Mitral valve repair for severe mitral regurgitation caused by endomyocardial biopsy

Mitral regurgitation (MR) following endomyocardial biopsy is a rare and severe complication. A 70-year-old man with severe MR due to chordal injury caused by left ventricular endomyocardial biopsy is described. In this patient, a few chordae tendineae of the posterior-median papillary muscle were injured by the biopsy forceps. Due to the chordal rupture, both anterior and posterior leaflets were prolapsed and severe MR developed. MR was successfully treated by artificial chordal replacement using extended polytetrafluoroethylene sutures and ring annuloplasty. This mitral valve repair with artificial chordal replacement was considered suitable to treat MR resulting from iatrogenic chordal injury as the leaflets were not involved in the degenerative process and papillary muscle function was preserved. To avoid MR, the transvenous approach should be used routinely for endomyocardial biopsies; biopsy from the left ventricle is not justified.     

Surgical treatment of endomyocardial fibrosis with preservation of mitral valve.

A 48-year-old Kenyan African, who presented with a history of coronary and cerebral embolism, was found to have endomyocardial fibrosis of the left ventricle. It proved possible to remove all diseased tissue at operation, and at the same time to preserve the mitral valve. It is important to inspect the mitral valve from both the atrial and ventricular aspects so that the valve can be spared, if it is not involved in the disease process. The choice of transatrial of transventricular surgical approach for the removal of pathological tissue may depend on whether or not the mitral valve requires replacement.     

Mitral valve repair for significant mitral insufficiency.

There has been skepticism since the early days of open heart surgery that good long-term or even short-term results were possible with repair of pure mitral insufficiency. The authors report 145 patients in whom a markedly insufficient mitral valve was repaired 6 months to 17 years previously and another 55 patients in whom repair of the insufficient mitral valve was performed along with myocardial revascularization from 6 months to 7 years previously. Comparative data with other published work reveals superior results with repair than with replacement with Starr-Edwards and Hancock glutaraldehyde-treated porcine valves and with far less emboli. Conservatism is urged in operating upon patients with mitral insufficiency. Repair of the valve rather than replacement is stressed for those patients requiring surgery.     

小儿风湿性二尖瓣狭窄并关闭不全成型手术1例

<正>1临床资料患儿,女,7岁。因查体发现心脏杂音,反复肺部感染入院。患儿在2年前曾确诊为风湿热,自述曾被治愈出院。入院查体:患儿发育迟缓,体质量仅15.1 kg,身高110 cm,体温正常,口唇无紫绀,心前区饱满,心尖明显抬举样搏动,位于胸骨左缘第6肋间腋前线,触诊心尖搏动位置同前,胸骨左缘第4肋间可触及收缩期、舒张期震颤。未触及心包摩擦感,听诊心率100次/min,律齐,心尖区闻及全期     

Left atrial thrombosis following mitral valve repair and maze procedure: case report

The case is described of a 71-year-old woman with left atrial thrombosis after successful mitral valve repair and a Kosakai-maze procedure. At three months after surgery, electrocardiography showed a normal sinus rhythm, but echocardiography revealed a mural thrombus on the posterior wall of the left atrium. During those three months, the anticoagulation level (thrombotest index range: 29-41%) was lower than target level. Anticoagulant therapy with heparin plus warfarin failed to reduce the thrombus size. Anticardiolipin antibodies were positive, and lupus anticoagulants negative. A Doppler study of the mitral valve indicated peak velocity 1.48 m/s, mean pressure gradient 4.5 mmHg, and valve area 2.1 cm2. During reoperation, an old spherical thrombus (weight 38 g) which was firmly adhered to the posterior wall and included an incision line of the Kosakai-maze procedure, was identified and totally removed. After reoperation, the patient received warfarin and an antiplatelet agent to maintain the INR at 2.5-3.5. Echocardiography performed at 11 months postoperatively revealed no thrombus formation on the left atrium.     

