Effect Of Mitral Valve Replacement Research Articles

Effect of mitral valve replacement on left ventricular function in subjects with severe rheumatic mitral regurgitation.

This study describes the effects of mitral valve replacement (MVR) on left ventricular (LV) function in patients with severe rheumatic mitral regurgitation (MR). This was a retrospective analysis over a nine-year period (2005-2013). Clinical and echocardiographic parameters were recorded pre-operatively and at two weeks, six weeks to three months and six months following MVR. Of the 132 patients included in the study, 66% were in New York Heart Association (NYHA) class III-IV and 38% presented with clinical features of heart failure. Pre-operatively, 28% of subjects had impaired LV function [ejection fraction (EF) < 60%] and the majority had advanced chamber dilatation [left ventricular end-diastolic diameter (LVEDD) 60.7 ± 7.9 mm (n = 132), left ventricular end-systolic diameter (LVESD) 39.9 ± 7.2 mm (n = 118) and left atrial size 61.2 ± 12.6 mm (n = 128)]. Paired analysis of 83 patients revealed that the EF was > 55% in 87% (n = 72) pre-operatively, decreasing to 20% (n = 17) of patients at two weeks postoperatively (p < 0.001); thereafter an EF > 55% was recorded in 60% (n = 50) at the six-month follow-up visit (p < 0.001). On multivariate analysis, only LVESD emerged as a significant predictor of postoperative LV dysfunction. In this study, most patients with severe MR presented late with significant impairment of LV function and chamber dilatation that often did not recover fully after surgery. This study emphasises early comprehensive evaluation of severe MR followed by timeous surgery in order to preserve LV function.

The effect of mitral valve replacement on atrial fibrillation behaviour

Background: Atrial fibrillation (AF) persisting after mitral valve surgery reduces survival due to heart failure and thrombo-embolisms and impairs quality of life. Restoration of the sinus rhythm might lead to a lower incidence of thrombo-embolism and valve-related complications in the postoperative period.Methods: This non-randomized prospective study was carried out between period April 2015 to December 2018 in the Department of Cardiothoracic and Vascular Surgery, Government General hospital, Guntur, Andhra Pradesh, India. A total of 80 patients underwent mitral valve replacement during the study period. 50 patients out of these were with atrial fibrillation and were part of this study, who underwent mitral valve replacement.Results: All fifty patients were in atrial fibrillation based on clinical examination and the echocardiogram. 13 patients preoperatively were in atrial fibrillation with fast ventricular rate. These patients were placed on antiarrhythmic drugs to control the ventricular rate prior to mitral valve replacement. After surgery twenty out of fifty (40%) patients reverted to NSR and maintained the same rhythm till the 6 months of follow-up. Twenty-nine (58%) patients continued in atrial fibrillation after surgery.Conclusions: The results of the present study showed that preoperative atrial rhythm strongly determines postoperative rhythm. In view of the promising results of combined mitral valve and anti-atrial fibrillation surgery, the inescapable conclusion is that the anti-arrhythmic procedure should be offered routinely to all patients with a history of preoperative AF.

Reversal of Left Ventricular Functions in Chronic Mitral Regurgitation after Mitral Valve Replacement.

Mitral valve regurgitation leads to deterioration of left ventricular functions if not treated early. We aimed to study the effect of mitral valve replacement on normalization of ejection fraction, remodeling of left ventricular dimensions, and left atrial reduction in patients with chronic mitral regurgitation. Between December 2012 and August 2014, 45 patients with chronic mitral regurgitation underwent isolated mitral valve replacement. None of the patients had any other severe valvular or concomitant disease or severe coronary heart disease. The patients were evaluated by echocardiography (preoperative, 1-week, and 1-year postoperative). The results were statistically analyzed by paired t test. Forty-five patients who underwent mitral valve replacement in our hospital were included in the study. The group comprised 20 men and 25 women; the mean age was 31.8 ± 6.76 years. The mean left ventricular ejection fraction was 61.09 ± 7.6 and decreased significantly to 59.04 ± 6.65 and 59.67 ± 6.56, 1-week and 1-year postoperative follow up, respectively. The left atrium showed significant reduction in size (4 ± 0.54 cm) at 1-year postoperative follow up, from (4.51 ± 0.57 cm) one-week postoperative, and from (5.55 ± 0.88 cm) preoperatively. The mean left ventricular end systolic diameter significantly decreased from 4.06 ± 0.65 cm preoperatively to 3.4 ± 0.4 cm, 1-week postoperative (P = .01), and also decreased significantly to 3.45 ± 0.51 cm at 1-year follow up postoperatively, but was higher than that at 1-week follow up. Also, the mean left ventricular end diastolic diameter decreased significantly during periods of follow up (P &lt; .001). Reversal of left ventricular functions and reduction of left-sided chamber dimensions are possible if early mitral valve replacement is considered in chronic mitral regurgitation before worsening of the condition.

