Mitral valve infective endocarditis (IE) is the most

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Mitral valve infective endocarditis (IE) is the most"

Transcription

1 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 (IE) is the most common form of left-sided IE. A mitral annular abscess is present in 15% of cases of mitral valve IE. Annular abscesses are almost always located in the posterior mitral annulus. The presence of an annular abscess mandates careful debridement and reconstruction of the atrioventricular (AV) groove with a patch, prior to mitral valve replacement. We use a bovine pericardial patch to reconstruct the posterior annulus. The patch is fashioned to cover the defect by at least 1 2cm circumferentially and is anchored with a running suture, starting at the deepest location in the ventricle and working in both directions toward the atrium. This suture line then extends across the AV groove and anchors the patch to the posterior left atrium. Close spacing of sutures, solid bites in the myocardium, and gentle tension on the suture assures a reliable and hemostatic repair. Operative Techniques in Thoracic and Cardiovasculary Surgery 20:17-30 r 2015 Published by Elsevier Inc. KEYWORDS mitral, abscess, bovine pericardium, valve, infective endocarditis Introduction Mitral valve infective endocarditis (IE) is the most common form of left-sided IE and has an in-hospital mortality rate of 20%-30%. Though nearly half of the patients with mitral valve IE undergo surgical intervention, this remains an uncommon procedure, making up less than 5% of all mitral valve operations, and thus, individual surgeon experience is limited. Choosing the correct patients for operative intervention, at the optimal time, and performing a technically sound operation are critical for optimizing outcomes in this challenging disease process. At our center, indications for operation include the presence of severe mitral regurgitation, paravalvular abscess, vegetations that are mobile or are more than 1 cm in size, embolic events, failure of antibiotic therapy, and fungal etiology. Most patients with mitral valve IE present with cerebral embolism, which we do not consider a contraindication to surgical repair unless associated with significant hemorrhage. The key principle of operative therapy for mitral valve IE is complete debridement of all vegetations and infected tissue, leaving only native tissue that is of sufficient quality to hold suture. Diligence in this regard is essential for the durability of subsequent repair or replacement. A mitral annular abscess is present in approximately 15% of cases of mitral valve IE. 1 Mitral abscesses are almost always located in the posterior mitral annulus and involve the posterior leaflet, the annulus, and the underlying myocardium. The presence of an annular abscess or significant destruction of the posterior annulus mandates careful debridement and reconstruction of the atrioventricular groove with a patch, before mitral valve replacement or repair. We prefer to use bovine pericardium to reconstruct the posterior annulus (Figs. 1 9). Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD Address reprint requests to James S. Gammie, MD, Division of Cardiac Surgery, University of Maryland School of Medicine, 110 S Paca St, 7th Floor, Baltimore, MD /$-see front matter r 2015 Published by Elsevier Inc. 17

2 18 G.J. Bittle et al. Operative Technique Right atrial appendage Aorta SVC IVC Vegetation on posterior leaflet and annulus Figure 1 The patient is centrally cannulated for cardiopulmonary bypass with bicaval drainage. No pericardial stay sutures are placed on the left side of the heart, allowing the heart to rotate to the left. The cavae are mobilized, the interatrial groove is developed, and a longitudinal incision is made from the right superior pulmonary vein inferiorly toward the inferior vena cava, facilitating exposure of the mitral valve. The valve is then assessed. In this case, a vegetation is identified involving the posterior leaflet. SVC ¼ superior vena cava; IVC ¼ inferior vena cava.

3 Mitral valve replacement for infective endocarditis with annular abscess 19 Resection of vegetation and debridement of posterior leaflet & annulus Figure 2 Complete debridement. All affected tissue is sharply excised. This may include leaflet, chords, and other parts of the subvalvular apparatus, as well as portions of the annulus and surrounding atrial tissue.

4 20 G.J. Bittle et al. A Papillary muscle Remnant of posterior leaflet Anterior Leaflet Papillary muscle Remnant of Posterior leaflet Posterior annulus Abscess cavity Figure 3 Assessment. Following complete debridement, the valve is assessed and the decision is made to proceed with either repair or replacement (A).

