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1
Mannan, Md Abdul, AAS Majumder, Solaiman Hossain, Mohammad Ullah, and SNI Kayes. "Effect of Mitral Valve Leaflets Excursion on Mitral Valve area after Percutaneous Trans- Venous Mitral Commissurotomy." Cardiovascular Journal 10, no. 1 (2017): 3–7. http://dx.doi.org/10.3329/cardio.v10i1.34354.
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Background: Aim of our study was to predict the effect of mitral valve leaflets excursion on mitral valve area following percutaneous transvenous mitral commissurotomy PTMC in patients of mitral stenosis.Methods: Total 70 patients with severe mitral stenosis who underwent PTMC were enrolled in the study.Transthoracic echocardiography was done the day before PTMC and 24-48 hours after PTMC. Mitral valve area, anterior and posterior leaflets excursion were recorded. The relation between leaftlet excursion and mitral valve after PTMC was evaluated.Results: Following PTMC there were significant increasein anterior leaflet excursion from 1.9 ± 0.2 to 2.3 ± 0.2cm (p<0.001), posterior leaflet excursion from 1.6±0.2to1.9 ± 0.2cm (p<0.001). Mitral valve areas increased from 0.8 ± 0.1 to1.7 ± 0.2cm²(p<0.001). Both leaflet excursion increased significantly with the increase in mitral valve area till the area reached a value of about 1.5 cm2, after which any further increase in mitral valve area was not associated with any further increase in leaflet excursion.Conclusion: PTMC is associated with immediate significant changes in mitral valve morphology in terms of splitting of fused mitral commissures, increased leaflets excursion and splitting of the subvalvular structures. Post PTMC leaflet excursion increases significantly with the increase in mitral valve area till the area reaches a value of about 1.5 cm2 after which any further increase in mitral valve area is not associated with any further increase in leaflet excursion.Cardiovasc. j. 2017; 10(1): 3-7
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Karlsson, Matts O., Julie R. Glasson, Ann F. Bolger, et al. "Mitral valve opening in the ovine heart." American Journal of Physiology-Heart and Circulatory Physiology 274, no. 2 (1998): H552—H563. http://dx.doi.org/10.1152/ajpheart.1998.274.2.h552.
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To study the three-dimensional size, shape, and motion of the mitral leaflets and annulus, we surgically attached radiopaque markers to sites on the mitral annulus and leaflets in seven sheep. After 8 days of recovery, the animals were sedated, and three-dimensional marker positions were measured by computer analysis of biplane videofluorograms (60/s). We found that the oval mitral annulus became most elliptical in middiastole. Both leaflets began to descend into the left ventricle (LV) during the rapid fall of LV pressure (LVP), before leaflet edge separation. The anterior leaflet exhibited a compound curvature in systole and maintained this shape during opening. The central cusp of the posterior leaflet was curved slightly concave to the LV during opening. Markers at the border of the “rough zone” were separated by 10 mm during systole. We conclude that coaptation occurs very near the leaflet edges, that the annulus and leaflets move toward their open positions during the rapid fall of LVP, and that leaflet edge separation, the last event in the opening sequence, occurs near the time of minimum LVP.
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EL Adel, Mohamed, Mohammed Mahmoud Mostafa, Ahmed Ghoneim, and Mohamed Abdelkader Osman. "Clinical and echocardiographic evaluation of patients undergoing total leaflets preservation during mitral valve replacement; Does it make a difference?" Egyptian Cardiothoracic Surgeon 1, no. 2 (2019): 32–39. http://dx.doi.org/10.35810/ects.v1i2.39.
