We report the case of a patient with mitral regurgitation complicated by type B dissection and Marfan syndrome (MFS) who was managed successfully with minimally invasive mitral valve repair. Without type A aortic dissection or aortic root dilation, MFS patients may develop mitral valve regurgitation, as in this case, and need valve surgery to improve their symptoms and long-term survival. However, it is not clear that a full sternotomy and prophylactic aortic surgery are necessary. Although retrograde perfusion to the dissected aorta is controversial, our approach minimizes the risk of future anticipated aortic surgery in MFS patients.
Aorta ; Female ; Humans ; Marfan Syndrome ; Minimally Invasive Surgical Procedures ; Mitral Valve Annuloplasty ; Mitral Valve Insufficiency ; Mitral Valve ; Perfusion ; Sternotomy

Percutaneous transvenous mitral annuloplasty (PTMA) has evolved as a latest procedure for the treatment of functional mitral regurgitation. It reduces mitral valve annulus (MVA) size and increases valve leaflet coaptation via compression of coronary sinus (CS). Anatomical considerations for this procedure were elucidated in the present study. In 40 formalin fixed adult cadaveric human hearts, relation of the venous channel formed by CS and great cardiac vein (GCV) to MVA and the adjacent arteries was described, at 6 points by making longitudinal sections perpendicular to the plane of MVA, numbered 1–6 starting from CS ostium. CS/GCV formed a semicircular venous channel on the atrial side of MVA. Based on the distance of CS/GCV from MVA, two patterns were identified. In 37 hearts, the venous channel at point 2 was widely separated from the MVA compared to the two ends and in three hearts a nonconsistent pattern was observed. GCV crossed circumflex artery superficially. GCV or CS crossed the left marginal artery and ventricular branches of circumflex artery superficially in 17 and 23 hearts, respectively. As the venous channel was related more to the left atrial wall, PTMA devices probably exert an indirect traction on MVA. The arteries crossing deep to the venous channel may be compressed by PTMA device leading to myocardial ischemia. Knowledge of the spatial relations of MVA and a preoperative and postoperative angiogram may help to reduce such complications during PTMA.
Adult ; Arteries ; Cadaver ; Coronary Sinus ; Formaldehyde ; Heart ; Humans ; Mitral Valve ; Mitral Valve Annuloplasty* ; Mitral Valve Insufficiency* ; Myocardial Ischemia ; Traction ; Veins

Microangiopathic hemolytic anemia occurs in a diverse group of disorders, including thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, and prosthetic cardiac valves. Hemolytic anemia also occurs as a rare complication after mitral valve repair. In this report, we describe a case of microangiopathic hemolytic anemia following myxoma excision and mitral valve repair, which was presented as hemolytic uremic syndrome.
Anemia, Hemolytic* ; Heart Valves ; Hemolytic-Uremic Syndrome* ; Mitral Valve Annuloplasty ; Mitral Valve* ; Myxoma* ; Purpura, Thrombotic Thrombocytopenic

BACKGROUND AND OBJECTIVES: The development of postoperative left ventricular (LV) dysfunction is a frequent complication in patients with chronic severe mitral valve regurgitation (MR) and portends a poor prognosis. Assessment of myocardial deformation enables myocardial contractility to be accurately estimated. The aim of the present study was to evaluate the predictive value of preoperative regional LV contractile function assessment using two-dimensional multilayer speckle-tracking echocardiography (2D MSTE) analysis in patients with chronic severe MR with preserved LV systolic function. SUBJECTS AND METHODS: Forty-three consecutive patients with chronic severe MR with preserved LV systolic function scheduled for mitral valve replacement (MVR) or MV repair were prospectively enrolled. Serial echocardiographic studies were performed before surgery, at 7 days follow-up, and at least 3 months follow-up postoperatively. The conventional echocardiographic parameters were analyzed. Global longitudinal strain (GLS) was obtained quantitatively by 2D MSTE. RESULTS: The mean age of patients was 51.7±14.3 years and 25 (58.1%) were male. In receiver-operating characteristic curve analysis, the most useful cutoff value for discriminating postoperative LV remodeling in severe MR with normal LV systolic function was -20.5% of 2D mid-layer GLS. Patients were divided into two groups by the baseline GLS -20.5%. Preoperative GLS values strongly predicted postoperative LV remodeling or LV dysfunction. The postoperative degree of decrease in LV end-diastolic dimension might be an additive predictive factor. CONCLUSION: STE can be used to predict a decrease in LV function after MVR in patients with chronic severe MR. This promising method could be of use in the clinic when trying to decide upon the optimum time to schedule surgery for such patients.
Appointments and Schedules ; Echocardiography* ; Follow-Up Studies ; Humans ; Male ; Mitral Valve ; Mitral Valve Annuloplasty ; Mitral Valve Insufficiency* ; Prognosis ; Prospective Studies ; Ventricular Dysfunction, Left*

