1
|
Yamane T, Kuwajima K, Kagawa S, Hasegawa H, Rader F, Siegel RJ, Shiota T. Outcome of Patients With Both Moderate Aortic Stenosis and Moderate Mitral Stenosis. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100183. [PMID: 37745685 PMCID: PMC10512010 DOI: 10.1016/j.shj.2023.100183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 09/26/2023]
Abstract
Aims This study aimed to investigate the symptoms and prognosis of patients with both moderate aortic stenosis (AS) and mitral stenosis (MS). Methods and Results We studied 82 patients with moderate AS and MS diagnosed via transthoracic echocardiography. The patients had a mean age of 79 ± 13 years and 95% of patients had degenerative MS. Out of 82 patients, 34 (41%) had heart failure (HF) symptoms (New York Heart Association class ≥ Ⅱ) or a history of HF admission. Left ventricular ejection fraction, stroke volume index, atrial fibrillation, and right ventricular systolic pressure were independent determinants of HF symptoms. The median follow-up duration was 3.2 (interquartile range, 1.0-4.9) years and clinical events occurred in 48 (59%) patients, including death in 11 (13%) patients, aortic or mitral valve interventions in 22 (27%) patients, and HF hospitalization in 15 (18%) patients. The 5-year survival free of the combined endpoint of aortic or mitral valve interventions, HF hospitalization, or death was 19%. A multivariate predictor of clinical events was HF symptoms (hazard ratio [HR], 2.32; 95% confidence interval [CI], 1.30-4.14; p = 0.0045). Kaplan-Meier survival at 5 years was 61% without intervention and HF symptoms were not associated with mortality. Conclusions Among patients with both moderate AS and MS, left ventricular ejection fraction, stroke volume index, atrial fibrillation, and right ventricular systolic pressure were strong determinants of HF symptoms. HF symptoms were independently predictive of clinical events.
Collapse
Affiliation(s)
- Takafumi Yamane
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ken Kuwajima
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shunsuke Kagawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hiroko Hasegawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Robert J. Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
2
|
Boudoulas KD, Triposkiadis F, Koenig S, Marmagkiolis K, Iliescu C, Pitsis A, Boudoulas H. Acute mitral regurgitation with and without acute heart failure. Heart Fail Rev 2023:10.1007/s10741-023-10322-5. [PMID: 37414917 DOI: 10.1007/s10741-023-10322-5] [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] [Accepted: 05/08/2023] [Indexed: 07/08/2023]
Abstract
Acute severe mitral regurgitation (MR) is rare, but often leads to cardiogenic shock, pulmonary edema, or both. Most common causes of acute severe MR are chordae tendineae (CT) rupture, papillary muscle (PM) rupture, and infective endocarditis (IE). Mild to moderate MR is often seen in patients with acute myocardial infarction (AMI). CT rupture in patients with floppy mitral valve/mitral valve prolapse is the most common etiology of acute severe MR today. In IE, native or prosthetic valve damage can occur (leaflet perforation, ring detachment, other), as well as CT or PM rupture. Since the introduction of percutaneous revascularization in AMI, the incidence of PM rupture has substantially declined. In acute severe MR, the hemodynamic effects of the large regurgitant volume into the left atrium (LA) during left ventricular (LV) systole, and in turn back into the LV during diastole, are profound as the LV and LA have not had time to adapt to this additional volume. A rapid, but comprehensive evaluation of the patient with acute severe MR is essential in order to define the underline cause and apply appropriate management. Echocardiography with Doppler provides vital information related to the underlying pathology. Coronary arteriography should be performed in patients with an AMI to define coronary anatomy and need for revascularization. In acute severe MR, medical therapy should be used to stabilize the patient before intervention (surgery, transcatheter); mechanical support is often required. Diagnostic and therapeutic steps should be individualized, and a multi-disciplinary team approach should be utilized.
Collapse
Affiliation(s)
- Konstantinos Dean Boudoulas
- Division of Cardiovascular Medicine, The Ohio State University, 473 W. 12th Avenue, Suite 200, Columbus, OH, 43210, USA
| | | | - Sara Koenig
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, USA
| | - Konstantinos Marmagkiolis
- Tampa Heart, Tampa, FL, USA
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Cezar Iliescu
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Harisios Boudoulas
- Division of Cardiovascular Medicine, The Ohio State University, 473 W. 12th Avenue, Suite 200, Columbus, OH, 43210, USA.
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, USA.
| |
Collapse
|
3
|
Petolat E, Theron A, Resseguier N, Fabre C, Norscini G, Badaoui R, Habib G, Collart F, Zaffran S, Porto A, Avierinos JF. Prognostic value of forward flow indices in primary mitral regurgitation due to mitral valve prolapse. Front Cardiovasc Med 2023; 10:1076708. [PMID: 36910534 PMCID: PMC9995829 DOI: 10.3389/fcvm.2023.1076708] [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: 10/21/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
Background Degenerative mitral regurgitation (DMR) due to mitral valve prolapse (MVP) is a common valve disease associated with significant morbidity and mortality. Timing for surgery is debated for asymptomatic patients without Class I indication, prompting the search for novel parameters of early left ventricular (LV) systolic dysfunction. Aims To evaluate the prognostic impact of preoperative forward flow indices on the occurrence of post-operative LV systolic dysfunction. Methods We retrospectively included all consecutive patients with severe DMR due to MVP who underwent mitral valve repair between 2014 and 2019. LVOTTVI, forward stroke volume index, and forward LVEF were assessed as potential risk factors for LVEF <50% at 6 months post-operatively. Results A total of 198 patients were included: 154 patients (78%) were asymptomatic, and 46 patients (23%) had hypertension. The mean preoperative LVEF was 69 ± 9%. 35 patients (18%) had LVEF ≤ 60%, and 61 patients (31%) had LVESD ≥40 mm. The mean post-operative LVEF was 59 ± 9%, and 21 patients (11%) had post-operative LVEF<50%. Based on multivariable analysis, LVOTTVI was the strongest independent predictor of post-operative LV dysfunction after adjustment for age, sex, symptoms, LVEF, LV end systolic diameter, atrial fibrillation and left atrial volume index (0.75 [0.62-0.91], p < 0.01). The best sensitivity (81%) and specificity (63%) was obtained with LVOTTVI ≤15 cm based on ROC curve analysis. Conclusion LVOTTVI represents an independent marker of myocardial performance impairment in the presence of severe DMR. LVOTTVI could be an earlier marker than traditional echo parameters and aids in the optimization of the timing of surgery.
Collapse
Affiliation(s)
- Elisabeth Petolat
- Department of Cardiology, La Timone Hospital, Marseille, France.,Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Alexis Theron
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | | | | | - Giulia Norscini
- Department of Cardiology, La Timone Hospital, Marseille, France
| | - Rita Badaoui
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Gilbert Habib
- Department of Cardiology, La Timone Hospital, Marseille, France
| | - Frederic Collart
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Stéphane Zaffran
- U1251 INSERM, Marseille Medical Genetics, Aix-Marseille University, Marseille, France
| | - Alizée Porto
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | | |
Collapse
|
4
|
Mirza J, Trenschel RW, Davenport J. Prosthetic Mitral Valve Thrombosis: A Complication Following Mitral Valve Surgery and Coronary Artery Bypass Graft Surgery. Cureus 2022; 14:e28013. [PMID: 36134064 PMCID: PMC9470538 DOI: 10.7759/cureus.28013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022] Open
Abstract
Mitral valve regurgitation is a common valvular defect that can lead to severe complications, requiring surgical intervention, often in the form of either mitral valve repair or replacement. This case report follows a 63-year-old male with multivessel coronary artery disease, who initially presented to the emergency department (ED) with a non-ST elevation myocardial infarction (NSTEMI) secondary to multivessel coronary artery disease with severe mitral regurgitation, and subsequently underwent coronary artery bypass grafting (CABG) with repair of the mitral valve. He was readmitted a month later with endocarditis of the mitral valve and underwent a reoperation with a bioprosthetic mitral valve replacement and massive reconstruction of the right ventricle, after which he failed to recover postoperatively. A repeat transesophageal echocardiogram (TEE) during his final chest washout procedure revealed echodensities suspicious for thrombi and, despite the team’s best efforts, the patient expired. This report demonstrates that even with appropriate medical decision-making, poor outcomes still result, especially in patients with comorbidities including multivessel disease, respiratory illness, and endocarditis. This study suggests that continuing to characterize repairs or replacements of the mitral valve is essential. Additionally, aggressive and newly emerging procedures, such as percutaneous approaches to mitral valve repair or replacement, may be considered for use to mitigate negative outcomes, especially with an aging population.
Collapse
|
5
|
Irqsusi M, Mansouri AL, Ramaswamy A, Rexin P, Salman M, Mahmood S, Mirow N, Ghazi T, Ramzan R, Rastan AJ, Vogt S. Role of matrix metalloproteinases in mitral valve regurgitation: Association between the of MMP-1, MMP-9, TIMP-1, and TIMP-2 expression, degree of mitral valve insufficiency, and pathologic etiology. J Card Surg 2022; 37:1613-1622. [PMID: 35343608 DOI: 10.1111/jocs.16449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/07/2022] [Accepted: 03/02/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The pathogenesis of mitral valve insufficiency is not yet fully understood. Several studies stressed the role of matrix metalloproteinases (MMPs) in the emergence of valvular pathologies. The primary objective of the present study is to analyze the role of selected MMPs and their inhibitors in mitral valve insufficiency. PATIENTS AND METHODS Eighty patients (33 female/47 male, mean age 67 years) underwent cardiopulmonary bypass surgery for mitral valve reconstruction between 2007 and 2015. All patients suffered from mitral insufficiency (MI) Stages iii and iv. When tissue resection was acquired specimens were taken immediately frozen and used for histological examination. Expression of MMP-1, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-1, and TIMP-2 was examined immunohistochemically and distribution was analyzed in regard to preoperative clinical, echocardiographic, and histopathological findings. RESULTS A clear correlation between the MMP expression and the MI degree of severity could be shown. The expression of MMPs proved to be high in relation to mild insufficiencies and relatively weak in the case of severe ones. Additionally, the etiology of the MI was considered in the analysis and a significant difference in the expression of MMPs between the mitral valves with endocarditis and the ones featuring a degenerative disease could be shown. Within the group of valves with degenerative diseases, no significant difference could be established between the subgroups (myxoid and sclerosed valves). CONCLUSION The increased expression of MMPs and their inhibitors in mild insufficiencies could prove that the molecular changes in the valve precede the macroscopical and thus the echocardiographically diagnosable changes. Hence, new options for early diagnosis and therapy of MIs should be examined in further studies, respectively. Herein, the correlation of the MMP blood levels with MMP tissue expression should be addressed for surgical therapeutical decisions.
