The clinical problem of atrioventricular valve regurgitation

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "The clinical problem of atrioventricular valve regurgitation"

Transcription

1 Mitral Regurgitation in Congenital Heart Defects: Surgical Techniques for Reconstruction Richard G. Ohye Mitral valve regurgitation (MR) is an important source of morbidity and mortality worldwide. While globally the primary etiology is rheumatic, the incidence of MR appears to be increasing in the United States as well. There are multiple etiologies for MR, and the specific pathologic anatomy varies widely. Similarly, there are a multitude of options for operative repair, and recent series report very good survival rates as well as freedom from re-intervention. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 15: Elsevier Inc. All rights reserved. Introduction The clinical problem of atrioventricular valve regurgitation (AVVR) in children is an area of increasing concern for pediatric cardiologists and pediatric cardiac surgeons. Worldwide, rheumatic heart disease and associated AVVR is a significant health issue, affecting an estimated 12 million people. 1 Of these 12 million people, many will require surgical intervention and a large proportion of these patients will be children. 2 Because of a variety of factors, the incidence of AVVR requiring surgical intervention also appears to be increasing in the United States. These factors include an apparent increase in the incidence of childhood rheumatic fever, and improving survival for complex congenital heart disease. 3,4 Etiology Associate Professor of Cardiac Surgery, Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, MI. Address correspondence to Richard G. Ohye, MD Room , 1540 E. Hospital Drive/SPC 4204, Ann Arbor, MI ; While the predominant etiology in mitral stenosis is rheumatic disease, there are multiple causes of mitral regurgitation (MR) (Table 1). 5 Of these causes, the most commonly encountered etiology in the congenital population would be in the setting of a repaired atrioventricular septal defect (AVSD). In a series of pediatric patients (n 17) undergoing repair for MR, Delmo Walter and colleagues 6 reported incidence of the various etiologies as congenital 76% (13), rheumatic 11% (2), infectious 6% (1), and traumatic 6% (1). However, regardless of the etiology, a descriptive approach of the pathologic anatomy, such as described by Carpentier, 7 may be of greater practical utility. The incidence of the anatomies by Carpentier Classification has been published in case series by Lee et al 8 (n 125) and Stellin et al 9 (n 48) (Tables 2 and 3). Mitral Valve Repair Surgical intervention for MR is predicated on attempted repair, rather than replacement. Mitral valve (MV) replacement, particularly in children, is less desirable because of the need for anticoagulation, the lack of growth potential, the risk of thromboembolism, the risk of endocarditis, and the lack of availability of small sized prostheses. MV repair in the pediatric population results in lower rates of morbidity, such as heart block, thromboembolism, and endocarditis, when compared with MV replacement. 10, 11 Multiple techniques have been described for the repair of MR and are tailored to the particular pathologic anatomy. The most straightforward is the closure of a MV cleft, most often seen in the setting of an AVSD; although it can also occur as an isolated congenital lesion. The cleft is simply closed with interrupted, non-absorbable monofilament suture (Fig. 1), with the caveat that the left lateral leaflet (in the setting of an AVSD) or the posterior leaflet (in the setting of an isolated cleft) must be adequate enough to allow an acceptable remaining MV orifice. Several types of annuloplasty have been described that may be useful in the setting of a dilated mitral annulus. While complete annuloplasty rings can be very effective /12/$-see front matter 2012 Elsevier Inc. All rights reserved. doi: /j.pcsu

2 76 R.G. Ohye Table 1 Causes of Mitral Regurgitation Congenital malformations (eg, AVSD, isolated clefts) Trauma Mitral valve prolapse Endocarditis (active or healed) Collagen-vascular disorders (eg, lupus) Marfan s and other connective tissue disorders Mucopolysaccharidoses (eg, Hurler s) Dilated and hypertrophic cardiomyopathies Papillary muscle dysfunction Annular calcification Idiopathic chordal rupture Endocardial fibrosis for the treatment of MR, a partial annuloplasty is preferable in the growing pediatric patient. Techniques that can be selectively applied include a very limited annular plication in the region of the commissures only (Fig. 2), longer plications involving regions of the annulus, or complete plication along the entire posterior leaflet (Fig. 3). These annuloplasties can be unsupported running suture lines of non-absorbable monofilament, or supported with autologous pericardium, xenograft (eg, bovine pericardium), or polytetrafluoroethylene (PTFE) strips or felt (Fig. 4). In older patients, commercially available complete or partial annuloplasty rings can be used. Recently, Dr. Kalangos developed a bioabsorbable intra-annular annuloplasty ring. 12 Although this ring is not currently commercially available, it has the advantage of gradually undergoing hydrolytic degradation over 6 months, allowing for the potential for growth in pediatric patients. Leaflet prolapse may be caused by chordal rupture or elongation. Many techniques have been described for chordal shortening, papillary muscle shortening, chordal translocation and creation of artificial chordae. Fig. 5 shows techniques for papillary and chordal shortening, although often simple pledgeted monofilament mattress sutures will suffice because the chordae are often thickened from the regurgitant flow. For chordal translocation, either individual chordae Table 3 Incidence of Anatomic Pathology by Carpentier Classification Classification can be transferred or chordae with a wedge of attached leaflet can be transferred. Artificial PTFE chordae can be constructed as shown in Fig. 6. Prolapsing segments of the leaflet can also be resected (Fig. 7). Failure of coaptation, particularly in the setting of a nondilated annulus, can be addressed with leaflet augmentation with autologous pericardium or other tissue. This technique is illustrated in Fig. 8. One of the keys to leaflet augmentation is the mobilization of the underlying papillary muscle and chordal apparatus, as simple leaflet augmentation without increasing the excursion of the free edge, will not improve coaptation. Results of MV Repair Lee 8 (n 125) Stellin 9 (n 48) Type I Normal leaflet motion 55% 67% Type II Leaflet prolapse 37% 19% Type III Restricted leaflet motion 8% 15% The reported results of MV repair are very good. However, most manuscripts do not separate out the results for MR and mitral stenosis. Stellin and colleagues 9 reported their experience over 36 years with 93 patients (median age, 4.5 years; range, 0.16 to 19.8 years) with congenital MV malformations (52% predominant MR). There was a 7.5% (7/93) early mortality, and an 8% (7/86) late mortality at a median follow-up of 8.4 years. Twelve patients required Table 2 Carpentier Classification of Mitral Valve Malformations Type I (normal leaflet motion) Annular dilatation Cleft anterior leaflet Leaflet defect Type II (leaflet prolapse) Elongated chordae Type III (restricted leaflet motion) Type A (normal papillary muscles) Papillary muscles commissure fusion Short chordae Type B (abnormal papillary muscles) Parachute MV Hammock MV Figure 1 MV cleft closure. Illustration also shows the addition of a partial annuloplasty to improve leaflet coaptation. (Reprinted with permission from Pediatric Cardiac Surgery, Mavroudis C, Backer CL p. 594, with permission from Mosby.)

