A 55-year-old man was admitted to another hospital because of dry cough and dyspnea that rapidly worsened before admission. Chest computed tomography revealed a low-density mass that nearly obstructed the main pulmonary arterial trunk. Pulmonary thromboembolism was suspected and treated with catheter-directed thrombolysis therapy. Despite optimal thrombolysis and anticoagulant therapy, ...

Subaortic stenosis caused by an accessory mitral valve is an exceedingly rare finding. We report the case of an asymptomatic 14-year-old patient, in whom transthoracic echocardiography revealed an accessory mitral valve in the left ventricular outflow tract, producing mild subaortic stenosis. Except for an aneurysm of the interventricular septum, with ...

Historically, contraindications to minimally invasive or robotic mitral valve surgery have included prior mastectomy, thoracic reconstruction, or chest radiation. However, we believe that by granting flexibility in the choice of skin incision site while performing careful dissection, surgeons can provide these patients the outstanding results afforded by a minithoracotomy. We ...

During mitral valve replacement, total chordae preservation is very important for left ventricular functions. But leaving anterior leaflet and chordae may cause serious complications, such as left ventricular outflow tract obstruction and impairment in prosthetic valve functions. In this article, we present the anterior leaflet preservation technique by excising the ...

We investigated a total of 15 mitral valves with myxomatous degeneration and compared these with normal mitral valves. In normal mitral valves, stromal cells located in the fibrosa and spongiosa showed small bipolar cytoplasmic processes and were found to be positive for CD34, suggesting a close relationship to CD34+ fibrocytes. ...

Factors predisposing patients to systolic anterior motion of the mitral valve (SAM) with left ventricular outflow tract (LVOT) obstruction after mitral valve repair are the presence of a myxomatous mitral valve with redundant leaflets, a nondilated hyperdynamic left ventricle, and a short distance between the mitral valve coaptation point and ...

A 20-year-old man was admitted to hospital because of general fatigue during exercise. He had had a heart murmur since the age of 6 years. Echocardiography showed severe mitral regurgitation (MR, IV), probably caused by an anterior leaflet cleft or tendon rupture. During surgery, a cleft measuring 9 mm in ...

The purpose of this study was to evaluate the possibility of using high-intensity focused ultrasound (US), or HIFU, to create lesions in cardiac valves in vitro. Calf mitral valves and aortic valves were examined. Focused US energy was applied with an operating frequency of 4.67 MHz at a nominal acoustic ...

Atrioventricular groove tear or disruption is a disastrous and technically challenging complication after mitral valve replacement surgery. This report details the untimely spontaneous occurrence of an atrioventricular tear during manipulation of the heart for off-pump coronary artery bypass grafting and its successful repair. Significant distortion of the mitral annulus and ...

A 52-year-old non-insulin-dependent diabetic man presented with cerebral emboli and mitral valve endocarditis with posterior leaflet vegetations and perforation. Surgical intervention demonstrated hemorrhagic pericarditis and an atrioventricular groove abscess. Extensive debridement of the pericardium, valve and abscess cavities, reconstruction of the mitral annulus with a patch of fresh autologous pericardium, ...

Paraprosthetic leaks are a postoperatively complication recurring with a frequency from 15 to 30%, and mostly in the mitral than in the aortic position. Transthoracic echocardiography can suspect prosthesis valve dysfunction, but for both diagnosis and evaluation of the paraprosthetic dysfunction severity, transesophageal study is required. In this report a ...

We report a successful treatment of the complete papillary muscle rupture occurring 16 months after coronary artery bypass grafting (CABG). A 57-year-old man was admitted for the sudden onset of chest pain and cardiogenic shock. Emergency cardiac catheterization revealed severe mitral regurgitation and total occlusion in the right coronary artery, ...

A 68-year-old woman with concentric left ventricular hypertrophy, prosthetic valve endocarditis with aortic root abscess, and sepsis had aortic root replacement with an aortic allograft. On weaning from cardiopulmonary bypass, she had hemodynamic instability caused by systolic anterior motion of the mitral valve, which resulted in a left ventricular outflow ...

In the mitral valve, regional variations in structure and material properties combine to affect the biomechanics of the entire valve. Previous biaxial testing has shown that mitral valve leaflet tissue is highly extensible, and exhibits nonlinear, anisotropic material properties. In this study, experimental measurements of mitral valve leaflet deformation under ...

A case of mitral valve aneurysm associated with infective endocarditis is reported. Two-dimensional echocardiography revealed a saccular structure in the anterior leaflet that bulged into the left atrium throughout the cardiac cycle. During operation, the vegetation on the commissure of the right and left aortic leaflet and a 3-mm perforation ...

A 78-year-old man underwent mitral valve replacement with a no. 33 Hancock porcine bioprosthesis for severe mitral regurgitation. Postoperatively, a transthoracic echocardiogram (TTE) revealed a mean mitral valve gradient (MVG) of 4 mm Hg, a calculated mitral valve area (MVA) of 2.8 cm(2), and no mitral regurgitation. Eighteen months later, ...

