Prosthetic Mitral Valve Dysfunction Research Articles

A challenging case of prosthetic mitral valve dysfunction: the value of multimodality imaging.

A challenging case of prosthetic mitral valve dysfunction: the value of multimodality imaging.

An Early Prosthetic Valve Endocarditis in Presence of COVID-19-Associated Pneumonia

Introduction. Coronavirus disease (COVID-19)-associated pneumonia was a dangerous disease at the beginning of 2021. However, there are almost no records of early infectious endocarditis of prosthetic heart valve in the presence of such a disease. We present an interesting clinical case of successful treatment of complicated pathology.
 The COVID-19 outbreak involved unique clinical complications that were superimposed on the progressive heart failure due to prosthetic mitral valve dysfunction (its detachment) which did not allow time for active antiinflammatory therapy. Urgent replacement of the prosthesis made it possible to eliminate the infection and paved the way for successful long-term antibacterial, antifungal and antiviral therapy.
 The aim. To determine the features of management of patients with complex clinical pathology: prosthetic valve endocarditis associated with COVID-19 and severe lung inflammation in the early postoperative period.
 Case report. This work presents rare clinical case. A 46-year old male patient underwent successful surgery (mitral valve replacement with posterior leaflet preservation and left atrium resection) at the Department of Surgical Treatment of Acquired Heart Diseases of the National Amosov Institute of Cardiovascular Surgery and was discharged in satisfactory condition. One month later, he was hospitalized again and diagnosed with an early infectious endocarditis of prosthetic mitral valve and bilateral polysegmental COVID-19-associated pneumonia. After a week of medicinal preparation (antibacterial therapy), the patient underwent repeat mitral valve replacement in the presence of progressive heart insufficiency due to increasing paravalvular insufficiency. Postoperative period elapsed without significant complications. The patient was discharged in satisfactory condition on day 15 after surgery and primary rehabilitation.
 Conclusion. Having a specific etiology, pneumonia significantly damaged mitral prosthesis structures by increasing paravalvular insufficiency. Consequently, the patient underwent life-saving repeat mitral valve replacement in the presence of COVID-19-associated pneumonia and under massive antibacterial treatment which continued for 60 days after the patient’s discharge. An important element of successful treatment of COVID-19-associated pneumonia is the selection of adequate antibacterial, antifungal and antiviral drugs.

Focused Transesophageal Echocardiography in Critical Care: The COVID-19 Pandemic.

Background:The use of transesophageal echocardiography (TEE) is controversial in patients with COVID-19. The aim of this case series was to demonstrate the usefulness of transesophageal echocardiography in acute cardiovascular care settings in patients with COVID-19 infection.Materials and Methods:We enrolled 13 patients with confirmed SARS-CoV-2 infection admitted to the critical care unit of our center from April 1, 2020, to July 30, 2020, in which transesophageal echocardiography was performed. TOE was performed by three cardiologists with training in echocardiography.Results:The main indication was suspected infective endocarditis in four cases, venovenous extracorporeal membrane oxygenation cannulation in four cases, suspected prosthetic mitral valve dysfunction in two patients, suspected pulmonary embolism in two patients, and acute right ventricular dysfunction and prone position ventilation in one patient. The final diagnosis was confirmed in 11 patients and discarded in 2 patients. None of the operators result infected.Conclusions:TOE is safe in the context of COVID-19 infection; it must be performed in well-selected cases and in a targeted manner.

Transcatheter Mitral Valve-in-Valve Procedure for Dilated Cardiomyopathy Concomitant with Prosthetic Mitral Valve Dysfunction in a Heart Transplant Candidate

Transcatheter Mitral Valve-in-Valve Procedure for Dilated Cardiomyopathy Concomitant with Prosthetic Mitral Valve Dysfunction in a Heart Transplant Candidate

Outcome Prediction after Surgical Management of Prosthetic Mitral Valve Dysfunction; a single center experience

Background: Prosthetic Mitral valve dysfunction is a serious complication associated with a high mortality rate particularly in obstructive cases. The number of cases undergoing redo mitral valve surgery is increasing. This study aims to identify the risk factors of mortality and morbidity in patients who underwent redo mitral valve surgery for prosthetic mitral valve dysfunction.
 