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Background: The effect of anterior and posterior leaflet preservation on left ventricular function after mitral valve replacement is still the subject of ongoing research. The objective of this study is to analyze the early outcomes of total leaflets preservation compared to posterior and non-leaflet preservation during mitral valve surgery on cardiac function and dimensions measured by echocardiography and on the clinical outcomes.Methods: This prospective cohort study recruited 155 patients who had mitral valve replacement (MVR) from April 2016 to March 2018 at Assiut University Hospital. Patients were divided into three groups according to the technique of leaflets preservation; Group I (no leaflet preservation-N-MVR), Group II (total leaflet preservation- T-MVR) and Group III (posterior leaflet preservation-P-MVR). Patients who underwent redo mitral valve replacement (MVR) or those with endocarditis and had combined coronary artery bypass grafting with the MVR were excluded from the study.Results: There were nine early deaths (6%); eight patients were in Group I (N-MVR). Causes of mortality were massive intracranial hemorrhage (n= 2) and left ventricular failure (n=6). One patient died in Group III (P-MVR) from intracranial hemorrhage (1.3%). Hospital stay was significantly longer in N-MVR group compared to T-MVR and P-MVR (10.6±2.13 days in N-MVR group; p= 0.03 and 0.011 respectively). Postoperative low cardiac output occurred in all patients in N-MVR group. Left ventricular function (ejection fraction= 61.28±6.02%) and dimensions (end-diastolic diameter= 5.18±0.69 mm, end-systolic diameter= 3.58±0.78 mm) improved significantly in total leaflets preservation group.Conclusion: Leaflet preservation during mitral valve replacement was associated with improved clinical and echocardiographic outcomes. Non-leaflets preservation increased the risk of postoperative complications and length of hospital stay. Leaflet preservation is recommended as the standard approach during mitral valve replacement.
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Buzila, Cosmin Alexandru, Iulian Antoniac, Florin Miculescu, Marius Dumitrescu, and Ionel Droc. "Investigation of a Mechanical Valve Impairment after Eight Years of Implantation." Key Engineering Materials 583 (September 2013): 137–44. http://dx.doi.org/10.4028/www.scientific.net/kem.583.137.
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A 55-year-old female who undergone mitral valve replacement eight years ago with a mechanical graft, presented accusing sudden decrease of effort tolerance and two episodes of pulmonary edema in the last month. Anamnesis, physical examination, electrocardiogram (ECG), transthoracic echocardiography and coronarography were performed. The mechanical valve leaflets and the tissue surrounding the prosthetic ring were evaluated by: optical microscopy (hematoxylin eosin stain and immunohistochemistry), scanning electron microscopy (SEM) and EDAX analysis (Energy Dispersive X-ray spectroscopy). Anamnesis: inferior myocardial infarction in 2006, congestive cardiac insufficiency, pulmonary hypertension, and arterial hypertension. Clinical examination and ECG: minimal perimaleolar edema bilateral, sinus rhythm on admission. Transthoracic echocardiography: 55% ejection fraction, a pression gradient across the mitral valve (Gmax/Gmed= 24/11 mmHg), tricuspid regurgitation, and pulmonary hypertension. A mitral prosthetic valve’s leaflet was found immobile. No thrombus was evidenced. Coronarography: an immobile graft’s leaflet, stenoses on the right coronary artery, stenosis on left anterior descending artery and occlusion at the circumflex artery emergence. The prosthesis was replaced, and two coronary artery bypasses were performed. Macroscopic examination: a fibroconjunctive tissue expansion in close contact with the leaflet. Histopathological evaluation: muscle cells with altered phenotypes, fibroblasts along with fibrous connective tissue and calcium depots areas. SEM evaluation: tissue depots on the immobile leaflet, suggesting that the connective tissue expansion was blocking the leaflet’s movements. EDAX analysis: the metallic leaflets surface was made of tantalum; sodium, calcium and chloride deposits were also detected. Graft failure was caused by the tissue proliferation affecting leaflet’s mobility. SEM is a viable method for failed cardiovascular grafts investigation.
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Mannan, Md Abdul, AAS Majumder, Solaiman Hossain, et al. "Effect of Subvalvular Changes on Mitral Valve Leaflets Excursion after Percutaneous Transvenous Mitral Commissurotomy." Cardiovascular Journal 8, no. 1 (2015): 8–12. http://dx.doi.org/10.3329/cardio.v8i1.24758.
