Accessory mitral valve tissue associated with situs inversus in an elderly patient

We report an unusual case of accessory mitral valve tissue associated with a situs inversus and missing obstruction of the left ventricular outflow tract. To our knowledge our patient is the only elderly patient with an accessory mitral valve with associated situs inversus undergoing surgical resection. The report emphasizes direct cardioscopy through the aortic annulus allowing precise excision of the abnormal tissue.     

Lobectomy for lung cancer in an elderly man on maintenance hemodialysis

An 82-year-old man who had been undergoing hemodialysis for chronic renal failure, 3 times a week for the last 3 years, was admitted to our hospital for the treatment of lung cancer. Under careful perioperative management, we successfully performed a lobectomy. Histological examination revealed well differentiated squamous cell carcinoma and the postoperative staging was pT1N0M0. On postoperative day 1, he was commenced on hemodialysis with nafamostat mesilate instead of heparin sodium, and there was no postoperative bleeding. The patient had an uneventful postoperative course and was discharged 3 weeks after his operation.     

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.     

Accessory mitral valve leaflet in an adult with coronary artery disease

Accessory mitral valve leaflet is a very rare cause of left ventricular outflow tract obstruction. We report a patient presenting this cardiac abnormality who undergone cardiac surgery. A 60-year-old man, presented coronary artery disease and moderate left ventricular tract obstruction due to accessory mitral valve leaflet. The accessory mitral valve leaflet had the typical morphology of a parachute-shaped attached partially to the anterior mitral valve leaflet, with chordae tendinae attached to: 1) an accessory papillary muscle inserted at the free-wall closed to the apex; 2) interconnected with the chordae tendinae of the anterior mitral valve leaflet; 3) a second accessory papillary muscle inserted to the interventricular septum. He underwent successful coronary revascularization of 2 vessels and accessory leaflet excision. A review of 21 cases with accessory mitral valve leaflet is reported.     

Accessory mitral valve causing left ventricular outflow tract obstruction in an adult

Accessory mitral valve (AMV) is a rare congenital abnormality that, rarely, causes left ventricular outflow tract (LVOT) obstruction in adults. We report the case of a 47-year-old man with deteriorating exertional dizziness. Evaluations revealed that the left ventricular outflow tract obstruction was caused by the accessory mitral valve. The patient underwent a successful operation for removal of the accessory mitral valve.     

Accessory mitral valve associated with transient ischemic attacks

Accessory mitral valve (AMV) is an unusual congenital cardiac anomaly typically presenting with left ventricular outflow obstruction. We describe a patient with AVM presenting with transient ischemic attack.     

Isolated accessory mitral valve tissue in an asymptomatic elderly patient

Accessory mitral valve tissue is a membranous or tumor-like structure observed in the left ventricular outflow tract. This congenital anomaly has been reported in more than 100 cases since 1842; however, most of them were found in patients with complex cardiac malformations. We report a 72-year-old Asian woman with isolated accessory mitral valve tissue incidentally found during the evaluation of hypertension and arrhythmia. Her left ventricular outflow tract obstruction was mild. Because worsening of the left ventricular outflow tract obstruction was reported in patients without significant obstruction at the time of diagnosis, periodical echocardiographic follow-up is necessary.     

Isolated true parachute mitral valve in an asymptomatic elderly patient

We report the extremely rare case of a 73-year-old asymptomatic patient who has an isolated true parachute mitral valve (PMV). In the echocardiographic examination, the parasternal long-axis view showed a single papillary muscle. The short-axis view revealed the presence of a symmetric mitral valve orifice with all chordae attaching to a large anterolateral papillary muscle. Because detailed examination did not reveal the presence of other complications, this patient was diagnosed as an isolated true PMV.     

Accessory mitral valve tissue causing severe left ventricular outflow tract obstruction in an adult

Accessory mitral valve (AMV) is a rare cause of left ventricular outflow tract (LVOT) obstruction and is extremely rare in adults. We report a case of an older adult with an AMV that caused severe LVOT obstruction. A parachute-like piece of tissue (the AMV) protruding into the LVOT during systole was first detected in a 45-year-old woman by echocardiography. Because the pressure gradient and dyspnea gradually progressed, she finally underwent a successful operation for removal when she was 48 years old.     