 Methods: This study was conducted on 80 patients who underwent re-operation for management of prosthetic mitral valve dysfunction from December 2014 to February 2018. Patients’ age ranged between 21 and 58 years with a mean of 36.8±9.60 years, and 53 patients (66.3%) were males. The causes of mitral valve malfunction were thrombus in 67 patients (83.7%) and pannus in 13 patients (16.3%).
 Results: 53 patients (66.25%) had urgent surgical intervention. Thrombectomy or pannus resection was done in 75 patients (93.75%) and valve replacement in 5 patients (6.25%). Re-exploration was required in 11 patients (13.75%) and was significantly associated with diabetes (p= 0.004), preoperative liver dysfunction (p= 0.04), elevated INR (p= 0.006), trial of thrombolysis (p<0.001) and prolonged ischemic time (p= 0.01). Postoperative renal failure occurred in 11 patients (13.75%) and was associated with diabetes (p< 0.001), preoperative renal dysfunction (p< 0.001), prolonged cardiopulmonary bypass and ischemic times (p< 0.001). 17 patients (21%) required prolonged mechanical ventilation and it was significantly associated with chronic obstructive lung disease (p< 0.001), pulmonary edema (p <0.001), low systolic blood pressure (p <0.001), low ejection fraction (p<0.001) and thrombectomy (p<0.001). Operative mortality occurred in 13 patients (16%) and was significantly associated with preoperative stroke, renal dysfunction, low blood pressure and acute pulmonary edema (p <0.001).
 Conclusion: Reoperation for prosthetic mitral valve dysfunction is associated with high morbidity and mortality. Outcomes can be predicted based on preoperative clinical status and operative times. Thrombectomy and pannus resection with the repair of the paravalvular leak is a simple and easy technique for management of those patients with a reduction of cardiopulmonary bypass and cross-clamp times.

Emergency surgery for prosthetic mitral valve dysfunction: risk factors and technical consideration

Objective Prosthetic mitral valve dysfunction remains a devastating complication in heart surgery. This study aims to assess the risk factors and the technical approaches to reach the best way to deal with and improve the outcome in these patients. Patients and methods Between January 2002 and March 2005, 60 patients underwent emergency reoperation for prosthetic mitral valve dysfunction, where 36 (60%) patients were in New York Heart Association class III, and 24 (40%) patients were in New York Heart Association class IV. There were 33 (55%) male and 27 (45%) female patients. The mean age at operation was 32.4 ± 6.3 years. Nine (15%) patients presented with fever. Hemodynamic status was unstable in 18 (30%) patients. Surgery has been carried out through repeat sternotomy or right anterolateral thoracotomy. Results The 30-day mortality rate was 12 (20%) patients. Analysis of preoperative, intraoperative, and postoperative factors revealed that significant predictors of early mortality were the surgical approach, time until surgical intervention, and depression of left ventricular function. The cause of prosthetic mitral valve malfunction was valve thrombosis in 39 (65%) patients, pannus formation in nine (15%) patients, paravalvular leakage in three (5%) patients, and prosthetic valve endocarditis (PVE) in nine (15%) patients. Right anterolateral thoracotomy (24.3 ± 8.5 min) proved to be faster than median sternotomy (63.1 ± 63 min) from skin incision to on bypass with a significant reduction of intraoperative complications and postoperative wound infections. Conclusion Hospital mortality can be reduced in patients with prosthetic mitral valve dysfunction if the surgery is carried out before cardiac dysfunction develops, with excellent results. Right anterolateral thoracotomy is feasible and safe for selected patients and should be considered whenever repeat median sternotomy could prove to be hazardous especially in the prominent right ventricle and pulmonary hypertension.

The utility of mitral valve index in the detection of prosthetic mitral valve dysfunction

The utility of mitral valve index in the detection of prosthetic mitral valve dysfunction

Mechanical Prosthetic Valve Dysfunction Causing Pulsus Alternans Leading to Intermittent Electromechanical Dissociation: A Case Report and Literature Review

We describe a case of electromechanical dissociation (EMD) in a 62-year-old female patient following insertion of a Medtronic Hall mitral valve prosthesis. She initially developed pulsus alternans which led, over a few hours, to intermittent electromechanical dissociation. Clinical and echocardiographic findings are described. Emergency surgical intervention revealed a piece of chorda wedged between the disc occluder and the valve ring. This case illustrates clinical and Doppler echocardiographic features associated with a rare presentation of an unusual perioperative complication of prosthetic mitral valve dysfunction. We have also included a brief review of related literature.

Prótesis mecánica mitral y cuadros presincopales

The incidence of mitral prosthetic valve thrombosis is low and generally dependent on low levels of anticoagulation. The clinical presentation is highly variable and ranges from asymptomatic patient though to arterial embolism or hemodynamic symptoms of valve obstruction. We report a case of a patient with presyncope and prosthetic mitral valve dysfunction with intermittent flow obstruction.

Cardiac Lymphoma Following Mitral Valve Replacement

A primary cardiac lymphoma was encountered in a patient with prosthetic mitral valve dysfunction. Although rare, this tumor could be related to the presence of prosthetic material and specifically that of Dacron. Primary cardiac tumors have to be considered in the differential diagnosis of prosthetic valve dysfunction.