Forensic Sciences and Growth of Cardiology

th century. Harvey’s discovery was made possible by the lift of ban on medical autopsies. Harvey was a pioneer in recognizing that clinic-pathologic correlations from postmortem findings are pivotal in gaining anatomical knowledge and recognizing the basis of clinical symptoms and signs. Andreas Vesalius, a predecessor of Harvey had noted marked differences between Galen’s teaching and the real anatomy from observations in dissected human bodies. He traced the elaborate network of the blood vessels and accurately described the anatomy of the heart [1]. The significance of the approach of these two path finders is evident from the observations that over centuries, there has been no significant decrease in the rate of unexpected findings detected in either medico-legal autopsies or postmortem studies on patients dying from natural causes in hospitals [2,3]. Autopsy studies have contributed immensely to our understanding of the anatomical basis of a number of heart diseases. A large number of heart diseases such as myocarditis, and carcinoid heart disease were first described during autopsies. Several infections that are not diagnosed clinically have been detected at autopsy for the first time as causes for cardiac symptoms and signs [4]. We recognize at present that influenza and pneumonia can trigger acute vascular events and increase the risk of myocardial infection. Studies have linked pre-eclampsia, a major cause of death due to vascular factors to maternal infection. It was through autopsy studies that Chaga’s disease was recognized as a cause for cardiomyopathy as well as for sudden death in patients with asymptomatic infection with T. Cruzi [5,6]. Pathological features of another tropical problem rheumatic heart disease were clarified through post-mortem observations. Autopsy studies aided in understanding the pathogenesis of chronic valve disease, effects of mitral valve replacement and valve repair as well as the causes for failure of such treatment in patients with rheumatic valve disease. Complex congenital heart diseases such as tetralogy of Fallot, transposition of the great vessels, tricuspid atresia, hypoplastic left heart syndrome, coarctation of the aorta, hypoplastic right heart syndrome, anomalous position of the heart, endocardial cushion defects and tricuspid valve dysplasias have all been characterized during postmortem examinations [7,8]. Post mortem studies on adults with congenital heart diseases and who have underwent surgical corrections could provide novel information and guidance for revision of present approaches to management of patients with congenital heart defects [9].

Effect of mitral valve replacement on reduction of left atrial size

asymptomatic left atrial enlargement is not uncommon in rheumatic mitral valve disease. We studied the change in size of the left atrium after mitral valve replacement. between January and December 2005, 116 patients underwent isolated mitral valve replacement. Two groups were identified based on left atrial size: group 1 < 60 mm (n = 79) and group 2 > 60 mm (n = 37). The patients were followed up for 40.4 ± 19.3 months Clinical assessment, preoperative and last postoperative echocardiograms were considered for analysis. the left atrium decreased by 5.84 mm ± 10.5 in group 1 compared to 20.9 mm ± 10.64 in group 2 (p = 0.0001). This correlated with preoperative mitral valve area (p = 0.009), preoperative mitral regurgitation (p = 0.000), and preoperative atrial fibrillation (p = 0.022). Linear regression analysis revealed atrial fibrillation (p = 0.001, b1 = 6.006), a high grade of mitral regurgitation (p = 0.001, b1 = -3.812), and larger size of the left atrium (p = 0.000, b1 = -0.701) predicted a greater reduction of left atrial size during follow-up. Left atrial size decreased by 28 mm in patients with a preoperative left atrium >60 mm (75% sensitivity and 100% specificity). the asymptomatic left atrium reduces in size considerably after mitral valve replacement, and the decrease is greater in patients with a left atrium >60 mm in size.

Effect of mitral valve replacement with unipolar radiofrequency ablation of atrial fibrillation

Effect of mitral valve replacement with unipolar radiofrequency ablation of atrial fibrillation

World Health Organization Pulmonary Hypertension Group 2: Pulmonary hypertension due to left heart disease in the adult—a summary statement from the Pulmonary Hypertension Council of the International Society for Heart and Lung Transplantation

Pulmonary hypertension associated with left heart disease is the most common form of pulmonary hypertension encountered in clinical practice today. Although frequently a target of therapy, its pathophysiology remains poorly understood and its treatment remains undefined. Pulmonary hypertension in the context of left heart disease is a marker of worse prognosis and disease severity, but whether its primary treatment is beneficial or harmful is unknown. An important step to the future study of this important clinical problem will be to standardize definitions across disciplines to facilitate an evidence base that is interpretable and applicable to clinical practice. In this current statement, we provide an extensive review and interpretation of the current available literature to guide current practice and future investigation. At the request of the Pulmonary Hypertension (PH) Council of the International Society for Heart and Lung Transplantation (ISHLT), a writing group was assembled and tasked to put forth this document as described above. The review process was facilitated through the peer review process of the Journal of Heart and Lung Transplantation and ultimately endorsed by the leadership of the ISHLT PH Council.

