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Bileaflet mitral valve prolapse

Vincent Chan, Elsayed Elmistekawy, Marc Ruel, Mark Hynes, Thierry G Mesana
BACKGROUND: Repair of mitral regurgitation (MR) caused by prolapse has been well validated. Although favorable early and late results after repair have been reported, few data are available that mechanistically describe how a mitral repair fails beyond the mere need for mitral valve reoperation. We therefore sought to determine the modes of valve repair failure in patients who underwent surgical correction of MR caused by prolapse. METHODS: Between 2001 and 2015, 855 patients underwent repair of MR caused by prolapse...
October 6, 2016: Annals of Thoracic Surgery
Faisal F Syed, Michael J Ackerman, Christopher J McLeod, Suraj Kapa, Siva K Mulpuru, Chenni S Sriram, Bryan C Cannon, Samuel J Asirvatham, Peter A Noseworthy
BACKGROUND: Although the vast majority of mitral valve prolapse (MVP) is benign, a small subset of patients, predominantly women, with bileaflet prolapse, complex ventricular ectopy (VE), and abnormal T waves comprise the recently described bileaflet MVP syndrome. We compared findings on electrophysiological study in bileaflet MVP syndrome patients with and without cardiac arrest to identify factors that may predispose to malignant ventricular arrhythmia. METHODS AND RESULTS: Fourteen consecutive bileaflet MVP syndrome patients (n=13 women; median [limits], age at index ablation, 33...
May 2016: Circulation. Arrhythmia and Electrophysiology
Rakesh M Suri, Marie-Annick Clavel, Hartzell V Schaff, Hector I Michelena, Marianne Huebner, Rick A Nishimura, Maurice Enriquez-Sarano
BACKGROUND: The risk for and consequences of recurrent mitral regurgitation (MR) following degenerative mitral valve repair are poorly understood. OBJECTIVES: This study sought to examine recurrent MR risk along with reoperation and survival rates. METHODS: We evaluated patients undergoing primary mitral repair for isolated degenerative MR over 1 decade. Median follow-up was 11.5 years (interquartile range: 9.2 to 13.6 years) and was 99% complete...
February 9, 2016: Journal of the American College of Cardiology
Gonçalo F Coutinho, Pedro M Correia, Carlos Branco, Manuel J Antunes
OBJECTIVES: To evaluate the feasibility of mitral valve repair in patients with anterior leaflet (ALP) or bileaflet prolapse (BLP) and identify factors predisposing patients to replacement. To compare long-term survival of patients submitted to repair (Group Repair) against those submitted to replacement (Group Replacement), and investigate causes of early and late failures of repair. METHODS: From January 1992 through December 2012, 768 patients with ALP or BLP were submitted to mitral valve surgery, of whom 501 had degenerative involvement [Myxomatous (Myx)-336 (67...
July 2016: European Journal of Cardio-thoracic Surgery
Jaqueline G da Rocha E Silva, Ricardo Spampinato, Martin Misfeld, Joerg Seeburger, Bettina Pfanmüller, Sandra Eifert, Friedrich W Mohr, Michael A Borger
BACKGROUND: Barlow's mitral valve (MV) disease remains a surgical challenge. We compared short- and medium-term outcomes of neochordal ("loop") versus edge-to-edge ("Alfieri") minimally invasive MV repair in patients with Barlow's disease. METHODS: From January 2009 to April 2014, 123 consecutive patients with Barlow's disease (defined as bileaflet billowing or prolapse [or both], excessive leaflet tissue, and annular dilatation with or without calcification) underwent minimally invasive MV operations for severe mitral regurgitation (MR) at our institution...
December 2015: Annals of Thoracic Surgery
Andrea Colli, Roberto Bellu, Demetrio Pittarello, Gino Gerosa
A 74-year old lady was admitted for the presence of a symptomatic severe mitral regurgitation (MR) due to bileaflet prolapse. The patient refused any surgical conventional procedure because of severe arthrosis and osteoporosis documented by previous fractures requiring knee and hip replacements, and was sent directly to us for transapical off-pump mitral valve repair with Neochord implantation (TOP-MINI procedure). The TOP-MINI procedure was performed under general anaesthesia and transoesophageal echocardiographic guidance...
October 2015: Interactive Cardiovascular and Thoracic Surgery
Cristina Basso, Martina Perazzolo Marra, Stefania Rizzo, Manuel De Lazzari, Benedetta Giorgi, Alberto Cipriani, Anna Chiara Frigo, Ilaria Rigato, Federico Migliore, Kalliopi Pilichou, Emanuele Bertaglia, Luisa Cacciavillani, Barbara Bauce, Domenico Corrado, Gaetano Thiene, Sabino Iliceto
BACKGROUND: Mitral valve prolapse (MVP) may present with ventricular arrhythmias and sudden cardiac death (SCD) even in the absence of hemodynamic impairment. The structural basis of ventricular electric instability remains elusive. METHODS AND RESULTS: The cardiac pathology registry of 650 young adults (≤40 years of age) with SCD was reviewed, and cases with MVP as the only cause of SCD were re-examined. Forty-three patients with MVP (26 females; age range, 19-40 years; median, 32 years) were identified (7% of all SCD, 13% of women)...