Collapse
Affiliation(s)
- Marc Irqsusi
- Department of Cardiovascular Surgery, University Hospital Gießen and Marburg, Marburg, Germany
| | - Azza Labene Mansouri
- Department of Cardiovascular Surgery, University Hospital Gießen and Marburg, Marburg, Germany
| | - Anette Ramaswamy
- Institute for Pathology, University Hospital Gießen and Marburg, Marburg, Germany
| | - Peter Rexin
- Institute for Pathology, University Hospital Gießen and Marburg, Marburg, Germany
| | - Midhat Salman
- Department of Forensic Sciences, University of Health Sciences, Lahore, Pakistan
| | - Saqib Mahmood
- Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan
| | - Nikolas Mirow
- Department of Cardiovascular Surgery, University Hospital Gießen and Marburg, Marburg, Germany
| | - Tamer Ghazi
- Department of Cardiovascular Surgery, University Hospital Gießen and Marburg, Marburg, Germany
| | - Rabia Ramzan
- Department of Cardiovascular Surgery, University Hospital Gießen and Marburg, Marburg, Germany
| | - Ardawan J Rastan
- Department of Cardiovascular Surgery, University Hospital Gießen and Marburg, Marburg, Germany
| | - Sebastian Vogt
- Department of Cardiovascular Surgery, University Hospital Gießen and Marburg, Marburg, Germany
| |
Collapse
|
6
|
Gomes NFA, Silva VR, Levine RA, Esteves WAM, de Castro ML, Passos LSA, Dal-Bianco JP, Pantaleão AN, da Silva JLP, Tan TC, Dutra WO, Aikawa E, Hung J, Nunes MCP. Progression of Mitral Regurgitation in Rheumatic Valve Disease: Role of Left Atrial Remodeling. Front Cardiovasc Med 2022; 9:862382. [PMID: 35360029 PMCID: PMC8962951 DOI: 10.3389/fcvm.2022.862382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/14/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Mitral regurgitation (MR) is the most common valve abnormality in rheumatic heart disease (RHD) often associated with stenosis. Although the mechanism by which MR develops in RHD is primary, longstanding volume overload with left atrial (LA) remodeling may trigger the development of secondary MR, which can impact on the overall progression of MR. This study is aimed to assess the incidence and predictors of MR progression in patients with RHD. Methods Consecutive RHD patients with non-severe MR associated with any degree of mitral stenosis were selected. The primary endpoint was a progression of MR, which was defined as an increase of one grade in MR severity from baseline to the last follow-up echocardiogram. The risk of MR progression was estimated accounting for competing risks. Results The study included 539 patients, age of 46.2 ± 12 years and 83% were women. At a mean follow-up time of 4.2 years (interquartile range [IQR]: 1.2–6.9 years), 54 patients (10%) displayed MR progression with an overall incidence of 2.4 per 100 patient-years. Predictors of MR progression by the Cox model were age (adjusted hazard ratio [HR] 1.541, 95% CI 1.222–1.944), and LA volume (HR 1.137, 95% CI 1.054–1.226). By considering competing risk analysis, the direction of the association was similar for the rate (Cox model) and incidence (Fine-Gray model) of MR progression. In the model with LA volume, atrial fibrillation (AF) was no longer a predictor of MR progression. In the subgroup of patients in sinus rhythm, 59 had an onset of AF during follow-up, which was associated with progression of MR (HR 2.682; 95% CI 1.133–6.350). Conclusions In RHD patients with a full spectrum of MR severity, progression of MR occurs over time is predicted by age and LA volume. LA enlargement may play a role in the link between primary MR and secondary MR in patients with RHD.
Collapse
Affiliation(s)
- Nayana F. A. Gomes
- School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Vicente Rezende Silva
- School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Robert A. Levine
- Cardiac Ultrasound Lab, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - William A. M. Esteves
- School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marildes Luiza de Castro
- School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Livia S. A. Passos
- The Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jacob P. Dal-Bianco
- Cardiac Ultrasound Lab, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Timothy C. Tan
- Department of Cardiology, Blacktown Hospital, University of Western Sydney, Penrith, NSW, Australia
| | - Walderez O. Dutra
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, and National Institutes for Science and Technology, Belo Horizonte, Brazil
| | - Elena Aikawa
- The Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Judy Hung
- Cardiac Ultrasound Lab, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Maria Carmo P. Nunes
- School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
- *Correspondence: Maria Carmo P. Nunes
| |
Collapse
|
7
|
Buja LM, Zhao B, Segura A, Lelenwa L, McDonald M, Michaud K. Cardiovascular pathology: guide to practice and training. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
8
|
Senthilnathan G, Dhandapani V, Ramraj B, Logaraj M. Clinical presentation and prognosis of non valvular mitral regurgitation-A single institution experience. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
9
|
Goodwin RL, Kheradvar A, Norris RA, Price RL, Potts JD. Collagen Fibrillogenesis in the Mitral Valve: It's a Matter of Compliance. J Cardiovasc Dev Dis 2021; 8:jcdd8080098. [PMID: 34436240 PMCID: PMC8397013 DOI: 10.3390/jcdd8080098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/30/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
Collagen fibers are essential structural components of mitral valve leaflets, their tension apparatus (chordae tendineae), and the associated papillary muscles. Excess or lack of collagen fibers in the extracellular matrix (ECM) in any of these structures can adversely affect mitral valve function. The organization of collagen fibers provides a sophisticated framework that allows for unidirectional blood flow during the precise opening and closing of this vital heart valve. Although numerous ECM molecules are essential for the differentiation, growth, and homeostasis of the mitral valve (e.g., elastic fibers, glycoproteins, and glycans), collagen fibers are key to mitral valve integrity. Besides the inert structural components of the tissues, collagen fibers are dynamic structures that drive outside-to-inside cell signaling, which informs valvular interstitial cells (VICs) present within the tissue environment. Diversity of collagen family members and the closely related collagen-like triple helix-containing proteins found in the mitral valve, will be discussed in addition to how defects in these proteins may lead to valve disease.
Collapse
Affiliation(s)
- Richard L. Goodwin
- Department of Biomedical Sciences, School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA
- Correspondence:
| | - Arash Kheradvar
- Department of Biomedical Engineering, The Henry Samueli School of Engineering, University of California, Irvine, CA 92697, USA;
| | - Russell A. Norris
- Department of Regenerative Medicine, School of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Robert L. Price
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Greenville, SC 29605, USA; (R.L.P.); (J.D.P.)
| | - Jay D. Potts
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Greenville, SC 29605, USA; (R.L.P.); (J.D.P.)
| |
Collapse
|
10
|
Morningstar JE, Nieman A, Wang C, Beck T, Harvey A, Norris RA. Mitral Valve Prolapse and Its Motley Crew-Syndromic Prevalence, Pathophysiology, and Progression of a Common Heart Condition. J Am Heart Assoc 2021; 10:e020919. [PMID: 34155898 PMCID: PMC8403286 DOI: 10.1161/jaha.121.020919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/21/2021] [Indexed: 01/01/2023]
Abstract
Mitral valve prolapse (MVP) is a commonly occurring heart condition defined by enlargement and superior displacement of the mitral valve leaflet(s) during systole. Although commonly seen as a standalone disorder, MVP has also been described in case reports and small studies of patients with various genetic syndromes. In this review, we analyzed the prevalence of MVP within syndromes where an association to MVP has previously been reported. We further discussed the shared biological pathways that cause MVP in these syndromes, as well as how MVP in turn causes a diverse array of cardiac and noncardiac complications. We found 105 studies that identified patients with mitral valve anomalies within 18 different genetic, developmental, and connective tissue diseases. We show that some disorders previously believed to have an increased prevalence of MVP, including osteogenesis imperfecta, fragile X syndrome, Down syndrome, and Pseudoxanthoma elasticum, have few to no studies that use up-to-date diagnostic criteria for the disease and therefore may be overestimating the prevalence of MVP within the syndrome. Additionally, we highlight that in contrast to early studies describing MVP as a benign entity, the clinical course experienced by patients can be heterogeneous and may cause significant cardiovascular morbidity and mortality. Currently only surgical correction of MVP is curative, but it is reserved for severe cases in which irreversible complications of MVP may already be established; therefore, a review of clinical guidelines to allow for earlier surgical intervention may be warranted to lower cardiovascular risk in patients with MVP.
Collapse
Affiliation(s)
- Jordan E. Morningstar
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Annah Nieman
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Christina Wang
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Tyler Beck
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Andrew Harvey
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Russell A. Norris
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| |
Collapse
|
11
|
Del Forno B, Ascione G, De Bonis M. Advances in Mitral Valve Repair for Degenerative Mitral Regurgitation: Philosophy, Technical Details, and Long-Term Results. Cardiol Clin 2021; 39:175-184. [PMID: 33894931 DOI: 10.1016/j.ccl.2021.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Degenerative mitral valve disease represents the most common cause of mitral regurgitation in industrialized countries. When left untreated, patients with severe degenerative mitral regurgitation show a poor clinical outcome. Conversely, a timely and appropriate correction provides a restored life expectancy and a good quality of life. Therefore, in this scenario, surgical mitral valve repair represents the gold standard of treatment. This review aims to analyze the indications, timing, and contemporary surgical techniques of mitral valve repair for degenerative mitral regurgitation. Moreover, the value of heart team approach and centers of excellence for mitral valve repair are also deeply discussed.
