scholarly journals IMPACT OF THE PRESERVATION OF THE SUBVALVULAR APPARATUS OF THE ANTERIOR MITRAL LEAFLET ON THE LEFT VENTRICULAR FUNCTION AFTER MITRAL VALVE REPLACEMENT IN EARLY POST-OPERATIVE PERIOD

2020 ◽  
Vol 8 (11) ◽  
pp. 1030-1047
Author(s):  
Mahmoud F. El-Safty ◽  
◽  
Hazem Gamal Bakr ◽  
Mohamed A. El Badawy ◽  
Mohamed Abd El-Hady ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Young Patients ◽  
Left Ventricular ◽  
Valve Disease ◽  
Lv Function ◽  
Mitral Leaflet ◽  
Anterior Mitral Leaflet ◽  
Group I

Background:Long-term morbidity and mortality appear to be associated with mitral valve replacement for mitral valve disease. The morbidity rate has not decreased dramatically over the years, despite enhancements in myocardial safety and prosthetic valves. Cardiac failure is the most common cause of death following MVR. Subvalvular apparatus preservation preserves LV function and thus improves survival. Repair, particularly with rheumatic valve disease in young patients and extremely disorganised valves, is not always feasible or effective. The use of smaller valve prothesis was not only the argument of preserving the anterior leaflet, but also that it could cause LVOT obstruction. Methods:A prospective controlled randomized study will include(sixty patients aged from 25 to 55 years of both sexes) They will be divided into two groups of patients: Group I: thirty patients who underwent MVR without preservation of The chordae tendinae of the anterior mitral leaflet and only preserving the posterior mitral leaflet. Group II: thirty patients who underwent MVR with complete or partial Preservation of the chordae tendinaeof the anterior mitral leaflet. Results:The sixty patients were divided into two groups where 30 of them underwent preservation of AML, These patients had a better LV function in the early and the short term postoperative period. Conclusion:Results of this study concluded that preservation of the AML leads to better postoperative outcome. We recommend its application on a greater scale of cases of MVR.

scholarly journals Mitral valve Replacement in a 4 yrs old Child: First Time in Bangladesh

2014 ◽  
Vol 6 (2) ◽  
pp. 167-169
Author(s):  
MR Hoque ◽  
MSA Sunny ◽  
MM Rahman
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Symptomatic Improvement ◽  
Complex Congenital Heart Disease ◽  
Lv Function ◽  
Mitral Leaflet ◽  
Posterior Mitral Leaflet ◽  
Total Preservation ◽  
First Time

Congenital mitral valve incompetence is a rare and complex congenital heart disease in children. We report, a case of a 4-year-old child admitted to hospital with fever, dyspnea on exertion or feeding and repeated respiratory infection for last 3 years. The transthoracic echocardiogram revealed grossly dilated left atrium and left ventricle and severe mitral regurgitation due to cleft in anterior mitral leaflet. Per-operatively mitral valve annulus was found very much dilated; leaflet thinned out and rudimentary posterior mitral leaflet. Morphology of mitral valve was totally distorted, leaflets were diminutive and beyond repairable. Mitral valve replacement was done with 25 mm Edward Life Science porcine tissue heart valve with total preservation of subvalvular structure and the patient showed dramatic symptomatic improvement and later follow up revealed good LV function with alleviation of symptoms. This is a rare and unusual case of congenital mitral valve disease with better prognosis after surgical replacement with tissue valve. DOI: http://dx.doi.org/10.3329/cardio.v6i2.18362 Cardiovasc. j. 2014; 6(2): 167-169

scholarly journals Single versus bilateral chordo-papillary apparatus preservation in mitral valve replacement: a hemodynamic study

2020 ◽  
Vol 2 (2) ◽  
pp. 62-69
Author(s):  
Mostafa Alaaeldin Abdelfatah Shalaby ◽  
Haytham Mohamed Abd el.Moaty ◽  
Mohamed Hossiny Mahmoud ◽  
Mohamed S H Abdallah
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Ventricular Geometry ◽  
Ventricular Ejection Fraction ◽  
Group Iii ◽  
Group I ◽  
Single Versus

