Complication Of Mitral Valve Repair Research Articles

Hypoglycemia after Mitral Valve Repair in Dogs.

Hypoglycemia has not been previously reported as a postoperative complication of mitral valve repair (MVR) in dogs; however, the authors have encountered cases of hypoglycemia after MVR. This study aimed to determine the incidence of hypoglycemia in dogs after MVR and investigate its causes. Blood glucose levels were measured at multiple timepoints in dogs undergoing MVR. Simultaneously, insulin and glucagon blood concentrations in dogs with hypoglycemia preoperatively and postoperatively were compared to verify the physiological responses to hypoglycemia. Furthermore, risk factors for hypoglycemia, using variables selected based on the characteristics of MVR and dogs undergoing MVR, were examined prospectively. The incidence of hypoglycemia after MVR was 14.2%, and plasma glucagon concentrations increased in these dogs (mean: 260 pg/mL and 644 pg/mL pre- and postoperatively, p < 0.001), whereas serum insulin concentrations decreased (median: 0.50 ng/mL and 0.29 ng/mL pre- and postoperatively, p = 0.002). Therefore, hyperinsulinemia or hypoglucagonemia is unlikely to be the cause of postoperative hypoglycemia. The identified risk factors for hypoglycemia included low body weight and asymptomatic myxomatous mitral valve disease. Monitoring blood glucose levels after MVR should be included in the standard hospitalization plan to prevent hypoglycemic emergencies in dogs.

HEMOLYTIC ANEMIA AFTER MITRAL VALVE REPAIR: A CASE REPORT

We present a case report of a 52-year-old male who de­veloped hemolytic anemia after undergoing mitral valve repair surgery. Hemolytic anemia is a rare complication of mitral valve repair, occurring in less than 1% of pa­tients. Fragmentation of the mitral regurgitant jet is the leading cause of intravascular hemolytic anemia after the surgery. In this particular case, the jet was following the anterior leaflet and hitting the mitral annulus. The pre­sence of schistocytes and echocardiographic evaluation help diagnose the mechanical origin of hemolysis after mitral valve repair. Hemolytic anemia is managed with blood transfusions and treated with mitral reoperation. In this case, the patient required mechanical mitral valve replacement surgery, and their condition improved fol­lowing the surgery.

MITRAL ANNULOPLASTY RING DEHISCENCE: A BAFFLING PROBLEM

Mitral valve (MV) annuloplasty ring dehiscence is an infrequent but serious complication of MV repair. For patients with high operative risk, off-label percutaneous strategies may be considered as a treatment. An 82 year old male status post MV repair with 32 mm Carpentier-Edwards mitral

The Imbrication Technique: An Alternative to the Sliding Leaflet Technique

Systolic anterior motion (SAM) represents a common and troublesome complication of mitral valve repair. The prevention of SAM has traditionally been based on the sliding leaflet technique, which involves resection of posterior leaflet tissue. However, this approach has not been universally adopted owing to its technical difficulty and inconsistent efficacy. We present an imbrication technique that avoids additional leaflet resection and achieves a reliable prevention of SAM. The approach has been successfully implemented in the treatment of 124 consecutive patients at high risk for SAM.

Finite element analysis for edge-to-edge technique to treat post-mitral valve repair systolic anterior motion.

Systolic anterior motion of the mitral valve is an uncommon complication of mitral valve repair, which requires immediate supplementary surgical action. Edge-to-edge suture is considered as an effective technique to treat post-mitral valve repair systolic anterior motion by clinical researchers. However, the fundamentals and quantitative analysis are vacant to validate the effectiveness of the additional edge-to-edge surgery to repair systolic anterior motion. In the present work, finite element models were developed to simulate a specific clinical surgery for patients with posterior leaflet prolapse, so as to analyze the edge-to-edge technique quantificationally. The simulated surgery procedure concluded several actions such as quadrangular resection, mitral annuloplasty and edge-to-edge suture. And the simulated results were compared with echocardiography and measurement data of the patients under the mitral valve surgery, which shows good agreement. The leaflets model with additional edge-to-edge suture has a shorter mismatch length than that of the model merely under quadrangular resection and mitral annuloplasty actions at systole, which assures a better coaptation status. The stress on the leaflets after edge-to-edge suture is lessened as well.

