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Reddy P, Anand V, Rajiah P, Larson NB, Bird J, Williams JM, Williamson EE, Nishimura RA, Crestanello JA, Arghami A, Collins JD, Bratt A. Predicting postoperative systolic dysfunction in mitral regurgitation: CT vs. echocardiography. Front Cardiovasc Med 2024; 11:1297304. [PMID: 38464845 PMCID: PMC10920321 DOI: 10.3389/fcvm.2024.1297304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Volume overload from mitral regurgitation can result in left ventricular systolic dysfunction. To prevent this, it is essential to operate before irreversible dysfunction occurs, but the optimal timing of intervention remains unclear. Current echocardiographic guidelines are based on 2D linear measurement thresholds only. We compared volumetric CT-based and 2D echocardiographic indices of LV size and function as predictors of post-operative systolic dysfunction following mitral repair. Methods We retrospectively identified patients with primary mitral valve regurgitation who underwent repair between 2005 and 2021. Several indices of LV size and function measured on preoperative cardiac CT were compared with 2D echocardiography in predicting post-operative LV systolic dysfunction (LVEFecho <50%). Area under the curve (AUC) was the primary metric of predictive performance. Results A total of 243 patients were included (mean age 57 ± 12 years; 65 females). The most effective CT-based predictors of post-operative LV systolic dysfunction were ejection fraction [LVEFCT; AUC 0.84 (95% CI: 0.77-0.92)] and LV end systolic volume indexed to body surface area [LVESViCT; AUC 0.88 (0.82-0.95)]. The best echocardiographic predictors were LVEFecho [AUC 0.70 (0.58-0.82)] and LVESDecho [AUC 0.79 (0.70-0.89)]. LVEFCT was a significantly better predictor of post-operative LV systolic dysfunction than LVEFecho (p = 0.02) and LVESViCT was a significantly better predictor than LVESDecho (p = 0.03). Ejection fraction measured by CT demonstrated significantly greater reproducibility than echocardiography. Discussion CT-based volumetric measurements may be superior to established 2D echocardiographic parameters for predicting LV systolic dysfunction following mitral valve repair. Validation with prospective study is warranted.
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Affiliation(s)
- Prajwal Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Prabhakar Rajiah
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN, United States
| | - Nicholas B. Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Jared Bird
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - James M. Williams
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN, United States
| | - Eric E. Williamson
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN, United States
| | - Rick A. Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Juan A. Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
| | - Jeremy D. Collins
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN, United States
| | - Alex Bratt
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN, United States
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2
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Abadie BQ, Cremer PC, Vakamudi S, Gillinov AM, Svensson LG, Cho L. Sex-Specific Prognosis of Left Ventricular Size and Function Following Repair of Degenerative Mitral Regurgitation. J Am Coll Cardiol 2024; 83:303-312. [PMID: 38199708 DOI: 10.1016/j.jacc.2023.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/29/2023] [Accepted: 10/13/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Prior studies have demonstrated worse long-term outcomes for women after surgery for severe mitral regurgitation (MR). The current Class I indications for surgery for severe degenerative MR use cutoffs of left ventricular end-systolic dimension (LVESD) and left ventricular ejection fraction (EF) that do not account for known sex-related differences. OBJECTIVES The primary objective of this study was to assess long-term mortality following mitral valve repair in women compared with men on the basis of preoperative left ventricular systolic dimensions and EF. METHODS Consecutive patients who underwent isolated mitral valve repair for degenerative MR at a single institution between 1994 and 2016 were screened. Adjusted HRs for all-cause mortality were compared according to baseline LVESD, LVESD indexed to body surface area (LVESDi), and EF for men and women. RESULTS Among 4,589 patients, 1,825 were women (40%), and after a median follow-up period of 7.2 years, 344 patients (7.5%) had died. The risk for mortality for women increased from the baseline hazard at an LVESD of 3.6 cm, whereas an inflection point for increased risk with LVESD was not evident in men. Regarding LVESDi, the risk for women increased at 1.8 cm/m2 compared with 2.1 cm/m2 in men. For EF, women and men had a similar inflection point (58%); however, mortality was higher for women as EF decreased. CONCLUSIONS After mitral valve repair, women have a higher risk for all-cause mortality at lower LVESD and LVESDi and higher EF. These results support consideration of sex-specific thresholds for LVESDi in surgical decision making for patients with severe MR.
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Affiliation(s)
- Bryan Q Abadie
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul C Cremer
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sneha Vakamudi
- Ascension Texas Cardiovascular and the University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - A Marc Gillinov
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lars G Svensson
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Leslie Cho
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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3
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Almeida ALC, Melo MDTD, Bihan DCDSL, Vieira MLC, Pena JLB, Del Castillo JM, Abensur H, Hortegal RDA, Otto MEB, Piveta RB, Dantas MR, Assef JE, Beck ALDS, Santo THCE, Silva TDO, Salemi VMC, Rocon C, Lima MSM, Barberato SH, Rodrigues AC, Rabschkowisky A, Frota DDCR, Gripp EDA, Barretto RBDM, Silva SME, Cauduro SA, Pinheiro AC, Araujo SPD, Tressino CG, Silva CES, Monaco CG, Paiva MG, Fisher CH, Alves MSL, Grau CRPDC, Santos MVCD, Guimarães ICB, Morhy SS, Leal GN, Soares AM, Cruz CBBV, Guimarães Filho FV, Assunção BMBL, Fernandes RM, Saraiva RM, Tsutsui JM, Soares FLDJ, Falcão SNDRS, Hotta VT, Armstrong ADC, Hygidio DDA, Miglioranza MH, Camarozano AC, Lopes MMU, Cerci RJ, Siqueira MEMD, Torreão JA, Rochitte CE, Felix A. Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023. Arq Bras Cardiol 2023; 120:e20230646. [PMID: 38232246 DOI: 10.36660/abc.20230646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Central Illustration : Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023 Proposal for including strain in the integrated diastolic function assessment algorithm, adapted from Nagueh et al.67 Am: mitral A-wave duration; Ap: reverse pulmonary A-wave duration; DD: diastolic dysfunction; LA: left atrium; LASr: LA strain reserve; LVGLS: left ventricular global longitudinal strain; TI: tricuspid insufficiency. Confirm concentric remodeling with LVGLS. In LVEF, mitral E wave deceleration time < 160 ms and pulmonary S-wave < D-wave are also parameters of increased filling pressure. This algorithm does not apply to patients with atrial fibrillation (AF), mitral annulus calcification, > mild mitral valve disease, left bundle branch block, paced rhythm, prosthetic valves, or severe primary pulmonary hypertension.
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Affiliation(s)
| | | | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felicio Rocho, Belo Horizonte, MG - Brasil
| | | | - Henry Abensur
- Beneficência Portuguesa de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | - Vera Maria Cury Salemi
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - Camila Rocon
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Márcio Silva Miguel Lima
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardiaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Veronica Camara Dos Santos
- Departamento de Cardiologia Pediátrica (DCC/CP) da Sociedade Brasileira de Cardiologia (SBC), São Paulo, SP - Brasil
- Sociedade Brasileira de Oncologia Pediátrica, São Paulo, SP - Brasil
| | | | | | - Gabriela Nunes Leal
- Instituto da Criança e do Adolescente do Hospital das Clinicas Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | | | - Viviane Tiemi Hotta
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Grupo Fleury, São Paulo, SP - Brasil
| | | | - Daniel de Andrade Hygidio
- Hospital Nossa Senhora da Conceição, Tubarão, SC - Brasil
- Universidade do Sul de Santa Catarina (UNISUL), Tubarão, SC - Brasil
| | - Marcelo Haertel Miglioranza
- EcoHaertel - Hospital Mae de Deus, Porto Alegre, RS - Brasil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS - Brasil
| | | | | | | | | | - Jorge Andion Torreão
- Hospital Santa Izabel, Salvador, BA - Brasil
- Santa Casa da Bahia, Salvador, BA - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Alex Felix
- Diagnósticos da América SA (DASA), São Paulo, SP - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
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4
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El-Sayed Ahmad A, Salamate S, Bakhtiary F. Lessons learned from 10 years of experience with minimally invasive cardiac surgery. Front Cardiovasc Med 2023; 9:1053572. [PMID: 36698927 PMCID: PMC9868475 DOI: 10.3389/fcvm.2022.1053572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/25/2022] [Indexed: 01/11/2023] Open
Abstract
Since its inception more than a quarter of a century ago, minimally invasive cardiac surgery has attracted the increasing interest of cardiac surgeons worldwide. The need to surgically treat patients with smaller and better-tolerated incisions coupled with high-quality clinical outcomes, particularly in structural heart disease, has become imperative to keep pace with the evolution of transcatheter valve implantation. We have learned numerous lessons from our longstanding experience in this field of surgical care, especially in terms of endoscopic access via mini-thoracotomy. To improve the safety and efficacy of this minimally invasive endoscopic access, this study summarizes and highlights the lessons we have learned, acting as a template for newly established cardiac surgeons in minimally invasive techniques.
