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Open access

Agnė Drąsutienė, Sigita Aidietienė and Diana Zakarkaitė

Summary

Real time (RT) three-dimensional (3D) imaging is one of the most significant developments of the last decade and is now being used with increasing frequency in echocardiography and interventional cardiology laboratories. Improvements in transducer technologies and the development of a matrix array transducer were the most important achievements that lead to the new era of real time 3D transoesophageal echocardiography (TEE). RT 3D TEE is ideal for assessing the mitral valve (MV) because of its high spatial resolution altering in improved MV anatomic detail. This imaging modality provides images of high quality which is of a great clinical value inmaking diagnosis of MV disease and a valuable tool for surgeons and interventional cardiologists in planning and guiding interventional procedures. This review is intended to provide data about normal MV anatomy and clinical usefulness of RT 3D TEE in defining acquired MV pathology.

Open access

Uldis Strazdins, Gvido Janis Bergs, Martins Kalejs and Indra Vilumsone

Summary

Mitral regurgitation is common valvular heart disease and a major cause of congestive heart failure and death. It is most often associated with degenerative changes in mitral valve which leads to valve prolapse. Transapical off-pump mitral valve repair is a new minimally invasive procedure to treat mitral regurgitation. Here we report 64-year old female who suffered from grade III mitral regurgitation due to ruptured chorda and posterior leaflet P2/P3 segment prolapse. During surgery 4 artificial chordae were implanted and postoperative echocardiography results showed minimal residual grade I mitral regurgitation, therefore significant clinical improvement can be achieved with minimally invasive approach.

Open access

Aleksandra Domanjko Petrič

Abstract

Myxomatous mitral valve disease is a common cause of congestive heart failure in geriatric dogs. Many studies have been done in terms of epidemiology, pathology, associated neurohormonal changes in the disease progression, prognostic factors, and survival and treatment modalities. The presented paper presents a review of some of the studies in the mitral valve disease story.

Open access

I Tilea, L Moraru, V Raicea, Brindusa Tilea, Andreea Elena Bocicor and H Suciu

Abstract

Bicoronary - pulmonary artery fistulae are rare conditions. Their association with mitral valve prolapse is even rarer and randomly reported. This association is important to be recognized in clinical practice because of the differential diagnose problems. Closing the coronary fistulae and mitral valve replacement during the same surgical procedure is probably the optimal management of these patients. We report a case involving the correction of congenital bicoronarypulmonary artery fistulae and mitral valve replacement within the same surgical procedure in a 56 years old female patient with angina and clinical signs of left ventricular failure associating the fistulae to severe mitral regurgitation due to mitral valve prolapse. Past medical history revealed autoimmune thyroiditis, atrial fibrillation, mitral and tricuspid valve regurgitation. At admission physical examination revealed stable vital signs, irregular tachycardia with significant pulse and a mitral regurgitation systolic murmur. ECG showed atrial fibrillation, no ischemia. Echocardiography revealed severe mitral regurgitation, prolapse of anterior and posterior mitral leaflets, moderate tricuspid valve regurgitation, and mild pulmonary hypertension. Coronary angiogram showed no significant lesions of the epicardial vessels but high flow congenital bicoronary-pulmonary fistulae (right coronary artery and left coronary artery to main pulmonary artery). Surgical correction of the congenital bicoronarypulmonary fistulae was performed simultaneously with mitral valve replacement in the same session. Postsurgical evolution was uneventful. Post-procedural ECG showed atrial fibrillation with a controlled heart rate, postoperative echocardiography showed normal functional and normal positioned prosthetic mitral mechanical valve, and rather normal left ventricle function. Coexistence of bicoronary-pulmonary fistulae and mitral valve insufficiency due to prolapse in a symptomatic patient with angina pectoris is a very rare clinical entity. Solving both abnormalities within the same surgical procedure was the optimal management for this patient.

