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mitral regurgitation guidelines

Sotirios Nedios, Emmanuel Koutalas, Philipp Sommer, Arash Arya, Sascha Rolf, Daniela Husser, Andreas Bollmann, Gerhard Hindricks, Ole-Alexander Breithardt
AIMS: The association between anatomical left atrial (LA) remodelling and ventricular diastolic dysfunction (DD) in atrial fibrillation (AF) patients is not well studied. We aimed to examine the effect of DD on anatomic LA remodelling and their relation with ablation outcomes. METHODS AND RESULTS: In 104 patients (58 ± 10 years, 69% male) referred for AF ablation, LA volume (LAV) was determined by computed tomography. A cutting plane, between the pulmonary vein (PV) ostia and the appendage and parallel to the posterior wall, divided LAV into anterior- (LA-A) and posterior-LA parts...
October 12, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Leandro Slipczuk, Asim M Rafique, Carlos D Davila, Roy Beigel, Gregg S Pressman, Robert J Siegel
Mitral regurgitation (MR) is a common valvular disorder that has important health and economic consequences. Standardized guidelines exist regarding when and in whom to perform mitral valve surgery, but little information is available regarding medical treatment of MR. Many patients with moderate or severe MR do not meet criteria for surgery or are deemed to be at high risk for surgical therapy. We reviewed the available published data on medical therapy in the treatment of patients with primary MR. b-blockers and renin-angiotensin-aldosterone system inhibitors had the strongest supporting evidence for providing beneficial effects...
2016: Reviews in Cardiovascular Medicine
Martina Chantal de Knegt, Tor Biering-Sørensen, Peter Søgaard, Jacob Sivertsen, Jan Skov Jensen, Rasmus Møgelvang
BACKGROUND: The current method for a non-invasive assessment of diastolic dysfunction is complex with the use of algorithms of many different echocardiographic parameters. Total average diastolic longitudinal displacement (LD), determined by colour tissue Doppler imaging (TDI) via the measurement of LD during early diastole and atrial contraction, can potentially be used as a simple and reliable alternative. METHODS: In 206 patients, using GE Healthcare Vivid E7 and 9 and Echopac BT11 software, we determined both diastolic LD, measured in the septal and lateral walls in the apical 4-chamber view by TDI, and the degree of diastolic dysfunction, based on current guidelines...
2016: Cardiovascular Ultrasound
Rosemarijn Jansen, Jolanda Kluin, Simon G Ray, Maarten Jan M Cramer, Willem J L Suyker, Steven A J Chamuleau
Organic mitral regurgitation (MR) is a common disorder, and due to the increase in population and its aging, the occurrence of MR is steadily increasing. Current guideline recommendations on the management of asymptomatic severe MR are conflicting and based solely on registries or non-randomized trials in expert heart valve clinics, resulting in a lack of evidence for the best treatment strategy. In this review we will evaluate the latest evidence on diagnostic approaches and treatment strategies for asymptomatic patients without a clear indication for surgical intervention...
August 19, 2016: Cardiology in Review
Kevin O Maher, James S Tweddell
OBJECTIVES: In this review, we will discuss aortic stenosis, aortic regurgitation, mitral regurgitation, and mitral stenosis. We will review the etiology, anatomy, pathophysiology, presentation, and treatment of aortic and mitral valve disease. Age and lesion specific treatments are outlined based on the severity of valve disease with an aim at long-term preservation of left ventricular function. DATA SOURCE: MEDLINE and PubMed. CONCLUSIONS: Mitral and aortic valve disease leads to unique hemodynamic burdens that can impact left ventricular function, quality of life, and longevity...
August 2016: Pediatric Critical Care Medicine
Aeshita Dwivedi, Alan Vainrib, Muhamed Saric
PURPOSE OF REVIEW: Functional mitral regurgitation (FMR) is a common complication of left ventricular dysfunction. It is now recognized as an important clinical entity and an independent predictor of poor prognosis in cardiomyopathy patients. In this review, we provide a comprehensive summary of the pathophysiology, latest imaging modalities, and diagnostic criteria for FMR. Additionally, we discuss the recent literature on the continuously evolving surgical and percutaneous treatment options...
September 2016: Current Opinion in Cardiology
Mustafa I Ahmed, Jason L Guichard, Namakkal S Rajasekaran, Shama Ahmad, Nithya Mariappan, Silvio Litovsky, Himanshu Gupta, Steven G Lloyd, Thomas S Denney, Pamela Cox Powell, Inmaculada Aban, James F Collawn, James E Davies, David C McGiffin, Louis J Dell'Italia
OBJECTIVE: Recent studies have demonstrated improved outcomes in patients receiving early surgery for degenerative mitral regurgitation (MR) rather than adhering to conventional guidelines for surgical intervention. However, studies providing a mechanistic basis for these findings are limited. METHODS: Left ventricular (LV) myocardium from 22 patients undergoing mitral valve repair for American Heart Association class I indications was evaluated for desmin, the voltage-dependent anion channel, α-B-crystallin, and α, β-unsaturated aldehyde 4-hydroxynonenal by fluorescence microscopy...