Transapical off-pump mitral valve repair following prior mitral valve surgery: A case report

Rationale:Redo surgeries after mitral valve repair are technically demanding. Procedures applying the NeoChord device (NeoChord Inc, St. Louis Park, MN) have proven to be safe and feasible in selected patients requiring mitral valve repair due to a leaflet prolapse or flail. However, its use for redo procedures after conventional surgical repair has not been well established yet.Patient concerns:We report the case of a 57-year-old man who presented with dyspnea upon exertion. The patient had undergone a minimally invasive surgical mitral valve repair because of a flail leaflet of the segments segment 2 of the posterior mitral valve leaflet (P₂)/segment 3 of the posterior mitral valve leaflet (P₃) 4 years before.Diagnoses:Transesophageal echocardiography identified a relapse of severe mitral valve regurgitation. The recurring regurgitant jet was caused by a flail leaflet due to newly ruptured native chords.Interventions:After discussion in an interdisciplinary heart team, we performed a minimally invasive off-pump redo procedure applying the NeoChord device under three-dimensional transesophageal echocardiographic guidance.Outcomes:The echocardiographic result with only trivial residual mitral regurgitation as well as the further clinical course of the patient were favorable.Lessons:As redo surgery after minimally invasive mitral valve repair is challenging, the NeoChord device represents a novel treatment option that does not require cardiopulmonary bypass.     

双孔成形术治疗二尖瓣关闭不全

目的总结双孔二尖瓣成形术治疗二尖瓣关闭不全的经验。方法诊断为二尖瓣关闭不全接受此手术治疗30例，男12例，女18例，年龄14～52（33±17）岁。心功能Ⅱ级5例，Ⅲ级23例，Ⅳ级2例，用超声心动图对瓣膜进行评价。结果全组术前二尖瓣反流面积（9．8±3．5）cm^2，术后为（0．72±0．31）cm^2。全组无术后死亡，痊愈出院。随访1～48个月，效果满意，心功能为Ⅰ～Ⅱ级。结论双孔二尖瓣成形术是一种简单有效的手术方法。     

二尖瓣成形治疗小儿二尖瓣关闭不全

目的 总结小儿二尖瓣关闭不全外科矫治经验。方法 回顾近12年我院收治75例小儿二尖瓣关闭不全患,其中男31例,女44例,年龄1．5－12岁,平均7．1岁。单纯二尖瓣关闭不全8例,合并其它心血管畸形67例。二尖瓣关闭不全轻度7例,中度47例,重度21例。二尖瓣脱垂24例,瓣叶裂38例,瓣叶发育不良2例,单纯二尖瓣环扩大11例。手术在中低温体外循环心内直视下进行,行腱索缩短13例（含多根腱索缩短4例）,乳头肌缩短1例,腱索移植3例,瓣叶修复41例,瓣环成形25例,二尖瓣置换2例。同时矫正合并心血管畸形。结果 全组无手术死亡。完全矫正二尖瓣关闭不全54例（71．2％）,残留少量反流17例（23．3％）,中度反流4例（5．5％）。术后随访1．5－13年（平均7．8年）,1例术后4．5年因急性左心衰再次行人工瓣置换术,1例合并严重肺动脉高血压术后5年死于右心衰竭,1例人工瓣置换术后失访。其余患发育良好,心功能均恢复正常。结论 二尖瓣成形术治疗小儿二尖瓣关闭不全可取得良好的效果。     

Surgical treatment of biventricular endomyocardial fibrosis. A case report

The clinical, fono-mechano-echocardiographic, hemodynamic and angiographic findings before and after surgery of a patient who developed bilateral extensive endomyocardial fibrosis probably secondary to filariasis, are described. The patient was surgically treated by endocardial decortication and insertion of a mitral and tricuspid Ionescu Shiley low profile valve, which was followed by a marked subjective and objective improvement during a follow-up period of 42 months.     

Bicaval Medtronic Melody valve implantation for treatment of severe mitral regurgitation following the Mustard repair: A case report

We present a case of successful bicaval Melody valve implantation to treat severe mitral regurgitation in a 44‐year‐old man with d‐transposition of the great arteries, repaired via a Mustard operation. The patient sustained injury to the anterior mitral valve leaflet during laser extraction of a ventricular pacing lead resulting in acute, severe, symptomatic mitral regurgitation. The presence of systemic venous baffles of similar caliber to right ventricular outflow tract conduits allowed for implantation of Melody valves within each baffle. The patient remains asymptomatic with excellent Melody valve function 14 months post procedure.     

