二尖瓣置换术后巨大左室的几何形态学变化及其与左室收缩功能的关系

目的　动态观察二尖瓣置换术后巨大左室的几何形态学变化 ,探讨其与左室收缩功能变化的关系。方法　回顾性分析 1991年 1月至 2 0 0 0年 12月间 2 7例巨大左室病人施行二尖瓣置换术后的超声心动图随访资料。结果　二尖瓣重度关闭不全引起的巨大左室主要以离心性扩大为主 ,换瓣术后左心室显著呈进行性缩小 ,至术后 2年心肌肥厚基本逆转 ,但左心室形态多半仍未能缩小至正常范围。术后 6个月左室射血分数和短轴内径缩短率的变化主要与术中保留瓣下结构和术前左室后壁厚度呈正相关 ,与左室收缩末直径 (LVDs)或容积 (ESV)呈负相关 (P <0 0 1)。结论　对于二尖瓣关闭不全合并巨大左室者 ,争取尽早手术 (LVDs≤ 6 0cm或ESV≤ 15 0ml前 )以及术中保留瓣下结构 ,有利于术后左心室形态的逆转和左心收缩功能的恢复。     

主动脉瓣置换术后室间隔厚度对主动脉瓣跨瓣压差的影响

目的 探讨主动脉瓣置换术后室间隔厚度对主动脉瓣跨瓣压差的影响.方法 2005年1月至2010年12月,接受主动脉瓣置换术患者273例,全部为单纯主动脉瓣狭窄.根据手术时使用的主动脉瓣不同品牌,将患者分为3组:Regent组、On-x组、其他品牌组.定义术后跨瓣压差大小为:轻度(0～30 mm Hg,1 mm Hg=0.133 kPa)、中度(30 ～60 mm Hg)及重度(大于60 mm Hg).分别比较术前、术后测量的左心室收缩期末径、左心室舒张期末径、左心室射血分数(EF值)和室间隔厚度.结果 3组患者术前的左心室收缩期末径、左心室舒张期末径及EF值差异无统计学意义(P＞0.05).Regent组患者,术后跨瓣压差为重度的患者术前室间隔厚度明显多于轻、中度(P＜0.05).使用On-x组患者,术后跨瓣压差为重度与中度的患者术前室间隔厚度者明显多于轻度组(P＜0.05).其他品牌组患者,术后跨瓣压差为重度的患者术前室间隔厚度明显多于中、轻度组(P＜0.05).结论 行主动脉瓣置换术后,术前室间隔厚度大于13.6 mm的患者其主动脉瓣跨瓣压差较厚度小于13.6 mm的患者显著增高.室间隔厚度大于15.3 mm的患者,应同期行室间隔部分切除或替换无支架瓣膜以减少主动脉瓣替换后的跨瓣压差.     

主动脉瓣置换术前合并中度功能性二尖瓣关闭不全治疗策略的回顾性队列研究

目的 分析主动脉瓣置换术(aortic valve replacement,AVR)同期不同方式处理中度功能性二尖瓣关闭不全(functional mitral regurgitation,FMR)对患者预后的影响.方法 回顾性纳入2014～2018年在本中心接受AVR且合并中度FMR的118例患者,其中男84例、女3...     

巨大左心室主动脉瓣置换术的远期疗效--125例随访报告

目的随访巨大左心室单纯主动脉瓣置换术治疗的远期疗效,并分析其影响因素.方法对125例左心室舒张末径(LVDD)大于70mm行主动脉瓣置换手术的病人采用信访、电话随访和门诊复查相结合的方法进行长期随访.终止日期为1998年12月,随访时间为1～14年,平均(6.6±3.4)年.随访到123例,完整随访率为98.4%.结果远期死亡15例,5年生存率为90.1%,10年生存率为81.2%.瓣周漏5例,生物瓣坏损再次置换5例.3年及5年免除心脏事件发生率为87.3%和79.4%.随访结果与术前及术后早期结果进行统计学处理,LVDD、左室射血分数(LVEF)及心功能等指标均显著改善(P＜0.05).死亡组术前的LVDD和LVEF与生存组对比差异存在显著性.多因素相关分析显示,LVEF小于0.40、LVDD大于85mm为独立相关危险因素(P＜0.05).结论巨大左心室单纯主动脉瓣病变行主动脉瓣置换手术,远期疗效良好.左心室扩大的可复性,应从术前LVEF、LVDD、病变性质、年龄等因素综合考虑.     