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Affiliation(s)
- Ali El-Sayed Ahmad
- Department of Cardiac Surgery, Heart Center Siegburg, Siegburg, Germany,*Correspondence: Ali El-Sayed Ahmad ✉
| | - Saad Salamate
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
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5
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Delling FN, Noseworthy PA, Adams DH, Basso C, Borger M, Bouatia-Naji N, Elmariah S, Evans F, Gerstenfeld E, Hung J, Tourneau TL, Lewis J, Miller MA, Norris RA, Padala M, Perazzolo-Marra M, Shah DJ, Weinsaft JW, Enriquez-Sarano M, Levine RA. Research Opportunities in the Treatment of Mitral Valve Prolapse: JACC Expert Panel. J Am Coll Cardiol 2022; 80:2331-2347. [PMID: 36480975 PMCID: PMC9981237 DOI: 10.1016/j.jacc.2022.09.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/31/2022] [Accepted: 09/12/2022] [Indexed: 12/10/2022]
Abstract
In light of the adverse prognosis related to severe mitral regurgitation, heart failure, or sudden cardiac death in a subset of patients with mitral valve prolapse (MVP), identifying those at higher risk is key. For the first time in decades, researchers have the means to rapidly advance discovery in the field of MVP thanks to state-of-the-art imaging techniques, novel omics methodologies, and the potential for large-scale collaborations using web-based platforms. The National Heart, Lung, and Blood Institute recently initiated a webinar-based workshop to identify contemporary research opportunities in the treatment of MVP. This report summarizes 3 specific areas in the treatment of MVP that were the focus of the workshop: 1) improving management of degenerative mitral regurgitation and associated left ventricular systolic dysfunction; 2) preventing sudden cardiac death in MVP; and 3) understanding the mechanisms and progression of MVP through genetic studies and small and large animal models, with the potential of developing medical therapies.
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Affiliation(s)
- Francesca N. Delling
- Department of Medicine (Cardiovascular Division), University of California-San Francisco, San Francisco, California, USA
| | - Peter A. Noseworthy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - David H. Adams
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | | | - Sammy Elmariah
- Department of Medicine (Cardiovascular Division), University of California-San Francisco, San Francisco, California, USA,Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Frank Evans
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Edward Gerstenfeld
- Department of Medicine (Cardiovascular Division), University of California-San Francisco, San Francisco, California, USA
| | - Judy Hung
- Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thierry Le Tourneau
- Nantes Université, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, Nantes, France
| | - John Lewis
- Heart Valve Voice US, Washington, DC, USA
| | - Marc A. Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Russell A. Norris
- Department of Regenerative Medicine and Cell Biology, Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Muralidhar Padala
- Department of Surgery (Cardiothoracic Surgery Division), Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Dipan J. Shah
- Department of Cardiology, Houston Methodist, Weill Cornell Medical College, Houston, Texas, USA
| | | | | | - Robert A. Levine
- Massachusetts General Hospital Cardiac Ultrasound Laboratory, Boston, Massachusetts, USA
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6
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Tse YK, Li HL, Yu SY, Wu MZ, Ren QW, Huang J, Tse HF, Bax JJ, Yiu KH. Prognostic value of right ventricular remodelling in patients undergoing concomitant aortic and mitral valve surgery. Eur Heart J Cardiovasc Imaging 2022; 24:653-663. [PMID: 35993804 DOI: 10.1093/ehjci/jeac162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/02/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Long-term risk stratification and surgical timing remain suboptimal in concomitant aortic and mitral (double) valve surgery. This study sought to examine the predictors, changes, and prognostic implications of right ventricular (RV) remodelling in patients undergoing double-valve surgery. METHODS AND RESULTS In 152 patients undergoing double-valve surgery, four RV remodelling patterns were characterized using transthoracic echocardiography: normal RV size and systolic function (Pattern 1); dilated RV (tricuspid annulus diameter >35 mm) with normal systolic function (Pattern 2); normal RV size with systolic dysfunction (percentage RV fractional area change <35%; Pattern 3); and dilated RV with systolic dysfunction (Pattern 4). The primary endpoint was the composite of heart failure hospitalization and all-cause mortality. Patterns 1, 2, 3, and 4 RV remodelling were present in 41, 20, 23, and 16% of patients, respectively. Patients with Stage 4 RV remodelling had worse renal function, higher EuroSCORE II, and impaired left ventricular ejection fraction. During a 3.7-year median follow up, 45 adverse events occurred. Patterns 3 and 4 RV remodelling were associated with significantly higher adverse event rates compared with Pattern 1 (37 and 75% vs. 11%, P < 0.01) and had incremental prognostic value when added to clinical parameters and EuroSCORE II (χ2 increased from 30 to 66, P < 0.01). At 1 year after surgery (n = 100), Patterns 3 and 4 RV remodelling had a higher risk of adverse events compared with Pattern 1. CONCLUSION Right ventricular remodelling was strongly related to adverse outcomes and deserves consideration as part of the risk and decision-making algorithms in double-valve surgery.
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Affiliation(s)
- Yi Kei Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, 518000 Shenzhen, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 000000 Hong Kong, China
| | - Hang Long Li
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 000000 Hong Kong, China
| | - Si Yeung Yu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, 518000 Shenzhen, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 000000 Hong Kong, China
| | - Mei Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, 518000 Shenzhen, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 000000 Hong Kong, China
| | - Qing Wen Ren
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, 518000 Shenzhen, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 000000 Hong Kong, China
| | - Jiayi Huang
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, 518000 Shenzhen, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 000000 Hong Kong, China
| | - Hung Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, 518000 Shenzhen, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 000000 Hong Kong, China
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.,Department of Cardiology, Turku Heart Center, University of Turku and Turku University Hospital, 20521 Turku, Finland
| | - Kai Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, 518000 Shenzhen, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 000000 Hong Kong, China
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7
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Pizzino F, Furini G, Casieri V, Mariani M, Bianchi G, Storti S, Chiappino D, Maffei S, Solinas M, Aquaro GD, Lionetti V. Late plasma exosome microRNA-21-5p depicts magnitude of reverse ventricular remodeling after early surgical repair of primary mitral valve regurgitation. Front Cardiovasc Med 2022; 9:943068. [PMID: 35966562 PMCID: PMC9373041 DOI: 10.3389/fcvm.2022.943068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/04/2022] [Indexed: 12/11/2022] Open
Abstract
Introduction Primary mitral valve regurgitation (MR) results from degeneration of mitral valve apparatus. Mechanisms leading to incomplete postoperative left ventricular (LV) reverse remodeling (Rev-Rem) despite timely and successful surgical mitral valve repair (MVR) remain unknown. Plasma exosomes (pEXOs) are smallest nanovesicles exerting early postoperative cardioprotection. We hypothesized that late plasma exosomal microRNAs (miRs) contribute to Rev-Rem during the late postoperative period. Methods Primary MR patients (n = 19; age, 45-71 years) underwent cardiac magnetic resonance imaging and blood sampling before (T0) and 6 months after (T1) MVR. The postoperative LV Rev-Rem was assessed in terms of a decrease in LV end-diastolic volume and patients were stratified into high (HiR-REM) and low (LoR-REM) LV Rev-Rem subgroups. Isolated pEXOs were quantified by nanoparticle tracking analysis. Exosomal microRNA (miR)-1, -21-5p, -133a, and -208a levels were measured by RT-qPCR. Anti-hypertrophic effects of pEXOs were tested in HL-1 cardiomyocytes cultured with angiotensin II (AngII, 1 μM for 48 h). Results Surgery zeroed out volume regurgitation in all patients. Although preoperative pEXOs were similar in both groups, pEXO levels increased after MVR in HiR-REM patients (+0.75-fold, p = 0.016), who showed lower cardiac mass index (-11%, p = 0.032). Postoperative exosomal miR-21-5p values of HiR-REM patients were higher than other groups (p < 0.05). In vitro, T1-pEXOs isolated from LoR-REM patients boosted the AngII-induced cardiomyocyte hypertrophy, but not postoperative exosomes of HiR-REM. This adaptive effect was counteracted by miR-21-5p inhibition. Summary/Conclusion High levels of miR-21-5p-enriched pEXOs during the late postoperative period depict higher LV Rev-Rem after MVR. miR-21-5p-enriched pEXOs may be helpful to predict and to treat incomplete LV Rev-Rem after successful early surgical MVR.
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Affiliation(s)
- Fausto Pizzino
- Unit of Translational Critical Care Medicine, Scuola Superiore Sant'Anna, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giulia Furini
- Unit of Translational Critical Care Medicine, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Valentina Casieri
- Unit of Translational Critical Care Medicine, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | | | | | | | | | | | - Vincenzo Lionetti
- Unit of Translational Critical Care Medicine, Scuola Superiore Sant'Anna, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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8
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Nath SS, Parashar S. Perioperative management of patients with prosthetic heart valves-A narrative review. Ann Card Anaesth 2022; 25:254-263. [PMID: 35799551 PMCID: PMC9387617 DOI: 10.4103/aca.aca_109_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Worldwide, about 13% of the 200,000 annual recipients of prosthetic heart valves (PHV) present for various surgical procedures. Also, more and more females are opting for pregnancies after having PHV. All patients with PHV present unique challenges for the anesthesiologists, surgeons and obstetricians (in case of deliveries). They have to deal with the perioperative management of anticoagulation and a host of other issues involved. We reviewed the English language medical literature relevant to the different aspects of perioperative management of patients with PHV, particularly the guidelines of reputed societies that appeared in the last 20 years. Regression of cardiac pathophysiology following valve replacement is variable both in extent and timeline. The extent to which reverse remodeling occurs depends on the perioperative status of the heart. We discussed the perioperative assessment of patients with PHV, including focused history and relevant investigations with the inferences drawn. We examined the need for prophylaxis against infective endocarditis and management of anticoagulation in such patients in the perioperative period and the guidelines of reputed societies. We also reviewed the conduct of anesthesia, including general and regional anesthesia (neuraxial and peripheral nerve/plexus blocks) in such patients. Finally, we discussed the management of delivery in this group of high-risk patients. From the discussion of different aspects of perioperative management of patients with PHV, we hope to guide in formulating the comprehensive plan of management of safe anesthesia in such patients.
