 patients). Type A was considered the more favorable morphology. Results Median age was 67.7±13.4 y. Median EuroSCORE-II 2.7%±1.91. Procedural success was achieved in 28 patients (84,9%). 5 patients, 2 type A and 3 type D, underwent conversion to open surgery for immediate failure. The median number of chords implanted was 3.1±0.6. 1 high-risk patient considered inoperable because of severe comorbidities and extensive annular calcifications died before discharge. Postoperative length of stay was 4.25±1 days. At 12.3±4.9 months median follow-up, MR≤moderate was present in 25 (90%). Overall 1-year survival was 100%. Freedom from reintervention was 97% for overall population. Transthoracic echocardiography at 1 year revealed ventricular reverse remodeling, with a significant decrease in indexed left ventricular end- end-systolic volumes (25.3±6.4 to 21.6±8.2 mL/m2, P<0.001). 92.9% were in New York Heart Association class I. Conclusions TOP-MINI procedure is a feasible, low-risk technique that allows safely repair degenerative mitral valve failure secondary to prolapse/flail valvular and its efficacy is maintained up to 1-year. Funding Acknowledgement Type of funding source: None

scholarly journals Anterior Mitral Leaflet Translocation during Correction of Combined Mitral-Aortic Valve Disease

2020 ◽  
pp. 40-44
Author(s):  
V. V. Popov ◽  
O. O. Bolshak ◽  
V. J. Boukarim ◽  
R. M. Vitovskiy ◽  
Y. V. Bakhovska
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Aortic Valve Disease ◽  
Left Ventricular ◽  
Posterior Leaflet ◽  
Anterior Leaflet ◽  
Mitral Prosthesis ◽  
Group A ◽  
Group B

The aim. To study the possibilities of techniques for preserving left ventricular (LV) contractility during mitral valve replacement (MVR) and correction of combined mitral-aortic valve disease (CMAVD). The analyzed group included 257 patients with CMAVD who were undergoing surgical treatment at the Institute. In 97 patients, MVR was performed with translocation of the chordae of the anterior leaflet muscles in combination with complete preservation of the posterior leaflet. Of the 97 operated patients, 2 (2.1%) died at the hospital stage (within 30 days after the operation). Inotropic support (dobutamine) ranged from 3 to 4 ¤g/min/kg during the first 48 hours. The patients were discharged on average 9-12 days after surgery without clinically significant complications. There were no complications at the hospital stage associated with the operative technique. In significant dilation of the left ventricle, MVR with an option of maximizing the preservation of the chordo-papillary continuum is an essential procedure. Materials and methods. The analyzed group included 257 patients with CMAVD who were undergoing surgical treatment at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from January 01, 2006 to January 01, 2020. In addition to MVR, all the patients underwent aortic valve replacement with a mechanical prosthesis. The patients had left ventriculomegaly with an end-diastolic volume exceeding 300.0 ml. In 97 patients, MVR was performed with translocation of the chordae of the anterior leaflet with simultaneous complete preservation of the posterior leaflet of the mitral valve (main group A). The remaining 160 patients underwent MVR without preserving the subvalvular chordopapillary continuum (comparison group B). Results. Among 97 operated patients of the group A, 2 died (2.1%) at the hospital stage (within 30 days after the operation). The dynamics of echocardiographic indicators within 10-11 days of the postoperative period was as follows: LV end-systolic index (ml/sq.m) was 88.4 ± 11.1 (before surgery), 69.4 ± 8.2 (after surgery) and 49.4 ± 7.2 (long-term period); left ventricular ejection fraction (LVEF) was 0.52 ± 0.03 (before surgery), 0.55 ± 0.03 (after surgery) and 0.57 ± 0.03 (long-term period); left atrium (LA) diameter was 62.2 ± 4.5 mm (before surgery), 49.5 ± 1.7 mm (after surgery) and 50.5 ± 1.5 mm (long-term period). Diastolic gradient of a mitral prosthesis was 13.2 ± 2.4 mm Hg. In the long-term period, the mean follow-up of the patients was 8.2 ± 2.4 years. In group B, among 160 operated patients, 5 (3.1%) died at the hospital stage. The dynamics of echocardiographic indicators within 10-11 days of the postoperative period was as follows: LV end-systolic index ( ml/sq.m) was 89.4 ± 11.5 (before surgery), 76.4 ± 9.2 (after surgery) and 62.4 ± 7.2 (long-term period); LVEF was 0.52 ± 0.03 (before surgery), 0.54 ± 0.03 (after surgery) and 0.55 ± 0.03 (long-term period ); LA diameter (uncorrected) was 63.2 ± 3.5 mm (before surgery), 60.5 ± 1.7 mm (after surgery) and 64.5 ± 2.7 mm (long-term period). Diastolic gradient of a mitral prosthesis was 12.7 ± 2.4 mm Hg. Conclusions. Based on the obtained clinical experience, it seems appropriate to recommend the original operation of translocation of the anterior mitral valve leaflet for the correction of combined mitral-aortic defects.