亚急性心肌梗死合并重度缺血性功能性二尖瓣关闭不全的处理方式探讨

目的 探讨亚急性心肌梗死合并重度二尖瓣关闭不全患者的处理方法及手术时机. 方法 2005年1月至2011年12月北京安贞医院采用外科手术治疗89例亚急性心肌梗死合并重度二尖瓣关闭不全患者[男66例,女23例；平均年龄64(55～73)岁].所有患者手术前先用药物治疗3个月后行单纯冠状动脉旁路移植术,二尖瓣病变未做处理.就诊时、术前和术后6个月做超声心动图检查,观察二尖瓣反流情况,并检测左心室收缩期末内径、左心室舒张期末内径和左心室射血分数(LVEF). 结果 无手术死亡,无围术期心肌缺血和其它严重并发症发生.随访81例(91.0％),随访时间6～60个月,术后6个月二尖瓣反流面积[(3.1±1.3) cm2 vs.(5.6±2.3)cm2]、左心室舒张期末内径[(51.3±4.2) mm vs.(54.3±5.5)mm]和左心室收缩期末内径[(31.7±3.9) mm vs.(34.6±4.3) mm]均较术前明显减小(P＜0.05),而术后6个月LVEF与术前比较差异无统计学意义(59.1％±3.9％vs.58.9％±5.6％,P＞ 0.05).术后3年起,随访患者每年行冠状动脉血管CT检查1次,未发现移植血管存在明显狭窄(狭窄＞50％). 结论 对亚急性心肌梗死合并重度二尖瓣关闭不全患者,适当的延缓手术,结合正确的药物治疗,可能不再需要同期处理二尖瓣病变,可降低手术风险,减少医疗费用.     

左心室功能受损低压力阶差主动脉瓣狭窄外科干预的近中期疗效

目的研究左心室功能受损低压力阶差主动脉瓣狭窄程度的简便评估方法,探讨该类患者行主动脉瓣置换术的临床指征及疗效。方法回顾性分析2011年1月至2014年5月我院21例左心室功能受损低压力阶差主动脉瓣狭窄患者外科治疗的临床资料,其中男15例、女6例,年龄41~66(54.6±10.7)岁。主动脉瓣平均跨瓣压差40 mm Hg,左心室射血分数(leftventricular ejection fraction,LVEF)50%。结果对多巴酚丁胺试验有反应的20例患者均行主动脉瓣置换术,术中见主动脉瓣二叶瓣畸形11例,退行性改变5例,风湿性心脏病4例,同期行心房颤动射频消融术3例、升主动脉置换术1例、冠状动脉旁路移植术2例、二尖瓣成形术1例。1例并发多脏器衰竭术后第4 d死亡,其余患者康复出院。术后随访3~37个月,心功能分级(NYHA)多数改善为Ⅰ或Ⅱ级。术后3个月超声心动图复查示人工瓣膜功能状态良好,LVEF由术前的35.7%±8.2%提高至49.4%±7.2%。1例患者术后11个月不明原因猝死。结论对多巴酚丁胺超声负荷试验显示为真性重度主动脉瓣狭窄且左心室具备收缩储备能力的患者行主动脉瓣置换术后,梗阻解除,左心室后负荷明显下降,左心室功能也随之好转,术后LVEF及生活质量明显改善。     