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Affiliation(s)
- Soumya Sankar Nath
- Department of Anesthesiology and Critical Care Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Samiksha Parashar
- Department of Anesthesiology and Critical Care Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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9
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Hibino M, Dhingra NK, Chan V, Mazer CD, Teoh H, Quan A, Verma R, Leong-Poi H, Bisleri G, Connelly KA, Verma S. Stage-based approach to predict left ventricular reverse remodeling after mitral repair. Clin Cardiol 2022; 45:921-927. [PMID: 35748086 PMCID: PMC9451668 DOI: 10.1002/clc.23879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Although predictors of reverse left ventricular (LV) remodeling postmitral valve repair are critical for guiding perioperative decision‐making, there remains a paucity of randomized, prospective data to support the criteria that potential predictor variables must meet. Methods and Results The CAMRA CardioLink‐2 randomized trial allocated 104 patients to either leaflet resection or preservation strategies for mitral repair. The correlation of indexed left ventricular end‐systolic volume (LVESVI), indexed left ventricular end‐diastolic volume (LVEDVI), and left ventricular ejection fraction (LVEF) were tested with univariate analysis and subsequently with multivariate analysis to determine independent predictors of reverse remodeling at discharge and at 12 months postoperatively. At discharge, both LVESVI and LVEDVI were independently associated with their preoperative values (p < .001 for both) and LVEF by preoperative LVESVI (p < .001). Mitral ring size was favorably associated with the change in LVESVI (p < .05) and LVEF (p < .01) from predischarge to 12 months, while the mean mitral valve gradient after repair was adversely associated with the change in LVESVI (p < .05) and LVEDVI (p < .05). No significant associations were found between reverse remodeling and coaptation height nor mitral repair technique. Conclusions Beyond confirming the lack of impact of mitral repair technique on reverse remodeling, this investigation suggests that recommending surgery before significant LV dilatation or dysfunction, as well as higher postoperative mitral valve hemodynamic performance, may enhance remodeling capacity following mitral repair.
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Affiliation(s)
- Makoto Hibino
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nitish K Dhingra
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - C David Mazer
- Department of Anesthesia, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Adrian Quan
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Raj Verma
- Royal College of Surgeon Ireland, Dublin, Ireland
| | - Howard Leong-Poi
- Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kim A Connelly
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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10
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Pype LL, Bertrand PB, Paelinck BP, Heidbuchel H, Van Craenenbroeck EM, Van De Heyning CM. Left Ventricular Remodeling in Non-syndromic Mitral Valve Prolapse: Volume Overload or Concomitant Cardiomyopathy? Front Cardiovasc Med 2022; 9:862044. [PMID: 35498019 PMCID: PMC9039519 DOI: 10.3389/fcvm.2022.862044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/07/2022] [Indexed: 01/11/2023] Open
Abstract
Mitral valve prolapse (MVP) is a common valvular disorder that can be associated with mitral regurgitation (MR), heart failure, ventricular arrhythmias and sudden cardiac death. Given the prognostic impact of these conditions, it is important to evaluate not only mitral valve morphology and regurgitation, but also the presence of left ventricular (LV) function and remodeling. To date, several possible hypotheses have been proposed regarding the underlying mechanisms of LV remodeling in the context of non-syndromic MVP, but the exact pathophysiological explanation remains elusive. Overall, volume overload related to severe MR is considered the main cause of LV dilatation in MVP. However, significant LV remodeling has been observed in patients with MVP and no/mild MR, particularly in patients with bileaflet MVP or Barlow’s disease, generating several new hypotheses. Recently, the concept of “prolapse volume” was introduced, adding a significant volume load to the LV on top of the transvalvular MR volume. Another possible hypothesis is the existence of a concomitant cardiomyopathy, supported by the link between MVP and myocardial fibrosis. The origin of this cardiomyopathy could be either genetic, a second hit (e.g., on top of genetic predisposition) and/or frequent ventricular ectopic beats. This review provides an overview of the different mechanisms and remaining questions regarding LV remodeling in non-syndromic MVP. Since technical specifications of imaging modalities impact the evaluation of MR severity and LV remodeling, and therefore might influence clinical decision making in these patients, this review will also discuss assessment of MVP using different imaging modalities.
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Affiliation(s)
- Lobke L. Pype
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Genetics, Pharmacology and Physiopathology of Heart, Vasculature and Skeleton (GENCOR) Research Group, University of Antwerp, Antwerp, Belgium
| | - Philippe B. Bertrand
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Cardio and Organ Systems (COST) Resarch Group, Hasselt University, Hasselt, Belgium
| | - Bernard P. Paelinck
- Genetics, Pharmacology and Physiopathology of Heart, Vasculature and Skeleton (GENCOR) Research Group, University of Antwerp, Antwerp, Belgium
- Department of Cardiac Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Genetics, Pharmacology and Physiopathology of Heart, Vasculature and Skeleton (GENCOR) Research Group, University of Antwerp, Antwerp, Belgium
| | - Emeline M. Van Craenenbroeck
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Genetics, Pharmacology and Physiopathology of Heart, Vasculature and Skeleton (GENCOR) Research Group, University of Antwerp, Antwerp, Belgium
| | - Caroline M. Van De Heyning
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Genetics, Pharmacology and Physiopathology of Heart, Vasculature and Skeleton (GENCOR) Research Group, University of Antwerp, Antwerp, Belgium
- *Correspondence: Caroline M. Van De Heyning,
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11
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Arghami A, Jahanian S, Daly RC, Hemmati P, Lahr BD, Rowse PG, Crestanello JA, Dearani JA. Robotic Mitral Valve Repair: A Decade of Experience with Echocardiographic Follow-up. Ann Thorac Surg 2021; 114:1587-1595. [PMID: 34800487 DOI: 10.1016/j.athoracsur.2021.08.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical approaches for mitral valve (MV) disease have evolved with the aim of developing minimally invasive techniques. While the safety of robotic procedures has been documented, there are limited data on long-term echocardiographic follow-up. This review demonstrates outcomes of 11 years of robotic MV repair at a single, tertiary institution. METHODS From 2008 to 2019, 843 patients underwent robotic MV repair at our institution. Repeated measures generalized least squares (GLS) modelling was used to assess the echocardiographic changes over time. RESULTS The median age was 58 years (IQR 50.8, 65.5) (591 males, 70.1%). Mechanism of MR was posterior leaflet prolapse in 479 (56.8%), bileaflet prolapse in 325 (38.6%), and anterior leaflet prolapse in 36 (4.3%). There were 3 early deaths (0.4%) and 24 early reoperations (2.8%). Echocardiographic follow up demonstrated left ventricular end systolic and diastolic dimensions, left atrial volume index and pulmonary pressure all continuously improvement up to 2 years postoperatively. Ejection fraction immediately declined postoperatively but then gradually improved to near normal over 2 years. Survival and freedom from reoperation at 10 years were 93% and 92.6%, respectively. When surveyed after dismissal, 93.4% reported their activity level at or above their peers and 93.3% reported no activity limitation from cardiac symptoms. CONCLUSIONS Robotic MV repair is safe and effective with excellent long-term results, including echocardiographic parameters that demonstrated early improvement in cardiac chamber size and maintenance of postoperative cardiac function. Exceedingly low mortality rates and freedom from reoperation are comparable to those of the standard open repair.
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Affiliation(s)
- Arman Arghami
- Cardiovascular Surgery Department, Mayo Clinic, Rochester MN.
| | | | - Richard C Daly
- Cardiovascular Surgery Department, Mayo Clinic, Rochester MN
| | - Pouya Hemmati
- Cardiovascular Surgery Department, Mayo Clinic, Rochester MN
| | - Brian D Lahr
- Biostatistics Department, Mayo Clinic, Rochester, MN
| | - Phillip G Rowse
- Cardiovascular Surgery Department, Mayo Clinic, Rochester MN
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12
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McCarthy PM. Commentary: More ado about nothing: Resect "versus" respect and left ventricular function after repair. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01388-X. [PMID: 34642077 DOI: 10.1016/j.jtcvs.2021.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Patrick M McCarthy
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Ill.
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13
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Mitral repair with leaflet preservation versus leaflet resection and ventricular reverse remodeling from a randomized trial. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01310-6. [PMID: 34702564 DOI: 10.1016/j.jtcvs.2021.08.081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In the Canadian Mitral Research Alliance (CAMRA) Trial CardioLink-2 leaflet resection versus preservation techniques for posterior leaflet prolapse was investigated and no difference was shown in their effect on mean mitral gradient at peak exercise at 12 months postoperatively. The purpose of this subanalysis was to evaluate the effect of the 2 strategies on left ventricular (LV) reverse remodeling after repair. METHODS A total of 104 patients were randomized to either a leaflet resection or leaflet preservation strategy. Echocardiograms, performed at baseline (preoperative), predischarge, and 12 months postoperatively, were analyzed in a blinded fashion at a core laboratory. RESULTS All patients underwent successful mitral repair. At discharge, 3 patients showed moderate mitral regurgitation, whereas the remainder showed mild or less regurgitation. Compared with the baseline echocardiogram, the indexed end diastolic volume was reduced at the discharge echocardiogram (P < .0001) and was further reduced at the 12-month echocardiogram (P = .01). In contrast, the indexed end systolic volume did not significantly change from baseline assessed at the predischarge echocardiogram (P = .32) but improved at 12 months postoperatively (P < .0001), resulting in a corresponding improvement in ejection fraction at 12 months (P < .0001). The type of mitral repair strategy had no significant effect on LV reverse remodeling trends. CONCLUSIONS The mitral repair strategies used did not influence postoperative LV reverse remodeling, which occurred in stages. Although LV end diastolic dimensions recovered before discharge, improvements in LV end systolic dimension were evident 12 months after repair.