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Background: Aim of our study was to predict the effect of subvalvular changes on mitral valve leaflets excursion in a patient with mitral stenosis following percutaneous trans-venous mitral commissurotomy.Methods: Total of 60 patients of severe mitral stenosis were enrolled in the study. Transthoracic echocardiography was done on the day before percutaneous trans-venous mitral commissurotomy and 24-48 hours after percutaneous trans-venous mitral commissurotomy. Subvalvular area, anterior and posterior leaflets excursion were recorded.Results: Following percutaneous trans-venous mitral commissurotomy there were significant increase in anterior leaflet excursion from 1.8 ± 0.2 to 2.2 ± 0.2cm (p=<0.001), posterior leaflet excursion from 1.5±0.2to1.8 ± 0.2cm (p<0.001) . Subvalvular splitting areas was from 0.8 ± 0.2 to1.2 ± 0.2cm²(p=<0.001). Pulmonary arterial systolic pressure and left atrial diameter were significantly reduced respectively 55.6 ± 19.5 vs. 31.6 ± 9.5 mmHg,(p < 0.001) and 4.3 ± 0.6 cm vs. 3.8 ± 0.6 cm (p < 0.001). Post percutaneous trans-venous mitral commissurotomy subvalvular splitting area was found to be the predictor of increased excursion of both anterior and posterior mitral leaflets.Conclusion: percutaneous trans-venous mitral commissurotomy is associated with immediate significant changes in mitral valve morphology in terms of splitting of fused mitral commissures, increased valve leaflets excursion and splitting of the subvalvular structures. Post percutaneous trans-venous mitral commissurotomy subvalvular splitting area was found to be the predictor of increased excursion of both anterior and posterior mitral leaflets.Cardiovasc. j. 2015; 8(1): 8-12
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Toma, Milan, Daniel R. Einstein, Keshav Kohli, et al. "Effect of Edge-to-Edge Mitral Valve Repair on Chordal Strain: Fluid-Structure Interaction Simulations." Biology 9, no. 7 (2020): 173. http://dx.doi.org/10.3390/biology9070173.
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Edge-to-edge repair for mitral valve regurgitation is being increasingly performed in high-surgical risk patients using minimally invasive mitral clipping devices. Known procedural complications include chordal rupture and mitral leaflet perforation. Hence, it is important to quantitatively evaluate the effect of edge-to-edge repair on chordal integrity. in this study, we employ a computational mitral valve model to simulate functional mitral regurgitation (FMR) by creating papillary muscle displacement. Edge-to-edge repair is then modeled by simulated coaptation of the mid portion of the mitral leaflets. in the setting of simulated FMR, edge-to-edge repair was shown to sustain low regurgitant orifice area, until a two fold increase in the inter-papillary muscle distance as compared to the normal mitral valve. Strain in the chordae was evaluated near the papillary muscles and the leaflets. Following edge-to-edge repair, strain near the papillary muscles did not significantly change relative to the unrepaired valve, while strain near the leaflets increased significantly relative to the unrepaired valve. These data demonstrate the potential for computational simulations to aid in the pre-procedural evaluation of possible complications such as chordal rupture and leaflet perforation following percutaneous edge-to-edge repair.
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Kadyrova, M. V., N. N. Askerova, Yu A. Stepanova, et al. "Possibilities of Echocardiography at the Stages of Surgical Treatment of the Patient with the Mitral Valve Posterior Leaflet Prolapse Resulted in Mitral Insufficiency and Atrial Fibrillation (A Case Report)." Medical Visualization, no. 2 (April 28, 2017): 103–13. http://dx.doi.org/10.24835/1607-0763-2017-2-103-113.
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The mitral valve prolapse is characterized by the degeneration of the valve leaflets, accompanied by their thickening, increasing surface area and flexibility. The mitral valves leaflets bulge (prolapse) beyond the plane of the atrioventricular ring into the left atrium during ventricular systole and lose the ability to close tightly, leading to the mitral regurgitation. Acute chord rupture of the mitral valve posterior leaflet is a rare but important cause of severe mitral regurgitation and the development of acute or progressive chronic heart failure. Acute mitral insufficiency, accompanied by hemodynamic disorders, requires an urgent valve plastic surgery or valve prosthetics. The mitral valve plastic surgery gives a number of undeniable advantages over prosthetics, providing the best hemodynamic parameters, saving the patient from lifelong receiving of anticoagulant drugs. Detailed qualified echocardiographic evaluation of all structures of the mitral valve (fibrous ring, MV leaflets by segments, overlapping structures, structure of the chordal apparatus, papillary muscles) provides the necessary information for the mitral valve reconstructive plastic surgery with the choice of the method that is most optimal for a certain patient at the preoperative stage. We report herein a clinical observation of the patient with a diagnosis: acquired heart disease, the mitral valve posterior leaflet prolapse with mitral insufficiency Grade 3. Chronic heart failure IIA. II FC. Atrial fibrillation. The patient underwent multicomponent mitral valve reconstruction with the creation of a neochord and the fibrous ring plastic on the duplicate of a PTFE strip (soft support ring), pairwise isolation of the pulmonary vein entrance and right cavotricuspid isthmus.
