Case Of Mitral Valve Replacement Research Articles

Successful Anesthetic Management for Redo Mitral Valve Replacement in the Setting of Severe Postoperative Right Ventricular Failure: A Case Report

: Mitral regurgitation, a prevalent form of heart valve dysfunction, presents a significant challenge in global cardiovascular health. With diverse etiologies, this condition increasingly affects adult populations. Over the past decades, the demand for redo valvular surgeries has steadily risen. The complexity of such procedures is further compounded when patients have underlying conditions such as severe ventricular failure, chronic hypertension, anemia, or drug allergies. Right ventricular failure occurs when the right ventricle cannot maintain adequate blood flow through the pulmonary circulation to ensure proper filling of the left ventricle. This report highlights a remarkable case of mitral valve replacement (MVR) in a 46-year-old female with an extensive surgical history, including previous mitral valve repair and atrioventricular septal defect (AVSD) repair. The patient also had chronic hypertension, anemia, and a documented allergy to valsartan. During surgery, she experienced acute right ventricular failure, necessitating complex medical management. This case underscores the critical need for thorough preoperative evaluation and meticulous intraoperative medical management in patients with intricate medical histories.

Mechanisms of repair failure after mitral valve repair using chordal replacement

Mechanisms of repair failure after mitral valve repair (MVr) using chordal replacement and annuloplasty for degenerative mitral regurgitation were analyzed. All mitral valve reoperations after isolated MVr using solely chordal replacement and annuloplasty for degenerative mitral regurgitation at the German Heart Center Munich were reviewed. This retrospective observational study aims to analyze mechanisms of repair failure leading to reoperations. Between 2003 and 2010, a total of 344 patients received MVr with chordal replacement and annuloplasty. During a mean follow-up of 9.7 years (0.00 - 15.9 years) in 38 (11.0%) cases reoperation on the mitral valve was necessary. Reoperations were performed after a mean of 6.8 years (0.00 - 14.1 years). The mechanisms of MVr failure were disease progression (39.5%), technical failure (36.8%) and endocarditis (18.4%). Re-repair was performed in 28.9% and was accomplished using redo annuloplasty (90.9%), chordal replacement (90.9%), resection techniques (27.3%) and leaflet patch reconstruction (9.1%). One patient (2.6%) received transcatheter edge-to-edge repair for reoperation. Mitral valve replacement (MVR) was necessary in 63.2%. Redo MVr was mainly performed in cases of technical failure and MVR was more frequently performed in cases with mitral valve sclerosis. Re-reoperation was necessary in 3/24 cases of MVR and in 2/11 cases of redo MVr after a median of 3.8 (0.01 - 10.04) years. MVr using chordal replacement allows a variety of methods for re-repair including transcatheter solutions. Redo MVr is more often feasible in cases of technical failure, while MVR for reoperation is more frequently necessary in mitral valve sclerosis.

Initial experience with a 5G cellular network and robotic arm-based remote echocardiographic system in an all-comers setting