October 2016: Journal of Thoracic and Cardiovascular Surgery
Bruno R Nascimento, Andrea Z Beaton, Maria Carmo P Nunes, Adriana C Diamantino, Gabriel A L Carmo, Kaciane K B Oliveira, Cassio M Oliveira, Zilda Maria A Meira, Sandra Regina T Castilho, Eduardo L V Lopes, Iara M Castro, Vitória M L R Rezende, Graziela Chequer, Taylor Landay, Allison Tompsett, Antônio Luiz P Ribeiro, Craig Sable
BACKGROUND: Accurate estimates of Rheumatic Heart Disease (RHD) burden are needed to justify improved integration of RHD prevention and screening into the public health systems, but data from Latin America are still sparse. OBJECTIVE: To determine the prevalence of RHD among socioeconomically disadvantaged youth (5-18years) in Brazil and examine risk factors for the disease. METHODS: The PROVAR program utilizes non-expert screeners, telemedicine, and handheld and standard portable echocardiography to conduct echocardiographic screening in socioeconomically disadvantaged schools in Minas Gerais, Brazil...
September 15, 2016: International Journal of Cardiology
A Schlitt, E Lubos, M Guha, C Hegeler-Molkewehrum, M Sudau, H Schmidt
Many patients with moderate to severe mitral regurgitation cannot be subjected to surgical therapy due to their multimorbidity. For these patients, MitraClip® implantation is a therapeutic alternative.The aim of this article is to present recommendations for treatment after a MitraClip® procedure. For this purpose, a selective literature review has been carried out based on the current literature, notably on national and international guidelines.After a MitraClip® procedure, rehabilitation is indicated because of the underlying heart failure as well as the treatment of a heart valve...
June 27, 2016: Herz
Francesco Nappi, Mario Lusini, Cristiano Spadaccio, Antonio Nenna, Elvio Covino, Christophe Acar, Massimo Chello
BACKGROUND: Guidelines recommend surgery for patients with severe ischemic mitral regurgitation (MR). Nonrandomized studies suggest that subvalvular repair is associated with longer survival, but randomized studies are lacking. OBJECTIVES: This study sought to investigate the benefit of papillary muscle surgery on long-term clinical outcomes of patients with ischemic MR. METHODS: Ninety-six patients with severe ischemic MR were randomized to either undersizing restrictive mitral annuloplasty (RA) or papillary muscle approximation with undersizing restrictive mitral annuloplasty (PMA) associated with complete surgical myocardial revascularization...
May 24, 2016: Journal of the American College of Cardiology
Veena Nanjappa, Gopi Aniyathodiyil, R Keshava
BACKGROUND: Gender disparity, with respect to women receiving less medical therapy, undergoing fewer invasive procedures, and experiencing worse outcome than men, has been noted in various observational and randomized trials, though guidelines on acute coronary syndrome (ACS) are gender-neutral. Indian data with focus on women with ACS are lacking. AIM: This study was undertaken to give us an insight on the clinical presentation, risk factors, and in-hospital outcome of ACS in women and at 30 days...
March 2016: Indian Heart Journal
L Bassin, B Weiss, G Cranney, D Gimpel, P Gilhooly, R Smith, Z Akhunji, P Grant, H Wolfenden
INTRODUCTION: American Heart Association (AHA) guidelines recommend mitral valve repair for myxomatous mitral regurgitation whenever possible to prevent LV dysfunction and early mortality. Here we review our early operative outcomes with mitral valve repair for myxomatous mitral regurgitation. METHODS: We collected data from 586 consecutive patients that underwent mitral repair for myxomatous disease at the Prince Henry and Prince of Wales Hospitals Sydney between 1997 and 2012...
August 2016: Heart, Lung & Circulation
Andrea Beaton, Bruno R Nascimento, Adriana C Diamantino, Gabriel T R Pereira, Eduardo L V Lopes, Cassio O Miri, Kaciane K O Bruno, Graziela Chequer, Camila G Ferreira, Luciana C X Lafeta, Hedda Richards, Lindsay Perlman, Catherine L Webb, Antonio L P Ribeiro, Craig Sable, Maria do Carmo P Nunes
The ability to integrate echocardiographic for rheumatic heart disease (RHD) into RHD prevention programs is limited because of lack of financial and expert human resources in endemic areas. Task shifting to nonexperts is promising; but investigations into workforce composition and training schemes are needed. The objective of this study was to test nonexperts' ability to interpret RHD screening echocardiograms after a brief, standardized, computer-based training course. Six nonexperts completed a 3-week curriculum on image interpretation...
