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In-Hospital Outcomes in Minimally Invasive mitral valve Surgery: First Results in a Brazilian Single Center

Open Journal of Thoracic Surgery 2024年第1期14卷 17-28页

作者： Daniel de Magalhães Freitas João Alberto Pansani Max Weyler Nery Stanlley de Oliveira Loyola Maurício Lopes Prudente Giulliano Gardenghi Artur Henrique de Souza Department of Cardiovascular Surgery Encore Hospital Aparecida de Goiania Brazil Anesthesia Clinic (Clianest) Goiania Brazil

Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel® program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m2, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.

关键词： Minimally Invasive Surgical Procedures mitral valve Outcome Assessment Health Care

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Fluid-structure interaction simulation of pathological mitral valve dynamics in a coupled mitral valve-left ventricle model

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智慧医学(英文) 2023年第2期3卷 104-114页

作者： Li Cai Tong Zhao Yongheng Wang Xiaoyu Luo Hao Gao NPU-UoG International Cooperative Lab for Computation and Application in Cardiology School of Mathematics and StatisticsNorthwestern Polytechnical UniversityXi’anShaanxi 710129China Xi’an Key Laboratory of Scientific Computation and Applied Statistics Xi’anShaanxi 710129China School of Mathematics and Statistics University of GlasgowGlasgowG128QQUnited Kingdom

Background Understanding the interaction between the mitral valve(MV)and the left ventricle(LV)is very important in assessing cardiac pump function,especially when the MV is *** dysfunction is a major medical problem owing to the essential role of the MV in cardiac pump *** modelling can provide new approaches to gain insight into the functions of the MV and *** In this study,a previously developed LV-MV model was used to study cardiac dynamics of MV leaflets under normal and pathological conditions,including hypertrophic cardiomyopathy(HOCM)and calcification of the *** coupled LV-MV model was implemented using a hybrid immersed boundary/finite element method to enable assessment of MV haemodynamic *** parameters of the HOCM and calcified valves were inversely determined from published experimental *** LV compensation mechanism was further studied in the case of the calcified *** Our results showed that MV dynamics and LV pump function could be greatly affected by MV *** example,the HOCM case showed bulged MV leaflets at the systole owing to low stiffness,and the calcified MV was associated with impaired diastolic filling and much-reduced stroke *** further demonstrated that either increasing the LV filling pressure or increasing myocardial contractility could enable a calcified valve to achieve near-normal pump *** The modelling approach developed in this study may deepen our understanding of the interactions between the MV and the LV and help in risk stratification of heart valve disease and in silico treatment planning by exploring intrinsic compensation mechanisms.

关键词： mitral valve Left ventricle valve disease Hybrid immersed boundary/finite element method Calcification Hypertrophic cardiomyopathy

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mitral valve Abnormalities during Hypertrophic Cardiomyopathy: Study on a Cohort in Dakar

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World Journal of Cardiovascular Diseases 2023年第11期13卷 710-717页

作者： Simon Antoine Sarr Hicham Fassi-Fehri Marguerite Tening Diouf Youssou Diouf Fatou Aw Joseph Salvador Mingou Khadimu Rassoul Diop Serigne Mor Beye Aliou Alassane Ngaidé Malick Bodian Mouhamadou Bamba Ndiaye Alassane Mbaye Adama Kane Maboury Diao Abdoul Kane Cardiology Unit Aristide Le Dantec Hospital Dakar Senegal Cardiology Unit Dalal Jamm Hospital Dakar Senegal UFR2S Saint Louis Saint-Louis Senegal Cardiology Unit Idrissa Pouye General Hospital Dakar Senegal