3 Mitral regurgitation in congenital heart defects 77 Figure 2 Wooler -type partial annuloplasty. (Reprinted with permission from Pediatric Cardiac Surgery, Mavroudis C, Backer CL p. 591, with permission from Mosby.) Figure 3 Paneth -type partial annuloplasty. (Modified and reprinted with permission from Delmo Walter EM, Siniawski H, Ovroutski S, Hetzer R. Mitral valve growth after posterior annular stabilization with untreated autologous pericardial strip in children with mitral valve insufficiency. Ann Thorac Surg 2010;90:1580.) Figure 4 Various options for supported partial annuloplasties (Modified and reprinted with permission from Oppido G, et al. Surgical treatment of congenital mitral valve disease: Midterm results of a repairoriented policy. J Thorac Cardiovasc Surg 2008;135:1315). Figure 5 (A) Chordal shortening. (B) Papillary muscle shortening. (Modified and reprinted with permission from Oppido G, et al. Surgical treatment of congenital mitral valve disease: Midterm results of a repair-oriented policy. J Thorac Cardiovasc Surg 2008; 135:1315.)

4 78 R.G. Ohye Figure 6 Two techniques for creation of artificial chordae. (Modified and reprinted with permission from Pediatric Cardiac Surgery, Mavourdis C, Backer CL Figure 32-14, p. 593, with permission from Mosby and from Oppido G, et al. Surgical treatment of congenital mitral valve disease: Midterm results of a repair-oriented policy. J Thorac Cardiovasc Surg 2008; 135:1315 [Figure 2].) MV reintervention, including 11 replacements and one re-repair. Lee and associates 8 reported 139 patients less than age 18 years of age (median age, 2.3 years; range, 2 months to 17.6 years), of whom 125 (90%) had predominantly MR. There were no early deaths and % actuarial survival at 15 years. At 15 years, actuarial freedom from re-operation was % and freedom from MV replacement was %. Delmo Walter and colleagues 10 reported 17 children (mean age, years) who underwent repair for MR. Their repair technique consisted of one of two techniques for posterior annuloplasty, supported by an autologous pericardial strip (Fig. 3). They achieved 100% complete follow-up at a mean of years. There were no early or late deaths. The 3-year actuarial freedom from re-operation was 81.9% and anterior leaflet size paralleled somatic growth over time. When necessary, MV replacement can be undertaken with similar good results, with the majority of the mortality occurring in the peri-operative period, despite the need for chronic anticoagulation. Caldarone 11 reported the experience of the Pediatric Cardiac Care Consortium. There were 176 MV replacements in 139 patients less than 5 years of age. Mean age at initial MV replacement was years; median follow-up was 6.2 years (range, 0 to 20 years) and was 96% complete. Actuarial survival was 82% at 30 days, 79% at 1 year, 75% at 5 years, and 74% at 10 years. Among survivors, the 5-year freedom from reoperation was 81% with 32 patients undergoing a second replacement, and five patients undergoing a third replace- Figure 7 Quadrangular resection. A, Area of resection. B, Resection of prolapsing segment of leaflet. C, Closure of the resulting defect. Associated annuloplasty has been accomplished. D, Completed repair with partial annuloplasty ring in place. (Reprinted with permission from Pediatric Cardiac Surgery, Mavroudis C, Backer CL Figure 32-12, p. 591, with permission from Mosby.)

5 Mitral regurgitation in congenital heart defects 79 Figure 8 Leaflet augmentation. 1, Leaflet is divided at the annulus. 2, Papillary muscles and cordae are mobilize. 3, Leaflet is augmented with autologous pericardium. (Modified from Oppido G, et al. Surgical treatment of congenital mitral valve disease: Midterm results of a repair-oriented policy. J Thorac Cardiovasc Surg 2008;135:1315 [Figures 3].) ment 16% required implantation of a permanent pacemaker; bacterial endocarditis occurred in 6%, thrombosis in 3%, and stroke in 2%. References 1. Murray CJ: Global health statistics. Cambridge, MA; Harvard University Press; 1996: pp Kaplan EL: Recent epidemiology of group A streptococcal infections in North America and abroad: an overview. Pediatrics 1996;97: World Health Organization. Rheumatic fever and rheumatic heart disease. Geneva, Switzerland; World Health Organization; Veasy LG, Tani LY, Hill HR: Persistence of acute rheumatic fever in the intermountain area of the United States. J Pediatr 1994;124: Waller BF, Howard J, Fess S: Pathology of mitral valve stenosis and pure mitral regurgitation Part II. Clin Cardiol 1994;17: Delmo Walter EM, Siniawski H, Ovroutski S, et al: Mitral valve growth after posterior annular stabilization with untreated autologous pericardial strip in children with mitral valve insufficiency. Ann Thorac Surg 2010;90: Carpentier A, Branchini B, Cour JC, et al: Congenital malformations of the mitral valve in children. Pathology and surgical treatment. J Thorac Cardiovasc Surg 1976;72: Lee C, Lee C-H, Kwak JG, et al: Long-term results after mitral valve repair in children. Eur J Cardiothorac Surg 2010;37: Stellin G, Padalino MA, Vida VL, et al: Surgical repair of congenital mitral valve malformations in infancy and childhood: A single-center 36-year experience. J Thorac Cardiovasc Surg 2010;140: Delmo Walter EM, Siniawski H, Ovroutski S, et al: Mitral valve growth after posterior annular stabilization with untreated autologous pericardial strip in children with mitral valve insufficiency. Ann Thorac Surg 2010;90: Caldarone CA: Long-term survival after mitral valve replacement in children aged 5 years: a multi-institutional study. Circulation 2001; 104(suppl 1):I143-I Kalangos A, et al. Annuloplasty for valve repair with a new biodegradable ring: an experimental study. J Heart Valve Dis 2006;15:

Χειρουργική Αντιμετώπιση της Ανεπάρκειας της Μιτροειδούς Βαλβίδας

Χειρουργική Αντιμετώπιση της Ανεπάρκειας της Μιτροειδούς Βαλβίδας Χειρουργική Αντιμετώπιση της Ανεπάρκειας της Μιτροειδούς Βαλβίδας Dr Χρήστος ΑΛΕΞΙΟΥ MD, PhD, FRCS(Glasgow), FRCS(CTh), CCST(UK) Consultant Cardiothoracic Surgeon Normal Mitral Valve Function Mitral Regurgitation

More information

Posterior leaflet prolapse is the most common lesion seen

Posterior leaflet prolapse is the most common lesion seen Techniques for Repairing Posterior Leaflet Prolapse of the Mitral Valve Robin Varghese, MD, MS, and David H. Adams, MD Posterior leaflet prolapse is the most common lesion seen in degenerative mitral valve

More information

Repair of Congenital Mitral Valve Insufficiency

Repair of Congenital Mitral Valve Insufficiency Repair of Congenital Mitral Valve Insufficiency Roland Hetzer, MD, PhD, and Eva Maria Delmo Walter, MS, MD, PhD Principles of Mitral Valve Repair We believe that mitral valve repair for congenital mitral

More information

Valve Analysis and Pathoanatomy: THE MITRAL VALVE

Valve Analysis and Pathoanatomy: THE MITRAL VALVE : THE MITRAL VALVE Marc R. Moon, M.D. John M. Shoenberg Chair in CV Disease Chief, Cardiac Surgery Washington University School of Medicine, St. Louis, MO Secretary, American Association for Thoracic Surgery

More information

Surgical Treatment for Atrioventricular Septal Defect. Masakazu Nakao Consultant, Paediatric Cardiothoracic Surgery

Surgical Treatment for Atrioventricular Septal Defect. Masakazu Nakao Consultant, Paediatric Cardiothoracic Surgery Surgical Treatment for Atrioventricular Septal Defect Masakazu Nakao Consultant, Paediatric Cardiothoracic Surgery 1 History Rastelli classification (Rastelli) Pulmonary artery banding (Muller & Dammann)

More information

8/31/2016. Mitraclip in Matthew Johnson, MD

8/31/2016. Mitraclip in Matthew Johnson, MD Mitraclip in 2016 Matthew Johnson, MD 1 Abnormal Valve Function Valve Stenosis Obstruction to valve flow during that phase of the cardiac cycle when the valve is normally open. Hemodynamic hallmark - pressure

More information

Echocardiographic Evaluation of Primary Mitral Regurgitation

Echocardiographic Evaluation of Primary Mitral Regurgitation Echocardiographic Evaluation of Primary Mitral Regurgitation Roberto M Lang, MD 0-10 o ME 4CH Med A2 P2 50-70 o Commissural P3 P1 A2 80-100 o ME 2CH P3 A2 A1 A1 125-135 o - ME Long axis P2 A2 P3 A3 P2

More information

RECONSTRUCTIVE SURGERY IN CONGENITAL MITRAL VALVE INSUFFICIENCY (CARPENTIER'S TECHNIQUES): LONG-TERM RESULTS

RECONSTRUCTIVE SURGERY IN CONGENITAL MITRAL VALVE INSUFFICIENCY (CARPENTIER'S TECHNIQUES): LONG-TERM RESULTS RECONSTRUCTIVE SURGERY IN CONGENITAL MITRAL VALVE INSUFFICIENCY (CARPENTIER'S TECHNIQUES): LONG-TERM RESULTS Sylvain Chauvaud, MD Jean Francois Fuzellier, MD R6mi Houel, MD Alain Berreb!, MD Serban Mihaileanu,

More information

Nimesh D. Desai, M.D., Ph.D. Director, Thoracic Aortic Surgery Research Program University of Pennsylvania

Nimesh D. Desai, M.D., Ph.D. Director, Thoracic Aortic Surgery Research Program University of Pennsylvania Nimesh D. Desai, M.D., Ph.D. Director, Thoracic Aortic Surgery Research Program University of Pennsylvania Primarily Expert/pioneer series from 5 10 groups No RCTs, limited controls and rapidly changing

More information

In 1980, Bex and associates 1 first introduced the initial

In 1980, Bex and associates 1 first introduced the initial Technique of Aortic Translocation for the Management of Transposition of the Great Arteries with a Ventricular Septal Defect and Pulmonary Stenosis Victor O. Morell, MD, and Peter D. Wearden, MD, PhD In

More information

Surgery For Ebstein Anomaly

Surgery For Ebstein Anomaly Surgery For Ebstein Anomaly Christian Pizarro, MD Chief, Pediatric Cardiothoracic Surgery Director, Nemours Cardiac Center Alfred I. dupont Hospital for Children Professor of Surgery and Pediatrics Sidney

More information

Aortic valve repair is an accepted option for aortic valve

Aortic valve repair is an accepted option for aortic valve Complex Aortic Valve Disease in Children Christopher W. Baird, MD,* and Pedro J. del Nido, MD Aortic valve repair is an accepted option for aortic valve pathologic conditions in children and young adults.