5 Mitral valve replacement for infective endocarditis with annular abscess 21 B Removal of anterior leaflet leaving 3-5 mm rim Figure 3 Continued (B and C) If the valve needs to be replaced, the anterior leaflet is resected, leaving a rim of leaflet tissue measuring 4-5 mm attached to the annulus. Alternatively the anterior leaflet and chords can be spared by dividing the anterior leaflet in half and translocating the right and left "tabs" to 9:00 and 2:00 and incorporating them into the replacement suture line.

6 22 G.J. Bittle et al. C Resection of anterior leaflet completed with scissors Figure 3 (Continued)

7 Mitral valve replacement for infective endocarditis with annular abscess 23 A Bovine pericardial patch trimmed to fit over defect Directional pattern for suturing patch Defect under patch Figure 4 Annular reconstruction. The integrity of the annulus is then evaluated. In this case, adequate debridement has necessitated resection of annular tissue and the annular abscess is clearly visible. We prefer to use bovine pericardium to reconstruct the atrioventricular continuity. (A) We use a bovine pericardial patch measuring either 5 10 cm or 9 14 cm. The thickness of this patch is mm (St. Jude Medical, Inc, Minneapolis, MN; catalog C0510 [5 10 cm] or C0914 [9 14 cm]). The patch is intentionally oversized such that it comfortably covers the defect by at least 1-2 cm circumferentially. It is secured in place using running 4-0 polypropylene suture, starting at the deepest location in the ventricle and working in both directions toward the atrium.

8 24 G.J. Bittle et al. B Patch sewn into place beginning at mid-position of patch, deepest location in ventricle Figure 4 Continued (B) This suture line then extends across the atrioventricular groove and similarly anchors the patch to the posterior left atrium. Close spacing of sutures, solid bites in the myocardium, and gentle tension on the suture assure a reliable and hemostatic repair. Injury to the underlying left circumflex coronary artery is avoided when traversing the annulus by placing sutures at a depth similar to that for mitral valve replacement. Oversizing the patch provides a rim of pericardium that is sealed by intracavitary ventricular pressure against the underlying normal myocardium, thereby contributing to hemostasis (Fig. 9). This is the same principle underlying the repair of an atrioventricular groove disruption.

9 Mitral valve replacement for infective endocarditis with annular abscess 25 Patch over abscess cavity Figure 5 Inspect the patch. The patch should completely cover the annular defect without tension. The suture line is inspected for laxity.

10 26 G.J. Bittle et al. Sutures placed for securing bioprosthetic valve Figure 6 Place valve sutures. Valve sutures are placed in the intact annulus and are seated in the patch overlying the defect.

11 Mitral valve replacement for infective endocarditis with annular abscess 27 Seating replacement value Figure 7 Seat the valve. The sutures are passed through the sewing ring of the bioprosthetic valve such that the 2 marked posts are approximately aligned with the trigones, avoiding obstruction of the left ventricular outflow tract.

12 28 G.J. Bittle et al. Mitral valve replacement completed Figure 8 Final inspection. After securing all the valve sutures, the valve is inspected one last time for evidence of instability or potential areas of paravalvular leak. The visible margin of the patch is also inspected for integrity. We pass a Foley catheter across the valve at this point, inflate the balloon with 5-6 cc of saline, and leave it in place for use as a left ventricular vent. The left atrium is closed with polypropylene sutures.

13 Mitral valve replacement for infective endocarditis with annular abscess 29 Atrial pressure Defect Patch Ventricular pressure Figure 9 Demonstrates the completed annular reconstruction with bovine pericardium with a bioprosthetic mitral valve replacement. Ventricular and atrial pressure contribute to hemostasis at the margins of the pericardial patch.

