Document Detail

Echocardiographic measurements alone do not provide accurate non-invasive selection of annuloplasty band size for robotic mitral valve repair.
MedLine Citation:
PMID:  16901048     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIM OF THE STUDY: Successful mitral valve repair (MVP) is dependent on accurate annuloplasty band sizing. This is difficult and time-consuming when performed via port-access, or through a 4-cm minithoracotomy used in robotically assisted MVP. With the goal of moving toward a less-invasive approach and minimizing cross-clamp time, an attempt was made to determine annuloplasty band size using transesophageal echocardiography (TEE) alone. METHODS: The intertrigonal distance (ITD) was determined by dividing the left ventricular outflow tract diameter (LVOT: measured on standard midesophageal aortic valve long-axis view) by 0.8. The ITD was compared to a nomogram developed to select the best Cosgrove-Edwards annuloplasty band size. RESULTS: Between July and October, 2004, 11 patients (mean age 52.6 +/- 17.9 years; four Barlow's valves with bileaflet prolapse, four posterior leaflet prolapses, one anterior leaflet prolapse, one rheumatic, one dilated annulus) undergoing robotically assisted MVP had the annuloplasty band chosen using TEE alone. Seven patients (63.6%) had no or mild mitral regurgitation (MR) on postoperative TEE. Three patients (27.2%) had some systolic anterior motion (SAM), with one (Barlow's valve) requiring a second repair (same operation). One patient (9.1%, rheumatic) had grade 2+ MR on postoperative TEE. CONCLUSION: In this small case series, a substantial proportion of patients had suboptimal immediate postoperative results. This suggests that selection of the annuloplasty band should not be based on a single echocardiographic variable as it depends on the etiology of the MR, and other dimensions of the mitral valve. Further studies are ongoing to develop a non-invasive method for the selection of annuloplasty band size.
Richard C Cook; L Wiley Nifong; Graham G Lashley; Robert A Duncan; Julie A Campbell; Y Brandon Law; W Randolph Chitwood
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  15     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-08-11     Completed Date:  2006-11-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  524-7; discussion 527     Citation Subset:  IM    
University of British Columbia, Vancouver, British Columbia, Canada.
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MeSH Terms
Cardiac Surgical Procedures / methods*
Echocardiography, Transesophageal / methods*
Intraoperative Period
Middle Aged
Mitral Valve / pathology,  surgery*,  ultrasonography
Mitral Valve Insufficiency / complications,  etiology,  surgery,  ultrasonography
Mitral Valve Prolapse / surgery*,  ultrasonography
Postoperative Period
Retrospective Studies
Ventricular Function, Left / physiology
Comment In:
J Heart Valve Dis. 2006 Jul;15(4):521-3   [PMID:  16901047 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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