More information

Treatment of severe tricuspid regurgitation: the surgeon's point of view

Treatment of severe tricuspid regurgitation: the surgeon's point of view Treatment of severe tricuspid regurgitation: the surgeon's point of view Mauro Rinaldi MD SC Cardiochirurgia U Universita degli Studi di Torino Direttore: Prof. M. Rinaldi Introduction Right-sided cardiac

More information

Mitral Valve Disease, When to Intervene

Mitral Valve Disease, When to Intervene Mitral Valve Disease, When to Intervene Swedish Heart and Vascular Institute Ming Zhang MD PhD Interventional Cardiology Structure Heart Disease Conflict of Interest None Current ACC/AHA guideline Stages

More information

Regurgitant Lesions. Bicol Hospital, Legazpi City, Philippines July Gregg S. Pressman MD, FACC, FASE Einstein Medical Center Philadelphia, USA

Regurgitant Lesions. Bicol Hospital, Legazpi City, Philippines July Gregg S. Pressman MD, FACC, FASE Einstein Medical Center Philadelphia, USA Regurgitant Lesions Bicol Hospital, Legazpi City, Philippines July 2016 Gregg S. Pressman MD, FACC, FASE Einstein Medical Center Philadelphia, USA Aortic Insufficiency Valve anatomy and function LVOT and

More information

MitraClip in the ICCU: Which Patient will Benefit?

MitraClip in the ICCU: Which Patient will Benefit? MitraClip in the ICCU: Which Patient will Benefit? DAVID MEERKIN STRUCTURAL A ND CONGENITAL HEART DISEASE UNIT SHAARE ZEDEK MEDICAL CENTER JERUSALEM Conflict of Interest No relevant disclosures Complex

More information

Repair or Replacement

Repair or Replacement Surgical intervention post MitraClip Device: Repair or Replacement Saudi Heart Association, February 21-24 Rüdiger Lange, MD, PhD Nicolo Piazza, MD, FRCPC, FESC German Heart Center, Munich, Germany Division

More information

Understanding the Parable Of Rheumatic Mitral Valve Repair. Ahmed Abdullah Jamjoom

Understanding the Parable Of Rheumatic Mitral Valve Repair. Ahmed Abdullah Jamjoom Understanding the Parable Of Rheumatic Mitral Valve Repair Ahmed Abdullah Jamjoom Table of Content Introduction Surgical options KFSH&RC Jeddah, Experience Conclusion A sore throat can lead to a broken

More information

There is increasing acceptance of the value of reconstructing

There is increasing acceptance of the value of reconstructing Fleur de Lys Repair of Posterior Mitral Valve Leaflet Richard A. Hopkins, MD There is increasing acceptance of the value of reconstructing mitral valves and retaining the various components of the mitral

More information

Minimally Invasive Mitral Valve Surgery: Not Another Flash in the Pan The MUSC Experience

Minimally Invasive Mitral Valve Surgery: Not Another Flash in the Pan The MUSC Experience Minimally Invasive Mitral Valve Surgery: Not Another Flash in the Pan The MUSC Experience MUSC Minimally Invasive Cardiac Surgery Mario Castillo- Sang, MD Assistant Professor of Surgery Division of Cardiothoracic

More information

Historical perspective R1 黃維立

Historical perspective R1 黃維立 Degenerative mitral valve disease refers to a spectrum of conditions in which morphologic changes in the connective tissue of the mitral valve cause structural lesions that prevent normal function of the

More information

Risk Factors for Development of Tricuspid Regurgitation after Heart Transplantation and Long-term Outcome of Tricuspid Valve Surgery

Risk Factors for Development of Tricuspid Regurgitation after Heart Transplantation and Long-term Outcome of Tricuspid Valve Surgery Risk Factors for Development of Tricuspid Regurgitation after Heart Transplantation and Long-term Outcome of Tricuspid Valve Surgery Roland Hetzer Anja Claudia Baier Eva Maria Delmo Walter 29 April 2015

More information

Really Less-Invasive Trans-apical Beating Heart Mitral Valve Repair: Which Patients?

Really Less-Invasive Trans-apical Beating Heart Mitral Valve Repair: Which Patients? Really Less-Invasive Trans-apical Beating Heart Mitral Valve Repair: Which Patients? David H. Adams, MD Cardiac Surgeon-in-Chief Mount Sinai Health System Marie Josée and Henry R. Kravis Professor and

More information

International Journal of Pharma and Bio Sciences MORPHOMETRIC STUDY OF MITRAL VALVE IN HUMAN HEARTS A COMPARATIVE ANATOMICAL STUDY ABSTRACT

International Journal of Pharma and Bio Sciences MORPHOMETRIC STUDY OF MITRAL VALVE IN HUMAN HEARTS A COMPARATIVE ANATOMICAL STUDY ABSTRACT Research Article Anatomy International Journal of Pharma and Bio Sciences ISSN 0975-6299 MORPHOMETRIC STUDY OF MITRAL VALVE IN HUMAN HEARTS A COMPARATIVE ANATOMICAL STUDY DR. B. SENTHIL KUMAR 1* DR. A.

More information

Mitral valve infective endocarditis (IE) is the most

Mitral valve infective endocarditis (IE) is the most Mitral Valve Replacement for Infective Endocarditis With Annular Abscess: Annular Reconstruction Gregory J. Bittle, MD, Murtaza Y. Dawood, MD, and James S. Gammie, MD Mitral valve infective endocarditis

More information

Ischemic Mitral Valve Disease: Repair, Replace or Ignore?

Ischemic Mitral Valve Disease: Repair, Replace or Ignore? Ischemic Mitral Valve Disease: Repair, Replace or Ignore? Fabio B. Jatene Full Professor of Cardiovascular Surgery, Medical School, University of São Paulo, Brazil DISCLOSURE I have no financial relationship

More information

Long-Term Assessment of Mitral Valve Reconstruction With Resection of the Leaflets: Triangular and Quadrangular Resection

Long-Term Assessment of Mitral Valve Reconstruction With Resection of the Leaflets: Triangular and Quadrangular Resection Long-Term Assessment of Mitral Valve Reconstruction With Resection of the Leaflets: Triangular and Quadrangular Resection Yoshimasa Sakamoto, MD, Kazuhiro Hashimoto, MD, Hiroshi Okuyama, MD, Shinichi Ishii,

More information

Valve Repair for Mitral Regurgitation Caused by Isolated Prolapse of the Posterior Leaflet