Collapse
Affiliation(s)
- Benedetto Del Forno
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
| | - Guido Ascione
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
| |
Collapse
|
12
|
Putative Circulating MicroRNAs Are Able to Identify Patients with Mitral Valve Prolapse and Severe Regurgitation. Int J Mol Sci 2021; 22:ijms22042102. [PMID: 33672625 PMCID: PMC7924183 DOI: 10.3390/ijms22042102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/23/2022] Open
Abstract
Mitral valve prolapse (MVP) associated with severe mitral regurgitation is a debilitating disease with no pharmacological therapies available. MicroRNAs (miRNA) represent an emerging class of circulating biomarkers that have never been evaluated in MVP human plasma. Our aim was to identify a possible miRNA signature that is able to discriminate MVP patients from healthy subjects (CTRL) and to shed light on the putative altered molecular pathways in MVP. We evaluated a plasma miRNA profile using Human MicroRNA Card A followed by real-time PCR validations. In addition, to assess the discriminative power of selected miRNAs, we implemented a machine learning analysis. MiRNA profiling and validations revealed that miR-140-3p, 150-5p, 210-3p, 451a, and 487a-3p were significantly upregulated in MVP, while miR-223-3p, 323a-3p, 340-5p, and 361-5p were significantly downregulated in MVP compared to CTRL (p ≤ 0.01). Functional analysis identified several biological processes possible linked to MVP. In addition, machine learning analysis correctly classified MVP patients from CTRL with high accuracy (0.93) and an area under the receiving operator characteristic curve (AUC) of 0.97. To the best of our knowledge, this is the first study performed on human plasma, showing a strong association between miRNAs and MVP. Thus, a circulating molecular signature could be used as a first-line, fast, and cheap screening tool for MVP identification.
Collapse
|
13
|
Budra M, Janušauskas V, Drąsutienė A, Zorinas A, Zakarkaitė D, Lipnevičius A, Ručinskas K. Midterm results of transventricular mitral valve repair: Single-center experience. J Thorac Cardiovasc Surg 2021; 164:1820-1828. [PMID: 33612306 DOI: 10.1016/j.jtcvs.2020.12.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/23/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The study objective was to evaluate the midterm outcomes of transventricular mitral valve repair and its association with the initial anatomy of the mitral valve. METHODS This nonrandomized observational study included 88 patients (mean age, 60 years; 69% were men) who underwent transventricular mitral valve repair for severe degenerative mitral regurgitation between 2011 and 2017. Mitral valve function was assessed by echocardiography at 1 and 6 months and annually after the procedure. According to the location of mitral valve pathology, all patients were stratified into 4 anatomic types (A, B, C, and D). Results were assessed using Kaplan-Meier method, mixed-effects continuation ratio model, and multivariable Cox regression. RESULTS Median follow-up of 42 months (interquartile range, 27-55) was complete for 83 patients (94.3%). There were 3 late deaths: 2 cardiac and 1 noncardiac. Recurrent mitral regurgitation greater than 2+ was observed in 29 patients (33%), and 18 patients (20.5%) underwent repeat surgery. Device success was 82% in type A at 6 months and thereafter; 87%, 85%, and 75% at 6, 12, and 36 months in type B, respectively; and 53% at 1 month and 20% at 24 months in type C. Probability of postoperative mitral regurgitation progression was higher in patients with greater preoperative left ventricular end-diastolic diameter, type B pathology, and type C pathology (P < .05). Risk factors of mitral regurgitation recurrence included increased left ventricle size (hazard ratio, 1.11; 95% confidence interval, 1.04-1.20; P = .001) and type C pathology (hazard ratio, 5.99; 95% confidence interval, 1.87-19.21; P = .003). CONCLUSIONS Initial acceptable mitral regurgitation reduction after transventricular mitral valve repair of isolated P2 prolapse was possible but found durable in only 82% at 3 years. Higher risk of mitral regurgitation recurrence occurred with complex degenerative pathology.
Collapse
Affiliation(s)
- Mindaugas Budra
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania.
| | - Vilius Janušauskas
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
| | - Agnė Drąsutienė
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
| | - Aleksejus Zorinas
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
| | - Diana Zakarkaitė
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
| | - Artūras Lipnevičius
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
| | - Kęstutis Ručinskas
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
| | -
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
| |
Collapse
|
14
|
Zervides C, Verran S, Yoganantharajah P, Sifeldeen KK. Don't go breaking my heart valve: historical review of mitral valve replacement. Future Cardiol 2020; 17:899-915. [PMID: 33191786 DOI: 10.2217/fca-2020-0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Management of mitral valve disease in the western world continues to lag behind its aortic counterpart, particularly in the realm of percutaneous valve replacement. It is a more complex anatomical region, with varying disease states and unique pathophysiological and epidemiological characteristics that make it a distinct challenge to treat in modern medicine. Latest research and development, however, have provided new answers to the challenges associated with the mitral valve. In this review, the most common disease states afflicting the mitral valve are outlined, specific challenges associated with treatment are discussed, and both current and cutting-edge replacement devices are described. This review focuses on replacement and prosthetic devices, while acknowledging the role of valve repair. The future of mitral valve replacement remains to be seen, as new methodologies and prosthetic designs continue to present themselves as the best answer to the challenge.
Collapse
Affiliation(s)
- Constantinos Zervides
- Department of Basic and Clinical Sciences, School of Medicine, University of Nicosia, Nicosia 2414, Cyprus
| | - Samantha Verran
- Department of Basic and Clinical Sciences, School of Medicine, University of Nicosia, Nicosia 2414, Cyprus
| | - Prusothman Yoganantharajah
- Department of Basic and Clinical Sciences, School of Medicine, University of Nicosia, Nicosia 2414, Cyprus
| | - Kassem K Sifeldeen
- Department of Basic and Clinical Sciences, School of Medicine, University of Nicosia, Nicosia 2414, Cyprus
| |
Collapse
|
15
|
Dziadzko V, Dziadzko M, Medina-Inojosa JR, Benfari G, Michelena HI, Crestanello JA, Maalouf J, Thapa P, Enriquez-Sarano M. Causes and mechanisms of isolated mitral regurgitation in the community: clinical context and outcome. Eur Heart J 2020; 40:2194-2202. [PMID: 31121021 DOI: 10.1093/eurheartj/ehz314] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/15/2019] [Accepted: 05/06/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS To define the hitherto unknown aetiology/mechanism distributions of mitral regurgitation (MR) in the community and the linked clinical characteristics/outcomes. METHODS AND RESULTS We identified all isolated, moderate/severe MR diagnosed in our community (Olmsted County, MN, USA) between 2000 and 2010 and classified MR aetiology/mechanisms. Eligible patients (n = 727) were 73 ± 18 years, 51% females, with ejection fraction (EF) 49 ± 17%. MR was functional (FMR) in 65%, organic (OMR) in 32% and 2% mixed. Functional MR was linked to left ventricular remodelling (FMR-v) 38% and isolated atrial dilatation (FMR-a) 27%. At diagnosis FMR-v vs. FMR-a, vs. OMR displayed profound differences (all P < 0.0001) in age (73 ± 14, 80 ± 10, 68 ± 21years), male-sex (59, 33, 51%), atrial-fibrillation (28, 54, 13%), EF (33 ± 14, 57 ± 11, 61 ± 10%), and regurgitant-volume (38 ± 13, 37 ± 11, 51 ± 24 mL/beat). Dominant MR mechanism was Type I (normal valve-movement) 38%, Type II (excessive valve-movement) 25%, Type IIIa (diastolic movement-restriction) 3%, and Type IIIb (systolic movement-restriction) 34%. Outcomes were mediocre with excess-mortality vs. general-population in FMR-v [risk ratio 3.45 (2.98-3.99), P < 0.0001] but also FMR-a [risk ratio 1.88 (1.52-2.25), P < 0.0001] and OMR [risk ratio 1.83 (1.50-2.22), P < 0.0001]. Heart failure was frequent, particularly in FMR-v (5-year 83 ± 3% vs. 59 ± 4% FMR-a, 40 ± 3% OMR, P < 0.0001). Mitral surgery during patients' lifetime was performed in 4% of FMR-v, 3% of FMR-a, and 37% of OMR. CONCLUSION Moderate/severe isolated MR in the community displays considerable aetiology/mechanism heterogeneity. Functional MR dominates, mostly FMR-v but FMR-a is frequent and degenerative MR dominates OMR. Outcomes are mediocre with excess-mortality particularly with FMR-v but FMR-a, despite normal EF incurs notable excess-mortality and frequent heart failure. Pervasive undertreatment warrants clinical trials of therapies tailored to specific MR cause/mechanisms.
