Hammock Mitral Valve Research Articles

Moderate Mitral Regurgitation Secondary to Hammock Congenital Mitral Valve Disease

A 30-year-old woman with a history of systemic lupus erythematosus and hypothyroidism . She started with dyspnea on moderate exertion, orthopnea, and a sensation of palpitations an early systolic murmur of mitral regurgitation was found. Transthoracic and transesophageal echocardiography reported hammock congenital mitral valve disease as a cause of mitral regurgitation with impaired functional class, requiring surgical valve replacement. The mitral arcade, or hammock mitral valve, is a very rare entity, even more so in the adult population, with a reported prevalence of 0.5%. It is characterized by abnormal papillary muscles connected directly to the anterior mitral.

A rare coexistence: Hammock mitral valve and aortopulmonary window.

Congenital mitral stenosis is a broad-spectrum pathology in which blood flow to the left ventricle is obstructed both functionally and anatomically. Hammock mitral valve, also known as anomalous mitral arcade, is a rare congenital anomaly particularly in infants and children. Hammock mitral valve may not be suitable for repair regarding the advanced dysplastic mitral valve structure. Aortopulmonary window is an unusual cardiac anomaly which is defined as a communication between the main pulmonary artery and the ascending aorta. As a result of the excessive left-to-right shunt, early intervention and surgical closure deemed mandatory to avoid development of severe pulmonary hypertension and its consequences. All patients with an aortopulmonary window necessitates prompt repair immediately. In this brief report, mitral valve replacement with a mechanical valve and repair of aortopulmonary window with a Dacron patch were performed simultaneously in a 5-month-old patient with a hammock mitral valve and accompanying aortopulmonary window.

Evaluation of midterm outcomes after Shone's complex surgery: Analysis of reoperation and mortality risk factors

The midterm results of patients who underwent biventricular repair surgery for Shone's complex were examined, and mortality and reoperation risk factors were evaluated. This retrospective study included 34 patients with Shone's complex who underwent mitral valve (MV) surgery between 2005 and 2020. A total of 19 patients (56%) had coarctation, 10 (29%) patients had subaortic stenosis, 9 (26.5%) patients had a hypoplastic aortic arch (AA), and 9 (26.5%) patients had aortic valve (AV) stenosis. Twenty-four (70.6%) patients had bileaflet AV. Associated left-sided in-flow stenotic lesions included parachute MV in 19 (56%) patients and supramitral ring in 18 (53%) patients. The estimated freedom from reoperation rate on the 6th month, 1 year and 2 years after surgery was 84.4%, 79.5%, and 71.5%, respectively. The overall mortality rate was 20.6% (seven patients) with a median follow-up of 10 months (0-41). The estimated survival rate on the 6th month, 1 year, and 3 years after surgery was 83.8%, 79.4%, and 79.4 respectively. Bicuspid aortic valve (p = .017) (HR (95% CI) = 0.130 (0.025-0.695) and hammock mitral valve (p = .038) (HR (95% CI) = 11,008 (1,146->100) were associated with mortality. The presence of a bicuspid aortic valve hammock mitral valve might have an effect on negative effect on the outcome.

Hammock mitral valve anomaly with patent ductus arteriosus in an adult patient.

Hammock mitral valve anomaly with patent ductus arteriosus in an adult patient.

