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mitral valve gradients

Naser Aslanabadi, Samad Ghaffari, Naser Khezerlouy Aghdam, Masoumeh Ahmadzade, Babak Kazemi, Babak Nasiri, Ahmad Separham, Bahram Sohrabi, Mohamadreza Taban, Arash Aslanabadi
Introduction: Atrial fibrillation (AF) is the most common arrhythmia in patients with mitral stenosis (MS) and it may increase complications and decreases success rates of percutaneous balloon mitral valvotomy (PBMV). This study aimed to investigate the short and long term results of PBMV in patients with AF compared to sinus rhythm (SR). Methods: In this cross sectional study, 1000 patients with MS who had undergone PBMV between 1999 and 2013 were enrolled including 585 and 415 patients with AF and SR respectively...
2016: Journal of Cardiovascular and Thoracic Research
E Mazzotta, C Guglielmini, G Menciotti, B Contiero, M BaronToaldo, M Berlanda, H Poser
BACKGROUND: Red blood cell distribution width (RDW) is a quantitative measurement of anisocytosis. RDW has prognostic value in humans with different cardiovascular and systemic disorders, but few studies have investigated this biomarker in dogs. OBJECTIVES: To compare the RDW in dogs with precapillary and postcapillary pulmonary hypertension (PH) and a control population of dogs and to correlate RDW with demographic, echocardiographic, and laboratory variables. ANIMALS: One hundred and twenty-seven client-owned dogs including 19 healthy dogs, 82 dogs with myxomatous mitral valve disease (50 dogs without PH and 32 dogs with postcapillary PH), and 26 dogs with precapillary PH...
October 17, 2016: Journal of Veterinary Internal Medicine
Shiro Miura, Takeshi Arita, Takenori Domei, Kyohei Yamaji, Yoshimitsu Soga, Makoto Hyodo, Shinichi Shirai, Kenji Ando
Optimal time to perform percutaneous mitral valvuloplasty (PMV) for patients with significant mitral stenosis (MS) and atrial fibrillation (AF) remains controversial. We sought to identify prognostic factors and evaluate long-term clinical outcomes after PMV of 77 consecutive patients with MS with a mitral valve area (MVA) <1.5 cm(2). According to baseline heart rhythm, these patients were divided into sinus rhythm (SR; n = 24) and AF (n = 53) groups. The study endpoint was defined as a composite of all-cause mortality, admission for heart failure, mitral valve surgery, repeated PMV, and major cerebral vascular accident during follow-up...
October 5, 2016: Cardiovascular Intervention and Therapeutics
Sitaram M Emani, Breanna L Piekarski, David Zurakowski, Christopher A Baird, Audrey C Marshall, James E Lock, Pedro J Del Nido
BACKGROUND: Options for cardiac valve replacement in children are limited to fixed-diameter prostheses that do not accommodate for somatic growth. An externally stented bovine jugular vein graft has been modified for surgical valve replacement in pediatric patients, with the intention of subsequent valve expansion in the catheterization laboratory as the child grows. METHODS: Pediatric patients at a single institution who underwent surgical implantation of an expandable bovine jugular vein valve between 2010 and 2014 were reviewed retrospectively...
August 31, 2016: Journal of Thoracic and Cardiovascular Surgery
Danny Dvir, John Webb
There is a growing practice of transcatheter treatment of failed mitral valves after cardiac surgery, including valve-in-valve and valve-in-ring. Although commonly successful, these procedures can be associated with device malposition (including delayed malposition) and elevated post-procedural gradients (especially when performed inside small surgical valves). Valve-in-ring procedures have elevated risks of left ventricular outflow tract obstruction and post-procedural regurgitation. Careful patient selection and meticulous evaluation of patient anatomy and surgical implant characteristics are essential to achieve optimal clinical results with mitral valve-in-valve and valve-in-ring implantation...
September 18, 2016: EuroIntervention
John B Chambers
This is a practical description of how replacement valves are assessed using echocardiography. Normal transthoracic appearances including normal variants are described. The problem of differentiating normal function, patient-prosthesis mismatch and pathological obstruction in aortic replacement valves with high gradients is discussed. Obstruction and abnormal regurgitation is described for valves in the aortic, mitral and right-sided positions and when to use echocardiography in suspected infective endocarditis...
September 2016: Echo Research and Practice
Fatima I Lunze, Babar S Hasan, Kimberlee Gauvreau, David W Brown, Steven D Colan, Doff B McElhinney
BACKGROUND: Relief of postoperative right ventricular outflow tract (RVOT) obstruction with transcatheter pulmonary valve replacement (TPVR) results in functional improvement in the short term which we investigated at baseline (BL), early follow-up (FU), and midterm FU after TPVR. METHODS: Echocardiography and cardiopulmonary exercise testing were performed at BL and at early (median 6 months) and midterm FU (median 2.5years) after TPVR. RESULTS: Patients with RVOT obstruction (n=22, median age 17years) were studied...
