Bulging Subaortic Septum: An Important Risk Factor for Systolic Anterior Motion After Mitral Valve Repair
|
|
- Shana Cameron
- 5 years ago
- Views:
Transcription
1 Bulging Subaortic Septum: An Important Risk Factor for Systolic Anterior Motion After Mitral Valve Repair Sameh M. Said, MD, Hartzell V. Schaff, MD, Rakesh M. Suri, MD, DPhil, Kevin L. Greason, MD, Joseph A. Dearani, MD, and Rick A. Nishimura, MD Divisions of Cardiovascular Surgery and Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota ADULT CARDIAC Background. The purpose of this study is to determine etiologic factors of systolic anterior motion (SAM) of the mitral valve after repair. Methods. We describe 6 patients with mitral valve repair (MVRep) for degenerative mitral valve disease and a bulging angulated subaortic septum that seemed a risk factor for SAM. Results. No patient had a hypertrophic cardiomyopathy diagnosis. All patients had an angulated septum (angle of long axis of left ventricle and aorta, >60 ) with a discrete septal bulge (proximal septum, >1.5 cm with normal midseptal thickness). One patient had severe mitral regurgitation and became hypotensive intraoperatively, with a SAM. He had successful valve repair and septal myectomy. In 2 patients, the bulging septum was not appreciated preoperatively, and SAM developed postoperatively, causing symptomatic left ventricular (LV) outflow tract (LVOT) obstruction and recurrent mitral regurgitation. At reoperation, SAM and associated regurgitation were abolished with septal myectomy. In 2 patients undergoing mitral repair, bulging septum was identified preoperatively, and prophylactic septal myectomy was performed at valve repair. One patient was referred for valve replacement because of severe mitral regurgitation due to bileaflet prolapse and associated SAM. Doppler echocardiography showed minimal resting gradient. He had a prominent subaortic septum, and mitral regurgitation seemed due to organic valve disease and dynamic outflow obstruction. He received septal myectomy and mitral valve repair with resolution of SAM and mitral regurgitation. Conclusions. Bulging subaortic septum may be a risk factor for SAM after mitral valve repair. Treatment should include septal myectomy with valvuloplasty. (Ann Thorac Surg 2011;91: ) 2011 by The Society of Thoracic Surgeons Accepted for publication Jan 28, Address correspondence to Dr Schaff, Division of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905; schaff@mayo.edu. With modern surgical methods, systolic anterior motion (SAM) of the mitral valve anterior leaflet occurs in 4% to 8.4% of patients after mitral valve repair (MVRep), and the incidence depends in part on whether intraoperative or early postoperative echocardiography is used for diagnosis [1 4]. SAM can produce mitral valve regurgitation (MR) and left ventricular outflow tract (LVOT) obstruction, but in many cases SAM resolves with conservative management, including intravascular volume augmentation and increasing systemic vascular resistance [3, 5 7]. In some patients, however, SAM and the resulting MR (with or without LVOT obstruction) can cause recurrent symptoms and requires prompt reoperation. Several approaches to prevent or correct SAM have been reported, including complex leaflet repair and even prosthetic replacement. Systolic anterior motion of the mitral apparatus was initially described in association with hypertrophic obstructive cardiomyopathy [8]. The combination of SAM and septal hypertrophy leads to LVOT obstruction that resolves with extended left ventricular (LV) septal myectomy [9, 10]. SAM has also been described as a rare complication of mitral valve replacement with preservation of the anterior mitral valve leaflet [11]. Most techniques aimed at preventing SAM during MVRep focus on reducing excessive height of the posterior leaflet. However, SAM may occur in patients without an abnormally elongated posterior leaflet. We present a new concept that may explain the development of SAM after MVRep in some patients in whom an abnormal bulging septum predisposes them to SAM after correction of MR. This SAM can be prevented by concomitant septal myectomy. Patients, Methods, and Results Case 1 A 69-year-old man with severe MR and atrial fibrillation was referred for MVRep. Preoperative transthoracic and transesophageal echocardiography (TEE) showed bileaflet prolapse with normal LV ejection fraction and wall thickness. Intraoperatively, during preparation for bypass, he became hypotensive, with a systolic blood pressure of 60 to 65 mm Hg that did not respond to inotropic agents. The hypotension appeared to be due to SAM detected on intraoperative TEE. Before MVRep, we ex by The Society of Thoracic Surgeons /$36.00 Published by Elsevier Inc doi: /j.athoracsur
2 ADULT CARDIAC 1428 SAID ET AL Ann Thorac Surg BULGING SUBAORTIC SEPTUM AND SAM AFTER MVRep 2011;91: Fig 1. Transthoracic echocardiography (TEE) of the patient in Case 2 during first cardiac procedure. (A) Posterior mitral valve leaflet prolapse and ventricular septal bulge (white arrow). No evidence of SAM was found at time of TEE. (B) The mitral valve regurgitant jet is eccentric and anteriorly directed. plored the septum through an aortotomy and found a focal bulging septum with endocardial scar that may have been a contact lesion. A septal myectomy was performed in addition to a maze procedure and MVRep with posterior leaflet plication and posterior annuloplasty band. On postoperative echocardiography, no residual MR or LVOT obstruction was seen. Case 2 A 42-year-old man with severe MR due to prolapse of the middle scallop of the posterior leaflet (Fig 1) underwent standard repair with triangular excision of the unsupported segment of the middle scallop (P2) and insertion of a posterior annuloplasty band (length, 63 mm) [12]. Early after discontinuation of the cardiopulmonary bypass, SAM was observed on TEE. The SAM appeared to be due to decreased systemic vascular resistance and hypotension and was abolished by intravascular volume augmentation and vasopressors. The patient recovered smoothly, but postoperative echocardiography showed residual SAM with dynamic LVOT obstruction (maximal late-peaking pressure gradient, 58 mm Hg). At this time, the degree of MR was mild to moderate, and the posterolateral trajectory of the jet suggested that MR was related Fig 2. Intraoperative transthoracic echocardiography (TEE) of the patient in Case 2 during second cardiac procedure. (A) Severe systolic anterior motion (SAM) with prominent septal bulge (white arrow) before bypass. (B) Severe SAM with severe mitral valve regurgitation (MR) and severe left ventricular outflow tract (LVOT) obstruction before bypass. (C) After septal myectomy (white arrow), no evidence of SAM was found when LVOT was opened wide. (D) Postseptal myectomy TEE with no SAM, widely opened LVOT, and minimal MR.
