485 Novel Insights Into the Effect of Loading Conditions and Inotropy on Mitral Valve Function

2012 ◽  
Vol 28 (5) ◽  
pp. S278
Author(s):  
S. Dhillon ◽  
T. Colon ◽  
N. Khoo ◽  
J. Tyberg ◽  
C. Kroeker ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Loading Conditions ◽  
Valve Function

A Complex Mitral Valve Reconstruction: A Case Report

2005 ◽  
Vol 6 (2) ◽  
pp. 27
Author(s):  
Dimitrios Buklas ◽  
Massimo Massetti ◽  
Eric Saloux ◽  
Eugenio Neri ◽  
Olivier LePage ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Surgical Techniques ◽  
Mitral Valve Insufficiency ◽  
Left Ventricular ◽  
Mitral Valve Reconstruction ◽  
Mitral Repair ◽  
Valve Reconstruction ◽  
Valve Insufficiency ◽  
Valve Function ◽  
Valvular Function

Several techniques are currently in use for mitral valve reconstruction. We report a mitral repair case in which the use of a combination of different surgical techniques resulted in the necessary correction. A 47-year-old woman underwent surgical intervention to treat severe mitral valve insufficiency due to A1/A2/A3 and P2 prolapsed valve tissue. A combination of quadrangular resection, sliding leaflet, single chordal transposition, "flip-over" leaflet, and ring annuloplasty techniques were applied, and postsurgical correct valve function was documented by results of a left ventricular saline filling test and transesophageal echocardiography control. Complex mitral valve repairing techniques can be combined to reestablish valvular function.

scholarly journals Use of a Sandwich Technique to Repair a Left Ventricular Rupture after Mitral Valve Replacement

2014 ◽  
Vol 41 (2) ◽  
pp. 195-197 ◽  
Author(s):  
Myles E. Lee ◽  
Mallika Tamboli ◽  
Anthony W. Lee
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Aneurysm ◽  
Sandwich Technique ◽  
Ventricular Rupture ◽  
Left Ventricular Rupture ◽  
Valve Function ◽  
Normal Mitral Valve

One difficulty with external repair of left ventricular rupture after mitral valve replacement is collateral bleeding in friable myocardium adjacent to the rupture. The bleeding is caused by tension on the closing sutures, whether or not pledgets have been used. We report the case of a 69-year-old woman who underwent an uneventful mitral valve replacement. After cardiopulmonary bypass was terminated, brisk bleeding started from high in the posterior left ventricular wall, typical of a type III defect. We undertook external repair, placing a plug of Teflon felt into the cavity of the rupture and sandwiching it into place with pledgeted mattress and figure-of-8 sutures. The space occupied by the plug decreased the distance needed to obliterate the defect and thereby reduced the tension on the sutures necessary to achieve hemostasis. This simple technique enabled closure of the defect and avoided collateral tears that would have compromised an otherwise successful repair. Two years postoperatively, the patient had normal mitral valve function and no left ventricular aneurysm. In addition to reporting the patient's case, we review the types of left ventricular rupture that can occur during mitral valve replacement and discuss the various repair options.

scholarly journals Pursuing the non-invasive assessment of cardiac contractility: the added value of pressure-area-strain loop analysis in volume overload-induced heart failure

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Tokodi ◽  
BK Lakatos ◽  
M Ruppert ◽  
A Olah ◽  
AA Sayour ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Cardiac Contractility ◽  
Volume Overload ◽  
Left Ventricular ◽  
Stroke Work ◽  
Loading Conditions ◽  
Innovation And Technology ◽  
Pressure Area ◽  
Area Strain

