Anterior Mitral Valve Leaflet Research Articles

Application of Transcatheter Electrosurgery in Structural Heart Interventions: A Report of Three Different Techniques

Transcatheter electrosurgery is a novel technique to traverse or cut tissue, within blood-filled spaces, using alternating current directed by guidewires and catheters. We report the first series of transcatheter electrosurgery procedures in Asia including transcaval access for transcatheter aortic valve implantation, intentional aortic leaflet laceration to mitigate the risk of coronary occlusion in transcatheter aortic valve implantation and intentional laceration of anterior mitral valve leaflet to mitigate the risk of left ventricular outflow tract obstruction. These procedures are potentially valuable in Asian patients because of their smaller body build compared to Caucasians posing a higher risk of coronary or left ventricular outflow tract obstruction during transcatheter valve implantation. There is a need to adopt transcatheter electrosurgery in Asia to treat more surgically inoperable patients, including proper simulation training, bench training and clinical proctorship.

Improved Spatiotemporal Resolution in Echocardiography Using Mixed Geometry Imaging Sequences.

Cardiac ultrasound seeks to image the most dynamic environment in the body-the moving heart. Many modern ultrasound imaging techniques address the tradeoff between spatial and temporal resolution using either narrow focused beams or with broad beam, synthetic aperture (SA) sequences that have been shown to suffer from motion artifacts. Retrospective encoding for conventional ultrasound sequences (REFoCUS) unifies the processing of these various geometric sequences, but the motion sensitivity of this approach has yet to be investigated. We hypothesize that a "mixed sequence" enabled by the REFoCUS method incorporating several beam geometries may better resolve cardiac motion over a wide field of view (FOV) and at a high frame rate. First, the motion sensitivity of REFoCUS was evaluated in simulation for several focused and broad transmit profiles. Focused transmissions resolve both lateral and axial motion much more effectively than broad transmissions, with performance similar to conventional beamforming techniques. Second, a mixed sequence was designed that insonifies the full field-of-view with plane wave (PW) transmissions and key moving targets with focused transmissions. This mixed sequence was tested in simulation and in vivo and was used to image the heart as well as the liver, a low-motion control. By combining a sparse PW sequence ( n=60 ) with a small group of targeted focused transmissions ( n = 10), the anterior mitral valve leaflet (AML) at its peak observed velocity was better resolved. We believe that mixed sequences have strong potential to resolve cardiac motion at clinically relevant frame rates.

Differential Development of the Chordae Tendineae and Anterior Leaflet of the Bovine Mitral Valve.

There is increasing evidence that some adult mitral valve pathologies may have developmental origins involving errors in cell signaling and protein deposition during valvulogenesis. While early and late gestational stages are well-documented in zebrafish, chicks, and small mammalian models, longitudinal studies in large mammals with a similar gestational period to humans are lacking. Further, the mechanism of chordae tendineae formation and multiplication remains unclear. The current study presents a comprehensive examination of mitral anterior leaflet and chordae tendineae development in a bovine model (a large mammal with the same gestational period as humans). Remarkably distinct from small mammals, bovine development displayed early branched chordae, with increasing attachments only until birth, while the anterior leaflet grew both during gestation and postnatally. Chordae also exhibited accelerated collagen deposition, maturation, and crimp development during gestation. These findings suggest that the bovine anterior leaflet and chordae tendineae possess unique processes of development despite being a continuous collagenous structure and could provide greater insight into human valve development.