Valve Repair for Mitral Regurgitation Caused by Isolated Prolapse of the Posterior Leaflet Valve Repair for Mitral Regurgitation Caused by Isolated Prolapse of the Posterior Leaflet Patrick Perier, MD, J/2rgen Stumpf, MD, Christian GStz, MD, Fitsoum Lakew, MD, Andr6 Schneider, MD, Bernd Clausnizer,

More information

The outlook for patients with hypoplastic left heart syndrome (HLHS) Tricuspid valve repair in hypoplastic left heart syndrome CHD

The outlook for patients with hypoplastic left heart syndrome (HLHS) Tricuspid valve repair in hypoplastic left heart syndrome CHD Ohye et al Surgery for Congenital Heart Disease Tricuspid valve repair in hypoplastic left heart syndrome Richard G. Ohye, MD a Carlen A. Gomez, MD b Caren S. Goldberg, MD, MS b Holly L. Graves, BA a Eric

More information

Recurrent mitral regurgitation after repair: Should the mitral valve be re-repaired?

Recurrent mitral regurgitation after repair: Should the mitral valve be re-repaired? Surgery for Acquired Cardiovascular Disease Recurrent mitral regurgitation after repair: Should the mitral valve be re-repaired? Rakesh M. Suri, MD, DPhil, Hartzell V. Schaff, MD, Joseph A. Dearani, MD,

More information

Isolated tricuspid valve surgery: timing and indications

Isolated tricuspid valve surgery: timing and indications Cartagena de Indias, Colombia. September 2017 Isolated tricuspid valve surgery: timing and indications José L. Pomar, MD, PhD Professor of Surgery The Cardiovascular Institute Hospital Clinic and University

More information

I have nothing to disclose.

I have nothing to disclose. I have nothing to disclose. New approaches in tricuspid valve repair Christian Schreiber ..more than a simple displacement.., the valvar orifice is formed within the ventricular cavity.. Ebstein Historical

More information

I challenging management problems in cardiac surgery. Mitral Valve Repair for Ischemic Mitral Insufficiency

I challenging management problems in cardiac surgery. Mitral Valve Repair for Ischemic Mitral Insufficiency Mitral Valve Repair for Ischemic Mitral Insufficiency William G. Hendren, MD, James J. Nemec, MD, Bruce W. Lytle, MD, Floyd D. Loop, MD, Paul C. Taylor, MD, Robert W. Stewart, MD, and Delos M. Cosgrove

More information

Percutaneous Mitral Valve Repair: What Can We Treat and What Should We Treat

Percutaneous Mitral Valve Repair: What Can We Treat and What Should We Treat Percutaneous Mitral Valve Repair: What Can We Treat and What Should We Treat Innovative Procedures, Devices & State of the Art Care for Arrhythmias, Heart Failure & Structural Heart Disease October 8-10,

More information

Evolution of the concept and practice of mitral valve repair

Evolution of the concept and practice of mitral valve repair Keynote Lecture Series Evolution of the concept and practice of mitral valve repair Lawrence H. Cohn 1, Vakhtang Tchantchaleishvili 1,2, Taufiek K. Rajab 1 1 Brigham and Women s Hospital, Harvard Medical

More information

An anterior aortoventriculoplasty, known as the Konno-

An anterior aortoventriculoplasty, known as the Konno- The Konno-Rastan Procedure for Anterior Aortic Annular Enlargement Mark E. Roeser, MD An anterior aortoventriculoplasty, known as the Konno-Rastan procedure, is a useful tool for the cardiac surgeon. Originally,

More information

Since the Ross procedure was first described in 1967

Since the Ross procedure was first described in 1967 Ross-Konno Procedure With Mitral Valve Surgery Norihiko Oka, MD, PhD, Osman Al-Radi, MD, Abdullah A. Alghamdi, MD, Siho Kim, MD, and Christopher A. Caldarone, MD Division of Cardiovascular Surgery, The

More information

Aortic valve repair: Techniques and Pitfalls. Allan Stewart, MD Columbia University Medical Center New York, NY

Aortic valve repair: Techniques and Pitfalls. Allan Stewart, MD Columbia University Medical Center New York, NY Aortic valve repair: Techniques and Pitfalls Allan Stewart, MD Columbia University Medical Center New York, NY Take Away Points 1. Valve anatomy is essential to assess repair 2. Unique Decisions with Aneurysm/AI

More information

DEVELOPMENT OF A CRYO-ANCHORING AND RADIOFREQUENCY ABLATION CATHETER FOR PERCUTANEOUS TREATMENT OF MITRAL VALVE PROLAPSE. Steven Michael Boronyak

DEVELOPMENT OF A CRYO-ANCHORING AND RADIOFREQUENCY ABLATION CATHETER FOR PERCUTANEOUS TREATMENT OF MITRAL VALVE PROLAPSE. Steven Michael Boronyak DEVELOPMENT OF A CRYO-ANCHORING AND RADIOFREQUENCY ABLATION CATHETER FOR PERCUTANEOUS TREATMENT OF MITRAL VALVE PROLAPSE By Steven Michael Boronyak Dissertation Submitted to the Faculty of the Graduate

More information

Barlow s disease is a common cause of mitral regurgitation. Large Annuloplasty Rings Facilitate Mitral Valve Repair in Barlow s Disease

Barlow s disease is a common cause of mitral regurgitation. Large Annuloplasty Rings Facilitate Mitral Valve Repair in Barlow s Disease Large Annuloplasty Rings Facilitate Mitral Valve Repair in Barlow s Disease David H. Adams, MD, Ani C. Anyanwu, MD, Parwis B. Rahmanian, MD, Vivian Abascal, MD, Sacha P. Salzberg, MD, and Farzan Filsoufi,

More information

Repair of Mitral Valve Prolapse with a Novel Leaflet Plication Clip in an Animal Model

Repair of Mitral Valve Prolapse with a Novel Leaflet Plication Clip in an Animal Model Repair of Mitral Valve Prolapse with a Novel Leaflet Plication Clip in an Animal Model Eric N. Feins 1, Haruo Yamauchi 1, Gerald R. Marx 2, Franz P. Freudenthal 3, Hua Liu 1, Pedro J. del Nido 1, Nikolay

More information

MITRAL STENOSIS. Joanne Cusack

MITRAL STENOSIS. Joanne Cusack MITRAL STENOSIS Joanne Cusack BSE Breakdown Recognition of rheumatic mitral stenosis Qualitative description of valve and sub-valve calcification and fibrosis Measurement of orifice area by planimetry

More information

Reoperation after previous Ross procedure

Reoperation after previous Ross procedure Reoperation after previous Ross procedure Victor Tsang Society of Thoracic Surgeons of Thailand 2016 As a living autograft, the transplanted pulmonary valve has the prospect of long term or permanent survival.

