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Ischaemic mitral regurgitation

Yong Zhang, Dongxu Wang, Yu Liu, Dengshun Tao, Yan Jin, Hui Jiang, Zengwei Wang, Huishan Wang
BACKGROUND: Coronary artery bypass graft surgery (CABG) with mitral valve surgery is undisputed in severe ischaemic mitral regurgitation (IMR) treatment, but the controversy is whether mitral valve replacement (MVR) or mitral valvuloplasty (MVP) should be used. METHODS: Data was collected from 130 cases of severe IMR patients who underwent CABG and MVP or MVR from June 2010 to June 2015 to compare the short-term efficacy of CABG with MVP or MVR in the treatment of severe IMR patients...
May 9, 2017: Heart, Lung & Circulation
Bilal Jalil, Karim El-Kersh, Jarrod Frizzell, Shozab Ahmed
Ischaemic papillary muscle rupture causing acute severe mitral regurgitation (MR) has a dramatic presentation and a very high mortality. Emergent surgical repair improves outcomes, which necessitates robust preoperative stabilisation. Here we discuss a patient with cardiogenic shock with an acute severe MR that was deemed very high risk for emergent valve replacement due to haemodynamic instability and respiratory failure. A percutaneous left ventricular assist device Impella 2.5 (Abiomed, Danvers, MA) drastically improved clinical status, and the patient underwent a successful surgical mitral valve replacement soon after placement of the temporary assist device...
May 22, 2017: BMJ Case Reports
Shaban Mohammed, Ayman El-Menyar, Haifa Al-Janubi, Adel Shabana, Zaid Alanazi
The optimal antithrombotic therapies for transcatheter aortic valve implantation (TAVI) and MitraClip implantation have not been well established. We conducted a narrative review from currently available studies between January 2002 and May 2016 to highlight the advantages and disadvantages of antithrombotic therapy use in cardiac catheter-based therapeutic techniques. Recently, these techniques have dramatically altered the approach towards valvular heart diseases management. The introduction into clinical practice, of TAVI for severe aortic stenosis and MitraClip for mitral regurgitation, has revolutionized interventional cardiology...
April 6, 2017: Current Vascular Pharmacology
Vasileios Kamperidis, Suzanne E van Wijngaarden, Philippe J van Rosendael, William Kok Fai Kong, Madelien V Regeer, Frank van der Kley, Georgios Sianos, Nina Ajmone Marsan, Jeroen J Bax, Victoria Delgado
Aims: It remains unclear whether surgical or transcatheter mitral valve repair for secondary mitral regurgitation (MR) in patients with non-ischaemic cardiomyopathy reverse the underlying left ventricular (LV) pathophysiology. We hypothesized that mitral valve repair improves LV systolic function and forward flow and induces LV reverse remodelling in this group of patients. Methods and results: Seventy-six patients (65 ± 14 years old, 43% male) with non-ischaemic cardiomyopathy and moderate to severe chronic secondary MR treated successfully with transcatheter or surgical mitral valve repair were evaluated...
February 23, 2017: European Heart Journal Cardiovascular Imaging
Hitoshi Yaku, Suguru Ohira, Sachiko Yamazaki, Kiyoshi Doi, Hidetake Kawajiri, Kazuki Morimoto, Satoshi Numata
We report a novel method of surgical ventricular restoration for an infarcted lateral wall: the endocardial linear infarct exclusion technique. First, transmural ventriculotomy is performed at the centre of the scar longitudinally along the coronary artery. Second, the inner layer is sutured in a longitudinal direction with 4-0 polypropylene continuous sutures to approximate the border between the normal and infarcted myocardium. Finally, the outer layer is closed with a combination of interrupted buttress and continuous over-and-over sutures with outer felt reinforcement...
December 31, 2016: Interactive Cardiovascular and Thoracic Surgery
Amgad Mentias, Mohammad Q Raza, Amr F Barakat, Elizabeth Hill, Dalia Youssef, Amar Krishnaswamy, Milind Y Desai, Brian Griffin, Stephen Ellis, Venu Menon, E Murat Tuzcu, Samir R Kapadia
BACKGROUND: Ischaemic mitral regurgitation (IMR) is a detrimental complication of ST elevation myocardial infarction (STEMI). OBJECTIVE: We sought to determine patient characteristics and outcomes of patients with IMR with focus on anterior or inferior location of STEMI. METHODS: All patients presenting with STEMI complicated by IMR to our centre who underwent primary percutaneous coronary intervention within the first 12 hours of presentation from 1995 to 2014 were included...
2016: Open Heart
H Zhang, Y Liu, J Bin, S Qiu, F Chen
No abstract text is available yet for this article.