Echocardiographic assessment of morphofunctional and hemodynamic changes of rheumatic mitral valve dysfunction in the young. Morphological changes in rheumatic valve lesions

Background- Rheumatic fever and its sequel rheumatic heart disease remain a major health problem across the globe. This investigation aims to analyse the mitral valve morphofunctional changes, stratified by severity, and the magnitude of the mitral regurgitation and stenosis through a simplified echocardiographic scoring system in patients with rheumatic heart disease. Methods- As cross-sectional echocardiographic study was carried out in 98 consecutive patients with confirmed rheumatic heart disease. Patients undergoing outpatient clinical care over an 18-month period (mean follow-up period of 9,7±2,9 years) were selected for echocardiographic investigation. After a double-blind echocardiograms review, the inter-rater reliability was calculated (Kappa=0.875 (0.775- 0.974; CI 95%). The morphofunctional data of mitral apparatus were scored on a rating scale from one to fifteen, encompassing three categories (1-5: mild; 6-10: moderate; 10-15: severe) to quantify the degrees of severity. Pearson's Chi-squared test with Yates' continuity correction were performed for comparative analysis and the Wilcoxon test and the Cliff's Delta effect size was calculated to examine differences related to morphological features. Results- The majority of patients had rheumatic heart disease with clinical evidence and twenty patients (20,4%) had subclinical disease.The thickening of both mitral valve leaflets and the restrictive motion of the posterior leaflet were most frequently found in contrast with the low percentage of chordal and/or commissural fusion. The degree of the anterior mitral valve leaflet thickening was proportional to the magnitude of the mitral valve regurgitation (p=0.021). The higher degrees of mitral valve dysfunction were associated with more severe carditis (mitral valve regurgitation, p: 0.000; mitral valve stenosis, p: 0.031). No association was found between the severity of valvular lesions and patient age or length of the disease (p=0.320). The presence of beading was only observed in the acute phase (p=0,000); coaptation defect of the mitral valve was associated with significant left ventricle enlargement (p=0.000). The morphofunctional score of mitral apparatus, stratified by severity, was associated with the magnitude of mitral valve regurgitation (p=0,000) and of mitral valve stenosis (p=0,031) also quantified by severity. The highest scores were observed in patients with the most severe degrees of carditis (p=0,000); however, no association was found with either, the patients’ age (p=0.373) or the duration of the disease (p=0.361). Conclusions- In the analysis of severity of the mitral apparatus deformities and the resulting valve dysfunction, the morphofunctional score stratification was highly associated with the magnitude of mitral regurgitation and stenosis. In this young cohort, the higher scores were associated to severe carditis, but not to the patients’ age or the duration of the disease. Taking into account the low prevalence of severe valve dysfunctions, these results highlight the importance of early intervention and adequate prevention.

Outcomes of latent rheumatic heart disease: External validation of a simplified score in patients with and without secondary prophylaxis

BackgroundSecondary antibiotic prophylaxis reduces progression of latent rheumatic heart disease (RHD) but not all children benefit. Improved risk stratification could refine recommendations following positive screening. We aimed to evaluate the performance of a previously developed echocardiographic risk score to predict mid-term outcomes among children with latent RHD. MethodsWe included children who completed the GOAL, a randomized trial of secondary antibiotic prophylaxis among children with latent RHD in Uganda. Outcomes were determined by a 4-member adjudication panel. We applied the point-based score, consisting of 5 variables (mitral valve (MV) anterior leaflet thickening (3 points), MV excessive leaflet tip motion (3 points), MV regurgitation jet length ≥ 2 cm (6 points), aortic valve focal thickening (4 points) and any aortic regurgitation (5 points)), to panel results. Unfavorable outcome was defined as progression of diagnostic category (borderline to definite, mild definite to moderate/severe definite), worsening valve involvement or remaining with mild definite RHD. Results799 patients (625 borderline and 174 definite RHD) were included, with median follow-up of 24 months. At total 116 patients (14.5%) had unfavorable outcome per study criteria, 57.8% not under prophylaxis. The score was strongly associated with unfavorable outcome (HR = 1.26, 95% CI 1.16–1.37, p < 0.001). Unfavorable outcome rates in low (≤6 points), intermediate (7–9 points) and high-risk (≥10 points) children at follow-up were 11.8%, 30.4%, and 42.2%, (p < 0.001) respectively (C-statistic = 0.64 (95% CI 0.59–0.69)). ConclusionsThe simple risk score provided an accurate prediction of RHD status at 2-years, showing a good performance in a population with milder RHD phenotypes.

