Cardiomyopathies ; complications ; surgery ; Child ; Female ; Humans ; Male ; Mitral Valve Insufficiency ; etiology ; surgery ; Mitral Valve Prolapse ; Treatment Outcome

Adult onset Still's disease (AOSD) is an uncommon acute systemic inflammatory disease of unknown origin. The clinical features include high spiking fever, arthralgia or arthritis, transient maculopapular rash, lymphadenopathy, hepatosplenomegaly, and serositis. Pericarditis is the most common cardiac manifestation of AOSD and occurs in approximately 30% of cases. A simultaneous occurrence of rapidly progressive bi-valvular regurgitation associated with AOSD has not been previously described. We report a case of a 55-year old woman who underwent mitral valve replacement and Bentall's operation due to acute severe mitral and aortic regurgitation associated with AOSD.
Time Factors ; Still's Disease, Adult-Onset/*complications ; Mitral Valve Insufficiency/*etiology/pathology ; Middle Aged ; Humans ; Female ; Aortic Valve Insufficiency/*etiology/pathology ; Age Factors ; Acute Disease

We report here on a case of double-orifice mitral valve with mitral regurgitation in a 75-year-old female who had complaints of mild dyspnea. Transthoracic and transesophageal echocardiography showed two orifices that were supplied by their own chordae from a different papillary muscle. Color Doppler echocardiography revealed moderate to severe mitral regurgitation due to the flail posterior leaflet of the anterolateral orifice. Except for the persistent left superior vena cava, no other congenital anomaly was demonstrated. The patient became asymptomatic with the administration of angiotensin-converting enzyme inhibitor and diuretics, and she has been scheduled for long term follow-up.
Papillary Muscles/abnormalities/ultrasonography ; Mitral Valve Insufficiency/*etiology/ultrasonography ; Mitral Valve/*abnormalities/ultrasonography ; Humans ; Female ; Echocardiography, Doppler, Color ; Chordae Tendineae/abnormalities/ultrasonography ; Aged

Objective: To evaluate and compare the short-term efficacy of domestic mechanical-locked (Clip2Edge) and elastic self-locked (ValveClip) transcranial mitral valve edge-to-edge interventional repair (TEER) devices in the treatment of functional mitral regurgitant valves. Methods: In this retrospective non-randomized comparative study, patients underwent TEER procedure in Fuwai Yunnan Cardiovascular Disease Hospital from May 2022 to April 2023 for heart failure combined with moderate to severe or severe functional mitral valve were divided into Clip2Edge and ValveClip groups based on the TEER system used. Baseline, perioperative, and postoperative 30 d follow-up data were collected and compared between the two groups. The primary outcome was the success rate on the 30 d post operation, while secondary outcomes included immediate postoperative technical success rate and the incidence of all-cause mortality on the 30 d post operation, readmission rate of acute heart failure, cerebral infarction, severe bleeding, and other serious adverse events rates. Results: A total of 60 patients were enrolled, 34 patients were in the Clip2Edge group and 26 in the ValveClip group, mean age was (63.8±9.3) years, and 24 patients (40%) were female. There were no significant differences in baseline data of age, cardiac function, comorbidities, mitral regurgitation 4+(19(73%) vs. 29(85%)), the end-diastolic volume of left ventricle ((220.8±91.2) ml vs. (210.8±71.7) ml) between the two groups (all P>0.05). The technical success rate immediately after the procedure was 100%. There were no readmission of acute heart failure, death, cerebral infarction, severe bleeding, and other serious adverse events up to the 30 d follow-up. Device success rate was similar between the ValveClip group (24 cases (100%)) and the Clip2Edge group (27 cases (96%)) (P>0.05). Conclusion: Both types of novel domestic TEER devices are safe and feasible in treating patients with functional mitral regurgitation.
Humans ; Female ; Middle Aged ; Aged ; Male ; Mitral Valve Insufficiency/etiology* ; Retrospective Studies ; East Asian People ; Heart Valve Prosthesis Implantation ; Treatment Outcome ; China ; Heart Failure/etiology* ; Cardiac Catheterization

