Case Of Mitral Valve Replacement Research Articles

Paroxysmal cold hemoglobinuria and cardiopulmonary bypass

Paroxysmal cold hemoglobinuria, a cold-reactive autoimmune disease associated with the Donath-Landsteiner antibody, has not been described in patients undergoing cardiac surgery. We report a case of mitral valve replacement in a woman with a positive Donath-Landsteiner antibody and a history of recurrent hemolysis and hemoglobinuria secondary to cold exposure. Successful perioperative management is described, as is a discussion of paroxysmal cold hemoglobinuria.

A high aged surgical case of mitral valve replacement for mitral regurgitation caused by papillary muscle rupture after acute myocardial infarction

A high aged surgical case of mitral valve replacement for mitral regurgitation caused by papillary muscle rupture after acute myocardial infarction

Double valve repair in a transplanted heart

The first case of mitral valve replacement after heart transplantation was published in 1991. Since then, three additional cases of mitral valve replacement (one in combination with a tricuspid valve repair), two aortic valve replacements, and 12 cases of tricuspid valve replacement have been reported. In all these cases the damaged valves were deemed beyond surgical repair and were replaced by either a porcine bioprosthesis or a mechanical valve prosthesis. In two instances bench mitral valve repair before heart transplantation was described. In seven patients tricuspid valve repair was performed (combined with mitral valve replacement in one, as just mentioned). 4 This report presents the first case of mitral and tricuspid valve repair in a transplanted heart. The patient was a 60-year-old man with a history of heart failure resulting from dilated cardiomyopathy for which he underwent orthotopic heart transplantation in April 1990. The donor was a 12-year-old boy with no history of heart disease, normal auscultatory findings, and normal electrocardiographic findings. The procedure was performed by means of the biatrial method with Prolene running sutures (Ethicon, Inc., Somerville, N.J.) for the atria and the great vessels. The operation was uncomplicated. Postoperatively the patient had bradycardia, for which he received isoproterenol (INN: isoprenaline) treatment for 11 days. Recovery was otherwise uneventful. Immunosuppressive therapy consisted of OKT3, followed by cyclosporine (INN: ciclosporin) and low-dose steroids as maintenance therapy. Echocardiography in the first postoperative weeks showed some pericardial effusion. From the first week on, some billowing of the anterior mitral valve leaflet was noted. There were no rejection episodes. A total of seventeen endomyocardial biopsies were performed in the first year after transplantation and seven in the following years. Follow-up by transthoracic echocardiography showed gradual progression of mitral regurgitation. In 1993 moderate tricuspid regurgitation was also found. Despite this the man enjoyed a productive working life without symptoms during these 5 years. At the yearly catheterization, mild regurgitation of the mitral valve was noted on cineangiography. In 1996, 6 years after cardiac transplantation, the patient began having easy fatiguability and dyspnea on exertion. On those occasions he also reported abdominal distention. Physical examination revealed a holosystolic apical murmur, no pulmonary abnormalities, and no hepatomegaly. Transesophageal echocardiography showed a nondilated hypertrophic left ventricle with good systolic function. Billowing of both mitral valve leaflets was noted, with a prolapse of the anterior leaflet and severe regurgitation. At that time, an insignificant tricuspid regurgitation was noted. Heart catheterization showed elevated filling pressures (right atrial pressure 15 mm Hg, pulmonary capillary wedge pressure 20 mm Hg, and left ventricular end-diastolic pressure 23 mm Hg), no significant stenosis of the coronary arteries, good left ventricular function, but severe mitral valve regurgitation (Sellers grade 3/4). Valve repair was proposed for this patient, and on February 4, 1997, he was operated on. A redo sternotomy was performed. Cardiopulmonary bypass with selective venous cannulation of both the superior and inferior venae cavae and moderate hypothermia with cardioplegic arrest were used. The mitral valve was well exposed via a right atrial, transseptal approach. Inspection revealed a prolapse of both valve leaflets adjacent to the posteromedial commissure resulting from papillary muscle elongation. The papillary muscle appeared to be unnaturally pale, as did other parts of the endocardial tissues. Marked myxomatous degeneration was noted on the right side of both valve leaflets. The left side was unaffected. The anulus was severely dilated. Papillary muscle shortening was performed by folding back the tip of the muscle onto its base and suturing it into place. The annular dilation was corrected by inserting a size 34 Cosgrove-Edwards ring (Baxter Healthcare Corp., Irvine, Calif.). Transesophageal echocardiography after closure of the atrial septum and the atrial wall showed a good result. However, at this time tricuspid valve regurgitation was considered more severe than previously appreciated because of two flail valve leaflets. Cardiopulmonary bypass was restarted and the tricuspid valve was exposed with a beating heart. The chordae of the posterior part of anterior valve leaflet, as well as chordae of the posterior leaflet, were ruptured, with resulting partially flail leaflets. The septal and posterior valve leaflets were sutured together to make a functionally bicuspid valve. A small prolapsing segment of the anterior leaflet was resected, and a partial De Vega annuloplasty at the base of the posterior leaflet and adjoining commissures completed the reconstruction. Transesophageal echocardiography showed a good result with minor regurgitation of both the mitral and tricuspid valves. Postoperative recovery was uneventful. Transthoracic echocardiography on the seventh day after operation From the Department of Cardiopulmonary Surgery and Cardiology, Thorax Center, University Hospital Rotterdam “Dijkzigt,” Rotterdam, The Netherlands.