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the New National Excellence Programme (ÚNKP-19-3-I) of the Ministry for Innovation and Technology in Hungary, and the Artificial Intelligence Research Field Excellence Programme of the National Research, Development and Innovation Office of the Ministry of Innovation and Technology in Hungary. Background Global longitudinal strain (GLS) by speckle-tracking echocardiography (STE) is a sensitive parameter of left ventricular (LV) systolic function. Nevertheless, GLS is dependent on loading conditions. Through the analysis of pressure-strain loops, myocardial work was recently introduced and tested in different clinical scenarios. Myocardial work incorporates afterload, but still, it neglects changes in preload and LV geometry. Purpose Accordingly, our aim was to test our hypothesis that adding instantaneous LV size to myocardial work calculation can further mitigate the load-dependency of GLS, and therefore, a better correlation with intrinsic myocardial contractility can be achieved. Methods Volume overload-induced heart failure was established by an aortocaval fistula (ACF) in male Wistar rats (n = 12). Age-matched sham-operated animals served as controls (n = 12). STE was performed to assess GLS, which was immediately followed by invasive pressure-volume (P-V) analysis to assess LV pressure and to compute a gold-standard index of cardiac contractility (preload recruitable stroke work [PRSW]). Global myocardial work index (GMWI) was calculated from GLS and the invasively measured LV pressure. To compute GMWI indexed to LV area (GMWIA), the instantaneous power (calculated by multiplying the strain rate and the instantaneous LV pressure) was divided by the instantaneous LV area, and then it was integrated from mitral valve closure until mitral valve opening. Results LV ejection fraction did not differ significantly (ACF vs. controls: 59 ± 4 vs. 65 ± 9%, p = NS), whereas GLS (Figure 1A - representative animals) was slightly decreased in the ACF group (-13.2 ± 2.3 vs. -15.4 ± 1.9%, p < 0.05). In contrast, PRSW, GMWI (Figure 1B - representative animals) and GMWIA (Figure 1C - representative animals) were considerably reduced in ACF compared to controls (57 ± 13 vs. 111 ± 38mmHg, 1383 ± 382 vs. 1928 ± 281mmHg%, 11.6 ± 3.7 vs. 47.9 ± 22.8mmHg%/mm2, all p < 0.01). GLS showed moderate correlation with PRSW (r=-0.550, p < 0.01), whereas GMWI correlated more significantly, but still moderately with the invasively measured LV contractility (r = 0.681, p < 0.001). Correlation between the pressure-area-strain loop-derived GMWIA and P-V analysis-derived PRSW (Figure 1D) was found to be very strong (r = 0.924, p < 0.001). Conclusions In the case of LV volume overload-induced heart failure, our pressure-area-strain loop-derived metric reflected LV contractility better than GLS and even GMWI. Therefore, the incorporation of instantaneous LV size into myocardial work calculation represents a promising clinical tool to assess and monitor intrinsic myocardial function independently of loading conditions. Abstract Figure 1

Coordinate-Free Analysis of Mitral Valve Dynamics in Normal and Ischemic Hearts

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Paul Dagum ◽  
Tomasz A. Timek ◽  
G. Randall Green ◽  
David Lai ◽  
George T. Daughters ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Color Doppler ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Free System ◽  
Ring Annuloplasty ◽  
3D Geometry ◽  
Valve Function ◽  
Valve Dynamics ◽  
Radiopaque Markers

Background —The purpose of this investigation was to study mitral valve 3D geometry and dynamics by using a coordinate-free system in normal and ischemic hearts to gain mechanistic insight into normal valve function, valve dysfunction during ischemic mitral regurgitation (IMR), and the treatment effects of ring annuloplasty. Methods and Results —Radiopaque markers were implanted in sheep: 9 in the ventricle, 1 on each papillary tip, 8 around the mitral annulus, and 1 on each leaflet edge midpoint. One group served as a control (n=7); all others underwent flexible Tailor partial (n=5) or Duran complete (n=6) ring annuloplasty. After an 8±2-day recovery, 3D marker coordinates were measured with biplane videofluoroscopy before and during posterolateral left ventricular ischemia, and MR was assessed by color Doppler echocardiography. Papillary to annular distances remained constant throughout the cardiac cycle in normal hearts, during ischemia, and after ring annuloplasty with either type of ring. Papillary to leaflet edge distances similarly remained constant throughout ejection. During ischemia, however, the absolute distances from the papillary tips to the annulus changed in a manner consistent with leaflet tethering, and IMR was observed. In contrast, during ischemia in either ring group, those distances did not change from preischemia, and no IMR was observed. Conclusions —This analysis uncovered a simple pattern of relatively constant intracardiac distances that describes the 3D geometry and dynamics of the papillary tips and leaflet edges from the dynamic mitral annulus. Ischemia perturbed the papillary-annular distances, and IMR occurred. Either type of ring annuloplasty prevented such changes, preserved papillary-annular distances, and prevented IMR.