INTRODUCTION: mitral valve abnormalities in hypertrophic cardiomyopathy (HCM) are becoming increasingly well defined, and their role in intra-ventricular obstruction is well defined. The aim of this study was to evaluate mitral valve abnormalities in patients with HCM. PATIENTS AND METHODS: We conducted a descriptive cross-sectional study from May 1 to July 1, 2022 in the Cardiology Department of Aristide Le Dantec Hospital. All patients with HCM aged at least 18 years old were included. The parameters studied concerned mainly the mitral valvular apparatus (papillary muscles abnormalities, leaflet length, mitral insufficiency). RESULTS: A total of 10 patients were included. Mean age was 58.3. On Doppler echocardiography, mean interventricular septal thickness was 20.6 mm. The mean maximum intra-ventricular gradient was 21.06 mmHg. Two patients had significant intraventricular obstruction. The mean length of the anterior mitral valve leaflet was 28.7 ± 3.55 mm, with extremes of 22 and 33 mm. The posterior mitral leaflet averaged 14.8 ± 3.16 mm. Nine (9) out of 10 patients had an elongated anterior valve leaflet. Elongation of the posterior leaflet was noted in 6 patients. With regard to papillary muscle position, 6 patients had an anterolateral ascending pillary muscle. These patients had a mean intra-ventricular gradient of 25 mmHg, compared with 16.5 mmHg in the others cases. We found no direct insertion on the mitral valve. mitral insufficiency was noted in 9 patients, including 5 with mild insufficiency and 4 with moderate one. CONCLUSION: mitral valve abnormalities in HCM appear to be frequent. They should be analyzed for a better diagnostic and therapeutic approach.

关键词： Hypertrophic Cardiomyopathy mitral valve Obstruction

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Detection of mitral valve Diseases by Bicoherence Analysis of Heart Sound Signals

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光谱学与光谱分析 2017年第10期37卷 3270-3273页

作者： O.Akgun H.S.Varol Department of Computer Engineering Marmara University Department of Electric and Electronic Engineering Dogus University

The analysis of 10 normal and 51 mitral valve pathology making a total of 61 heart sound signals that were obtained with Littmann 4100 Digital Stethoscope were conducted in this *** the recorded sound signals were denoised by using wavelet filters,the signals were applied bicoherence analysis that is an high order spectral analysis *** has been demonstrated that varieties of mitral valve pathology could be determined by three-dimensional surfaces of bicoherence and maximum bicoherence values.

关键词： mitral valve Heart sound signals Bicoherence analysis

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Outcome of Cox Maze procedure concomitant with mitral valve operation in treatment of atrial fibrillation

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Chinese Medical Journal 2006年第16期119卷 1392-1395页

作者： ZHANG Sai CHEN Ru-kun DONG Ai-qiang WANG Yong-qin CHEN Suo-cheng LI Zhi-jun Department of Cardiothoracic Surgery Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou 310009 China Department of Cardiothoracic Surgery Sir Run Run Shao Hospital Zhejiang University School of Medicine Hangzhou 310016 China Department of Cardiothoracic Surgery First People＇s Hospital Zhenjiang 212000 China

Atrial fibrillation （AF） is fairly common in patients with chronic mitral valve disease and a markedly dilated left atrium. These patients rarely return to sinus rhythm spontaneously, even after a successful mitral valve operation. The Maze procedure, developed by Cox and associates,15 has been used in patients undergoing a mitral valve operation. Restoration of normal sinus rhythm and atrial contraction in such patients have been reported by some groups. This study will summarize retrospectively a group of patients who underwent the Cox Maze procedure for the treatment of AF associated with rheumatic mitral valve disease in China.

关键词： atrial fibrillation rheumatic heart disease cardiac surgery procedures mitral valve retrospective study treatment outcome

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MitraClip:a novel percutaneous approach to mitral valve repair

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2011年第8期12卷 633-637页

作者： Hasan JILAIHAWI Asma HUSSAINI Saibal KAR Cardiovascular Interventional Center Heart InstituteCedars-Sinai Medical Center

As life expectancy increases,valvular heart disease is becoming more *** of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to the elderly *** years have brought a progression of surgical treatments toward less invasive *** has given rise to percutaneous approaches for the correction of valvular heart *** mitral valve repair using the MitraClip system (Abbott Vascular,Santa Clara,CA,USA) creates a double orifice and has been successfully used in selected patients with mitral *** review the rationale,procedural aspects,and clinical data thus far available for the MitraClip approach to mitral regurgitation.