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Roy Chowdhuri, Kuntal, Nilanjan Dutta, Nayem Raja, et al. "Mid-Term Follow-Up of Neonatal Neochordal Reconstruction of Tricuspid Valve for Perinatal Chordal Rupture Causing Severe Tricuspid Valve Regurgitation." World Journal for Pediatric and Congenital Heart Surgery 11, no. 5 (2020): 587–94. http://dx.doi.org/10.1177/2150135120929011.
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Background: Papillary muscle rupture in the perinatal period is a rare event that leads to severe mitral or tricuspid insufficiency due to a flail leaflet. Neonatal tricuspid chordal reconstruction for this condition is rarely reported. Early recognition and treatment have the potential to be lifesaving. We present our surgical experience with five such patients, along with their midterm follow-up. Methods: Between August 2010 and November 2012, five neonates (aged 1-30 days) underwent surgery for severe atrioventricular valve regurgitation. All neonates had severe tricuspid regurgitation due to ruptured chordae. In addition, two had moderate mitral regurgitation; one due to ruptured chordae of the posterior mitral leaflet and the other due to prolapse of the anterior mitral leaflet. All underwent emergent surgery where the ruptured chordae to the anterior tricuspid leaflet were replaced with neochordae made with expanded polytetrafluoroethylene (ePTFE) suture. The mitral valve was repaired in two patients. Results: All patients survived surgery without the need for postoperative mechanical circulatory assist. Predischarge echocardiograms showed good coaptation of tricuspid and mitral leaflets with minimal regurgitation in all. At follow-up between 75 months to 102 months, four patients had excellent outcomes with less than mild tricuspid regurgitation. One child with flail tricuspid and mitral leaflets developed progressive tricuspid and mitral regurgitation requiring surgical re-repair at 20 months following the initial surgery. Conclusion: Repair of chordal rupture of the tricuspid valve in neonates using e PTFE neo-chordae can provide acute salvage and gratifying midterm results in the management of this potentially fatal condition.
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Onan, Burak, Unal Aydin, Zeynep Kahraman, Korhan Erkanli, and Ihsan Bakir. "Robot-Assisted Mitral Valve Repair with Posterior Leaflet Extension for Rheumatic Disease." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 12, no. 1 (2017): 60–63. http://dx.doi.org/10.1097/imi.0000000000000335.
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Mitral valve repair has been one of the widely used applications of robotic surgery. Patients with rheumatic mitral disease usually present at an early age with thickening, retraction, or fusion of the leaflets and subvalvular apparatus. Robotic mitral repair can be feasible among this group of patients, rather than replacement. Herein, we describe a young woman who presented with rheumatic mitral valve insufficiency. A complex mitral repair with posterior leaflet extension with an autologous pericardial patch was successfully conducted using robot assistance.
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Itoh, Akinobu, Gaurav Krishnamurthy, Julia C. Swanson, et al. "Active stiffening of mitral valve leaflets in the beating heart." American Journal of Physiology-Heart and Circulatory Physiology 296, no. 6 (2009): H1766—H1773. http://dx.doi.org/10.1152/ajpheart.00120.2009.
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The anterior leaflet of the mitral valve (MV), viewed traditionally as a passive membrane, is shown to be a highly active structure in the beating heart. Two types of leaflet contractile activity are demonstrated: 1) a brief twitch at the beginning of each beat (reflecting contraction of myocytes in the leaflet in communication with and excited by left atrial muscle) that is relaxed by midsystole and whose contractile activity is eliminated with β-receptor blockade and 2) sustained tone during isovolumic relaxation, insensitive to β-blockade, but doubled by stimulation of the neurally rich region of aortic-mitral continuity. These findings raise the possibility that these leaflets are neurally controlled tissues, with potentially adaptive capabilities to meet the changing physiological demands on the heart. They also provide a basis for a permanent paradigm shift from one viewing the leaflets as passive flaps to one viewing them as active tissues whose complex function and dysfunction must be taken into account when considering not only therapeutic approaches to MV disease, but even the definitions of MV disease itself.
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Toh, Hiroyuki, Shumpei Mori, Yu Izawa, et al. "Prevalence and extent of mitral annular disjunction in structurally normal hearts: comprehensive 3D analysis using cardiac computed tomography." European Heart Journal - Cardiovascular Imaging 22, no. 6 (2021): 614–22. http://dx.doi.org/10.1093/ehjci/jeab022.