Objective: To evaluate and compare the short-term efficacy of domestic mechanical-locked (Clip2Edge) and elastic self-locked (ValveClip) transcranial mitral valve edge-to-edge interventional repair (TEER) devices in the treatment of functional mitral regurgitant valves. Methods: In this retrospective non-randomized comparative study, patients underwent TEER procedure in Fuwai Yunnan Cardiovascular Disease Hospital from May 2022 to April 2023 for heart failure combined with moderate to severe or severe functional mitral valve were divided into Clip2Edge and ValveClip groups based on the TEER system used. Baseline, perioperative, and postoperative 30 d follow-up data were collected and compared between the two groups. The primary outcome was the success rate on the 30 d post operation, while secondary outcomes included immediate postoperative technical success rate and the incidence of all-cause mortality on the 30 d post operation, readmission rate of acute heart failure, cerebral infarction, severe bleeding, and other serious adverse events rates. Results: A total of 60 patients were enrolled, 34 patients were in the Clip2Edge group and 26 in the ValveClip group, mean age was (63.8±9.3) years, and 24 patients (40%) were female. There were no significant differences in baseline data of age, cardiac function, comorbidities, mitral regurgitation 4+(19(73%) vs. 29(85%)), the end-diastolic volume of left ventricle ((220.8±91.2) ml vs. (210.8±71.7) ml) between the two groups (all P>0.05). The technical success rate immediately after the procedure was 100%. There were no readmission of acute heart failure, death, cerebral infarction, severe bleeding, and other serious adverse events up to the 30 d follow-up. Device success rate was similar between the ValveClip group (24 cases (100%)) and the Clip2Edge group (27 cases (96%)) (P>0.05). Conclusion: Both types of novel domestic TEER devices are safe and feasible in treating patients with functional mitral regurgitation.
Humans ; Female ; Middle Aged ; Aged ; Male ; Mitral Valve Insufficiency/etiology* ; Retrospective Studies ; East Asian People ; Heart Valve Prosthesis Implantation ; Treatment Outcome ; China ; Heart Failure/etiology* ; Cardiac Catheterization

OBJECTIVEThe clinical diagnosis and treatment of ischemia mitral regurgitation (IMR) remained difficult because of its unclear mechanisms. This paper reviews studies on the mechanisms of IMR during the last 20 years, and discusses the relevance of the various mechanisms.

DATA SOURCESData used in this review were mainly from CNKI and Pubmed in English. The search terms were "ischemia mitral regurgitation mechanism", "myocardial infarction" AND "mitral regurgitation".

STUDY SELECTIONArticles were selected if they involved mechanisms of IMR.

RESULTSIMR is one of the common complications of coronary artery disease. But currently, the clinical diagnosis and treatment of IMR remained difficult because of its unclear mechanisms.

CONCLUSIONSFor now, dominating theory of ischemic mitral regurgitation mechanisms are left ventricular remodeling, imbalance of leaflet tethering and the closing force, left ventricular dysfunction, changes in spatial structure of the annulus and the dyssynchrony of the left ventricular electromechanical activity.

Animals ; Humans ; Mitral Valve Insufficiency ; etiology ; Myocardial Ischemia ; complications ; Papillary Muscles ; physiology ; Systole ; Ventricular Dysfunction, Left ; complications ; Ventricular Remodeling

Occurrence of dynamic left ventricular outflow tract (LVOT) obstruction is not infrequent in critically ill patients, and it is associated with potential danger. Here, we report a case of transient heart failure with hemodynamic deterioration paradoxically induced by extreme dehydration. This article describes clinical features of the patient and echocardiographic findings of dynamic LVOT obstruction and significant mitral regurgitation caused by systolic anterior motion of the mitral valve in a volume-depleted heart.
Cardiac Volume ; Dehydration/*complications ; Echocardiography/methods ; Female ; Heart Failure/*etiology/therapy ; Humans ; Middle Aged ; Mitral Valve Insufficiency/complications/*etiology ; Pulmonary Edema/etiology ; Ventricular Outflow Obstruction/*complications/etiology

OBJECTIVETo study the clinical results of mitral valve repair in patients of primary infective endocarditis with mitral insufficiency.