Successful Transcatheter Closure of Iatrogenic Mitral Regurgitation After Aortic Valve Surgery

We present 2 cases of significant mitral regurgitation secondary to pericardial patch avulsion from the anterior mitral valve leaflet after aortic valve replacement with aortic annulus enlargement. Both cases were successfully managed by transcatheter repair with off-label implantation of occluder devices.

Congenital Hypoplastic Mitral Valve Annulus: An Incidental Finding in a 30-Year-Old Male with Pericarditis

Introduction: Congenital malformation of mitral valve could encounter in isolation or with other congenital heart diseases. Objectives: Here, we report a case of congenital hypoplastic anterior mitral valve leaflet (AMVL). Methods: A 30-year-old male with a history of diabetes mellitus was referred with pleuritic chest pain since the previous day. He was admitted with impression of pericarditis. Trans thoracic echocardiography showed no pericardial effusion with incidental finding of lipomatous change of mitral valve annulus and hypoplastic AMVL with mild to moderate mitral regurgitation. Results: Cardiac magnetic resonance imaging showed thickening and fibrosis replacement of intervalvular fibrosa which extended to AMVL and resulted in restricted mitral valve annulus (12.4 mm) with subsequent restricted MV opening without significant mitral stenosis or regurgitation. These data were in favor of congenital hypoplastic MV annulus. Conclusions: Hypoplastic AMVL with restricted mitral valve annulus is a rare cause of mitral valve malformation and could be well tolerated since adulthood with good prognosis.

Aerococcus urinae infective endocarditis in a healthy young man: a case report

BackgroundAerococcus urinae infection is a rare clinical condition that causes urinary tract infections in older individuals. Infective endocarditis (IE) caused by A. urinae in healthy young men is extremely rare; however, the mortality rates of IE caused by A.urinae are high if appropriate surgical treatment is not performed.Case presentationA 39-year-old healthy man was admitted to our hospital with complaints of fever, cough, and dyspnea. Blood cultures revealed gram-positive cocci, and echocardiography revealed a 20 × 12-mm vegetation on the aortic valve and perforation of the anterior mitral valve leaflet. He was diagnosed with IE and underwent aortic valve replacement and mitral valve repair after removal of the infective focus. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry was used to identify A. urinae. The patient was discharged in good health after 6 weeks of ampicillin/sulbactam therapy.ConclusionPrompt diagnosis and surgical removal of infectious foci with optimal antibacterial therapy are critical to protect patients from rare and potentially fatal IE caused by A. urinae.

Transapical beating-heart septal myectomy for recurrent left ventricular outflow tract obstruction after septal reduction therapy in hypertrophic obstructive cardiomyopathy.

We present a case of a 58-year-old man for surgical myectomy due to recurrent left ventricular outflow tract (LVOT) obstruction, who had prior transaortic septal myectomy and embolization of the septal branch. On admission, transthoracic echocardiography showed a typical hypertrophic obstructive cardiomyopathy (HOCM) with asymmetric septal hypertrophy, significant LVOT obstruction, and severe mitral regurgitation (MR) due to the systolic anterior movement (SAM) of the anterior mitral valve leaflet. We performed a novel procedure of the transapical beating-heart septal myectomy (TA-BSM), following which the LVOT obstruction was resolved. And a decreased grade of SAM and a reduction in the severity of MR were observed.

Systolic anterior motion of the anterior mitral valve leaflet begins in subclinical hypertrophic cardiomyopathy.

