Transesophageal echo X-plane view of the mitral valve post MitraClip placement showing a single leaflet device attachment of MitraClip to the anterior mitral leaflet

ASVIDE ◽  
2017 ◽  
Vol 4 ◽  
pp. 560-560
Author(s):  
William E. Katz ◽  
Anson J. Conrad Smith ◽  
Frederick W. Crock ◽  
João L. Cavalcante
Keyword(s):  
Mitral Valve ◽  
Mitral Leaflet ◽  
Anterior Mitral Leaflet ◽  
Plane View

scholarly journals A predictor for mitral valve repair in patient with rheumatic heart disease: the bending angle of anterior mitral leaflet

2018 ◽  
Vol 10 (5) ◽  
pp. 2908-2915 ◽  
Author(s):  
Jin-Tao Fu ◽  
Mohammad Sharif Popal ◽  
Yu-Qing Jiao ◽  
Hai-Bo Zhang ◽  
Shuai Zheng ◽  
...  
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Rheumatic Heart Disease ◽  
Mitral Valve Repair ◽  
Mitral Leaflet ◽  
Valve Repair ◽  
Bending Angle ◽  
Anterior Mitral Leaflet ◽  
Rheumatic Heart

A family study of anterior mitral leaflet thickness and mitral valve prolapse

1998 ◽  
Vol 82 (6) ◽  
pp. 823-826 ◽  
Author(s):  
Alfredo Zuppiroli ◽  
Mary J Roman ◽  
Michael O’Grady ◽  
Richard B Devereux
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Family Study ◽  
Mitral Leaflet ◽  
Anterior Mitral Leaflet

scholarly journals Systematic cutting of selected secondary mitral valve chordae, in association with a shallow myectomy, in obstructive hypertrophic cardiomyopathy:impact on mitral valve function and patient management

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Margonato ◽  
R Abete ◽  
A Zyrianov ◽  
A Sorropago ◽  
M Chioffi ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Septal Defect ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Anterior Leaflet ◽  
Mitral Leaflet ◽  
Access To Treatment ◽  
Anterior Mitral Leaflet ◽  
Septal Myectomy ◽  
Number Of Patients

Abstract Introduction Few centers worldwide have large experience with performing an extended septal myectomy in patients with obstructive hypertrophic cardiomyopathy (HCM). Therefore, many HCM patients eligible for surgical relief of left ventricular (LV) outflow gradient do not have access to treatment. In a previous study, cutting fibrotic anterior mitral leaflet secondary chordae, in association with only a shallow myectomy, proved highly effective in moving the mitral valve (MV) apparatus away from the LV outflow tract and relieving the outflow gradient in our HCM patients with mild hypertrophy (<19 mm), a surgical approach that simplifies the operation. Purpose To assess whether chordal cutting is equally effective in improving MV geometry and relieving LV outflow gradient and heart failure symptoms in HCM patients with more marked hypertrophy. Methods Surgical outcome and MV geometry and function were assessed in 226 consecutive HCM patients who underwent systematic cutting of fibrotic anterior mitral leaflet secondary chordae, in association with a shallow myectomy and independently of magnitude of septal thickness, at our center from January 2015 to December 2018. Results Of 226 study patients, 1 (0.4%) died perioperatively. None had iatrogenic septal defect. Postoperatively, LV outflow gradient at rest decreased from 70±36 to 10±2 mmHg (P<0.001). In the 77 patients in whom data on the outflow gradient provoked with physiologic maneuvers after surgery were available, the provocable gradient was 16±10 mmHg. NYHA functional class improved significantly (P<0.001), with the number of patients in class III-IV decreasing from 178 (79%) to 2 (0.9%). No patient had residual severe MV regurgitation and only 4 (1.7%) had moderate-to-severe regurgitation. Quality of the echocardiogram allowed assessment of MV geometry in 212 (94%) patients. In the 62 patients with mild hypertrophy, anterior leaflet-annulus ratio increased 27% postoperatively, from 0.43+0.06 to 0.55+0.06 and MV tenting area decreased 34% from 2.9+0.6 to 1.9+0.4 cm2 (P<0.001), indicating repositioning of MV coaptation away from the outflow tract (with increased outflow tract dimension). Similarly, in 150 patients with marked hypertrophy, anterior leaflet-annulus ratio increased 27% from 0.43+0.05 to 0.55+0.06 and tenting area decreased 28% from 2.9+0.6 to 2.1+0.4 cm2 (P<0.001). Conclusions Our results show that cutting fibrotic anterior mitral leaflet secondary chordae, by moving the MV apparatus away from the LV outflow tract and independently of the magnitude of septal hypertrophy, contributes to improve the results of septal myectomy and reduces the need for a deep septal excision (and associated risk of iatrogenic septal defect) in patients with obstructive HCM. Therefore, chordal cutting could make the myectomy operation more accessible to surgeons, increasing the availability of surgical treatment for HCM patients eligible for invasive abolition of LV outflow obstruction. Funding Acknowledgement Type of funding source: None

