Objective To evaluate clinical outcomes of mild-to-moderate or moderate functional mitral regurgitation（FMR）after aortic valve replacement （AVR） in patients with severe aortic stenosis （AS），and analyze prognostic factors of these patients with mild-to-moderate or moderate FMR （2＋to 3＋）. Methods From September 2008 to December 2011，a total of 156 patients with severe AS （peak aortic gradient （PAG）≥50 mm Hg） as well as FMR （2＋to 3＋） underwent surgical treatment in Zhongshan Hospital. There were 95 male and 61 female patients with their average age of 59.2±10.5 years. Detailed perioperative clinical data were collected，and postoperative patients were followed up. The ratio of FMRpreoperative/FMR postoperative was calculated. Patient age，gender，body weight，history of hypertension，ventricular arrhythmia，atrial fibrillation （AF），left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVEDD），left atrial diameter （LAD），pulmonary artery hypertension （PAH），PAG were assessed by logistic multivariate regression analysis. Results Six patients died postoperatively，including 4 patients with low cardiac output syndrome and 2 patients with refractory ventricular arrhythmia. Perioperative mortality was 3.8%. The average follow-up time was 20.3±8.5 months and follow-up rate was 85.3% （133/156）. Eight patients died during follow-up，including 3 patients with heart failure，2 patients with ventricular arrhythmia，and 3 patients with anticoagulation-related cerebrovascular accident. Multivariate regression analysis showed that FMR preoperative/FMR postoperative ratio was not correlated with age≥55 years，male gender，body weight≥80 kg，LVEDD≥55 mm，LVEF≤50%，history of hypertension or ventricular arrhythmia. However，LAD≥50 mm，PAH≥50 mm Hg，PAG≤75 mm Hg and preoperative AF were negatively correlated with postoperative FMR improvement. Conclusions Risk factors including LAD≥50 mm，PAH≥50 mm Hg，PAG≤75 mm Hg and preoperative AF are negatively correlated with postoperative improvement of FMR （2＋to 3＋）. Patients with severe AS and above risk factors should receive concomitant surgical treatment for their FMR during AVR，since preoperative FMR（2＋to 3＋）usually does not improve or even aggravate after AVR.
ObjectiveTo report the short-term outcomes of a standardized, simplified and reproducible strategy of mitral valvuloplasty (MVP), which was focused on leaflet foldoplasty and anatomic anomalies of congenital mitral regurgitation (MR).MethodsConsecutive 74 patients who underwent MVP by our standardized strategy in our institution from 2016 to 2018 were included retrospectively. There were 30 males and 44 females with a median age of 18.5 (6-146) months and weight of 15.4 (7-51) kg.ResultsAnatomic anomalies of MR included: (1) subvalvular apparatus: 72 (97.3%) patients with mal-connected chordae tendineae, 31 (41.9%) with absent chordae tendineae and 14 (18.9%) with fused or dysplastic papillary muscle; (2) leaflet: 10 (13.5%) patients with cleft of anterior leaflet, 61 (82.4%) with leaflet prolapse including 56 (91.8%) with anterior leaflet prolapse; (3) annulus: 71 (95.9%) patients with annular dilatation. Leaflet foldoplasty was performed in 61 (82.4%) patients with leaflet prolapse. All patients were successfully discharged and 4 (5.4%) patients were with moderate MR. The follow-up time was 22.0 (9.1-41.8) months. During the follow-up period, 3 patients had moderate MR and 1 patient had reoperation for severe MR. All patients were in normal cardiac function with a mean left ventricular ejection fraction of 66.0%±6.1%. In addition, the mean left ventricular end-diastolic dimension was 31.8±6.0 mm, which was significant smaller than that before the operation (t=6.090, P<0.000 1).ConclusionThe standardized leaflet foldoplasty with resection of mal-connected chordae tendineae and posterior annuloplasty technique is safe and feasible with favorable short-term outcomes in MR patients.