Myectomy as an alternative solution for systolic anterior motion in a patient who underwent mitral valve repair

Systolic anterior motion (SAM) of the mitral apparatus is a relatively frequent complication of mitral valve repair. When significant SAM persists despite intraoperative medical therapies, a second repair is generally required. We describe a rare case of SAM due to a hypertrophic septum in a patient who underwent mitral valve repair, with no preoperative obstruction of the left ventricular outflow tract. The present case of SAM was successfully treated only with transaortic septal myectomy. Therefore, myectomy might be considered as an alternative solution for SAM that is suspected to be caused by a hypertrophic septum after mitral valve repair.

Partial Anterior Leaflet Valvuloplasty to Avoid Systolic Anterior Motion After Mitral Valve Repair

Systolic anterior motion (SAM) of the mitral apparatus and consequent obstruction of the left ventricular outflow tract is a known complication of mitral valve repair (MVREP). The edge-to-edge technique has been advocated for the repair of myxomatous mitral valves to avoid SAM. We present a new technique to prevent SAM in patients with a redundant lateral segment of the anterior leaflet by folding its elongated portion underneath the body of the anterior leaflet.

Hemolysis after Mitral Valve Repair

Hemolysis is a potential complication of mitral valve repair. We report a case of hemolytic anemia after mitral valve repair successfully treated with re-repair, and review the literature on reoperation after failure of mitral valve repair with associated hemolysis.

Massive hemolysis after mitral valve repair

Hemolysis is a rare, but serious complication of mitral valve repair. It should be considered in every patient with the history of mitral valve repair and who has unexpected impairment in the functional capacity during early or late postoperative period. If the functional impairment is not consisted with the severity of patient residual mitral regurgitation, hemolysis should always be considered. In this article, we present two cases suffering from intravascular hemolysis after mitral valve repair.

Severe left ventricular outflow tract obstruction as a complication of mitral valve repair: Case report

Systolic anterior motion (SAM) is a postoperative complication of mitral valve repair, with an incidence of 5–10%. Early recognition of the signs and symptoms of SAM is essential for the management of these patients. This article focuses on the pathophysiology and dynamics of SAM and the treatment strategies described in the literature. The authors present a case study and echocardiographic images illustrating the clinical relevance of the mechanism involved, in order to clarify whether surgical reintervention is necessary.

Obstrução grave do tracto de saída do ventrículo esquerdo como complicação de valvuloplastia mitral: a propósito de um caso clínico

Systolic anterior motion (SAM) is a postoperative complication of mitral valve repair, with an incidence of 5 to 10%. Early recognition of the signs and symptoms of SAM is essential for the management of these patients. This article focuses on the pathophysiology and dynamics of SAM and the treatment strategies described in the literature. The authors present a case study and echocardiographic images illustrating the clinical relevance of the mechanism involved, in order to clarify whether surgical reintervention is necessary.

Edge-to-Edge Technique to Treat Post-Mitral Valve Repair Systolic Anterior Motion and Left Ventricular Outflow Tract Obstruction

Systolic anterior motion of the mitral valve causing left ventricular outflow tract obstruction is an uncommon complication of mitral valve repair that may necessitate immediate additional surgical action. We prospectively evaluated the technique of the edge-to-edge suture on post-mitral repair systolic anterior motion, which persisted despite conservative treatment. From March 2002 to March 2004, 4 of 112 patients requiring mitral valve repair surgery for chronic degenerative mitral regurgitation had systolic anterior motion with severe left ventricular outflow tract obstruction and mitral regurgitation. All 4 patients (mean age, 50 years) had posterior leaflet prolapse with chordal rupture with a billowing anterior leaflet, but without chordal rupture. Repair was achieved through a quadrangular resection of the posterior leaflet, completed by plication of the annulus in 2 patients and leaflet sliding in the other 2. All patients had mitral annuloplasty; two patients had a complete CE Physio ring (Edwards Lifesciences, Irvine, CA) inserted, whereas the other 2 patients had an open CG Future band (Medtronic, Minneapolis, MN). Routine perioperative transesophageal echocardiography showed systolic anterior motion, severe left ventricular outflow tract obstruction (> 50 mm Hg), and mitral regurgitation. After resuming cardiopulmonary bypass, all patients had an edge-to-edge suture at the middle part of the free edge of the anterior and posterior leaflets. The control transesophageal echocardiography showed in all cases disappearance of the systolic anterior motion, of the left ventricular outflow tract obstruction and of mitral regurgitation. Mean follow-up was 14 months (range, 6 to 28 months). All patients were in New York Heart Association's functional class I. With the edge-to-edge repair, the early and 2-year results were satisfactory with total disappearance of the systolic anterior motion, of the left ventricular outflow tract obstruction and of the recurrent mitral regurgitation.