Peak early diastolic velocity rather than pressure half-time is the best index of mechanical prosthetic mitral valve function

Reliable screening of mechanical prosthetic mitral valve (PMV) dysfunction by transthoracic echocardiography (TTE) is mandatory because transesophageal echocardiography (TEE) cannot be routinely used. However, acoustic shadowing seriously hampers detection of PMV dysfunction with TTE, particularly regurgitation. To identify TTE indexes that can detect PMV dysfunction (regurgitation or obstruction), 134 patients (age 60 ± 12 years, 64 men) with PMV who underwent TTE and TEE within 3 ± 5 days were assessed. There were 73 normal and 61 dysfunctional valves (40 regurgitant, 21 obstructive). By multivariate analysis, peak E velocity was the best predictor of a dysfunctional valve. Both peak E velocity (E ≥1.9 m/s; sensitivity 92%, specificity 78%) and the ratio of velocity-time integrals of flow through the prosthesis to that of the left ventricular outflow (VTI pmv/VTI lvo ≥2.2; sensitivity 91%, specificity 74%) were successful in detecting PMV dysfunction. Although pressure half-time (PHT) readily identified PMV obstruction, it did not detect regurgitation. Logistic models including peak E velocity and VTI pmv/VTI lvo or PHT were equally successful in detecting PMV dysfunction. However, all 3 variables were needed to best distinguish among normal, obstructed, and regurgitant valves. A peak E velocity ≥1.9 m/s and VTI pmv/VTI lvo ratio ≥2.2 predicted valve regurgitation in 83% of valves when PHT was <130 ms, and valve stenosis in 95% when PHT was >130 ms. Importantly, a peak E velocity <1.9 m/s, VTI pmv/VTI lvo ratio <2.2, and a PHT <130 ms had a predictive accuracy for a normal valve of 98%. Thus, TTE Doppler indexes can be used as screening parameters of PMV dysfunction and help select patients for further diagnostic evaluation with TEE.

Cyclic Decrease in Mixed Venous Oxygen Saturation for the Early Diagnosis of Seizure Complications After Cardiac Surgery

Cyclic Decrease in Mixed Venous Oxygen Saturation for the Early Diagnosis of Seizure Complications After Cardiac Surgery

Evaluation of the severity of mitral regurgitation by transesophageal Doppler flow echocardiography

The severity of mitral regurgitation (MR) was assessed by transesophageal Doppler flow echocardiography (TEE) using new criteria in 87 patients. The severity of MR assessed by TEE (TEE-MR) was compared with that obtained by left ventriculography (LVG-MR). Although the severity of TEE-MR has been evaluated by MR jet area, it is often difficult because the MR jet extends beyond a single frame image in severe MR. We found that (1) when the MR area was larger than 3 cm 2, the severity of MR was more than second-degree by LVG; (2) there was systolic turning flow (STF) of the MR jet within the left atrial cavity in 27 of 30 patients with third- and fourth-degree LVG-MR; and (3) there was late systolic backward flow (SBF) in the pulmonary veins in 9 of 10 patients with fourth-degree LVG-MR. A new grading of the severity of MR by TEE was proposed, which combined the findings of STF, SBF, and the MR area. These new criteria of the severity of TEE-MR excellently correlated with that by LVG (y = 0.94x + 0.08; r = 0.95, p < 0.01). The criteria for MR by TEE were also useful for assessment of MR in patients with prosthetic mitral valve dysfunction (y = 0.96x + 0.04; r = 0.97, p < 0.01). We conclude from this study that the severity of MR can be accurately assessed with TEE by measuring the MR area and the specific flow patterns in the left atrium and pulmonary veins.

Long-term effects of excision of the mitral apparatus on global and regional ventricular function in humans

To evaluate the long-term sequelae of mitral valve excision on global and regional wall motion, contrast left ventriculograms from 21 patients with suspected prosthetic mitral valve dysfunction performed 10.4 ± 2.1 years after mitral valve replacement were analyzed by a computerized radial shortening method. Patients with significant coronary artery disease (>30% stenosis in any vessel) were excluded.In 8 of the 21 patients in whom preoperative ventriculograms were available, regional wall motion was normal before valve replacement. Although average radial shortening (35.6 ± 4.8% versus 35.3 ± 3.8%, p = NS) and left ventricular ejection fraction (62.8±4.2% versus 57.9 ± 2.8%, p = NS) were unchanged in the preoperative and postoperative studies of these eight patients, radial shortening in the vicinity of insertion of the posteromedial papillary muscle declined significantly (38.4 ± 6.4% to 20.8 ± 4.4%, p < 0.04). Postoperative radial shortening for all 21 patients at the site of insertion of the papillary muscle was also reduced to a significant degree compared with the average radial shortening (32.9 ± 10.3% versus 17.5±2.0%,p < 0.001).The findings demonstrate significant long-term and possibly permanent regional ventricular dysfunction after severing the chordae tendineae during mitral valve replacement.

Echocardiographic findings in prosthetic mitral valve dysfunction

Echoand phonocardiography have been shown to be useful tools in the assessment of prosthetic valve dysfunction.1-6 Between 1980 and 1982 we have observed seven patients with different forms of prosthetic mitral valve dysfunction documented by surgery in six and by autopsy in one. Five of these patients presented with thrombotic obstruction of a disc prosthesis, three with Omniscience and two with Bjiirk-Shiley prostheses. One patient had intermittent interference with valve opening due to pannus formation at the ring of a Bjiirk-Shiley prosthesis. One