More information

Joseph E. Bavaria, M.D. Roberts Measy Professor and Vice Chief CardioVascular Surgery Director: Thoracic Aortic Surgery Program University of

Joseph E. Bavaria, M.D. Roberts Measy Professor and Vice Chief CardioVascular Surgery Director: Thoracic Aortic Surgery Program University of Joseph E. Bavaria, M.D. Roberts Measy Professor and Vice Chief CardioVascular Surgery Director: Thoracic Aortic Surgery Program University of Pennsylvania, USA AVRS Philadelphia Sept 2016 Pictures courtesy

More information

Percutaneous Mitral Valve Repair

Percutaneous Mitral Valve Repair Percutaneous Mitral Valve Repair MitraClip: Procedure, Data, Patient Selection Chad Rammohan, MD FACC Director, Cardiac Cath Lab El Camino Hospital Mountain View, California Mitral Regurgitation MitraClip

More information

Ischemic mitral valve reconstruction and replacement: Comparison of long-term survival and complications

Ischemic mitral valve reconstruction and replacement: Comparison of long-term survival and complications Surgery for Acquired Cardiovascular Disease Ischemic mitral valve reconstruction and replacement: Comparison of long-term survival and complications Eugene A. Grossi, MD Judith D. Goldberg, ScD Angelo

More information

PERCUTANEOUS MITRAL VALVE THERAPIES 13 TH ANNUAL CARDIAC, VASCULAR AND STROKE CARE CONFERENCE PIEDMONT ATHENS REGIONAL

PERCUTANEOUS MITRAL VALVE THERAPIES 13 TH ANNUAL CARDIAC, VASCULAR AND STROKE CARE CONFERENCE PIEDMONT ATHENS REGIONAL PERCUTANEOUS MITRAL VALVE THERAPIES 13 TH ANNUAL CARDIAC, VASCULAR AND STROKE CARE CONFERENCE PIEDMONT ATHENS REGIONAL DISCLOSURES I WILL BE DISCUSSING OFF-LABEL USAGE OF DEVICES RELATED TO TMVR OBJECTIVES

More information

MEMO 3D RECHORD. Ready to repair. Guiding standards in Mitral valve repair

MEMO 3D RECHORD. Ready to repair. Guiding standards in Mitral valve repair MEMO 3D RECHORD TM Ready to repair Guiding standards in Mitral valve repair CARDIAC SURGERY SOLUTIONS A 45-year long history of innovative records in cardiac surgery LivaNova s relentless commitment to

More information

The benefits of mitral valve reconstruction for operative

The benefits of mitral valve reconstruction for operative Prophylactic Mitral Reconstruction for Mitral Regurgitation Iva A. Smolens, MD, Francis D. Pagani, MD, PhD, G. Michael Deeb, MD, Richard L. Prager, MD, Seema S. Sonnad, PhD, and Steven F. Bolling, MD Section

More information

Repair of very severe tricuspid regurgitation following detachment of the tricuspid valve

Repair of very severe tricuspid regurgitation following detachment of the tricuspid valve OPEN ACCESS Images in cardiology Repair of very severe tricuspid regurgitation following detachment of the tricuspid valve Ahmed Mahgoub 1, Hassan Kamel 2, Walid Simry 1, Hatem Hosny 1, * 1 Aswan Heart

More information

Marfan s S drome: Combined Composite Valve GrAeplacement of the Aortic Root and Transaortic Mihal Valve Replacement

Marfan s S drome: Combined Composite Valve GrAeplacement of the Aortic Root and Transaortic Mihal Valve Replacement Marfan s S drome: Combined Composite Valve GrAeplacement of the Aortic Root and Transaortic Mihal Valve Replacement E. Stanley Crawford, M.D., and Joseph S. Coselli, M.D. ABSTRACT Echocardiographic studies

More information

Worldwide Results and Review of MitraClip : What Is the Future?

Worldwide Results and Review of MitraClip : What Is the Future? Worldwide Results and Review of MitraClip : What Is the Future? Darío Echeverri, M.D., F.A.C.C. Disclosure Information The following relationships exist: Consultant: Medtronic, Abbott Vascular Off label

More information

Correction of anterior mitral prolapse: The parachute technique

Correction of anterior mitral prolapse: The parachute technique Correction of anterior mitral prolapse: The parachute technique Konstantinos Zannis, MD, a Laurens Mitchell-Heggs, MD, a Valentina Di Nitto, MD, a Matthias E. W. Kirsch, MD, PhD, b Milena Noghin, MD, a

More information

Clinical material and methods. Copyright by ICR Publishers 2007

Clinical material and methods. Copyright by ICR Publishers 2007 16847_JHVD_Biancari_3197_(116-121)_r1:Layout 1 21/3/07 17:07 Page 116 Predicting Immediate and Late Outcome after Surgery for Mitral Valve Regurgitation with EuroSCORE Jouni Heikkinen, Fausto Biancari,

More information

The Tricuspid Valve: The Not So Forgotten Valve. Manuel J Antunes Cardiothoracic Surgery Coimbra, Portugal

The Tricuspid Valve: The Not So Forgotten Valve. Manuel J Antunes Cardiothoracic Surgery Coimbra, Portugal The Tricuspid Valve: The Not So Forgotten Valve Manuel J Antunes Cardiothoracic Surgery Coimbra, Portugal No Conflicts of Interest to declare with regards to this subject 2 INCIDENCE OF TRICUSPID REGURGITATION

More information

Management of complex CHD in adults

Management of complex CHD in adults Management of complex CHD in adults Victor Tsang Society of Thoracic Surgeons of Thailand 2016 The impact of infant cardiac surgery Over 90 % of infants born with CHD will reach adulthood By 2010, adults

More information

Partial atrioventricular septal defect (AVSD), the socalled

Partial atrioventricular septal defect (AVSD), the socalled Surgery for Partial Atrioventricular Septal Defect in the Adult Michael A. Gatzoulis, MD, Sloane Hechter, Gary D. Webb, MD, and William G. Williams, MD The Toronto Congenital Cardiac Centre for Adults,

More information

What echo measurements are key prior to MitraClip?

