Mitral valve diseases: Pathophysiology and interventions

Harky, Amer; Botezatu, Bianca; Kakar, Sahil; Ren, MoLiu; Shirke, Manasi Mahesh; Pullan, Mark

doi:10.1016/j.pcad.2021.03.008

Cited by 17 publications

(11 citation statements)

References 64 publications

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“…The main pathophysiological variation of mitral stenosis is that the stenotic mitral valve prevents the left atrium from emptying properly. Finally, pulmonary hypertension and right heart failure have occurred in severe cases [ 7 ]. The occurrence of valve disease, pulmonary hypertension, and coronary artery diseases dramatically enhances the risk of anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic considerations in Shrinking Man syndrome: two case reports

Hong

Liu

et al. 2023

BMC Anesthesiol

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Background Shrinking Man syndrome (SMS) is a rare but often serious complication of dialysis-dependent end-stage renal disease, characterized by significant loss of height, bone pain, bone deformity, and skin itching. Patients with SMS always have abnormal facial changes and cardiovascular system damage (manifested by hypertension, hypotension, cardiovascular calcification, and valvular heart disease), which pose a great challenge to anaesthesiologists. The purpose of this report is to describe our anaesthetic experience regarding two patients with SMS combined with alterations of the airway and cardiovascular system. Case presentation We describe two cases of SMS treated at West China Hospital, a tertiary care centre in Chengdu, China. All cases met the diagnostic criteria, which comprised 1) dialysis-dependent end-stage renal disease, 2) loss of height, and 3) bone pain and bone deformity. One patient had an anticipated difficult airway and moderate-to-severe mitral stenosis. The other patient presented with significant hypotension. Anaesthetic considerations included awake fibreoptic bronchoscopy-assisted tracheal intubation, real-time transoesophageal echocardiogram monitoring and individualized blood pressure management strategies. Conclusion This case series highlights the importance of adequate preoperative assessment and preparation, as well as individualized anaesthetic management, in patients with SMS.

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Section: Discussionmentioning

confidence: 99%

Anaesthetic considerations in Shrinking Man syndrome: two case reports

Hong

Liu

et al. 2023

BMC Anesthesiol

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“…Minimally invasive cardiac surgery has become a new trend in modern medicine because of its reduced trauma, less bleeding and shorter post-operative recovery time [ 1 – 3 ], and there has been a significant increase in the number of studies related to minimally invasive mitral valve surgery [ 4 – 7 ]. Since minimally invasive mitral valve surgery was first described by Cohn and Cosgrove in the mid-1990s, a variety of minimally invasive procedures, including the parasternal, hemi-sternotomy, mini-thoracotomy, totally robotic approach, and totally endoscopic approach, have been proposed [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Attaining competency and proficiency in minimally invasive mitral valve repair: a learning curve assessment using cumulative sum analysis

Shu

Yin

et al. 2023

J Cardiothorac Surg

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Objective To evaluate the learning curve of minimally invasive mitral valvuloplasty (MVP). Background Minimally invasive MVP is characterized by minimal trauma, minimal bleeding, and short postoperative recovery time. The learning curve of any new procedure needs to be evaluated for learning and replication. However, minimally invasive mitral valve technique is a wide-ranging concept, no further analysis of the outcomes and learning curve of minimally invasive Mitral valvuloplasty has been performed. Methods One hundred and fifty consecutive patients who underwent minimally invasive MVP alone without concurrent surgery were evaluated. Using cardiopulmonary bypass (CPB) time and aortic clamping (AC) time as evaluation variables, we visualized the learning curve for minimally invasive MVP using cumulative sum analysis. We also analyzed important postoperative variables such as postoperative drainage, duration of mechanical ventilation, ICU stay and postoperative hospital stay. Results The slope of the fitted curve was negative after 75 procedures, and the learning curve could be crossed after the completion of the 75th procedure when AC and CPB time were used as evaluation variables. And as the number of surgical cases increased, CPB, AC, postoperative drainage, duration of mechanical ventilation, ICU stay and postoperative hospital stay all showed different degrees of decrease. The incidence of postoperative adverse events is similar to conventional Mitral valvuloplasty. Conclusion Compared to conventional MVP, minimally invasive MVP provides the same satisfactory surgical results and stabilization can be achieved gradually after completion of the 75th procedure.

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“…Transcatheter edge-to-edge repair (TEER) of the mitral valve (MV) caused a revolution in MR treatment when the MitraClip system (Abbott) was approved in Europe in 2008 for both indications, i.e., SMR and FMR, whereas it was approved in 2013 in the United States and only for SMR [ 3 ]. The treatment was primarily intended for FMR patients with very high operative risk, but it was soon adopted as an efficient therapeutic option in SMR patients with unacceptable operative risk [ 4 , 5 ]. More than one decade later, a new system for MV TEER, the PASCAL device (Edwards), was approved in Europe, but still not in the US.…”

Section: Introductionmentioning

confidence: 99%

“…Over more than one decade, our knowledge about MV repair has significantly increased; however, most published studies have been focused on the outcomes of MR patients after this procedure [ 4 , 5 ]. The demographic and clinical characteristics of SMR and FMR patients who underwent this procedure have been significantly less investigated.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological Trends in Patients Undergoing Mitral Valve Transcatheter Edge-to-Edge Repair over the Last Decade: Functional vs. Structural Mitral Regurgitation

Schneider

Nita

Dahme

et al. 2022

JCM

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Objective: We aimed to investigate the demographic, clinical and hemodynamic characteristics of patients who underwent percutaneous mitral valve (MV) repair over the last decade, as well as to determine the potential changes in trends of these parameters among patients with structural and functional MR (SMR and FMR). Methodology: We analyzed all patients who underwent interventional MV repair in our institution between January 2010 and March 2021. Our study included both SMR and FMR patients. All data were obtained from a local registry. Results: Nine hundred and seventeen patients (357 SMR patients and 563 FMR patients) were involved in this study. We did not find significant differences in demographical, clinical and hemodynamic characteristics among SMR and FMR patients. Left ventricular remodeling and systolic dysfunction were more pronounced in FMR patients. Systemic vascular resistance was the only hemodynamic parameter that differed between SMR and FMR patients; it was higher in SMR group. An evaluation of the trend between the first and last five years of our experience revealed that the number of patients treated with this technique is constantly increasing, but that this is more pronounced in SMR patients. It was also found that the operative risk of SMR and FMR patients was significantly higher in the first five years. Additionally, our results showed change in medical therapy in MR patients over the last decade in terms of increased use of angiotensin II receptor blockers and the introduction of angiotensin receptor II blocker-neprilysin inhibitor. Conclusion: SMR and FMR patients who underwent interventional MV repair have similar clinical and hemodynamic characteristics. The percentage of SMR patients increased more significantly than FMR patients over the last five years.

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Mitral valve diseases: Pathophysiology and interventions

Cited by 17 publications

References 64 publications

Anaesthetic considerations in Shrinking Man syndrome: two case reports

Anaesthetic considerations in Shrinking Man syndrome: two case reports

Attaining competency and proficiency in minimally invasive mitral valve repair: a learning curve assessment using cumulative sum analysis

Epidemiological Trends in Patients Undergoing Mitral Valve Transcatheter Edge-to-Edge Repair over the Last Decade: Functional vs. Structural Mitral Regurgitation

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