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mitral regurgitation guidelines

Philipp E Bartko, Noemi Pavo, Ana Pérez-Serradilla, Henrike Arfsten, Stephanie Neuhold, Raphael Wurm, Irene M Lang, Guido Strunk, Jacob P Dal-Bianco, Robert A Levine, Martin Hülsmann, Georg Goliasch
Aims: Secondary mitral regurgitation (MR) drives adverse remodelling towards late heart failure stages. Little is known about the evolution of MR under guideline-directed therapy (GDT) and its relation to cardiac remodelling and outcome. We therefore aimed to assess incidence, impact, and predictors of progressive secondary MR in patients under GDT. Methods and results: We prospectively enrolled 249 patients with chronic heart failure and reduced ejection fraction receiving GDT in this long-term observational study...
March 9, 2018: European Heart Journal Cardiovascular Imaging
R Jansen, A M Wind, M J Cramer, F Nijhoff, P Agostoni, F Z Ramjankhan, W J Suyker, P R Stella, S A J Chamuleau
The purpose of this study was to evaluate mitral regurgitation (MR) severity in patients undergoing transcatheter aortic valve replacement (TAVR) by standardized assessment of two-dimensional (2D) transthoracic echocardiography (TTE) and 1-year echocardiographic and clinical outcomes. Pre- and post-procedural TTE's of patients undergoing TAVR between 2008 and 2014 were analyzed. MR was graded according to current guidelines with a systematic and integrated approach. Longitudinal echocardiographic and clinical results were analyzed...
March 10, 2018: International Journal of Cardiovascular Imaging
Tirone E David, Carolyn M David, Cedric Manlhiot
BACKGROUND: Heart valve surgery guidelines suggest that tricuspid valve annuloplasty may be beneficial in patients with a tricuspid annulus (TA) ≥40 mm even in the absence of functional tricuspid regurgitation (TR) at the time of surgery for left-sided valve lesions (class 2a). Given the broad spectrum of degenerative diseases that affect the atrioventricular valves, we hypothesize that this measurement might not be predictive of TR after mitral valve (MV) repair. METHODS: The diameter of the TA was measured preoperatively in a cohort of 312 consecutive patients who had isolated MV repair for degenerative diseases...
February 1, 2018: Journal of Thoracic and Cardiovascular Surgery
Baotong Li, Shanglin Chen, Hansong Sun, Jianping Xu, Yunhu Song, Wei Wang, Shuiyun Wang
Although practice guidelines recommend surgery for patients with severe chronic ischemic mitral regurgitation (CIMR), they do not specify whether to repair or replace the mitral valve. 436 consecutive patients with severe CIMR were eligible for inclusion in the study, of which 316 (72.5%) underwent mitral valve annuloplasty (MVA) whereas 120 (27.5%) received mitral valve replacement (MVR). At 59 months (interquartile range, 37-85 months) follow-up, though the left ventricle end-diastolic diameter was markedly larger (P = 0...
January 24, 2018: Scientific Reports
Sabato Sorrentino, Gennaro Giustino, Kamilia Moalem, Ciro Indolfi, Roxana Mehran, George D Dangas
Transcatheter heart valve replacement technology was introduced as alternative to surgery for the growing high-risk profile population. Developed first, aortic valve replacement (TAVR) became a standard of care for patients with severe aortic stenosis at high operative risk, with a potential future use also for low-risk subjects. In the last decade, a multitude of transcatheter mitral valve replacement (TMVR) devices have been developed for the treatment of severe mitral regurgitation, with encouraging results coming from first-in-man and feasibility studies...
February 2018: Seminars in Thrombosis and Hemostasis
Bernard Iung, Victoria Delgado, Patrice Lazure, Suzanne Murray, Per Anton Sirnes, Raphael Rosenhek, Susanna Price, Marco Metra, Céline Carrera, Michele De Bonis, Michael Haude, Gerhard Hindricks, Jeroen Bax, Alec Vahanian
Aims: To assess the knowledge and application of European Society of Cardiology (ESC) Guidelines in the management of mitral regurgitation (MR). Methods and results: A mixed-methods educational needs assessment was performed. Following a qualitative phase (interviews), an online survey was undertaken using three case scenarios (asymptomatic severe primary MR, symptomatic severe primary MR in the elderly, and severe secondary MR) in 115 primary care physicians (PCPs), and 439 cardiologists or cardiac surgeons from seven European countries...