影响缺血性心肌病血运重建后左心室射血分数的多因素分析

目的探讨如何筛选出血运重建后左心室射血分数(LVEF)明显增加的缺血性心肌病(ischaemic cardiomyopathy,ICM)患者。方法回顾性分析我院2010年7月至2015年12月期间,245例行冠状动脉旁路移植术(coronary bypass grafting,CABG)(30%≤LVEF≤40%),其中合并缺血性二尖瓣反流146例(146/245,59.6%),有41例患者因中度以上的缺血性二尖瓣反流而同时行二尖瓣成形术/置换术。围术期死亡13例(12例为CABG+二尖瓣成形术或置换术,1例为单纯行CABG术),余232例随访6个月以上为研究对象,根据术后LVEF是否增加10%分为两组,即LVEF恢复组(A组)124例,LVEF不恢复组(B组)108例。结果单因素分析发现A组术前NT-proBNP值明显高于B组(P=0.036),有心肌梗死病史的比例明显低于B组(P=0.047),而术前仍有心绞痛的比例明显高于B组(P=0.024)。两组之间的二尖瓣反流程度及二尖瓣成形术或置换术比例差异无统计学意义(P=0.199)。A组患者的左心室舒张期末内径(LVEDD)、左心室收缩期末内径(LVESD)、左室舒张期末容积(LVEDV)均明显低于B组(P0.05)。多因素分析发现LVEDD明显增大、术前无明显心绞痛是ICM(30%≤LVEF≤40%)患者行血运重建后LVEF不能恢复的术前危险因素。以245例患者(包括13例围术期死亡患者)为研究对象,其LVEDD为41～71 mm,发现LVEDD≥60 mm与ICM患者的预后不良有显著关系(χ2=8.63,P=0.003,OR=2.21,95%CI 1.25～3.91)。结论发现LVEDD明显增大、术前无明显心绞痛是ICM(30%≤LVEF≤40%)患者行血运重建后LVEF不能恢复的术前危险因素。LVEDD≥60 mm可以作为ICM(30%≤LVEF≤40%)患者预后不良的术前临床筛选指标之一。     

部分可曲性人工二尖瓣瓣环成形技术的临床应用

目的 总结部分可曲性人工二尖瓣瓣环成形技术治疗二尖瓣关闭不全疾病的临床应用经验,探讨其治疗效果.方法 回顾性分析我院1998年1月～2006年8月施行部分可曲性人工瓣环二尖瓣成形术治疗259例二尖瓣疾病患者的临床资料,二尖瓣疾病的病理分类为风湿性二尖瓣狭窄或关闭不全16例,二尖瓣感染性心内膜炎16例,缺血性二尖瓣关闭不全13例,先天性二尖瓣关闭不全40例,退行性二尖瓣关闭不全174例.围术期采用超声心动图监测左心房(LA)、左心室舒张期末内径(LVEDD)、左心室收缩期末内径(LVESD)、左心室射血分数(LVEF)和左心室短轴缩短分数(LVFS)等指标;观察并记录围手术期和随访中生存率、二尖瓣反流率、二次手术率.结果 259例患者主动脉阻断时间为74±30min,体外循环时间为105±37min.术后围术期生存率为96.5%(250/259),无脑、肝、肾等重要器官并发症发生率为93.4% (242/259),无左室流出道梗阻、冠状动脉狭窄发生.术后随访45±28个月,随访60个月时的生存率为93.8%(243/259);无二次手术率为96.1%(249/259).术后LVEDD由术前的62.60±10.19mm缩小至52.88±8.67mm, LVEF由术前的57.91%增加为61.00%,均较术前明显改善(P＜0.05).随访中无或微量反流188例(72.6%),轻度反流62例(23.9%),中度反流8例(3.1%),重度反流1例(0.4%),二尖瓣反流程度较术前得到明显改善(P＜0.05).结论 这种部分可曲性人工二尖瓣瓣环成形技术操作简单,临床效果良好.     