An in vitro pulsatile simulator with a porcine mitral valve was developed in order to simulate physiologic and diseased mitral valve conditions. Evaluation of these conditions was conducted from a hydrodynamic and annulus behavior point of view. We found it possible to simulate mild "mitral valve prolapse" and to obtain ...

This randomised, single-blind, double-control study compared and established prospectively the best transoesophageal echocardiography methods for determining cardiac output in patients after cardiac surgery. Thirty patients undergoing coronary artery bypass grafting were included. Measurements were taken postoperatively, after stabilisation in the intensive care unit. Cardiac output was determined by transoesophageal echocardiography ...

OBJECTIVE: To describe a series of fetuses diagnosed as having Shone's syndrome, which includes four cardiac defects and for which there is a wide variety of clinical presentations, surgical treatments and outcomes, and to discuss the counseling strategy. METHODS: We reviewed retrospectively the records of four babies who were suspected ...

A new partial translocation technique to repair left ventricular rupture after mitral valve replacement and reimplant a mitral prosthesis is described. We repaired a tear from the interior by using mattress stitches buttressed with strips of Dacron felt, constructed a new annulus with a crescent-shaped piece of bovine pericardium on ...

A previously unreported case of a complex congenital cardiac anomaly consisting of coronary and valvular angiodysplasia, complicated by an eosinophilic endomyocardial disease, is described. The disorder presented clinically with congestive heart failure, which was characterized by evidence of floating masses causing severe pulmonary stenosis and dysfunction of the mitral and ...

The availability of Internet-enabled computers in the operating room (OR) facilitates unparalleled physician access to current peer reviewed research, either in abstract or full text format, a development that provides physicians with an exciting opportunity to incorporate such findings into clinical practice at the point-of-care. In this report I describe ...

A 45-year-old man presented to our hospital with severe dyspnea 4 months after antibiotic treatment for aortic valve endocarditis. Transesophageal echocardiography revealed severe aortic regurgitation and an aneurysm of the anterior leaflet of the mitral valve. In addition to aortic valve replacement, we excised the aneurysm and repaired the anterior ...

Congenital malformations of the mitral valve are numerous and can be confusing. The functional expression is an insufficiency, a stenosis or a combined lesion. The anatomic classification is replaced by a functional approach. Anatomy and functional manifestations are analyzed by echocardiography pre-, intra- and postoperatively. Conservative surgery is the goal ...

In patients with acute bacterial endocarditis and annular abscess formation, cardiac valve replacement is associated with high perioperative mortality and morbidity. We present two patients who had had infective endocarditis and annular abscess formation in the mural leaflet region. Before replacing the mitral valve, we covered the atrium and annulus ...

Mitral valve repair surgery has progressed dramatically since its inception over 40 years ago. As techniques have evolved, complicated mitral valve reconstruction has become commonplace, with durable late results. Likewise, the value of concomitant annuloplasty during valve repair has been firmly established as contributing to late valve repair durability. This ...

Beating mitral valve replacement was performed for mitral valve stenosis in a patient with a porcelain aorta after aortic valve replacement. The 77-year-old patient had developed heart failure several times. A chest computed tomographic scan revealed severe calcification on the ascending aorta and aortic arch. A cardiopulmonary bypass was established ...

Systemic infection with Aspergillus fumigatus is an opportunistic disease that affects mainly immunocompromised hosts and is associated with a high mortality rate. We report a case of A. fumigatus endocarditis after an episode of thrombotic thrombocytopenic purpura. Diagnosis was established after sudden rupture of posterior papillary muscle of the normal ...

A one-year-old boy without congenital cardiac anomaly suffered from meningitis and subsequent acute infective endocarditis that resulted in mitral regurgitation. During antibiotic therapy and management of congestive heart failure, he suddenly developed an acute subdural hematoma, and an aneurysm of the cerebral artery was detected by brain computed tomography. Clipping ...

BACKGROUND: This study was undertaken to evaluate the clinical performance of the Carbomedics, Medtronic Hall and On-X valves in the challenging setting of a Third World population with incomplete anticoagulation coverage. METHODS: In the Carbomedics group 140 valves were implanted in 126 patients (aortic 30, mitral 82, and aortic and ...

Williams-Beuren syndrome is a rare and usually sporadic genetic anomaly with an estimated frequency of 1:25,000, that also has cardiac defects due to the effect on the elastin locus of a deletion on the 7th chromosome. Identical twin boys presented with exercise-induced syncope. Echocardiographic examination revealed severe calcification at the ...

Left ventricular outflow tract obstructive (LVOTO) malformations are a leading cause of infant mortality from birth defects. Genetic mechanisms are likely, and there may be a higher rate of asymptomatic LVOTO anomalies in relatives of affected children. This study sought to define the incidence of cardiac anomalies in first-degree relatives ...

BACKGROUND: Surgical edge-to-edge repair has been used in the treatment of mitral regurgitation. We evaluated the ability of a catheter-delivered clip (Evalve, Inc) to achieve edge-to-edge mitral valve approximation without cardiopulmonary bypass and the healing response of this technique. METHODS AND RESULTS: Twenty-one pigs underwent general anesthesia and left thoracotomy. ...

