Mitral Stenosis Publications (21957)
Mitral Stenosis Publications
The patients' mean age was 67 ± 17 years; 27 (73%) were in New York Heart Association Class III or IV. Aortic and mitral valve insufficiency was more common than stenosis. Ninety-three percent of surviving patients were followed for a mean period of 58 ± 24 months.
Aortic valve procedures consisted of 24 (65%) replacements and 13 (35%) repairs. The mitral valve was repaired in 28 (76%) patients, whereas tricuspid valve repair was feasible in all patients. No conversion to full sternotomy was necessary. Myocardial infarction was not observed. Chest tube drainage was 330 ± 190 ml, and 4 patients required reopening for bleeding (1, 3%) or tamponade (3, 8%). One stroke was observed due to heparin-induced thrombocytopaenia after initial unremarkable neurological recovery. Early mortality included 5 (13.5%) patients. Actuarial survival at 5 years was 52 ± 10%.
A partial upper sternotomy provides adequate exposure to all heart valves. We did not experience technical limitations with this approach. Wound dehiscence, postoperative bleeding, intensive care unit and hospital stay and early deaths were low compared to data from other published series of triple valve surgery through a full median sternotomy. Early and mid-term outcomes were not adversely affected by this less invasive approach.
Her echocardiogram showed a decreased ejection fraction at 45%, severe mitral stenosis (mean gradient 13 mmHg, area 0.8 cm2) with severe MAC, and severe AS (mean gradient 35 mmHg, area 0.6 cm2). Surgical risk was felt to be very high after evaluation by our cardiothoracic sur-gery group (Society of Thoracic Surgeons risk score of 19%). She underwent simultaneous and fully percutaneous trans-femoral TAVR and transseptal TMVR using SAPIEN 3 valves. Post-implant TEE showed trace paravalvular mitral regurgitation and a mean gradient of 4 mmHg and mean aortic gradient of 8 mmHg with trace paravalvular leak. There was no LVOT obstruction. The patient was discharged seven days after the intervention.
After careful evaluation by experienced Heart Teams, combined native stenotic mitral and aortic valves can be percutaneously replaced using transcatheter SAPIEN 3 valves via transfemoral access in carefully selected high surgical risk patients.
Preoperative planning was carried out by multiplanar reconstruction from cardiac CT. Through a transapical access, the mitral valve was replaced first by an inverted 29 mm Edwards SAPIEN 3 prosthesis, then the aortic valve by a 23 mm SAPIEN 3, both during rapid pacing. Both prostheses revealed excellent function in angiography and echocardiography. The patient was extubated early after surgery and transferred to the normal ward the following day. After five months, she exhibited signs of cardiac failure again. Migration of the mitral prosthesis was detected, and the mitral valve was replaced surgically.
Transcatheter double valve replacement can be performed through a transapical access. The key to success is thorough preoperative planning based on CT, not only for sizing, but also for estimating the anatomical relationship of the prostheses. However, late migration can be expected and may lead to LVOT obstruction.
From January 2003 to January 2009, a total of 199 consecutive patients were recruited in this study. Patients were classified as group MS (n = 123) and MI (n = 76) according to the manifestation of mitral valvular disease. The mean age for patients was 50.1 ± 10.5 years and follow-up time was 7.2 ± 2.0 years. The MS after operation were more likely to experience atrial fibrillation (p = 0.002). The New York Heart Association (NYHA) class in MI showed a greater improvement (p = 0.006) than in MS. The left ventricular end-diastolic dimension (LVEDD) (p = 0.010) and stroke volume (SV) (p = 0.000) in MI were still larger than that in MS patients. These differences did not disappear with time after operation. The long-term echocardiographic results of mechanical mitral valve prostheses between MS and MI patients are significantly different. Over a long-term follow up, MI patients still have a larger LVEDD and SV than MS, and associated with a greater improvement of NYHA class.
Eighteen children who underwent surgery for severe MR and bileaflet prolapse were identified. All were treated with ring annuloplasty and Alfieri edge-to-edge repair. Median age and weight were 8.2 years (range, 0.4-17.2 years) and 24.9 kg (5.6-63.3 kg), respectively. Median left ventricular end diastolic dimension median z score was 4.9 (2.1-11.9). One patient died (5.6%), and there were no other major complications. Among survivors, 94.4% had mild regurgitation or less, with no stenosis or SAM at median clinical follow-up of 2.4 years (range, 0-13.9 years). Median left ventricular end-diastolic dimension z score regressed to 1.3 (-0.5 to 4.3).