主动脉瓣重度狭窄伴左心室收缩功能受损患者的外科疗效分析

目的分析主动脉瓣置换术在治疗主动脉瓣重度狭窄伴左心室收缩功能受损患者中的疗效。方法回顾性分析2000年1月至2011年12月在第二军医大学长海医院接受手术治疗的主动脉瓣重度狭窄伴左心室收缩功能受损[左心室射血分数（LVEF）〈50％]患者的临床资料,排除二尖瓣狭窄患者。共纳入29例患者,男22例、女7例,年龄14～76（56.3±12．9）岁。将患者手术前后临床及心脏超声心动图相关指标进行比较,评价手术效果,并根据患者LVEF恢复情况,分析可能影响患者术后心脏功能恢复的危险因素。结果术后早期死亡1例。其余28例患者术后主动脉瓣跨瓣压差由（97．6±25．1）mmHg降至（25．0±9．7）mmHg,LVEF由41％±6％增加至56％±11％,左心室舒张／收缩期末直径／容积均较术前明显改善（P均〈0．001）。结论主动脉瓣膜置换术是主动脉瓣重度狭窄伴左心室收缩功能受损患者的有效治疗方法,术后左心室超声指标显著改善。术前左心室扩大程度较低可能更利于术后LVEF的恢复。     

主动脉瓣关闭不全合并巨大左心室外科治疗的危险因素分析及远期结果

目的探讨主动脉瓣关闭不全合并巨大左心室患者外科治疗的适应证、危险因素及远期结果。方法回顾性分析了2004年3月至2012年12月共收治主动脉瓣关闭不全合并巨大左心室患者42例(左心室舒张期末内径≥70mm和左心室收缩期末内径≥50mm)的临床资料。其中男38例、女4例,年龄16~73(45.86±14.99)岁。所有患者均行主动脉瓣置换术,术前、术后1周、术后3个月行超声心动图检查,并对患者随访12~132个月,分析影响术后心功能恢复及导致死亡的危险因素。结果术后早期死亡1例,远期死亡5例。41例患者术后1周经胸超声心动图检查,左心室舒张期末内径(62.00±13.21)mm、左心室收缩期末内径(50.71±14.02)mm、左心室舒张期末内径指数(35.23±8.58)mm/m~2、左心室收缩期末内径指数(28.92±9.08)mm/m~2,与术前相比均明显减小(P0.01)。左心室射血分数(46.41%±12.4%)明显低于术前(P0.01)。术前心功能分级、射血分数、左心室舒张期末内径、左心室舒张期末内径指数是预测术后早期左心室功能恢复的预测因子。左心功能不全及室性心律失常是导致术后死亡的危险因素。术后1年、5年、10年生存率分别为92.9%、90.2%和83.8%。结论大多数主动脉瓣关闭不全合并巨大左心室患者仍有手术指征,术后疗效满意。但术前左心功能不全、室性心律失常是影响手术疗效和远期存活的危险因素。     

Reverse left ventricular remodelling after aortic valve replacement for severe aortic insufficiency

 Open in a separate windowOBJECTIVESThe goal of this study was to investigate the long-term outcome of aortic valve replacement (AVR) for severe aortic insufficiency with a focus on pre- and postoperative left ventricular (LV) function to explore predictive factors that influence the recovery of LV function and clinical outcome.METHODSA total of 478 patients who underwent AVR for pure severe aortic insufficiency were grouped according to the preoperative echocardiographical LV ejection fraction (EF): low (LO) EF <35% (n = 43), moderate EF 35–50% (n = 150) or normal EF >50% (n = 285).RESULTSActuarial survival at 10 years post-AVR was 64% with a LO EF, 92% with a moderate EF and 93% with a normal EF (P = 0.016), whereas 10-year rates of freedom from major adverse cerebral and cardiovascular events were 47%, 79% and 84%, respectively (P < 0.0001). Echocardiography at 1 year post-AVR demonstrated that EF substantially improved in all groups. We noted a significant difference in survival (P = 0.0086) and in freedom from major adverse cerebral and cardiovascular events (P = 0.024) between patients with an EF ≥35% and those with an EF <35% in the LO EF group. The multivariable logistic regression model showed that predictive factors for lack of improvement in EF 1 year post-AVR in the LO EF group included plasma brain natriuretic peptide >365 pg/mL (P = 0.0022) and echocardiographic LV mass index) >193 g/m² (P = 0.0018).CONCLUSIONSLong-term outcome post-AVR for severe aortic insufficiency was largely influenced by preoperative LV function. Predictive factors of failure to recover ventricular function post-AVR included EF <25%, pre-brain natriuretic peptide >365 pg/mL or LV mass index >193 g/m².     