January 2, 2018: European Heart Journal
Ajay Kumar Jha, Vishwas Malik
Anatomical, functional, and pathophysiologic mechanisms of ischemic mitral regurgitation (IMR) are markedly different from the primary mitral regurgitation. The older and ubiquitous cutoff of EROA (effective regurgitant orifice area) and Rvol (regurgitant volume) for IMR has been reinstated in the new guideline after a brief hiatus. There had always been a lack of good-quality evidence for its introduction for guiding IMR severity in the previous guideline, and we still do not have quality evidences that could justify its reintroduction...
December 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
Abhishek Sharma, Sunny Goel, Sahil Agarwal
Mitral regurgitation (MR) is the most frequent Valvular Heart Disease (VHD) and is an important cause of heart failure. MR can be caused by primary valve abnormality (Degenerative MR/Primary MR) or it can be secondary to cardiomyopathy (Functional MR/Secondary MR). Medical management alleviates symptoms but does not alter the progression of the disease. Current guidelines recommend surgery for moderate-to-severe (Grade > 3) MR in patients with symptoms or evidence of left ventricular dysfunction. Despite current practice guidelines, the majority of patients with severe MR do not undergo surgery...
December 27, 2017: Advances in Experimental Medicine and Biology
Anton Tomšic, Bardia Arabkhani, Jan W Schoones, Thomas J van Brakel, Johanna J M Takkenberg, Meindert Palmen, Robert J M Klautz
OBJECTIVES: Standardized outcome reporting is of critical importance for performance monitoring, improvement of existing techniques and introduction of novel technologies. Whether outcome reporting for surgical treatment of degenerative mitral valve disease complies with the guidelines has not been assessed to date. METHODS: A systematic review of PubMed, EMBASE, Web of Science and the Cochrane Library was conducted for articles published between 1 January 2009 and 7 March 2016...
December 8, 2017: Interactive Cardiovascular and Thoracic Surgery
Bobby Yanagawa, Amine Mazine, Derrick Y Tam, Subodh Verma
PURPOSE OF REVIEW: There is a growing emphasis on the conduct of large-scale, multicenter randomized controlled trials (RCTs) to guide decision-making in cardiac surgery. Here we review recent landmark RCTs in cardiac valvular surgery. RECENT FINDINGS: RCTs are the gold-standard level of data in medicine. However, there are unique challenges of conducting large-scale surgical trials including funding, blinding, generalizability, nonstandardization of the surgical technique, crossover, among others...
March 2018: Current Opinion in Cardiology
Christos G Mihos, Romain Capoulade, Evin Yucel, Steve Xydas, Francesco Nappi, Roy F Williams, Orlando Santana
Secondary mitral regurgitation (MR) is a common finding in patients with dilated cardiomyopathy, and it is associated with poor outcomes. It is the result of incomplete systolic closure of the mitral valve (MV) as a consequence of left ventricular dilatation, papillary muscle displacement with impaired systolic shortening, and mitral leaflet tethering. MV surgery may be performed in cases of significant secondary MR despite guideline-directed medical therapy. However, MV repair, which is most commonly performed with an undersized ring annuloplasty, is associated with a 30-60% recurrence of moderate or greater MR at mid-term follow-up...
January 2018: Cardiology in Review
Boyang Liu, Nicola C Edwards, Desley A H Neal, Christopher Weston, Gerard Nash, Nicolas Nikolaidis, Thomas Barker, Ramesh Patel, Moninder Bhabra, Richard P Steeds
BACKGROUND: The optimal management of chronic severe primary degenerative mitral regurgitation (MR) is to repair the valve but identification of the optimal timing of surgery remains challenging. Current guidelines suggest 'watchful waiting' until the onset of symptoms or left ventricular (LV) dysfunction but these have been challenged as promoting 'rescue surgery'. Better predictors are required to inform decision-making in relation to the necessity and timing of surgery. Chronic volume overload is a stimulus for adverse adaptive LV remodelling...
November 22, 2017: BMC Cardiovascular Disorders
Jennifer J Huang, Sridhar Reddy, Tam H Truong, Prakash Suryanarayana, Joseph S Alpert
BACKGROUND: The risk of stroke and thromboembolism in atrial fibrillation is established. There are clear guidelines in anticoagulation management of patient's with atrial fibrillation, however, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography (TEE); thereby possibly leading to a lower stroke risk...