14 30 Discussion At least half of the patients with mitral valve IE require surgery, and mitral valve IE should be considered a surgical disease until proven otherwise. There is a clear correlation between the percentage of patients undergoing early surgical intervention and lower in-hospital mortality rates in patients with mitral valve IE, and contemporary series with high rates of early surgery report mortality rates of 10% or lower. 2 A recent prospective randomized trial compared early surgery with antibiotic therapy for patients with left-sided IE and large (41 cm) vegetations and found that early surgery significantly reduced the composite end point of death or embolic events by reducing the risk of systemic embolism. 1 Evidence of cerebral embolism is present on cranial magnetic resonance (MR) imaging in approximately 80% of patients presenting with active IE and in 50% of patients on computed tomography and should not be a contraindication to early operative intervention. In our institutional experience, hemorrhagic conversion is an exceptionally rare event, and a policy of early operative intervention has been associated with a low stroke rate 3 and has the benefit of prevention of further embolic events, rapid resolution of valvular insufficiency, and an increased likelihood of repair. Rather than the presence of heart failure, we believe that the presence of severe MR is a key trigger for operative intervention. MR precedes and leads to the development of heart failure, which has been demonstrated to be the most important risk factor for mortality in IE. Antibiotic therapy alone does not lead to a decrease in the severity of mitral regurgitation. The scale and nature of operative intervention is dictated by the extent of tissue destruction always adherent to the principle of complete debridement and may require G.J. Bittle et al. annular reconstruction. The material with which the neoannulus is created is a matter of surgeon preference. The use of bovine pericardium, fixed and fresh autologous pericardium, as well as Dacron have all been described. Pericardial tissue has the advantage of increased pliability and the ability to conform to the underlying myocardium, decreasing the likelihood of flow under the patch, which could result in the development of a pseudoaneurysm or ventriculoatrial shunt. Importantly, this material has not been associated with an increased risk of reinfection. 4 Following patch placement, either valve repair or replacement can be performed depending on the extent of destruction of the valve leaflets. As is the case for noninfectious mitral valve disease, repair when possible has been shown to decrease the risk of stroke, recurrent endocarditis, reoperation, and death in patients with mitral valve IE. 1 If repair is undertaken, the surgeon should not hesitate to use an annuloplasty: the risk of annuloplasty ring infection is negligible, and the consequences of a failed repair are significant. 5 References 1. Kang D, Kim Y, Kim S, et al: Early versus conventional treatment for infective endocarditis. New Engl J Med 366:2466, Thuny F, Grisoli D, Collart F, et al: Management of infective endocarditis: challenges and perspectives. Lancet, Shang E, Forrest G, Chizmar T, et al: Mitral valve infective endocarditis: benefit of early operation and aggressive use of repair. Ann Thorac Surg 87: , Kerchove L, Price J, Tamer S, et al: Extending the scope of mitral valve repair in active endocarditis. J Thorac Cardiovasc Surg 143:s91 s95, Gillinov AM, Faber CN, Sabik JF, et al: Endocarditis after mitral valve repair. Ann Thorac Surg 73: , 2002

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

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

Cardiac tumors are unusual and cardiac malignancy, usually

Cardiac tumors are unusual and cardiac malignancy, usually Cardiac Autotransplantation Shanda H. Blackmon, MD,* and Michael J. Reardon, MD Cardiac tumors are unusual and cardiac malignancy, usually sarcoma, is a very small subset of these. The literature on cardiac

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

The pericardial sac is composed of the outer fibrous pericardium

The pericardial sac is composed of the outer fibrous pericardium Pericardiectomy for Constrictive or Recurrent Inflammatory Pericarditis Mauricio A. Villavicencio, MD, Joseph A. Dearani, MD, and Thoralf M. Sundt, III, MD Anatomy and Preoperative Considerations The pericardial

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

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

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

Disease of the aortic valve is frequently associated with

Disease of the aortic valve is frequently associated with Stentless Aortic Bioprosthesis for Disease of the Aortic Valve, Root and Ascending Aorta John R. Doty, MD, and Donald B. Doty, MD Disease of the aortic valve is frequently associated with morphologic abnormalities

More information

Heart transplantation is the gold standard treatment for

Heart transplantation is the gold standard treatment for Organ Care System for Heart Procurement and Strategies to Reduce Primary Graft Failure After Heart Transplant Masaki Tsukashita, MD, PhD, and Yoshifumi Naka, MD, PhD Primary graft failure is a rare, but

More information

Anatomy determines the close vicinity of the sinuses of

Anatomy determines the close vicinity of the sinuses of Aortic Valve Reimplantation According to the David Type I Technique Matthias Karck, MD, and Axel Haverich, MD Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.

More information

Heart Dissection. 5. Locate the tip of the heart or the apex. Only the left ventricle extends all the way to the apex.