二尖瓣关闭不全的外科治疗

目的 总结二尖瓣关闭不全外科治疗的经验.方法 2001年1月至2007年7月共治疗二尖瓣关闭不全56例,男性25例,女性31例.先天性11例,风湿性3例,非风湿性42例,合并先天性心脏病19例.中度关闭不全18例,中度-重度关闭不全17例,重度关闭不全21例.病变类型腱索异常37例,如腱索断裂,缺如,一根或多根腱索延长;腱索和乳头肌异常11例;瓣叶发育异常16例;感染性心内膜炎造成的二尖瓣关闭不全3例;瓣环扩大54例.手术方式单纯腱索短缩13例,乳头肌劈开腱索包埋短缩8例,瓣叶和腱索移植5例,人工腱索再造2例.前瓣叶楔形切除或折叠9例,后叶矩形切除与sliding技术8例,缘对缘技术1例,感染性心内膜炎造成的二尖瓣损害局部修复3例.自制涤纶带环缩2例,二尖瓣环部分环缩38例,置入Duran环16例.结果 全组没有手术死亡病例.有2例在手术后8个月和15个月发生二尖瓣返流行二尖瓣瓣膜置换术;二尖瓣功能正常29例(51.79%),残留轻度关闭不全14例(25.00%),残留轻-中度关闭不全11例(19.64%).随访1～6年(2.3年),结果良好.结论 外科修复是治疗二尖瓣关闭不全的主要方法,该方法是安全,有效的,早期效果良好.     

Tropical endomyocardial fibrosis or Davies disease. A case report

Endomyocardial fibrosis is a restrictive endomyocardial myocardiopathy of unclear etiology, it is an endemic disease in tropical and subtropical countries. The patients are usually young and the disease has an insidious onset and poor prognosis. Surgery may lead to clinical improvement and prolong life expectancy, although it is only a palliative treatment and does not stop disease progression. We present a case of endomyocardial fibrosis from Equatorial Guinea with severe clinical involvement and clear improvement following surgery. The current etiopathogenic hypothesis, the results obtained and the management of these cases, which are infrequent in Spain, are discussed. We also comment upon the differences with the historically related Loeffler syndrome according to one of the etiopathogenic hypotheses.     

Massive hemolysis and acute mitral insufficiency one year following mitral valve repair. Apropos of a case

The authors report a case of massive haemolytic anaemia with acute mitral valve regurgitation and left cardiac failure, which occurred one year after surgical reconstruction of the mitral valve for rupture of smaller leaflet chordae. Anaemia, mitral regurgitation and cardiac failure disappeared after mitral valve replacement, using a Carpentier Edwards No. 29 valve. Haemolytic anaemia following mitral valve reconstruction is exceptional. It seems to be due to the suture material lying in a turbulent regurgitation stream when mitral incompetence develops again.     

Congenital uni‐leaflet mitral valve with severe stenosis: A case report with literature review

Numerical abnormalities of mitral leaflets is a special entity in congenital mitral malformations. Previously reported cases of uni‐leaflet mitral valve were primarily related to absence or dysplasia of certain leaflets. We present a case here with mitral leaflets that were not divided into anterior and posterior as usual, but developed as an integral structure instead, which is different from previously documented cases of uni‐leaflet mitral valves. Real time three‐dimensional echocardiography (RT3DE) provides a visual presentation of the abnormal mitral structure which was confirmed by surgical operation. To the best of our knowledge, this unusual form of uni‐leaflet mitral valve has not been reported yet.     

