The role of cardiac computed tomography (CT) for evaluating the mitral valve (MV) has been limited since echocardiography is the main method of evaluation. However, recent advances in cardiac CT have enable detailed evaluation of the anatomy and geometry of the MV. We describe assessments of the anatomy and coaptation geometric parameters of normal MVs, and also review repair of diseased/damaged MV. We also discuss pre- and post-surgical imaging of MV pathology using cardiac CT and various CT images. We found that cardiac CT could be used as an alternative imaging modality to echocardiography for pre-operative MV evaluation and to predict clinical outcomes following repair.
Echocardiography ; Heart Valves ; Methods ; Mitral Valve Insufficiency ; Mitral Valve* ; Pathology

The role of cardiac computed tomography (CT) for evaluating the mitral valve (MV) has been limited since echocardiography is the main method of evaluation. However, recent advances in cardiac CT have enable detailed evaluation of the anatomy and geometry of the MV. We describe assessments of the anatomy and coaptation geometric parameters of normal MVs, and also review repair of diseased/damaged MV. We also discuss pre- and post-surgical imaging of MV pathology using cardiac CT and various CT images. We found that cardiac CT could be used as an alternative imaging modality to echocardiography for pre-operative MV evaluation and to predict clinical outcomes following repair.
Echocardiography ; Heart Valves ; Methods ; Mitral Valve Insufficiency ; Mitral Valve* ; Pathology

Mitral valve repair is the preferred treatment, especially for mitral regurgitation and could be performed successfully in the majority of the patients. To decrease the time for learning curve and achieve successful results, an overall knowledge of the anatomic, functional, and pathology of the mitral valve and familiarization with many useful repair techniques is necessary. With such point of view, we reviewed mitral valve anatomy, physiology, pathology, and many mitral valve repair techniques.
Humans ; Learning Curve ; Mitral Valve Insufficiency ; Mitral Valve* ; Pathology ; Physiology

Mitral valve repair is the preferred treatment, especially for mitral regurgitation and could be performed successfully in the majority of the patients. To decrease the time for learning curve and achieve successful results, an overall knowledge of the anatomic, functional, and pathology of the mitral valve and familiarization with many useful repair techniques is necessary. With such point of view, we reviewed mitral valve anatomy, physiology, pathology, and many mitral valve repair techniques.
Humans ; Learning Curve ; Mitral Valve Insufficiency ; Mitral Valve* ; Pathology ; Physiology

BACKGROUND: To compare flexible ring with rigid ring for annular remodeling and hemodynamic changes of left ventricle (LV) in mitral valve repair (MVR) at short term interval. METHODS: From January 1998 to March 2001, 35 patients with mitral valve prolapse underwent mitral valve repair with ring annuloplasty. The mean age of these patients was 49 years. Eighteen patients underwent mitral annuloplasty with Carpentier-Edwards Classic-ring (Group A). Seventeen patients underwent mitral annuloplasty with Physio-ring (Group B). LV fun-ction and annulus size were assessed by echocardiography on the day before operation and 2 to 3 months later. Mitral annular motion had been examined by means of the extent of mitral annular systolic excursion (MASE) as measured in two longitudinal LV segments (septal and lateral). RESULTS: 1) In valve pathology, anterior leaflet lesion was 14 cases, posterior was 14, combined lesion was 7 cases. 2) At all, left ventricular end-systolic dimension, left ventricular end-diastolic dimension and LV mass decreased postoperatively. But, no differences existed between the groups. 3) Postoperatively (after 2-3 months), echocardiograms in 35 patients demonstrated no mitral regurgitation (MR) in 16 cases, trace to mild MR in 17 cases, moderate MR in 2 patients. In Classic-ring group, MR was demostrated in 11 cases (61%). In Physio-group, MR was demonstrated in 8 cases (47%). 4) Postoperatively, mitral valve area increased significantly only in patients with Physio-ring (1.93+/-0.33 vs 2.38+/-0.92, p<0.05). 5) No differences existed between the groups in MASE. CONCLUSION: There are the significant reduc-tion in cardiac chambers and annulus size and improvement of LV function after both types of ring annuloplasty at short term result. There are no significant differences between Classic-ring and Physio-ring except 2 cases postrepair SAM (systolic anterior motion) of mitral valve in Classic-ring.
Echocardiography ; Follow-Up Studies* ; Heart Ventricles* ; Hemodynamics* ; Humans ; Mitral Valve Annuloplasty ; Mitral Valve Insufficiency ; Mitral Valve Prolapse* ; Mitral Valve* ; Pathology