Repair of the Mitral Valve Anterior Leaflet: Early Results

1996 ◽  
Vol 4 (4) ◽  
pp. 214-216 ◽  
Author(s):  
Taweesak Chotivatanapong ◽  
Pradistchai Chaiseri ◽  
Udom Leelataweewud ◽  
Promporn Petchyungthong
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Anterior Leaflet ◽  
Mitral Leaflet ◽  
Anterior Mitral Leaflet ◽  
Early Results ◽  
Hospital Deaths ◽  
Prosthetic Ring

Between March 1994 and December 1995 a total of 27 cases of mitral valve anterior leaflet repair were undertaken at our institution. Five of the patients were excluded from the study; 3 with predominant mitral stenosis and 2 with atrial septal defect primum type. Of the 22 anterior mitral leaflet repair patients, there were 12 males and 10 females with a mean age of 41.5 years. Follow-up was complete in all patients and ranged from 2 to 22 months with a mean of 8.6 months. Mitral valve disease was attributed to rheumatic disease in the majority of cases (12). Other causes included degenerative (5), endocarditis (2), ischemic (2), and congenital conditions (1). Preoperatively there, were 18 cases of mitral regurgitation, and 4 of mixed mitral stenosis and regurgitation. The most commonly used surgical procedures were prosthetic ring implantation, chordal shortening and chordal transposition. Most of the patients required multiple procedures to accomplish the repair with an average of 3.4 procedures per patient. Neochordal implantation with polytetrafluoroethylene was performed in 4 cases. Reconstruction of the anterior mitral leaflet using autologous glutaraldehyde-treated pericardium was completed in 2 patients who had bacterial endocarditis. There were no hospital deaths nor late mortality in this series. None of the patients required reoperation during the follow-up. The patients' functional status as well as the severity of the mitral regurgitation improved markedly after the operation. We conclude from our study that repair of the mitral valve anterior leaflet is possible in selected patients with good early results.

scholarly journals Anterior mitral leaflet length and mitral annulus diameter impact the echocardiographic outcome after isolated myectomy

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Mateusz Kuć ◽  
Magdalena Kumor ◽  
Mariusz Kłopotowski ◽  
Maciej Dąbrowski ◽  
Natalia Kopyłowska-Kuć ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Nyha Class ◽  
Mitral Annulus ◽  
Outflow Tract ◽  
Mitral Leaflet ◽  
Anterior Mitral Leaflet ◽  
Anterior Posterior ◽  
Annulus Diameter

Abstract Background Myectomy remains the standard surgical treatment of patients with hypertrophic cardiomyopathy (HOCM). New surgical methods developed in the last decades mainly address the mitral valve and are controversial because of their conflicting assumptions. This study assesses the influence of anterior mitral valve leaflet (AML) length and the anterior-posterior diameter of the mitral annulus (MAD) on dynamic left ventricle outflow tract obstruction and mitral regurgitation (MR) after extended myectomy. Methods We retrospectively analysed the transthoracic echocardiograms (TTE) of 36 patients. AML length and MAD were obtained from TTE performed before the operation. The greatest maximal left ventricle outflow tract (LVOT) gradient and MR registered in follow-up were analysed. After surgery, patients were divided into two groups; those with moderate or milder MR and/or an LVOT gradient < 30 mmHg (responders), and those with more than moderate MR and/or an LVOT gradient ≥30 mmHg (non-responders). Results Patients in responders group had significantly longer AML: 32.3 ± 2.3 mm vs 30.0 ± 3.8 mm (p = 0.03) [parasternal long axis view – PLAX view], 25.9 ± 2.3 mm vs 23.5 ± 2.7 mm (p = 0.008) [four chamber view - 4CH view] and larger anterior-posterior mitral annulus diameter 28.1 ± 2.8 mm vs 25.4 ± 3.2 mm (p = 0.011) than those in non-responders group. Among all analysed patients longer anterior mitral leaflet was correlated with lower postoperative LVOT gradient when measured in PLAX view (p = 0.02) and lower degree of MR due to systolic anterior motion (SAM) when measured in 4CH view (p = 0.009). Greater [AML x mitral annulus] ratio correlated with lower postoperative LVOT gradient in both projections: 4CH (p = 0.025), PLAX (p = 0.012). There was significant reduction in NYHA Class after surgery (p = 0.000). There were no significant differences in NYHA class after surgery (p = 0.633) neither in NYHA class reduction (p = 0.475) between patients divided into responders and non-responders group according to echocardiographic parameters. Conclusions Patients with a longer AML and a greater diameter of the mitral annulus are less likely to have mitral regurgitation due to residual SAM and increased LVOT gradient after an extended myectomy. Division of patients according to echocardiographic criteria into responders and non-responders was not in concordance with clinical improvement. Trial registration Retrospective study. Approved by ethics committee (IK-NPIA-0021-21/1763/19) at 16.01.2019.

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