Long-term results for aortic valve replacement with small aortic annulus

We determined whether aortic prosthesis size influences survival and hemodynamic function. Eighty-nine patients who underwent small aortic valve replacement were followed. The small internal orifice area index (IOAI) group was defined as having an internal orifice area/body surface area ratio of < or = 1.3 cm(2)/m(2) (n = 34). The control group was defined as having an IOAI >1.3 cm(2)/m(2) (n = 55). The actuarial survival rate at 10 years was 74.5% in the small IOAI group and 75% in the control group (NS). Freedom from valve-related impairment at 10 years was 87% in the small IOAI group and 85% in the control group (NS). Postoperative pressure gradients were higher in the small IOAI group (p < 0.05). Left ventricular mass index decreased in both groups (albeit nonsignificantly in the small group, but significantly decreased in the control group). The long-term results of aortic valve replacement for patients with small aortic annulus were satisfactory. However, the postoperative pressure gradient through the prosthesis and left ventricular hypertrophy remained at a high level in the small IOAI group.     

Relationship between aortic valve sclerosis and left ventricular hypertrophy in chronic haemodialysis patients

Background Cardiac valve calcification is a frequent finding in chronic haemodialysis patients. Left ventricular hypertrophy (LVH) is a significant predictor of cardiovascular mortality in patients with end-stage renal disease. We evaluated the influence of aortic valve sclerosis (AVS) on the development of LVH in chronic haemodialysis patients. Methods A total of 82 consecutive patients (52 male, mean age 48 ± 12 years) undergoing chronic haemodialysis treatment for >1 year were subjected to echocardiography for the screening of AVS and the assessment of transaortic flow velocity and the left ventricular mass index (LVMI). The absence (group 1, n = 42) and presence of AVS (group 2, n = 40) was established. The average values of systolic, diastolic and pulse pressure were obtained. Plasma calcium, phosphorus, intact parathyroid hormone, C-reactive protein, haemoglobin and lipid levels were also measured. Results LVH was detected in 59 (72%) of the study patients. The LVMI was higher in the AVS group (171 ± 39 vs. 132 ± 41 g/m², p < 0.001). Patients with AVS also had higher transaortic flow velocities (1.64 ± 0.36 vs. 1.21 ± 0.21 m/s, p < 0.01) and maximal pressure gradients (10.8 ± 7.1 vs. 5.9 ± 3.4 mmHg, p < 0.01). The LVMI showed a direct correlation with transaortic flow velocity in the AVS group (r = 0.60, p < 0.01). Stepwise linear regression analysis revealed transaortic flow velocity (p = 0.02), pulse pressure (p = 0.01) and haemoglobin levels (inverse relationship) (p = 0.02) to be independent predictors of the LVMI. Conclusion These data suggest that AVS is strongly and independently interrelated with LVH in chronic haemodialysis patients. The underlying mechanism might be the valve resistance to left ventricular outflow, as shown by increased transaortic flow velocities and maximal pressure gradients in AVS patients.     