2016: Acta Cardiologica
Yushu Wang, Xiuli Shi, Meiqin Wen, Yucheng Chen, Qing Zhang
BACKGROUND: No agreement has been reached for the best surgical treatment for patients with chronic ischemic mitral regurgitation (IMR) undergoing coronary artery bypass grafting (CABG). Our objective was to meta-analyze the clinical outcomes of repair and replacement. METHODS: A computerized search was performed using Pubmed, Embase, Ovid medline and Cochrane Library. The search terms "ischemic or ischaemic" and "mitral valve" and "repair or replacement or annuloplasty" and "coronary artery bypass grafting" were entered as MeSH terms and keywords...
September 1, 2016: Journal of Cardiothoracic Surgery
Astrid Apor, Anikó Ilona Nagy, Attila Kovács, Aristomenis Manouras, Péter Andrássy, Béla Merkely
BACKGROUND: Real-time three-dimensional transesophageal echocardiography has increased our understanding of the distinct pathomechanisms underlying functional, ischaemic or degenerative mitral regurgitation. However, potential differences in dynamic morphology between the subtypes of degenerative mitral prolapse have scarcely been investigated. METHODS: In order to compare the dynamic behavior of the different phenotypes of degenerative mitral valve prolapse, real-time three-dimensional transesophageal echocardiography recordings of 77 subjects, 27 with Barlow disease (BD), 32 with Fibroelastic deficiency (FED) and 18 normal controls (NC) were analysed...
August 15, 2016: Cardiovascular Ultrasound
Olivier Villemain, Wojciech Kwiecinski, Alain Bel, Justine Robin, Patrick Bruneval, Bastien Arnal, Mickael Tanter, Mathieu Pernot, Emmanuel Messas
AIMS: Basal chordae surgical section has been shown to be effective in reducing ischaemic mitral regurgitation (IMR). Achieving this section by non-invasive mean can considerably decrease the morbidity of this intervention on already infarcted myocardium. We investigated in vitro and in vivo the feasibility and safety of pulsed cavitational focused ultrasound (histotripsy) for non-invasive chordal cutting guided by real-time 3D echocardiography. METHODS AND RESULTS: Experiments were performed on 12 sheep hearts, 5 in vitro on explanted sheep hearts and 7 in vivo on beating sheep hearts...
October 2016: European Heart Journal Cardiovascular Imaging
Tomas Ondrus, Jozef Bartunek, Marc Vanderheyden, Bernard Stockman, Martin Kotrc, Frank Van Praet, Guy Van Camp, Patrick Lecomte, Yujing Mo, Martin Penicka
OBJECTIVES: To compare the outcomes of MitraClip versus minimally invasive surgical mitral valve repair in high-risk patients with significant functional mitral regurgitation (FMR) and severe heart failure in a centre having pilot versus extensive experience with the MitraClip and the minimally invasive surgical approach, respectively. METHODS: The MitraClip group consisted of 24 high-surgical-risk patients [age 75 ± 9 years, 75% males, NYHA III/IV 88%, left ventricular (LV) ejection fraction 31 ± 9%, EuroSCORE II 18 ± 14%], while the surgical group consisted of 48 patients matched for age, NYHA class and LV ejection fraction...
November 2016: Interactive Cardiovascular and Thoracic Surgery
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
Rimantas Benetis, Paulius Orda, Jolanta Justina Vaškelytė, Vytenis Ivanauskas, Eglė Ereminienė, Povilas Jakuška, Loreta Jankauskienė
OBJECTIVE: To evaluate late outcomes after posterior mitral valve (MV) annulus double-suture annuloplasty for degenerative (non-ischaemic) MV insufficiency. DESIGN: Between 2005 and 2011, 138 patients underwent MV repair using posterior MV double-suture annuloplasty and an additional 105 patients underwent tricuspid valve repair. The study protocol included operative mortality, reoperation rate and reasons, as well as echocardiographic parameters at pre- and postoperative and follow-up periods (2-9 years)...
October 2016: Perfusion
Ibtihal Al Amri, Philippe Debonnaire, Frank van der Kley, Martin J Schalij, Jeroen J Bax, Nina Ajmone Marsan, Victoria Delgado
AIMS: Our aim was to evaluate the acute effects of transcatheter edge-to-edge mitral valve repair using the MitraClip device on mitral valve geometry in patients with functional mitral regurgitation (FMR). METHODS AND RESULTS: Forty-two patients (age 73 years [IQ range 66.1-78.0], 55% men, 62% ischaemic FMR) with moderate-to-severe and severe FMR treated with the MitraClip were included. Three-dimensional transoesophageal echocardiography was performed prior to and immediately after MitraClip implantation...