Child, Preschool ; Humans ; Infant ; Mitral Valve ; abnormalities ; pathology ; Mitral Valve Insufficiency ; pathology

BACKGROUND: The optimal treatment for mitral regurgitation from leaflet prolapse or multiple leaflet pathology is not yet established. Recently, new chordae formation(NC) with olytetra-fluoroethylene(PTFE) has become increasingly popular. The aims of the current study was to see the effects of new chordae formation on mitral alvuloplasty. MATERIAL AND METHOD: From January 1994 to december 1999 322 patients receiving itral valvuloplasty were divided into two groups in which 144 patients(Group I) received NC and 178 patients(group II) received mitral valvuloplasty without NC. Echocardiograms were performed in the immediate postoperative period, at 6 months and 1 year after surgery and annually thereafter. RESULT: Mitral valvuloplasty was performed for mitral regurgitation in 95%(322/ 337) of the patients and the mean followup period was 27+/-20.6 months of which follow-up was complete for 95.4%(306/ 322). The degree of mitral regurgitation in both groups I and II improved from 3.8+/-0.4 to 1.3+/-0.9 and 3.6+/-0.3 to 1.1+/-0.7, respectively. There was also no significant difference in the mean mitral area or transvavular pressure gradient across the mitral valve. The overall early and late mortality rates were 0.9%(3) and 1.2%(4), also showing no significant difference between the two groups. The late survival rate(97.8+/-1.6 vs 97.7+/-1.6%), freedom from structural degeneration 93.7+/-3.6 vs 90.7+/-3.4%) freedom from reoperation(99.3+/-0.7 vs 96.6+/-1.8%), freedom from thromboembolism, freedom infective endocarditis, and valve related complications showed no significant difference between the two groups. CONCLUSION: Mitral valvuloplasty with NC not only resulted in an increase in the volume of mitral reconstruction(r=0.98, p<0.01) but enhanced urability and stability comparable to currently established methods. Mitral valvuloplasty with NC was especially effective in the treatment of pan valvular pathology, commissural lesions and multiple leaflet pathology which would otherwise have been difficult to treat with current methods.
Endocarditis ; Follow-Up Studies ; Freedom ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Prolapse ; Mitral Valve* ; Mortality ; Pathology ; Postoperative Period ; Prolapse ; Thromboembolism

OBJECTIVETo study the morphologic classification and its clinical significance of giant left atrium (GLA) combined with mitral valvular disease.

METHODSBetween January 1993 and December 1999, a total of 62 consecutive patients with mitral valvular disease, whose preoperative left atrial endodiastolic volume index >/= 300 ml/m(2) or endosystolic diameter >/= 6.0 cm, were enrolled as research candidates. Morphologically, GLA was classified by Q Hierarchical cluster analysis according to the right or left side cardiothoracic ratio of the left atrium (r- or l-LATR) on an anteroposterior chest roentgenogram and the ratio of the distant diameter of the left main bronchus to the approximate diameter of the left main bronchus (LBDd/Dp) or to the trachea (LB/TR) on an left anterior oblique chest roentgenogram.