3 Ann Thorac Surg SAID ET AL 2011;91: BULGING SUBAORTIC SEPTUM AND SAM AFTER MVRep 1429 Fig 3. Intraoperative transesophageal echocardiography of the patient in Case 3 during first cardiac procedure. (A) Septal bulge (white arrow) before bypass. (B) Anteriorly directed mitral valve regurgitation (MR) jet and septal bulge (white arrow) but no systolic anterior motion (SAM) before bypass. (C) Severe SAM with mild LVOT obstruction noted initially after bypass. (D) Severe mitral valve regurgitation (MR). MR and left ventricular outflow tract (LVOT) obstruction improved with administration of vasopressors and fluids after bypass. ADULT CARDIAC to SAM. The patient was treated with -blockers and monitored. Neither the preoperative nor the postoperative echocardiographic evaluation was interpreted as showing LV septal hypertrophy or any other evidence of hypertrophic obstructive cardiomyopathy. The patient did well for almost 3 years but then had effort intolerance. Doppler echocardiography was repeated and showed marked SAM and a resting dynamic LVOT obstruction with a maximum instantaneous gradient of 81 mm Hg and a secondary MR that appeared moderate in severity. At reoperation, we noted a bulging subaortic septum on TEE. We did not know whether the septal bulge was an acquired form of hypertrophy of the subaortic septum or whether the patient had underlying hypertrophic cardiomyopathy before his MVRep. Because of the patient s symptoms and exercise limitation, we proceeded to relieve the LVOT obstruction using transaortic LV septal myectomy, with a possible mitral valve second repair or replacement. Before the cardiopulmonary bypass, measured resting aortic pressure was 81/52 mm Hg and LV pressure was 153/5 mm Hg, producing a gradient of 72 mm Hg. After a premature ventricular contraction (Brockenbrough-Braunwald-Morrow maneuver), the aortic pressure decreased to 65/41 mm Hg and the LV pressure rose to 212/9 mm Hg, producing a gradient of 147 mm Hg. After aortotomy, we noticed a prominent, bulging subaortic basal septum (Fig 2A) and evidence of endocardial scarring due to SAM (Fig 2B). We proceeded with an extended LV septal myectomy (Fig 2C), and nothing was done to the previous MVRep. After myectomy, the LVOT was opened wide (Fig 2D), the aortic pressure was 128/45 mm Hg, and the LV pressure was 128/15 mm Hg. There was no gradient after a premature ventricular contraction. The patient did well after the surgery, and successive echocardiography confirmed no residual LVOT obstruction. Case 3 A 58-year-old woman was referred for repair of severe MR. Intraoperative echocardiography showed prolapse of the medial (P1) and middle (P2) scallops of the posterior leaflet, with an anteriorly directed regurgitant jet (Fig 3A, 3B). Surgical inspection identified an additional perforation of the posterior leaflet, likely due to healed endocarditis. The medial half of the middle scallop and the lateral half of the medial scallop were excised, and the leaflet was repaired in two layers with 4-0 polypropylene suture. The leaflet repair was enforced with a 63-mm posterior annuloplasty band. After cardiopulmonary bypass, the patient had intermittent SAM, which produced moderate to severe MR (Fig 3C, 3D) and some degree of LVOT narrowing. However, when the systemic vascular resistance was increased, SAM improved dramatically. The patient had
4 ADULT CARDIAC 1430 SAID ET AL Ann Thorac Surg BULGING SUBAORTIC SEPTUM AND SAM AFTER MVRep 2011;91: Fig 4. Intraoperative transesophageal echocardiography of the patient in case 3 during second cardiac procedure. (A) Severe mitral valve regurgitation (MR) due to severe systolic anterior motion (SAM) with a posteriorly directed jet (white arrow) before bypass. (B) Septal bulge (white arrow) and severe SAM before bypass. (C) Postseptal myectomy with no SAM. (D) No MR and no left ventricular outflow tract (LVOT) obstruction after septal myectomy. almost no regurgitation, and the LVOT obstruction abated. Nothing further was done surgically. The patient was observed regularly, and almost a year later she was found to have severe symptomatic MR due to SAM (Fig 4A) and LVOT obstruction. At reoperation, TEE showed a prominent basal septum (Fig 4B) that, in retrospect, was determined to have been present before the initial repair. We proceeded with extended LV septal myectomy, and after repair aortic pressure was 146/70 mm Hg and LV pressure was 146/5 mm Hg. After a premature ventricular contraction, there was no gradient. We administered sodium nitroprusside to decrease the systemic vascular resistance, and this medical therapy did not produce an LVOT gradient or MR (Fig 4C, 4D). The patient recovered uneventfully. Case 4 A 70-year-old woman underwent MVRep with insertion of artificial chordae to the anterior leaflet and a posterior annuloplasty band for correction of severe MR. The preoperative echocardiogram showed severe MR, LV enlargement, and normal ventricular wall thickness. Intraoperative TEE showed focal basal septal thickening with no LVOT obstruction. Because this septal bulge appeared to be the anatomic substrate for LVOT obstruction after repair, we elected to perform septal myectomy to prevent SAM, in addition to MVRep. At the conclusion of the cardiopulmonary bypass procedure, there was no MR and no SAM or LVOT obstruction. The patient recovered well, and follow-up echocardiography showed a similar good result. Case 5 The fifth patient was a 49-year-old woman with Barlow s disease and severe MR due to bileaflet prolapse. In addition, preoperative transthoracic echocardiography showed LV enlargement with normal wall thickness and an ejection fraction of 63%. Although not previously reported, a distinct septal bulge was noted at preoperative surgical review and was confirmed on intraoperative TEE. There was no resting gradient before repair, but isoproterenol infusion produced SAM and LVOT obstruction with a maximum instantaneous gradient of 67 mm Hg. The patient underwent transaortic septal myectomy and MVRep with triangular resection of the middle scallop of the posterior leaflet and insertion of a 63-mm posterior annuloplasty band. Postoperative echocardiography showed no SAM and only trace MR. Case 6 A 54-year-old man was referred with severe MR due to bileaflet mitral valve prolapse. However, his major symptom was exertional chest pain, not shortness of breath, and transthoracic echocardiography showed basal septal