P1720 Hammock mitral valve, a challenging echocardiographic diagnosis

Abstract We report a 43 year-old female with a past TTE echocardiography of rheumatic valve disease performed in her district hospital , ( No clear symptomatology of rheumatic fever in the past). She was transferred to our tertiary hospital for elective cardiac surgery. Preoperative echocardiogram showed a non-dilated left ventricle with preserved contractility, mild-moderate left atrium enlargement with severe mitral regurgitation and basal displacement of papillary muscles and severe tricuspid regurgitation.All of it resembling a hammock mitral valve instead of former echocardiogram described as rheumatic valve disease. Preoperative cardiac study showed severe pulmonary hypertension with increased pulmonary vascular resistances. Preserved biventricular cardiac output and increased proto and telesystolic pressures. During surgery , ifindings were described as a mitral valve with a large papillary muscle inserted in the distal third of the left ventricle with none tendinous cords at the anterior leaflet and without cords in the posterior leaflet with an isolated papillary muscle with cords at A3 and P3 scallops, compatible with hammock mitral valve. A tendinous muscle/fibrous or fibromuscular band connecting the septum to the posterior wall of the left ventricle was described. Moreover over, there was an enlarged tricuspid ring with very short tendinous cords on the septal leaflet, although the leaflet was bigger than usual. Surgery consisted of resection of the mitral valve preserving A3 and P3 scallops with a 29mm Bicarbon Sorin mechanical mitral prosthesis and a 32mm Carpentier tricuspid ring implantation and pulmonary veins ablation combined with occlusion of left atrial appendage. After 112 minutes of cross-clamping time, the patient was weaned from cardiopulmonary bypass. She had important left ventricle dysfunction which improved with dobutamine and AAI pacemaker at 90lpm. Postoperative TEE showed moderate dysfunction of right ventricle, mild left ventricular dysfunction, moderate tricuspid regurgitation and a good functioning of the prosthesis. TTE before discharge showed good function of mitral valve prosthesis, good left ventricle function, mild tricuspid regurgitation, mild-moderate right ventricular enlargement, although less than preoperatively. Conclusion Congenital mitral valulophaty is a rare condition in the adulthood. The estimated prevalence is 0,5%. The hammock mitral valve is a more uncommon pathology which affects the mitral valve and subvalvular apparatus. This anomaly, was first described in 1967 and it is characterised by anomalous papillary muscles directly connected to the anterior mitral valve by a fibrous bridge without chordae tendineae in between them. This fibrous bridge hampers the opening and closure of the mitral valve. Diagnosis requires a high index of suspicion, both ultrasound studies and medical history, to avoid misdiagnosis. Abstract P1720 Figure.

89 Simultaneous ocurrence of hammock mitral valve and no-compaction cardiomyopathy

Abstract We report a 62-year-old man with a past medical history of dyslipidemia, paranoid schizophrenia and permanent atrial fibrillation. A ATTE performed at his district hospital revealed rheumatic mitral valve disease with double lesion: severe regurgitation and mild stenosis, plus moderate tricuspid regurgitation and a mean PAP of 32mm Hg. Cardiac catheterization showed no abnormalities of the coronary arteries. He was transferred to our hospital and scheduled for mitral valve replacement and tricuspid ring valvuloplasty. Preoperative transesophageal echocardiography showed an abnormal subvalvular mitral apparatus, with false tendons and multiple papillary muscles, resembling a hammock mitral valve. Most cordae tendinae arose from a single dominant papillary muscle at a posterior medial region, which provoke severe mitral regurgitation due to coaptation defect and mild subvalvular mitral stenosis. It could also be appreciated hypertrabeculation in the lateral medial, basal and apical segments. This suggested no-compaction cardiomyopathy associated with hammock mitral valve. Left ventricular systolic function was preserved. No evidence of rheumatic mitral valve disease was found in transesophageal echocardiographic study performed at our hospital. On the 30th April 2019 he underwent mechanic mitral valve replacement (Bicarbon 29mm) and tricuspid ring valvuloplasty (Edwards Physio 32mm) surgery. Once the patient was weaned from cardiopulmonary bypass, severe left ventricle systolic dysfunction ensued, predominantly localized in the anterior, inferior septal, inferior lateral basal and medial segments. Apical segments had preserved mobility An adrenalin infusion prior weaning from CBP was initiated. Preserved mobility of the mitral prosthesis discs was observed. The patient developed cardiogenic shock in spite of high doses of dobutamin and adrenaline infused. IACB was implanted with 1:1 assistance. The patient was transfered to the hemodynamic room in order to rule out coronary complications. Cardiac catheterization showed no significant angiographic lesions. During the first postoperative hours, the patient was stabilized allowing progressive lowering of the drugs (adrenaline, dobutamine). TTE showed normally functioning prosthetic mitral valve and preserved left ventricle systolic function. An MRI was performed demostrating no-compaction cardiomyopathy Conclusion This case report describes a rare presentation of simultaneous ocurrence of hammock mitral valve and no-compaction cardiomyopathy. Perioperative left ventricle dysfunction in no-compaction cardiomyopathy is related to subendocardial ischemia caused during extracorporeal circulation in the multiple prominent ventricular trabeculations with deep intertrabecular recesses corresponding to non-compacted myocardium .This must be taken account in those patients with no-compaction cardiomyopathy scheduled for cardiac surgery in order to take preventive measures. Abstract 89 Figure. non - compacted myocardium