What echo measurements are key prior to MitraClip? APHP CHU Bichat - Claude Bernard What echo measurements are key prior to MitraClip? Eric Brochet,MD Cardiology Department Hopital Bichat Paris France No disclosure Conflict of interest Case 69 y.o man

More information

Echo in Asymptomatic Mitral and Aortic Regurgitation

Echo in Asymptomatic Mitral and Aortic Regurgitation 2017 ASE Florida Orlando, FL October 9, 2017 10:40 11:00 PM 20 min Grand Harbor Ballroom South Echo in Asymptomatic Mitral and Aortic Regurgitation Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology

More information

MITRAL REGURGITATION ECHO PARAMETERS TOOL

MITRAL REGURGITATION ECHO PARAMETERS TOOL Comprehensive assessment of qualitative and quantitative parameters, along with the use of standardized nomenclature when reporting echocardiographic findings, helps to better define a patient s MR and

More information

What is Ebstein Anomaly?

What is Ebstein Anomaly? Echocardiograpnhic Evaluation of : Definition, Detection and Determinants of Outcome P. W. O Leary, M.D. Division of Pediatric Cardiology Mayo Clinic No Conflicts to Disclose What is? Failure of the TV

More information

Mitral valve repair is the treatment of choice for most. Hemolysis After Mitral Valve Repair: Mechanisms and Treatment

Mitral valve repair is the treatment of choice for most. Hemolysis After Mitral Valve Repair: Mechanisms and Treatment Hemolysis After Mitral Valve Repair: Mechanisms and Treatment Buu-Khanh Lam, MD, Delos M. Cosgrove III, MD, Sunil K. Bhudia, MD, and A. Marc Gillinov, MD Department of Thoracic and Cardiovascular Surgery,

More information

Excellence in Care of Mitral Regurgitation: Centers of Excellence & Physician Competence

Excellence in Care of Mitral Regurgitation: Centers of Excellence & Physician Competence Excellence in Care of Mitral Regurgitation: Centers of Excellence & Physician Competence Vinay Badhwar, MD University of Pittsburgh UPMC Disclosures None Chair, STS Public Reporting Task Force ACC Evolving

More information

Article. Reference. Is minimally invasive mitral valve repair with artificial chords reproducible and applicable in routine surgery?

Article. Reference. Is minimally invasive mitral valve repair with artificial chords reproducible and applicable in routine surgery? Article Is minimally invasive mitral valve repair with artificial chords reproducible and applicable in routine surgery? PANOS, Aristotelis, et al. Abstract Traditional resectional techniques and chordal

More information

MITRAL VALVE DISEASE- ASSESSMENT AND MANAGEMENT. Irene Frantzis P year, SGUL Sheba Medical Center

MITRAL VALVE DISEASE- ASSESSMENT AND MANAGEMENT. Irene Frantzis P year, SGUL Sheba Medical Center MITRAL VALVE DISEASE- ASSESSMENT AND MANAGEMENT Irene Frantzis P year, SGUL Sheba Medical Center MITRAL VALVE DISEASE Mitral Valve Regurgitation Mitral Valve Stenosis Mitral Valve Prolapse MITRAL REGURGITATION

More information

Get Ready for Percutaneous Mitral Valve Approaches

Get Ready for Percutaneous Mitral Valve Approaches Get Ready for Percutaneous Mitral Valve Approaches Paul A. Grayburn, MD Baylor Scott and White Healthcare System The Heart Hospital Baylor Plano and Baylor Heart and Vascular Hospital Dallas, TX HOPE Unmet

More information

The Bicuspid AV Surgical Considerations

The Bicuspid AV Surgical Considerations The Bicuspid AV Surgical Considerations Ehud Raanani, MD Cardiothoracic Surgery, Sheba Medical Center Sackler School of Medicine, Tel Aviv University September 12, 2014 Homburg BAV Repair Congenital variations

More information

PRINCIPLES OF ENDOCARDITIS

PRINCIPLES OF ENDOCARDITIS 015 // Endocarditis CONTENTS 140 Principles of Endocarditis 141 Native Valve Endocarditis 143 Complications of Native Valve Endocarditis 145 Right Heart Endocarditis 145 Prosthetic Valve Endocarditis 146

More information

Aortic root enlargement is an invaluable surgical technique

Aortic root enlargement is an invaluable surgical technique Aortic Root Enlargement in the Adult Christopher M. Feindel, MD, CM, FRCS(C) Aortic root enlargement is an invaluable surgical technique with which every cardiac surgeon performing aortic valve replacement

More information

ICE: Echo Core Lab-CRF

ICE: Echo Core Lab-CRF APPENDIX 1 ICE: Echo Core Lab-CRF Study #: - Pt Initials: 1. Date of study: / / D D M M M Y Y Y Y 2. Type of Study: TTE TEE 3. Quality of Study: Poor Moderate Excellent Ejection Fraction 4. Ejection Fraction

More information

Understanding the guidelines for Interventions in MR. Ali AlMasood

Understanding the guidelines for Interventions in MR. Ali AlMasood Understanding the guidelines for Interventions in MR Ali AlMasood Mitral regurgitation The most diverse from all acquired valve diseases About 50% of patients with an LVEF 35 percent had moderate to severe

More information

PROGRESS IN CARDIOVASCULAR SURGERY. Congenital Mitral Stenosis and Mitral Insufficiency

PROGRESS IN CARDIOVASCULAR SURGERY. Congenital Mitral Stenosis and Mitral Insufficiency PROGRESS IN CARDIOVASCULAR SURGERY Congenital Mitral Stenosis and Mitral Insufficiency GEORGE W. B. STARKEY, M.D.* Boston, Massachusetts CONGENITAL MITRAL STENOSIS AND mitral insufficiency are rare, particularly

More information

My Choice For Percutaneous Mitral Valve Replacement. Jose Luis Navia, MD.

