Document Detail


Indications for surgical replacement of the mitral valve. With particular reference to common and uncommon causes of mitral regurgitation.
MedLine Citation:
PMID:  377933     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Mitral valve replacement is considered when there is severe mitral stenosis, severe mitral insufficiency or a combination of the two. Ordinarily, surgical replacement is considered only for patients who are in functional classes III or IV and do not respond to medical management. Patients with symptomatic mitral stenosis should be treated with mitral commissurotomy whenever possible. Patients selected for commissurotomy should have a pliable valve, no other major valve dysfunction, sinus rhythm, no systemic embolism and good left ventricular function. Early operation is not ordinarily required. Mitral insufficiency may require mitral valve replacement in six rather common settings: rheumatic disease, rupture of mitral chordae tendineae, postinfarction rupture of a papillary muscle, intractable infective endocarditis, floppy mitral valve and malfunction of a prosthetic valve. Rupture of mitral chordae tendineae can usually be recognized from the history, physical examination, echocardiogram and angiocardiogram. Severe left ventricular papillary muscle dysfunction is usually due to cardiac infarction, and occurs within the first 9 days of infarction. When only a papillary muscle tip is ruptured the patient may survive long enough for a mitral valve replacement. In infective endocarditis, operation is more often needed because of congestive heart failure than because of refractory infection. Evidence of mitral stenosis or insufficiency in a patient with a previously implanted prosthetic valve usually indicates an urgent need for study and early operation. Uncommon causes of mitral incompetence that may require valve replacement are endocardial fibroelastosis, Marfan's syndrome, calcified mitral anulus, osteogenesis imperfecta, methysergide-induced heart disease and carcinoid heart disease.
Authors:
N O Fowler; J M van der Bel-Kahn
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The American journal of cardiology     Volume:  44     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1979 Jul 
Date Detail:
Created Date:  1979-08-29     Completed Date:  1979-08-29     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  148-57     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Calcinosis / complications,  surgery
Carcinoid Heart Disease / complications,  surgery
Cardiomyopathies / chemically induced,  surgery
Cardiomyopathy, Hypertrophic / surgery
Child
Chordae Tendineae
Echocardiography
Endocardial Fibroelastosis / complications,  surgery
Endocarditis, Bacterial / complications,  surgery
Female
Heart Rupture / complications,  surgery
Heart Valve Prosthesis* / adverse effects,  mortality
Humans
Male
Marfan Syndrome / complications
Methysergide / adverse effects,  therapeutic use
Middle Aged
Mitral Valve / abnormalities
Mitral Valve Insufficiency / etiology,  mortality,  surgery*
Mitral Valve Stenosis / congenital,  mortality,  surgery*
Osteogenesis Imperfecta / complications
Rheumatic Heart Disease / complications,  surgery
Rupture, Spontaneous
Chemical
Reg. No./Substance:
361-37-5/Methysergide

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


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