异氟醚预处理对心脏联合瓣膜置换术患者左心功能的影响

目的观察异氟醚预处理对心脏手术患者左心功能的影响。方法择期二尖瓣和主动脉瓣联合置换术患者30例,随机均分为两组:G组麻醉诱导后吸入1.1%~1.2%的异氟醚30min,洗脱15 min;C组不吸入异氟醚作为对照。于吸入异氟醚前(T0)、主动脉开放30 min(T1)、关胸后(T2)、主动脉开放6 h(T3)、12 h(T4)和24 h(T5)通过肺动脉导管观察相关左心功能指标,于T0、T1、T3~T5时测血浆N端脑钠素前体肽(NT-proBNP)浓度。结果与T0时比较,两组MAP在T1~T4、肺动脉阻塞压(PAOP)在T2~T5、全身血管阻力(SVR)在T1~T5时均降低(P0.05或P0.01),两组每搏指数(SI)、心脏指数(CI)和左心室每博做功指数(LVSWI)在T1~T5时均升高(P0.05或P0.01)。与C组比较,G组PAOP在T5时降低,混合静脉血氧饱和度(SvO2)在T2~T5时升高,SI在T4、T5时升高,CI和LVSWI在T3~T5时升高,NT-proBNP在T4、T5时降低。结论异氟醚预处理对心脏联合瓣膜置换术患者主动脉开放12~24 h左心功能可能有改善作用。     

主动脉瓣关闭不全合并巨大左心室麻醉的处理

目的 总结既往主动脉瓣关闭不全合并巨大左心室的麻醉经验.方法 术前30 min肌注吗啡10 mg,东莨菪碱0.3 mg.根据患者反应和血流动力学变化,静脉给予依托咪酯0.1～0.2mg/kg,舒芬太尼1μg/kg,哌库溴铵0.1 mg/kg分次给药,缓慢诱导经口明视插管.根据血气结果调整呼吸参数,维持术中血气在正常范围.吸入1.0%～1.5%异氟醚,间断静脉注射舒芬太尼和哌库溴铵维持麻醉.连续监测心电图、有创血压、脉搏血氧饱和度、呼吸末二氧化碳分压、中心静脉压、体温.结果 术后均无室颤及其他恶性心律失常发生,均康复出院.结论 术前处理重点保证足够的前负荷,维持较快的心率,适度减轻后负荷,适度强心.术后处理重点保证足够的前负荷,早期继续使用多巴胺等正性肌力药物进行辅助,使用硝酸甘油扩张冠脉.     

超声心动图评价小主动脉瓣环者机械瓣置换术后的心功能改变

目的 探讨小主动脉瓣环病人行瓣膜置换术后的心功能改变。方法 1996年1月至1998年12月间,21例主动脉瓣置换外径≤20mm机械瓣的病人,用彩色多普勒超声仪对左心功能进行术前、术后监测,并与21例置换外径≥23mm机械瓣病人进行对比。结果 小主动脉瓣环者行瓣膜置换术后的左心功能指标较术前明显好转,左室射血分数、左室缩短分数、心室间隔厚度与后壁厚度之比有所上升,左室重量指数、左室壁厚度与左室腔半径之比及主动脉跨瓣压差均有不同程度降低。但与置换较大外径主动脉瓣病人的指标仍有差别。结论 置换较小外径的主动脉瓣,术后左心功能仍可有明显改善。     

Changes in patterns of left ventricular hypertrophy after aortic valve replacement for aortic stenosis and regurgitation with St. Jude Medical cardiac valves