Collapse
Affiliation(s)
- Volha Dziadzko
- Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, USA
| | - Mikhail Dziadzko
- Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, USA
| | - Jose R Medina-Inojosa
- Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, USA
| | - Giovanni Benfari
- Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, USA
| | - Hector I Michelena
- Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, USA
| | - Juan A Crestanello
- Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, USA
| | - Joseph Maalouf
- Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, USA
| | - Prabin Thapa
- Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, USA
| | - Maurice Enriquez-Sarano
- Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, USA
| |
Collapse
|
16
|
Cohen BD, Napolitano MA, Edelman JJ, Thourani KV, Thourani VH. Contemporary Management of Mitral Valve Disease. Adv Surg 2020; 54:129-147. [PMID: 32713426 DOI: 10.1016/j.yasu.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Brian D Cohen
- Department of Surgery, MedStar Georgetown/Washington Hospital Center, 3800 Reservoir Road Northwest, 2051 Gorman, Washington, DC 20007, USA
| | - Michael A Napolitano
- Department of Surgery, George Washington University, 1255 New Hampshire Avenue Northwest Apartment 1001, Washington, DC 20036, USA
| | - J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia
| | - Keegan V Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, 95 Collier Road, Suite 5015, Atlanta, GA 30342, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, 95 Collier Road, Suite 5015, Atlanta, GA 30342, USA.
| |
Collapse
|
17
|
Auckland K, Mittal B, Cairns BJ, Garg N, Kumar S, Mentzer AJ, Kado J, Perman ML, Steer AC, Hill AVS, Parks T. The Human Leukocyte Antigen Locus and Rheumatic Heart Disease Susceptibility in South Asians and Europeans. Sci Rep 2020; 10:9004. [PMID: 32488134 PMCID: PMC7265443 DOI: 10.1038/s41598-020-65855-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/07/2020] [Indexed: 12/28/2022] Open
Abstract
Rheumatic heart disease (RHD), an autoinflammatory heart disease, was recently declared a global health priority by the World Health Organization. Here we report a genome-wide association study (GWAS) of RHD susceptibility in 1,163 South Asians (672 cases; 491 controls) recruited in India and Fiji. We analysed directly obtained and imputed genotypes, and followed-up associated loci in 1,459 Europeans (150 cases; 1,309 controls) from the UK Biobank study. We identify a novel susceptibility signal in the class III region of the human leukocyte antigen (HLA) complex in the South Asian dataset that clearly replicates in the Europeans (rs201026476; combined odds ratio 1.81, 95% confidence intervals 1.51-2.18, P = 3.48×10-10). Importantly, this signal remains despite conditioning on the lead class I and class II variants (P = 0.00033). These findings suggest the class III region is a key determinant of RHD susceptibility offering important new insight into pathogenesis while partly explaining the inconsistency of earlier reports.
Collapse
Affiliation(s)
- Kathryn Auckland
- The Wellcome Centre for Human Genetics, University of Oxford, Oxford, Oxfordshire, OX3 7BN, UK
| | - Balraj Mittal
- Department of Biotechnology, Babasaheb Bhimrao Ambedkar University, Lucknow, 226025, Uttar Pradesh, India
| | - Benjamin J Cairns
- MRC Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, OX3 7LF, UK
| | - Naveen Garg
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, Uttar Pradesh, India
| | - Surendra Kumar
- Department of Cytogenetics/Anatomy, All India Institute of Medical Sciences, New Delhi, 110029, Delhi, India
| | - Alexander J Mentzer
- The Wellcome Centre for Human Genetics, University of Oxford, Oxford, Oxfordshire, OX3 7BN, UK
| | - Joseph Kado
- Department of Medical Science, Fiji National University, Suva, PO Box 7222, Viti Levu, Fiji
| | - Mai Ling Perman
- Department of Medical Science, Fiji National University, Suva, PO Box 7222, Viti Levu, Fiji
| | - Andrew C Steer
- Tropical Infectious Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, 3052, Australia
| | - Adrian V S Hill
- The Wellcome Centre for Human Genetics, University of Oxford, Oxford, Oxfordshire, OX3 7BN, UK
| | - Tom Parks
- The Wellcome Centre for Human Genetics, University of Oxford, Oxford, Oxfordshire, OX3 7BN, UK.
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, Greater London, WC1E 7HT, UK.
| |
Collapse
|
18
|
Ahmed K, Rehman Memon A, Liaquat H, Mujtaba M, Parkash C, Sultan FAT, Karim M. The Frequency of Left Atrial Thrombus on Transthoracic Echocardiogram in Patients with Mitral Stenosis. Cureus 2020; 12:e7453. [PMID: 32351832 PMCID: PMC7188021 DOI: 10.7759/cureus.7453] [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: 11/24/2022] Open
Abstract
Background Patients with mitral stenosis (MS) are more prone to develop left atrial (LA) thrombus. This cross-sectional study was conducted to determine the frequency of LA thrombus on transthoracic echocardiography (TTE) in patients with MS. Methods In this study, we included patients diagnosed with MS undergoing TTE at the echocardiography department of the National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. The severity of MS was classified based on the mitral valve area (MVA) as follows: very severe: MVA of ≤1.0 cm2; severe: MVA of ≤1.5 cm2; and mild to moderate: MVA of >1.5 cm2. The LA thrombus was observed and noted on TTE. Results A total of 256 MS patients were included in this study, out of which 46.5% (119) were male. The mean age was 33.78 ±11.51 years. MS was classified as mild to moderate in 3.5% of the patients, severe in 54.3%, and very severe in 42.2%. In 98.8% of the patients, the etiology of MS was rheumatic. LA thrombus was observed in 25% (64) of the patients and LA smoke was observed in 12.1% (31). Among other findings, mitral regurgitation (MR) was observed in 17.2% of the patients, aortic regurgitation (AR) in 5.1%, aortic stenosis (AS) in 4.7%, and tricuspid regurgitation (TR) in 48.8%. Five (2%) patients had atrial septal defect (ASD), 17.3% had left ventricular (LV) dysfunction, 15.2% had right ventricular (RV) dysfunction, and vegetation was seen in 11.8% of the patients. Patients with LA thrombus were found to be associated with the following conditions on a higher scale compared to those without: decreased ejection fraction (EF) (52 ±8.5% vs. 54.94 ±6.6%; p: 0.011); RV dysfunction (39.1% vs. 7.3%; p: <0.001); and presence of associated pathologies (82.8% vs. 43.8%; p: <0.001). Conclusion LA thrombus on TTE was detected in a significant number (25%) of patients with MS. It was also found to be strongly associated with the severity of the disease, reduced EF, RV dysfunction, and the presence of associated value pathologies.
Collapse
Affiliation(s)
- Khalil Ahmed
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Aziz Rehman Memon
- Critical Care Medicine, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Hussain Liaquat
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Mustajab Mujtaba
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Chander Parkash
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | | | - Musa Karim
- Statistics, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| |
Collapse
|
19
|
Adam MEAE, Osman SME, Abdalrasoul DIA, Yagoup IAO, Hussein MMA, Haron MDY, Mahmoud ZIT, Ahmed AA. Echocardiography Effectiveness in Improving Diagnosis of Rheumatic Heart Disease in North Darfur: A Hospital-based Study. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2020; 000:1-8. [DOI: 10.14218/erhm.2019.00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
20
|
Bitan A, Mazor-Dray E, Weinstein JM, Carmel S, Ilia R. Rheumatic Mitral Stenosis: Long-Term Follow-Up of Adult Patients with Nonsevere Initial Disease. Cardiology 2020; 145:155-160. [PMID: 32018250 DOI: 10.1159/000505481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 12/16/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is no consensus regarding the natural history of rheumatic mitral stenosis (MS) among adults presenting with nonsevere disease. This study aims to describe the progression of stenosis among adult rheumatic MS patients, to identify predictive factors for progression, and to assess the incidence of complications. METHODS A retrospective cohort analysis was performed among patients with rheumatic MS treated at a single center. Eighty-five patients were included with mild to moderate MS, ≥30 years old on initial echocardiography. Demographics, medical history, echocardiographic reports over at least 10 years, and related complications were obtained from a computerized database. RESULTS Over a period of 13.1 ± 2.38 years, 75 patients (88%) had no significant progression in stenosis severity. The final echocardiographic assessment demonstrated 2 groups with a significant difference between them regarding the mitral valve area (1.58 ± 0.44 vs. 1.1 ± 0.26 cm2, p = 0.001) and mean valvular pressure gradient (6.27 ± 2.52 vs. 8.5 ± 2.69 mm Hg, p = 0.01). Patients with indolent MS (group A) were compared to patients with progressive disease (group B), and a higher percent of Bedouin patients were found in group B (OR 8.036, p = 0.015). No significant differences were found in other parameters. Complications including atrial fibrillation, cerebral ischemic events, and impaired right ventricle function, although frequent, were not statistically different between the groups. CONCLUSIONS An indolent natural progression of rheumatic MS was observed in our study. Despite this finding, it still has potentially deleterious effects. Bedouin patients have a higher risk for progressive disease.
Collapse
Affiliation(s)
- Amram Bitan
- Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Efrat Mazor-Dray
- Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Jean Marc Weinstein
- Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Sarah Carmel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Reuben Ilia
- Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel,
| |
Collapse
|
21
|
Bhatt M, Kumar S, Garg N, Siddiqui MH, Mittal B. Influence of IL-1β, STAT3 & 5 and TLR-5 gene polymorphisms on rheumatic heart disease susceptibility in north Indian population. Int J Cardiol 2019; 291:89-95. [DOI: 10.1016/j.ijcard.2019.03.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/06/2019] [Accepted: 03/18/2019] [Indexed: 12/24/2022]
|
22
|
Quantitative Description of Mitral Valve Geometry Using Real-Time Three-Dimensional Echocardiography. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 2:237-44. [DOI: 10.1097/imi.0b013e31815bdbdf] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives Leaflet and annular geometry are important determinants of mitral valve (MV) stress. Repair techniques which optimize valvular geometry will reduce stress and potentially increase repair durability. The development of such procedures will require image processing methodologies that provide a quantitative description of three-dimensional valvular geometry. Using three-dimensional echocardiography in conjunction with novel geometric modeling and rendering techniques, we have developed a high-resolution, quantitative, three-dimensional methodology for imaging the human MV. Methods Five normal adults underwent MV imaging using real-time three-dimensional echocardiography. Using specially designed image analysis software, multiple valvular geometric parameters, including the magnitude and orientation of leaflet curvature, leaflet surface area, annular height, intercommissural width, septolateral annular diameter, and annular area were determined for each subject. Image rendering techniques that allow for the clear and concise presentation of this detailed information are also presented. Results Although three-dimensional annular and leaflet geometry were found to be highly conserved among normal human subjects, substantial regional variation in leaflet geometry was observed. Interestingly, leaflet geometric heterogeneity was most pronounced in the midposterior leaflet, the region most commonly involved in leaflet flail in subjects with myxomatous disease. Conclusions The image processing and graphical rendering techniques that we have developed can be used to provide a complete description of three-dimensional MV geometry in human subjects. Widespread application of these techniques to normal subjects and patients with MV disease will provide insight into the geometric basis of both valvular pathology and repair durability.