5 Ann Thorac Surg SAID ET AL 2011;91: BULGING SUBAORTIC SEPTUM AND SAM AFTER MVRep Table 1. Echocardiographic Features of Patients With Bulging Septum Patient No. Basal Septal Thickness (cm) Midventricular Septal Thickness (cm) Basal Septal Thickness to Midventricular Septal Thickness Ratio Angle Between Left Ventricular and Aortic Long Axes degrees degrees degrees degrees degrees degrees 1431 ADULT CARDIAC prominence with dynamic LVOT obstruction (peak gradient with Valsalva maneuver, 34 mm Hg). The left ventricle was enlarged, but wall thickness was normal. Cardiac catheterization was performed to assess hemodynamics. In the baseline state, aortic pressure was 96/57 mm Hg and LV pressure was 118/0 mm Hg with enddiastolic pressure of 12 mm Hg. There was a dynamic LVOT gradient, which increased to 80 mm Hg after premature ventricular contraction. This LVOT gradient was found to be associated with SAM on echocardiography. Also, a left ventriculogram showed moderate to severe MR that was clearly worse with vasodilatation due to contrast injection. With phenylephrine infusion (peak dose, 0.8 g/kg/min), the LVOT gradient decreased to 0 mm Hg. No SAM was observed on echocardiography during phenylephrine infusion. A repeated left ventriculogram done at this time showed only mild MR. Overall, the catheterization showed that the MR was dynamic and improved with treatment of the LVOT gradient. The patient was treated with -blockade and underwent septal myectomy combined with MVRep. During operation, the posterior leaflet was repaired with triangular excision of the unsupported portion of the posterior leaflet without ring annuloplasty. The patient had a smooth postoperative recovery with improvement in his symptoms; on follow-up echocardiography, only mild residual MR was detected, and no evidence of SAM of the mitral valve or LVOT obstruction was seen. Comment SAM of the mitral valve is the term that describes anterior motion of one or both mitral valve leaflets during systole. The resulting narrowing or obstruction of the LVOT may be accompanied by MR. SAM was described in early reports of MVRep [13]. In clinical practice, a spectrum of SAM severity is seen, extending from minor, chordalonly SAM to the most severe form with LVOT obstruction. Initially, the LVOT obstruction was thought to be the result of septal hypertrophy producing a Venturi effect that would suck the mitral valve leaflet in the LV cavity [14], but the occurrence is more complex than this. It has been shown that the mitral leaflets are being pushed into the LVOT by a drag force that is produced by the accelerated flow around the hypertrophied septum [15]. Despite numerous descriptions of preventive techniques [16 19], SAM continues to occur in a small percentage of patients undergoing MVRep. Assessment for SAM is an integral part of echocardiographic evaluation after MVRep. A previous review from our institution of 2,076 patients having MVReps indicated that postoperative SAM was seen mainly in patients with degenerative mitral valve disease who had an annuloplasty ring placed as part of their reconstruction [3]. Medical management, including volume loading, vasoconstriction, and -blockade, often eliminated SAM in the early postoperative period, and frequency of SAM diminished further with ventricular remodeling in many patients. Reoperation for SAM late after MVRep is rare [5 7]. Many techniques have been described to manage this problem, including sliding plasty of the posterior leaflet, posterior leaflet shortening, and even prosthetic replacement. Carpentier identified various features as risk factors for SAM, including excess tissue, high posterior leaflet, hyperkinetic heart, extensive quadrangular resection of the posterior leaflet, closed aortic-mitral angle, an undersized annuloplasty ring, incorrect orientation of the ring, and a bulging septum [1]. The present series of cases represent 0.6% of 948 isolated MVReps performed between May 2001 and December This experience is similar to the report published by Civelek and associates [20], in which the authors identified 5 of 358 patients (1.4%) over a 2-year period with SAM that occurred after operation and was relieved by septal myectomy. The experience emphasizes the importance of a bulging septum in the pathophysiologic factors of SAM in some patients. Understanding this mechanism and the potential for treatment with transaortic septal myectomy may help preserve the patient s native valve and avoid some of the complex techniques that have been described to treat SAM that may decrease the repair s long-term durability. In contrast to patients with hypertrophic obstructive cardiomyopathy, the cases we describe had little additional hypertrophy in the distal septum and LV free wall, none had significant SAM preoperatively, and none had a family history of hypertrophic cardiomyopathy. Also, no patient had a contact lesion on the septal endocardium indicating preexisting SAM. Hypertrophic cardiomyopathy in elderly patients may be associated with obstruction when septal hypertrophy is combined with