RESULTSAccording to r-LATR and l-LATR, the morphology of GLA was classified clinically into three types: type L (l-LATR >/= 0.6 and r-LATR < 0.58), type R (r-LATR >/= 0.58 and l-LATR < 0.6) and type B (r-LATR >/= 0.58 and l-LATR >/= 0.6). According to LBDd/Dp and LB/TR, GLA in type L and B was further classified into two subtypes, respectively: left posterior downward type (L(I) and B(I)), in which LBDd/Dp is equal or exceeds 0.38 or LB/TR is equal or exceeds 0.33, and left posterior upward type (L(II) and B(II)), in which LBDd/Dp is less than 0.38 or LB/TR less than 0.33.

CONCLUSIONThe morphologic classification of GLA may represent the main pathophysiological changes of GLA and might be a guideline for the selection of the optimal plication procedures of GLA in patients with valve diseases.

Adolescent ; Adult ; Cardiomegaly ; pathology ; Female ; Heart Atria ; pathology ; Humans ; Male ; Middle Aged ; Mitral Valve Insufficiency ; pathology ; Mitral Valve Stenosis ; pathology

A precise pre-procedural evaluation of mitral valve (MV) pathology is essential for planning the surgical strategy for severe mitral regurgitation (MR) and preparing for the intraoperative procedure. In the present case, a 38-year-old woman was scheduled to undergo MV replacement due to severe MR. She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis during a previous pregnancy. A preoperative transthoracic echocardiography suggested a tear in the mid tip of the anterior mitral leaflet. However, the "en face" view of the MV in the left atrial perspective using intraoperative real time three-dimensional transesophageal echocardiography (RT 3D-TEE) provided a different diagnosis: a torn cleft in the P2-scallop of the posterior mitral leaflet (PML) with rupture of the chordae. Thus, surgical planning was changed intraoperatively to MV repair (MVRep) consisting of patch closure of the PML, commissurotomy, and lifting annuloplasty. The present case shows that intraoperative RT 3D-TEE provides more precise and reliable spatial information of MV for MVRep and facilitates critical surgical decision-making.
Adult ; Balloon Valvuloplasty ; Diagnosis ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Humans ; Lifting ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Pathology ; Pregnancy ; Rupture

BACKGROUND AND OBJECT: A considerable proportion of patients who require mitral valve (MV) replacement present with a coexisting pathology of the aortic valve (AV). However, combined AV and MV replacement is associated with higher operative risk and poorer long-term survival than MV replacement (MVR) only. Little is known about the natural history of AV disease in patients undergoing MV surgery. The purpose of this study was to analyze long-term clinical outcome and the need for subsequent AV replacement (AVR) in patients with mild to moderate AV disease at the time of MV surgery. MATERIALS AND METHODS: One hundred forty-one patients (97 female, mean age 43 years) with mild to moderate AV disease and severe rheumatic MV disease were treated with MV surgery. The patients were followed for an average period of 8+/-3 years (range 1-16) after MV surgery. Primary outcomes (death and subsequent AVR) were evaluated. METHODS: At the time of MV surgery, 104 patients (73.8%) had mild aortic regurgitation (AR), 37 patients (26.2%) moderate AR, 5 patients (3.5%) mild aortic stenosis (AS) and 2 patients (1.4%) moderate AS. At the end of follow-up period, only one patient had severe AR. Eight patients (5.7%) died during the follow-up, and four patients (2.8%) treated with AVR after a mean period of 9 years. Survival analysis with Kaplan-Meier method revealed 10-year survival rates of 95.5% and 10-year event free survival rates of 93.6%. CONCLUSION: In most patients with mild to moderate rheumatic AV disease at the time of MV surgery, subsequent AVR is rarely needed after a long follow-up period. These data may support the decision not to recommend prophylactic AVR at the time of MV surgery in these patients.
Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Aortic Valve* ; Disease Progression ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Mitral Valve* ; Natural History ; Pathology ; Rheumatic Heart Disease* ; Survival Rate