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14
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Nair VV, Das S, Nair RB, George TP, Kathayanat JT, Chooriyil N, Radhakrishnan R, Thanathu Krishnan Nair J. Mitral valve repair in chronic severe mitral regurgitation: short-term results and analysis of mortality predictors. Indian J Thorac Cardiovasc Surg 2021; 37:506-513. [PMID: 34511756 DOI: 10.1007/s12055-021-01160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Mitral valve repair is the accepted treatment for mitral regurgitation (MR) but lack of resources and socioeconomic concerns delay surgical referral and intervention in developing countries. We evaluated immediate and short-term results of mitral valve repair for non-ischemic MR at our centre and aimed to identify the predictors of in-hospital and follow-up mortality. Materials and methods The study was conducted at a tertiary-level hospital in South India. All patients >18 years with severe non-ischemic MR who underwent mitral valve repair over a period of 6 years were included. Perioperative data was collected from hospital records and follow-up data was obtained by prospective methods. Results There were 244 patients (170 males). Most of the patients were in the age group 31-60 years (76.6%). Aetiology of MR was degenerative (n = 159; 65.2%), rheumatic (n = 34; 13.9%), structural (n = 42; 17.2%), or miscellaneous (n = 9; 3.7%). All patients underwent ring annuloplasty with various valve repair techniques. One hundred patients (44.7%) underwent additional cardiac procedures. At discharge, MR was moderate in 4 patients; the rest had no or mild MR. The mean hospital stay of survivors was 7.1 days (SD 2.52, range 5-25 days). There were 9 in-hospital deaths (3.68%) and 10 deaths during follow-up (4.2%). The mean follow-up period was 1.39 years, complete for 87.6%. Pre-operative left ventricle ejection fraction (LVEF) <60% (p = 0.04) was found to be significantly associated with immediate mortality. Logistic regression analysis detected age (p = 0.019), female sex (p = 0.015), and left ventricular (LV) dysfunction at discharge (p = 0.025) to be significantly associated with follow-up mortality. Conclusion Pre-operative LV dysfunction was identified as a significant risk factor for in-hospital mortality. Female sex, age greater than 45 years, and LV dysfunction at discharge were found to be significantly associated with follow-up mortality. Hence, it is important to perform mitral valve repair in severe regurgitation patients before significant LV dysfunction sets in for a better outcome.
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Affiliation(s)
| | - Syam Das
- Government Medical College, Kottayam, India
| | | | | | | | - Nidheesh Chooriyil
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, India
| | - Ratish Radhakrishnan
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, India
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15
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An SM, Nam JS, Kim HJ, Bae HJ, Chin JH, Lee EH, Choi IC. Postoperative changes in left ventricular systolic function after combined mitral and aortic valve replacement in patients with rheumatic heart disease. J Card Surg 2021; 36:3654-3661. [PMID: 34252984 DOI: 10.1111/jocs.15814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/05/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUNDS We sought to identify short- and long-term changes in postoperative left ventricular systolic function in patients with rheumatic heart disease (RHD) who underwent combined aortic and mitral valve replacement. METHODS We analyzed 146 patients according to their preoperative left ventricular ejection fraction (LVEF) (113 with preoperative LVEF ≥50% and 33 with preoperative LVEF <50%). A restricted cubic spline model was used to assess the effect of time on the postoperative changes in echocardiographic parameters. RESULTS There were no significant difference in preoperative and immediately postoperative LVEF before discharge in either group. During median follow-up of 3.2 years (interquartile range: 1.3-4.7 years) after surgery, postoperative LVEF increased slightly and then plateaued in patients with preoperative LVEF ≥50%, whereas it increased over 3-4 years after surgery and then gradually decreased in patients with preoperative LVEF <50% (p < .001). CONCLUSION Long-term postoperative LVEF showed a downward trend in RHD patients with reduced preoperative LVEF, whereas it reached a plateau in RHD patients with normal preoperative LVEF.
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Affiliation(s)
- Sang-Mee An
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Jae-Sik Nam
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyeun Joon Bae
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji-Hyun Chin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun-Ho Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - In-Cheol Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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16
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Changes in Left Ventricular Ejection Fraction after Mitral Valve Repair for Primary Mitral Regurgitation. J Clin Med 2021; 10:jcm10132830. [PMID: 34206958 PMCID: PMC8267705 DOI: 10.3390/jcm10132830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022] Open
Abstract
This study sought to identify the short- and long-term changes in left ventricular ejection fraction (LVEF) after mitral valve repair (MVr) in patients with chronic primary mitral regurgitation according to preoperative LVEF (pre-LVEF) and preoperative left ventricular end-systolic diameter (pre-LVESD). This study evaluated 461 patients. Restricted cubic spline regression models were constructed to demonstrate the long-term changes in postoperative LVEF (post-LVEF). The patients were divided into four groups according to pre-LVEF (<50%, 50–60%, 60–70%, and ≥70%). The higher the pre-LVEF was, the greater was the decrease in LVEF immediately after MVr. In the same pre-LVEF range, immediate post-LVEF was lower in patients with pre-LVESD ≥ 40 mm than in those with pre-LVESD < 40 mm. The patterns of long-term changes in post-LVEF differed according to pre-LVEF (p for interaction < 0.001). The long-term post-LVEF reached a plateau of approximately 60% when the pre-LVEF was ≥50%, but it seemed to show a downward trend after reaching a peak at approximately 3–4 years after MVr when the pre-LVEF was ≥70%. The patterns of short- and long-term changes in post-LVEF differed according to pre-LVEF and pre-LVESD values in patients with chronic primary mitral regurgitation after MVr.
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17
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Gammie JS, Bartus K, Gackowski A, Szymanski P, Bilewska A, Kusmierczyk M, Kapelak B, Rzucidlo-Resil J, Duncan A, Yadav R, Livesey S, Diprose P, Gerosa G, D'Onofrio A, Pittarello D, Denti P, La Canna G, De Bonis M, Alfieri O, Hung J, Kolsut P, D'Ambra MN. Safety and performance of a novel transventricular beating heart mitral valve repair system: 1-year outcomes. Eur J Cardiothorac Surg 2021; 59:199-206. [PMID: 33038223 DOI: 10.1093/ejcts/ezaa256] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the safety and performance of a novel, beating heart procedure that enables echocardiographic-guided beating heart implantation of expanded polytetrafluoroethylene (ePTFE) artificial cords on the posterior mitral leaflet of patients with degenerative mitral regurgitation. METHODS Two prospective multicentre studies enrolled 13 (first-in-human) and 52 subjects, respectively. Patients were treated with the HARPOON beating heart mitral valve repair system. The primary (30-day) end point was successful implantation of cord(s) with mitral regurgitation reduction to ≤moderate. An independent core laboratory analysed echocardiograms. RESULTS Of 65 patients enrolled, 62 (95%) achieved technical success, 2 patients required conversion to open surgery and 1 procedure was terminated. The primary end point was met in 59/65 (91%) patients. Among the 62 treated patients, the mean procedural time was 2.1 ± 0.5 h. Through discharge, there were no deaths, strokes or renal failure events. At 1 year, 2 of the 62 patients died (3%) and 8 (13%) others required reoperations. At 1 year, 98% of the patients with HARPOON cords were in New York Heart Association class I or II, and mitral regurgitation was none/trace in 52% (n = 27), mild in 23% (n = 12), moderate in 23% (n = 12) and severe in 2% (n = 1). Favourable cardiac remodelling outcomes at 1 year included decreased end-diastolic left ventricular volume (153 ± 41 to 119 ± 28 ml) and diameter (53 ± 5 to 47 ± 6 mm), and the mean transmitral gradient was 1.4 ± 0.7 mmHg. CONCLUSIONS This initial clinical experience with the HARPOON beating heart mitral valve repair system demonstrates encouraging early safety and performance. CLINICAL REGISTRATION NUMBERS NCT02432196 and NCT02768870.
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Affiliation(s)
- James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Andrzej Gackowski
- Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Krakow, Poland
| | - Piotr Szymanski
- MSWiA Central Clinical Hospital, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Agata Bilewska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | | | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Jolanta Rzucidlo-Resil
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Alison Duncan
- Department of Surgery, The Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Rashmi Yadav
- Department of Surgery, The Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Steve Livesey
- Division of Cardiac Surgery, St. George's Hospital, London, UK
| | - Paul Diprose
- Cardiac Anesthesia and Critical Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac Thoracic and Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Augusto D'Onofrio
- Division of Cardiac Surgery, Department of Cardiac Thoracic and Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | | | - Paolo Denti
- Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy
| | | | - Michele De Bonis
- Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy
| | - Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Michael N D'Ambra
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
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18
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Predictive Value of Pre-Operative 2D and 3D Transthoracic Echocardiography in Patients Undergoing Mitral Valve Repair: Long Term Follow Up of Mitral Valve Regurgitation Recurrence and Heart Chamber Remodeling. J Cardiovasc Dev Dis 2020; 7:jcdd7040046. [PMID: 33092178 PMCID: PMC7712008 DOI: 10.3390/jcdd7040046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 01/30/2023] Open
Abstract
The “ideal” management of asymptomatic severe mitral regurgitation (MR) in valve prolapse (MVP) is still debated. The aims of this study were to identify pre-operatory parameters predictive of residual MR and of early and long-term favorable remodeling after MVP repair. We included 295 patients who underwent MV repair for MVP with pre-operatory two- and three-dimensional transthoracic echocardiography (2DTTE and 3DTTE) and 6-months (6M) and 3-years (3Y) follow-up 2DTTE. MVP was classified by 3DTTE as simple or complex and surgical procedures as simple or complex. Pre-operative echo parameters were compared to post-operative values at 6M and 3Y. Patients were divided into Group 1 (6M-MR < 2) and Group 2 (6M-MR ≥ 2), and predictors of MR ≥ 2 were investigated. MVP was simple in 178/295 pts, and 94% underwent simple procedures, while in only 42/117 (36%) of complex MVP a simple procedure was performed. A significant relation among prolapse anatomy, surgical procedures and residual MR was found. Post-operative MR ≥ 2 was present in 9.8%: complex MVP undergoing complex procedures had twice the percentage of MR ≥ 2 vs. simple MVP and simple procedures. MVP complexity resulted independent predictor of 6M-MR ≥ 2. Favorable cardiac remodeling, initially found in all cases, was maintained only in MR < 2 at 3Y. Pre-operative 3DTTE MVP morphology identifies pts undergoing simple or complex procedures predicting MR recurrence and favorable cardiac remodeling.