6 ADULT CARDIAC 1432 SAID ET AL Ann Thorac Surg BULGING SUBAORTIC SEPTUM AND SAM AFTER MVRep 2011;91: anterior displacement of the mitral valve (sigmoid septum). Our patients appear to be distinct because only 2 were elderly (69 years and 70 years) and systemic hypertension was not a prominent feature. Also, SAM and LVOT gradients in elderly patients with sigmoid septa tend to be associated with very narrow outflow tracts, anterior displacement of the entire mitral valve apparatus, and a large area of contact between the mitral valve leaflet and the septum. Morphologic features of the septem may differ considerably. Table 1 lists the quantitative measures of the bulging septa in our patients. Of note, the maximum thickness ranged from 1.5 cm to 2.0 cm. We found that the ratio between the basal septal thickness and the midseptum was at least 1.3, and, interestingly, contact was abnormally close between the anterior mitral valve leaflet and the interventricular septum in diastole. Also, the angle between the long axis of the left ventricle and that of the aorta was at least 60 degrees. When the septum in the immediate subaortic area appears unusually thick in a patient undergoing MVRep, the surgeon should consider concomitant subaortic myectomy or additional maneuvers to clarify whether the finding may lead to SAM after repair. In such situations, we perform simultaneous measurement of LV and aortic pressures and stimulate the heart through pharmacologic means (isoproterenol or sodium nitroprusside) or a Brockenbrough maneuver. As illustrated in Cases 2 and 3, it is important to evaluate the subaortic area carefully in patients who manifest SAM early after mitral repair. Identification and treatment with myectomy may eliminate any need for revision of the repair or valve replacement. Conclusion A bulging subaortic septum without dynamic LVOT obstruction can predispose to the development of SAM after MVRep. Identification of a bulging septum (ratio of basal septal thickness to midventricular septal thickness, 1.3) should prompt consideration of transaortic septal myectomy at the time of valvuloplasty. References 1. Grossi EA, Galloway AC, Parish MA, et al. Experience with twenty-eight cases of systolic anterior motion after mitral valve reconstruction by the Carpentier technique. J Thorac Cardiovasc Surg 1992;103: Jebara VA, Mihaileanu S, Acar C, et al. Left ventricular outflow tract obstruction after mitral valve repair: results of the sliding leaflet technique. Circulation 1993;88(5 Pt 2):II Brown ML, Abel MD, Click R, et al. Systolic anterior motion after mitral valve repair: is surgical intervention necessary? J Thorac Cardiovasc Surg 2007;133: Gazoni LM, Fedoruk LM, Kern JA, et al. A simplified approach to degenerative disease: triangular resections of the mitral valve. Ann Thorac Surg 2007;83: Doguet F, Zegdi R, Garcon P, et al. [Systolic anterior motion (SAM): a rare cause of late failure in mitral valve repair]. Arch Mal Coeur Vaiss 2006;99: [In French]. 6. Dumont E, Gillinov AM, Blackstone EH, et al. Reoperation after mitral valve repair for degenerative disease. Ann Thorac Surg 2007;84: Zegdi R, Carpentier A, Doguet F, et al. Systolic anterior motion after mitral valve repair: an exceptional cause of late failure. J Thorac Cardiovasc Surg 2005;130: Maron BJ, Epstein SE. Hypertrophic cardiomyopathy: recent observations regarding the specificity of three hallmarks of the disease: asymmetric septal hypertrophy, septal disorganization and systolic anterior motion of the anterior mitral leaflet. Am J Cardiol 1980;45: Wan CK, Dearani JA, Sundt TM 3rd, et al. What is the best surgical treatment for obstructive hypertrophic cardiomyopathy and degenerative mitral regurgitation? Ann Thorac Surg 2009;88: Ommen SR, Maron BJ, Olivotto I, et al. Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 2005;46: Okamoto K, Kiso I, Inoue Y, et al. Left ventricular outflow obstruction after mitral valve replacement preserving native anterior leaflet. Ann Thorac Surg 2006;82: Brown ML, Schaff HV, Li Z, et al. Results of mitral valve annuloplasty with a standard-sized posterior band: is measuring important? J Thorac Cardiovasc Surg 2009;138: Termini BA, Jackson PA, Williams CD. Systolic anterior motion of the mitral valve following annuloplasty. Vasc Surg 1977;11: Wigle ED, Rakowski H, Kimball BP, et al. Hypertrophic cardiomyopathy: clinical spectrum and treatment. Circulation 1995;92: Sherrid MV, Chu CK, Delia E, et al. An echocardiographic study of the fluid mechanics of obstruction in hypertrophic cardiomyopathy. J Am Coll Cardiol 1993;22: Carpentier A. [The sliding leaflet technique]. Le Club Mitrale Newsletter 1988;I:5.8 [In French]. 17. Sternik L, Zehr KJ. Systolic anterior motion of the mitral valve after mitral valve repair: a method of prevention. Tex Heart Inst J 2005;32: Quigley RL. Prevention of systolic anterior motion after repair of the severely myxomatous mitral valve with an anterior leaflet valvuloplasty. Ann Thorac Surg 2005;80: Grossi EA, Galloway AC, Kallenbach K, et al. Early results of posterior leaflet folding plasty for mitral valve reconstruction. Ann Thorac Surg 1998;65: Civelek A, Szalay Z, Roth M, et al. Post-mitral valve repair systolic anterior motion produced by non-obstructive septal bulge. Eur J Cardiothorac Surg 2003;24:
Outcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease
Outcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease TIRONE E. DAVID, MD ; SEMIN THORAC CARDIOVASC SURG 19:116-120c 2007 ELSEVIER INC. PRESENTED BY INTERN 許士盟 Mitral valve
More informationWhat Is the Best Surgical Treatment for Obstructive Hypertrophic Cardiomyopathy and Degenerative Mitral Regurgitation?
What Is the Best Surgical Treatment for Obstructive Hypertrophic Cardiomyopathy and Degenerative Mitral Regurgitation? ADULT CARDIAC Calvin K. N. Wan, MD, Joseph A. Dearani, MD, Thoralf M. Sundt III, MD,
More informationmarked increase in thickness of walls of heart in patient with HCM.
Surgical Management of Hypertrophic Obstructive Cardiomyopathy Hani K. Najm MD, Msc, FRCSC, FRCS (Glasg Glasg), FACC, FESC President of Saudi Heart Association King Abdulaziz Cardiac Centre Riyadh, Saudi
More informationSeptal Myectomy, Papillary Muscle Resection, and Mitral Valve Replacement for Hypertrophic Obstructive Cardiomyopathy: A Case Report
Case Report Septal Myectomy, Papillary Muscle Resection, and Mitral Valve Replacement for Hypertrophic Obstructive Cardiomyopathy: A Case Report Junichiro Takahashi, MD, 1 Yutaka Wakamatsu, MD, 1 Jun Okude,
More informationHOCM: Alcohol ablation or LVOT Surgery: When and what?
HOCM: Alcohol ablation or LVOT Surgery: When and what? Paul R Vogt/ Pascal A. Berdat Cardiovascular Center Zurich Clinic Im Park Zurich SKG/SGHC Annual Meeting, Zurich, 10.-12.6.15 ASA/Myectomy: Common
More informationJournal of the American College of Cardiology Vol. 34, No. 7, by the American College of Cardiology ISSN /99/$20.