Heart Dissection. 5. Locate the tip of the heart or the apex. Only the left ventricle extends all the way to the apex. Heart Dissection Page 1 of 6 Background: The heart is a four-chambered, hollow organ composed primarily of cardiac muscle tissue. It is located in the center of the chest in between the lungs. It is the

More information

CJ Shuster A&P2 Lab Addenum Beef Heart Dissection 1. Heart Dissection. (taken from Johnson, Weipz and Savage Lab Book)

CJ Shuster A&P2 Lab Addenum Beef Heart Dissection 1. Heart Dissection. (taken from Johnson, Weipz and Savage Lab Book) CJ Shuster A&P2 Lab Addenum Beef Heart Dissection 1 Heart Dissection. (taken from Johnson, Weipz and Savage Lab Book) Introduction When you have finished examining the model, you are ready to begin your

More information

Ischemic mitral regurgitation (IMR) is an insufficiency of

Ischemic mitral regurgitation (IMR) is an insufficiency of Repair Techniques for Ischemic Mitral Regurgitation Damien J. LaPar, MD, MSc, and Irving L. Kron, MD Ischemic mitral regurgitation (IMR) is an insufficiency of the mitral valve (MV) secondary to myocardial

More information

THE HEART. A. The Pericardium - a double sac of serous membrane surrounding the heart

THE HEART. A. The Pericardium - a double sac of serous membrane surrounding the heart THE HEART I. Size and Location: A. Fist-size weighing less than a pound (250 to 350 grams). B. Located in the mediastinum between the 2 nd rib and the 5 th intercostal space. 1. Tipped to the left, resting

More information

MODIFICATION OF THE MAZE PROCEDURE FOR ATRIAL FLUTTER AND ATRIAL FIBRILLATION

MODIFICATION OF THE MAZE PROCEDURE FOR ATRIAL FLUTTER AND ATRIAL FIBRILLATION MODIFICATION OF THE MAZE PROCEDURE FOR ATRIAL FLUTTER AND ATRIAL FIBRILLATION II. Surgical technique of the maze III procedure The operative technique of the maze III procedure for the treatment of patients

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

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

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

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

Diversion of the inferior vena cava following repair of atrial septal defect causing hypoxemia

Diversion of the inferior vena cava following repair of atrial septal defect causing hypoxemia Marshall University Marshall Digital Scholar Internal Medicine Faculty Research Spring 5-2004 Diversion of the inferior vena cava following repair of atrial septal defect causing hypoxemia Ellen A. Thompson

More information

The Cardiovascular System Part I: Heart Outline of class lecture After studying part I of this chapter you should be able to:

The Cardiovascular System Part I: Heart Outline of class lecture After studying part I of this chapter you should be able to: The Cardiovascular System Part I: Heart Outline of class lecture After studying part I of this chapter you should be able to: 1. Describe the functions of the heart 2. Describe the location of the heart,

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

THE HEART OBJECTIVES: LOCATION OF THE HEART IN THE THORACIC CAVITY CARDIOVASCULAR SYSTEM

THE HEART OBJECTIVES: LOCATION OF THE HEART IN THE THORACIC CAVITY CARDIOVASCULAR SYSTEM BIOLOGY II CARDIOVASCULAR SYSTEM ACTIVITY #3 NAME DATE HOUR THE HEART OBJECTIVES: Describe the anatomy of the heart and identify and give the functions of all parts. (pp. 356 363) Trace the flow of blood

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

Read Chapters 21 & 22, McKinley et al

Read Chapters 21 & 22, McKinley et al ACTIVITY 9: BLOOD AND HEART OBJECTIVES: 1) How to get ready: Read Chapters 21 & 22, McKinley et al., Human Anatomy, 5e. All text references are for this textbook. Read dissection instructions BEFORE YOU

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

Sheep Pluck Dissection

Sheep Pluck Dissection Sheep Pluck Dissection What is a sheep pluck? A pluck is the lungs, heart, and liver of an animal. Objectives 1. Explore the heart anatomy and relate the function to structure 2. Trace the course of blood

More information

The clinical problem of atrioventricular valve regurgitation

The clinical problem of atrioventricular valve regurgitation 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

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

Heart Transplant ation Technique

Heart Transplant ation Technique Heart Transplant ation Technique R. Morton Bolman I11 Since its clinical inception in 1967, heart transplantation has benefited thousands of patients with heart failure. The surgical technique has remained