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Abstract Aims Mitral annular disjunction is fibrous separation between the attachment of the posterior mitral leaflet and the basal left ventricular myocardium initially described in dissected hearts. Currently, it is commonly evaluated by echocardiography, and potential relationships with mitral valve prolapse and ventricular arrhythmia have been suggested. However, controversy remains as its prevalence and extent have not been fully elucidated in normal living subjects. Methods and results Systolic datasets of cardiac computed tomography obtained from 98 patients (mean age, 69.1 ± 12.6 years; 81% men) with structurally normal hearts were assessed retrospectively. Circumferential extent of both mitral leaflets and disjunction was determined by rotating orthogonal multiplanar reconstruction images around the central axis of the mitral valvar orifice. Distribution angle within the circumference of the mitral valvar attachment and maximal height of disjunction were quantified. In total, 96.0% of patients demonstrated disjunction. Average distribution angles of the anterior and posterior mitral leaflets were 91.3 ± 9.4° and 269.8 ± 9.7°, respectively. Average distribution angle of the disjunction was 105.1 ± 49.2°, corresponding to 39.0 ± 18.2% of the entire posterior mitral valvar attachment. Median value of the maximal height of disjunction was 3.0 (1.5–7.0) mm. Distribution prevalence map of the disjunction revealed characteristic double peaks, with frequent sites of the disjunction located at the anterior to antero-lateral and inferior to infero-septal regions. Conclusion Mitral annular disjunction is a rather common finding in the normal adult heart with bimodal distribution predominantly observed involving the P1 and P3 scallops of the posterior mitral leaflet.
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Kohorst, Kelly, and Mias Pretorius. "Future Technology." Seminars in Cardiothoracic and Vascular Anesthesia 23, no. 1 (2018): 123–33. http://dx.doi.org/10.1177/1089253218779787.
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Mitral regurgitation is the most common valvular disease and significant (moderate/severe) mitral regurgitation is found in 2.3% of the population older than 65 years. New transcatheter minimally invasive technologies are being developed to address mitral valve disease in patients deemed too high a risk for conventional open-heart surgery. There are several features of the mitral valve (saddle-shaped noncalcified annulus with irregular leaflet geometry) that make a transcatheter approach to repair or replacing the valve more challenging compared with the aortic valve. Several devices are under investigation for transcatheter mitral valve replacement, and also for mitral valve repair targeting the mitral valve leaflets, chordae tendinae, and mitral annulus. The MitraClip device is the only Food and Drug Administration–approved device to treat mitral regurgitation by targeting the mitral leaflets. There are eight minimally invasive devices being studied in humans that target the mitral annulus, and at least two devices being studied in animal models. There are 5 devices in clinical trials for minimally invasive approaches targeting the chordae tendinae. More than 10 different transcatheter mitral valves are in various stages of development and clinical trials. These transcatheter mitral valves can be delivered either through a transseptal, transapical, transaortic, or left atriotomy approach. It seems likely that transcatheter treatment approaches to mitral valve disease will become more common, at least in the sick and elderly patient population.
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Hoque, MR, MSA Sunny, and MM Rahman. "Mitral valve Replacement in a 4 yrs old Child: First Time in Bangladesh." Cardiovascular Journal 6, no. 2 (2014): 167–69. http://dx.doi.org/10.3329/cardio.v6i2.18362.
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Congenital mitral valve incompetence is a rare and complex congenital heart disease in children. We report, a case of a 4-year-old child admitted to hospital with fever, dyspnea on exertion or feeding and repeated respiratory infection for last 3 years. The transthoracic echocardiogram revealed grossly dilated left atrium and left ventricle and severe mitral regurgitation due to cleft in anterior mitral leaflet. Per-operatively mitral valve annulus was found very much dilated; leaflet thinned out and rudimentary posterior mitral leaflet. Morphology of mitral valve was totally distorted, leaflets were diminutive and beyond repairable. Mitral valve replacement was done with 25 mm Edward Life Science porcine tissue heart valve with total preservation of subvalvular structure and the patient showed dramatic symptomatic improvement and later follow up revealed good LV function with alleviation of symptoms. This is a rare and unusual case of congenital mitral valve disease with better prognosis after surgical replacement with tissue valve. DOI: http://dx.doi.org/10.3329/cardio.v6i2.18362 Cardiovasc. j. 2014; 6(2): 167-169
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Toktosunova, Dinara, Murat Djundubaev, Elmira Seytahunova, and Irina Akhmedova. "Remodeling of the left heart in patients with rheumatic mitral valve disease after mitral valve replacement with preservation of subvalvular structures." Heart, Vessels and Transplantation 4, Issue 2 (2020): 40. http://dx.doi.org/10.24969/hvt.2020.204.