Collapse
|
23
|
Enriquez A, Shirai Y, Huang J, Liang J, Briceño D, Hayashi T, Muser D, Fulton B, Han Y, Perez A, Frankel DS, Schaller R, Supple G, Callans D, Marchlinski F, Garcia F, Santangeli P. Papillary muscle ventricular arrhythmias in patients with arrhythmic mitral valve prolapse: Electrophysiologic substrate and catheter ablation outcomes. J Cardiovasc Electrophysiol 2019; 30:827-835. [PMID: 30843306 DOI: 10.1111/jce.13900] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/06/2019] [Accepted: 02/15/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mitral valve prolapse (MVP) is a common valve condition and has been associated with sudden cardiac death. Premature ventricular contractions (PVCs) from the papillary muscles (PMs) may play a role as triggers for ventricular fibrillation (VF) in these patients. OBJECTIVES To characterize the electrophysiological substrate and outcomes of catheter ablation in patients with MVP and PM PVCs. METHODS Of 597 patients undergoing ablation of ventricular arrhythmias during the period 2012-2015, we identified 25 patients with MVP and PVCs mapped to the PMs (64% female). PVC-triggered VF was the presentation in 4 patients and a fifth patient died suddenly during follow-up. The left ventricle ejection fraction (LVEF) was 50.5% ± 11.8% and PVC burden was 24.4% ± 13.1%. A cardiac magnetic resonance imaging was performed in nine cases and areas of late gadolinium enhancement were found in four of them. A detailed LV voltage map was performed in 11 patients, three of which exhibited bipolar voltage abnormalities. Complete PVC elimination was achieved in 19 (76%) patients and a significant reduction in PVC burden was observed in two (8%). In patients in which the ablation was successful, the PVC burden decreased from 20.4% ± 10.8% to 6.3% ± 9.5% (P = 0.001). In 5/6 patients with depressed LVEF and successful ablation, the LV function improved postablation. No significant differences were identified between patients with and without VF. CONCLUSIONS PM PVCs are a source of VF in patients with MVP and can induce PVC-mediated cardiomyopathy that reverses after PVC suppression. Catheter ablation is highly successful with more than 80% PVC elimination or burden reduction.
Collapse
Affiliation(s)
- Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada.,Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yasuhiro Shirai
- Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason Huang
- Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jackson Liang
- Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Briceño
- Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tatsuya Hayashi
- Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniele Muser
- Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian Fulton
- Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yuchi Han
- Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Armando Perez
- Arrhythmia Service, Department of Medicine, Hospital Guillermo Gran Benavente, Concepcion, Chile
| | - David S Frankel
- Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Schaller
- Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory Supple
- Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Callans
- Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis Marchlinski
- Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fermin Garcia
- Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pasquale Santangeli
- Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
24
|
MitraClip Implantation in Younger Patients and Pediatric Populations: 19 Year-Old Patient with Multiple Comorbidities and a Prior Mitral Valve Annuloplasty. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:1027-1030. [PMID: 30503037 DOI: 10.1016/j.carrev.2018.11.008] [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: 09/01/2018] [Revised: 10/15/2018] [Accepted: 11/12/2018] [Indexed: 11/23/2022]
Abstract
MitraClip is an effective treatment method for severe mitral regurgitation in high-risk populations in terms of reducing morbidity and frequency of hospitalizations. Efficacy and safety of MitraClip device in elderly population have been established, yet there are only 2 case reports of MitraClip implantation in the younger patients, who generally tend to have less surgical risk (Gorenflo et al.; Joffe et al., 2016). We describe a 19-year-old patient with severe mitral regurgitation with prior mitral valve annuloplasty and received MitraClip implantation due to high-surgical risk.
Collapse
|
25
|
Guérin P. [Percutaneous treatment of mitral regurgitation by Mitraclip in the elderly]. Ann Cardiol Angeiol (Paris) 2018; 67:474-481. [PMID: 30389097 DOI: 10.1016/j.ancard.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Mitral regurgitation (MR) is the second most common form of valvular heart disease. It is classified as either primary (degenerative) or secondary (functional). Secondary MR is the consequence of myocardium disease. Primary MR from degenerative valve disease is due to a primary disruption of the mitral valve apparatus from either prolapsed or flail leaflets. It covers all aetiologies in which intrinsic lesions affect one or several components of the mitral valve apparatus. Gold-standard therapeutic management of severe primary MR is surgery usually to repair but sometime to replace the mitral valve. However patients considered to be at high-risk due to their age or the presence of comorbidities - accounting for 50% of all patients - are not eligible for surgery. Catheter-based interventions have been developed to correct MR percutaneously. The only such intervention which has been evaluated in organic MR is the edge-to-edge procedure using the MitraClip® (Abbott Vascular, Menlo Park, CA). MitraClip® offers an alternative to open surgical repair or replacement via a minimally invasive route and it was shown in the EVEREST II study that MitraClip® was safer than surgery even though it was less effective in reducing MR. A substantial number of patients are ineligible for mitral valve surgery because of prohibitive surgical risk. For those patients, MitraClip® may offer an alternative treatment option. Percutaneous edge-to-edge repair is the first percutaneous option accepted in the 2012 ESC guidelines: Percutaneous edge-to-edge procedure may be considered in patients with symptomatic severe primary MR who fulfill the echo criteria of eligibility, are judged inoperable or at high surgical risk by a 'heart team', and have a life expectancy greater than 1 year (recommendation class IIb, level of evidence C). Because of its frailty, MitraClip® in the elderly may be a good alternative to mitral surgery when indicated for primary or secondary MD.
Collapse
Affiliation(s)
- P Guérin
- Unité de cardiologie interventionnelle, l'institut du thorax, CHU Nantes, 44000 Nantes, France.
| |
Collapse
|
26
|
Savic V, Pozzoli A, Gülmez G, Demir H, Batinkov N, Kuwata S, Weber A, Vogel R, Tanner F, Zuber M, Maisano F, Taramasso M. Transcatheter mitral valve chord repair. Ann Cardiothorac Surg 2018; 7:731-740. [PMID: 30598886 DOI: 10.21037/acs.2018.09.09] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The field of mitral valve disease diagnosis and management is rapidly evolving. New understanding of pathophysiology and improvements in the adoption of sophisticated multimodality imaging modalities have led to early diagnosis and to more complex treatment. The most common cause of mitral regurgitation (MR) in the western world is in the primary alteration of the valve, which leads to degenerative leaflet prolapse due to chordal elongation or rupture and annular dilatation. Untreated, significant MR has a negative impact prognosis, leading to reduction of survival. In the setting of degenerative MR, surgical repair currently represents the standard of care. Treatment of asymptomatic patients with severe MR in the Valve Center of Excellence, in which successful repair reaches more than 95% and surgical mortality less than 1%, symbolizes the direction for the next years. Transcatheter mitral valve repair with different devices, more recently the chordal replacement ones, is providing good outcomes and became a therapeutic option in high-risk patients with degenerative MR. In the future, more advances are expected from further development of interventional techniques, careful evaluation and better patient selection. This review will focus on long-term surgical outcomes of mitral valve repair with artificial chordae and on the emerging transcatheter chordal repair devices as therapeutic options for degenerative MR patients.
Collapse
Affiliation(s)
- Vedran Savic
- Heart Valve Clinic, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Alberto Pozzoli
- Heart Valve Clinic, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Gökhan Gülmez
- Heart Valve Clinic, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Halil Demir
- Heart Valve Clinic, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Nikola Batinkov
- Heart Valve Clinic, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Shingo Kuwata
- Heart Valve Clinic, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Alberto Weber
- Heart Surgery, HerzZentrum Hirslanden Zürich, Zürich, Switzerland
| | - Rolf Vogel
- Department of Cardiology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Felix Tanner
- Heart Valve Clinic, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Michel Zuber
- Heart Valve Clinic, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Francesco Maisano
- Heart Valve Clinic, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Maurizio Taramasso
- Heart Valve Clinic, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| |
Collapse
|
27
|
Hayashi H, Abe Y, Morita Y, Nakane E, Haruna Y, Haruna T, Inoko M. The Accuracy of a Large V Wave in the Pulmonary Capillary Wedge Pressure Waveform for Diagnosing Current Mitral Regurgitation. Cardiology 2018; 141:46-51. [DOI: 10.1159/000493007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 11/19/2022]
Abstract
Background: Large V waves in the pulmonary capillary wedge pressure (PCWP) waveform traditionally indicate severe mitral regurgitation (MR). However, our understanding of MR etiology and hemodynamics has changed in recent decades. Objectives: We aimed to reevaluate the association between large V waves and current MR to determine whether traditional large V wave criteria remain optimal. Method: We reviewed 1,964 right heart catheterizations (RHCs) performed at our institution from 2010 to 2017, and retrospectively selected 126 patients with sinus rhythm who underwent echocardiography within 2 days (0.3 ± 0.5 days) of the RHC. The diagnostic accuracy of 3 traditional criteria for large V waves was assessed, and the optimal cut-off points were determined as those with the maximal Youden indices. Results: Severe MR was observed on echocardiography in 26 (21%) patients, including 15 (58%) with Carpentier classification type II MR and 11 (42%) with type IIIB MR. Large V waves, defined as a difference between the peak V wave and mean PCWP ≥10 mm Hg, had a high specificity of 94% (95% confidence interval: 87–98%), but a low sensitivity of 27% (12–48%) for diagnosing severe MR. The optimal cut-off point for the V wave was 3 mm Hg above the mean PCWP, with a sensitivity of 73% (52–88%) and a specificity of 64% (54–73%). Conclusions: For diagnosing current MR, the cut-off point for a large V wave should be reduced from that previously employed for rheumatic valvular heart disease. This information may be useful in guiding contemporary transcatheter therapies for MR under RHC monitoring.
