• Title, Summary, Keyword: mitral regurgitation

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Severe mitral regurgitation after repair of partial form of atrioventricular canal: one case report (1차공 결손 심방중격결손증 수술후 발생한 승모판폐쇄부전증 환자에서 승모판막대치수술 치험 1)

  • 이두연
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.17 no.2
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    • pp.171-176
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    • 1984
  • Successful correction of the partial form of atrioventricular[AV] canal is now readily achievable. The most challenging technical features of this anomaly are the associated mitral valvular deformity and the frequent inability to obtain mitral competence. Residual mitral incompetence after repair of mitral cleft figures importantly in the causes of early and late failure. So, accurate and complete repair of the mitral valve cleft might be important. Determination of residual severe mitral regurgitation after repair is desirable to permit mitral valve replacement at the time. We have experienced one case of severe mitral regurgitation which was occurred 6 months after repair of partial form of A-V canal [ASD primum] in 22 years old virgin. Pre-op. left ventriculogram revealed severe mitral regurgitation in this patient. We preferred to perform mitral valve replacement with St. Jude valve in this patient at March 1984. Post-op. course was uneventful to now for 5 months and we report this case, review and discuss the literatures.

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Preoperative Risk Factors for the Prognosis of Mitral Regurgitation in Patients with Coronary Artery Stenosis and Mitral Regurgitation Who Underwent Coronary Artery Bypass Surgery Alone (승모판폐쇄부전증을 동반한 관상동맥협착증 환자에서 시행한 단독 관상동맥우회술 후 승모판폐쇄부전증의 예후에 영향을 미치는 수술 전 요인)

  • Jin, Ung;Park, Chan-Beom;Choi, Si-Young;Kim, Chi-Kyung
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.37 no.5
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    • pp.410-415
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    • 2004
  • Background: In the operation for coronary artery stenosis, the procedures for mitral regurgitation are restricted to cases of more than moderate mitral regurgitation or for the lesions in leaflets. This is based on the belief that the less than mild regurgitation are a form of reversible change results from ischemia with coronary artery stenosis. We studied the changes and prognostic factors of mitral regurgitation in patients with coronary artery stenosis and mitral regurgitation who underwent coronary artery bypass surgery alone. Material and Method: We reviewed the medical records of 90 patients with coronary artery stenosis and mitral regurgitation who underwent coronary artery bypass surgery alone by a single surgeon from Jan. 1995 to Dec. 2002, We grouped the patients according to the postoperative changes of mitral regurgitation, and then we statistically compared the findings of echocardiogram between preoperative and last follow up. Result: There were 24 cases with progression of mitral regurgitation, 12 cases without changes, 54 cases with improvements of mitral regurgitation in total 90 patients. The bypass to LAD was proven as the significant prognostic factor of mitral regurgitation. The preoperative end diastolic left ventricular volume index were higher in aggravated group with 105.38$\pm$38.89 $m\ell$ compared to 71.75$\pm$28,45 $m\ell$ in improvement group, and 84.00$\pm$11.66 $m\ell$ in no change group. The grade of preoperative mitral regurgitation did not show significant differences among the groups. Conclusion: The mitral regurgitation in patient with coronary artery stenosis can be improved after the coronary artery bypass surgery alone. However, the expectation of improvements based on the degree of preparative mitral regurgitation can not be justified, therefore, the procedures for mitral regurgitation should be aggressively considered even in the cases of mild mitral regurgitation. Also, further study should be performed to identify the exact prognostic factors of mitral regurgitation including the left ventricular volume index, and whether the left anterior descending artery has been bypassed.

Early Results of Mitral Valve Reconstruction in Mitral Regurgitation (승모판막 폐쇄부전에 있어 승모판막 성형술의 단기성적)

  • Kim, Kyung-Hwan;Won, Tae-hee;Kim, Ki-Bong;Ahn, Hyuk
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.33 no.1
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    • pp.32-37
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    • 2000
  • Background: Reconstruction surgery of mitral valve regurgitation is now considered as an effective operative technique and has shown good long-term results. Although reconstructive surgery of mitral valve has been performed since 1970s, we have started only in early 1990s in full scale because of small number of the mitral regurgitation compared to mitral stenosis and lack of knowledge from the viewpoint of patients and physicians. Material and Method: From January 1992 to December 1996, 100 patients underwent repair of the mitral valve for mitral regurgitation with or without mitral stenosis in Seoul National University Hospital. 45(45%) of the patients were men and 55(55%) were women. The mean age was 39.9$\pm$14.4 years. The causes of the mitral regurgitation were rheumatic in 61, degenerative in 28 and others in 11. According to the Carpentier's pathological classification of mitral regurgitation 5 patients were type I. 55 patients were type II and 40 patients were type III. 7 patients underwent concomitant aortic valvuloplasty and 8 patients underwent aortic valve replacement. 7 patients underwent Maze operation or pulmonary vein isolation. Result: There were no operative death but 3 major operative complications: 2patients were postoperative low cardiac output syndrome(needed intra-aortic ballon pump support) and 1 patient was postoperative bleeding. There was one late death(1.0%) The cause of death was sepsis secondary to acute bacterial endocarditis. 3 patients required reoperation for recurred mitral regurgitation. There were no statistically significant risk factors for reoperation. The other 96 patients showed no or mild degree of mitral regurgitation 99 survivors were in NYHA functional class I or II. There were two throumboembolisms but no anticoagulation-related complications. Conclusion: We concluded that mitral valve repair could be performed successfully in most cases of mitral regurgitation even in the rheumatic and combined lesions with very low operative mortality and morbidity. The early results are very promising.