Journal of the American College of Cardiology Vol. 34, No. 7, 1999 1999 by the American College of Cardiology ISSN 0735-1097/99/$20.00 Published by Elsevier Science Inc. PII S0735-1097(99)00464-7 Echocardiographic
More informationThe Management of HOCM: What are the Surgical Options
The Management of HOCM: What are the Surgical Options Konstadinos A Plestis, MD System Chief of Cardiac Thoracic and Vascular Surgery Main Line Health Care System Professor Sidney Kimmel Medical College
More informationPosterior 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 informationThe surgical management of hypertrophic obstructive cardiomyopathy with the concomitant mitral valve abnormalities
Interactive CardioVascular and Thoracic Surgery 21 (2015) 722 726 doi:10.1093/icvts/ivv257 Advance Access publication 15 September 2015 ORIGINAL ARTICLE ADULTCARDIAC Cite this article as: Cui B, Wang S,
More informationTechnical aspects of robotic posterior mitral valve leaflet repair
rt of Operative Techniques Technical aspects of robotic posterior mitral valve leaflet repair Hoda Javadikasgari, Rakesh M. Suri, Tomislav Mihaljevic, Stephanie Mick,. Marc Gillinov Department of Thoracic
More informationSurgical Repair of the Mitral Valve Presenter: Graham McCrystal Cardiothoracic Surgeon Christchurch Public Hospital
Mitral Valve Surgical intervention Graham McCrystal Chairs: Rajesh Nair & Gerard Wilkins Surgical Repair of the Mitral Valve Presenter: Graham McCrystal Cardiothoracic Surgeon Christchurch Public Hospital
More informationHow NOT to miss Hypertrophic Cardiomyopathy? Adaya Weissler-Snir, MD University Health Network, University of Toronto
How NOT to miss Hypertrophic Cardiomyopathy? Adaya Weissler-Snir, MD University Health Network, University of Toronto Introduction Hypertrophic cardiomyopathy is the most common genetic cardiomyopathy,
More informationChordae replacement versus leaflet resection in minimally invasive mitral valve repair
Perspective Chordae replacement versus leaflet resection in minimally invasive mitral valve repair Tomas Holubec, Simon H. Sündermann, Stephan Jacobs, Volkmar Falk Division of Cardiovascular Surgery, University
More informationRecurrent 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 informationThe Edge-to-Edge Technique f For Barlow's Disease
The Edge-to-Edge Technique f For Barlow's Disease Ottavio Alfieri, Michele De Bonis, Elisabetta Lapenna, Francesco Maisano, Lucia Torracca, Giovanni La Canna. Department of Cardiac Surgery, San Raffaele
More informationMyxomatous degeneration of the mitral valve is the
CARDIOVASCULAR Midterm Results of the Edge-to-Edge Technique for Complex Mitral Valve Repair Derek R. Brinster, MD, Daniel Unic, MD, Michael N. D Ambra, MD, Nadia Nathan, MD, and Lawrence H. Cohn, MD Division
More informationSurgical Myectomy for HOCM
Surgical Myectomy for HOCM Volkmar Falk Deutsches Herzzentrum Berlin Different Pathology of HOCM Impact on surgical strategy Said SM Expert Rev Cardiovasc Ther 2013 Different Pathology of HOCM Impact on
More informationPROSTHETIC VALVE BOARD REVIEW
PROSTHETIC VALVE BOARD REVIEW The correct answer D This two chamber view shows a porcine mitral prosthesis with the typical appearance of the struts although the leaflets are not well seen. The valve
More informationΧειρουργική 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 informationIndex of subjects. effect on ventricular tachycardia 30 treatment with 101, 116 boosterpump 80 Brockenbrough phenomenon 55, 125
145 Index of subjects A accessory pathways 3 amiodarone 4, 5, 6, 23, 30, 97, 102 angina pectoris 4, 24, 1l0, 137, 139, 140 angulation, of cavity 73, 74 aorta aortic flow velocity 2 aortic insufficiency
More informationSystolic Anterior Motion of Mitral Valve Subchordal Apparatus: A Rare Echocardiographic Pattern in Non- Obstructive Hypertrophic Cardiomyopathy
Case Report Cardiol Res. 2017;8(5):258-264 Systolic Anterior Motion of Mitral Valve Subchordal Apparatus: A Rare Echocardiographic Pattern in Non- Obstructive Hypertrophic Cardiomyopathy Jezreel L. Taquiso
More informationLong-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(Ann Thorac Surg 2008;85:845 53)
I Made Adi Parmana The utility of intraoperative TEE has become increasingly more evident as anesthesiologists, cardiologists, and surgeons continue to appreciate its potential application as an invaluable
More informationMitral Valve Abnormalities in Hypertrophic Cardiomyopathy: Echocardiographic Features and Surgical Outcomes
Mitral Valve Abnormalities in Hypertrophic Cardiomyopathy: Echocardiographic Features and Surgical Outcomes Ryan K. Kaple, BS, Ross T. Murphy, MD, Linda M. DiPaola, BA, Penny L. Houghtaling, MS, Harry
More informationResearch Proposal. Hypertrophic obstructive cardiomyopathy surgery. Which surgery for which patients?
Research Proposal Hypertrophic obstructive cardiomyopathy surgery. Which surgery for which patients? An echocardiography, cardiac magnetic resonance and surgical techniques study. Giuseppe Raffa, MD November,
More informationDespite advances in our understanding of the pathophysiology
Suture Relocation of the Posterior Papillary Muscle in Ischemic Mitral Regurgitation Benjamin B. Peeler MD,* and Irving L. Kron MD,*, *Department of Cardiovascular Surgery, University of Virginia, Charlottesville,
More informationQuality Outcomes Mitral Valve Repair
Quality Outcomes Mitral Valve Repair Moving Beyond Reoperation Rakesh M. Suri, D.Phil. Professor of Surgery 2015 MFMER 3431548-1 Disclosure Mayo Clinic Division of Cardiovascular Surgery Research funding
More informationIdiopathic Hypertrophic Subaortic Stenosis and Mitral Stenosis
CASE REPORTS Idiopathic Hypertrophic Subaortic Stenosis and Mitral Stenosis Martin J. Nathan, M.D., Roman W. DeSanctis, M.D., Mortimer J. Buckley, M.D., Charles A. Sanders, M.D., and W. Gerald Austen,
More informationValve 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 information8/31/2016. 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 informationThe modified Konno procedure, or subaortic ventriculoplasty,
Modified Konno Procedure for Left Ventricular Outflow Tract Obstruction David P. Bichell, MD The modified Konno procedure, or subaortic ventriculoplasty, first described by Cooley and Garrett in1986, 1
More informationManagement of HOCM: Non-Surgical Options
Management of HOCM: Non-Surgical Options Howard C. Herrmann, MD, FACC, MSCAI John Bryfogle Professor of Cardiovascular Medicine and Surgery Health System Director for Interventional Cardiology Director,
More informationWhat is the Role of Surgical Repair in 2012
What is the Role of Surgical Repair in 2012 The Long-Term Results of Surgery Raphael Rosenhek Department of Cardiology Medical University of Vienna European Society of Cardiology 2012 Munich, August 27th
More informationCase # 1. Page: 8. DUKE: Adams
Case # 1 Page: 8 1. The cardiac output in this patient is reduced because of: O a) tamponade physiology O b) restrictive physiology O c) coronary artery disease O d) left bundle branch block Page: 8 1.