Left atrial function, cytokines and soluble apoptotic markers in mitral stenosis: effects of valvular replacement

Background: Patients with mitral stenosis (MS) and heart failure (HF) are characterized by changes in the left atrial (LA) function and activation of the apoptotic process. The purpose of the present study was the evaluation of the effect of mitral valve replacement on the LA function, on inflammatory process and apoptotic markers in patients with MS and HF. Methods: We studied 30 patients with MS and HF (15 in NYHA III–IV and 15 in NYHA IV) in sinus rhythm (mean age 56.2±4.6 years), and 20 age and gender matched healthy volunteers. Blood samples were obtained before and 6 months after surgical mitral valve replacement, and plasma levels of soluble Fas/APO-1 receptor (sFas), tumor necrosis factor-alpha (TNF-a) and interleukin-6 (IL-6) were measured. Echocardiographically, LA volumes were measured at mitral valve opening (Vmax), at the onset of left atrial systole (P wave of the electrocardiogram, Vp) and at the mitral valve closure (Vmin). LA contractile function was assessed by the LA active emptying fraction (ACTEF). Results: After mitral valve replacement, TNF-a, IL-6 and sFas levels, as well as the Vmax LA volume, were significantly reduced ( p<0.05). ACTEF showed a significant postoperative decrease (0.29±0.09 vs. 0.23±0.06, p<0.01) and it was significantly correlated with sFas ( r=−0.88, p=0.001), TNF-a ( r=−0.81, p=0.001) and IL-6 ( r=−0.74, p=0.001) levels. Conclusion: The present findings indicate that mitral valve replacement in patients with mitral valve stenosis, reduces the size of the left atrium, improves left atrial contractile function and depresses inflammatory and apoptotic process.

The effects of mitral valve replacement with or without preservation of subvalvular apparatus on postoperative left ventricular function Xianhong Shu, Cuizhen Pan, Xuedong Shen, Ang Yu, Guoqian Huang. Zhongshan Hospital of Fudan University Medical Center, Shanghai, People's Republic of China, Shanghai Institute of Cardiovascular Diseases, Shanghai, People's Republic of China

The effects of mitral valve replacement with or without preservation of subvalvular apparatus on postoperative left ventricular function Xianhong Shu, Cuizhen Pan, Xuedong Shen, Ang Yu, Guoqian Huang. Zhongshan Hospital of Fudan University Medical Center, Shanghai, People's Republic of China, Shanghai Institute of Cardiovascular Diseases, Shanghai, People's Republic of China

Immediate effects of mitral valve replacement on left ventricular function and its determinants

Immediate effects of mitral valve replacement on left ventricular function and its determinants

Effects of mitral valve replacement on regional left ventricular systolic strain

Background. Mitral valve replacement (MVR) with chordal excision impairs left ventricular (LV) systolic function, but the responsible mechanisms remain incompletely characterized. Loss of normal annular-papillary continuity also adversely affects LV torsional deformation, possibly due to changes in myocardial fiber contraction pattern. Methods. Twenty-seven dogs underwent insertion of LV myocardial markers and a sham procedure (cardiopulmonary bypass, no MVR, n = 6), conventional MVR with chordae tendineae excision (n = 7), or chordal-sparing MVR with reattachment of the anterior leaflet chordae to the anterior annulus (n = 7) or to the posterior annulus (n = 7). In the anterior, lateral, posterior, and septal LV regions, linear chords were constructed from each region’s central marker to its surrounding markers. Percent systolic shortening (regional LV strain) was calculated for each chord, and the chords were assigned to one of four angular groups: I, left-handed oblique (subepicardial fiber direction); II, circumferential (midwall); III, right-handed oblique (subendocardial); or IV, longitudinal. Regional LV strain data were compared before and after MVR. Results. Sham and anterior chordal-sparing MVR had minimal effects on regional LV strain. With posterior chordal-sparing MVR: anteriorly, left-oblique (I) strain fell (31%, p < 0.05), as did circumferential (II) and right-oblique (III) strains (by 49% and 51%, respectively; p < 0.01). Laterally, left-oblique (I) strain fell by 36% ( p < 0.05), as did longitudinal (IV) strain (54% decline, p < 0.01). Conventional MVR with chordal excision disrupted regional fiber shortening diffusely, affecting oblique fibers (I and III) in the anterior and septal regions and impairing longitudinal (IV) strain in all regions (45% to 68% fall, p < 0.05). Conclusions. Sham and anterior chordal-sparing MVR did not substantially alter regional LV strain; however, loss of normal anatomic valvular-ventricular integrity (conventional MVR) or posterior chordal-sparing MVR resulted in pronounced alterations in LV strain, most notably in the longitudinal and oblique fiber directions. These findings demonstrate that the deleterious effects of chordal excision are associated with perturbed internal myocardial systolic deformation, which suggests that chordal disruption distorts myofiber architecture or regional systolic loading.