November 8, 2017: American Journal of Medicine
Bhavna Balaney, Diego Medvedofsky, Anuj Mediratta, Amita Singh, Boguslawa Ciszek, Eric Kruse, Atman P Shah, Karima Addetia, Roberto M Lang, Victor Mor-Avi
BACKGROUND: Recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines for echocardiographic evaluation of left ventricular (LV) diastolic function provide a practical, simplified diagnostic algorithm for estimating LV filling pressure. The aim of this study was to test the accuracy of this algorithm against invasively measured pressures and compare it with the accuracy of the previous 2009 guidelines in the same patient cohort...
January 2018: Journal of the American Society of Echocardiography
Claude Daubert, Fredrik Gadler, Philippe Mabo, Cecilia Linde
In hypertrophic cardiomyopathy (HCM) patients with symptoms caused by left ventricular outflow tract obstruction (LVOTO), treatment options include negative inotropic drugs, myectomy, septal alcohol ablation and AV sequential pacing with or without an implantable cardioverter defibrillator (ICD). Pacing is rarely used in spite of its relative simplicity and promising results. In this review the current evidence of AV sequential pacing from observational, randomised studies and long and very long-term follow-up studies is given and put in the context of present guidelines recommendations...
June 30, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Susanne Anna Schlossbauer, Jelena-Rima Ghadri, Frank Scherff, Christian Templin
Takotsubo syndrome (TTS) was first described in 1991 as a rare, spontaneous and completely reversible left ventricular regional systolic dysfunction. Today the incidence of TTS is estimated at 2% in patients with an initial diagnosis of acute coronary syndrome (ACS). Notably, the incidence can be as high as 5.9 to 7.5% in female patients. TTS occurs predominantly in postmenopausal women, but both sexes may be affected, at any age. Acute chest pain or dyspnoea is a characteristic symptom of TTS, but initial presentation can also include more severe disease manifestation such as acute heart failure with pulmonary oedema or haemodynamic instability, especially in an in-hospital setting...
October 17, 2017: Swiss Medical Weekly
M Cameli, E Incampo, S Mondillo
In chronic mitral regurgitation (MR) left atrium is one of the first cardiac structures that is involved in remodeling and ultrastructural changes for a progressive volume overload. Severe left atrial (LA) dilation on echocardiography and new onset of atrial fibrillation in asymptomatic patients with preserved Left Ventricular (LV) function, appeared as a Class IIb recommendation for consideration for surgical mitral valve repair in the actual guidelines. However, before atrial dilatation and dysfunction, several ultrastructural changes appear in the atrial muscle tissue that are difficult to identify with the standard echocardiography...
December 2017: IJC Heart & Vasculature
Francesco Grigioni, Marie-Annick Clavel, Jean-Louis Vanoverschelde, Christophe Tribouilloy, Rodolfo Pizarro, Marianne Huebner, Jean-Francois Avierinos, Andrea Barbieri, Rakesh Suri, Agnés Pasquet, Dan Rusinaru, Gaetano D Gargiulo, Pablo Oberti, Alexis Théron, Francesca Bursi, Hector Michelena, Siham Lazam, Catherine Szymanski, Vuyisile T Nkomo, Martin Schumacher, Letizia Bacchi-Reggiani, Maurice Enriquez-Sarano
Aims: In degenerative mitral regurgitation (DMR), lack of mortality scores predicting death favours misperception of individual patients' risk and inappropriate decision-making. Methods and results: The Mitral Regurgitation International Database (MIDA) registries include 3666 patients (age 66 ± 14 years; 70% males; follow-up 7.8 ± 5.0 years) with pure, isolated, DMR consecutively diagnosed by echocardiography at tertiary (European/North/South-American) centres...
August 13, 2017: European Heart Journal
Michael Mack, Paul Grayburn
No abstract text is available yet for this article.
September 2017: JACC. Heart Failure
Marvin Allen, John Allen, Take Naseri, Rebecca Gardner, Dennis Tolley, Lori Allen
BACKGROUND: Echocardiography has been proposed as a method to screen children for rheumatic heart disease. The World Heart Federation has established guidelines for echocardiographic screening. In this study, we describe a rapid echocardiogram screening protocol according to the World Heart Federation guidelines in Samoa, endemic for rheumatic heart disease. METHODS: We performed echocardiogram screening in schoolchildren in Samoa between 2013 and 2015. A brief screening echocardiogram was performed on all students...
October 2017: Cardiology in the Young
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