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Objectives: to evaluate the advantage of preserving the subvalvular structures of the mitral valve from both leaflets compared with the preservation of the subvalvular structures only from the posterior valve during mitral valve replacement surgery (MVR). Methods: A retrospective analysis of case histories of 41 patients with isolated rheumatic lesions of the mitral valve who underwent MVR, which were divided into 2 groups: with complete preservation of subvalvular structures (n = 24) and preservation of only the posterior leaflet (n = 17), was performed. Results: In the group with complete preservation of the chordal-papillary apparatus, there was a significant decrease in the end-systolic volume (p&lt;0.05) and a slight increase in the ejection fraction of the left ventricle in the immediate postoperative period compared with the group with the preservation of the chordal-papillary apparatus only from the posterior cusp, where end-systolic volume decreased slightly (p&qt;0.05) and the ejection fraction of the left ventricle remained at the same levels. Conclusion: Our preliminary results of the study indicate better remodeling and optimization of the geometry of the left ventricle when assessing the closest postoperative parameters in a group of patients with preservation of chordo-papillary structures of both leaflets, both the anterior and the posterior leaflets.
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Yajima, Shin, Satsuki Fukushima, Takashi Kakuta, and Tomoyuki Fujita. "Robotic mitral valve repair for rheumatic mitral stenosis and regurgitation: a case report." European Heart Journal - Case Reports 4, no. 1 (2020): 1–6. http://dx.doi.org/10.1093/ehjcr/ytz240.
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Abstract Background Rheumatic mitral valve (MV) disease is the major cause of congestive cardiac failure in children and young adults, particularly in developing countries. Mitral valve repair with minimum prosthetic material is the gold standard treatment for this condition. However, MV repair for rheumatic MV disease is known to be technically demanding. Case summary A 27-year-old woman without a history of cardiac disease presented with dyspnoea on exertion. Echocardiography revealed rheumatic severe mitral stenosis and regurgitation, with thickening of the bileaflets, doming of the anterior leaflet, shortening of the posterior leaflet, fusions of the lateral and particularly the medial commissure, and enlargement of the mitral annulus. We successfully performed robot-assisted MV repair with bicommissural release, patch augmentation of the two leaflets, and implantation of an originally sized partial band. Discussion Robotic MV repair can contribute to precise valve inspection and operative procedures. This approach seems feasible for complex rheumatic MV disease particularly in young patients.
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Bayburt, Selin, Sahin Senay, Ahmet Umit Gullu, et al. "Robotic Septal Myectomy and Mitral Valve Repair for Idiopathic Hypertrophic Subaortic Stenosis with Systolic Anterior Motion." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 11, no. 2 (2016): 146–49. http://dx.doi.org/10.1097/imi.0000000000000249.
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Combined therapeutic approach with performing mitral valve repair may be necessitated for the treatment of idiopathic hypertrophic subaortic stenosis (IHSS) with systolic anterior motion. This report includes operative technique for combined robotic septal myectomy and mitral valve repair. A 45-year-old man with IHSS was admitted to our center for surgical intervention. The transthoracic echocardiography showed typical asymmetric ventricular hypertrophy. Left ventricle posterior wall thickness was 11 mm, and interventricular septum thickness was 21 mm. Mitral valve leaflets were found to be elongated. Mild-to-severe mitral regurgitation was detected with eccentric mitral jet. Aortic peak gradient was 128 mm Hg. Robotic mitral repair and septal myectomy through left atrial exposure was performed. The anterior leaflet was detached, and the septal muscle in a mass of 1 × 0.7 × 0.5 cm was resected. Next, the anterior leaflet was reattached with continuous suture. The plication of the posterior leaflet with transverse incision was performed to diminish the length of posterior leaflet. After the magic suture for posteromedial commissure was performed, a 34 Medtronic Future ring was implanted for mitral annuloplasty. Postoperative course was uneventful. The patient was discharged on the sixth postoperative day. Combined robotic septal myectomy and mitral valve repair for IHSS with systolic anterior motion may be feasible.