More information

Special considerations in mitral valve repair during aortic root surgery

Special considerations in mitral valve repair during aortic root surgery Safeguards and Pitfalls Special considerations in mitral valve repair during aortic root surgery Friedhelm Beyersdorf Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg im

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

2018 CODING AND REIMBURSEMENT FOR. Cardiac Surgical Ablation and Left Atrial Appendage Management

2018 CODING AND REIMBURSEMENT FOR. Cardiac Surgical Ablation and Left Atrial Appendage Management 2018 CODING AND REIMBURSEMENT FOR Cardiac Surgical Ablation and Left Atrial Appendage Management Introduction This information is shared for educational purposes and current as of January 2018. Healthcare

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

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

Cardiac Radiography. Jared D. Christensen, M.D.

Cardiac Radiography. Jared D. Christensen, M.D. Cardiac Radiography Jared D. Christensen, M.D. Cardiac radiography Jared D. Christensen, M.D. Overview Basic Concepts Technique Normal anatomy Cases Technique 3 Standard Views Posterior-Anterior (PA) Anterior-Posterior

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

The heart=a muscular double pump with 2 functions Overview

The heart=a muscular double pump with 2 functions Overview The Heart 1 The heart=a muscular double pump with 2 functions Overview The right side receives oxygen-poor blood from the body and tissues and then pumps it to the lungs to pick up oxygen and dispel carbon

More information

Surgical treatment of ventricular septal defect

Surgical treatment of ventricular septal defect Thorax (1965), 20, 278. VIKING OLOV BJORK From the Department of Thoracic Surgery, University Hospital, Uppsala, Sweden Since the first report of direct vision closure of ventricular septal defects in

More information

April 6, 2017 VIA ELECTRONIC MAIL

April 6, 2017 VIA ELECTRONIC MAIL April 6, 2017 VIA ELECTRONIC MAIL Patricia Brooks, RHIA Centers for Medicare and Medicaid Services CMM, HAPG, Division of Acute Care Mail Stop C4-08-06 7500 Security Boulevard Baltimore, Maryland 21244-1850

More information

Tetralogy of Fallot (TOF) with absent pulmonary valve

Tetralogy of Fallot (TOF) with absent pulmonary valve Repair of Tetralogy of Fallot with Absent Pulmonary Valve Syndrome Karl F. Welke, MD, and Ross M. Ungerleider, MD, MBA Tetralogy of Fallot (TOF) with absent pulmonary valve syndrome (APVS) occurs in 5%

More information

Case Studies in Complex Endocarditis

Case Studies in Complex Endocarditis Case Studies in Complex Endocarditis Vera H. Rigolin, MD Professor of Medicine Northwestern University Feinberg School of Medicine Medical Director, Echocardiography Laboratory Northwestern Memorial Hospital

More information

Circulatory Systems. All cells need to take in nutrients and expel metabolic wastes.

Circulatory Systems. All cells need to take in nutrients and expel metabolic wastes. Circulatory Systems All cells need to take in nutrients and expel metabolic wastes. Single celled organisms: nutrients from the environment can diffuse (or be actively transported) directly in to the cell

More information

Adult Cardiac Surgery

Adult Cardiac Surgery Adult Cardiac Surgery Mahmoud ABU-ABEELEH Associate Professor Department of Surgery Division of Cardiothoracic Surgery School of Medicine University Of Jordan Adult Cardiac Surgery: Ischemic Heart Disease

More information

Techniques to preserve the native aortic valve during aortic

Techniques to preserve the native aortic valve during aortic Valve-Sparing Aortic Root Replacement with the Valsalva Graft Duke Cameron, MD, and Luca Vricella, MD Techniques to preserve the native aortic valve during aortic root replacement have evolved considerably

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

The Cardiovascular System. Chapter 15. Cardiovascular System FYI. Cardiology Closed systemof the heart & blood vessels. Functions

The Cardiovascular System. Chapter 15. Cardiovascular System FYI. Cardiology Closed systemof the heart & blood vessels. Functions Chapter 15 Cardiovascular System FYI The heart pumps 7,000 liters (4000 gallons) of blood through the body each day The heart contracts 2.5 billion times in an avg. lifetime The heart & all blood vessels