The effect of mitral valve replacement with preservation of mitral complex on left ventricular function in mitral regurgitation

The effect of mitral valve replacement with preservation of mitral complex on left ventricular function in mitral regurgitation

Chronic mitral regurgitation: Predictive value of preoperative echocardiographic indexes of left ventricular function and wall stress

The effect of mitral valve replacement on left ventricular volume, mass, function and clinical symptoms was examined in 20 patients with chronic mitral regurgitation. Pre- and postoperative echocardiograms demonstrated that two outcomes could be defined. Left ventricular dimension at end-diastole was reduced to normal postoperatively in the 16 Group I patients, but was unchanged in the 4 Group II patients. The Group I response was associated with a dramatic reduction in left ventricular mass and a decrease in clinical symptoms; all 16 patients reached New York Heart Association functional class I. No change in left ventricular mass was seen in the Group II patients and all four remained symptomatic despite continued medical therapy. Examination of the preoperative echocardiographic measurements indicates that these data have significant prognostic value in predicting surgical outcome. When ventricular dimension at end-systole exceeds 2.6 cm/m2 or fractional shortening is less than 31% or end-systolic wall stress index exceeds 195 mm Hg, all Group II patients are identified and there are no false positive results in Group I. It is concluded that echocardiographic measurements of left ventricular size, function and wall stress can provide important prognostic information in patients with chronic mitral regurgitation. Such data may allow improved patient selection and a better definition of an optimal time for mitral valve replacement.

Effect of mitral valve replacement on left ventricular function in mitral regurgitation.

To evaluate the effect of mitral valve replacement on left ventricular function in mitral regurgitation, we measured (1) the end-systolic stress/volume ratio, which is practically independent of changes in loading conditions, and (2) the left ventricular contractile reserves upon isometric exercise, both before and one year after mitral valve replacement in 11 patients with mitral regurgitation. The end-systolic stress/volume ratio increased, though the ejection fraction decreased after mitral valve replacement. The ejection fraction decreased and the end-systolic stress/volume ratio remained unchanged during isometric exercise before operation, whereas afterwards the ejection fraction remained unchanged and the end-systolic stress/volume ratio increased during exercise. Ventricular function improves after mitral valve replacement in patients with mitral regurgitation, though the ejection fraction, which is affected by altered loading conditions, deteriorates. The left ventricular response to stress caused by isometric exercise is also improved after surgery.

Rheumatic mitral insufficiency in children: Course, prognosis and effect of mitral valve replacement

When the heart is involved as a result of rheumatic fever in children, mitral insufficiency is the most common lesion. Significant mitral stenosis, though it does occur, is not common in this age group. Twenty-eight children with rheumatic mitral insufficiency were divided into 3 groups of severity according to symptoms and heart size. Cardiac volume index and cardiothoracic ratio were compared as indexes of heart size in these patients. The course and prognosis were studied in each group by using cardiac volume index, cardiothoracic ratio, electrocardiographic, phonocardiographic, hemodynamic and clinical data as parameters of severity. In severe cases the course is one of progressive deterioration with development of atrial fibrillation or left atrial and right ventricular hypertension, or both. This course was illustrated by 8 fatal cases, death occurring between 11.5 and 15.5 years of age. In 2 patients the mitral valve was replaced by a Starr-Edwards valve. The patients are surviving and well, 12 and 17 months later. Guides are suggested for the selection of patients with mitral insufficiency for mitral valve surgery.

EFFECTS OF MITRAL-VALVE REPLACEMENT ON THE PULMONARY VASCULAR DYNAMICS OF PATIENTS WITH PULMONARY HYPERTENSION.

THE development of an elevation of the pulmonary vascular resistance is a common complication of severe mitral-valve disease, and this abnormality has been attributed to a combination of obliterative changes in the pulmonary vascular bed and pulmonary vasoconstriction.1 2 3 In many patients the elevation of pulmonary vascular resistance is extreme and constitutes the major hemodynamic burden faced by the right ventricle.4 Under these circumstances the secondary changes in the pulmonary vascular bed become primarily responsible for many of the clinical findings, including ventricular failure. In view of these considerations determination of the extent to which these abnormalities in the pulmonary circulation . . .