scholarly journals 1635 Catch me if you can: a rare case of two-staged MitraClip detachment

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M G Bucci ◽  
M Previtali ◽  
M C Araujo Dos Anjos ◽  
G Binda ◽  
A Mazzola ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Mitral Valve ◽  
Artery Bypass ◽  
Clinical Status ◽  
Left Ventricular ◽  
Lv Function ◽  
Chronic Obstructive ◽  
Heart Team ◽  
Posterior Leaflet ◽  
Stable Conditions

Abstract Case report A 74-year-old man presented with acute heart failure and chronic obstructive pulmonary disease exacerbation. His medical history revealed: anterior myocardial infarction in 2005, treated with primary PCI of left anterior descending coronary artery followed by triple coronary artery bypass, atrial fibrillation, hypertension, diabetes mellitus and obesity. Transthoracic and transesophageal echocardiography (TEE) showed severe functional ischemic mitral regurgitation (MR) with multiple jets, the main one involving the A2-P2 scallops due to asymmetric tethering of the posterior leaflet. The vena contracta diameter (VC) was 8 mm, the effective regurgitant orifice area (EROA) 0.53 cm². Global left ventricular (LV) function was preserved with inferior-posterior wall akinesis. After "Heart Team" discussion, due to high surgical risk, the patient was referred for percutaneous mitral valve repair (PMVR) using MitraClip (MC) system (Abbott Vascular, Illinois). One clip (MC-XTR) was placed at the A3-P3 segments; subsequently, prior to releasing a second clip (MC-XTR), the first one partially detached from the posterior leaflet (Fig A). A third clip (MC-NTR) was implanted medially. The grasp was challenging but at the end of the procedure, the first clip appeared stable and marked reduction of MR was achieved (Fig B). 7 days later, the patient became symptomatic for resting dyspnea and worsened his clinical status. A control 2D-3D TEE revealed a complete detachment of the first implanted clip, visible distally into the LV, trapped in the mitral valve subchordal apparatus (Fig C). This resulted in massive MR (VC: 12 mm, EROA: 0.91 cm²) with an eccentric posteriorly directed regurgitant jet (Fig D). The patient underwent emergency surgical retrieval of the migrated clip, and removal of the torn mitral valve anterior leaflet. The other two clips were also removed (Fig E), and a bioprosthetic mitral valve was implanted. The procedure was completed uneventfully and the patient is in stable conditions at 2-months follow-up. Discussion The constant stretching and whip effect of the mitral leaflets captured between the clips arms, used in PMVR, can lead to complications. Partial clip detachment is a rare adverse event described in ∼0.7-4.9% of patients within 30 days after MC intervention*. We experienced a two-staged MC detachment that is an even rarer complication and requires emergency surgery. In addition, we highlights the usefulness of 3D TEE for early diagnosis and better imaging characterization in patients who develop complications after MC procedure. No conflict of interest. *Puls M, Lubos E, Boekstegers P, von Bardeleben RS, Ouarrak T, Butter C, Zuern CS, Bekeredjian R, Sievert H, Nickenig G, Eggebrecht H, Senges J, Schillinger W. One-year outcomes and predictors of mortality after MitraClip therapy in contemporary clinical practice: results from German transcatheter mitral valve interventions registry. Eur Heart J 2016;37:703-12. Abstract 1635 Figure.

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