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Mitral Annuloplasty Using Carpentier Ring: Report of 5 Cases (Carpentier Ring 을 이용한 승모판윤 성형술 [5례 보고])

  • Chang, Bung-Chul;Jo, Seung-Yeon;Cho, Bum-Koo
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.14 no.1
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    • pp.33-39
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    • 1981
  • In the presence of severe non-calcific mitral regurgitation, a dilated mitral annulus, absence of severe subvalvular chordal thickening, and no major loss of leaflet substance, reconstructive surgery for mitral regurgitation is a reasonable approach. Between March, 1980 to November, 1980, 5 patients underwent mitral annuloplasty using Carpentier Ring for severe mitral regurgitation. All 5 cases were of rheumatic in origin. There were no ruptured chorda tendinae or ruptured papillary muscles except slight thickening of the leaflet. There was no operative or late death. As is Carpentier`s report, in patient with severe mitral regurgitation who meet above criteria, mitral annuloplasty using Carpentier Ring is preferable to valve replacement.

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Patent ductus arteriosus associated with mitral regurgitation (승모판막 폐쇄부전증이 동반된 개방성 동맥관의 치험 10예)

  • 이철주
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.15 no.3
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    • pp.321-324
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    • 1982
  • Patent ductus arteriosus is not uncommon congenital heart disease. Patent ductus arteriosus associated with mitral regurgitation is very rare, however especially nonrheumatic in character. In such a case, a ligation of ductus arteriosus alone makes it regress the symptoms and signs of mitral regurgitation. Till recent days, we have experienced 10 cases of patent ductus arteriosus with mitral regurgitation who had been undergone a ligation of ductus arteriosus alone with good clinical benefits. In 5 cases among above patients, we have followed up the patients from 4 months to 6 years. Herewith, we report these cases with review of some literatures.

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Idiopathic Hypertropic Subaortic Stenosis with Mitral Regurgitation -Report of 3 Cases- (특발성 비후성 대동맥판하 협착증 및 승모판 폐쇄부전증 -3례 보고-)

  • 강청희
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.27 no.4
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    • pp.313-317
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    • 1994
  • Surgical treatment is possible for the obstructive form of hypertrophic cardiomyopathy and transaortic left ventricular septal myectomy and myotomy has been the procedure of choice. If coexisting intrinsic mitral valve disease exists, mitral valve replacement has been performed. But abnormal systolic anterior motion of anterior mitral leaflet[SAM] with intrinsic normal mitral valve disease is the typical feature of IHSS and we prefer not to replace mitral valve. 3 patients underwent transaortic myotomy and myectomy for IHSS with mitral regurgitation. 2 patients of them have coexisting intrinsic mitral valve diseases such as mitral valve vegetation and chorda rupture. Concomittent mitral valve replacement were performed. 1 patient shows SAM of mitral anterior leaflet but has intrinsic normal mitral valve morphologically and transepicardial echocardiogram and direct monitoring of pressure gradient during the operative procedure gives better information for subsided mitral regurgitation. Post operative course during the 12 months follow-up was uneventful.

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Repair of Acute Post Infarction Mitral Regurgitation with Papillary Muscle Reimplantation - A case report -

  • Park, Won-Kyoun;Kim, Joon-Bum;Choo, Suk-Jung
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.44 no.4
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    • pp.285-287
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    • 2011
  • A 53-year-old man presenting with dyspnea and chest pain was diagnosed with acute myocardial infarction secondary to occlusion of the left circumflex coronary artery. Urgent revascularization by percutaneous stenting was successfully performed. However, the post-echocardiography revealed a ruptured papillary muscle that was causing severe mitral regurgitation and aggravation of congestive heart failure. The patient subsequently underwent mitral valve repair with papillary muscle re-implantation. Postoperative echocardiography showed a competent mitral valve without residual stenosis or regurgitation. The patient was discharged from the hospital with an uneventful recovery and has been doing well on outpatient follow up.