Open access

Yi Chih Chang, Tien Hsing Chen, Pyng Jing Lin, Kuo Chun Hung, Fen Chiung Lin, Chun Chieh Wang, I Chang Hsieh, Jian Liang Wang, Hung Ta Wo and Chien Chia Wu

Abstract

Background: Maintaining continuity between the mitral valve and the subvalvular apparatus during mitral valve replacement (MVR) maximizes the left ventricular (LV) function and increases the survival rate. However, MVR potentially cause rupture of the papillary muscles, systemic embolization, or dehiscence of the mitral annulus from the transposed position.

Objective: We presented a case with severe rheumatic mitral valve disease treated with MVR and partial preservation of the posterior and anterior chordae tendineae.

Methods: Retrospectively review of medical records.

Results: Transthoracic echocardiography performed two weeks after surgery revealed a floating mass in the posterior inferior aspect of the left atrium and a lobulated mass joining the tip of the posterior papillary muscle in the left ventricle. Perioperative examination confirmed a large thrombus in the left atrium and the stump of the preserved posterior papillary muscle of the mitral valve.

Conclusion: Thus, the papillary muscle could present itself as an abnormal mass on echocardiography, resulting in misdiagnosing.

Open access

Irena Mitevska, Elizabeta Srbinovska, Marijan Bosevski, Sasko Jovev and Omer Dzemali

Abstract

Case presentation

Hypertrophic cardiomyopathy (HCM) is the most common and very heterogeneous genetic cardiac disease with a different clinical presentation and prognosis. The overall prevalence of the disease is estimated between 0.05-0.2% of the population. Left ventricular outflow obstruction at rest is present in about 20% of patients. Most of the patients have a normal life expectancy, however high risk patients might develop heart failure, atrial fibrillation, ventricular arrhythmias and sudden cardiac death.

We present the case of 47-year-old Caucasian man who was hospitalized at our clinic with a history of chest pain and shortness of breath on physical activity in the last six months, which caused significant limitations of his life quality. Hypertrophic obstructive cardiomyopathy was diagnosed in 2011, when the patient was put on therapy with beta blocker. Transthoracic echocardiography revealed normal systolic function, presence of systolic anterior mitral valve motion (SAM) with moderate mitral regurgitation (MR). There was a significant concentric left ventricular hypertrophy predominantly located in the ventricular septum. The intraventricular gradient at rest was 77.8 mmHg. MRI of the heart confirmed significant LV hypertrophy with regions of fibrosis at the septum. The patient shortness of breath worsened progressively in the last month (NYHA III) despite optimized medical treatment with maximal beta blocker dose. Surgical approach with septal myectomy was performed with mitral valve repair. There were no operative complications, with excellent postoperative recovery and complete symptoms resolution. Control Doppler echocardiograms revealed LVOT rest gradient reduction to 34 mmHg. The good operative results were still present 9 months after the intervention.

Our case confirmed that septal myectomy with MV repair is an excellent treatment approach in young patient with obstructive hypertrophic cardiomyopathy and mitral valve involvement refractory to medical treatment.

Open access

Orhan Pinar, Aziz Arda Sancak, Yücel Meral and Duygu Dalğin

Abstract

Mitral valve (MV) disease is the most important valvular condition affecting athletic performance in horses. Twenty and 22 years old Thoroughbred Stallions used for breeding had suffered from increased respiratory and heart rate, poor performance and incomplete ejaculate release during covering, since three months ago. Cardiac examination projected irregular cardiac rhythm after a halt and an early-mid-systolic murmur.

Mitral regurgitation (MR) and valvular changes were visible on echocardiography. Also volume overload of the Left Atrium (LA) and Left Ventricle (LV) were observed. Color Flow Doppler echocardiography confirmed moderate mitral valve regurgitation. A band-like fibrous and nodular degeneration of the left coronary leaflet was present. There was minimal secondary left ventricular remodeling of the apex of the left ventricle due to chronic volume overload.

The therapeutic attempts included Quinapril and Furosemide. In these cases, normally no structural effect could be achieved, but clinical improvement and successful covering sessions were obtained, and when the therapy was terminated, clinical problems reappeared. In conclusion, in horses with MR, early diagnosis and appropriate therapy with Quinapril promises a reasonable performance.