September 2016: American Heart Journal
Jong Hun Kim, Tae Youn Kim, Jong Bum Choi, Ja Hong Kuh
Patients requiring redo cardiac surgery for diseased heart valves other than mitral valves may show increased pressure gradients and reduced valve areas of previously placed mechanical mitral valves due to subvalvular pannus formation. We treated four women who had mechanical mitral valves inserted greater than or equal to 20 years earlier and who presented with circular pannus that protruded into the lower margin of the valve ring but did not impede leaflet motion. Pannus removal improved the haemodynamic function of the mitral valve...
September 1, 2016: Interactive Cardiovascular and Thoracic Surgery
Riccardo Vismara, Guido Gelpi, Santosh Prabhu, Paolo Romitelli, Lauren G Troxler, Andrea Mangini, Claudia Romagnoni, Monica Contino, Dylan T Van Hoven, Federico Lucherini, Michal Jaworek, Alberto Redaelli, Gianfranco B Fiore, Carlo Antona
BACKGROUND: Although associated with left heart pathologies, functional tricuspid regurgitation (FTR) is often left untreated during left heart surgery. Hence, owing to its degenerative character, reoperation is often needed, encompassing an impressive (25% to 35%) mortality rate. Thus transcatheter approaches to FTR are raising great interest. OBJECTIVES: The authors evaluated the post-treatment effectiveness of the edge-to-edge technique using the percutaneous mitral valve repair device in an ex vivo pulsatile model of FTR...
September 6, 2016: Journal of the American College of Cardiology
Devin W Kehl, Florian Rader, Charles Pollick, Alfredo Trento, Robert J Siegel
Systolic anterior motion of the mitral valve (SAM) occurs intraoperatively after mitral valve repair (MVRr) in up to 14% of cases and typically resolves in the operating room with conservative measures. Less commonly SAM may also occur in the early or late postoperative period. The clinical course and optimal management of such cases is poorly defined, but reoperation is common. We describe our experience using disopyramide to successfully treat postoperative SAM refractory to beta blockade. Seven patients were retrospectively identified with mitral valve prolapse who underwent MVRr from 2003 to 2015 and were found during follow-up to have severe SAM with a left ventricular outflow tract (LVOT) gradient not observed intraoperatively...
October 1, 2016: American Journal of Cardiology
Ibtesam Ibrahim El-Dosouky
BACKGROUND: Mitral valve resistance (MVR) is a hemodynamic consequence of mitral stenosis (MS), but it has no clear threshold with a shortage of data to be reliable. We aimed to investigate match and mismatch between opening area and resistance especially in patients with moderate and mild MS. METHODS: This study comprised 88 patients with moderate and mild rheumatic MS. Transthoracic echocardiographic study estimated the following: mitral valve area (MVA) by both planimetry (2D) and pressure half-time (PHT), mitral valve score (MVS), mean transmitral pressure gradient (MPG), diastolic filling time (DFT), left ventricular out flow tract diameter (LVOTd) and velocity-time integral (LVOTvti), and MVR = MPG/aortic flow ratio [(LVOTd) (LVOTvti)/DFT] in dynes·s/cm(5) ...
August 26, 2016: Echocardiography
Yin-Jian Yang, Chao-Mei Fan, Jin-Qing Yuan, Shui-Yun Wang, Yun-Hu Song, Shu-Bin Qiao, Shi-Jie You, Zhi-Min Wang, Fu-Jian Duan, Yi-Shi Li
OBJECTIVES: Investigate the effectiveness of alcohol septal ablation (ASA) and transaortic extended myectomy (TEM) in hypertrophic cardiomyopathy (HCM) with midventricular obstruction (MVO). BACKGROUND: MVO is less common than subaortic obstruction. Data on the effectiveness of ASA and TEM in MVO are lacking. METHODS: The clinical profiles of 22 patients undergoing ASA and 37 patients undergoing TEM were compared. No patient had apical aneurysm, abnormal chordae, mitral valve replacement or repair...
August 22, 2016: Journal of Interventional Cardiology
Cesare Quarto, Simon Davies, Alison Duncan, Alistair Lindsay, Georg Lutter, Lucian Lozonschi, Neil Moat
OBJECTIVE: A small number of transcatheter mitral valve implants (TMVIs) have been reported using devices designed to treat secondary mitral regurgitation (MR). However, MR has many etiologies, and patients have a broad spectrum of annular size, geometry, and lesions. There are a number of technical challenges for TMVI including left ventricular outflow tract obstruction and paravalvular MR. Thirty days' outcome of first-in-man implants with a novel TMVI device is reported. METHODS: The Tendyne TMVI system consists of a porcine pericardial valve in a tethered nitinol frame...