In pediatric patients with CTD and severe MR, a simplified approach is associated with intermediate-term competence, absence of SAM or significant stenosis, and regression of left ventricular enlargement.
All patients underwent echocardiography before and also 24 to 48 hours after PTMC. Peripheral blood samples were taken for measurement of NT-Pro BNP before as well as 24 to 48 hours after PTMC. The patients were also classified in group with normal sinus rhythm or having atrial fibrillation (AF) based on their 12-lead electrocardiogram.
It was shown a significant decrease in the parameters of PPG (peak pressure gradient), MPG (mean pressure gradient), PHT (pressure half time), PAP (pulmonary arterial pressure), LAV (left atrial volume), and also a significant increase in MVA (mitral valve area) RVS (right ventricular S velocity), and strains of lateral, septal, inferior and anterior walls of LA following PTMC. The mean LVEF remained unchanged after PTMC. The mean NT-Pro-BNP before PTMC was 309.20 ± 17.97pg/lit that significantly diminished after PTMC to 235.72 ± 22.46pg/lit (p = 0.009). Among all echocardiography parameters, only MPG was positively associated with the change in NT-Pro-BNP after PTMC. Comparing the change in echocardiography indices between the patients with normal rhythm and those with AF, lower change in PAP was showed in the group with AF. However, more change in the level of NT-Pro-BNP after PTMC was shown in the patients with AF compared to those without this arrhythmia Conclusion: PTMC procedure leads to reduce the level of NT-Pro-BNP. The change in NT-Pro-BNP is an indicator for change in MS severity indicated by decreasing MPG parameter. Lower change in PAP as well as higher change in NT-Pro-BNP is predicted following PTMC in the group with AF compared to those with normal sinus rhythm.
We found only one other report of this atrioventricular valve abnormality in association with atrioventricular septal defect. To our knowledge, our patient (at a body weight of 1,800 g) is the smallest to survive corrective surgery of an accessory mitral valve leaflet with severe left ventricular outflow tract obstruction. In addition to our patient's case, we discuss the relevant medical literature.
The primary end point was all-cause mortality at 1 year post procedure, and secondary end point included cardiac function class(NYHA), vascular complication, valvular function, non-fatal myocardial infarction, new atrial fibrillation, stroke, bleeding, pacemaker implantation, acute renal failure, and readmission. We used the Kaplan-Meier method to estimate survival function based on follow up data and survival was compared between groups with the use of the log-rank test. Results: (1) In the baseline data, there were statistically significant difference among 3 groups for the age, left ventricular ejection fraction, cardiac function class Ⅲ and Ⅳ, rates of combined diabetes, chronic renal failure, mild and moderate mitral regurgitation (P<0.01 or 0.05). The risk score of the Society of Thoracic Surgeons(STS) was 7.28±4.98 in the TAVI group, and 5.67±3.49 in the SAVR group(P=0.036). (2) The perioperative rates of pacemaker implantation(11.3%(9/81) vs. 0, P=0.025) and mild paravalvular regurgitation(29.6%(24/81) vs.1.7%(1/59), P<0.001) were significantly higher in TAVI group than in SAVR group.(3)The rate of rehospitalization was significantly lower in TAVI group than in SAVR group(3.0%(2/67) vs. 22.7%(10/44) P=0.005) and the rate of pacemaker implantation was significantly higher in TAVI group than in SAVR group(17.5 (12/67) vs. 0, P=0.008) after 1 year. The rates of death from any cause in the TAVI (5.8%(4/67)) and SAVR group (11.4%(5/44)) were significantly lower than that in the drug therapy group (54.9%(50/91), both P<0.05) after 1 year and was similar between TAVI group and SAVR group(P=0.622). (4) The rates of cardiac function classⅠandⅡ increased and Ⅲ and Ⅳ decreased in TAVI and SAVR group after 1 year when compared with base line(P<0.001). The rates of cardiac function class Ⅱ, and Ⅲ increased , class Ⅰ and Ⅳ decreased in drug therapy group after 1 year compared with base line (P=0.020). (5)The survival rates after 1 year were significantly higher in the TAVI group and SAVR group than in the drug therapy group(log-rank test, P<0.001), and the difference was similar between TAVI group and SAVR group (log-rank test, P=0.062). Conclusion: In surgical high-risk elderly patients with SAS, the prognosis of drug therapy was poor, and TAVI and SAVR were associated with similarly improved rates of survival after 1 year, although there were significant differences in periprocedural complications between TAVI and SAVR groups.