Anterior mitral valve leaflet (AMVL) elongation is detectable in overt and subclinical hypertrophic cardiomyopathy (HCM). We sought to investigate the dynamic motion of the aorto-mitral apparatus to understand the behaviour of the AMVL and the mechanisms of left ventricular outflow tract obstruction (LVOTO) predisposition in HCM. Cardiovascular magnetic resonance imaging using a 1.5 Tesla scanner was performed on 36 HCM sarcomere gene mutation carriers without left ventricular hypertrophy (G+LVH-), 31 HCM patients with preserved ejection fraction carrying a pathogenic sarcomere gene mutation (G+LVH+), and 53 age-, sex-, and body surface area-matched healthy volunteers. Dynamic excursion of the aorto-mitral apparatus was assessed semi-automatically on breath-held three-chamber cine steady-state free precession images. Four pre-defined regions of interest (ROIs) were tracked: ROIPMVL: hinge point of the posterior mitral valve leaflet; ROITRIG: intertrigonal mitral annulus; ROIAMVL: AMVL tip; and ROIAAO: anterior aortic annulus. Compared with controls, normalized two-dimensional displacement-vs.-time plots in G+LVH- revealed subtle but significant systolic anterior motion (SAM) of the AMVL (P < 0.0001) and reduced longitudinal excursion of ROIAAO (P = 0.014) and ROIPMVL (P = 0.048). In overt and subclinical HCM, excursion of the ROITRIG/AMVL/PMVL was positively associated with the burden of left ventricular fibrosis (P < 0.028). As expected, SAM was observed in G+LVH+ together with reduced longitudinal excursion of ROITRIG (P = 0.049) and ROIAAO (P = 0.008). Dyskinesia of the aorto-mitral apparatus, including SAM of the elongated AMVL, is detectable in subclinical HCM before the development of LVH or left atrial enlargement. These data have the potential to improve our understanding of early phenotype development and LVOTO predisposition in HCM.

A Pilot Study Evaluating LV Diastolic Function with M-Mode Measurement of Mitral Valve Movement in the Parasternal Long Axis View.

This pilot study aimed to develop a new, reliable, and easy-to-use method for the evaluation of diastolic function through the M-mode measurement of mitral valve (MV) movement in the parasternal long axis (PSLA), similar to E-point septal separation (EPSS) used for systolic function estimation. Thirty healthy volunteers from a tertiary emergency department (ED) underwent M-mode measurements of the MV anterior leaflet in the PSLA view. EPSS, A-point septal separation (APSS), A-point opening length (APOL), and E-point opening length (EPOL) were measured in the PSLA view, along with the E and A velocities and e' velocity in the apical four-chamber view. Correlation analyses were performed to assess the relationship between M-mode and Doppler measurements, and the measurement time was evaluated. No significant correlations were found between M-mode and Doppler measurements in the study. However, M-mode measurements exhibited high reproducibility and faster acquisition, and the EPOL value consistently exceeded the APOL value, resembling the E and A pattern. These findings suggest that visually assessing the M-mode pattern on the MV anterior leaflet in the PSLA view may be a practical approach to estimating diastolic function in the ED. Further investigations with a larger and more diverse patient population are needed to validate these findings.

Exaggerated myocardial torsion may contribute to dynamic left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.

Dynamic left ventricular (LV) outflow tract obstruction (LVOTO) is associated with symptoms and increased risk of developing heart failure in hypertrophic cardiomyopathy (HCM). The association of LVOTO and LV twist mechanics has not been well studied in HCM. The aim of the study was to compare the pattern of LV twist in patients with HCM associated with asymmetrical septal hypertrophy with and without LVOTO. Echocardiography (including speckle tracking) was performed in 212 patients with HCM, divided according to the absence (n = 130) or presence (n = 82) of LVOTO (defined as peak pressure gradient ≥30 mmHg either at rest and/or with Valsalva manoeuvre). Patients with LVOTO were older, had smaller LV dimensions, a higher LV ejection fraction (LVEF), a longer anterior mitral valve leaflet length, and a higher early transmitral pulsed wave to septal tissue Doppler velocity ratio (E/E'). A univariate analysis showed that peak twist was significantly higher in patients with LVOTO compared with patients without LVOTO (19.7 ± 7.3 vs. 15.7 ± 6.0, P = 0.00015). Peak twist was similarly enhanced in patients with LVOTO, manifesting only during Valsalva (19.2 ± 5.6, P = 0.007) and patients with resting LVOTO (19.9 ± 8.0, P = 0.00004) compared with patients without LVOTO (15.7 ± 6.0). A stepwise forward logistic regression analysis showed that LVEF, LV end-systolic dimension indexed to body surface area, anterior mitral valve leaflet length, E/E', and peak twist were all independently associated with LVOTO. This study demonstrates that increased peak LV twist is independently associated with LVOTO in patients with HCM. Peak twist was similarly exaggerated in patients with only latent LVOTO, suggesting that it may play a contributory role to LVOTO in HCM.