Abstract Background Echocardiography is the test-of-choice for the initial evaluation of many cardiac diseases and requires expertise that is often limited in rural area. Robotic arm-assisted remote echocardigram has been attampted for teleconsultation but was limited to heart failure patients(ref), primarily due to the network delay in telecommunication and the subsequent incoordination in robotic arm control. Purpose We aim to assess the feasibility and diagnostic accuracy of a 5G cellular network and robotic arm-based remote echocardiographic system in an all-comers setting. Methods 51 pts were enrolled from the outpatient cardiology clinic of our institute. All pts underwent standard comprehensive echocardiography on a 5G cellular network and robotic arm-based remote echocardiographic system (the robotic part was deployed at our hospital and the control part was located at another campus 20 kilometers away) (Figure 1)and a conventional echocardiographic platform (at our hospital) successively. The order in which patients were examined on the remote and conventional instruments was randomly determined. There was no interval between the two examinations, and examinations of the same patient were performed by experienced but different cardiologists, who were blinded to each other’s diagnosis. The doctor who used the remote system was also randomly allocated and had not been previously specifically trained. The exams were real-time and diagnoses were made right after the exams. Results Of the 51 pts, the image quality was sufficient for diagnosis in 50 patients (48% female, 40±18 years). 1 pt was excluded because some key views could not be obtained using the remote system (98% of exams successful). 17 pts had positive findings, including 10 with a primary diagnosis of valvulopathy (1 Barlow's syndrome, 1 bicuspid aortic valve and 8 less-than-moderate regurgitation), 2 cardiac surgery follow-ups (1 case of aortic valve replacement and septal myectomy, and 1 case of mitral valve replacement and tricuspid annuloplasty), and 2 hypertrophic cardiomyopathy (including 1 case of obstruction at papillary muscle level), 2 with abnormal left ventricular wall motion(including 1 case of apical mural thrombus) (Figure 2), and 1 with congenital heart disease (secumdum atrial septal defect). The main diagnosis was consistent in 98% of cases (papillary muscle level obstruction was missed in one case), using conventional echocardiographic findings as the standard. Time for image acquision using remote echocardiography was significantly longer than conventional one (24 minutes 36 seconds ± 4 minutes 52 seconds vs. 16 minutes 15 seconds ± 1 minute 54 seconds, p<0.0001, paired t-test). Conclusions Comprehensive echocardiographic exam with a 5G cellular network and robotic arm-based remote system is feasible with relatively good diagnostic accuracy.Figure 1Figure 2

Heart Valve Involvement (Mitral Valve Regurgitation) Caused by Libman–Sacks Endocarditis in Systemic Lupus Erythematosus : A Case Report and Review of the Literature

Libman–Sacks (LS) endocarditis is one of the most common cardiac manifestations of both systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS). We report a case of mitral valve replacement for mitral regurgitation (MR) caused by Libman-Sacks endocarditis in young patient with systemic lupus erythematosus (SLE). In conclusion, Although typically mild and asymptomatic, the disease can lead to serious complications, including superimposed bacterial endocarditis, thromboembolic events, and severe valvular regurgitation and/or stenosis requiring surgery.

A Case of Mitral Valve Replacement for Mitral Stenosis with Narrow Annulus after TAVI and PTMC

A Case of Mitral Valve Replacement for Mitral Stenosis with Narrow Annulus after TAVI and PTMC

Comments of results after surgical replacement of mechanical mitral and aortic valve in children at Hanoi Heart Hospital

Objective: Assessment of early results after surgical treatment of mechanical mitral valve and aortic valve replacement in children at Hanoi Heart Hospital from 2004 to June 2019.
 Methods: Analysis and evaluation based on data collected from patients undergoing surgery and from the results of follow-up examination.
 Results: The total number of patients was 50, in which 34 cases of simple mechanical mitral valve replacement, 16 cases of simple mechanical aortic valve replacement. Average age of surgery: 7.58 ± 6.01 years (The lowest age is 7 months, the highest is 15 years). Male: 29 patients (58%), female: 21 patients (42%). Ultrasound before discharge and after 3 months, we found similar results: mean EF: mechanical mitral valve: 56.28 ± 10.67 %; Aortic valve: 54.72 ± 9.66% .Mean pressure : Mitral valve: 3.18 ± 1.25; Aortic valve: 12.12 ± 3.25 mmHg. INR index: mitral valve : 2.58 ± 1.20; Aortic valve: 2.34 ± 0.92. Complications of valve replacement: 2 cases of mitral valve replacement after surgery 3 years and 4 years; There was 1 case of aortic valve 5 years after surgery. Death immediately after surgery: mitral valve: 2 cases (5.88%); aortic valve: 1 case (6.25%); Late death: After 2 years, there was 1 case of death after mitral valve replacement; After 4 years, there was 1 case of death after aortic valve replacement.
 Conclusion: The results of heart valve replacement surgery in children are positive. It is necessary to have better equipment and experience in open heart surgery in low-birth-weight children in order to operate the disease as early and effectively as possible, in which the treatment of complications of heart failure and post-operative coagulopathy should be considered important.