Reemplazo valvular mitral en los primeros 5 años de vida

Introduction and objectivesReconstructive surgery is considered the main objective in patients with congenital malformations of the mitral valve. However, in patients with severely dysplastic valves, mitral valve replacement is considered the only option.The purpose of this study is to evaluate results in the short and medium term of mitral valve replacement with mechanical prosthesis in the first 5 years of life. MethodsData was collected on 15 patients less than 5 years of age, who underwent mitral valve replacement in our hospital between 2003 and 2012. ResultsThe mean age was 21.5months and mean weight 8.2kg. A total of 53% of the patients presented with symptoms before 6months of age. Parachute mitral valve was the most frequent type of malformation (33%), followed by hammock mitral valve (26%). In 80% of the cases mitral valve repair was unsuccessful. The most frequent used prosthesis was St. Jude Medical® No.23. The mean follow-up time was 47.9 months. As for complications, a permanent pacemaker was implanted in one patient, another patient had gastrointestinal bleeding due to anticoagulation, and another patient required another mitral valve replacement after 3years and 4months. Hospital mortality was 6.6%. ConclusionsMitral valve replacement in children less than 5years of age involves high risks. In our experience, the medium term results are satisfactory.

Hammock mitral valve: A rare case report

Congenital mitral stenosis is a relatively rare disorder comprising 0.2% of all congenital heart defects. Hammock mitral valve producing severe mitral stenosis is a rare variant of congenital mitral stenosis. We report a 2-year-old boy who had hammock mitral valve producing severe mitral stenosis with severe pulmonary artery hypertension. He underwent successful surgical repair. Post-surgery, the mitral valve opening was adequate without residual stenosis or regurgitation. Pulmonary artery pressure had normalized. Follow-up data showed he had significant clinical and echocardiography improvement. This is the first reported case of successful surgical repair done for hammock mitral valve from our institute.

Hammock mitral valve as a cause of atrial flutter: Three months old infant case

Hammock mitral valve is a very rare congenital valve disorder It may lead to mitral stenosis or insufficiency in the pediatric age group These patients generally present with the symptoms of congestive heart failure or sometimes sudden death may occur Our case was a 3 month old female infant who presented to our clinic with the symptoms of heart failure Her cardiac evaluation revealed hammock mitral valve left atrial dilatation severe mitral valve insufficiency and atrial flutter In contrast to adult patients atrial flutter is a very rare type of cardiac aryhtmia in the pediatric age group We present this case because no such case with atrial flutter resulting from hammock mitral valve has been reported in the literature Turk Arch Ped 2013; 48: 244 247

Hammock mitral valve in an adult patient

We describe a case of hammock mitral valve in an adult. A 38-year-old woman presented with recently acquired dyspnea. Echocardiography showed severe mitral stenosis related to a hammock mitral valve characterized by the presence of an overdeveloped papillary muscle that gives short chordae to both mitral leaflets. No other valve insufficiency was noted. At operation, we observed direct continuity accompanying several fenestrations between both leaflets and the huge abnormal muscular band just underneath the mural leaflet. Resection of the anterior leaflet and was successfully replaced with a bioprosthetic valve. Her postoperative course was unremarkable.

Mitral Valve Repair for Congenital Mitral Valve Stenosis in the Pediatric Population