More informationMedical Policy and and and and
ARBenefits Approval: 10/12/2011 Effective Date: 01/01/2012 Revision Date: Code(s): 93799, Unlisted cardiovascular service or procedure Medical Policy Title: Percutaneous Transluminal Septal Myocardial
More information14 Valvular Stenosis
14 Valvular Stenosis 14-1. Valvular Stenosis unicuspid valve FIGUE 14-1. This photograph shows severe valvular stenosis as it occurs in a newborn. There is a unicuspid, horseshoe-shaped leaflet with a
More informationLong term outcomes of posterior leaflet folding valvuloplasty for mitral valve regurgitation
Featured Article Long term outcomes of posterior leaflet folding valvuloplasty for mitral valve regurgitation Igor Gosev 1, Maroun Yammine 1, Marzia Leacche 1, Siobhan McGurk 1, Vladimir Ivkovic 1, Michael
More informationTSDA Boot Camp September 13-16, Introduction to Aortic Valve Surgery. George L. Hicks, Jr., MD
TSDA Boot Camp September 13-16, 2018 Introduction to Aortic Valve Surgery George L. Hicks, Jr., MD Aortic Valve Pathology and Treatment Valvular Aortic Stenosis in Adults Average Course (Post mortem data)
More information*The first two authors contributed equally to this work
Original Research Hellenic J Cardiol 2014; 55: 132-138 Surgical Septal Myectomy for Hypertrophic Cardiomyopathy in Greece: A Single-Center Initial Experience Georgios K. Efthimiadis 1*, Antonis Pitsis
More informationTHE FOLDING LEAFLET. Rafael García Fuster. Cardiac Surgery Department University General Hospital of Valencia
THE FOLDING LEAFLET Rafael García Fuster Cardiac Surgery Department University General Hospital of Valencia School of Medicine Catholic University of Valencia San Vicente Mártir SPAIN Carpentier s principles
More informationDegenerative mitral valve disease is now the most common
Triangular Resection for Repair of Mitral Regurgitation Due to Degenerative Disease Rakesh M. Suri, MD, DPhil, FRCS(C), and Thomas A. Orszulak, MD, FACC Degenerative mitral valve disease is now the most
More informationHistorical 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 informationHypertrophic Cardiomyopathy: basics and management
Hypertrophic Cardiomyopathy: basics and management Bette Kim, MD Program Director, Cardiomyopathy Program Director, Roosevelt Hospital Echocardiography Lab Assistant Professor of Clinical Medicine Mount
More informationΣεμινάρια Ομάδων Εργασίας 2017 Ανεπάρκεια μιτροειδούς μυξωματώδους αιτιολογίας
Σεμινάρια Ομάδων Εργασίας 2017 Ανεπάρκεια μιτροειδούς μυξωματώδους αιτιολογίας Μυτάς Δημήτρης MD, PhD Επιμ Α ΕΣΥ Σισμανόγλειο Γενικό Νοσοκομείο Αττικής Δηλώνω υπεύθυνα ότι η παρούσα ομιλία δεν επιχορηγείται
More informationSurgery for Valvular Heart Disease. Very Long-Term Survival and Durability of Mitral Valve Repair for Mitral Valve Prolapse
Surgery for Valvular Heart Disease Very Long-Term Survival and Durability of Mitral Valve Repair for Mitral Valve Prolapse Dania Mohty, MD; Thomas A. Orszulak, MD; Hartzell V. Schaff, MD; Jean-Francois
More informationAortic 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 informationThere 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 informationECHOCARDIOGRAPHY DATA REPORT FORM
Patient ID Patient Study ID AVM - - Date of form completion / / 20 Initials of person completing the form mm dd yyyy Study period Preoperative Postoperative Operative 6-month f/u 1-year f/u 2-year f/u
More informationSurgery for Congenital Heart Disease. 1 Its heterogeneity is well documented in terms of clinical
Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae Kenji Minakata, MD a Joseph A. Dearani, MD a Rick A. Nishimura, MD b Barry J. Maron,
More informationMITRAL 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 informationClinical material and methods. Centennial Medical Center, Vanderbilt University, Nashville, TN, USA
A New Mitral Valve Repair Strategy for Hypertrophic Obstructive Cardiomyopathy J. Scott Rankin, Robert S. Binford, Thomas S. Johnston, John T. Matthews, David D. Alfery, A. Thomas McRae, Louis A. Brunsting
More informationCase 47 Clinical Presentation
93 Case 47 C Clinical Presentation 45-year-old man presents with chest pain and new onset of a murmur. Echocardiography shows severe aortic insufficiency. 94 RadCases Cardiac Imaging Imaging Findings C
More informationHYPERTROPHIC CARDIOMYOPATHY: Severe Heart Failure. Paolo Spirito, Genoa, Italy
HYPERTROPHIC CARDIOMYOPATHY: Severe Heart Failure Paolo Spirito, Genoa, Italy Clinical Substrates for Heart Failure Symptoms in HCM Diastolic dysfunction Atrial fibrillation LV outflow obstruction Evolution
More informationHypertrophic cardiomyopathy in children
Perspective Hypertrophic cardiomyopathy in children Arman Arghami 1, Joseph A. Dearani 1, Sameh M. Said 1, Patrick W. O Leary 2, Hartzell V. Schaff 1 1 Department of Cardiovascular Surgery, 2 Division
More informationOptions for my no option Patients Treating Heart Conditions Via a Tiny Catheter
Options for my no option Patients Treating Heart Conditions Via a Tiny Catheter Nirat Beohar, MD Associate Professor of Medicine Director Cardiac Catheterization Laboratory, Medical Director Structural
More informationExpanding Relevance of Aortic Valve Repair Is Earlier Operation Indicated?
Expanding Relevance of Aortic Valve Repair Is Earlier Operation Indicated? RM Suri, V Sharma, JA Dearani, HM Burkhart, RC Daly, LD Joyce, HV Schaff Division of Cardiovascular Surgery, Mayo Clinic, Rochester,
More informationHypertrophic Cardiomyopathy
019-CardioCase:019-CardioCase 4/16/07 1:39 PM Page 19 Hypertrophic Cardiomyopathy Abdullah Alshehri, MD; and Andrew Ignaszewski, MD, FRCPC CardioCase presentation Presley s check-up Presley, 37, discovered
More informationWhich Type of Secondary Tricuspid Regurgitation Accompanying Mitral Valve Disease Should Be Surgically Treated?
Ann Thorac Cardiovasc Surg 2013; 19: 428 434 Online January 31, 2013 doi: 10.5761/atcs.oa.12.01929 Original Article Which Type of Secondary Tricuspid Regurgitation Accompanying Mitral Valve Disease Should
More informationMitral valve repair is the gold standard to treat mitral regurgitation.