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19
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Preoperative left atrial volume index is associated with postoperative outcomes in mitral valve repair for chronic mitral regurgitation. J Thorac Cardiovasc Surg 2019; 160:661-672.e5. [PMID: 31627945 DOI: 10.1016/j.jtcvs.2019.08.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/28/2019] [Accepted: 08/01/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess determinants of left atrial reverse remodeling after mitral valve repair and to evaluate the impact of preoperative left atrial volume on postoperative outcomes. METHODS We reviewed the records of 720 patients who underwent mitral valve repair from September 2008 to July 2015 and had preoperative measurement of left atrial volume index. We analyzed the association of preoperative left atrial volume index on early and late outcomes, and determined which baseline characteristics are associated with left atrial reverse remodeling, as measured by changes in left atrial volume index in 512 patients who had at least 1 postoperative measurement. RESULTS The median (interquartile range) preoperative left atrial volume index was 54.0 (44.0-66.0) mL/m2. Preoperative left atrial volume index, age, body mass index, and atrial fibrillation were independently associated with the degree of left atrial reverse remodeling over the follow-up period. Reverse remodeling was greatest in patients with higher baseline left atrial volume index (P < .001), but less reverse remodeling was observed in patients with advanced age (P < .001), preoperative atrial fibrillation (P < .001), and extreme values of body mass index (P = .004), although these effects were moderately attenuated when limiting the analysis to 6-month follow-up. Secondary analysis demonstrated marginally significant effects of preoperative left atrial volume index on risks of early postoperative atrial fibrillation (P = .030) and late mortality (P = .077) after adjusting for age and sex. CONCLUSIONS In patients with degenerative mitral valve regurgitation who had mitral valve repair, preoperative left atrial volume index was associated with extent of left atrial reverse remodeling, risk of early postoperative atrial fibrillation, and late mortality. The majority of reverse remodeling occurs within the first month after operation and is greatest in younger patients.
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20
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Le Tourneau T, Topilsky Y, Inamo J, Mahoney DW, Suri R, Schaff HV, Sarano M. Reverse Left Ventricular Remodeling after Surgery in Primary Mitral Regurgitation: A Volume-Related Phased Process. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1639870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Thierry Le Tourneau
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
- Institut du Thorax, Inserm, CNRS, Université de Nantes, Nantes, France
| | - Yan Topilsky
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jocelyn Inamo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas W. Mahoney
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Rakesh Suri
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell V. Schaff
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Maurice Sarano
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
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21
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Hage F, Hage A, Manian U, Tzemos N, Chu MWA. Left ventricular remodeling after mini-mitral repair-does the complexity of mitral disease matter? J Card Surg 2019; 34:913-918. [PMID: 31269266 DOI: 10.1111/jocs.14146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Degenerative mitral valve (MV) regurgitation (MR) is associated with left ventricular (LV) dilatation. Surgical treatment of MR has been shown to favorably affect LV remodeling. We prospectively compared the long-term echocardiographic outcomes of LV remodeling following mini-mitral repair for simple versus complex MV disease. METHODS We prospectively followed up 203 consecutive patients who underwent mini-MV repair for severe degenerative MR over a 9-year period. Simple disease (n = 122 patients: posterior leaflet prolapse) was compared to complex disease (n = 81 patients: anterior, bilateral or commissural prolapse). Baseline demographics were similar between simple and complex groups (age: 63 ± 13 years vs 60 ± 15 years; p = .2; sex: 71% male vs 72% male, p = 1; preoperative MR grade ≥ 3+: 100%; n = 122; vs 100%; n = 81; p = 1), respectively. RESULTS Preoperative left ventricular ejection fraction (LVEF) was significantly lower in the complex group as compared to the simple group (57.2% simple vs 56.0% complex; p = .04). Preoperative LV end-systolic diameter (LVESD: 35 mm simple vs 36 mm complex, p < .05) and LV end-diastolic diameter (LVEDD: 50 mm simple vs 51 mm complex; p < .05), as well as LV mass index (99.5 g/m2 vs 102.4 g/m2 ; p = .06) were larger in the complex group. Despite different baseline characteristics of LV function and geometry, both groups had similar remodeling of LV after MV repair. CONCLUSIONS Patients with complex MV disease are referred late for surgical repair, causing LV function and dimensions to never fully recover. This suggests that earlier referral (before LV changes and potentially before symptoms) may be the preferred approach in those with complex disease.
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Affiliation(s)
- Fadi Hage
- Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, London, Ontario
| | - Ali Hage
- Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, London, Ontario
| | - Usha Manian
- Division of Cardiology, Department of Medicine, Western University, London Health Sciences Centre, London, Ontario
| | - Nikolaos Tzemos
- Division of Cardiology, Department of Medicine, Western University, London Health Sciences Centre, London, Ontario
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, London, Ontario
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22
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Lo KB, Dayanand S, Ram P, Dayanand P, Slipczuk LN, Figueredo VM, Rangaswami J. Interrelationship Between Kidney Function and Percutaneous Mitral Valve Interventions: A Comprehensive Review. Curr Cardiol Rev 2019; 15:76-82. [PMID: 30360746 PMCID: PMC6520580 DOI: 10.2174/1573403x14666181024155247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 11/22/2022] Open
Abstract
Percutaneous mitral valve repair is emerging as a reasonable alternative especially in those with an unfavorable surgical risk profile in the repair of mitral regurgitation. At this time, our understanding of the effects of underlying renal dysfunction on outcomes with percutaneous mitral valve repair and the effects of this procedure itself on renal function is evolving, as more data emerges in this field. The current evidence suggests that the correction of mitral regurgitation via percutaneous mitral valve repair is associated with some degree of improvement in cardiac function, hemodynamics and renal function. The improvement in renal function was more significant for those with greater renal dysfunction at baseline. The presence of Chronic Kidney Disease (CKD) in turn has been associated with poor long-term outcomes including increased mortality and hospitalization among patients who undergo percutaneous mitral valve repair. This was true regardless of the degree of improvement in GFR post repair advanced CKD. The adverse impact of CKD on long-term outcomes was consistent across all studies and was more prominent in those with GFR<30 mL/min/1.73 m². It is clear that from these contrasting evidences of improved renal function post mitral valve repair but poor long-term outcomes including increased mortality in patients with CKD, that proper patient selection for percutaneous mitral valve repair is key. There is a need to have better-standardized criteria for patients who should qualify to have percutaneous mitral valve replacement with Mitraclip. In this new era of percutaneous mitral valve repair, much work needs to be done to optimize long-term patient outcomes.
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Affiliation(s)
- Kevin Bryan Lo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Sandeep Dayanand
- Department of Cardiology, Einstein Medical Center, Philadelphia, PA, United States
| | - Pradhum Ram
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Pradeep Dayanand
- University of Miami - JFK Miller School of Medicine GME Consortium, Florida, FL, United States
| | - Leandro N Slipczuk
- Department of Cardiology, Einstein Medical Center, Philadelphia, PA, United States
| | - Vincent M Figueredo
- Department of Cardiology, Einstein Medical Center, Philadelphia, PA, United States.,Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, United States
| | - Janani Rangaswami
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States.,Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, United States
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23
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Hei S, Iwataki M, Jang JY, Kuwaki H, Mahara K, Fukuda S, Kim YJ, Nabeshima Y, Onoue T, Nagata Y, Nishino S, Watanabe N, Takeuchi M, Nishimura Y, Song JK, Levine RA, Otsuji Y. Possible mechanism of late systolic mitral valve prolapse: systolic superior shift of leaflets secondary to annular dilatation that causes papillary muscle traction. Am J Physiol Heart Circ Physiol 2018; 316:H629-H638. [PMID: 30575434 DOI: 10.1152/ajpheart.00618.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Progressive superior shift of the mitral valve (MV) during systole is associated with abnormal papillary muscle (PM) superior shift in late systolic MV prolapse (MVP). The causal relation of these superior shifts remains unclarified. We hypothesized that the MV superior shift is related to augmented MV superiorly pushing force by systolic left ventricular pressure due to MV annular dilatation, which can be corrected by surgical MV plasty, leading to postoperative disappearance of these superior shifts. In 35 controls, 28 patients with holosystolic MVP, and 28 patients with late systolic MVP, the MV coaptation depth from the MV annulus was measured at early and late systole by two-dimensional echocardiography. The PM tip superior shift was monitored by echocardiographic speckle tracking. MV superiorly pushing force was obtained as MV annular area × (systolic blood pressure - 10). Measurements were repeated after MV plasty in 14 patients with late systolic MVP. Compared with controls and patients with holosystolic MVP, MV and PM superior shifts and MV superiorly pushing force were greater in patients with late systolic MVP [1.3 (0.5) vs. 0.9 (0.6) vs. 3.9 (1.0) mm/m2, 1.3 (0.5) vs. 1.2 (1.0) vs. 3.3 (1.3) mm/m2, and 487 (90) vs. 606 (167) vs. 742 (177) mmHg·cm2·m-2, respectively, means (SD), P < 0.001]. MV superior shift was correlated with PM superior shift ( P < 0.001), which was further related to augmented MV superiorly pushing force ( P < 0.001). MV and PM superior shift disappeared after surgical MV plasty for late systolic MVP. These data suggest that MV annulus dilatation augmenting MV superiorly pushing force may promote secondary superior shift of the MV (equal to late systolic MVP) that causes subvalvular PM traction in patients with late systolic MVP. NEW & NOTEWORTHY Late systolic mitral valve prolapse (MVP) is associated with mitral valve (MV) and papillary muscle (PM) abnormal superior shifts during systole, but the causal relation remains unclarified. MV and PM superior shifts were correlated with augmented MV superiorly pushing force by annular dilatation and disappeared after surgical MV plasty with annulus size and MV superiorly pushing force reduction. This suggests that MV annulus dilatation may promote secondary superior shifts of the MV (late systolic MVP) that cause subvalvular PM traction.