Objective To evaluate the relationship between pattern of left ventricular dilation and functional mitral regurgitation (FMR) by echocardiography. Methods A single-center retrospective observational study was conducted on 117 patients with age of 31-77 years and left ventricular end diastolic dimension≥60 mm treated in our hospital from January 2013 through May 2016. These patients were divided into four groups by FMR degree: FMR-None/Trace (FMR-N/T group,n=33), FMR-Minor (FMR-Mi group,n=37), FMR-Moderate (FMR-Mo group,n=34) and FMR-Severe (FMR-Se group,n=13). We analyzed their basic information and echocardiographic parameters including left ventricular dimension, volume, systolic function, spherical index, regional wall motion score index, tenting height and area of mitral vavle as well as anterior/posterior angle. Results The incidences of inferior/posterior/lateral myocardial infarction and basal myocardial dyskinesia/aneurysm increased with the increase of FMR degree (FMR-N/T vs. FMR-Mi vs. FMR-Mo vs. FMR-Se: 12.1% vs. 18.9% vs. 44.1% vs. 46.2%,P=0.001 and 12.1% vs. 27.0% vs.47.1% vs. 53.8%,P=0.005, respectively). The tenting height and area of mitral valve, anterior/posterior angle, regional wall score index of the left ventricle where the papillary muscle was attached to had a positive correlation with FMR degree (P＜0.05). Conclusion There is a relationship between regional left ventricular dilation and FMR. Evaluating and improving those parameters is very important when we choose the treatment strategy of functional mitral regurgitaion.
Mitral regurgitation (MR) is the most common type of valvular heart disease. Mitral valve repair/replacement can improve the prognosis of patients with severe MR, but a large proportion of patients cannot tolerate surgical procedures due to comorbidities and surgical risks. Transcatheter mitral valve replacement (TMVR) is a kind of treatment for mitral valve disease in which an artificial valve is delivered to the mitral valve annulus through a catheter and released into place, with the advantages of no thorax opening, less trauma and high safety. Early clinical studies of TMVR have shown good results, but still face many challenges. Strict indications are effective measures to reduce surgical risks and postoperative complications. This article explores the relevant indications of TMVR by analyzing several studies at home and abroad.
Ischemic mitral regurgitation represents a common complication after myocardial infarction, the severity of the mitral regurgitation increases the risk of mortality. There is continuing debate regarding the management of moderate ischemic mitral regurgitation in patients undergoing surgical management. The debates lie in whether adding mitral valve surgery to coronary artery bypass grafting. So the review is about the analysis of existing evidence and expectation about it.
ObjectiveTo summarize the surgical strategy on treating mitral desease patient associated with hypertrophic obstructive cadiomyopathy (HOCM). MethodsWe retrospectively analyzed the clinical data of 17 patients with HOCM underwent surgical treatment from November 2003 to May 2015 year. There were 10 males and 7 females with a mean age of 42.2±15.5 years ranging from 7-62 years. There were 16 patients underwent modified Morrow procedure and 1 patient underwent modified Konno procedure to relieve the obstruction of left ventricular outflow tract. And different surgical treatment of mitral valve disease was implemented depending on the severity of regurgitation and under monitoring of transesophageal echocardiography. About 2 weeks after the surgery, we performed transthoracic echocardiography to evaluate the effect of operation. ResultsNo hospital death occurred and the surgery obviously improved the symptom and cardiac function in all cases. After surgery, echocardiography revealed that the mean thickness of the ventricular septum statistically decreased (P < 0.0001), the systolic anterior motion disappeared, the outflow track pressure of left ventricle statistically decreased (P < 0.0001), and the peak flow rate of left ventricle statistically decreased. However, there was no statistical difference in the change of the left ventricular ejection fraction(P=0.083). Nine patients with no mitral regurgitation (MR) or mild MR only underwent the unblock of the left ventricular outflow track, the MR decreased to mild or disappeared. Four patients with moderate or severe MR underwent mitral valve repair, and the MR decrease to mild or disappear. There were no complications occurred regarding to prosthesis implantation over the 4 patients underwent mitral valve replacement for infective endocarditis or other causes. ConclusionFor the HOCM patients with mild MR, the unblock of the left ventricular outflow track alone can effectively improve the MR. For those combined with moderate or severe MR, we should choose mitral valve repair or replacement based on individual situation of patient.