June 1, 2016: American Journal of Cardiology
Francesca Mantovani, Marie-Annick Clavel, Hector I Michelena, Rakesh M Suri, Hartzell V Schaff, Maurice Enriquez-Sarano
OBJECTIVES: The purpose of this study was to compare women and men with organic mitral regurgitation (MR) using pre- and post-operative comprehensive imaging and to analyze the effect on outcome. BACKGROUND: Management of organic MR has no sex-specific guideline recommendation, and sex differences on the basis of comprehensive imaging and links to outcome remain largely unknown. METHODS: Comprehensive imaging (MR cause, quantitation, ventricular and atrial measures, and post-operative reverse cardiac remodeling) was analyzed in 217 women and 447 men who underwent operations for organic MR from 1990 to 2000 with long-term follow-up analysis...
April 2016: JACC. Cardiovascular Imaging
Mounir Khafaga, Karl-Patrik Kresoja, Berndt Urlesberger, Igor Knez, Philipp Klaritsch, David Benjamin Lumenta, Robert Krause, Dirk von Lewinski
Background. Infective endocarditis is associated with considerable morbidity and mortality. Guidelines addressing prophylaxis and management of infective endocarditis do not extensively deal with concomitant pregnancy, and case reports on infective endocarditis are scarce. This is the first published report of infective endocarditis by Staphylococcus lugdunensis in a pregnant woman. Case Presentation. We report a single case of a 35-year-old woman in her 24th week of pregnancy who was admitted to our intensive care unit with fever and suspected infectious endocarditis...
2016: Case Reports in Obstetrics and Gynecology
Patrick M McCarthy
No abstract text is available yet for this article.
April 2016: Journal of Thoracic and Cardiovascular Surgery
Irving L Kron, Michael A Acker, David H Adams, Gorav Ailawadi, Steven F Bolling, Judy W Hung, D Scott Lim, Damien J LaPar, Michael J Mack, Patrick T O'Gara, Michael K Parides, John D Puskas
No abstract text is available yet for this article.
April 2016: Journal of Thoracic and Cardiovascular Surgery
Julia Wallenborn, Stefan Störk, Sebastian Herrmann, Olga Kukuy, Georg Fette, Frank Puppe, Armin Gorski, Kai Hu, Wolfram Voelker, Georg Ertl, Frank Weidemann
OBJECTIVES: We assessed the prevalence of moderately severe or severe mitral regurgitation (MR) justifying edge-to-edge mitral valve (MV) repair (MitraClip(®)) in patients attending the University Hospital Wuerzburg, a tertiary care centre located in Wuerzburg, Germany. BACKGROUND: Transcatheter edge-to-edge MV repair of advanced MR is a non-surgical treatment option in inoperable and high-risk patients. It is unknown how many patients are potentially eligible for MitraClip(®) since several anatomical prerequisites of the MV apparatus have to be met for optimal treatment results...
August 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Andrew Wang, Paul Grayburn, Jill A Foster, Marti L McCulloch, Vinay Badhwar, James S Gammie, Salvatore P Costa, Robert Michael Benitez, Michael J Rinaldi, Vinod H Thourani, Randolph P Martin
BACKGROUND: The revised 2014 American College of Cardiology (ACC)/American Heart Association valvular heart disease guidelines provide evidenced-based recommendations for the management of mitral regurgitation (MR). However, knowledge gaps related to our evolving understanding of critical MR concepts may impede their implementation. METHODS: The ACC conducted a multifaceted needs assessment to characterize gaps, practice patterns, and perceptions related to the diagnosis and treatment of MR...
February 2016: American Heart Journal
Jens Kienemund, Karl-Heinz Kuck, Christian Frerker
Secondary or functional mitral regurgitation (FMR) is a common problem in patients with chronic heart failure (HF). About one-third of patients with chronic HF also have left bundle branch block (LBBB). Approximately one-third of patients with an indication for cardiac resynchronisation therapy (CRT) have moderate-to-severe FMR. This FMR may either be a consequence of systolic dysfunction or it may occur due to dyssynchrony. Both directly reducing FMR and correcting cardiac dyssynchrony are viable therapeutic approaches in selected patients, according to the 2012 European Society of Cardiology (ESC) Guidelines for valvular heart disease...
November 2014: Arrhythmia & Electrophysiology Review
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