Papillary muscle repositioning for repair of anterior leaflet prolapse caused by chordal elongation Gilles D. Dreyfus, MD, PhD, FRCS, Olivio Souza Neto, MD, and Stéphane Aubert, MD, MSc Objective: Anterior
More informationRepair 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 informationTransthoracic Echocardiographic
Transthoracic Echocardiographic Findings of Mitral Regurgitation Caused by Commissural Prolapse 1 Hyue Mee Kim, 1 Kyung-Jin Kim, 1 Hyung-Kwan Kim*, 1 Jun-Bean Park, 2 Ho-Young Hwang, 3 Yeonyee E. Yoon,
More informationMechanism of and Risk Factors for Reoperation After Mitral Valve Repair for Degenerative Mitral Regurgitation
Circulation Journal Official Journal of the Japanese Circulation Society http://www.j-circ.or.jp Advance Publication by-j-stage Mechanism of and Risk Factors for Reoperation After Mitral Valve Repair for
More informationEffect of Recurrent Mitral Regurgitation After Mitral Valve Repair in Patients With Degenerative Mitral Regurgitation
Circ J 2018; 82: 93 101 doi: 10.1253/circj.CJ-17-0380 ORIGINAL ARTICLE Cardiovascular Surgery Effect of Recurrent Mitral Regurgitation After Mitral Valve Repair in Patients With Degenerative Mitral Regurgitation
More informationValve 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 informationMuscular (hypertrophic) subaortic stenosis (hypertrophic obstructive cardiomyopathy): the evidence for true obstruction
Postgraduate Medical Journal (1986) 62, 531-536 Muscular (hypertrophic) subaortic stenosis (hypertrophic obstructive cardiomyopathy): the evidence for true obstruction to left ventricular outflow E. Douglas
More informationBasic Principles of Degenerative Mitral Valve Repair Technical Aspects and Results. Manuel Antunes Coimbra-Portugal
Basic Principles of Degenerative Mitral Valve Repair Technical Aspects and Results Manuel Antunes Coimbra-Portugal Repair for Degenerative Disease Adams D H et al. Eur Heart J 2010;31:1958-1966 Published
More informationTricuspid and Pulmonic Valve Disease
Chapter 31 Tricuspid and Pulmonic Valve Disease David A. Tate Acquired disease of the right-sided cardiac valves is much less common than disease of the leftsided counterparts, possibly because of the
More informationWe present the case of an asymptomatic, 75-year-old
Images in Cardiovascular Medicine Asymptomatic Rupture of the Left Ventricle Lech Paluszkiewicz, MD; Stefan Ożegowski, MD; Mohammad Amin Parsa, MD; Jan Gummert, PhD, MD We present the case of an asymptomatic,
More informationUtility of Echocardiography
Hypertrophic Cardiomyopathy and Beyond- Echo Hawaii 2018 Lawrence Rudski MD FRCPC FACC FASE Professor of Medicine Director, Division of Cardiology and Azrieli Heart Center Jewish General Hospital, McGill
More informationHYPERTROPHIC CARDIOMYOPATHY (HCM) PRESENTED AS UNSTABLE ANGINA COMPLICATED BY SERIOUS VENTRICULAR ARRHYTHMIAS CASE REPORT AND REVIEW LITERATURE
HYPERTROPHIC CARDIOMYOPATHY (HCM) PRESENTED AS UNSTABLE ANGINA COMPLICATED BY SERIOUS VENTRICULAR ARRHYTHMIAS CASE REPORT AND REVIEW LITERATURE Lusyun Kumar Yadav * and Jin li Jun Department of Cardiology,
More informationValvular Heart Disease
Valvular Heart Disease MITRAL STENOSIS Pathophysiology rheumatic fever. calcific degeneration, malignant carcinoid disease, congenital mitral stenosis. SLE. The increased pressure gradient across the mitral
More informationChallenging Case. 77 year old man 1/24/2018. Two months PTA AVR with 21 Edwards Magna and VSD repair for S. Aureus endocarditis
Vumedi January 2018 77 year old man Challenging Case Paul Sorajja, MD Roger L. and Lynn C. Headrick Family Chair Valve Science Center, Minneapolis Heart Institute Foundation Abbott Northwestern Hospital
More informationEffects of Amyl Nitrite in Aortic Valvular and Muscular Subaortic Stenosis
Effects of Amyl Nitrite in Aortic Valvular and Muscular Subaortic Stenosis By E. W. HANCOCK, M.D., AND W. C. FoWKES, M.D. From the Department of Medicine, Stanford University School of Medicine, Palo Alto,
More informationPrimary Mitral Valve Disease: Natural History & Triggers for Intervention ACC Latin American Conference 2017
Disclosures: GE stock, Primary Mitral Valve Disease: Natural History & Triggers for Intervention ACC Latin American Conference 2017 Athena Poppas, MD FACC Past ACC Scientific Sessions Chair, ACC Board
More informationCardiac hypertrophy and how it may break an athlete s heart e the Cypriot case
Eur J Echocardiography (2005) 6, 301e307 Cardiac hypertrophy and how it may break an athlete s heart e the Cypriot case C.E. Chee a,1, C.P. Anastassiades a,1, A.G. Antonopoulos b, A.A. Petsas b, L.C. Anastassiades
More informationCardiac Myxoma Originating from the Anterior Mitral Leaflet. Case Reports
Case Reports Cardiac Myxoma Originating from the Anterior Mitral Leaflet Michael Yu-Chih CHEN, 1 MD, Ji-Hung WANG, 1 MD, Shen-Feng CHAO, 2 MD, Yung-Hsiang HSU, 3 MD, Da-Chung WU, 1 MD, and Cha-Po LAI,
More informationCases of mitral valve causing mitral regurgitation: the MV prolapse spectrum CASE
Cases of mitral valve causing mitral regurgitation: the MV prolapse spectrum Judy Hung, MD Cardiology Division Massachusetts General Hospital Boston, MA CASE Mr. M; 50 Year male presents to internist for
More informationManagement of Incomplete Initial Repair in the Treatment of Degenerative Mitral Insufficiency An Institutional Protocol and Mid-Term Outcomes
CLINICAL STUDY Management of Incomplete Initial Repair in the Treatment of Degenerative Mitral Insufficiency An Institutional Protocol and Mid-Term Outcomes Wenrui Ma, 1 MD, Wei Shi, 1 MD, Wei Zhang, 1
More informationDegenerative mitral valve disease is the leading cause of
Recurrence of Mitral Valve Regurgitation After Mitral Valve Repair in Degenerative Valve Disease Willem Flameng, MD, PhD; Paul Herijgers, MD, PhD; Kris Bogaerts, MSc Background Durability assessment of
More informationMilind Desai Christine Jellis Teerapat Yingchoncharoen Editors. An Atlas of Mitral Valve Imaging
Milind Desai Editors An Atlas of Mitral Valve Imaging 123 An Atlas of Mitral Valve Imaging Milind Desai Editors An Atlas of Mitral Valve Imaging Editors Milind Desai Department of Cardiovascular Medicine
More informationAlcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy. CardioVascular Research Foundation
Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy Alcohol Septal Ablation (ASA) Nonsurgical technique for septal myocardial reduction Dramatic hemodynamic improvement Technically easy
More informationMitral valve apparatus in Hypertrophic Cardiomyopathy: a specific assessment?
