Mitral Valve/surgery – ABC CARDIOL

ABC

Research Letter

Late-Onset Bioprosthetic Mitral Valve Thrombosis, Presenting with Significant Obstruction and Acute Heart Failure

Ana Filipa Cardoso et al. Tamara Pereira Filipa Cordeiro Marina Fernandes … Olga Azevedo António Lourenço

Introduction

Bioprosthetic valve thrombosis (BPVT) has an incidence ranging from 0.5% to 6%. However, it is most likely underreported given the technical limitations of 2D transthoracic echocardiography (TTE) and the unawareness of the condition.

Our study presents a case report of a middle-aged male who was admitted with acute heart failure and was diagnosed with BPVT. Recognition of the condition and prompt institution of parenteral anticoagulation allowed for the restoration of the normal functioning of the biological valve, avoiding invasive strategies.

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A Rare Subtype of a Rare Tumor

Paulo Medeiros et al. Ana Rita Coelho João Magalhães Nuno Salomé Vítor Pereira

A 71-year-old woman was admitted to our center, complaining of fatigue, dyspnea, and anorexia. Physical examination revealed a grade III low-pitched diastolic murmur at the mitral focus. Transthoracic echocardiogram (TTE) showed an oval mass inside the left atrium (LA) extending from its roof to the mitral valve ( ), causing significant transmitral pressure gradient ( ). Transesophageal echocardiogram (TEE) ( ) raised the suspicion of left superior pulmonary vein involvement, which was confirmed by computed tomography (CT) angiography ( ). Cardiac magnetic resonance imaging characterized the mass as isointense on T1 and hyperintense on T2-weightened images; there was a contrast uptake, in first-passage sequences, and a heterogeneous late gadolinium enhancement ( ).

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ABCIC

Case Report

Endocarditis Caused by Enterococcus Leading to Spondylodiscitis: Case Report and Literature Review

Wilson Pedro Guimarães Neto et al. Júlio César Queiroz de França Moacir Fernandes de Godoy Lilha Fátima Duarte da Silveira … Rodrigo Bottura de Araújo Márcio Rogério de Souza Braite

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ABCIC

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A Complicated Mitral Prosthesis Endocarditis: An Inevitable Outcome?

Sofia Alegria et al. Ana Marques Inês Rosário Cruz Nádia Junqueira Otília Simões

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ABCIC

Case Report

Left Ventricle Pseudoaneurysm After Mitral Valve Replacement: Case Report and Literature Update

Pedro Rafael de Oliveira Nascimento et al. Gustavo Henrique Belarmino de Góes Diana Patricia Lamprea Sepulveda Ricardo Carvalho Lima … José Maria Del Castillo Dário Celestino Sobral Filho

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ABC

Editorial

The Double-Orifice Technique in Mitral Valve Repair: 35 Years of History

Pablo Maria Alberto Pomerantzeff et al. Carlos Manuel de Almeida Brandão Arlindo Riso Fabio Biscegli Jatene

The advantages of mitral valve repair are lower morbidity and mortality, reduced risk of thromboembolism and endocarditis, improved survival, and better preservation of left ventricular function. The most common cause of degenerative mitral regurgitation is a myxomatous valve with segmental prolapse of the posterior leaflet, a lesion that can be corrected by classical techniques such as quadrangular resection, but other lesions may require more complex surgical techniques, for instance, correction of anterior leaflet prolapse or Barlow disease. Mitral valve repair in rheumatic patients is still a challenge.

In December 1984, Adib Domingos Jatene MD, PhD performed the first “duplication of the mitral orifice”, in a female patient with mitral insufficiency due to rupture of anterior leaflet chordae (). The technique restored mitral competence by anchoring the free edge of the prolapsing leaflets to the corresponding free edge of the opposing leaflet with a 5-0 polypropylene stitch reinforced with pledgets. The patient presented good immediate and long-term evolution.

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Mitral Valve Mass in a Patient Suspected of Systemic Lupus: Tumor, Endocarditis or Both?

Thiago Sant’Anna Coutinho et al. Bárbara Cristina Rodrigues de Almeida Guilherme Dalcol Torres de Amorim Monica Zappa … Clara Weksler Cristiane da Cruz Lamas

Abstract

We present a case report of a patient with an infected mitral valve myxoma and a literature review on the subject. A 33-year-old female presented with a history of fever and dyspnea evolving over a few days. On admission, she had a lupus-like syndrome with positive blood cultures for Haemophilus species . Echocardiogram revealed a giant mass involving both mitral leaflets causing severe regurgitation, requiring biological mitral valve replacement. Microscopy showed an infected myxoma and the patient was discharged asymptomatic upon completion of antibiotics. She did well on follow-up. This is the sixth case of an infected mitral valve myxoma reported in the literature and the third case of a cardiac myxoma infected by the HACEK group. Exceedingly high incidence of embolic events makes prompt imaging, antibiotic therapy and surgery crucial for better outcomes. Time to diagnosis was much briefer than usually reported in other cases of HACEK endocarditis. Valve replacement was the most common surgical procedure and all patients from previous reports did well on follow-up.