Clinical Analysis of Coronary Artery Bypass Surgery for Ischemic heart Disease

From August 1992 to July 1996, 63 consecutive patients underwent coronary artery bypass surgery. The mean age of these patient was 57 years(range form 30 to 71years). There were 44 men and 19 women. Preoperative 12 patients had stable angina pectoris and 23 patients were unstable angina pectoris. 8 patients had previous myocardial infarctation history and emergency or urgent myocardial revascularization were performed in 9 cases. In the risk factors of coronary atherosclerosis, 25 patients(40%) were hypercholesterolemia, 38 patients(60%) have smoking history and 19 patients(30%) have hypertension history. In the patterns of disease, 9 patients were single vessel disease, 18 patients were two vessele disease and 33 patients were three vessel disease. We performed total 284 distal anastomosis(mean 3.5 anastomosis per patient) and performed one case of ascending aorta graft interposition, two cases of mitral valve replacement, one case of aortic valve replacement, one case of ventricular septal defect repair and one case of atrial septal defect repair and the mean aortic cross clamp time was 115.3 minutes. The common complications were arrhythmia(7cases), wound infection(5cases), perioperative myocardial infarction(4cases), reoperation for bleeding control(4cases) and stroke(4cases). There were six hospital deaths due to low cardiac output syndrome, ventricular arrhythmia and respiratory failure. In the evaluation of operative risk factors, preoperative intravenous nitroglycerin requirement and prolonged aortic cross clamp tirne(>2hours) were found to be predective factor of morbidity and old age(>65years) was found to be predective factor of mortality.

A case of mitral valve replacement assodated with acute myocardial infarction due to coro nary spasm during thyroxine therapy

A case of mitral valve replacement assodated with acute myocardial infarction due to coro nary spasm during thyroxine therapy

Relationship between the myofibrillar ATPase activity of human biopsy material and hemodynamic parameters.

The myofibrillar ATPase activity and pyrophosphate gel electrophoretic pattern of native myosin of fresh human left ventricular papillary muscles were examined in 52 cases of mitral valve replacement. The myofibrillar ATPase activity of hypertrophied myocardium did not differ from that of non-hypertrophied myocardium (mean +/- SD, 36.2 +/- 8.7 vs 31.8 +/- 8.6 nmolPi/mg/min, ns) and there was no significant difference in myofibrillar ATPase activity as a function of left ventricular enddiastolic pressure. Pyrophosphate gel electrophoresis of myosin revealed the presence of two components. It is questionable whether the component of higher electrophoretic mobility (approximately 25-35% in concentration) is identical with rat ventricular myosin VM-1 because an increase in this component seems to correlate with a decrease of myofibrillar ATPase activity, its concentration was significantly higher in the hearts with left ventricular hypertrophy, high enddiastolic pressure, high aortic pressure or low cardiac index. From these results, it is not necessarily clear whether hemodynamic overload in valvular heart diseases can alter left ventricular myofibrillar ATPase activity, but it can be said that the overload influences the concentration of the two components of native myosin revealed by pyrophosphate gel electrophoresis.