Accessory fibrous band causing anterior mitral valve leaflet restriction

A 20-year-old woman with neurofibromatosis (type I), presented with heart failure due to severe mitral regurgitation. Echocardiography and surgery revealed an accessory fibrous band causing anterior mitral valve leaflet restriction. Resection of the fibrous band and correction of the mitral valve using the accessory fibrous band was performed. The further postoperative course was uncomplicated.     

Accessory mitral valve tissue causing left ventricular outflow tract obstruction

Among the various causes of left ventricular outflow tract obstruction accessory mitral valve tissue is the least common. To the best of our knowledge there have been only five such cases reported to date. The aim of presenting two more cases and reviewing the literature is to bring attention to this rare anomaly as it is easy to treat provided it has been diagnosed preoperatively or recognised at surgery.     

Accessory mitral valve tissue: an increasingly recognized cause of left ventricular outflow tract obstruction

Subvalvar left ventricular outflow tract obstruction (LVOTO) may be secondary to congenital abnormalities of the mitral valve, including abnormal attachments of the anterior leaflet of the mitral valve, parachute mitral valve, and accessory valve tissue. Successful correction of LVOTO due to accessory mitral valve tissue is reported in a 44-year-old man. Twenty-five patients with LVOTO due to accessory mitral valve tissue have been previously reported; however, only a few have been recognized preoperatively. A high index of suspicion is necessary for preoperative and intra-operative recognition and correction of the abnormality.     

老年维持性血液透析患者久坐行为现状及影响因素分析

目的 探讨老年维持性血液透析患者久坐行为现状,并分析影响因素,为制定针对性护理干预措施提供参考。方法 采用便利抽样法选取规律透析的老年维持性血液透析患者137例为研究对象,采用一般资料调查表、国际体力活动问卷、Piper疲乏修订量表、领悟社会支持量表进行调查。结果 老年维持性血液透析患者每日久坐时间为6.8（5.4,8.7）h,透析日久坐时间为7.7（6.8,9.2）h,非透析日为6.2（4.9,8.4）h,久坐行为总发生率为56.93%（78/137）;久坐发生地点首位是家庭,其次是医院。logistic回归分析显示,性别、合并症指数、营养风险、疲劳程度及社会支持是老年维持性血液透析患者久坐行为的独立影响因素（均P＜0.05）。结论 老年维持性血液透析患者久坐行为普遍,临床医护人员应重视男性、合并症指数高、营养不良及疲劳严重患者久坐行为的评估和干预,制定以家庭为中心的锻炼计划,鼓励患者积极参加社会活动及体力活动,从而改善老年患者久坐行为。     

Late results of mitral valve reconstruction in the elderly

BACKGROUND: This study attempts to confirm favorable results with mitral valve reconstruction (MVP) in patients greater than or equal to 70 years of age and to examine complication rates by actual analysis. METHODS: Between June of 1980 and December of 1997, 278 patients 70 years of age or older (mean, 75.2 years; range, 70 to 87 years) underwent MVP for mitral regurgitation. Most involved insertion of an annuloplasty ring. Concomitant procedures were performed in 72.3%, and 55.0% required coronary revascularization. RESULTS: For isolated MVP, the in-hospital mortality rate was 6.5% and 17.0% when combined with coronary revascularization. The mortality rate when combined with another valve procedure was 13.2%. The 5-year freedom from late cardiac death was 100% in the isolated MVP group and 79.7% for MVP with a concomitant procedure (p = 0.006). Complications were analyzed using actual (cumulative incidence) analysis to eliminate the competing risk of noncardiac death. Mean NYHA class improved from 3.32 to 1.71 postoperatively. Repair failure was rare, with a 5-year freedom from reoperation of 91.2%. CONCLUSIONS: These findings confirm the favorable outcome of MVP in elderly patients. Late repair failures are rare; comorbid disease is an important predictor of outcome.