Abstract 14338: Prevalence, Associations and Outcomes of Double Orifice and Parachute Mitral Valve

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
uzoma obiaka ◽  
Anna Chow ◽  
Jen Lie Yau ◽  
Valeria Matto Morina ◽  
Shubhika Srivastava
Keyword(s):  
Mitral Valve ◽  
Age At Diagnosis ◽  
Text Search ◽  
Associated Lesions ◽  
Significant Difference ◽  
Parachute Mitral Valve ◽  
Valve Function ◽  
Echocardiographic Images ◽  
Double Orifice

Background: The incidence of congenital mitral valve disease is 0.4%; Double Orifice Mitral Valve (DOMV) and Parachute Mitral Valve (PMV) are two morphologic pathologies that may result in mitral valve dysfunction. The objectives of this study are 1) To describe valve function and progression and 2) To define factors contributing to disease progression. Methods: Retrospective database review. Fyler codes for DOMV, PMV and text search was performed. Echocardiographic images, echo reports, and chart review were used to identify mitral regurgitation (MR), mitral stenosis (MS), morphology, and associated lesions. Results: 39 patients with DOMV and 76 patients with PMV were identified. In the DOMV cohort, 51% were male, median age at diagnosis was 0.17 years (IQR 0.01, 3.88); median follow-up of 5.92 years (IQR 0.46, 10.22). In the PMV cohort, 44% were male, median age at diagnosis at was 0.01 years (IQR 0, 0.34); median follow-up of 2.56 years (IQR 0.25, 9.55). 41% of DOMV and 23% of patients with PMV had normal valve function at initial visit. DOMV was associated with MR (p=0.04), and PMV with MS (p<0.0001). 23% of patients in the PMV cohort had progressive MS compared to 5% of patients in the DOMV cohort (p<0.0001). There was no significant difference in MR progression between both groups (p=0.02). Papillary muscle (PM) morphology was evaluated in 37 (excluding canals) of 76 patients in the PMV cohort. 5 had true PMV (single PM), 32 had variant PMV with two PM groups of which 62.5% had dominant posterior medial PM. 67% of those with posterior medial PM dominance had progressive MS irrespective of association with Shone’s complex. The anterolateral PM muscle group dominant PMV were not associated with Shone’s complex and progressive MS. Conclusion: DOMV are more likely to have MR while PMV are more likely to have MS. DOMV has non progressive MR and MS. Posterior medial PM dominance in PMV is more likely to have progressive MS.

Non-Invasive Assessment of Prosthetic Mitral Valve Function

1975 ◽  
pp. 102-102
Author(s):  
Ruth Ann Smith ◽  
Richard E. Kerber ◽  
James W. Snyder
Keyword(s):  
Mitral Valve ◽  
Non Invasive ◽  
Valve Function ◽  
Prosthetic Mitral Valve

Abstract 15167: Short-term Sequalae of Children With Paediatric Inflammatory Multisystem Syndrome Temporarily Associated With Sars-cov-2 Infection (pims-ts) Assessed by Cardiovascular Magnetic Resonance

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ivan Bermejo Altamar ◽  
Elisabeth Whittaker ◽  
jethro herberg ◽  
Alain Fraisse ◽  
Carles Bautista ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Ejection Fraction ◽  
Interventricular Septum ◽  
Short Term ◽  
Cardiac Inflammation ◽  
Echocardiographic Finding ◽  
Lv Dysfunction ◽  
Lv Mass ◽  
Valve Function ◽  
Lv Ejection Fraction