BACKGROUND: Mucopolysaccharidosis VII (MPS VII) is a lysosomal storage disease caused by deficient beta-glucuronidase (GUSB) activity resulting in defective catabolism of glycosaminoglycans (GAGs). Cardiac disease is a major cause of death in MPS VII because of accumulation of GAGs in cardiovascular cells. Manifestations include cardiomyopathy, mitral and aortic valve thickening, ...

We report a case of a true cleft in the anterior leaflet of the mitral valve. The cleft, however, is directed toward the ventricular septum, and the left ventricular papillary muscles have the same arrangement as seen in the setting of a common atrioventricular orifice. The atrioventricular septum is intact. ...

Although heart valve surgery continues to evolve in a dynamic fashion, there is still no optimal solution for all patients. Minimally invasive surgery currently receives considerable attention but its value still needs to be determined. Progress has been made in valve repair, which now allows reconstruction in most patients with ...

Complications of valve replacement are diverse. In addition to morbidity due to the prosthetic valve itself (e.g. endocarditis, thrombosis), complications due to operative technique may occur in complex cases, as in aortic valve replacement with annular enlargement. Postoperative echocardiography is a simple, non-invasive method to evaluate patients with prosthetic valves. ...

BACKGROUND: Stroke is a devastating complication in patients with prosthetic valves, but characterization of its late occurrence from a large cohort is lacking. METHODS: Three thousand one hundred eighty-nine adult patients who underwent a total of 3,576 operations for left-heart valve replacement were managed with contemporary anticoagulation guidelines and prospectively ...

INTRODUCTION: The success rate of catheter maze ablation procedures for atrial fibrillation depends upon adequate electrical isolation by performing linear ablation lesions. However, recurrence of atrial arrhythmias is not uncommon, particularly in the so-called left atrial isthmus, between the orifice of the left inferior pulmonary vein and the mitral valve ...

We evaluated a new trileaflet prosthesis and a control bileaflet prosthesis in the mitral and aortic positions in 27 calves. The prototype trileaflet valve (TV1) functioned satisfactorily in the mitral position (TV1m, n = 7) but later yielded thrombogenic complications in the aortic position (TV1a, n = 4). The valve ...

BACKGROUND: Atrial en-face reconstructions are commonly used to assess mitral valve morphology in three dimensional (3D) echocardiography but may miss important abnormalities. OBJECTIVE: To present a systematic method for the analysis of the regurgitant mitral valve using a combination of en-face and longitudinal views for better anatomical evaluation. METHODS: Detailed ...

In patients with partial anomalous pulmonary venous connection (PAPVC) to the superior cavoatrial junction, the standard right-sided left atriotomy does not allow sufficient access to the mitral valve and the left atrium. And the injury and traction of the sinus node and sinus node artery should be avoided for prevention ...

A successful resection of left ventricular tumor in an 82-year-old woman who had undergone coronary artery bypass grafting ten years ago is presented. In an attempt to make a procedure less invasive, we chose a trans-mitral endoscopic resection with minimum dissection because of reoperation on patient of advanced age. With ...

BACKGROUND: Predicting risk for aortic and mitral valve surgery is important both for informed consent of patients and objective review of surgical outcomes. Development of reliable prediction rules requires large data sets with appropriate risk factors that are available before surgery. METHODS: Data from eight Northern New England Medical Centers ...

During the past 20 years, transesophageal echocardiography (TEE) became an important diagnostic technique. Indications for TEE include: defining the cause and severity of native valve disease, particularly mitral regurgitation; detecting vegetations and other sequelae of endocarditis; assessing prosthetic valve function; and identifying a potential cardiac source for emboli.(1) TEE is ...

In establishing the indication for anticoagulation of patients with native heart valve disease, those with thromboembolic events and/or atrial fibrillation (AF) must be distinguished from patients with sinus rhythm. Anticoagulation should be started as a matter of principle in patients with thromboembolic events and/or AF who do not undergo valve ...

Synthetic sutures are used for mitral valve repair and as synthetic chordae tendinae to resuspend the mitral valve. The sutures soon get covered with connective tissue and work well for long periods. We report the first instance (in the literature) of rupture of a synthetic (PTFE) chordae tendinae. The synthetic ...

Prosthetic valve thrombosis (PVT) is classically a cardiothoracic surgical emergency. Case series, however, report thrombolysis as first line management for PVT. A case of mitral PVT treated successfully with thrombolysis is described. Immediately after thrombolysis a trivial paraprosthetic leak noted on pretreatment transoesophageal echocardiography had increased significantly in severity. The ...

Left ventricular (LV) rupture is an infrequent but potentially lethal complication of mitral valve replacement and repair. We report the case of an 82-year-old man who underwent mitral valve replacement and the repair of an atrial septal defect. Both valve leaflets were excised and the annulus was extensively decalcified, followed ...

A 75-year-old man had a significant mitral paravalvular leak following unsuccessful mitral valve repair at age 71 years and mitral valve replacement two years later. He was referred for percutaneous closure, which was performed with an atrial septal defect occluder device. Subsequently, a small residual leak was closed with an ...