Mitral valve replacement in patients with severe mitral calcification.

Mitral annular calcification (MAC) is a chronic degenerative process in the fibrous base of the mitral valve, complicating mitral valve surgery and resulting in greater mortality.1 We present a case of mitral valve replacement (MVR) with severe MAC, tricuspid valve repair, and aortic valve replacement.

A case of mitral valve replacement after cesarean section for infective endocarditis during pregnancy

A case of mitral valve replacement after cesarean section for infective endocarditis during pregnancy

A Case of Mitral Valve Replacement Complicated with Essential Thrombocythemia Preoperatively Interrupting Hydroxycarbamide

A Case of Mitral Valve Replacement Complicated with Essential Thrombocythemia Preoperatively Interrupting Hydroxycarbamide

A Rare Case of Mitral Valve Replacement in Antiphospholipid Antibody Syndrome

Antiphospholipid antibody syndrome (APLS) is commonly associated with cardiac valvular abnormalities with the involvement of the mitral valve. The mitral valve replacement (MVR) is a high-risk procedure owing to postoperative complications. The major challenge in the management of these patients is to maintain anticoagulation in pre-, intra-, and postoperative conditions. The optimal choice of prosthesis valve (bioprosthetic or mechanical valve) for MVR depends on the individual patient's clinical condition. Previous reports indicate no clear guidance on the ideal prosthesis for MVR in patients with APLS. In the present case report, we performed MVR using bioprosthetic valve in a 42-year-old female diagnosed with APLS with persistent dyspnea secondary to severe mitral regurgitation.

二尖瓣置换术后卡瓣行再次换瓣术1例

既往已有二尖瓣卡瓣的报道，但二尖瓣置换术后卡瓣行再次换瓣术的病例却极其少见，本文介绍了二尖瓣卡瓣后再次换瓣的病例1例，并结合相关文献对其诊治做了系统阐述。 Although cases of stuck of mitral valve have been reported before, the case of mitral valve replacement after stuck leaflet of mitral valve-in-valve implantation is rare. This article presents such a case and introduces the diagnosis and treatment systematically.

A Case of Mitral Valve Replacement with Neurologic Manifestations during Pregnancy

Introduction: Cardiopulmonary bypass in pregnant patient is considered a high-risk procedure. Maternal mortality is similar to that of the non-pregnant females about 1.5-5%. Variations in the timing of surgical intervention, gestational age, maternal health sta‌‌‌‌tus, perfusion protocol, and pharmacologic therapy are all factors that can influence fetomaternal outcome. Case Report: We present a case of 26- year- old pregnant woman (G1, Ab0, D0) in gestational age of 36 weeks with sudden CVA and neurological sequelae (disartheria, paresthesia of right side of face). In her past medical history, she had no positive history of neurologic problems, diabetes mellitus, hyperlipidemia or cardiovascular diseases. Left perisylvian encephalitis was reported in her brain MRI. In trans-thoracic echocardiography moderate Mitral Regurgitation (MR), severe mitral stenosis with gradient of 9mmHg, and valve surface of 1cm2 was observed. In obstetrics consultation, a healthy male fetus with approximate gestational age of 37 weeks was reported. Finally the pregnancy ended by caesarean section under general anesthesia, with presence of cardiologist and a healthy newborn was delivered at age of 37 weeks. Four days after caesarean section, Mitral Valve Replacement (MVR) was measured which proceeded successfully. Conclusion:Due to the risk of further neurological complications in a pregnant mother who suffers from mitral valve stenosis, provided the gestational age permits harmless termination of pregnancy, it is possible to perform the mitral valve replacement procedure during the same hospital stay after termination of pregnancy.