Introduction: Children with paediatric inflammatory multisystem syndrome temporally associated with SARS CoV2 infection (PIMS-TS) present with evidence of multiorgan dysfunction. Cardiac features include partial or typical Kawasaki disease symptoms or ventricular impairment. The aim of this study was to assess short term sequelae of cardiac involvement in patients with PIMS-TS. Methods: 17 consecutive paediatric patients with PIMS-TS were referred for CMR at our institution. The referring criteria were: Echocardiographic finding of LV dysfunction at presentation (53%), dilated coronary arteries (27%) and high cardiac markers without LV dysfunction (20%). 16 patients completed the scan and were included into the analysis. Results: Age of the patients was 17 months-12 years (mean 6.4 years), 12 (80%) were male. Six (40%) patients required general anaesthesia. The time between the onset of the symptoms and the scan was 12-72 days. All patients had SARS CoV2 PCR negative at the time of scan, 2 patients were previously positive and 12 (80%) had positive IgG. CMR indexed volumes (ml/m2) were in normal range: LVEDV 65±11, LVESV 24±7, RVEDV 67±12, RVESV 27±7. LV mass index were normal 45±8 gr/m2. No overt areas of myocardial oedema or acute inflammation on STIR (short tau inversion recovery) images were found. Mildly reduced LV ejection fraction was found in 1 patient with subtle linear late gadolinium enhancement (LGE) in the midventricular midmyocardial interventricular septum with negative STIR images. Another patient was found to have LGE of the proximal parts of mitral valve papillary muscles, but no abnormalities in the LV ejection fraction or mitral valve function were found. Two patients had a small pericardial effusion. 3 patients had dilated neck and/or innominate veins, 2 of them with phlebectatic appearance. One patient had enlarged liver, another liver and spleen. Conclusion: in conclusion no significant myocardial sequelae have been found in most of the patients presenting with PIMS-TS short-term after onset of symptoms. This might indicate rapid recovery of the cardiac inflammation in most of the patients. More follow up is needed to clarify if there will be any potential sequelae from the acute episode as well as the outcome of phlebectasia.

In Vivo Dynamic Strains of the Mitral Valve Annulus

2007 ◽  
Author(s):  
Brett Zubiate ◽  
Michael Sacks ◽  
Robert C. Gorman ◽  
Joseph H. Gorman
Keyword(s):  
Mitral Valve ◽  
Cardiac Cycle ◽  
Dimensional Space ◽  
Complex Structure ◽  
Three Dimensional ◽  
Mitral Annulus ◽  
Mitral Valve Leaflet ◽  
Valve Function ◽  
Integrated Operation

The mitral valve apparatus is a complex structure with multiple components that require seamless, integrated operation for normal valve function. One of these components is the annulus, a fibrous ring of tissue that defines the boundary between the mitral valve leaflets and the surrounding superstructure of the heart. During the cardiac cycle the annulus undergoes large deformations and dramatic shape changes. Moreover, the annulus motion represents a key boundary condition for mitral valve leaflet deformation. Yet, to date our knowledge of the subtle deformations this structure undergoes during the cardiac cycle remains very limited. In the present study, an array of 1 mm diameter piezoelectric sonocrystals was implanted in 5 sheep to quantify annular deformation over the complete cardiac cycle. These crystals act as fiducial markers for the mitral annulus with a temporal resolution of ∼1ms and a special resolution of .01mm in a calibrated three dimensional space. A quintic order generalized 3D spline was developed to reconstruct the annular geometry.

scholarly journals Peroperative assessment of mitral valve function

1972 ◽  
Vol 63 (3) ◽  
pp. 458-460 ◽  
Author(s):  
Keith M. Pagliero ◽  
Alan K. Yates
Keyword(s):  
Mitral Valve ◽  
Valve Function
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