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Affiliation(s)
- Soshi Hei
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Mai Iwataki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Jeong-Yoon Jang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul , South Korea
| | - Hiroshi Kuwaki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Keitaro Mahara
- Department of Cardiology, Sakakibara Heart Institute , Tokyo , Japan
| | - Shota Fukuda
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Yun-Jeong Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul , South Korea
| | - Yosuke Nabeshima
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Takeshi Onoue
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Yasufumi Nagata
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Shun Nishino
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center , Miyazaki , Japan
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center , Miyazaki , Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Yosuke Nishimura
- Department of Cardiovascular Surgery, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
| | - Jae-Kwan Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul , South Korea
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan
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Athanasuleas CL, Stanley AWH, Buckberg GD. Mitral regurgitation: anatomy is destiny. Eur J Cardiothorac Surg 2018; 54:627-634. [PMID: 29718159 DOI: 10.1093/ejcts/ezy174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/18/2018] [Indexed: 11/13/2022] Open
Abstract
Mitral regurgitation (MR) occurs when any of the valve and ventricular mitral apparatus components are disturbed. As MR progresses, left ventricular remodelling occurs, ultimately causing heart failure when the enlarging left ventricle (LV) loses its conical shape and becomes globular. Heart failure and lethal ventricular arrhythmias may develop if the left ventricular end-systolic volume index exceeds 55 ml/m2. These adverse changes persist despite satisfactory correction of the annular component of MR. Our goal was to describe this process and summarize evolving interventions that reduce the volume of the left ventricle and rebuild its elliptical shape. This 'valve/ventricle' approach addresses the spherical ventricular culprit and offsets the limits of treating MR by correcting only its annular component.
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Affiliation(s)
- Constantine L Athanasuleas
- Section of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Gerald D Buckberg
- Department of Cardiothoracic Surgery, University of California Los Angeles, Los Angeles, CA, USA
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25
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Gucuk Ipek E, Singh S, Viloria E, Feldman T, Grayburn P, Foster E, Qasim A. Impact of the MitraClip Procedure on Left Atrial Strain and Strain Rate. Circ Cardiovasc Imaging 2018. [DOI: 10.1161/circimaging.117.006553] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Esra Gucuk Ipek
- From the Department of Cardiology, University of California San Francisco Medical Center (E.G.I., S.S., E.V., E.F., A.Q.); Department of Cardiology, Evanston Hospital, IL (T.F.); and Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.)
| | - Siddharth Singh
- From the Department of Cardiology, University of California San Francisco Medical Center (E.G.I., S.S., E.V., E.F., A.Q.); Department of Cardiology, Evanston Hospital, IL (T.F.); and Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.)
| | - Esperanza Viloria
- From the Department of Cardiology, University of California San Francisco Medical Center (E.G.I., S.S., E.V., E.F., A.Q.); Department of Cardiology, Evanston Hospital, IL (T.F.); and Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.)
| | - Ted Feldman
- From the Department of Cardiology, University of California San Francisco Medical Center (E.G.I., S.S., E.V., E.F., A.Q.); Department of Cardiology, Evanston Hospital, IL (T.F.); and Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.)
| | - Paul Grayburn
- From the Department of Cardiology, University of California San Francisco Medical Center (E.G.I., S.S., E.V., E.F., A.Q.); Department of Cardiology, Evanston Hospital, IL (T.F.); and Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.)
| | - Elyse Foster
- From the Department of Cardiology, University of California San Francisco Medical Center (E.G.I., S.S., E.V., E.F., A.Q.); Department of Cardiology, Evanston Hospital, IL (T.F.); and Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.)
| | - Atif Qasim
- From the Department of Cardiology, University of California San Francisco Medical Center (E.G.I., S.S., E.V., E.F., A.Q.); Department of Cardiology, Evanston Hospital, IL (T.F.); and Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.)
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26
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Valve repair to avoid prosthetic valve pathology: Mid-term results in mitral valve repair. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:14-21. [PMID: 32082706 DOI: 10.5606/tgkdc.dergisi.2018.14503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/01/2017] [Indexed: 11/21/2022]
Abstract
Background In this study, we aimed to present our results of mitral valve repair. Methods Between January 2007 and November 2016, a total of 128 patients (72 males, 56 females; mean age 51.8±17.2 years; range 16 to 84 years) who underwent mitral valve repair in our heart center were retrospectively analyzed. There were mitral regurgitation in 86.7% (n=111), mitral stenosis in 7.8% (n=10), and mixed type valve disease in 5.5% of the patients (n=7). Mitral ring annuloplasty was performed in 80.5% (n=103), implantation of the artificial chordae in 36.7% (n=47), open mitral commissurotomy in 13.3% (n=17), and Alfieri procedure in 6.3% (n=8) of the patients. Sixty-two patients (48.8%) underwent isolated mitral valve repair, while concomitant surgical procedures were performed in the remaining patients. Postoperative mean follow-up was 52 months. Results Early (30-day) mortality was observed in seven patients due to low cardiac output. There was no mid-term mortality. During follow-up, various degree of mitral regurgitation was detected in 4 patients (3.6%), regurgitation was severe in two of them and these two require reoperation with the replacement of the valve. Patients with a myxomatous valve pathology who underwent isolated valve repair most benefited from valve repair. Patients with isolated mitral stenosis were the most successful group among the patients with a rheumatic etiology. Postoperative echocardiography showed a significant decrease in the left atrial diameter and pulmonary artery systolic pressures (p<0.01). Conclusion Mitral valve repair can be applied as an effective and safe treatment method in patients in whom the mitral valve anatomy is sufficient for repair. We suggest that each patient with mitral valve pathology should be evaluated in terms of reparability.
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27
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Gammie JS, Bartus K, Gackowski A, D'Ambra MN, Szymanski P, Bilewska A, Kusmierczyk M, Kapelak B, Rzucidlo-Resil J, Moat N, Duncan A, Yadev R, Livesey S, Diprose P, Gerosa G, D'Onofrio A, Pitterello D, Denti P, La Canna G, De Bonis M, Alfieri O, Hung J, Kolsut P. Beating-Heart Mitral Valve Repair Using a Novel ePTFE Cordal Implantation Device: A Prospective Trial. J Am Coll Cardiol 2017; 71:25-36. [PMID: 29102688 DOI: 10.1016/j.jacc.2017.10.062] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Conventional mitral valve (MV) operations allow direct anatomic assessment and repair on an arrested heart, but require cardiopulmonary bypass, aortic cross-clamping, sternotomy or thoracotomy, and cardioplegic cardiac arrest, and are associated with significant perioperative disability, and risks of morbidity and mortality. OBJECTIVES This study evaluated safety and performance of a transesophageal echocardiographic-guided device designed to implant artificial expanded polytetrafluoroethylene (ePTFE) cords on mitral leaflets in the beating heart. METHODS In a prospective multicenter study, 30 consecutive patients with severe degenerative mitral regurgitation (MR) were treated with a mitral valve repair system (MVRS) via small left thoracotomy. The primary (30-day) endpoint was successful implantation of cords with MR reduction to moderate or less. RESULTS The primary endpoint was met in 27 of 30 patients (90%). Three patients required conversion to open mitral surgery. There were no deaths, strokes, or permanent pacemaker implantations. At 1 month, MR was mild or less in 89% (24 of 27) and was moderate in 11% (3 of 27). At 6 months, MR was mild or less in 85 % (22 of 26), moderate in 8% (2 of 26), and severe in 8% (2 of 26). Favorable cardiac remodeling at 6 months included decreases in end-diastolic (161 ± 36 ml to 122 ± 30 ml; p < 0.001) and left atrial volumes (106 ± 36 ml to 69 ± 24 ml; p < 0.001). The anterior-posterior mitral annular dimension decreased from 34.7 ± 5.8 mm to 28.2 ± 5.1 mm; p < 0.001 as did the mitral annular area (10.0 ± 2.7 cm2 vs. 6.9 ± 2.0 cm2; p < 0.0001). CONCLUSIONS MVRS ePTFE cordal implantation can reduce the invasiveness and morbidity of conventional MV surgery. The device's safety profile is promising and prospective trials comparing the outcomes of the MVRS to conventional MV repair surgery are warranted. (CE Mark Study for the Harpoon Medical Device [TRACER]; NCT02768870).