Abstract： Objective To optimize surgical treatment for children with patent ductus arteriosus （PDA） and mitral regurgitation （MR） and evaluate its midterm to longterm outcome in terms of MR. Methods Between Jan. 2008 and Jan. 2011， 25 children with PDA and MR underwent surgical treatment in Shanghai Children’s Medical Center. There were 14 male patients and 11 female patients with average age of 26.36±40.75 （1.72-142.83）months and average weight of 8.98±6.85 （3.80-36.00） kg. The average diameter of PDA was 7.84±3.10 （3-15）mm. There were 22 children with duct-type PDA and 3 children with window-type PDA. There were 5 children with severe MR， 18 children with moderate MR， and 2 children with mild MR. Except one child with mitral stenosis who underwent PDA ligation plus mitral valvuloplasty supported with cardiopulmonary bypass， all other 24 children only underwent PDA ligation through left posterolateral thoracotomy without any management for the mitral valve. Results There was no in-hospital death. The average ventilation time in ICU was 6.70±4.39 （3-24） hours. Except one child was reintubated because of asthma， all other children recovered uneventfully without any postoperative complication. All the 25 children were followed up for 329.23±288.39 （29-967） days. During follow-up， 23 children （92.00%） had their MR level ameliorated in different degree. Preoperative severe MR in 5 children changed into moderate MR in 2 children and mild MR in 3 children. Preoperative moderate MR in 16 children changed into none MR in 5 children, trivial MR in 5 children and mild MR in 6 children. Preoperative mild MR in 2 children changed into none MR in 1 child and trivial MR in another child. Two children with preoperative moderate MR had no improvement during follow-up. Conclusion For infants and children with PDA and MR， conservative treatment strategy should be carried out. Simple PDA ligation can provide satisfactory clinical outcome， which may also avoid negative complications including myocardial injury caused by cardiopulmonary bypass.
Objective To summarize the surgical treatment strategies and the clinical outcomes of hypertrophic obstructive cardiomyopathy (HOCM) with severe mitral regurgitation. Method We retrospectively analyzed the clinical data of 23 patients of HOCM with severe mitral regurgitation in our hospital from January 2004 through January 2014 year. There were 14 males and 9 females, aged from 15-71(50.2±15.4) years. The preoperative left ventricular outflow tract gradient (LVOTPG) of these patients was 75-161(98.1±19.3) mm Hg. And the septal thickness was 25.8±2.8 mm. All 23 patients had at least moderate mitral regurgitation and systolic anterior motion (SAM). All of them had extend septal myectomy (extend Marrow procedure) and mitral valve repair(MVP),while 4 patients with atrial fibrillation had left atrial ablation and left atrial appendage operation. Results All patients were successfully operated. The left ventricular outflow tract pressure gradient was 16-39(26.9±4.9) mm Hg when the cardiopulmonary bypass stopped and SAM phenomenon was completely eliminated. Except for 2 mitral valve patients with trace amounts of regurgitation, 1 patient with mild regurgitation, the other 20 patients of mitral regurgitation were completely corrected. All patients survived after operation and only 1 patient suffered from transient complete atrioventricular block and then back to normal sinus rhythm. A long-term follow-up from 6 months to 126 months with an average of 53.1±34.9 months showed no late postoperative death. No mitral regurgitation need reoperation. Two patients had mild reflux. Four patients were of trace reflux. The left ventricular outflow tract the maximum pressure gradient was less than 42 mm Hg. The thickness of interventricular septum dropped from preoperative 25.8±2.8 mm to postoperative 14.1±1.3 mm (P<0.001) . No recurrence was noted in the 3 patients with atrial fibrillation. And one patient still had paroxysmal atrial fibrillation. Long term follow-up of the patients' symptoms disappeared or with only mild symptoms. And quality of their life improved significantly. And there was no long-term complication, reoperation, or death. Conclusions The extensive septal myectomy can completely dredge left ventricular outflow tract stenosis and eliminate SAM phenomenon. The mitral valve repair can correct mitral regurgitation. The comprehensive surgical treatment strategy can achieve a good long-term therapeutic effect.
Mitral regurgitation is the most prevalent valvular heart disease, with a poor prognosis that brings a heavy burden to population health and socio-economics. Transcatheter repair is a relatively mature technique for mitral regurgitation, but is strict in anatomical screening and the reduction of regurgitation is limited. With the advance in techniques and technology, transcatheter replacement has become an attractive treatment modality for mitral regurgitation in succession to transcatheter repair. At present, several replacement devices have initiated clinical trials to establish feasibility. Early data has shown that transcatheter replacement for mitral regurgitation is safe and effective, which needs to be confirmed with larger population and longer follow-up. Besides, some technical challenges remain to be addressed, in order to increase accessibility of this innovative technology.