乳頭筋異常による左室流出路狭窄に対して僧帽弁置換術を施行した1例

症例は72歳の男性．閉塞性肥大型心筋症と診断され，4年間，薬物加療が行われていたが，労作時倦怠感および呼吸苦が出現した．心エコー検査では，全周性の心筋肥大と左室中部から流出路における狭窄病変を認め，同部位での最大圧較差は94 mmHgと増悪していた．また，前乳頭筋が著明に肥大して前方に偏位しており，同乳頭筋から僧帽弁前尖へ付着する腱索が著明に短縮しtetheringを認めていた．収縮期には，肥大した前乳頭筋が心室中隔側へ偏位し，さらに僧帽弁前尖の収縮期前方運動も伴って左室内狭窄の原因となっていた．乳頭筋異常による左室内狭窄を合併した肥大型心筋症と診断し手術を施行した．手術は乳頭筋切除を含めた機械弁による僧帽弁置換術を行った．術後経過は良好で，合併症なく経過し，術後14日目に軽快退院した．術後の心エコー検査では，左心室内の狭窄病変は認めず，左室内圧較差は消失していた．僧帽弁下組織の異常に伴う左室内狭窄を合併した肥大型心筋症に対しては，経大動脈弁での中隔心筋の切除のみでは改善しないことがある．このような症例においては乳頭筋切除を伴った僧帽弁置換術も重要な選択肢のひとつであると思われた．

乳頭筋断裂による急性僧帽弁閉鎖不全症，僧帽弁置換術後の重症心不全に対しトルバプタン投与が有効であった1例

乳頭筋断裂による急性僧帽弁閉鎖不全症，僧帽弁置換術後の重症心不全に対しトルバプタン投与が有効であった1例

EComment. Percutaneous closure of prosthetic mitral paravalvular leaks with Amplatzer devices

I have read with great interest the article by Smith et al. [1]. They address one of the most important potential complications of the closure of paravalvular valve leaks (PVL) with an Amplatzer septal occluder device. Indeed, we have previously also published the direct relationship between residual mitral PVL and its closure by means of septal occluder devices [2]. PVLs are a common finding in mitral valve surgery. They are detected in up to 28% of the cases of mitral valve replacement, mainly related to the surgical technique, and the incidence may be as high as 32% when transoesophageal echocardiogram is available and utilized for this purpose [3]. However, most of the PVLs are small and generally benign. Surgery is clearly indicated in patients requiring blood transfusions and those with congestive heart failure. This has been developed as an alternative treatment option avoiding redo operation, as mortality rate increases with the number of previous operations. Amplatzer occluders rarely close the defect entirely. In a series reported by Shapira et al. [4], a residual leak was observed in 90% of the cases after PVL closure with an Amplatzer occluder. This is probably due to the fact that this is a circular device not designed for PVL closure, which commonly exhibit a crescent shape. In an attempt to completely close the defect, larger occluders are utilized. The larger the Amplatzer occluder, the higher the probability of interference with the prosthesis. Merin et al. [5] reported a case of impingement of valve leaflet motion. In our case, both complications described above occurred [2]. These are excellent examples to demonstrate that current devices frequently used for transcatheter percutaneous closure of PVLs are not geometrically adapted to the anatomy of PVLs.

Conservative treatment of a left atrial intramural hematoma after left atrial thrombus resection and concomitant mitral valve replacement - case report

Left atrial intramural hematoma is a seldom cause of left atrial mass. It has been described to occur spontaneously, after interventional procedures, after blunt chest trauma, or after aortocoronary bypass surgery. We present a case of mitral valve replacement together with the removal of a large intraatrial space-occupying lesion. Intraoperative transesophageal echocardiography confirmed a successful resection of this mass. Surprisingly, upon admission to ICU, transesophageal and transthoracic echocardiography revealed a recurrence of an intramural lesion, closest matching a hematoma, which was confirmed by contrast-enhanced computed tomography. Surgical intervention was thoroughly discussed but a conservative management was favoured. 3 months after surgery, a reassessed transthoracic echocardiography and computed tomography demonstrated an almost complete resolution of the pre-existing hematoma.