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Affiliation(s)
- James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
| | | | | | | | | | | | | | | | | | - Neil Moat
- Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Alison Duncan
- Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Rashmi Yadev
- Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Steve Livesey
- University Hospital Southampton National Health Service Foundation Trust, United Kingdom
| | - Paul Diprose
- University Hospital Southampton National Health Service Foundation Trust, United Kingdom
| | | | | | | | | | | | | | | | - Judy Hung
- Massachusetts General Hospital, Boston, Massachusetts
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28
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Dupuis M, Mahjoub H, Clavel MA, Côté N, Toubal O, Tastet L, Dumesnil JG, O'Connor K, Dahou A, Thébault C, Bélanger C, Beaudoin J, Arsenault M, Bernier M, Pibarot P. Forward Left Ventricular Ejection Fraction: A Simple Risk Marker in Patients With Primary Mitral Regurgitation. J Am Heart Assoc 2017; 6:JAHA.117.006309. [PMID: 29079561 PMCID: PMC5721745 DOI: 10.1161/jaha.117.006309] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The timing of mitral valve surgery in asymptomatic patients with primary mitral regurgitation (MR) is controversial. We hypothesized that the forward left ventricular (LV) ejection fraction (LVEF; ie, LV outflow tract stroke volume divided by LV end‐diastolic volume) is superior to the total LVEF to predict outcomes in MR. The objective of this study was to examine the association between echocardiographic parameters of MR severity and LV function and outcomes in patients with MR. Methods and Results The clinical and Doppler‐echocardiographic data of 278 patients with ≥mild MR and no class I indication of mitral valve surgery at baseline were retrospectively analyzed. The primary study end point was the composite of mitral valve surgery or death. During a mean follow‐up of 5.4±3.2 years, there were 147 (53%) events: 96 (35%) MV surgeries and 66 (24%) deaths. Total LVEF and global longitudinal strain were not associated with the occurrence of events, whereas forward LVEF (P<0.0001) and LV end‐systolic diameter (P=0.0003) were. After adjustment for age, sex, MR severity, Charlson probability, coronary artery disease, and atrial fibrillation, forward LVEF remained independently associated with the occurrence of events (adjusted hazard ratio: 1.09, [95% confidence interval]: 1.02–1.17 per 5% decrease; P=0.01), whereas LV end‐systolic diameter was not (P=0.48). Conclusions The results of this study suggest that the forward LVEF may be superior to the total LVEF and LV end‐systolic diameter to predict outcomes in patients with primary MR. This simple and easily measurable parameter may be useful to improve risk stratification and select the best timing for intervention in patients with primary MR.
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Affiliation(s)
- Marlène Dupuis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Haïfa Mahjoub
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Nancy Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Oumhani Toubal
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Lionel Tastet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Jean G Dumesnil
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Kim O'Connor
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Abdellaziz Dahou
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Christophe Thébault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Catherine Bélanger
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Jonathan Beaudoin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Marie Arsenault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Mathieu Bernier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
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Murashita T, Schaff HV, Suri RM, Daly RC, Li Z, Dearani JA, Greason KL, Nishimura RA. Impact of Left Ventricular Systolic Function on Outcome of Correction of Chronic Severe Aortic Valve Regurgitation: Implications for Timing of Surgical Intervention. Ann Thorac Surg 2017; 103:1222-1228. [DOI: 10.1016/j.athoracsur.2016.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 10/20/2022]
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30
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135:e1159-e1195. [PMID: 28298458 DOI: 10.1161/cir.0000000000000503] [Citation(s) in RCA: 1398] [Impact Index Per Article: 199.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Robert O Bonow
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Blase A Carabello
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - John P Erwin
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Lee A Fleisher
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Hani Jneid
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Michael J Mack
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Christopher J McLeod
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Patrick T O'Gara
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Vera H Rigolin
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Thoralf M Sundt
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Annemarie Thompson
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 70:252-289. [PMID: 28315732 DOI: 10.1016/j.jacc.2017.03.011] [Citation(s) in RCA: 1826] [Impact Index Per Article: 260.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Fukuda S, Song JK, Mahara K, Kuwaki H, Jang JY, Takeuchi M, Sun BJ, Kim YJ, Miyamoto T, Oginosawa Y, Sonoda S, Eto M, Nishimura Y, Takanashi S, Levine RA, Otsuji Y. Basal Left Ventricular Dilatation and Reduced Contraction in Patients With Mitral Valve Prolapse Can Be Secondary to Annular Dilatation. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.005113. [DOI: 10.1161/circimaging.115.005113] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 09/12/2016] [Indexed: 11/16/2022]
Abstract
Background—
Prominent mitral valve (MV) annular dilatation with only modest left ventricular (LV) dilatation in patients with MV prolapse (MVP) suggests predominant dilatation in adjacent basal LV, which may augment regional wall tension and attenuate contraction by Laplace’s law. We hypothesized that MV annular dilatation in patients with MVP is associated with the basal predominance of LV dilatation and attenuated contraction, which can be altered by surgical MV plasty with annulus reduction.
Methods and Results—
Echocardiography with speckle-tracking analysis to assess regional cross-sectional short-axis area and longitudinal contraction (strain) of basal, middle, and apical LV was performed in 30 controls and 130 patients with MVP. The basal value/averaged middle and apical values (B/M·A ratio) of LV cross-sectional area and strain were obtained. Patients with MVP showed significantly greater MV annular area (6.4±1.6 versus 3.7±0.6 cm
2
/m
2
), increased B/M·A LV area ratio (2.4±0.5 versus 1.8±0.2), and reduced B/M·A LV strain ratio (0.83±0.14 versus 0.96±0.09) than controls (
P
<0.001). Multivariable analyses identified that MV annular dilatation was independently associated with increased B/M·A LV area ratio (β=0.60,
P
<0.001), which was associated with reduced B/M·A LV strain ratio (β=−0.32,
P
<0.001). In 35 patients with MVP, B/M·A LV area and strain ratio significantly altered after surgical MV plasty with annulus reduction (2.5±0.5–1.8±0.3 and 0.73±0.10–0.89±0.17,
P
<0.001, respectively).
Conclusions—
In patients with MVP, MV annular dilatation was associated with the basal predominance of LV dilatation and reduced contraction, which can be altered by surgical MV plasty with annulus reduction, suggesting unfavorable influence from MV annular dilatation on basal LV.
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Affiliation(s)
- Shota Fukuda
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Jae-Kwan Song
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Keitaro Mahara
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Hiroshi Kuwaki
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Jeong Yoon Jang
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Masaaki Takeuchi
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Byung Joo Sun
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Yun Jeong Kim
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Tetsu Miyamoto
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Yasushi Oginosawa
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Shinjo Sonoda
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Masataka Eto
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Yosuke Nishimura
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Shuichiro Takanashi
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Robert A. Levine
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Yutaka Otsuji
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
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Wang Y, Gao CQ, Shen YS, Wang G. Echocardiographic Follow-up of Robotic Mitral Valve Repair for Mitral Regurgitation due to Degenerative Disease. Chin Med J (Engl) 2016; 129:2199-203. [PMID: 27625092 PMCID: PMC5022341 DOI: 10.4103/0366-6999.189909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Mitral valve (MV) repair can now be carried out through small incisions with the use of robotic assistance. Previous reports have demonstrated the excellent clinical result of robotic MV repair for degenerative mitral regurgitation (MR). However, there has been limited information regarding the echocardiographic follow-up of these patients. The present study was therefore to evaluate the echocardiographic follow-up outcomes after robotic MV repair in patients with MR due to degenerative disease of the MV. METHODS A retrospective analysis was undertaken using data from the echocardiographic database of our department. Between March 2007 and February 2015, 84 patients with degenerative MR underwent robotic MV repair. The repair techniques included leaflet resection in 67 patients (79.8%), artificial chordae in 20 (23.8%), and ring annuloplasty in 79 (94.1%). Eighty-one (96.4%) of the 84 patients were eligible for echocardiographic follow-up assessment, and no patients were lost to follow-up. RESULTS At a median echocardiographic follow-up of 36.0 months (interquartile range 14.3-59.4 months), four patients (4.9%) developed recurrent mild MR, and no patients had more than mild MR. Mean MR grade, left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF) were significantly decreased when compared with preoperative values. Mean MR grade decreased from 3.96 ± 0.13 to 0.17 ± 0.49 (Z = -8.456, P < 0.001), LAD from 43.8 ± 5.9 to 35.5 ± 3.8 mm (t = 15.131, P < 0.001), LVEDD from 51.0 ± 5.0 to 43.3 ± 2.2 mm (t = 14.481,P< 0.001), and LVEF from 67.3 ± 7.0% to 63.9 ± 5.1% (t = 4.585, P < 0.001). CONCLUSION Robotic MV repair for MR due to degenerative disease is associated with a low rate of recurrent MR, and a significant improvement in MR grade, LAD, and LVEDD, but a significant decrease in LVEF at echocardiographic follow-up.
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Affiliation(s)
- Yao Wang
- Department of Cardiovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Chang-Qing Gao
- Department of Cardiovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yan-Song Shen
- Department of Cardiovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Gang Wang
- Department of Cardiovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Argulian E, Borer JS, Messerli FH. Misconceptions and Facts About Mitral Regurgitation. Am J Med 2016; 129:919-23. [PMID: 27059381 DOI: 10.1016/j.amjmed.2016.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
Mitral regurgitation is a common heart valve disease. It is defined to be primary when it results from the pathology of the mitral valve apparatus itself and secondary when it is caused by distortion of the architecture or function of the left ventricle. Although the diagnosis and management of mitral regurgitation rely heavily on echocardiography, one should bear in mind the caveats and shortcomings of such an approach. Clinical decision making commonly focuses on the indications for surgery, but it is complex and mandates precise assessment of the mitral pathology, symptom status of the patient, and ventricular performance (right and left) among other descriptors. It is important for healthcare providers at all levels to be familiar with the clinical picture, diagnosis, disease course, and management of mitral regurgitation.