Mitral valve repair is the preferred approach for congenital mitral valve stenosis in children. However, repairs in this population remain challenging. From 2001 to 2009, mitral valve repair was attempted in 20 consecutive congenital mitral valve stenosis patients. The median age and body weight at operation were 1.4 +/- 1.9 years and 7.4 +/- 4.1 kg, respectively. Multiple level left-side heart obstruction was present in 14 patients (70%). Moderate or more mitral insufficiency was present in 5 patients. The main etiology of the stenosis was valvular in 5 patients, supravalvular mitral ring in 4, single or predominant papillary muscle in 9, and hammock mitral valve in 2. Freedom from hospital death or transplantation was 85% (17 of 20). Two patients required replacement before discharge. In the 15 successfully repaired patients, mean mitral valve inflow pressure gradient improved from 13.9 +/- 2.7 mm Hg to 5.5 +/- 1.6 mm Hg (p < 0.0001). There were no late deaths at a mean follow-up of 46 +/- 31 months (range, 6.3 to 98.5). One patient required a second repair, and no patient has required replacement. At the last follow-up, mean mitral valve inflow pressure gradient was 7.5 +/- 4.1 mm Hg, and moderate or more mitral insufficiency was detected in 2 patients. Mitral valve repair for congenital mitral valve stenosis can be performed in this challenging population of patients with good early survival and freedom from transplantation. Conditional follow-up for successfully repaired patients demonstrates preserved mitral valve function without need for replacement.

Hammock mitral valve and modified Paneth plasty

Fig. 2. Completion of modified Paneth plasty with 3-0 Prolene (polypropylene monofilament) sutures. The patient underwent modified Paneth suture plasty, in which two double-armed 3-0 Prolene sutures were anchored at each fibrous trigone, and each second running suture was placed around the first simple running suture already placed on both halves of the posterior mitral annulus. A 23-mm sizer was able to pass through the mitral valve. Intra-operative transoesophageal echocardiography revealed no mitral regurgitation, no mitral stenosis and no left ventricular outflow tract obstruction after valve repair.

Mitral Valve Replacement in “Complex” Mitral Insufficiency: An Unusual Case of an Isolated Hammock Mitral Valve

The hammock mitral valve is a rare congenital abnormality resulting in mitral regurgitation or stenosis, with incidences ranging from 0% to 12% in pediatric surgical series. It is difficult to correct this condition by reconstructive techniques. We describe here an alone hammock valve without any cardiac malformation in a five-year-old patient who underwent mitral valve replacement.

Functional classification dictates type of repair in “complex” mitral insufficiency: Application to a case of a hammock mitral valve in an adult patient

Functional classification dictates type of repair in “complex” mitral insufficiency: Application to a case of a hammock mitral valve in an adult patient

Repair of congenital malformations of the mitral valve: early and midterm results

Background. The aims of this study were to determine early and midterm survival and freedom from reoperation, and to identify the predictors for poor postoperative outcome in children undergoing mitral valve (MV) repair owing to congenital malformations of the mitral valve. Methods. Between January 1990 and February 2001, 94 consecutive children with congenital MV disease underwent valve repair. The mean age was 5.2 ± 3.3 years (range 20 days to 15 years). Twenty-five (26.6%) children were less than 1 year old. Isolated MV disease was found in 21 (22.4%) patients. MV stenosis was the predominant lesion in 21 (22.4%) patients with a mean left atrial to left ventricle diastolic peak gradient of 24.5 ± 9.2 mm Hg. MV regurgitation was the predominant pathophysiology in 73 (77.6%) patients with a mean regurgitation grade of 3.3 ± 0.7. Results. The hospital mortality was 8.5% (8 of 94). Three patients required permanent pacemaker implantation owing to complete atrioventricular block. Two patients underwent mediastinal exploration for significant bleeding. Postoperatively the echocardiography color Doppler study demonstrated a significantly lower mean end diastolic left atrium to left ventricle gradient 8.7 ± 2.2 mm Hg ( p < 0.001) in patients with MV stenosis and a mean regurgitation grade of 0.9 ± 0.6 ( p < 0.001) in patients with MV regurgitation. Actuarial survival and actuarial reoperation-free survival were 89.2% and 76.3%, respectively. Multivariate analysis demonstrated that age less than 1 year ( p = 0.035), hammock MV ( p = 0.0093), cardiothoracic ratio greater than 0.6 ( p < 0.0001), and associated cardiac anomalies ( p = 0.003) were strong predictors for poor overall freedom from reoperation and midterm survival. Conclusions. Mitral valve repair for congenital mitral valve disease yields acceptable early and midterm mortality and reoperation rates. Strong predictors for poor overall freedom from reoperation and midterm survival were age less than 1 year, hammock MV, cardiothoracic ratio greater than 0.6, and associated cardiac anomalies.