One-year outcome of percutaneous mitral valve repair in patients with severe symptomatic mitral valve regurgitation

AIM To investigate one-year outcomes after percutaneous mitral valve repair with Mitra Clip~? in patients with severe mitral regurgitation(MR). METHODS Our study investigated consecutive patients with symptomatic severe MR who underwent Mitra Clip~?implantation at the University Hospital Bergmannsheil from 2012 to 2014. The primary study end-point was all-cause mortality. Secondary end-points were degree of MR and functional status after percutaneous mitral valve repair.RESULTS The study population consisted of 46 consecutive patients(mean logistic Euro SCORE 32% ± 21%). The degree of MR decreased significantly(severe MR before Mitra Clip~? 100% vs after Mitra Clip~? 13%; P 0.001),and the NYHA functional classes improved(NYHA III/IV before Mitra Clip~? 98% vs after Mitra Clip~? 35%; P 0.001). The mortality rates 30 d and one year after percutaneous mitral valve repair were 4.3% and 19.5%,respectively. During the follow-up of 473 ± 274 d,11 patients died(90% due to cardiovascular death). A preprocedural plasma B-type natriuretic peptide level 817 pg/m L was associated with all-cause mortality(hazard ratio,6.074; 95%CI: 1.257-29.239; P = 0.012).CONCLUSION Percutaneous mitral valve repair with Mitra Clip~? has positive effects on hemodynamics and symptoms. Despite the study patients' multiple comorbidities and extremely high operative risk,one-year outcomes after Mitra Clip~? are favorable. Elevated B-type natriuretic peptide levels indicate poorer mid-term survival.     

多技术综合运用治疗复杂二尖瓣关闭不全13例

目的 总结多技术综合运用治疗复杂二尖瓣关闭不全的临床经验.方法 13例二尖瓣关闭不全且均存在2个以上反流点患者,其中男性9例,女性4例,年龄15～73 岁.病因分别为二尖瓣腱索断裂5例,二尖瓣黏液变性伴瓣叶脱垂6例,先心病继发房缺1例,冠心病伴二尖瓣乳头肌功能不全1例.二尖瓣反流程度中度4例、重度9例.术中联合应用二孔化成形、后瓣矩形切除、腱索转移、腱索缩短、人工腱索置入、人工瓣环置入等技术修补二尖瓣使其恢复功能.结果 本组无住院死亡病例,术后1周心脏彩超复查示二尖瓣无任何反流或微量反流8例,轻度返流5例,随访的患者中1例术后9个月二尖瓣由微量反流增加至中度反流,并患急性重症肝炎死亡.其余患者随访情况良好,心功能明显改善.结论 合理综合应用二孔化成形、人工腱索等多种技术治疗复杂多区域二尖瓣反流,近、中期疗效满意.     

Anterior leaflet augmentation with autologous pericardium for mitral repair in rheumatic valve insufficiency

BACKGROUND AND AIM OF THE STUDY: The mechanism of insufficiency in rheumatic valve disease includes annulus dilatation and restricted leaflet motion. In order to improve the treatment of restriction, the anterior mitral leaflet (AML) can be augmented with a piece of glutaraldehyde-treated autologous pericardium. METHODS: Between January 1995 and December 1999, among 274 patients referred for rheumatic mitral disease, 143 (52%) underwent a valve repair. Of these patients, 81% had pure regurgitation and 19% had significant associated stenosis. Ring annuloplasty was used in all cases. Techniques used to treat the restrictive component of the regurgitation were compared in two consecutive cohorts of patients, either with (n = 62) or without (n = 81) AML augmentation. Mean patient age was 42 +/- 3 years, and all preoperative variables were comparable except for the incidence of redo patients, who all underwent AML extension. RESULTS: In-hospital mortality was 0.7% (n = 1 with AML extension), and there was one early reoperation for pericardial patch dehiscence. After a mean follow up of 3.2 years, there was one sudden death (no AML extension). The reoperation rate was lower with (2.5%) than without (12.9%) AML augmentation (p <0.05). Echocardiography showed a lower incidence in recurrence of mitral insufficiency when AML augmentation was performed (grade 2, 9% versus grade 3, 3%) as compared to no AML augmentation (grade 2, 35% versus grade 3, 14%) (p <0.05). The mitral orifice area was larger (AML augmentation 2.2 +/- 0.3 cm versus no AML augmentation 1.8 +/- 0.4 cm2). CONCLUSION: Ring annuloplasty alone failed to correct rheumatic mitral insufficiency in all cases. AML augmentation improved the quality of the repair, and decreased the risk of reoperation.