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IJCS

Case Report

Mitral Valve Replacement with Regent Aortic Valve in Severe Mitral Stenosis

Negin Yavari et al. Mina Ghorbanpour Landy Negar Omidi Mahmoud Shirzad Seyed Hossein Ahmadi Tafti

Introduction

Mitral valve replacement (MVR) in the context of calcification of the mitral valve annulus (<25 millimeters diameter) is challenging, with an increased risk of postoperative complications. Mitral annular calcification is more common in elderly patients due to secondary aging and tissue degeneration. It can also be found in younger patients with connective tissue disorders and inflammatory conditions including the Marfan’s syndrome, rheumatoid arthritis, and rheumatic fever. Calcification of the mitral annulus has been associated with arrhythmias, heart block, stenosis, valve insufficiency, bacterial endocarditis, and arterial embolization. Although the condition is not common, calcified mitral annulus may been found in patients requiring surgery for mitral valve dysfunction. However, replacement of a calcified valve is challenging especially because of the difficulty in placing the sutures through the calcified annulus, increasing the risk of leakage, poor positioning and dehiscence.^, For this reason, some studies have suggested the implantation of an aortic mechanical valve (St. Jude Medical prosthesis) in mitral position due to its smaller surface area. Advantages of the St. Jude Medical valve prosthesis over other mechanical prostheses include a reduced sewing cuff size and a reduced frame diameter to allow a greater orifice area for a given annular size. There is limited number of studies on this kind of replacement surgeries, and here we report a case of successful placement of a St. Jude Medical aortic valve prosthesis in a calcified mitral annulus without postoperative complication.

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ABC

Case Report

Percutaneous Treatment of Mitral Paraprosthetic Regurgitation: an Alternative to Surgery

Roney Orismar Sampaio et al. Alessandra Gomes de Oliveira George Barreto Miranda Pedro Alves Lemos Neto … Marcelo Luiz Campos Vieira Flávio Tarasoutchi

Introduction

Paraprosthetic regurgitation occurs in approximately 7%–17% of patients undergoing mitral valve replacement and 2%–10% of patients undergoing aortic valve replacement^,. Typically, this regurgitation is discrete and does imply major clinical complications; however, when it is moderate or severe, the consequences can be serious, leading to heart failure and/or hemolysis^,. It is estimated that approximately 1%–5% of cases develop to more clinically severe conditions^,. The main causes of paraprosthetic regurgitation are calcification of the valvular annulus, infection, suture technique, and size and shape of the prosthesis^,.

Usually, surgical treatment is considered as the first treatment option for symptomatic patients. In 1992, however, an alternative treatment via percutaneous occlusion of the paravalvular orifice was proposed for cases in which the patient faces high risk from surgical treatment^–.

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ABC

Original Article

Assessment of Thromboembolism After the Cox-Maze Procedure for Chronic Atrial Fibrillation Secondary to Mitral Valve Lesion

Renato A. K. Kalil et al. Paula L. M. Nesralla Gustavo G. Lima Tiago L. Leiria … Rogério Abrahão Paulo Moreno Paulo R. Prates João R. M. Sant'Anna Ivo A. Nesralla

OBJECTIVE: To assess the occurrence of late thromboembolism after surgical repair of chronic atrial fibrillation (AF) simultaneously with repair of mitral valve using the Cox-Maze procedure. METHODS: 69 patients underwent Cox 3 procedure, with no cryoablation simultaneously with mitral valvuloplasty or prosthesis. Mean age was 49.9±13.2 years. Mean follow-up was of 31.7±19 months. Types of lesion were as follows: 33 (48%) stenoses, 23 (33%) insufficiencies, and 13 (19%) double lesions. Procedures were: 64 (93%) valvuloplasties, 3 (4%) biological and 2 (3%) mechanical prosthesis placement. There were 9 (13%) patients with previous systemic embolism and 2 (3%) had left atrial thrombi. RESULTS: Early mortality was 7% and late 1%. 2 patients (3%) were reoperated for mitral placement. At last evaluation, 10 patients (15%), were in AF. The remaining 59 (85%) were either in sinus / atrial rythm (74%) or under pacing (12%). There were no occurrence of early or late, systemic or pulmonary embolism. Permanent anticoagulation was employed in 16 cases, 10 in regular rythm and 6 in AF. The remaining 47 (75%), 2 in AF and 45 in regular rythm, did not receive anticoagulants. CONCLUSIONS: These results are in accordance with others series, where the occurrence of embolism was rare after maze procedure. Permanent systemic anticoagulation seems to be unnecessary in those cases.

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ABC

Original Article

Mitral valve repair with a malleable bovine pericardium ring

Marco Antônio Volpe et al. Domingo Marcolino Braile Reinaldo Wilson Vieira Dorotéia Rossi Silva Souza

OBJECTIVE: To describe a surgical procedure utilizing a malleable bovine pericardium ring in mitral valve repair and clinical and echodopplercadiographic results. METHODS: Thirty-two (25 female and 7 male) patients, aged between 9 and 66 (M=36.4±17.2) years, were studied over a 16-month period, with 100% follow-up. In 23 (72%) of the patients, the mitral approach was the only one applied; 9 patients underwent associated operations. The technique applied consisted of measuring the perimeter of the anterior leaflet and implanting, according to this measurement, a flexible bovine pericardium prosthesis for reinforcement and conformation of the posterior mitral annulus, reducing it to the perimeter of the anterior leaflet with adjustment of the valve apparatus. RESULTS: The patient survival ratio was 93.8%, with 2 (6.2%) fatal outcomes, one from unknown causes, the other due to left ventricular failure. Only one reoperation was performed. On echodopplercardiography, 88% of the patients had functional recovery of the mitral valve (50% without and 38% with mild insufficiency and no hemodynamic repercussions). Of four (12%) of the remaining patients, 6% had moderate and 6% had seigre insufficiency. Twenty-eight percent of class II patients and 72% of class III patients passed into classes I (65%), II (32%), and III (3%), according to NYHA classification criteria. CONCLUSION: Being flexible, the bovine pericardium ring fit perfectly into the valve annulus, taking into account its geometry and contractility. Valve repair was shown to be reproducible, demonstrating significant advantages during patient evolution, which did not require anticoagulation measures.

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