Escalation from impella 5.5 to ECPELLA support as a bridge to mitral valve surgery in a patient with degenerative mitral regurgitation.

Severe mitral regurgitation (MR) is an important cause of acute heart failure and significant contributor to morbidity and mortality. Mechanical circulatory support (MCS) devices such as Impella are readily used to hemodynamically stabilize patients with cardiogenic shock (CS) secondary to this valvular pathology. Impella can also be combined with VA-ECMO to an "ECPELLA" configuration if further escalation of hemodynamic support is needed. We report a case of a 57-year-old female who presented with CS secondary to a perforated anterior mitral valve leaflet and non-ischemic cardiomyopathy that did not stabilize with initial choice of Impella 5.5. She required further escalation from axillary Impella 5.5 to the combined ECPELLA configuration, which allowed hemodynamic stabilization and ultimately a successful high-risk isolated mitral valve replacement. Despite adequate Impella flow, escalation to a combined MCS configuration, such as ECPELLA, may need to be considered upfront for acute valvular insufficiency in the setting of pre-existing cardiomyopathy.

Is Congenital Muscular Mitral-Aortic Discontinuity Another Feature of Obstructive Hypertrophic Cardiomyopathy? A Pathology Validation Study

Hypertrophic cardiomyopathy (HCM) is an inherited myocardial disease at risk of sudden cardiac death and heart failure, even requiring heart transplantation. A “muscular mitral-aortic discontinuity” has been reported during surgery in the obstructive form. We aimed to validate these findings through pathological analysis of HCM heart specimens from the cardiovascular pathology tissue registry. Hearts with septal asymmetric HCM from sudden cardiac death, other causes of death, or heart transplantation were included. Sex-matched and age-matched patients without HCM served as controls. Gross and histologic analysis of the mitral valve (MV) apparatus and the mitral-aortic continuity were performed. Thirty HCM hearts (median age, 29.5 years; 15 men) and 30 controls (median age, 30.5 years; 15 men) were studied. In HCM hearts, a septal bulging was present in 80%, an endocardial fibrous plaque in 63%, a thickening of the anterior MV leaflet in 56.7%, and an anomalous insertion of papillary muscle in 10%. All cases but 1 (97%) revealed a myocardial layer overlapping the mitral-aortic fibrous continuity on the posterior side, corresponding to the left atrial myocardium. A negative correlation between the length of this myocardial layer and the age and the anterior MV leaflet length was found. The length did not differ between HCM and controls.Pathologic study of obstructive HCM hearts does not confirm the existence of a "muscular mitral-aortic discontinuity". An extension of left atrial myocardium, overlapping posteriorly the intervalvular fibrosa, is rather visible, and its length decreases with age, possibly as a consequence of left atrial remodeling. Our study highlights the fundamental role of thorough gross examination and the value of organ retention for further analysis in order to validate new surgical and imaging findings.

The Role of Focused 2-Dimensional Echocardiography in Managing Left Ventricular Outflow Tract Obstruction Mimicking Cardiogenic Shock.