More information

Aortic Valve Replacement By Mini-Sternotomy

Aortic Valve Replacement By Mini-Sternotomy Aortic Valve Replacement By Mini-Sternotomy Steven R. Gundry The introduction of the laparoscopic procedure, as well as later scope-based interventions by other surgical disciplines have resulted in the

More information

Bicuspid Aortic Valve Repair in the Setting of Severe Aortic Insufficiency

Bicuspid Aortic Valve Repair in the Setting of Severe Aortic Insufficiency Bicuspid Aortic Valve Repair in the Setting of Severe Aortic Insufficiency Edward P. Chen MD Director Thoracic Aortic Surgery Division of Cardiothoracic Surgery Emory University School of Medicine Atlanta,

More information

Morphological Assessment of RVOT: CT and CMR Imaging

Morphological Assessment of RVOT: CT and CMR Imaging JACC: CARDIOVASCULAR IMAGING VOL. 6, NO. 5, 2013 2013 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-878X/$36.00 PUBLISHED BY ELSEVIER INC. http://dx.doi.org/10.1016/j.jcmg.2012.06.018 IMAGING

More information

I with antibiotics [I, 21. The characteristics of the offending

I with antibiotics [I, 21. The characteristics of the offending ORIGINAL ARTICLES Heart Valve Operations in Patients With Active Infective Endocarditis Tirone E. David, MD, Joanne Bos, RN, George T. Christakis, MD, Paulo R. Brofman, MD, David Wong, MD, and Christopher

More information

Figure 10.1A Transparency Master 79

Figure 10.1A Transparency Master 79 Brain Carotid arteries Jugular vein Right front leg Lungs (inflated) Cranial Right atrium To left front leg Left subclavian Bronchus capillaries Brachiocephalic vein Left atrium Dorsal aorta Right ventricle

More information

Outline 9/17/2016. Advances in Percutaneous Mitral Valve Repair and Replacement. Scope of the Problem and Guidelines

Outline 9/17/2016. Advances in Percutaneous Mitral Valve Repair and Replacement. Scope of the Problem and Guidelines Advances in Percutaneous Mitral Valve Repair and Replacement Scott M Lilly MD PhD, Interventional Cardiology The Ohio State University Contemporary Multidisciplinary Cardiovascular Conference Orlando,

More information

Chapter 20: Cardiovascular System: The Heart

Chapter 20: Cardiovascular System: The Heart Chapter 20: Cardiovascular System: The Heart I. Functions of the Heart A. List and describe the four functions of the heart: 1. 2. 3. 4. II. Size, Shape, and Location of the Heart A. Size and Shape 1.

More information

Pediatric Echocardiography Examination Content Outline

Pediatric Echocardiography Examination Content Outline Pediatric Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 Anatomy and Physiology Normal Anatomy and Physiology 10% 2 Abnormal Pathology and Pathophysiology

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 Experience with Unroofed Coronary Sinus

Surgical Experience with Unroofed Coronary Sinus Surgical Experience with Unroofed Coronary Sinus Jan Quaegebeur, M.D., John W. Kirklin, M.D., Albert D. Pacifico, M.D., and Lionel M. Bargeron, Jr., M.D. ABSTRACT Between January, 1967, and October, 1977,

More information

The cardiovascular system is composed of the heart and blood vessels that carry blood to and from the body s organs. There are 2 major circuits:

The cardiovascular system is composed of the heart and blood vessels that carry blood to and from the body s organs. There are 2 major circuits: 1 The cardiovascular system is composed of the heart and blood vessels that carry blood to and from the body s organs. There are 2 major circuits: pulmonary and systemic. The pulmonary goes out to the

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

Complications following closure of atrial septal defects of the inferior vena caval type

Complications following closure of atrial septal defects of the inferior vena caval type Thorax (1972), 27, 754. Complications following closure of atrial septal defects of the inferior vena caval type J. K. ROSS1 and D. C. JOHNSON National Heart Hospital, London W.] An atrial septal defect

More information

The icoapsys Repair System for the percutaneous treatment of functional mitral insufficiency

The icoapsys Repair System for the percutaneous treatment of functional mitral insufficiency Percutaneous valve interventions The icoapsys Repair System for the percutaneous treatment of functional mitral insufficiency Wes R. Pedersen 1 *, MD, FACC, FSCAI; Peter Block 2, MD, FACC, FSCAI; Ted Feldman