Open access

Magdalena Garncarz, Marta Parzeniecka-Jaworska, Magdalena Hulanicka, Michał Jank, Olga Szaluś-Jordanow and Anna Kurek

Abstract

Introduction: Older small breed dogs are considered at risk for heart failure secondary to chronic mitral valve disease. However, few data are available on the onset of this disease in such dogs. This study was performed to determine if auscultation alone can be used to eliminate clinically relevant mitral valve regurgitation seen in echocardiography in Dachshund dogs. Material and Methods: Clinical and echocardiographic data were obtained from 107 dogs without heart murmurs. Results: The study revealed that 63.6% of the dogs had mitral regurgitation. Numbers increased with age and a larger percentage of male Dachshunds were affected than female Dachshunds. Mitral valve prolapse and thickening were mild, and the regurgitant area inextensive in most dogs. Conclusions: The study shows that mitral valve regurgitation is prevalent (63.6%) in Dachshunds without heart murmurs. Typical lesions often become apparent during echocardiographic examinations in dogs under 5 years of age.

Open access

Morteza Safi, Fariba Bayat, Zahra Ahmadi, Masood Shekarchizadeh, Isa Khaheshi and Mohammadreza Naderian

Abstract

Background. The change in the level of NT-pro-BNP (N-terminal-pro-Brain Natriuretic Peptide) is now considered as a reflection of the hemodynamic alterations and its circulatory reductions reported early after successful PTMC (percutaneous transvenous mitral commissurotomy). The present study aims to assess the change in the level of NT-pro BNP following PTMC in patients with mitral stenosis and also to determine the association between circulatory NT-pro-BNP reduction and post-PTMC echocardiography parameters.

Methods. Twenty five symptomatic consecutive patients with severe MS undergoing elective PTMC were prospectively enrolled. All patients underwent echocardiography before and also 24 to 48 hours after PTMC. Peripheral blood samples were taken for measurement of NT-pro-BNP before as well as 24 to 48 hours after PTMC. The patients were also classified in group with normal sinus rhythm or having atrial fibrillation (AF) based on their 12-lead electrocardiogram.

Results. It was shown a significant decrease in the parameters of PPG (Peak Pressure Gradient), MPG (Mean Pressure Gradient), PHT (Pressure Half Time), PAP (Pulmonary Arterial Pressure), LAV (Left Atrial Volume), and also a significant increase in MVA (Mitral Valve Area) RVS (Right Ventricular S velocity), and strains of lateral, septal, inferior and anterior walls of LA following PTMC. The mean LVEF remained unchanged after PTMC. The mean NT-pro-BNP before PTMC was 309.20 ± 17.97 pg/lit that significantly diminished after PTMC to 235.72 ± 22.46 pg/lit (p = 0.009). Among all echocardiography parameters, only MPG was positively associated with the change in NT-pro-BNP after PTMC. Comparing the change in echocardiography indices between the patients with normal rhythm and those with AF, lower change in PAP was shown in the group with AF. However, more change in the level of NT-pro-BNP after PTMC was shown in the patients with AF compared to those without this arrhythmia.

Conclusion. PTMC procedure leads to reduce the level of NT-pro-BNP. The change in NT-pro-BNP is an indicator for change in MS severity indicated by decreasing MPG parameter. Lower change in PAP as well as higher change in NT-pro-BNP is predicted following PTMC in the group with AF compared to those with normal sinus rhythm.

Open access

M. F. Popa, Lavinia-Simona Candea and I. Parlica

Abstract

The purpose of this paper is to present a case of prosthetic mitral valve thrombosis in a young patient with a history of acute articular rheumatism with bivalvular damage which required prosthetic mitral twin disc and tricuspid annuloplasty that, despite effective anticoagulation treatment, shows a high degree of mitral valve obstruction with severe hemodynamic disturbances that ultimately led to death.

The particularity of the case lies in the development of thrombosis in twin disc prosthesis type, complication that, in the literature, is cited as being more rarely met than the cases of single-disc prosthesis.