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1.
" href="/content/?Author=J%c%brg-Friedrich+Onnasch%cORF+RID%d%A%%e">J?rg-Friedrich Onnasch " href="/content/?Author=Felix+Schneider%cORF+RID%d%A%%e">Felix Schneider " href="/content/?Author=Marco+Mierzwa%cORF+RID%d%A%%e">Marco Mierzwa " href="/content/?Author=Friedrich+Wilhelm+Mohr%cORF+RID%d%A%%e">Friedrich Wilhelm Mohr 《Zeitschrift für Kardiologie》2001,2(5):VI75-VI80
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Marian Urban Jan Pirk Ondrej Szarszoi Ivo Skalsky Jiri Maly Ivan Netuka 《Experimental & Clinical Cardiology》2013,18(1):22-26
BACKGROUND:
Double valve replacement for concomitant aortic and mitral valve disease is associated with substantial morbidity and mortality. Excellent results with valve repair in isolated mitral valve lesions have been reported; therefore, whether its potential benefits would translate into better outcomes in patients with combined mitral-aortic disease was investigated.METHODS:
A retrospective observational study was performed involving 341 patients who underwent aortic valve replacement with either mitral valve repair (n=42) or double valve replacement (n=299). Data were analyzed for early mortality, late valve-related complications and survival.RESULTS:
The early mortality rate was 11.9% for valve repair and 11.0% for replacement (P=0.797). Survival (± SD) was 67±11% in mitral valve repair with aortic valve replacement and 81±3% in double valve replacement at five years of follow-up (P=0.187). The percentage of patients who did not experience major adverse valve-related events at five years of follow-up was 83±9% in those who underwent mitral valve repair with aortic valve replacement and 89±2% in patients who underwent double valve replacement (P=0.412). Age >70 years (HR 2.4 [95% CI 1.1 to 4.9]; P=0.023) and renal dysfunction (HR 1.9 [95% CI 1.2 to 3.7]; P=0.01) were independent predictors of decreased survival.CONCLUSIONS:
In patients with double valve disease, both mitral valve repair and replacement provided comparable early outcomes. There were no significant differences in valve-related reoperations, anticoagulation-related complications or prosthetic valve endocarditis. Patient-related factors appear to be the major determinant of late survival, irrespective of the type of operation. 相似文献3.
《Zeitschrift für Kardiologie》2001,90(18):VI75-VI80
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目的报道一组风湿性心脏病二尖瓣置换术后房性心动过速(房速)的机制及射频消融效果。方法共入选22例(男8例)二尖瓣置换术后持续性房速患者,在心动过速状态下采用三维电解剖系统建立右心房或左心房激动标测图和电压图,标出瘢痕区、低电压区及双电位区,并揭示心动过速的机制。根据标测结果选择心动过速的关键峡部或起源点进行消融。结果22例患者共标测33种心动过速,17例次房速起源于右心房(51.5%),16例次房速起源于左心房(48.5%)。符合大折返机制的31例次(93.9%),符合局灶起源机制的2例次(6.1%)。消融术中即时成功率90.9%(20/22)。随访过程中5例患者仍有房速发作,3例再次消融成功。结论二尖瓣置换术后房速机制复杂且个体化,在三维电解剖标测指导下射频消融治疗效果满意。 相似文献
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von Oppell UO Stemmet F Brink J Commerford PJ Heijke SA 《The Journal of heart valve disease》2000,9(1):64-73; discussion 73-4
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Relatively little attention has been paid to the frequency of atrial fibrillation (AF) in patients with mitral regurgitation (MR) secondary to mitral valve prolapse (MVP). We reviewed clinical, electrocardiographic, echocardiographic, hemodynamic, and angiographic findings in 246 patients aged 21 to 84 years (mean 61) (66% men) who had mitral valve repair or replacement for MR secondary to MVP. Immediately before the mitral operation by electrocardiogram, only 37 patients (15%) had AF and the other 209 patients were in sinus rhythm. Of the latter, 32 had had a history of AF that had reverted to sinus rhythm spontaneously or with antiarrhythmic therapy. Thus, a total of 69 patients (28%) had AF at some time. In conclusion, the frequency of AF in patients with MR secondary to MVP and sick enough to warrant a mitral valve operation have a relatively low frequency of AF (persistent in 15%, paroxysmal in another 13%), percentages considerably lower than that seen in patients with mitral stenosis just before a mitral commissurotomy or replacement. 相似文献
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Sud A Lester JL Lakier JB 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》1984,11(3):308-312
Acquired intracardiac shunt after prosthetic valve replacement is a rare complication, and reoperation for correction of this disorder carries a high mortality rate. We report such a case of left ventricular-right atrial fistula after mitral valve replacement in which the patient died of multiple complications. Awareness, prevention, and early diagnosis are, therefore, extremely important. 相似文献
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Chen Jindong Wang Hao Xie Xiaoyi Dai Huangdong Zhou Mengmeng Zheng Yue Zhao Liang 《Journal of thrombosis and thrombolysis》2021,51(1):129-135
Journal of Thrombosis and Thrombolysis - The aim of this study was to evaluate the risk factors and characteristics of long-term postoperative left atrial (LA) thrombi after mitral valve... 相似文献
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Santana O Lamelas J 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》2011,38(3):298-300
Herein, we report the case of a 77-year-old man who presented with congestive heart failure. Echocardiography and cardiac catheterization revealed severe aortic stenosis with severe mitral regurgitation and a left ventricular ejection fraction of 0.20. Because of comorbidities, the patient was considered to be at high risk for double-valve surgery. In order to reduce the operative risk, a minimally invasive aortic valve replacement was performed together with a transaortic edge-to-edge repair (Alfieri stitch) of the mitral valve. We discuss the surgical technique and note the positive outcome. To our knowledge, this is the 1st report of minimally invasive aortic valve replacement and transaortic mitral valve repair with use of the Alfieri stitch. 相似文献
10.