Quantitative Doppler echocardiography during Dobutamine stress test in canine mitral regurgitant model

  • Choi, Hojung;Won, Sungjun;Lee, Kichang;Choi, Mincheol;Yoon, Junghee
    • Korean Journal of Veterinary Research
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    • v.44 no.2
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    • pp.317-322
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    • 2004
  • This study was performed to evaluate echocardiographic parameters in dogs with experimental mitral regurgitation subjected to dobutamine stress testing. In 8 beagle dogs, a 4-prong grasping forceps was inserted into the left ventricle through the carotid artery with fluoroscopic guidance. The disruption of chordae or mitral valve leaflet was performed. Echocardiographic protocols included quantitative Doppler echocardiography and M-mode measurement for evaluating left ventricle function. After all measurement was obtained at rest, dobutamine was infused incrementally. In stress testing, all measurement also was performed at rest as the same method. In stress Doppler echocardiography, regurgitant fraction and aortic stroke volume was increased significantly (P<0.001). Effective regurgitant orifice and regurgitant volume was not changed. In M-mode examination, fractional shortening was increased significantly at stress test (P<0.001). From the results obtained in this study, it could be suggested that dobutamine stress echocardiography increase left ventricle performance in non-functional mitral regurgitation and quantitative Doppler echocardiography is non-invasive, accurate method in valvular regurgitation.

Long-term Influence of Mild to Moderate Ischemic Mitral Regurgitation after Off-pump Coronary Artery Bypass Surgery (무심폐기하 관상동맥우회술에서의 중등도의 허혈성 승모판막부전증의 중요성)

  • Hong, Jong-Myeon;Cartier, Raymond
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.43 no.3
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    • pp.246-253
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    • 2010
  • Background: Our objective was to review the long-term prognosis of patients with preoperative mild to moderate ischemic mitral regurgitation who underwent off-pump coronary artery bypass grafting. Material and Method: We prospectively followed 1,000 consecutive and systematic off-pump coronary artery bypass grafting patients who were operated on between September 1996 and March 2004; follow-up was achieved for 97%. Sixty-seven patients (6.7%) had mild to moderate ischemic mitral regurgitation at the time of surgery. Operative mortality, actuarial survival and major adverse cardiac event free survival were compared to assess the effect of ischemic mitral regurgitation. Result: Average follow-up was $66{\pm}22$ months. Patients with ischemic mitral regurgitation were older (p<0.001), had lower ejection fractions (p<0.001) and more comorbidities. Significantly more female patients presented with ischemic mitral regurgitation (p=0.002). There was no significant difference in operative mortality and perioperative myocardial infarction in ischemic mitral regurgitation patients (p=0.25). Eight-year survival was decreased in ischemic mitral regurgitation patients ($39.6{\pm}11.8%$ vs $76.7{\pm}2.2$, p<0.001). However, after correcting for risk factors, mild to moderate ischemic mitral regurgitation was not found to be a significant independent risk factor for long-term mortality (p=0.42). Major adverse cardiac event free survival at 8 years was significantly lower in ischemic mitral regurgitation patients ($53.12{\pm}12%$ vs $77{\pm}2%$, p<0.001). After correction for risk factors, ischemic mitral regurgitation remained a significant independent cause of major adverse cardiac events (HR: 2.31), especially congestive heart failure and recurrent myocardial infarction. Conclusion: In our series, patients with preoperative mild to moderate ischemic mitral regurgitation had a higher prevalence of preoperative risk factors than patients without ischemic mitral regurgitation. They had comparable perioperative mortality and morbidity, but, in the long term, were found to be at elevated risk for recurrent cardiac events.

Surgical Management of Mitral Regurgitation in Patients with Marfan Syndrome during Infancy and Early Childhood

  • Kim, Eung Re;Kim, Woong-Han;Choi, Eun Seok;Cho, Sungkyu;Jang, Woo Sung;Kim, Yong Jin
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.48 no.1
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    • pp.7-12
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    • 2015
  • Background: Mitral regurgitation is one of the leading causes of cardiovascular morbidity in pediatric patients with Marfan syndrome. The purpose of this study was to contribute to determining the appropriate surgical strategy for these patients. Methods: From January 1992 to May 2013, six patients with Marfan syndrome underwent surgery for mitral regurgitation in infancy or early childhood. Results: The median age at the time of surgery was 47 months (range, 3 to 140 months) and the median follow-up period was 3.6 years (range, 1.3 to 15.5 years). Mitral valve repair was performed in two patients and four patients underwent mitral valve replacement with a mechanical prosthesis. There was one reoperation requiring valve replacement for aggravated mitral regurgitation two months after repair. The four patients who underwent mitral valve replacement did not experience any complications related to the prosthetic valve. One late death occurred due to progressive emphysema and tricuspid regurgitation. Conclusion: Although repair can be an option for some patients, it may not be durable in infantile-onset Marfan syndrome patients who require surgical management during infancy or childhood. Mitral valve replacement is a feasible treatment option for these patients.