Mitral regurgitation (MR) represents the second most frequent valvular heart disease. The appropriate management of organic MR remains unclear in many aspects, especially in several specific clinical scenarios. This review aims to discuss the current guideline recommendations regarding the management of organic MR, while highlighting the controversial aspects encountered in daily clinical practice. The role of imaging is essential in establishing the most appropriate type of surgical treatment (repair or replace), which is based on morphological mitral valve (MV) characteristics (reparability of the valve) and local surgical expertise in valve repair. The potential advantages of 3-dimensional echocardiography in assessing the MV are discussed. Other modern imaging techniques (tissue Doppler and speckle tracking) may provide additional useful information in borderline cases. Exercise echocardiography (evaluating MR severity, pulmonary pressure, or right ventricular function) may have an important role in the management of difficult cases. Finally, the moment when surgery is no longer an option and alternative solutions should be sought is also discussed. Although in everyday clinical practice the timing of surgery is not always straightforward, some newer clinical and echocardiographic indicators can guide this decision and help improve the outcome of these patients.
Echocardiography ; Heart Valve Diseases ; Humans ; Mitral Valve ; Mitral Valve Annuloplasty ; Mitral Valve Insufficiency*

Aneurysm of the mitral valve, although uncommon, occurs most commonly in association with infective endocarditis of the aortic valve and true mitral valve aneurysm is a rare cause of mitral regurgitation. We report a case with perforated mitral valve aneurysm in the posterior leaflet without concurrent infective endocarditis initially mistaken diagnosis of cystic mass, which was confirmed at operation with successful mitral valve annuloplasty.
Aneurysm ; Aortic Valve ; Echocardiography ; Endocarditis ; Heart Aneurysm ; Mitral Valve ; Mitral Valve Annuloplasty ; Mitral Valve Insufficiency

OBJECTIVE: To evaluate the effect of mitral annuloplasty of anterior mitral valve prolapse with artificial chord and mitral annuloplasty ring. METHODS: From March 2009 to December 2011, 32 patients having anterior mitral valve prolapse received mitral annuloplasty with artificial chord and mitral annuloplasty ring in our department, among which 27 simple anterior mitral valve plasty and 5 combine anterior-posterior mitral valve plasty were completed. RESULTS: All patients survived. Postoperative echocardiography showed no or trivial mitral regurgitation in 28 patients and mild mitral regurgitation in the other 4 patients. The diameter of the left atrium (LA) and left ventricle (LV), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) obviously decreased after the operation. During the follow up of 3 months to 3 years, the cardiac function of the patients improved at different degrees. CONCLUSION Reparation of anterior mitral valve prolapse with artificial chord and mitral annuloplasty ring is simple, reliable and effective, and its early to midterm result after the operation proves good.
Adolescent ; Adult ; Cardiac Surgical Procedures ; methods ; Chordae Tendineae ; surgery ; Female ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery ; Mitral Valve Annuloplasty ; methods ; Mitral Valve Prolapse ; surgery ; Young Adult

