Ischemic mitral valve repair surgery due to inferior wall infarction

Ng, Chye Yew; Nesser, Joachim; Punzengruber, Christian; Auer, H; Pachinger, Otmar; Hartl, P.

doi:10.1055/s-2004-816824

Cited by 2 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among these patients, we excluded 37 patients who did not undergo MV surgery (MV repair or replacement) after cardiac CT scan, 26 patients with infective endocarditis, and one patient with an incomplete operation record. We excluded patients with infective endocarditis because the criteria for the assessment of a non-repairable valve (described in “Findings of a non-repairable valve”) could not be applied the same as in other etiologies, in the terms that extensive destruction of the valvular and subvalvular apparatus and rupture of the chordae tendineae would make repair impossible in patients with infective endocarditis (28). Finally, a total of 156 patients who underwent MV surgery after a cardiac CT scan due to severe MR from non-infective endocarditis were included.…”

Section: Methodsmentioning

confidence: 99%

“…We established findings of a non-repairable valve (requiring valve replacement) as those meeting the following conditions: 1) valve with anterior leaflet prolapse, 2) valve with bi-leaflet prolapse, or 3) valve with non-repairable morphology (242831). Non-repairable valve morphology was considered when at least one of following findings was present: 1) leaflet thickening (> 2 mm), 2) MV leaflet calcification, or 3) MAC.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Utility of Cardiac CT for Preoperative Evaluation of Mitral Regurgitation: Morphological Evaluation of Mitral Valve and Prediction of Valve Replacement

et al. 2019

View full text Add to dashboard Cite

Objective We aimed to investigate the diagnostic accuracy of cardiac computed tomography (CT) for the detection of mitral valve (MV) prolapse in mitral regurgitation (MR) with surgical findings as the standard reference, and to assess the predictability of MV replacement based on morphologic CT findings. Materials and Methods A total of 156 patients who had undergone preoperative cardiac CT and subsequently received MV surgery due to severe MR were retrospectively enrolled. Non-repairable MV was defined when at least one of the following conditions was met: 1) anterior leaflet prolapse, 2) bi-leaflet prolapse, or 3) valve morphology (leaflet thickening, calcification, or mitral annular calcification [MAC]). Diagnostic performance of CT for the detection of the prolapsed segment was assessed with surgical findings as the standard reference. Logistic regression analysis was performed to evaluate the value of CT findings to predict actual valve replacement. Results During surgery, MV prolapse was identified in 72.1%. The sensitivity, specificity, and diagnostic accuracy for the detection of MV prolapse were 99.1%, 81.4%, and 94.2%, respectively, per patient. One-hundred eighteen patients (75.6%) underwent MV repair and the remaining 38 patients received MV replacement. Bi-leaflet prolapse and valve morphology were independent predictors of valve replacement after adjusting for clinical variables (adjusted odds ratio, [OR] 8.63 for bi-leaflet prolapse; OR, 4.14 for leaflet thickening; and OR, 5.37 for leaflet calcium score > 5.6; p < 0.05). Conclusion Cardiac CT can have high diagnostic performance for detecting the prolapsed segment of the MV and predictability of valve replacement before surgery. Bi-leaflet prolapse and valve morphology, such as leaflet thickening, or calcification or MAC, are the most important predictors of valve replacement.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Utility of Cardiac CT for Preoperative Evaluation of Mitral Regurgitation: Morphological Evaluation of Mitral Valve and Prediction of Valve Replacement

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Finally, another group has reported posterior leaflet extension with pericardial patches to restore adequate surface area for the stretched valve [47]. As in the case of mitral valve prolapse, detailed mapping of the valvular and ventricular abnormalities underlying functional MR should allow tailoring of the ideal combination of annular, ventricular, and chordal approaches to achieve the best result in the individual patient.…”

Section: Toward Improved Therapymentioning

confidence: 99%

Mechanistic insights into functional mitral regurgitation

Levine

Hung²,

Messas³

et al. 2002

Curr Cardiol Rep

View full text Add to dashboard Cite

Effective valve repair in patients with mitral regurgitation (MR) demands an understanding of its mechanism. In patients with ischemic heart disease and functional MR, which doubles late mortality, normal leaflets are apically displaced. This reflects an altered balance of forces acting on the leaflets: increased tethering forces restricting closure, resulting from an altered geometry of leaflet attachments, and decreased ventricular forces acting to close the leaflets. Extensive evidence confirms a central and predominant role of tethering as the final common pathway inducing functional MR; left ventricular (LV) pressure dynamically modulates the orifice area. Because ischemic MR is a disease of the entire mitral complex, including the remodeling LV, reducing annular size alone is often ineffective. Undersizing rings attempts to compensate for tethering; new and potentially more effective strategies directly address tethering by infarct plication, papillary muscle repositioning with a localized patch, or basal chordal cutting to increase coaptational surface area without prolapse. A comprehensive understanding of the valve in its ventricular context, therefore, provides new opportunities for successful valve repair in patients.

show abstract

Ischemic mitral valve repair surgery due to inferior wall infarction

Cited by 2 publications

References 0 publications

Utility of Cardiac CT for Preoperative Evaluation of Mitral Regurgitation: Morphological Evaluation of Mitral Valve and Prediction of Valve Replacement

Utility of Cardiac CT for Preoperative Evaluation of Mitral Regurgitation: Morphological Evaluation of Mitral Valve and Prediction of Valve Replacement

Mechanistic insights into functional mitral regurgitation

Contact Info

Product

Resources

About