Left ventricular outflow tract obstruction (LVOTO) is a common cardiogenic shock (CS) mimic. We present 3 cases of patients presenting with CS following myocardial infarction, exhibiting a poor response to conventional treatment with inotropy and mechanical circulatory support. This triggered echocardiographic assessment by critical care physicians using focused 2-dimensional (2D) echocardiography. This timely assessment identified anterior mitral valve leaflet entrainment into the left ventricular outflow tract (LVOT), causing LVOTO as the underlying shock mechanism. Echocardiographic findings have led to significant changes in management. The patients underwent fluid administration, weaning from inotropy, and mechanical circulatory support explantation, leading to relief of LVOTO and improved hemodynamics. Critical care basic 2D echocardiography accreditations focus on myocardial function and pericardial effusions. Relevant societies administering these accreditations should consider adding LVOT assessment to enable timely diagnosis of this life-threatening CS mimic.

An Unusual Case of Corynebacterium simulans causes Infective Endocarditis with Embolic Events

Corynebacterium species are often treated as contaminants. However, there were several recent outbreaks involving Corynebacterium species reported across the globe. We report a rare case of Corynebacterium simulans causes infective endocarditis which led to debilitating embolic events. A 39-year-old lady presented with a prolonged fever for three weeks. She was in septic shock and had dense right hemiplegia, a pansystolic murmur at the mitral area and hepatosplenomegaly. There were no peripheral stigmata of infective endocarditis. An urgent computed tomography (CT) of the brain showed an infarct at the left corona radiata extending to the left parietal, left basal ganglia and left temporal lobe. She deteriorated and required mechanical ventilation and intensive care. Echocardiogram showed vegetation at both her anterior and posterior mitral valve leaflets leading to severe mitral regurgitation. Splenic infarction was seen in her contrasted computed tomography (CECT) of her abdomen. Her three samples of blood culture were positive for Corynebacterium simulans. She deteriorated rapidly and went into multi-organ failure and succumbed. Corynebacterium species should be taken seriously and should not be neglected as a contaminant as it can cause potentially fatal complications as described in this case report.

Cutting-Edge Trials in Structural Heart Disease at The Texas Heart Institute.