关键词： MitraClip mitral valve mitral regurgitation

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The Optimal Suture Technique for mitral valve Replacement in an <i>Ex Vivo</i>Animal Model

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Open Journal of Thoracic Surgery 2021年第1期11卷 36-45页

作者： Emilie Schultz Hougaard Marie Schäfer Lars Peter Riber Department of Cardiac Thoracic and Vascular Surgery at Odense University Hospital Odense Denmark

Objective: This study compared and evaluated three suture methods in order to find the method with the best durability for mitral valve replacement. The methods evaluated are horizontal mattress suture with subanular pledgets, horizontal mattress suture with supraanular pledgets and continuous running suture. Methods: Thirty hearts were explanted from newly terminated pigs. The hearts were randomized in the three groups. After an atriotomy, the mitral valve was cut out, and a patch was sutured into its place. An air pump model was connected to a balloon which was placed in the left ventricle through aorta and continuously filled with air to a maximum of 300 mmHg. The peak pressure at rupture was noted. If no rupture occurred before reaching 300 mmHg, the suture was found competent. Results: Two out of ten hearts in the continuous running suture-group had myocardial rupture within a pressure of 300 mmHg. In the remaining eight hearts there were no ruptures within 300 mmHg. In the two groups sutured with horizontal mattress with pledgets placed either subanular or supraanular, no rupture of myocardium occurred. When comparing continuous running suture with the horizontal mattress with subanular pledgets or the horizontal mattress with supraanular pledgets, the 1-sided Fishers’ exact was 0.237. At 5% significance level, there was no difference between the three suture methods. Conclusion: There was no statistically significant difference between the durability of the three suture methods, though rupture was only evident in the continuous running suture line. Since it is the surgeon’s choice to select the optimal suture technique, our study should be a reminder for the surgeon to reflect on the suturing factors that have an influence on successful mitral valve replacement.

关键词： mitral valve mitral valve Replacement Suture Technique

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How and where the mitral valve leaks in functional mitral regurgitation

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Medicine in Novel Technology and Devices 2019年第2期2卷 26-31页

作者： Zhongxi Zhou Bo Gao Teng Jing Stephanie Wang Shamini Parameswaran Zhaoming He Research Center of Fluid Machinery Engineering&Technology Jiangsu UniversityZhenjiangJiangsu Province212013PR China Division of Cardiothoracic Surgery Yale UniversityNew HavenCT06519USA Seven Lakes High School KatyTX77494USA Department of Mechanical Engineering Texas Tech UniversityLubbockTX79409USA

Background and Aim:It remains unknown how and where the mitral valve leaks in functional mitral *** objective of the current study was to quantify the geometry and position of the leaflet free edges in order to reveal gapping mechanism of the mitral valve,and develop a plug technique to prevent mitral ***:Eight porcine mitral valves were sutured onto a dilated annulus in an in-vitro experiment to simulate valve closure at hydrostatic transmitral *** sonocrystals were attached to the mitral valve leaflet free *** muscles(PM)were adjusted to the normal position,and subsequently to positions of asymmetric and symmetric papillary muscle *** positions were measured and ***:The leaflet free edges in the central and medial regions moved medially,apically,and posteriorly from normal to asymmetric PM *** potential in the posteromedial region *** displacement of the free edges sometimes generated a gap in the anterolateral region in the asymmetric PM *** leaflet free edges moved posteriorly and apically from the normal to symmetric PM position,and generated a dumb-bell shaped ***:Asymmetric PM position impairs the posteromedial coaptation region due to leaflet tenting,and compromises the anterolateral coaptation region due to medial leaflet *** gaps include multiple sites along the coaptation *** PM position impairs valve coaptation due to valve tenting *** gap is a symmetrical dumb-bell *** findings are crucial for development of the plug technique to prevent mitral regurgitation.