METHODSFrom January 2004 to July 2007, 40 patients who had undergone valve repair procedure for infective endocarditis with mitral insufficiency were analyzed retrospectively. There were 26 male and 14 female patients, with an average age of (34.0 +/- 3.5) years old, including 6 patients of underlying heart disease, 34 patients of no previously underlying heart disease. There were 12 patients in NYHA functional class II, 19 patients in class III, 9 patients in class IV preoperatively. Preoperative echocardiography showed moderate to severe MR in all patients. The surgery was performed under extracorporeal circulation and moderate hypothermia. The distribution of anatomical lesion according to surgical findings were vegetation in 32 patients, leaflet prolapsed in 34 patients, leaflet perforation in 16 patients, chordal rupture in 32 patients, and annular abscess in 2 patients. The vegetations and infected tissues were debrided. The surgery consisted of complex methods to repair mitral valve, including direction leaflet closure in 5 patients, pericardial patch closure of leaflet perforation in 18 patients, chords reimplantation in 4 patients and chords transference in 6 patients, quadrangular resection in 12 patients, double orifice method in 17, closure of the commissure in 8, rings annuloplasty in 28 cases, and so on. There were 28 selective surgeries and 12 emergent ones. Patients were evaluated for early and long-term clinic and echocardiographic outcome before and after operation.

RESULTSThere were no early postoperative death. Mitral valve repair was feasible in 39 patients, one patient was transformed to mitral valve replacement during the operation. Postoperative echocardiography demonstrated no (n = 24) or mild (n = 15) mitral regurgitation at the discharge examination and observed significant reductions in left ventricular end diastolic [from (62 +/- 7) mm to (51 +/- 6) mm, P < 0.05] and end systolic dimensions [from (45 +/- 3) mm to (40 +/- 4) mm, P < 0.05] and left atrial dimensions [from (49 +/- 4) mm to (42 +/- 6) mm, P < 0.05]. Mean follow-up (25.6 +/- 3.2) months, freedom from recurrent moderate to severe MR, freedom from repeat operation or infective endocarditis, revealed patients were 36 cases in NYHY class I, 3 cases in class II.

CONCLUSIONMitral valve repair for mitral valve endocarditis is feasible with a satisfied clinical outcome, maintains valve competency with significant reductions in left atrial and left ventricular dimensions after surgery.

Adolescent ; Adult ; Child ; Endocarditis ; complications ; Female ; Follow-Up Studies ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery ; Mitral Valve Insufficiency ; etiology ; surgery ; Retrospective Studies ; Treatment Outcome ; Young Adult

Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.
Acute Disease ; Aged ; Coronary Angiography ; Diagnosis, Differential ; Heart Atria/ultrasonography ; Heart Failure/diagnosis/etiology ; Humans ; Male ; Mitral Valve Insufficiency/ultrasonography ; Myocardial Infarction/complications/*diagnosis/therapy ; Pulmonary Edema/*diagnosis/etiology/therapy ; Shock, Cardiogenic/*diagnosis/etiology/therapy ; Tomography, X-Ray Computed

We compared clinical (30+/-24 months) and echocardiographic follow-up (22 +/- 20 months) data of 184 consecutive patients with myxomatous degenerative mitral regurgitation (Group A) and 85 consecutive patients with rheumatic mitral regurgitation (Group B) after repair. Selection criteria for rheumatic etiology was predominant mitral regurgitation with valve area >or= 2.0 cm2 and with no significant calcification in valvular apparatus. Repair was successful in 93% of group A and in 92% of group B (p>0.05). There was no difference of operative mortality (1% vs 0%) and of the incidence of the second-pump valve replacement (4% vs 5%). The 4-yr survival, 4-yr event-free survival, and 4-yr mitral regurgitation-free survival rates in group A were 96 +/- 2%, 89 +/- 4%, and 76 +/- 5%, respectively, which were not different from those in group B (97 +/-2 %, 93 +/- 4%, and 68 +/-7 %, p >0.05). Independent determinants of development of at least moderate regurgitation in group A were no use of ring annuloplasty (hazards ratio 6.6, 95% CI 2.0 to 21.5) and new chordae formation (hazards ratio 3.5, 95% CI 1.4 to 8.7). In group B, no use of ring annuloplasty (hazards ratio 15.3, 95% CI 3.5 to 66.7) also was independent predictor. Valve repair is highly feasible in selected patients with rheumatic mitral regurgitation, and clinical course is not significantly different from that of patients with degenerative mitral regurgitation.
Adult ; Comparative Study ; Disease-Free Survival ; *Echocardiography ; Female ; Follow-Up Studies ; Human ; Male ; Middle Aged ; Mitral Valve Insufficiency/etiology/mortality/*surgery/*ultrasonography ; Rheumatic Heart Disease/mortality/*surgery/*ultrasonography ; Survival Analysis ; Treatment Outcome