August 18, 2015: Circulation
Ruggero De Paulis, Daniele Maselli, Andrea Salica, Stefania Leonetti, Lorenzo Guerrieri Wolf, Luca Weltert, Saverio Nardella, Alessandro Bellisario
OBJECTIVES: Surgical treatment of Barlow's disease is usually demanding. In a sub-population of Barlow patients with bileaflets prolapse and central regurgitant jet, we performed mitral repair using only a semi-rigid annuloplasty band. Stress echocardiography follow-up was evaluated. METHODS: Of a total of 350 consecutive patients with mitral prolapse, 69 had anatomical features of Barlow's disease. Of these, 40 with multiple large central jets without chordal rupture were repaired only using an annuloplasty band, and these constituted the study group...
September 2015: Interactive Cardiovascular and Thoracic Surgery
Yohsuke Yanase, Nobuyuki Takagi, Hiroyuki Yamada, Toshitaka Watanabe, Mayuko Uehara, Kazutoshi Tachibana, Yasuko Miyaki, Toshiro Ito, Tetsuya Higami
BACKGROUND: We invented novel mitral valve repair technique; rough-zone trimming procedure (RZT) for anterior mitral valve prolapse. Prolapse site was resected in obtuse triangle shape and sutured edges to creates deep coaptation and improves regurgitation. Though it is simple and reproducible technique, functional mitral stenosis is a risk. Valve function and hemodynamics were investigated using dobutamine stress echocardiography (DSE) in patients after mitral valve repair using RZT...
2015: Journal of Cardiothoracic Surgery
Andrew B Goldstone, Jeffrey E Cohen, Jessica L Howard, Bryan B Edwards, Alexandra L Acker, William Hiesinger, John W MacArthur, Pavan Atluri, Y Joseph Woo
BACKGROUND: We examined the feasibility and efficacy of a "repair-all" strategy applied in all patients with degenerative mitral regurgitation, regardless of valve complexity, risk profile, and surgical approach. METHODS: Between 2002 and 2011, 4,241 patients underwent mitral operations at our institution. Analysis was limited to 525 consecutive patients with mitral regurgitation due to leaflet prolapse (posterior, 75%; anterior, 5%; bileaflet, 20%) who underwent isolated mitral operations...
June 2015: Annals of Thoracic Surgery
Hiroki Hata, Tomoyuki Fujita, Yusuke Shimahara, Shunsuke Sato, Hatsue Ishibashi-Ueda, Junjiro Kobayashi
OBJECTIVES: This study examines the outcome of mitral valve repair with chordal replacement using expanded polytetrafluoroethylene over the past 25 years. METHODS: From July 1988 to February 2013, 224 consecutive patients (mean age 57 years, 34% women) underwent mitral valve repair with chordal replacement using expanded polytetrafluoroethylene sutures at our institution. Isolated anterior leaflet prolapse was observed in 134 patients (60%), isolated posterior leaflet prolapse was observed in 13 patients (6%) and bileaflet prolapse was observed in 77 patients (34%)...
April 2015: Interactive Cardiovascular and Thoracic Surgery
Carlo Rostagno, Ginevra Droandi, Alessandra Rossi, Sergio Bevilacqua, Stefano Romagnoli, Gian Franco Montesi, Pier Luigi Stefàno
OBJECTIVE: Barlow disease is a still challenging pathology for the surgeon. Aim of the present study is to report anatomic abnormalities of mitral valve in patients undergoing mitral valve repair. METHODS: Between January 1st, 2007, and December 31st, 2010, 85 consecutive patients (54 men and 31 women, mean age 59 +/- 14 years--range: 28-85 years) with the features of a Barlow mitral valve disease underwent mitral repair Forty seven percent of patients were in New York Heart Association functional class III or IV...
2014: Italian Journal of Anatomy and Embryology, Archivio Italiano di Anatomia Ed Embriologia
L Salvador, E Cavarretta, G Minniti, E Di Angelantonio, V Salandin, G Frati, E Polesel, C Valfrè
AIM: Autologous pericardium annuloplasty (APA) is an alternative to prosthetic ring implantation for mitral valve (MV) repair, avoiding the use of foreign material and preserving the mitral annulus' physiological motion. However, data on durability are questionable. Therefore, we analyzed long-term outcomes of treating degenerative mitral regurgitation (MR) with APA. METHODS: Four hundred ninety patients (mean age, 54.3±11.3 years, [15-77 years]; N.=360 men [74...