In this study, we analyzed the extent and pattern of regression of left ventricular (LV) hypertrophy after aortic valve replacement in patients with aortic stenosis (AS) and compared the results with those of another group of patients with aortic regurgitation (AR). Seventy patients who underwent isolated aortic valve replacement were divided into 2 groups. Group 1 was comprised of 29 patients who underwent aortic valve replacement for aortic stenosis, and Group 2 of 41 patients who underwent aortic valve replacement for aortic regurgitation. A third group of 10 healthy subjects served as a healthy control group. Echocardiographic studies were done before the operation and 5 years postoperatively. At follow-up, a significant reduction in the left ventricular mass was found in both groups, but it remained significantly greater than in the healthy control group. The ratio of LV wall thickness to radius (th/r) in Group 1 decreased significantly, and at follow-up it was within the normal value. In Group 2, the th/r ratio increased, and at follow-up it was within the normal value. After aortic valve replacement, the wall thickness remained significantly greater than normal for patients with AS, and the chamber radius remained significantly greater than normal for patients with AR. For these reasons, LV hypertrophy still existed in both groups at postoperative follow-up. The actuarial survival rate was 85.3% at 16 years for Group 1 and 83.4% at 18 years for Group 2. There was no significant difference in the long-term survival rates between the 2 groups. Actuarial freedom from valve-related events was 91.9% at 16 years for Group 1 and 82% at 18 years for Group 2. There was no significant difference in the valve-related event free curves between groups. After 5 years of follow-up, th/r reached normal for both groups, indicating remodeling of the LV geometry after aortic valve replacement.     

Left ventricular pseudoaneurysm following mitral valve repair

We present a rare case of a left ventricular pseudoaneurysm following mitral valve repair probably due to testing the valve’s competence. The pseudoaneurysm was treated successfully with a sutureless technique in which layers of a biodegradable collagen system with fibrinogen-based coating were used. We reviewed the literature regarding left ventricular rupture following mitral valve surgery published from 1990 until 2006. Overall, the incidence of this complication was 0.56% for 10978 operations, and the mortality rate was 57.4%. We also describe a possible mechanism common to all forms of left ventricular rupture.     

Accessory mitral valve associated with aortic regurgitation in an elderly patient: report of a case

We encountered a 75-year-old man who complained of exertional dyspnea. An echocardiographic examination showed aortic regurgitation and a tumor in the left ventricular outflow tract. Under complete extracorporeal circulation, we surgically made an incision of the ascending aorta with a slight thickening of the aortic valve and an enlarged annulus. After excising the aortic valve, an examination of the subvalvular region revealed mitral valve-like tissue extending from the annular region of the right coronary cusp to the ventricular septum, while the chordae tendinae was attached to the septum. This issue was excised, and the aortic valve was replaced with a 27-mm SJM valve. The postoperative course was uneventful, and the patient was discharged in good condition on postoperative day 30. An accessory mitral valve is extremely rare. Since this indication for surgical treatment is associated with congenital heart disease or a left ventricular outflow tract obstruction, most patients are young. Our patient had no associated cardiac anomalies and no pressure gradient attributable to a left ventricular outflow tract obstruction. This accessory mitral valve was discovered during aortic valve replacement surgery. To our knowledge, our patient is the oldest reported with an accessory mitral valve to have undergone a surgical resection.     

Left ventricular unloading in a patient with end-stage cardiomyopathy and medically unresponsive pulmonary hypertension

Severe, medically unresponsive pulmonary hypertension (PHT) is considered to be a contraindication for orthotopic heart transplantation (OHT). Chronic left ventricular (LV) unloading using a left ventricular assist device (LVAD) might result in reversal of the elevated pulmonary vascular resistance (PVR), allowing successful OHT in such patients. In this study, we present a patient with end-stage ischemic cardiomyopathy and fixed, elevated PVR (7.1 Wood units) who underwent implantation of a Novacor LVAD (Baxter Healthcare Corp., Deerfield, IL, U.S.A.), with a subsequent reduction in PVR to 1.2 Wood units and successful OHT eleven months post-LVAD implantation. Three years after heart transplant, the patient still leads an active life with no right heart failure. In conclusion, OHT is not contraindicated in patients with end-stage heart failure and medically unresponsive PHT in the presence of elevated left atrial pressure. Left ventricular unloading should be considered in these patients to allow reversal of the elevated PVR before OHT.