More information

Chapter 14. The Cardiovascular System

Chapter 14. The Cardiovascular System Chapter 14 The Cardiovascular System Introduction Cardiovascular system - heart, blood and blood vessels Cardiac muscle makes up bulk of heart provides force to pump blood Function - transports blood 2

More information

COMPREHENSIVE EVALUATION OF FETAL HEART R. GOWDAMARAJAN MD

COMPREHENSIVE EVALUATION OF FETAL HEART R. GOWDAMARAJAN MD COMPREHENSIVE EVALUATION OF FETAL HEART R. GOWDAMARAJAN MD Disclosure No Relevant Financial Relationships with Commercial Interests Fetal Echo: How to do it? Timing of Study -optimally between 22-24 weeks

More information

THE VESSELS OF THE HEART

THE VESSELS OF THE HEART 1 THE VESSELS OF THE HEART The vessels of the heart include the coronary arteries, which supply the heart and the veins and lymph vessels, which drain the heart. THE CORONARY ARTERIES These are the blood

More information

Left ventricle pseudoaneurysm as late postoperative complication of a large apical aneurysm

Left ventricle pseudoaneurysm as late postoperative complication of a large apical aneurysm CASE REPORT Left ventricle pseudoaneurysm as late postoperative complication of a large apical aneurysm Mariana M. Floria 1, 4, Carmen Elena Pleșoianu 2, 4, Michel Buche 3, Baudouin Marchandise 4, Erwin

More information

Cardiovascular System Module 3: Heart Anatomy *

Cardiovascular System Module 3: Heart Anatomy * OpenStax-CNX module: m49683 1 Cardiovascular System Module 3: Heart Anatomy * Donna Browne Based on Heart Anatomy by OpenStax This work is produced by OpenStax-CNX and licensed under the Creative Commons

More information

Pacing in patients with congenital heart disease: part 1

Pacing in patients with congenital heart disease: part 1 Pacing in patients with congenital heart disease: part 1 September 2013 Br J Cardiol 2013;20:117 20 doi: 10.5837/bjc/2013.028 Authors: Khaled Albouaini, Archana Rao, David Ramsdale View details Only a

More information

Parasternal Approach for Minimally Invasive Aortic Valve Surgery

Parasternal Approach for Minimally Invasive Aortic Valve Surgery Parasternal Approach for Minimally Invasive Aortic Valve Surgery Lawrence H. Cohn Aortic valve replacement for the stenotic or regurgitant aortic valve has been one of the major advances of medical science

More information

DISSECTION OF A SHEEP HEART

DISSECTION OF A SHEEP HEART DISSECTION OF A SHEEP HEART I. INTRODUCTION A. You will soon appreciate the point made previously the heart models just don t teach us what a real heart is like! Dissecting a sheep heart will give you

More information

Post-Op Aorta: Differentiating Normal Post-Op vs. Complications. Linda C. Chu, MD Assistant Professor of Radiology Johns Hopkins University

Post-Op Aorta: Differentiating Normal Post-Op vs. Complications. Linda C. Chu, MD Assistant Professor of Radiology Johns Hopkins University Post-Op Aorta: Differentiating Normal Post-Op vs. Complications Linda C. Chu, MD Assistant Professor of Radiology Johns Hopkins University No disclosures Disclosures Goals and Objectives To review CT technique

More information

Management of Left Ventricular Aneurysm by Intracavitary Repair

Management of Left Ventricular Aneurysm by Intracavitary Repair Management of Left Ventricular Aneurysm by Intracavitary Repair Denton A. Cooley Left ventricular aneurysms (LVAs) occur in up to 40% of patients after myocardial Most LVAs are caused by occlusion of the

More information

Echocardiography as a diagnostic and management tool in medical emergencies

Echocardiography as a diagnostic and management tool in medical emergencies Echocardiography as a diagnostic and management tool in medical emergencies Frank van der Heusen MD Department of Anesthesia and perioperative Care UCSF Medical Center Objective of this presentation Indications

More information

Anomalous Systemic Venous Connection Systemic venous anomaly

Anomalous Systemic Venous Connection Systemic venous anomaly World Database for Pediatric and Congenital Heart Surgery Appendix B: Diagnosis (International Paediatric and Congenital Cardiac Codes (IPCCC) and definitions) Anomalous Systemic Venous Connection Systemic