April 20, 2016: EuroIntervention
Antonio M Calafiore, Angela L Iaco', Hatim Kheirallah, Azmat A Sheikh, Hussain Al Sayed, Mohammed El Rasheed, Ahmed Allam, Mohammed O Awadi, Juan J Alfonso, Ahmed A Osman, Michele Di Mauro
OBJECTIVES: After the publication of the Surgical Treatment for Ischaemic Heart Failure (STICH) trial, surgical indications to left ventricular surgical remodelling (LVSR) have become more restrictive. The experience we report reflects the changes in the real world after the publication of STICH trial. METHODS: From May 2009 to July 2014, 113 patients underwent LVSR, targeted mainly to the left anterior descending territory (89.4%). Of these, 18 patients (15.9%) were operated on an emergency basis...
October 2016: European Journal of Cardio-thoracic Surgery
Mohammad Yousuf Salmasi, Metesh Acharya, Nada Humayun, Dinnish Baskaran, Stephanie Hubbard, Hunaid Vohra
Ischaemic mitral regurgitation (MR) is associated with poor survival. The favoured surgical option remains debatable. Our aim was to perform a meta-analysis to compare the outcomes of mitral valve repair (MVRp) with replacement (MVR). A literature search was conducted in PubMed, Medline and Ovid using the terms 'ischaemic mitral regurgitation', 'repair' and 'replacement'. The primary outcome measure was 30-day survival. The secondary outcome measures were MR recurrence and reoperation. Out of 310 articles, 18 fulfilled the inclusion criteria...
July 2016: European Journal of Cardio-thoracic Surgery
Tomislav Kopjar, Hrvoje Gasparovic, Carlos A Mestres, Davor Milicic, Bojan Biocina
Ischaemic mitral regurgitation (IMR) is a complication of coronary artery disease with normal chordal and leaflet morphology. Controversy surrounds the issue of appropriate surgical management of moderate IMR. With the present meta-analysis, we aimed to determine whether the addition of mitral valve (MV) repair to coronary artery bypass grafting (CABG) improved clinical outcome over CABG alone in patients with moderate IMR. Databases were searched for studies reporting on clinical outcomes after CABG and MV repair or CABG alone for moderate IMR...
August 2016: European Journal of Cardio-thoracic Surgery
Marco Spartera, Maurizio Galderisi, Donato Mele, Matteo Cameli, Antonello D'Andrea, Andrea Rossi, Sergio Mondillo, Giuseppina Novo, Roberta Esposito, Flavio D'Ascenzi, Roberta Montisci, Sabina Gallina, Alberto Margonato, Eustachio Agricola
Functional mitral regurgitation (FMR) is a common complication of left ventricle (LV) dysfunction and remodelling. Recently, it has been recognized as an independent prognostic factor in both ischaemic and non-ischaemic LV dysfunctions. In this review article, we discuss the mechanisms through which cardiac dyssynchrony is involved in FMR pathophysiologic cascade and how cardiac resynchronization therapy (CRT) can have therapeutic effects on FMR by reverting specific dyssynchrony pathways. We analyse recent clinical trials focusing on CRT impact on FMR in 'real-world' patients, the limits and future perspectives that could eventually generate new predictors of CRT response in terms of FMR reduction...
May 2016: European Heart Journal Cardiovascular Imaging
Serenella Castelvecchio, Alessandro Parolari, Andrea Garatti, Piervincenzo Gagliardotto, Eugenio Mossuto, Alberto Canziani, Lorenzo Menicanti
OBJECTIVES: To assess the early and mid-term outcomes and related predictors in a consecutive series of patients who underwent surgical ventricular restoration (SVR) combined with additional mitral valve (MV) repair. METHODS: From January 2001 to October 2014, 626 patients underwent SVR; of these, 175 (28%, median age 65) had an additional MV repair. Anterior, inferior or diffuse remodelling was present in 124 (71%), 41 (23%) and 10 (6%) patients, respectively. The median ejection fraction was 30%, whereas mitral regurgitation grade was 3...
April 2016: European Journal of Cardio-thoracic Surgery
Vasileios Kamperidis, Nina Ajmone Marsan, Victoria Delgado, Jeroen J Bax
AIMS: Left ventricular (LV) ejection fraction (LVEF) is currently considered for the decision making of patients with mitral regurgitation (MR). However, LVEF represents change in LV volume between end-diastole and end-systole but does not characterize the intrinsic function of the myocardium. In contrast, speckle-tracking global longitudinal strain (GLS) characterizes myocardial deformation. The present study evaluated whether LV GLS may detect further impairment in LV systolic function in dilated cardiomyopathy patients with and without severe secondary MR matched based on LVEF...
March 7, 2016: European Heart Journal
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