Collapse
|
28
|
Raafat SS, Ramzy AA, El-Hadidy AF, Abd Allah MA, Hanna HF. Mitral leaflet separation index. An easy two dimensional echocardiography technique for assessment of mitral valve area before and after percutaneous balloon mitral valvuloplasty. Egypt Heart J 2018; 70:195-201. [PMID: 30190646 PMCID: PMC6123234 DOI: 10.1016/j.ehj.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/19/2018] [Indexed: 12/01/2022] Open
Abstract
AIM To evaluate the reliability of the mitral leaflet separation (MLS) index against the traditional echocardiographic methods in measuring mitral valve area (MVA) pre and post percutaneous balloon mitral valvuloplasty (PBMV). METHODS Ninety patients suffering symptomatic moderate to severe MS underwent PBMV at Ain Shams University Hospital in cardiology department. Seventy of the patients were females representing 77.8% and 20 were males representing 22.2%. Their age ranged from 22 to 56 years. All patients were subjected to full transthoracic echocardiography (TTE) examination pre and post PBMV. MLS index was introduced as a comparative parameter with traditional echocardiographic methods for assessment of MVA, measuring average of distance between tips of MV leaflets in parasternal long axis and four chamber two dimensional echocardiographic views. RESULTS MVA increased from 0.95 ± 0.28 to 2.21 ± 0.41 cm2 (P=0.001) using 2D planimetry; and increased from 0.93 ± 0.23 to 2.21 ± 0.46 cm2 (P= 0.0011) by pressure half time method (PHT). MLS index was correlated with MVA by 2D planimetry pre and post PBMV (r=0.453) and (r=0.668) respectively (p=0.0001) and strongly correlated with MVA using PHT post PBMV (r=0.768) (p=0.0001). Post PBMV 14 patients suffered significant mitral regurgitation 3 of them were transferred to surgery. MLS index above 11.75 mm and below 9.15 mm had excellent positive predictive value for detecting mild and severe MS respectively. CONCLUSION The MLS index it is a simple and effective method for assessment of the MVA, it has an excellent correlation with MVA with an excellent sensitivity and specificity for the prediction of effective MVA. The MLS index cannot evaluate outcome of PBMV because it is an anatomical parameter and not flow dependent thus does not correlate with grades of mitral regurgitation.
Collapse
Affiliation(s)
| | - Ali A. Ramzy
- Cardiology Department, Al-Azhar University, Egypt
| | | | | | | |
Collapse
|
29
|
Cameli M, Mandoli GE, Nistor D, Lisi E, Massoni A, Crudele F, Stricagnoli M, Lunghetti S, Mondillo S. Left heart longitudinal deformation analysis in mitral regurgitation. Int J Cardiovasc Imaging 2018; 34:1741-1751. [DOI: 10.1007/s10554-018-1391-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
|
30
|
Altered ADAMTS5 Expression and Versican Proteolysis: A Possible Molecular Mechanism in Barlow's Disease. Ann Thorac Surg 2018; 105:1144-1151. [DOI: 10.1016/j.athoracsur.2017.11.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 11/09/2017] [Accepted: 11/10/2017] [Indexed: 02/07/2023]
|
31
|
Fernández-Friera L, Salguero R, Vannini L, Argüelles AF, Arribas F, Solís J. Mechanistic insights of the left ventricle structure and fibrosis in the arrhythmogenic mitral valve prolapse. Glob Cardiol Sci Pract 2018; 2018:4. [PMID: 29644231 PMCID: PMC5857061 DOI: 10.21542/gcsp.2018.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/20/2017] [Indexed: 01/03/2023] Open
Abstract
Mitral valve prolapse (MVP) is a common and benign condition. However, some anatomic forms have been recently associated with life-threatening ventricular arrhythmias and sudden cardiac death. Imaging MVP holds the promise of individualized MVP risk assessment. Noninvasive imaging techniques available today are playing an increasingly important role in the diagnosis, prognosis and monitoring of MVP. In this article, we will review the current evidence on arrhythmogenic MVP, with special focus on the utility of echocardiography and CMR for identifying benign and "malignant" forms of MVP. The clinical relevance of this manuscript lies in the value of imaging technology to improve MVP risk prediction, including those arrhythmic-MVP cases with a higher risk of sudden cardiac death.
Collapse
Affiliation(s)
- Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM-CIEC, Madrid, Spain
| | | | - Luca Vannini
- Hospital Universitario 12 de Octubre, Madrid, Spain
- Universidad Rey Juan Carlos (PhD Etudent in Epidemiology and Public Health), Madrid
| | - Ana Fidalgo Argüelles
- HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM-CIEC, Madrid, Spain
| | | | - Jorge Solís
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM-CIEC, Madrid, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| |
Collapse
|
32
|
Outcomes in Degenerative Mitral Regurgitation: Current State-of-the Art and Future Directions. Prog Cardiovasc Dis 2017; 60:370-385. [DOI: 10.1016/j.pcad.2017.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
|
33
|
Tzizik D. Approaches to Valvular Heart Disease in the Primary Care Setting. PHYSICIAN ASSISTANT CLINICS 2017. [DOI: 10.1016/j.cpha.2017.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
34
|
Apostolidou E, Maslow AD, Poppas A. Primary mitral valve regurgitation: Update and review. Glob Cardiol Sci Pract 2017; 2017:e201703. [PMID: 31139637 PMCID: PMC6516795 DOI: 10.21542/gcsp.2017.3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mitral regurgitation is the second most common valvular disorder requiring surgical intervention worldwide. This review summarizes the current understanding of primary, degenerative mitral regurgitation with respect to etiology, comprehensive assessment, natural history and management. The new concept of staging of the valvular disorders, newer predictors of adverse and controversy of “watchful waiting” versus “early surgical intervention” for severe, asymptomatic, primary mitral regurgitation are addressed.
Collapse
Affiliation(s)
| | - Andrew D Maslow
- Section of Cardiac Anesthesia, Rhode Island and Miriam Hospital, Providence, RI, USA
| | | |
Collapse
|
35
|
The impact of functional vs degenerative mitral regurgitation on clinical outcomes among patients undergoing transcatheter aortic valve implantation. Am Heart J 2017; 184:71-80. [PMID: 27892889 DOI: 10.1016/j.ahj.2016.10.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/25/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Among patients undergoing transcatheter aortic valve implantation (TAVI), concomitant mitral regurgitation (MR) has been associated with adverse prognosis. We aimed to assess long-term clinical outcomes according to MR etiology. METHODS In a single-center registry of consecutive patients undergoing TAVI, we investigated the impact of functional (FMR) vs degenerative (DMR) MR on cardiovascular (CV) mortality throughout 2years of follow-up. RESULTS Among 603 patients (mean age 82.4±5.7years, 55% female) undergoing TAVI, 149 patients had moderate or severe MR (24.7%). Functional MR and DMR were documented in 53 (36%) and 96 (64%) patients, respectively. At 2years, patients with FMR and DMR had higher rates of CV mortality (30.2% vs 32.4%) as compared with patients with no MR (14.6%; FMR vs no MR: hazard ratio [HR] 2.32, 95% CI 1.34-4.02, P=.003; DMR vs no MR: HR 2.56, 95% CI 1.66-3.96, P<.001). In adjusted analyses, DMR was associated with an increased risk of CV mortality throughout the 2-year follow-up (adjusted HR 2.21, 95% CI 1.4-3.49, P=.001) as compared with FMR (adjusted HR 1.13, 95% CI 0.59-2.18, P=.707). Relevant MR was postprocedurally significantly reduced in both the DMR and FMR groups, whereas improvement of a decreased left ventricular ejection fraction was predominantly seen in the FMR group as compared with baseline. CONCLUSION Patients with severe, symptomatic aortic stenosis undergoing TAVI complicated by moderate or severe MR portend impaired prognosis. Particularly, patients with DMR are at increased risk for CV mortality during long-term follow-up.
Collapse
|
36
|
Mvondo CM, Pugliese M, Giamberti A, Chelo D, Kuate LM, Boombhi J, Dailor EM. Surgery for rheumatic mitral valve disease in sub-saharan African countries: why valve repair is still the best surgical option. Pan Afr Med J 2016; 24:307. [PMID: 28154662 PMCID: PMC5267788 DOI: 10.11604/pamj.2016.24.307.7504] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 05/12/2016] [Indexed: 11/11/2022] Open
Abstract
Rheumatic valve disease, a consequence of acute rheumatic fever, remains endemic in developing countries in the sub-Saharan region where it is the leading cause of heart failure and cardiovascular death, involving predominantly a young population. The involvement of the mitral valve is pathognomonic and mitral surgery has become the lone therapeutic option for the majority of these patients. However, controversies exist on the choice between valve repair or prosthetic valve replacement. Although the advantages of mitral valve repair over prosthetic valve replacement in degenerative mitral disease are well established, this has not been the case for rheumatic lesions, where the use of prosthetic valves, specifically mechanical devices, even in poorly compliant populations remains very common. These patients deserve more accurate evaluation in the choice of the surgical strategy which strongly impacts the post-operative outcomes. This report discusses the factors supporting mitral repair surgery in rheumatic disease, according to the patients' characteristics and the effectiveness of the current repair techniques compared to prosthetic valve replacement in developing countries.