My Choice For Percutaneous Mitral Valve Replacement. Jose Luis Navia, MD. My Choice For Percutaneous Mitral Valve Replacement Jose Luis Navia, MD. Disclosure Edwards Lifescienses St. Jude Medical MAQUET NaviGate Consultant, Investigator Consultant, Investigator Consultant, Investigator

More information

Surgical Treatment for Valvular Heart Disease

Surgical Treatment for Valvular Heart Disease Chapter 34 Surgical Treatment for Valvular Heart Disease Peter J. K. Starek Competency of the atrioventricular valves allows blood to enter the ventricles, where pressure is generated. When adequate systolic

More information

MitraClip. Brian Whisenant, MD. December 2015

MitraClip. Brian Whisenant, MD. December 2015 MitraClip Brian Whisenant, MD December 2015 Disclosure Statement of Financial Interest Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the

More information

Surgical Indications of Infective Endocarditis in Children

Surgical Indications of Infective Endocarditis in Children 2016 Annual Spring Scientific Conference of the KSC April 15-16, 2016 Surgical Indications of Infective Endocarditis in Children Cheul Lee, MD Pediatric and Congenital Cardiac Surgery Seoul St. Mary s

More information

The Use of Pericardium in Aortic Valve Repair: When is it a Durable Solution?

The Use of Pericardium in Aortic Valve Repair: When is it a Durable Solution? The Use of Pericardium in Aortic Valve Repair: When is it a Durable Solution? Laurent de Kerchove, Gebrine El Khoury Cliniques Universitaires St Luc, IREC, UCL Brussels, Belgium 29 th EACTS Annual Meeting

More information

Prognostic Impact of FMR

Prognostic Impact of FMR Secondary Mitral Valve Regurgitation in Heart Failure, Age 60 Years From Medical Therapy to Surgical Repair to Transcatheter Intervention The Interventionalist s View Samin K Sharma, MD, FACC, FSCAI Director

More information

Clinical material and methods. Fukui Cardiovascular Center, Fukui, Japan

Clinical material and methods. Fukui Cardiovascular Center, Fukui, Japan Mitral Valve Regurgitation after Atrial Septal Defect Repair in Adults Shohei Yoshida, Satoshi Numata, Yasushi Tsutsumi, Osamu Monta, Sachiko Yamazaki, Hiroyuki Seo, Takaaki Samura, Hirokazu Ohashi Fukui

More information

Atrioventricular Canal (Septal) Defects. Norman H Silverman MD. D Sc (Med),FACC, FAHA

Atrioventricular Canal (Septal) Defects. Norman H Silverman MD. D Sc (Med),FACC, FAHA Atrioventricular Canal (Septal) Defects Norman H Silverman MD. D Sc (Med),FACC, FAHA Embryology of the A-V Canal Looping NHS. Formation of the Atrial Septum Embryology of the A-V Canal NHS. Development

More information

SURGICAL ANATOMY OF THE MITRAL VALVE LEAFLETS

SURGICAL ANATOMY OF THE MITRAL VALVE LEAFLETS Revista Română de Anatomie funcţională şi clinică, macro- şi microscopică şi de Antropologie Vol. XV Nr. 4 2016 CLINICAL ANATOMY SURGICAL ANATOMY OF THE MITRAL VALVE LEAFLETS M. Enache 1,2, Diana Anghel

More information

16 YEAR RESULTS Carpentier-Edwards PERIMOUNT Mitral Pericardial Bioprosthesis, Model 6900

16 YEAR RESULTS Carpentier-Edwards PERIMOUNT Mitral Pericardial Bioprosthesis, Model 6900 CLINICAL COMMUNIQUé 6 YEAR RESULTS Carpentier-Edwards PERIMOUNT Mitral Pericardial Bioprosthesis, Model 69 The Carpentier-Edwards PERIMOUNT Mitral Pericardial Valve, Model 69, was introduced into clinical

More information

Transapical beating-heart chordae implantation in mitral regurgitation: a new horizon for repairing mitral valve prolapse

Transapical beating-heart chordae implantation in mitral regurgitation: a new horizon for repairing mitral valve prolapse Editorial Transapical beating-heart chordae implantation in mitral regurgitation: a new horizon for repairing mitral valve prolapse Patrizio Lancellotti 1,2, Marc Radermecker 3,4, Rodolphe Durieux 3, Thomas

More information

Management of Difficult Aortic Root, Old and New solutions

Management of Difficult Aortic Root, Old and New solutions Management of Difficult Aortic Root, Old and New solutions Hani K. Najm MD, Msc, FRCSC,, FACC, FESC Chairman, Pediatric and Congenital Heart Surgery Cleveland Clinic Conflict of Interest None Difficult

More information

MITROFLOW VALSALVA CONDUIT TM

MITROFLOW VALSALVA CONDUIT TM TM Features the only bovine pericardium aortic root surgery system THE REPLICATES THE NATIVE SINUS, NATURALLY 2 TM LIVANOVA S INNOVATIVE IS DESIGNED TO: Provide a reproducible and easy solution for better

More information

PATIENT BOOKLET MEDTRONIC SURGICAL VALVE REPLACEMENT. Tissue Valve for Aortic and Mitral Valve Replacement

PATIENT BOOKLET MEDTRONIC SURGICAL VALVE REPLACEMENT. Tissue Valve for Aortic and Mitral Valve Replacement PATIENT BOOKLET MEDTRONIC SURGICAL VALVE REPLACEMENT Tissue Valve for Aortic and Mitral Valve Replacement ARE MEDTRONIC SURGICAL TISSUE HEART VALVES RIGHT FOR YOU? Medtronic surgical heart valves are for

More information