Background: It has been postulated that disruption of the mitral valve apparatus at the time of mitral valve replacement (MVR) is a risk factor for postoperative ventricular dysfunction. The aim of this study was to evaluate the effect of single versus bilateral chordo-papillary preservation on the left ventricular function in comparison to no preservation. Methods: This study was conducted from 2015 to 2018 on sixty patients who had MVR. The patients were classified into group I included 20 patients who underwent MVR with complete excision of the subvalvular chordae and tips of papillary muscles, group II: included 20 patients who underwent MVR with preservation of posterior chordo-papillary apparatus, and group III: included 20 patients who underwent MVR with preservation of both posterior and anterior chordo-papillary apparatus. Results: There were 20 males (33.3%), and the mean age was 48.76± 8.91 years. Patients in group III were significantly older (37.15 ±4.92, 39.8 ± 5.49, and 57.25 ± 6.93 years in groups I, II, and III, respectively; p< 0.001). The left ventricular end-diastolic (5.40 ±0.34, 4.96 ± 0.43, and 4.44 ± 0.55 mm in group I, II and III, respectively, p<0.001) and end-systolic diameter (4.33 ±0.48, 3.58 ±0.43 and 3.20 ±0.43 mm in group I, II and III; respectively, p<0.001) were significantly reduced in partial and complete preservation groups after 6 months. Left ventricular ejection fraction improved in the bilateral preservation and partial preservation groups after 6 months (45.32 ±9.78, 56.79 ±10.14, and 56.60 ±11.68 % in groups I, II and III respectively, p<0.001). Mechanical ventilation was significantly longer in group I (24.10 ± 6.6, 16.80 ± 5.97, and 15.80 ± 5.24 hours in groups I, II and III, respectively, p<0.001) and the duration of ICU stay was significantly longer in group I (78.65 ± 15.32, 65.40 ± 14.21, and 60.20 ± 12.58 hours in groups I, II and III, respectively, p<0.001). Conclusion: Preservation of the annulo-papillary continuity may preserve left ventricular geometry and performance. Total preservation of chordae could be superior to partial preservation with better left ventricular remodeling and improvement in the left ventricular functions.

scholarly journals 89 Simultaneous ocurrence of hammock mitral valve and no-compaction cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Rodrigo ◽  
U Estandia ◽  
P Perez ◽  
C Perez ◽  
A Cortes ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Cardiac Catheterization ◽  
Mitral Valve Disease ◽  
Systolic Function ◽  
Paranoid Schizophrenia ◽  
Left Ventricular ◽  
Valve Disease

Abstract We report a 62-year-old man with a past medical history of dyslipidemia, paranoid schizophrenia and permanent atrial fibrillation. A ATTE performed at his district hospital revealed rheumatic mitral valve disease with double lesion: severe regurgitation and mild stenosis, plus moderate tricuspid regurgitation and a mean PAP of 32mm Hg. Cardiac catheterization showed no abnormalities of the coronary arteries. He was transferred to our hospital and scheduled for mitral valve replacement and tricuspid ring valvuloplasty. Preoperative transesophageal echocardiography showed an abnormal subvalvular mitral apparatus, with false tendons and multiple papillary muscles, resembling a hammock mitral valve. Most cordae tendinae arose from a single dominant papillary muscle at a posterior medial region, which provoke severe mitral regurgitation due to coaptation defect and mild subvalvular mitral stenosis. It could also be appreciated hypertrabeculation in the lateral medial, basal and apical segments. This suggested no-compaction cardiomyopathy associated with hammock mitral valve. Left ventricular systolic function was preserved. No evidence of rheumatic mitral valve disease was found in transesophageal echocardiographic study performed at our hospital. On the 30th April 2019 he underwent mechanic mitral valve replacement (Bicarbon 29mm) and tricuspid ring valvuloplasty (Edwards Physio 32mm) surgery. Once the patient was weaned from cardiopulmonary bypass, severe left ventricle systolic dysfunction ensued, predominantly localized in the anterior, inferior septal, inferior lateral basal and medial segments. Apical segments had preserved mobility An adrenalin infusion prior weaning from CBP was initiated. Preserved mobility of the mitral prosthesis discs was observed. The patient developed cardiogenic shock in spite of high doses of dobutamin and adrenaline infused. IACB was implanted with 1:1 assistance. The patient was transfered to the hemodynamic room in order to rule out coronary complications. Cardiac catheterization showed no significant angiographic lesions. During the first postoperative hours, the patient was stabilized allowing progressive lowering of the drugs (adrenaline, dobutamine). TTE showed normally functioning prosthetic mitral valve and preserved left ventricle systolic function. An MRI was performed demostrating no-compaction cardiomyopathy Conclusion This case report describes a rare presentation of simultaneous ocurrence of hammock mitral valve and no-compaction cardiomyopathy. Perioperative left ventricle dysfunction in no-compaction cardiomyopathy is related to subendocardial ischemia caused during extracorporeal circulation in the multiple prominent ventricular trabeculations with deep intertrabecular recesses corresponding to non-compacted myocardium .This must be taken account in those patients with no-compaction cardiomyopathy scheduled for cardiac surgery in order to take preventive measures. Abstract 89 Figure. non - compacted myocardium

scholarly journals Short Term Clinical Outcome in Patients with Mitral Valve Replacement with or without Preservation of Subvalvular Apparatus

