Cardiac transplantation after donor mitral valve commissurotomy

Risher, William H.; Ochsner, John L.; Meter, Clifford Van

doi:10.1016/0003-4975(94)90406-5

Cited by 16 publications

(18 citation statements)

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“…Bench repair of the mitral valve prior to transplantation was first described by Rishers et al [10] in 1994 with commissurotomy in the donor heart. Within 20 years, only six authors described their experiences with mitral valve repair prior to transplantation [10][11][12][13][14][15]. Additionally, there are only few reports on mitral valve replacement in the allograft [16,17].…”

Section: Discussionmentioning

confidence: 99%

Combined mitral valve repair and heart transplantation

Sprengel

Skwara

Ziegelhöffer

et al. 2018

Clinical Case Reports

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Section: Discussionmentioning

confidence: 99%

Combined mitral valve repair and heart transplantation

Sprengel

Skwara

Ziegelhöffer

et al. 2018

Clinical Case Reports

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“…4 There has been only one previous report of thymic abscess in an adult in the literature. 5 We report the first description of a Salmonella bacteremia associated with a thymic abscess within a thymoma.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, the only other case of repair of organic mitral valve disease (ie, open mitral commissurotomy) before orthotopic transplantation was reported in 1994. 5 The authors justified the decision mainly on the critical condition of the patient.…”

Section: Discussionmentioning

confidence: 99%

Donor Mitral Valve Repair in Cardiac Transplantation

Prieto¹,

Antunes²,

Antunes³

2009

Transplantation Proceedings

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C ardiac transplantation has become a relatively common procedure, but its major limiting factor is still the shortage of donor hearts. The donor pool can potentially be increased by relaxing selection criteria or by performing innovative procedures on the donor heart, such as valve repair. We present a recent case of successful transplantation after mitral valve repair in a heart with moderate rheumatic valve disease. Clinical SummaryA 52-year-old man with end-stage congestive heart failure caused by idiopathic dilated cardiomyopathy was evaluated and listed for cardiac transplantation. On January 18, 2004, a 35-year-old woman without a history of cardiac disease experienced brain death from a hemorrhagic cerebral accident and was selected as a multiorgan donor. The transthoracic echocardiogram showed evidence of mildly to moderately sclerotic leaflets with otherwise good motion and no evidence of stenosis (mitral valve area, 3.0 cm 2 ) and mild mitral regurgitation. Regional and global myocardial contractility was unimpaired, and the ejection fraction was normal. Because there were no other contraindications to heart donation, we decided to proceed with the transplantation.The heart was transported to our center, and the mitral valve was carefully inspected through the open left atrium. The free edges of the leaflets were mildly fibrosed and retracted, and the posteromedial commissure was moderately fused, as were the corresponding chordae tendineae. The valve was tested with injection of cold saline into the left ventricle after the aorta was clamped. There was a central jet of regurgitation caused by incomplete coaptation of the leaflets as a result of some retraction of the free edges. Because the valve disease was thought to be more significant than anticipated before the heart procurement, it was decided to proceed to bench repair of the mitral valve. A commissurotomy of the posteromedial commissure, followed by division of fused chordae tendineae, was performed. Additionally, although there was only mild annular enlargement, an annuloplasty was performed to increase the area of leaflet coaptation and to prevent future annular enlargement. The posterior annulus was plicated with a double continuous 3-0 polyester suture placed from trigone to trigone ( Figure 1). The valve was again tested, and good coaptation of the leaflets was observed. This was a straightforward procedure with understandably excellent exposure, and it required less than 10 minutes of additional ischemic time.The heart was them implanted by a bicaval anastomotic technique. The crossclamp time was 35 minutes. The ischemic time of the donor heart was 84 minutes. Intraoperative transesophageal echocardiography revealed minimal mitral regurgitation. Donor heart function was excellent. There was no transvalvular gradient, as determined by direct measurement of simultaneous left ventricular and left atrial pressures. DiscussionCardiac transplantation has become a relatively common procedure, with the major limiting factor being the shortage ...

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“…Some cases of valvular repair on the donor's heart prior to grafting have been described in the mitral and tricuspid position, even in associated aortic valve replacement [20][21][22][23].…”

Section: Transplantation In a Valvular Patientmentioning

confidence: 99%