Al-Shimaa Mohamed Sabry Heba Abd El-Kader Mansour Tarek Helmy Abo El-Azm Shimaa Ahmed Mostafa Basant Samy Zahid 《The Egyptian Heart Journal》2017,69(4):281-288
Objectives
Detection of the echocardiographic predictors of post-operative atrial fibrillation in patients with rheumatic mitral valve disease undergoing mitral valve replacement.Methods
The study included 50 patients with rheumatic mitral valve disease undergoing mitral valve replacement. Preoperative assessment included standard two-dimensional echocardiography to assess LA diameter, volume, and emptying fraction, LV volume and ejection fraction. TDI derived velocity, strain of the left atrium and speckle tracking to assess left ventricular function then postoperative follow up for 1 month for occurrence of atrial fibrillation.Results
The incidence of postoperative AF was 44%; these patients were significantly older (P = 0.001) and show higher prevalence of DM (P = 0.001) and HTN (P = 0.001). Also, LA diameters (antero-posterior, transverse and longitudinal) and LA volumes (maximal and minimal) were increased (P < 0.001), but no difference in LA emptying fraction (P > 0.05). Systolic LA strain and left ventricular global longitudinal strain were significantly reduced in those patients (P value <0.001). Echocardiographic predictors of AF were LA systolic strain (P value <0.001) and LV global longitudinal strain (P value = 0.003). Cutoff value for systolic LA strain ≤23 had sensitivity 90.91% and specificity 93.33% in predicting POAF. While, left ventricular global longitudinal strain ≤?14.9% had sensitivity 63.6% and specificity 100.0% in predicting AF.Conclusion
LA systolic strain and LV global longitudinal strain were significant predictors of POAF. Echocardiographic parameters can identify patients at greater risk of developing POAF who can benefit from preventive measure and guide the selection of prosthesis. 相似文献11.
Ablation of atrial fibrillation with mitral valve surgery 总被引:1,自引:0,他引:1
Gillinov AM 《Current opinion in cardiology》2005,20(2):107-114
PURPOSE OF REVIEW: Recent advances in understanding of the pathogenesis of atrial fibrillation and development of new technology have resulted in a surge of interest in the surgical ablation of atrial fibrillation, particularly in patients with mitral valve disease. For patients with both mitral valve dysfunction and atrial fibrillation, a variety of new approaches are available to enable a complete operation that includes both mitral valve repair and ablation of atrial fibrillation. The purposes of this review are to review the rationale for surgical ablation of atrial fibrillation (AF) in mitral valve patients, describe the classic Maze procedure and its results, detail new approaches to surgical ablation of AF, emphasize the importance of the left atrial appendage, and consider challenges and future directions in the ablation of AF in mitral valve patients. RECENT FINDINGS: Left untreated, atrial fibrillation increases mortality and morbidity in patients undergoing mitral valve surgery. While the Maze procedure effectively eliminates atrial fibrillation in most of these patients, its complexity and increased operative time has precluded widespread application. New operations that use alternative energy sources to create left atrial lesion sets ablate atrial fibrillation in 60 to 80% of patients having mitral valve surgery. SUMMARY: In mitral valve patients with atrial fibrillation of more than 6 months' duration, the operative strategy should include both mitral valve surgery and ablation of atrial fibrillation. In many cases, these procedures can be performed minimally invasively. Refinements in mapping and ablation technology are on the horizon, and these will facilitate more widespread application of minimally invasive approaches and further improve results. 相似文献
12.