Mitral and tricuspid valvular disease have been managed surgically; however, multiple transcatheter technologies have diversified the therapeutic arsenal and expanded the number of patients eligible for treatment. These new technologies and active trials currently being performed at The Texas Heart Institute will be highlighted.Transcatheter edge-to-edge repair (TEER) with MitraClip (Abbott Structural Heart) plays an important role in the management of degenerative and functional mitral regurgitation (MR). Despite its success, the limitations of MitraClip include challenging anatomy that may not be amenable to TEER, the common need for multiple devices, risk of device-related mitral stenosis, and a not-trivial rate of residual MR.1 Delivered via a 22F sheath, the PASCAL device (Edwards Lifesciences) offers several improvements.2 Its 3-catheter system (including a guide, steerable, and implantation catheter) offers easy maneuverability in 3 independent planes. It has a spacer that fills the interleaflet area, helping reduce regurgitation. Additionally, its relatively larger “clasps” are designed to reduce leaflet stress by better distributing tension. Similar to the latest generation of MitraClip, PASCAL has independent gripper action.The CLASP IID and CLASP IIF trials randomized patients with degenerative and functional MR, respectively, to PASCAL vs MitraClip. The CLASP IID trial, which has completed enrollment, reported noninferiority of the PASCAL device with relation to procedural safety and effectiveness.3 It also showed durable reductions in MR to ≤1+ (87.2% at discharge and 83.7% at 6 months in the PASCAL arm; 88.5% at discharge and 71.2% at 6 months in the MitraClip arm). The CLASP IIF trial is currently enrolling.Compared with TEER, transcatheter mitral valve replacement (TMVR) theoretically offers treatment for complex mitral valvular anatomies, including mixed valvular disease and the potential for lower rates of residual regurgitation.4 The Intrepid valve (Medtronic) is a promising transcatheter device being studied in the APOLLO trial. Intrepid is designed as a double stent composed of a nitinol mesh, with an inner stent containing a bovine, trileaflet valve and a larger, outer stent that fixates onto the mitral annulus. It is available in 42- and 48-mm outer diameter sizes, with a 54-mm size currently in development.5 The APOLLO trial initially began as a randomized controlled trial comparing transapical TMVR to surgery, but because of developments in TEER technology, has evolved into a single-arm trial of patients who are not candidates for TEER or conventional mitral valve surgery. More recently, a 35F transfemoral delivery platform for the Intrepid system has been developed.One particularly important complication of TMVR is left ventricular outflow tract obstruction that is caused by displacement of the anterior mitral valve leaflet. Multiple efforts have been made to prevent this complication, including sophisticated computed tomography–based prediction of the neo–left ventricular outflow tract that help guide patient selection and the use of interventional techniques including leaflet laceration and alcohol septal ablation.6Early results of the Intrepid valve show excellent procedural success (96%) with mild or less MR in 100% of patients at a median 173-day follow-up.5 Whereas the early experience with transapical delivery of the Intrepid valve in a high-risk patient cohort was associated with high mortality (14% at 1 month),5 the development of a transfemoral delivery platform promises to reduce procedural morbidity and mortality.Often labeled the “forgotten valve,” tricuspid valvular regurgitation (TVR) is common and associated with substantial morbidity and mortality—as low as 34% survival at 5 years.7 However, late patient presentation, high comorbidity burden, and a high associated surgical mortality preclude many patients from receiving surgical treatment. Additionally, whether tricuspid valve intervention can improve patient outcomes is unclear because TVR is usually secondary to right ventricular dysfunction rather than being primary valvular disease. Therefore, it may often be a marker of severe disease rather than a pathophysiologic mediator.Nonetheless, transcatheter technologies are being studied for their potential to improve clinical outcomes of patients with severe TVR. The CLASP-TR trial, in which patients are being randomized to TEER with the PASCAL device vs medical therapy, should provide insight into the natural history of TVR and the utility of intervention.8 One of the major challenges is imaging. Owing to its more anterior position, clear transesophageal windows of the tricuspid valve are more difficult to obtain than are those with the mitral valve. Whereas the tricuspid valve has traditionally been viewed as trileaflet, tricuspid anatomy is actually quite diverse, often consisting of 4 or even 5 leaflets.9 New structural imaging guidelines aid in the evaluation of tricuspid valve disease and procedural guidance.10New transcatheter valve repair devices and transcatheter valve replacement technologies hold the promise of increasing the number of patients with structural heart disease who are eligible for transcatheter technologies and may permit more complete, durable responses to treatment; this will hopefully translate into better long-term patient outcomes.

Трансмитральная миоэктомия и протезирование митрального клапана из минидоступа при обструктивной гипертрофической кардиомиопатии

Primary hypertrophic cardiomyopathy is an isolated genetic heart disease characterized by thickening of the myocardium in the absence of an apparent hemodynamic cause. There are two patterns of the obstruction: static, with a muscle band narrowing the outflow tract of the left ventricle, and dynamic, which implies elongation of the anterior mitral valve leaflet. The key to correct treatment of the condition is understanding of the mechanism behind the obstruction. Myectomy is the gold standard of invasive treatment of obstructive hypertrophic cardiomyopathy; it aims to remove the static component of the obstruction. Another common adidition is the mitral valve surgery, aimed at elimination of the obstruction's dynamic component. This article presents a successful mini-invasive transmitral myectomy and mitral valve replacement in a case of obstructive hypertrophic cardiomyopathy with a damaged mitral valve.

Morpho-mechanistic screening criteria for the echocardiographic detection of rheumatic heart disease

IntroductionScreening echocardiography, guided by the current World Heart Federation (WHF) criteria, has important limitations that impede the establishment of large-scale rheumatic heart disease (RHD) control programmes in endemic regions. The...

Prosthetic Mitral Valve Stenosis Caused by Preserved Native Anterior Mitral Valve Leaflet

Prosthetic Mitral Valve Stenosis Caused by Preserved Native Anterior Mitral Valve Leaflet