December 2014: Journal of Cardiovascular Surgery
Atsushi Shimizu, Hitoshi Kasegawa, Minoru Tabata, Toshihiro Fukui, Shuichiro Takanashi
BACKGROUND: Mitral valve repair has been shown to be effective for degenerative mitral regurgitation (MR). However, outcomes of mitral valve repair for commissural prolapse has not been well defined. Commissural prolapse has been often categorized into the groups of posterior leaflet prolapse or bileaflet prolapse, and outcomes and prognosis of isolated commissural prolapse has been rarely reported. We aimed to determine clinical and echocardiographic outcomes of mitral valve repair for isolated commissural lesion...
January 2015: Annals of Thoracic Surgery
Jiangang Wang, Jie Han, Yan Li, Chunlei Xu, Yuqing Jiao, Bo Yang, Xu Meng, Steven F Bolling
OBJECTIVES: This study aimed to evaluate risk factors that affect mitral valve (MV) repair outcomes. METHODS: From 2002 to 2012, 580 consecutive patients with mitral regurgitation (MR) underwent MV repair. Of the total number of patients, 48.9% were found to be in New York Heart Association (NYHA) Class III or IV. Anterior, posterior and bileaflet prolapse was present in 34.8, 47.6 and 17.6% of patients, respectively. Atrial fibrillation (AF) was found in 29.7% of patients...
December 2014: Interactive Cardiovascular and Thoracic Surgery
Tirone E David, Carolyn M David, Cedric Manlhiot
BACKGROUND: Sizing of annuloplasty rings and bands is variably based on intertrigonal or intercommissural distances or estimation of the anterior leaflet area. This study examines the results of mitral valve repair with Simplici-T annuloplasty band without predetermining its length in patients with mitral regurgitation (MR) as a result of degenerative disease. METHODS: Three hundred thirty-seven consecutive patients (median age, 58 years; 69% men) underwent mitral valve repair for MR as a result of degenerative disease (52% bileaflet prolapse and 36% anterior leaflet prolapse)...
November 2014: Annals of Thoracic Surgery
Ali Raza Rajani, Vagishwari Murugesan, Fahad Omar Baslaib, Muhammad Anwer Rafiq
A 27-year-old woman with a history of bileaflet mitral valve prolapse and moderate mitral regurgitation presented to our emergency with untractable polymorphic wide complex tachycardia and unstable haemodynamics. After cardiopulmonary resuscitation, return of spontaneous circulation was achieved 30 min later. Her post-resuscitation ECG showed a prolonged QT interval which progressively normalised over the same day. Her laboratory investigations revealed hypocalcaemia while other electrolytes were within normal limits...
2014: BMJ Case Reports
Claudio Muneretto, Gianluigi Bisleri, Lorenzo Bagozzi, Alberto Repossini, Nicola Berlinghieri, Ermanna Chiari
OBJECTIVES: Minimally invasive mitral valve (MV) surgery has recently gained popularity as the standard approach for MV repair, albeit there could be potential concerns about the feasibility of complex repair in the presence of extreme Barlow's disease via a minimally invasive route. METHODS: Fifty consecutive patients with advanced Barlow's disease and bileaflet prolapse underwent minimally invasive, video-assisted MV repair via a 5 cm right antero-lateral thoracotomy with peripheral cannulation and external aortic clamping...
January 2015: European Journal of Cardio-thoracic Surgery
Minoru Tabata, Hitoshi Kasegawa, Toshihiro Fukui, Atsushi Shimizu, Yasunori Sato, Shuichiro Takanashi
OBJECTIVE: Artificial chordal replacement has been shown to be effective and durable, with numerous techniques reported. However, the outcomes of each technique have remained poorly defined. We report the long-term outcomes of the tourniquet technique. METHODS: We reviewed the data from 700 patients who had undergone mitral valve repair with the tourniquet technique from 1992 to 2010. We analyzed the operative outcomes, long-term survival rate, freedom from reoperation, and freedom from recurrent moderate or severe mitral regurgitation (MR)...
November 2014: Journal of Thoracic and Cardiovascular Surgery
Toshihiko Shibata, Yasuyuki Kato, Manabu Motoki, Yosuke Takahashi, Akimasa Morisaki, Shinsuke Nishimura, Koji Hattori
OBJECTIVES: Artificial chordal reconstruction technique uses several expanded polytetrafluoroethylene loops to achieve mitral valve repair. METHODS: We studied retrospectively 180 patients who underwent mitral valve repair using the loop technique via median sternotomy: 86 for posterior leaflet prolapse, 48 for anterior leaflet prolapse and 26 for bileaflet prolapse. RESULTS: Of the 180 patients, 138 required 1 loop set; 40 patients required 2 and 2 patients with Barlow's disease required 3...
March 2015: European Journal of Cardio-thoracic Surgery
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