2017 ◽  
Vol 12 (1) ◽  
pp. 3-7
Author(s):  
Sabrina Sharmeen Husain ◽  
Chaudhury Meshkat Ahmed ◽  
Arif Mohmmad Sohan ◽  
Sohel Mahmud ◽  
Md Mustafizur Rahman ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Age Distribution ◽  
Left Ventricular ◽  
Hospital Death ◽  
P Value ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Background: Preservation of subvalvular apparatus (SAP) during mitral valve replacement (MVR) was introduced about forty years back, but the outcome of this procedure is not well studied yet. Our study aimed to measure the in-hospital outcome of this procedure in rheumatic patients.Method: 44 patients of rheumatic heart disease undergoing for MVR in the department of cardiac surgery, BSMMU were enrolled for the study. The technique of SAP was according to choice of surgeon. Patients were divided into two groups- I) with preservation: complete preservation, where entire chordo-papillary apparatus was preserved & partial preservation, where posterior leaflet was preserved, II) no preservation: where subvalvular apparatus was completely excised. Surgical technique was different according to patient’s requirement and one of either technique was adopted by Fuster et al or Miki et al. Patients’ demographic profile and mitral valve status were recorded. Outcome was recorded in terms of hemoynamic outcome and in hospital death. Data was analyzed by Chi squired test.Result: Mean±SD of age of patients was 32±8 years, 29±7years in group-I, 36±9years in group-II. There was no significant difference in age distribution between two groups. Both groups were female predominant, 82% in group-I and 73% in group-II. Low cardiac output syndrome was observed in 4.5% of group-I and 32% in group-II (P-value was <0.001). Left ventricular failure was observed as 0% & 32% respectively (p value was <0.001). Inotropic agent was needed 45% & 75% respectively (p value was <0.01). In hospital death occurred in 4.5% & 13.5% in two groups respectively with no significant difference.Conclusion: Hemodynamic outcome and in hospital mortality was better when subvalvular apparatus was preserved during mitral valve replacement in rheumatic population.University Heart Journal Vol. 12, No. 1, January 2016; 3-7

scholarly journals Tricuspid Valve Repair: Devega’s Tricuspid Annuloplasty in Moderate Secondary Tricuspid Regurgitation

2012 ◽  
Vol 9 (1) ◽  
pp. 64-68 ◽  
Author(s):  
S Pradhan ◽  
N C Gautam ◽  
Y M Singh ◽  
S Shakya ◽  
R B Timala ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Tricuspid Regurgitation ◽  
Left Ventricular ◽  
Functional Class ◽  
Group I ◽  
Group Ii ◽  
Repair Group ◽  
Tricuspid Repair

Background Moderate secondary tricuspid incompetence has variable natural history if left unattended during mitral valve surgery. Recent data suggest progression of the secondary tricuspid incompetence over time. Secondary moderate tricuspid regurgitation in rheumatic mitral valve disease may regress after mitral valve surgery without direct intervention. Objectives: The present retrospective comparative hospital based tudy was done to assess early result of DeVega tricuspid valve annuloplasty amongst those with moderate tricuspid regurgitation due to rheumatic mitral valve disease. Methods: Group I (mitral valve replacement with tricuspid repair) and Group II (mitral valve replacement only) were compared regarding functional class, heart rate, rhythm, cardiac dimensions, function and valve pathology. The two groups were followed up at three months post-operatively and evaluated for their functional class and echocardiography variables. The data was analyzed with SPSS 16.0 Results: There were 43 patients who underwent mitral valve replacement with moderate tricuspid regurgitation. Twenty three underwent mitral valve replacement with tricuspid repair group (Group 1). Most of the patients were women (28/43). The mean age was 31.4 + 14.8 and 25.13 + 9.4 years. Group I had 21(91.3%) and Group II had 17 (85%) in NYHA class III & IV. The pre-operative echocardiographic cardiac left ventricular and left atrial dimensions, left ventricular function and valve lesions were statistically similar for both groups, except PASP was higher amongst tricuspid repair (Group 1: 38.60 + 12.75mHg, Group 2: 61.52 + 19.76mmHg; p= <0.05). At three month’s review after surgery, four patients were in NYHA II amongst those without tricuspid repair (Group II), whilst the rest were in NYHA I. Left ventricular dimensions, Left Ventricular function and valve prosthetic valve function were similar between groups. Eleven (47.8%) patients in Group I and only five (25%) of Group II had trace or less TR at the follow-up (p < 0.05). There were 7 (16.2%) patients who had persistent moderate TR. Higher PASP and larger LV dimensions at three months were predictive of persistent moderate TR. Conclusion Mitral valve replacement does decrease the severity of tricuspid regurgitation amongst those with secondary moderate tricuspid regurgitation by at least one grade, but DeVega’s annuloplasty confers a better repair result. http://dx.doi.org/10.3126/kumj.v9i1.6266 Kathmandu Univ Med J 2011;9(1):64-8

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