Collapse
Affiliation(s)
| | - Marta Pugliese
- Divison of Cardiac Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - David Chelo
- Department of Pediatrics, Chantal Biya Foundation, Yaoundé, Cameroon
| | | | - Jerome Boombhi
- Department of Cardiology, Yaoundé General Hospital, Yaoundé Cameroon
| | - Ellen Marie Dailor
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| |
Collapse
|
37
|
Shinn SH, Dayan V, Schaff HV, Dearani JA, Joyce LD, Lahr B, Greason KL, Stulak JM, Daly RC. Outcomes of ring versus suture annuloplasty for tricuspid valve repair in patients undergoing mitral valve surgery. J Thorac Cardiovasc Surg 2016; 152:406-415.e3. [DOI: 10.1016/j.jtcvs.2016.04.068] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 04/05/2016] [Accepted: 04/14/2016] [Indexed: 11/30/2022]
|
38
|
Abdel Fattah EM, Girgis HYA, El Khashab K, Ashour ZA, Ezzat GM. B-type Natriuretic Peptide as an Index of Symptoms and Severity of Chronic Rheumatic Mitral Regurgitation. Heart Views 2016; 17:7-12. [PMID: 27293523 PMCID: PMC4879808 DOI: 10.4103/1995-705x.182648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The most common causes of severe mitral regurgitation (MR) in developing countries are rheumatic heart disease. The plasma level of B-type natriuretic peptide (BNP) is known to increase with left ventricular (LV) dysfunction. Aim of the Work: To study BNP level as an index of symptoms and severity of chronic rheumatic MR. Patients and Methods: One hundred and forty patients with rheumatic MR and LV ejection fractions (EFs) of >55% underwent assessment of symptoms, transthoracic echocardiography, and measurement of BNP. Results: The level of BNP rose with increasing left atrium (LA) dimensions and volumes, LV dimensions and volumes, echocardiographic parameters of MR severity (width of the vena contracta, regurgitation jet area, effective regurgitation orifice area, and regurgitant volume), and E waves. Results: BNP was significantly higher in patients with severe MR compared with moderate and mild MR (P < 0.001), and using cutoff point of 61 pg/mL mm had 97% sensitivity and 89% specificity for predicting patients with severe MR (0.99, 95% confidence interval [CI] 0.9–1). BNP was significantly higher in patients with New York Heart Association (NYHA III) compared with NYHA II, I and asymptomatic patients (P < 0.001) and using cutoff point of 53 pg/mL had 97% sensitivity and 87% specificity for predicting symptomatic patients with symptomatic MR (0.81, 95% CI 0.70–0.92). Conclusions: BNP level increase with increasing severity of rheumatic MR and are higher in symptomatic compared to asymptomatic patients, even in the presence of normal EF%.
Collapse
Affiliation(s)
| | | | | | | | - Ghada M Ezzat
- Department of Clinical Pathology, Fayoum University, Egypt
| |
Collapse
|
39
|
Sud K, Agarwal S, Parashar A, Raza MQ, Patel K, Min D, Rodriguez LL, Krishnaswamy A, Mick SL, Gillinov AM, Tuzcu EM, Kapadia SR. Degenerative Mitral Stenosis. Circulation 2016; 133:1594-604. [DOI: 10.1161/circulationaha.115.020185] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karan Sud
- From Departments of Cardiovascular Medicine (K.S., S.A., M.Q.R., K.P., D.M., L.L.R., A.K., E.M.T., S.R.K.), Internal Medicine (A.P.), and Thoracic and Cardiovascular Surgery (S.L.M., A.M.G.), Cleveland Clinic, OH
| | - Shikhar Agarwal
- From Departments of Cardiovascular Medicine (K.S., S.A., M.Q.R., K.P., D.M., L.L.R., A.K., E.M.T., S.R.K.), Internal Medicine (A.P.), and Thoracic and Cardiovascular Surgery (S.L.M., A.M.G.), Cleveland Clinic, OH
| | - Akhil Parashar
- From Departments of Cardiovascular Medicine (K.S., S.A., M.Q.R., K.P., D.M., L.L.R., A.K., E.M.T., S.R.K.), Internal Medicine (A.P.), and Thoracic and Cardiovascular Surgery (S.L.M., A.M.G.), Cleveland Clinic, OH
| | - Mohammad Q. Raza
- From Departments of Cardiovascular Medicine (K.S., S.A., M.Q.R., K.P., D.M., L.L.R., A.K., E.M.T., S.R.K.), Internal Medicine (A.P.), and Thoracic and Cardiovascular Surgery (S.L.M., A.M.G.), Cleveland Clinic, OH
| | - Kunal Patel
- From Departments of Cardiovascular Medicine (K.S., S.A., M.Q.R., K.P., D.M., L.L.R., A.K., E.M.T., S.R.K.), Internal Medicine (A.P.), and Thoracic and Cardiovascular Surgery (S.L.M., A.M.G.), Cleveland Clinic, OH
| | - David Min
- From Departments of Cardiovascular Medicine (K.S., S.A., M.Q.R., K.P., D.M., L.L.R., A.K., E.M.T., S.R.K.), Internal Medicine (A.P.), and Thoracic and Cardiovascular Surgery (S.L.M., A.M.G.), Cleveland Clinic, OH
| | - Leonardo L. Rodriguez
- From Departments of Cardiovascular Medicine (K.S., S.A., M.Q.R., K.P., D.M., L.L.R., A.K., E.M.T., S.R.K.), Internal Medicine (A.P.), and Thoracic and Cardiovascular Surgery (S.L.M., A.M.G.), Cleveland Clinic, OH
| | - Amar Krishnaswamy
- From Departments of Cardiovascular Medicine (K.S., S.A., M.Q.R., K.P., D.M., L.L.R., A.K., E.M.T., S.R.K.), Internal Medicine (A.P.), and Thoracic and Cardiovascular Surgery (S.L.M., A.M.G.), Cleveland Clinic, OH
| | - Stephanie L. Mick
- From Departments of Cardiovascular Medicine (K.S., S.A., M.Q.R., K.P., D.M., L.L.R., A.K., E.M.T., S.R.K.), Internal Medicine (A.P.), and Thoracic and Cardiovascular Surgery (S.L.M., A.M.G.), Cleveland Clinic, OH
| | - A. Marc Gillinov
- From Departments of Cardiovascular Medicine (K.S., S.A., M.Q.R., K.P., D.M., L.L.R., A.K., E.M.T., S.R.K.), Internal Medicine (A.P.), and Thoracic and Cardiovascular Surgery (S.L.M., A.M.G.), Cleveland Clinic, OH
| | - E. Murat Tuzcu
- From Departments of Cardiovascular Medicine (K.S., S.A., M.Q.R., K.P., D.M., L.L.R., A.K., E.M.T., S.R.K.), Internal Medicine (A.P.), and Thoracic and Cardiovascular Surgery (S.L.M., A.M.G.), Cleveland Clinic, OH
| | - Samir R. Kapadia
- From Departments of Cardiovascular Medicine (K.S., S.A., M.Q.R., K.P., D.M., L.L.R., A.K., E.M.T., S.R.K.), Internal Medicine (A.P.), and Thoracic and Cardiovascular Surgery (S.L.M., A.M.G.), Cleveland Clinic, OH
| |
Collapse
|
40
|
Guedes MAV, Pomerantzeff PMA, Brandão CMDA, Vieira MLC, Tarasoutchi F, Spinola PDC, Jatene FB. Mitral annulus morphologic and functional analysis using real time tridimensional echocardiography in patients submitted to unsupported mitral valve repair. Braz J Cardiovasc Surg 2016; 30:325-34. [PMID: 26313723 PMCID: PMC4541779 DOI: 10.5935/1678-9741.20140082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/22/2014] [Indexed: 11/20/2022] Open
Abstract
Introduction Mitral valve repair is the treatment of choice to correct mitral insufficiency,
although the literature related to mitral valve annulus behavior after mitral
repair without use of prosthetic rings is scarce. Objective To analyze mitral annulus morphology and function using real time tridimensional
echocardiography in individuals submitted to mitral valve repair with Double
Teflon technique. Methods Fourteen patients with mitral valve insufficiency secondary to mixomatous
degeneration that were submitted to mitral valve repair with the Double Teflon
technique were included. Thirteen patients were in FC III/IV. Patients were
evaluated in preoperative period, immediate postoperative period, 6 months and 1
year after mitral repair. Statistical analysis was made by repeated measures ANOVA
test and was considered statistically significant P<0.05. Results There were no deaths, reoperation due to valve dysfunction, thromboembolism or
endocarditis during the study. Posterior mitral annulus demonstrated a significant
reduction in immediate postoperative period (P<0.001),
remaining stable during the study, and presents a mean of reduction of 25.8%
comparing with preoperative period. There was a significant reduction in
anteroposterior and mediolateral diameters in the immediate postoperative period
(P<0.001), although there was a significant increase in
mediolateral diameter between immediate postoperative period and 1 year. There was
no difference in mitral internal area variation over the cardiac cycle during the
study. Conclusion Segmentar annuloplasty reduced the posterior component of mitral annulus, which
remained stable in a 1-year-period. The variation in mitral annulus area during
cardiac cycle remained stable during the study.
Collapse
Affiliation(s)
| | | | | | | | - Flávio Tarasoutchi
- Instituto do Coração do Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, BR
| | - Pablo da Cunha Spinola
- Instituto do Coração do Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, BR
| | - Fábio Biscegli Jatene
- Instituto do Coração do Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, BR
| |
Collapse
|
41
|
Abstract
The field of mitral valve disease diagnosis and management is rapidly changing. New understanding of disease pathology and progression, with improvements in and increased use of sophisticated imaging modalities, have led to early diagnosis and complex treatment. In primary mitral regurgitation, surgical repair is the standard of care. Treatment of asymptomatic patients with severe mitral regurgitation in valve reference centres, in which successful repair is more than 95% and surgical mortality is less than 1%, should be the expectation for the next 5 years. Transcatheter mitral valve repair with a MitraClip device is also producing good outcomes in patients with primary mitral regurgitation who are at high surgical risk. Findings from clinical trials of MitraClip versus surgery in patients of intermediate surgical risk are expected to be initiated in the next few years. In patients with secondary mitral regurgitation, mainly a disease of the left ventricle, the vision for the next 5 years is not nearly as clear. Outcomes from ongoing clinical trials will greatly inform this field. Use of transcatheter techniques, both repair and replacement, is expected to substantially expand. Mitral annular calcification is an increasing problem in elderly people, causing both mitral stenosis and regurgitation which are difficult to treat. There is anecdotal experience with use of transcatheter valves by either a catheter-based approach or as a hybrid technique with open surgery, which is being studied in early feasibility trials.