We report a case of pseudo-pseudoaneurysm, which is a very rare complication of myocardial infarction. A 69-year-old man was admitted to our clinic with chest tightness and dyspnea. He had undergone aortic valve replacement with a pericardial bioprosthetic valve, ring mitral annuloplasty, and reconstruction of an aortic annular defect due to infective endocarditis with bovine pericardium 4 years prior. Echocardiography and computed tomography showed pericardial effusion and a 16-mm cavity at the anterolateral wall of the left ventricle. Magnetic resonance imaging suggested either pseudo-pseudoaneurysm or myocardial abscess. We successfully repaired the myocardial defect using a patch made from a vascular graft with pledgeted horizontal mattress sutures under cardiopulmonary bypass.
Abscess ; Aged ; Aortic Valve ; Cardiopulmonary Bypass ; Dyspnea ; Echocardiography ; Endocarditis ; Heart Ventricles ; Humans ; Magnetic Resonance Imaging ; Mitral Valve Annuloplasty ; Myocardial Infarction ; Pericardial Effusion ; Pericardium ; Sutures ; Thorax ; Transplants

OBJECTIVETo evaluate the safety and efficacy of robotic mitral valve surgery using da Vinci S system.

METHODSWe conducted a retrospective review of 60 robotic mitral surgeries from March 2007 to December 2010. Of the 60 patients, 44 underwent mitral valve repair and 16 received mitral valve replacement. The surgical approach was through 4 right chest ports with femoral and internal jugular vein cannulations. Transesophageal echocardiography was used intraoperatively to estimate the surgical results.

RESULTSNone of the cases required a conversion to a median sternotomy. The mean cardiopulmonary bypass and cardiac arrest time was 132.2∓29.6 min and 88.1∓22.3 min for robotic mitral valve repair, and was 137.1∓21.9 min and 99.3∓17.4 min for robotic mitral valve replacement. Echocardiographic follow-up of all the patients revealed 3 cases of slight regurgitation in mitral valve repair group.

CONCLUSIONIn selected patients with mitral valve disease, robotic mitral surgery can be performed safely.

Adolescent ; Adult ; Aged ; Female ; Heart Valve Prosthesis Implantation ; methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Mitral Valve ; surgery ; Mitral Valve Annuloplasty ; methods ; Mitral Valve Insufficiency ; surgery ; Retrospective Studies ; Robotics ; methods ; Surgery, Computer-Assisted ; methods ; Young Adult

Management of ischemic mitral regurgitation (MR) is challenging. The aim of this study was to investigate long-term clinical and echocardiographic results of restrictive mitral annuloplasty for ischemic MR. From 2001 through 2010, 96 patients who underwent myocardial revascularization with restrictive mitral annuloplasty using a vascular strip for ischemic MR were analyzed. Patients were stratified into two groups based on left ventricular ejection fraction (LVEF): group I, n = 50, with LVEF > 35% and group II, n = 46, with LVEF < or = 35%. The early mortality rate was 2.1% (2/96) and the late cardiac mortality rate was 11.5% (11/96). MR grade was reduced at discharge (0.8 +/- 0.7) but increased during follow-up (1.1 +/- 0.8, P = 0.001). There was no intergroup difference in terms of freedom from recurrent MR > or = moderate eight years after surgery (94.1% +/- 5.7%, group I vs 87.8% +/- 7.2%, group II; P = 0.575). NYHA functional class (odds ratio [OR], 2.2; P = 0.044) and early postoperative residual MR > or = mild (OR, 25.4; P < 0.001) were independent predictors of recurrent MR. Restrictive mitral annuloplasty using a vascular strip is effective in ischemic MR. It is important to avoid early postoperative residual MR.
Aged ; Aged, 80 and over ; Coronary Artery Disease/mortality/*surgery ; Echocardiography ; Female ; Follow-Up Studies ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Mitral Valve/physiopathology/*surgery ; Mitral Valve Annuloplasty/*methods ; Mitral Valve Insufficiency/mortality/*surgery ; Myocardial Ischemia/mortality/*surgery ; Myocardial Revascularization ; Stroke Volume ; Treatment Outcome ; Vascular Surgical Procedures