We report two unusual cases of left atrial wall dissection creating a left atrial pseudoaneurysm associated with regurgitation a few months after mitral valve replacement. We emphasize the important role of transesophageal echocardiography in the diagnosis. The two patients successfully underwent surgery. 相似文献
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Chen T Lejemtel TH Garcia J Gordon GM Spevack DM 《Echocardiography (Mount Kisco, N.Y.)》2005,22(5):438-440
We report the case of a 51-year-old woman who underwent mitral valve replacement for prolapse with severe regurgitation, depressed ejection fraction, and atrial fibrillation. Two weeks post-operatively, a transesophageal echocardiogram was performed for bacteremia. The patient was found incidentally to have a large free-floating ball thrombus in the left atrium. The patient was managed with anticoagulation because of the high-risk nature of repeat surgery. One month following diagnosis, the patient still had persistent thrombus in the left atrium seen on transthoracic echocardiography despite therapeutic anticoagulation. Free-floating ball thrombus is a rare and dramatic finding seen on echocardiography in patients with mitral valve disease. 相似文献
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Percutaneous management of valvular heart disease is becoming a reality, with multicenter trials supporting minimally invasive procedures for both aortic and mitral valve disease. Historically, the treatment of choice has been aortic valve replacement with conventional surgery for patients with severe aortic stenosis, as the prognosis of untreated patients is poor, particularly if the patient is symptomatic. Transcatheter aortic valve replacement is now available as a minimally invasive option to treat select high-risk patients with severe aortic stenosis. At present more than 30,000 procedures have been performed worldwide, mostly confined to patients at high surgical risk. The short- and medium-term outcomes have been promising. 相似文献
16.
Urbanski PP 《The Thoracic and cardiovascular surgeon》2005,53(5):315-317
The appropriate length of the artificial chordae is crucial for the proper functioning of the mitral valve after chordal replacement. In the technique described here, the artificial chordae are assembled during surgery and their lengths fixed according to the individual anatomy; they are then first attached to the margin of the prolapsed leaflet and subsequently to the papillary muscle. This ensures that the ultimate length of the artificial chordae is determined during fixation at the papillary muscle and not during knotting at leaflet level. 相似文献
17.
Although mitral valve replacement (MVR) is a routine procedure, it may still result in structural defects causing significant hemodynamic compromise. One very rare complication is the development of a left ventricular-right atrial fistula. The resultant intracardiac shunt is commonly associated with concomitant heart failure, and immediate surgical closure is required. The case is described of a left ventricular-right atrial fistula following MVR. 相似文献
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Mesana TG Kulik A Ruel M Hendry P Masters R Rubens FD Bedard P Lam BK 《The Journal of heart valve disease》2006,15(4):515-520
BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the efficacy and outcome of radiofrequency (RF) atrial fibrillation (AF) ablation in patients undergoing mitral valve (MV) surgery. METHODS: Between March 2002 and December 2004, 61 patients (mean age 65.4 +/- 10 years) underwent isolated endo-left atrial AF ablation using a unipolar RF device (Cardioblate; Medtronic, USA) in conjunction with 34 MV repairs and 27 MV replacements. AF was paroxysmal in 13 patients (21%), and permanent in 48 (79%), with a mean duration of 3.6 +/- 3.5 years. The etiology was degenerative in 35 patients (57%), rheumatic in 17 (28%), and ischemic in nine (17%). All patients received amiodarone postoperatively. RESULTS: No patients died during the study, and there were no thromboembolic complications. All patients had intraoperative conversion. Forty-one patients (67%) presented with postoperative relapse; definitive conversion was achieved in 34 (83%) cases within three months. The overall success rate was 75.4% at 14 +/- 8.8 months; success was greater in the MV repair group (85%) than in the MV replacement group (66.7%), though not significantly so (p = 0.09). Factors associated with definitive conversion included smaller left atrial size (p = 0.007), decreased left ventricular end-diastolic diameter (p = 0.04), and NYHA class I (p = 0.05). Age, AF duration and etiology were not associated with conversion, but associated coronary artery bypass grafting showed a strong trend towards significance (p = 0.07). In these patients, AF duration did not predict conversion to sinus rhythm. CONCLUSION: Combined AF ablation with MV surgery is safe and effective. Although AF ablation seems more beneficial with MV repair, the success rate may vary significantly according to patient characteristics. 相似文献