Surgical treatment of congenital mitral valvar stenosis: “The Hôpital Broussais” experience

AbstractLesions producing congenital mitral valvar stenosis are complex and often multiple, From 1970 to 1994, 58 patients under 12 years of age (mean 5 ± 3.2 y) underwent surgical treatment for such malformations in our department. In order to provide a clear understanding of the pathology, we used a classification based on anatomy and function. Echocardiography was a major tool of the preoperative investigations. The lesions were classified as follows:Normal papillary muscles: commissural fusion in 19, excess leaflet tissue in 2, valvar ring in 12, and annular hypolasia in 2.Abnormal papillary muscles: paachute arrangement in 10 and hammock mitral valve in 13.Associated malformations were found in 63%, the most common being multiple stenosis in the left heart. Conservative treatment was possible in 54 patients (95%) using the techniques developed by Carpentier. Hospital mortality was 22%, with 95% confident limits between 13 and 36% (13/58). Of the 13 patients with a hammock valve, 6 died in hospital. The overall mean period of follow up was 7.8 + 5 years. No thromboembolic events occured after conservative surgery. Late death occured in 3%. The actuarial survival at 5 years was 64 + 15%. Reoperation was needed for residual mitral valvar stenosis in three patients or insufficiency in one.In spite of effective techniques to relieve mitral obstruction, 12% of our patients need early or delayed replacement of the valve. The hospital mortality remains high due to the complexity of the lesions, associated with the associated malformations. Echocardiography proved to be extremly helpful for the functional analysis. In order to improve operative results, simple and early valvar repair, even if considered palliative, seems to be appropriate.

Surgery for congenital mitral valve disease in the first year of life

Between 1980 and 1993, 20 patients less than 1 year of age underwent operations for congenital mitral valve disease. Ten patients had congenital mitral incompetence and 10 had congenital mitral stenosis. Mean age was 6.6 ± 3.4 months and mean weight was 5.6 ± 1.5 kg. Atrioventricular canal defects, univentricular heart, class III/IV hypoplastic left heart syndrome, discordant atrioventricular and ventriculoarterial connections, and acquired mitral valve disease were excluded. Indications for operation were intractable heart failure or severe pulmonary hypertension, or both. Associated lesions, present in 90% of the patients, had been corrected by a previous operation in seven. In congenital mitral incompetence there was normal leaflet motion ( n = 3), leaflet prolapse ( n = 2), and restricted leaflet motion ( n = 5). In congenital mitral stenosis anatomic abnormalities were parachute mitral valve ( n = 4), typical mitral stenosis ( n = 3), hammock mitral valve (n = 2), and supramitral ring ( n = 1). Mitral valve repair was initially performed in 19 patients and valve replacement in one with hammock valve. Concurrent repair of associated lesions was performed in 12 patients. The operative mortality rate was zero. There were six early reoperations in five patients for mitral valve replacement ( n = 4), a second repair ( n = 1), and prosthetic valve thrombectomy ( n = 1). One late death occurred 9 months after valve replacement. Late reoperations for mitral valve replacement ( n = 2), aortic valve replacement ( n = 1), mitral valve repair ( n = 2), subaortic stenosis resection ( n = 1), and second mitral valve replacement ( n = 1) were performed in five patients. Actuarial freedom from reoperation is 58.0% ± 11.3% (70% confidence limits 46.9% to 68.9%) at 7 years. After a mean follow-up of 67.6 ± 42.8 months, 94% of living patients are in New York Heart Association class I. Doppler echocardiographic studies among the 13 patients with a native mitral valve show mitral incompetence of greater than moderate degree in one patient and no significant residual mitral stenosis. Overall, six patients have mitral prosthetic valves with a mean transprosthetic gradient of 6.2 ± 3.7 mm Hg. These results show that surgical treatment for congenital mitral valve disease in the first year of life can be performed with low mortality. Valve repair is a realistic goal in about 70% of patients and possibly more with increased experience. Reoperation rate is still high and is related to complexity of mitral lesions and associated anomalies, but late functional results are encouraging. (J T horac C ardiovasc S urg 1995;109:164-74)