More information

Aortic Valve Leaflet Perforation after Mitral Valve Repair

Aortic Valve Leaflet Perforation after Mitral Valve Repair 172) Aortic Valve Leaflet Perforation after Mitral Valve Repair Aboelnasr M. 1, Rohn V. 2 1 Department of Cardiothoracic Surgery, Tanta University Hospital, Tanta, Egypt; 2 2 nd Department of Surgery Department

More information

Unusual Complications During Mitral Valve Replacement in the Presence of Calcification of the Annulus

Unusual Complications During Mitral Valve Replacement in the Presence of Calcification of the Annulus Unusual Complications During Mitral Valve Replacement in the Presence of Calcification of the Annulus Horace MacVaugh, 111, M.D., Claude R. Joyner, M.D., and Julian Johnson, M.D. ABSTRACT Replacement of

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

Supplemental Table 1. ICD-9 Codes for Diagnoses and Procedures

Supplemental Table 1. ICD-9 Codes for Diagnoses and Procedures Supplemental Table 1. ICD-9 Codes for Diagnoses and Procedures ICD-9 Code Description Heart Failure 402.01 Malignant hypertensive heart disease with heart failure 402.11 Benign hypertensive heart disease

More information

Embryology of the Heart

Embryology of the Heart *Page 1A: Embryology of the Heart Human embryonic disc is divided into three layers: ectoderm, intraembryonic mesoderm, and endoderm. The embryonic disc lies between the amniotic cavity and the primary

More information

Heart and Lung Dissection

Heart and Lung Dissection Heart and Lung Dissection Name(s) Before you begin any work or dissection of your specimen, please try to identify the following. You will need to illustrate what you see, so make sure to note size, texture

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

The Mammalian Circulatory System

The Mammalian Circulatory System The Mammalian Heart The Mammalian Circulatory System Recall: What are the 3 cycles of the mammalian circulatory system? What are their functions? What are the three main vessel types in the mammalian circulatory

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

Heart. Structure Physiology of blood pressure and heartbeat

Heart. Structure Physiology of blood pressure and heartbeat Heart Structure Physiology of blood pressure and heartbeat Location and Anatomy Location and Anatomy Pericardial cavity: surrounds, isolates, and anchors heart Parietal pericardium lined with serous membrane

More information

AP2 Lab 1 - Blood & Heart

AP2 Lab 1 - Blood & Heart AP2 Lab 1 - Blood & Heart Project 1 - Formed Elements Identification & Recognition See fig. 17.10 and Table 17.2. Instructor may also provide other images. Note: See Fig. 17.11 All formed elements are

More information

Circulatory system. Lecture #2

Circulatory system. Lecture #2 Circulatory system Lecture #2 The essential components of the human cardiovascular system: Heart Blood Blood vessels Arteries - blood vessels that conduct arterial blood from heart ventricle to organs

More information

Interventions in Adult Congenital Heart Disease: Role of CV Imaging. Associate Professor. ACHD mortality. Pillutla. Am Heart J 2009;158:874-9

Interventions in Adult Congenital Heart Disease: Role of CV Imaging. Associate Professor. ACHD mortality. Pillutla. Am Heart J 2009;158:874-9 Interventions in Adult Congenital Heart Disease: Role of CV Imaging Sangeeta Shah MD, FACC, FASE Associate Professor ACHD mortality Pillutla. Am Heart J 2009;158:874-9 Adult Congenital Heart Disease Heterogenity

More information

This is not a required assignment but it is recommended.

This is not a required assignment but it is recommended. SU 12 Name: This is not a required assignment but it is recommended. BIO 116 - Anatomy & Physiology II Practice Assignment 2 - The Respiratory and Cardiovascular Systems 1. The exchange of oxygen and carbon

More information

The Berlin Heart EXCOR ventricular assist device (Berlin

The Berlin Heart EXCOR ventricular assist device (Berlin Berlin Heart Implantation for Congenital Heart Defects Robert D.B. Jaquiss, MD, and Michiaki Imamura, MD, PhD The Berlin Heart EXCOR ventricular assist device (Berlin Heart AG, Berlin, Germany) was developed

More information