Collapse
|
42
|
Al Mosa AF, Omair A, Arifi AA, Najm HK. Mitral valve replacement for mitral stenosis: A 15-year single center experience. J Saudi Heart Assoc 2016; 28:232-8. [PMID: 27688670 PMCID: PMC5034490 DOI: 10.1016/j.jsha.2016.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/02/2016] [Accepted: 02/11/2016] [Indexed: 11/25/2022] Open
Abstract
Objectives Mitral valve replacement with either a bioprosthetic or a mechanical valve is the treatment of choice for severe mitral stenosis. However, choosing a valve implant type is still a subject of debate. This study aimed to evaluate and compare the early and late outcomes of mitral valve replacement [mechanical (MMV) vs. bioprosthetic (BMV)] for severe mitral stenosis. Methods A retrospective cohort study was performed on data involving mitral stenosis patients who have undergone mitral valve replacement with either BMV (n = 50) or MMV (n = 145) valves from 1999 to 2012. Data were collected from the patients’ records and follow-up through telephone calls. Data were analyzed for early and late mortality, New York Heart Association (NYHA) functional classes, stroke, pre- and postoperative echocardiographic findings, early and late valve-related complications, and survival. Chi-square test, logistic regression, Kaplan–Meier curve, and dependent proportions tests were some of the tests employed in the analysis. Results A total of 195 patients were included in the study with a 30-day follow-up echocardiogram available for 190 patients (97.5%), while 103 (53%) were available for follow-up over the telephone. One patient died early postoperatively; twelve patients died late in the postoperative period, six in the bioprosthesis group and six in the mechanical group. The late mortality had a significant association with postoperative stroke (p < 0.001) and postoperative NYHA Classes III and IV (p = 0.002). Postoperative NYHA class was significantly associated with age (p = 0.003), pulmonary disease (p = 0.02), mitral valve implant type (p = 0.01), and postoperative stroke (p = 0.02); 14 patients had strokes in the mechanical (9) and in the bioprosthetic (5) groups. NYHA classes were significantly better after the replacement surgeries (p < 0.001). BMV were significantly associated with worse survival (p = 0.03), worse NYHA postoperatively (p = 0.01), and more reoperations (p = 0.006). Survival was significantly better with MMV (p = 0.03). When the two groups were matched for age and mitral regurgitation, the analysis revealed that BMV were significantly associated with reoperations (p = 0.02) but not significantly associated with worse survival (p = 0.4) or worse NYHA (p = 0.4). Conclusion MMV replacement in mitral stenosis patients is associated with a lower reoperation rate, but there was no difference in survival compared with BMV replacement.
Collapse
Affiliation(s)
- Alqasem F. Al Mosa
- King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, aSaudi Arabia
| | - Aamir Omair
- King Saud bin Abdulaziz University for Health Sciences, Medical Education, Riyadh, bSaudi Arabia
| | - Ahmed A. Arifi
- Cardiac Clinical Research, Cardiac Surgery, Cardiac Sciences, King Abdulaziz Cardiac Center, Ministry of National Guard, Riyadh, cSaudi Arabia
| | - Hani K. Najm
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave/M41, Cleveland, Ohio, 44195, dUnited States
- Corresponding author at: Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave/M41, Cleveland, Ohio, 44195, United States.Heart and Vascular InstituteCleveland Clinic9500 Euclid Ave/M41ClevelandOhio44195United States
| |
Collapse
|
43
|
McNeely CA, Vassileva CM. Long-term outcomes of mitral valve repair versus replacement for degenerative disease: a systematic review. Curr Cardiol Rev 2015; 11:157-62. [PMID: 25158683 PMCID: PMC4356723 DOI: 10.2174/1573403x10666140827093650] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 11/24/2022] Open
Abstract
The short-term advantage of mitral valve repair versus replacement for degenerative disease has been extensively documented. These advantages include lower operative mortality, improved survival, better preservation of left-ventricular function, shorter post-operative hospital stay, lower total costs, and fewer valve-related complications, including thromboembolism, anticoagulation-related bleeding events and late prosthetic dysfunction. More recent written data are available indicating the long-term advantage of repair versus replacement. While at some institutions, the repair rate for degenerative disease may exceed 90%, the national average in 2007 was only 69%. Making direct comparisons between mitral valve repair and replacement using the available studies does present some challenges however, as there are often differences in baseline characteristics between patient groups as well as other dissimilarities between studies. The purpose of this review is to systematically summarize the long-term survival and reoperation data of mitral valve repair versus replacement for degenerative disease. A PubMed search was done and resulted in 12 studies that met our study criteria for comparing mitral valve repair versus replacement for degenerative disease. A systematic review was then conducted abstracting survival and reoperation data.
Collapse
|
44
|
Abstract
Echocardiography is an excellent method for evaluating cardiac morphology and dynamic function. It has a long history of innovative thinking mixed with some degree of serendipity. Its early applications were as a tool to evaluate the mitral valve, left ventricular characteristics, and pericardial effusion. Today it has evolved into a robust modality that allows for a very wide range cardiac interrogation, able to evaluate the valves, chambers, myocardium, and pericardium. The practice of echocardiography also is often separate from that of general or vascular sonography. The objective of this article is to provide the non–cardiac sonographer with an overview and appreciation of the basic principles and practices of echocardiography. It is not meant as a guide to scanning but rather, as a vehicle to spark the interest and imagination of the reader.
Collapse
Affiliation(s)
- Pamela Mayer
- Department of Radiology, Flagstaff Medical Center, Flagstaff, AZ, USA
| |
Collapse
|
45
|
Michelena HI, Topilsky Y, Suri R, Enriquez-Sarano M. Degenerative Mitral Valve Regurgitation: Understanding Basic Concepts and New Developments. Postgrad Med 2015; 123:56-69. [DOI: 10.3810/pgm.2011.03.2264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
46
|
|
47
|
Kayatta MO, Jensen H, Padala M, Gilmore RC, Thourani VH. Mitral valve repair with the MitraClip ®. Interv Cardiol 2014. [DOI: 10.2217/ica.14.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
48
|
Koo HJ, Yang DH, Oh SY, Kang JW, Kim DH, Song JK, Lee JW, Chung CH, Lim TH. Demonstration of Mitral Valve Prolapse with CT for Planning of Mitral Valve Repair. Radiographics 2014; 34:1537-52. [DOI: 10.1148/rg.346130146] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
49
|
Abstract
In industrially developed countries, moderate or severe mitral valve disease is relatively common and is usually caused by prolapse or is secondary to left ventricular disease. Mitral stenosis (MS), however, is uncommon and usually a sequela of rheumatic fever. This article discusses the natural history of mitral regurgitation and MS and their medical and surgical management.
Collapse
Affiliation(s)
- R Ray
- Cardiothoracic Centre, Guy's and St Thomas' Hospitals, London, UK
| | | |
Collapse
|
50
|
Wan B, Rahnavardi M, Tian DH, Phan K, Munkholm-Larsen S, Bannon PG, Yan TD. A meta-analysis of MitraClip system versus surgery for treatment of severe mitral regurgitation. Ann Cardiothorac Surg 2014; 2:683-92. [PMID: 24349969 DOI: 10.3978/j.issn.2225-319x.2013.11.02] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/23/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Mitral regurgitation (MR) is the second most common valvular heart disease after aortic stenosis. Without intervention, prognosis is poor in patients with severe symptomatic MR. While surgical repair is recommended for many patients with severe degenerative MR (DMR), as many as 49% of patients do not qualify as they are at high surgical risk. Furthermore, surgical correction for functional MR (FMR) is controversial with suboptimal outcomes and significant perioperative mortality. The percutaneous MitraClip implantation can be seen as a viable option in high surgical risk patients. The purpose of this meta-analysis is to compare the safety, clinical efficacy, and survival outcomes of MitraClip implantation with surgical correction of severe MR. METHODS Six electronic databases were searched for original published studies from January 2000 to August 2013. Two reviewers independently appraised studies, using a standard form, and extracted data on methodology, quality criteria, and outcome measures. All data were extracted and tabulated from the relevant articles' texts, tables, and figures and checked by another reviewer. RESULTS Overall 435 publications were identified. After applying selection criteria and removing serial publications with accumulating number of patients or increased length of follow-up, four publications with the most complete dataset were included for quality appraisal and data extraction. There was one randomized controlled trial (RCT) and three prospective observational studies. At baseline, patients in the MitraClip group were significantly older (P=0.01), had significantly lower LVEF (P=0.03) and significantly higher EuroSCORE (P<0.0001). The number of patients with post-procedure residual MR severity >2 was significantly higher in the MitraClip group compared to the surgical group (17.2% vs. 0.4%; P<0.0001). 30-day mortality was not statistically significant (1.7% vs. 3.5%; P=0.54), nor were neurological events (0.85% vs. 1.74%; P=0.43), reoperations for failed MV procedures (2% vs. 1%; P=0.56), NYHA Class III/IV (5.7% vs. 11.3; P=0.42) and mortality at 12 months (7.4% vs. 7.3%; P=0.66). CONCLUSIONS Despite a higher risk profile in the MitraClip patients compared to surgical intervention, the clinical outcomes were similar although surgery was more effective in reducing MR in the early post procedure period. We conclude the non-inferiority of the MitraClip as a treatment option for severe, symptomatic MR in comparison to conventional valvular surgery.
Collapse
Affiliation(s)
- Benjamin Wan
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Mohammad Rahnavardi
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - David H Tian
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Kevin Phan
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; ; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Stine Munkholm-Larsen
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; ; Department of Cardiology, Hvidovre University Hospital, Copenhagen, Denmark
| | - Paul G Bannon
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; ; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Tristan D Yan
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; ; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| |
Collapse
|