关键词： mitral valve Plug technique Gapping mechanism Ischemic disease

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Evaluation of mitral chordae tendineae length using four-dimensional computed

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World Journal of Cardiology 2024年第5期16卷 274-281页

作者： Takuya Mori Satoshi Matsushita Terumasa Morita Abulaiti Abudurezake Junji Mochizuki Atsushi Amano Department of Cardiovascular Surgery Juntendo University Faculty of MedicineTokyo 113-8421Japan Department of Cardiovascular Surgery JACCT Japan Animal Cardiovascular Care TeamOsaka 533-0033Japan Department of Radiology Minamino Cardiovascular HospitalTokyo 192-0918Japan

BACKGROUND mitral valvuloplasty using artificial chordae tendineae represents an effective surgical approach for treating mitral *** precise measurements of artificial chordae tendineae length(CL)is an important factor in the procedure;however,no objective index currently exists to facilitate this ***,preoperative assessment of CL is critical for surgical planning and ***-dimensional x-ray micro-computed tomography(4D-CT)may be useful for accurate CL measurement considering that it allows for dynamic three-dimensional(3D)evaluation compared to that with transthoracic echocardiography,a conventional inspection *** To investigate the behavior and length of mitral chordae tendineae during systole using *** Eleven adults aged>70 years without mitral valve disease were evaluated.A 64-slice CT scanner was used to capture 20 phases in the cardiac cycle in electrocardiographic *** length of the primary chordae tendineae was measured from early systole to early diastole using the 3D *** primary chordae tendineae originating from the anterior papillary muscle and attached to the A1-2 region and those from the posterior papillary muscle and attached to the A2-3 region were designated as cA and cP,*** behavior and maximum lengths[cA(ma),cP(max)]were compared,and the correlation with body surface area(BSA)was *** In all cases,the mitral anterior leaflet chordae tendineae could be *** most cases,the cA and cP chordae tendineae could be measured *** mean cA(max)and cP(max)were 20.2 mm±1.95 mm and 23.5 mm±4.06 mm,***(max)was significantly *** correlation coefficients(r)with BSA were 0.60 and 0.78 for cA(max)and cP(max),*** cA and cP exhibited constant variation in CL during systole,with a maximum 1.16-fold increase in cA and a 1.23-fold increase in cP from early to *** cP,CL reached a plateau at 15%and remaine

关键词： mitral valve Chordae tendineae Computed tomography Four-dimensional Cardiac cycle

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Leclercia adecarboxylata infective endocarditis in a man with mitral stenosis:A case report and review of the literature

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World Journal of Clinical Cases 2022年第29期10卷 10670-10680页

作者： Rui Tan Jiang-Quan Yu Jing Wang Rui-Qiang Zheng Department of Critical Care Medicine Northern Jiangsu People’s HospitalYangzhou 225001Jiangsu ProvinceChina

BACKGROUND Infective endocarditis(IE) is a rare disease with a high mortality *** adecarboxylata(***) is a movable Gram-negative bacillus of enterobacteriaceae,and it can rarely be a pathogen which often affects immunodeficient *** are about three cases of immunocompetent patients with monomicrobial *** *** are only three reported cases of IE caused by *** in the *** mitral valve is often affected in IE,and the prognosis for IE with mitral valve lesions is often *** SUMMARY A 51-year-old man was found to have moderate to severe mitral stenosis on *** came to our Cardiothoracic Surgery Department for surgical management.A diastolic murmur was heard on auscultation of the heart in the mitral *** the second day of hospitalisation,he presented with slurred speech,reduced muscle strength in the left limb,and acute cerebral infarction on cranial computed *** treatment was decided to *** the ninth day of admission,the patient developed a sudden high fever and shock and was transferred to the Cardiac Intensive Care Unit,where echocardiogram revealed an anterior mitral valve leaflet *** empirical anti-infective treatment with vancomycin(1g q12h),an emergency valve replacement was *** culture identified *** treatment with piperacillin-tazobactam(4.5g q8h) was added for 4 ***-up echocardiography showed normal bioprosthetic valve function after mitral valve *** We report the first case of *** IE in China,and clinicians should pay attention to this pathogen.

关键词： Leclercia adecarboxylata Infective endocarditis mitral valve Vegetation Cerebral infarction Case report

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