Catheter Ablation of an Accessory Pathway within the Marshall Vein in a Patient with Mechanical Mitral Valve

A 37-year-old man, known case of mitral valve replacement, was referred for ablation. Meticulous mapping showed the earliest signal in the distal coronary sinus (CS). Endocardial ablation via transseptal approach failed to permanently ablate the accessory pathway. Similarly, ablation within the CS was unsuccessful. Finally, the mapping catheter was introduced into the vein of Marshall (VoM) and a very early signal was obtained. In the first 3 seconds of the radiofrequency energy application within the VoM, delta wave disappeared. During 1-year follow-up, the patient had no recurrence of the palpitations and electrocardiogram showed no delta wave.

Mitral valve replacement in a twin pregnancy

A 35-year-old female with twin gestation diagnosed with severe mitral stenosis and pulmonary hypertension was successfully treated with open heart surgery for mitral valve replacement (MVR). She gave birth to twins with good Apgar scores at 33 weeks of gestation by cesarean section. Cardiac surgery in singleton pregnancy has been reported extensively. However, there is only a single reported case of MVR following therapeutic abortion of a twin pregnancy in the second trimester. In contrast, we report the first case of mitral valve replacement for severe mitral stenosis and pulmonary hypertension in an ongoing twin pregnancy with successful outcomes.

Argatroban as a substitute of heparin during cardiopulmonary bypass: a safe alternative?

The patient with a diagnosis of heparin-induced thrombocytopenia and thrombosis who requires urgent cardiac surgery represents a formidable challenge. Among the alternatives to heparin, argatroban has gained widespread use in non-cardiac surgery patients. The object of this communication is to report our recent experience with this agent during cardiopulmonary bypass (CPB) and to review the cases previously published in order to better define indications, dosage, monitoring and limitations in cardiac surgery patients. A case of mitral valve replacement where argatroban was used for anticoagulation during CPB is described. The literature on the subject is reviewed and the relationship between argatroban dosage and activated clotting time (ACT) is studied by regression analysis. Clotting of the oxygenator requiring prompt replacement occurred after release of cross-clamp. Upon termination of the drug, ACT remained elevated beyond the expected half-life. A significative (P<0.05) relationship was disclosed between increasing dosage and ACT, while the same relationship was absent on decreasing dosage. Because of unresolved issues like the possibility of clotting in the extracorporeal circuit and prolonged anticoagulation after discontinuing the drug, at present, the use of argatroban as a substitute of heparin during CPB should be restricted to those cases where the other thrombin inhibitors are contraindicated.

Mitral valve surgery for mitral regurgitation caused by Libman-Sacks endocarditis: a report of four cases and a systematic review of the literature

Libman-Sacks endocarditis of the mitral valve was first described by Libman and Sacks in 1924. Currently, the sterile verrucous vegetative lesions seen in Libman-Sacks endocarditis are regarded as a cardiac manifestation of both systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS). Although typically mild and asymptomatic, complications of Libman-Sacks endocarditis may include superimposed bacterial endocarditis, thromboembolic events, and severe valvular regurgitation and/or stenosis requiring surgery. In this study we report two cases of mitral valve repair and two cases of mitral valve replacement for mitral regurgitation (MR) caused by Libman-Sacks endocarditis. In addition, we provide a systematic review of the English literature on mitral valve surgery for MR caused by Libman-Sacks endocarditis. This report shows that mitral valve repair is feasible and effective in young patients with relatively stable SLE and/or APS and only localized mitral valve abnormalities caused by Libman-Sacks endocarditis. Both clinical and echocardiographic follow-up after repair show excellent mid- and long-term results.