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Affiliation(s)
- Edgar Argulian
- Division of Cardiology, Icahn School of Medicine, Mt Sinai St Luke's Hospital, New York, NY.
| | | | - Franz H Messerli
- Division of Cardiology, Icahn School of Medicine, Mt Sinai St Luke's Hospital, New York, NY
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35
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Miller JD, Suri RM. Left ventricular dysfunction after degenerative mitral valve repair: A question of better molecular targets or better surgical timing? J Thorac Cardiovasc Surg 2016; 152:1071-4. [PMID: 27523402 DOI: 10.1016/j.jtcvs.2016.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Jordan D Miller
- Department of Surgery, Mayo Clinic, Rochester, Minn; Department of Physiology and BME, Mayo Clinic, Rochester, Minn.
| | - Rakesh M Suri
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
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36
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37
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Mantovani F, Clavel MA, Michelena HI, Suri RM, Schaff HV, Enriquez-Sarano M. Comprehensive Imaging in Women With Organic Mitral Regurgitation. JACC Cardiovasc Imaging 2016; 9:388-96. [DOI: 10.1016/j.jcmg.2016.02.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/19/2016] [Accepted: 02/25/2016] [Indexed: 11/25/2022]
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Cho EJ, Park SJ, Yun HR, Jeong DS, Lee SC, Park SW, Park PW. Predicting Left Ventricular Dysfunction after Surgery in Patients with Chronic Mitral Regurgitation: Assessment of Myocardial Deformation by 2-Dimensional Multilayer Speckle Tracking Echocardiography. Korean Circ J 2016; 46:213-21. [PMID: 27014352 PMCID: PMC4805566 DOI: 10.4070/kcj.2016.46.2.213] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/11/2015] [Accepted: 07/21/2015] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Eun Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Division of Cardiology, Department of Internal Medicine, Cardiology Clinic, National Cancer Center, Goyang, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Rim Yun
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Seop Jeong
- Department of Thorax Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of Thorax Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Aplin M, Kyhl K, Bjerre J, Ihlemann N, Greenwood JP, Plein S, Uddin A, Tønder N, Høst NB, Ahlström MG, Hove J, Hassager C, Iversen K, Vejlstrup NG, Lav Madsen P. Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2016; 17:863-70. [DOI: 10.1093/ehjci/jev321] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/13/2015] [Indexed: 11/13/2022] Open
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40
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Imasaka KI, Tayama E, Tomita Y. Left ventricular performance early after repair for posterior mitral leaflet prolapse: Chordal replacement versus leaflet resection. J Thorac Cardiovasc Surg 2015; 150:538-45. [DOI: 10.1016/j.jtcvs.2015.06.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/19/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
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Hamilton-Craig C, Strugnell W, Gaikwad N, Ischenko M, Speranza V, Chan J, Neill J, Platts D, Scalia GM, Burstow DJ, Walters DL. Quantitation of mitral regurgitation after percutaneous MitraClip repair: comparison of Doppler echocardiography and cardiac magnetic resonance imaging. Ann Cardiothorac Surg 2015; 4:341-51. [PMID: 26309843 DOI: 10.3978/j.issn.2225-319x.2015.05.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/27/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Percutaneous valve intervention for severe mitral regurgitation (MR) using the MitraClip is a novel technology. Quantitative assessment of residual MR by transthoracic echocardiography (TTE) is challenging, with multiple eccentric jets and artifact from the clips. Cardiovascular magnetic resonance (CMR) is the reference standard for left and right ventricular volumetric assessment. CMR phase-contrast flow imaging has superior reproducibility for quantitation of MR compared to echocardiography. The objective of this study was to establish the feasibility and reproducibility of CMR in quantitating residual MR after MitraClip insertion in a prospective study. METHODS Twenty-five patients underwent successful MitraClip insertion. Nine were excluded due to non-magnetic resonance imaging (MRI) compatible implants or arrhythmia, leaving 16 who underwent a comprehensive CMR examination at 1.5 T (Siemens Aera) with multiplanar steady state free precession (SSFP) cine imaging (cine CMR), and phase-contrast flow acquisitions (flow CMR) at the mitral annulus atrial to the MitraClip, and the proximal aorta. Same-day echocardiography was performed with two-dimensional (2D) visualization and Doppler. CMR and echocardiographic data were independently and blindly analyzed by expert readers. Inter-rater comparison was made by concordance correlation coefficient (CCC) with 95% confidence intervals (CIs), and Bland-Altman (BA) methods. RESULTS Mean age was 79 years, and mean LVEF was 44%±11% by CMR and 54%±16% by echocardiography. Inter-observer reproducibility of echocardiographic visual categorical grading by expert readers was poor, with a CCC of 0.475 (-0.7, 0.74). Echocardiographic Doppler regurgitant fraction reproducibility was modest (CCC 0.59, 0.15-0.84; BA mean difference -3.7%, -38% to 31%). CMR regurgitant fraction reproducibility was excellent (CCC 0.95, 0.86-0.98; BA mean difference -2.4%, -11.9 to 7.0), with a lower mean difference and narrower limits of agreement compared to echocardiography. Categorical severity grading by CMR using published ranges had good inter-observer agreement (CCC 0.86, 0.62-0.95). CONCLUSIONS CMR performs very well in the quantitation of MR after MitraClip insertion, with excellent reproducibility compared to echocardiographic methods. CMR is a useful technique for the comprehensive evaluation of residual regurgitation in patients after MitraClip. Technical limitations exist for both techniques, and quantitation remains a challenge in some patients.
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Affiliation(s)
- Christian Hamilton-Craig
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Wendy Strugnell
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Niranjan Gaikwad
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Matthew Ischenko
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Vicki Speranza
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Jonathan Chan
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Johanne Neill
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - David Platts
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Gregory M Scalia
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Darryl J Burstow
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Darren L Walters
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
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Suri RM, Enriquez-Sarano M, Schaff HV. Preservation of left ventricular function after degenerative mitral valve repair: Refocusing on timing, techniques, and teaching. J Thorac Cardiovasc Surg 2015; 150:448-9. [PMID: 26319458 DOI: 10.1016/j.jtcvs.2015.07.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Rakesh M Suri
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
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Better to avoid disaster than rescue defeat--ventricular dysfunction after delayed mitral valve repair. J Thorac Cardiovasc Surg 2015; 149:941-2. [PMID: 25827381 DOI: 10.1016/j.jtcvs.2014.11.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 11/25/2014] [Indexed: 11/20/2022]
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Left ventricular dysfunction after mitral valve repair: Predetermined or caused? J Thorac Cardiovasc Surg 2015; 149:940. [DOI: 10.1016/j.jtcvs.2014.09.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/19/2014] [Indexed: 11/23/2022]
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Chan V, Ruel M, Elmistekawy E, Mesana TG. Determinants of Left Ventricular Dysfunction After Repair of Chronic Asymptomatic Mitral Regurgitation. Ann Thorac Surg 2015; 99:38-42. [DOI: 10.1016/j.athoracsur.2014.07.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/04/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
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Quintana E, Suri RM, Thalji NM, Daly RC, Dearani JA, Burkhart HM, Li Z, Enriquez-Sarano M, Schaff HV. Left ventricular dysfunction after mitral valve repair—the fallacy of “normal” preoperative myocardial function. J Thorac Cardiovasc Surg 2014; 148:2752-60. [DOI: 10.1016/j.jtcvs.2014.07.029] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/26/2014] [Accepted: 07/05/2014] [Indexed: 11/29/2022]
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Suri RM, Schaff HV, Enriquez-Sarano M. Mitral valve repair in asymptomatic patients with severe mitral regurgitation: pushing past the tipping point. Semin Thorac Cardiovasc Surg 2014; 26:95-101. [PMID: 25441000 DOI: 10.1053/j.semtcvs.2014.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2014] [Indexed: 11/11/2022]
Abstract
Degenerative mitral valve regurgitation (MR) is the one of the most frequent valvular heart conditions in the Western world and is increasingly recognized as an important preventable cause of chronic heart failure. This condition also represents the most common indication for mitral surgery and is of particular interest because the mitral valve can be repaired in most patients with very low surgical risk. Historical single-center studies have supported the performance of "early mitral valve repair" in asymptomatic patients with severe degenerative MR to normalize survival and improve late outcomes. Emerging recent evidence further indicates for the first time that the prompt surgical correction of severe MR due to flail mitral leaflets within 3 months following diagnosis in asymptomatic patients without classical Class I indications (symptoms or left ventricular dysfunction) conveys a 40% decrease in the risk of late death and a 60% diminution in heart failure incidence. A 10-point rationale based on the weight of rapidly accumulating clinical data, supports the performance of early mitral valve repair even in the absence of symptoms, left ventricular dysfunction, or guideline-based triggers; when effective operations can be provided using conventional or minimally invasive techniques at very low surgical risk.
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Affiliation(s)
- Rakesh M Suri
- Mayo Clinic College of Medicine, Rochester, Minnesota.
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Creager MA, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Stevenson WG, Yancy CW. 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Thorac Cardiovasc Surg 2014; 148:e1-e132. [DOI: 10.1016/j.jtcvs.2014.05.014] [Citation(s) in RCA: 631] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:2440-92. [PMID: 24589852 DOI: 10.1161/cir.0000000000000029] [Citation(s) in RCA: 1015] [Impact Index Per Article: 101.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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