May 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Lindsay R Freud, Gerald R Marx, Audrey C Marshall, Wayne Tworetzky, Sitaram M Emani
OBJECTIVES: Mitral valve replacement (MVR) in young children is limited by the lack of small prostheses. Our institution began performing MVR with modified, surgically placed, stented jugular vein grafts (Melody valve) in 2010. We sought to describe key echocardiographic features for pre- and postoperative assessment of this novel form of MVR. METHODS: The pre- and postoperative echocardiograms of 24 patients who underwent Melody MVR were reviewed. In addition to standard measurements, preoperative potential measurements of the mitral annulus were performed whereby dimensions were estimated for Melody sizing...
July 25, 2016: Journal of Thoracic and Cardiovascular Surgery
Niloufar Samiei, Mandana Amirsardari, Yousef Rezaei, Mozhgan Parsaee, Fahimeh Kashfi, Sedigheh Hantoosh Zadeh, Somayeh Beikmohamadi, Masoumeh Fouladi, Saeid Hosseini, Mohammad Mehdi Peighambari, Ahmad Mohebbi
Physiologic changes during pregnancy can deteriorate or improve patients' hemodynamic status in the setting of valvular heart disease. There are sparse data regarding the effect of pregnancy on valve hemodynamics in normal pregnant women with known valvular heart disease. In a prospective study from July 2014 to January 2016, a total of 52 normal pregnant women who had mitral stenosis, aortic stenosis, or a history of mitral valve or aortic valve replacements were assessed. All patients underwent echocardiographic examinations and hemodynamic parameters were measured for both the mitral valve and aortic valve at first, second, and third trimesters...
October 1, 2016: American Journal of Cardiology
Augusto D'Onofrio, Erjon Tarja, Laura Besola, Giampaolo Luzi, Marco Agrifoglio, Marco Aiello, Davide Gabbieri, Giuseppe Tarantini, Giulio Rizzoli, Francesco Musumeci, Gino Gerosa
BACKGROUND: Transcatheter valve-in-valve (VIV) implantation is an alternative option in inoperable or high-risk patients with prosthetic valve dysfunction. Aim of this retrospective multicenter study was to evaluate early and midterm clinical and hemodynamic outcomes of patients undergoing aortic (VIV-A) and mitral VIV (VIV-M). METHODS: We analyzed data of 66 procedures performed in 65 patients who underwent VIV procedures in the VIV-A and VIV-M position at 5 Italian institutions from January 2008 to May 2015...
August 2, 2016: Annals of Thoracic Surgery
Paul S Pagel, Brent T Boettcher, Derek J De Vry, Julie K Freed, Zafar Iqbal
OBJECTIVE: Transmitral blood flow produces a vortex ring (quantified using vortex formation time [VFT]) that enhances the efficiency of left ventricular (LV) filling. VFT is attenuated in LV hypertrophy resulting from aortic valve stenosis (AS) versus normal LV geometry. Many patients with AS also have aortic insufficiency (AI). The authors tested the hypothesis that moderate AI falsely elevates VFT by partially inhibiting mitral leaflet opening in patients with AS. DESIGN: Observational study...
October 2016: Journal of Cardiothoracic and Vascular Anesthesia
Saskia Pokorny, Katharina Huenges, Jan Hinerk Hansen, Yannik Schadow, Gunther Fischer, Michael M Morlock, Jochen Cremer, Georg Lutter
OBJECTIVES: A large cohort of patients suffering from severe mitral regurgitation does not meet the indications for conventional surgery and would greatly benefit from a transcatheter approach in the beating heart. Consequently, off-pump transcatheter mitral valve procedures have been the focus of recent research. The aim of this study was the in vivo evaluation and comparison of subannular versus apical fixation of mitral valved stents to show the feasibility of subannular anchorage...
July 29, 2016: European Journal of Cardio-thoracic Surgery
Y Tayyareci, R Dworakowski, P Kogoj, J Reiken, C Kenny, P MacCarthy, O Wendler, M J Monaghan
OBJECTIVE: To assess the impact of mitral geometry, left ventricular (LV) remodelling and global LV afterload on mitral regurgitation (MR) after trans-catheter aortic valve implantation (TAVI). METHODS: In this study, 60 patients who underwent TAVI were evaluated by 3D echocardiography at baseline, 1 month and 6 months after procedure. The proportional change in MR following TAVI was determined by examining the percentage change in vena contracta (VC) at 6 months...
September 2016: Echo Research and Practice
Maura Brioschi, Roberta Baetta, Stefania Ghilardi, Erica Gianazza, Anna Guarino, Alessandro Parolari, Gianluca Polvani, Elena Tremoli, Cristina Banfi
The mitral valve is a highly complex structure which regulates blood flow from the left atrium to the left ventricle (LV) avoiding a significant forward gradient during diastole or regurgitation during systole. The integrity of the mitral valve is also essential for the maintenance of normal LV size, geometry, and function. Significant advances in the comprehension of the biological, functional, and mechanical behavior of the mitral valve have recently been made. However, current knowledge of protein components in the normal human mitral valve is still limited and complicated by the low cellularity of this tissue and the presence of high abundant proteins from the extracellular matrix...
October 2016: Electrophoresis
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