Ventilatory support following open heart surgery

One thousand consecutive patients undergoing open heart surgical procedures were evaluated for the need for ventilation in the postoperative period. All cases of mitral valve replacement (237) and double valve replacement (85) were electively ventilated. Fifty-two other patients required ventilation for various reasons which included low cardiac output with inotropic support, ventricular arrhythmias, left atrial pressure above 18 mm Hg, bleeding, hypo or hyperthermia, unsatisfactory blood gases, neurological problems, overdosage of narcotics, incomplete reversal of relexants and flooded lungs at the end of operation. Twenty patients needed ventilation beyond 4 days. Prolonged ventilatory support was maintained with nasotracheal tube and only 3 patients required tracheostomy after 12 days for cerebral and pulmonary complications. The pulmonary complications encountered during postoperative ventilation were stiff lungs, copious secretions and bleeding in 20 patients.

Factors influencing long-term survival after mitral valve replacement.

Thirty-seven consecutive cases of mitral valve replacement have been retrospectively reviewed. The prognostic significance of preoperative clinical, hemodynamic and quantitative angiographic factors for survival has been evaluated. In the Mitral stenosis (MS) group, all of the patients who showed small Stroke volume index (SVI) (less than 45 ml/m2) with pulmonary hypertension died from the low output syndrome. The prognosis was poor in patients who had large cardiothoracic ratio (CTR) in the MS group. Aortic valve replacement must be considered when moderate aortic regurgitation is associated with mitral valve disease. In the MR factors for predicting the survival. The eccentricity ratio is also a sensitive parameter for recognizing a patient who will have a poor prognosis after mitral valve replacement. The main mode of death was found to be heart failure due to myocardial impairment.

A case of mitral valve replacement and simultaneous aortocoronary bypass surgery for rheumatic mitral stenoinsufficiency

A case of mitral valve replacement and simultaneous aortocoronary bypass surgery for rheumatic mitral stenoinsufficiency

Mitral valve replacement for mitral regurgitation due to Libman-Sacks endocarditis: Report of a case

A case of mitral valve replacement for Libman-Sacks endocarditis is described. The incidence of this lesion and the difficulty in diagnosis is discussed. Due to the frequency of this lesion, the ineffectiveness of steroid therapy in preventing its occurrence, and the increasing longevity of patients with systemic lupus erythematosus (SLE), more patients with hemodynamically significant valvular lesions may require valve replacement. The advantages of the porcine xenograft are discussed. This case demonstrates that patients with SLE can tolerate an open-heart operation and should be considered for operative intervention when their cardiac disease warrants it.

OPERATIVE RESULTS OF ARTIFICIAL VALVE REPLACEMENT

We had 49 cases of mitral valve replacement. Aortic valve replacement has been performed 30 cases. Double valve replacement was performed in 7 cases, which were all serious.94 artificial valve were used in the valve replacement of our cases, and 61 of them were a ball valve of Starr-Edwards. 26 were a disc valve of SAKAKIBARA (SAM).Postoperatively, anticoagulant treatment was given to all cases. On the surgical result of our artificial valve replacement, early death was seen in 22 (25.5%) and late death in 10 (11.6%) of 86 cases.Postoperative complication and cause of death were low cardiac output syndrome, hemorrhage, pulmonary edema, infection and embolism. On the Pre and postoperative changes of functional capacity by NYHA, the most of cases were improved to II or III grade.