Nancy, September 17th, 2015 Mitral valve apparatus in Hypertrophic Cardiomyopathy: a specific assessment? Inserm UMR1087 Institut du Thorax, Nantes Thierry le Tourneau Déclaration de Relations Professionnelles
More informationAnn Thorac Cardiovasc Surg 2015; 21: Online April 18, 2014 doi: /atcs.oa Original Article
Ann Thorac Cardiovasc Surg 2015; 21: 53 58 Online April 18, 2014 doi: 10.5761/atcs.oa.13-00364 Original Article The Impact of Preoperative and Postoperative Pulmonary Hypertension on Long-Term Surgical
More informationCardiac ultrasound protocols
Cardiac ultrasound protocols IDEXX Telemedicine Consultants Two-dimensional and M-mode imaging planes Right parasternal long axis four chamber Obtained from the right side Displays the relative proportions
More informationEmergency Intraoperative Echocardiography
Emergency Intraoperative Echocardiography Justiaan Swanevelder Department of Anaesthesia, Glenfield Hospital University Hospitals of Leicester NHS Trust, UK Carl Gustav Jung (1875-1961) Your vision will
More informationHISTORY. Question: What category of heart disease is suggested by the fact that a murmur was heard at birth?
HISTORY 23-year-old man. CHIEF COMPLAINT: Decreasing exercise tolerance of several years duration. PRESENT ILLNESS: The patient is the product of an uncomplicated term pregnancy. A heart murmur was discovered
More informationProf. Patrizio LANCELLOTTI, MD, PhD Heart Valve Clinic, University of Liège, CHU Sart Tilman, Liège, BELGIUM
The Patient with Aortic Stenosis and Mitral Regurgitation Prof. Patrizio LANCELLOTTI, MD, PhD Heart Valve Clinic, University of Liège, CHU Sart Tilman, Liège, BELGIUM Aortic Stenosis + Mitral Regurgitation?
More informationCASE CONFERENCES. Case Conferences: The Clinical Physiologist 1855
Loulmet DF, Yaffee DW, Ursomanno PA, Rabinovich AE, Applebaum RM, Galloway AC, Grossi EA. Systolic anterior motion of the mitral valve: a 30-year perspective. J Thorac Cardiovasc Surg 2014;148:2787 2793.
More informationThe Key Questions in Mitral Valve Interventions. Where Are We in 2018?
The Key Questions in Mitral Valve Interventions Where Are We in 2018? Gilles D. DREYFUS, MD, FRCS, FESC Professor of Cardiothoracic Surgery 30 GIORNATE CARDIOLOGICHE TORINESI - OCT 2018 Are guidelines
More informationDoes Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement?
Original Article Does Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement? Hiroaki Sakamoto, MD, PhD, and Yasunori Watanabe, MD, PhD Background: Recently, some articles
More informationMITRAL 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 informationORIGINAL PAPER. R. C. Steggerda & J. C. Balt & K. Damman & M. P. van den Berg & J. M. ten Berg
Neth Heart J (2013) 21:504 509 DOI 10.1007/s12471-013-0453-4 ORIGINAL PAPER Predictors of outcome after alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy. Special interest
More informationThe need for right ventricular outflow tract reconstruction
Polytetrafluoroethylene Bicuspid Pulmonary Valve Implantation James A. Quintessenza, MD The need for right ventricular outflow tract reconstruction and pulmonary valve replacement is increasing for many
More informationEchocardiographic Evaluation of the Cardiomyopathies. Stephanie Coulter, MD, FACC, FASE April, 2016
Echocardiographic Evaluation of the Cardiomyopathies Stephanie Coulter, MD, FACC, FASE April, 2016 Cardiomyopathies (CMP) primary disease intrinsic to cardiac muscle Dilated CMP Hypertrophic CMP Infiltrative
More informationJournal of the American College of Cardiology Vol. 36, No. 4, by the American College of Cardiology ISSN /00/$20.
Journal of the American College of Cardiology Vol. 36, No. 4, 2000 2000 by the American College of Cardiology ISSN 0735-1097/00/$20.00 Published by Elsevier Science Inc. PII S0735-1097(00)00830-5 Systolic
More informationThe 2014 Mayo Approach to the Management of HCM and Non-Compaction
The 2014 Mayo Approach to the Management of HCM and Non-Compaction R A Nishimura MD MACC MACP Judd and Mary Morris Leighton Professor Mayo Clinic No disclosures or conflict of interest CP1288794-1 Let
More informationThe risk-benefit ratio of mitral valve operation is
Degenerative Mitral Regurgitation: When Should We Operate? Malcolm J. R. Dalrymple-Hay, PhD, Mark Bryant, Richard A. Jones, MRCP, Stephen M. Langley, FRCS, Steven A. Livesey, FRCS, and James L. Monro,
More informationNew Technique for Aortic Valve Functional Annulus Reshaping Using a Handmade Prosthetic Ring
New Technique for Aortic Valve Functional Annulus Reshaping Using a Handmade Prosthetic Ring Khalil Fattouch, MD, PhD, Roberta Sampognaro, MD, Giuseppe Speziale, MD, and Giovanni Ruvolo, MD Department
More informationDegenerative Mitral Regurgitation: Etiology and Natural History of Disease and Triggers for Intervention
Degenerative Mitral Regurgitation: Etiology and Natural History of Disease and Triggers for Intervention John N. Hamaty D.O. FACC, FACOI November 17 th 2017 I have no financial disclosures Primary Mitral
More informationDegenerative mitral valve disease-contemporary surgical approaches and repair techniques
Perspective Degenerative mitral valve disease-contemporary surgical approaches and repair techniques Marijan Koprivanac 1, Marta Kelava 2, Shehab Alansari 1, Hoda Javadikasgari 1, Bassman Tappuni 1, Stephanie
More information