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Sapp, Matthew C., Varun K. Krishnamurthy, Daniel S. Puperi, et al. "Differential cell-matrix responses in hypoxia-stimulated aortic versus mitral valves." Journal of The Royal Society Interface 13, no. 125 (2016): 20160449. http://dx.doi.org/10.1098/rsif.2016.0449.
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Tissue oxygenation often plays a significant role in disease and is an essential design consideration for tissue engineering. Here, oxygen diffusion profiles of porcine aortic and mitral valve leaflets were determined using an oxygen diffusion chamber in conjunction with computational models. Results from these studies revealed the differences between aortic and mitral valve leaflet diffusion profiles and suggested that diffusion alone was insufficient for normal oxygen delivery in mitral valves. During fibrotic valve disease, leaflet thickening due to abnormal extracellular matrix is likely to reduce regional oxygen availability. To assess the impact of low oxygen levels on valve behaviour, whole leaflet organ cultures were created to induce leaflet hypoxia. These studies revealed a loss of layer stratification and elevated levels of hypoxia inducible factor 1-alpha in both aortic and mitral valve hypoxic groups. Mitral valves also exhibited altered expression of angiogenic factors in response to low oxygen environments when compared with normoxic groups. Hypoxia affected aortic and mitral valves differently, and mitral valves appeared to show a stenotic, rheumatic phenotype accompanied by significant cell death. These results indicate that hypoxia could be a factor in mid to late valve disease progression, especially with the reduction in chondromodulin-1 expression shown by hypoxic mitral valves.
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Pinto, J. E., A. J. Nazarali, T. Torda, and J. M. Saavedra. "Autoradiographic characterization of beta-adrenoceptors in rat heart valve leaflets." American Journal of Physiology-Heart and Circulatory Physiology 256, no. 3 (1989): H821—H827. http://dx.doi.org/10.1152/ajpheart.1989.256.3.h821.
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beta-Adrenoceptors were localized and characterized in valve leaflets of the rat heart. Sixteen micrometer-thick tissue sections containing the mitral and aortic valves were incubated with (-)3-[125I]iodocyanopindolol followed by autoradiography with computerized microdensitometry and comparison with 125I-labeled standards. beta-Adrenoceptors were present in all the valves studied. The selective beta 1-adrenoceptor antagonist CGP 20712 A (100 nM) displaced not more than 20% of the total binding sites, suggesting that most of the beta-adrenoceptors in the valve leaflets are of the beta 2-subtype. Forskolin-binding sites were detected in the mitral valve leaflet by incubation of adjacent tissue sections with [12-3H]forskolin. Our results indicate that catecholamines could regulate the function of the heart valves through stimulation of beta 2-adrenoceptors.
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Vitovskiy, R., O. Bolshak, V. Boukarim, Yu Bakhovska, and V. Popov. "Mitral Valve Plasty During Correction of Combined Mitral-Aortic Valve Diseases." Ukrainian journal of cardiovascular surgery, no. 4 (41) (December 16, 2020): 63–68. http://dx.doi.org/10.30702/ujcvs/20.4112/059063-068/407-08-097.
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The aim. To study reconstructive operations on the mitral valve (MV) combined with aortic valve replacement (AVR) for combined mitral-aortic valve defects (CMAVD).
 Materials and methods. The study included 1690 patients with CMAVD who underwent surgical treatment at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine for the period from 01/01/2006 to 01/01/2020. Of these, 429 (23.4%) patients underwent MV reconstruction with AVR.
 The following valve-sparing procedures were performed: – application of annuloplasty ring: 123 (28.7%); – MV suture annuloplasty: 137 (31.9%); – open mitral commissurotomy: 47 (11.0%); – open mitral commissurotomy + leaflet plication: 4 (0.9%); – application of autopericardial patch on the MV leaflet: 7 (1.6%); – alfieri procedure (MV bicuspidalization): 34 (7.9%); – mitral valve debridgment 12: (2.8%); – plasty with autopericardial patch: 18 (4.2%); – removal of vegetation from MV structures : 7 (1.6%); – resection of MV leaflets with addition of suture annuloplasty: 19 (4.4%); – resection of MV leaflets with addition of an annuloplasty ring: 21 (4.9%).
 Results. Fatal complications occurred in 4 cases due to heart failure (n = 2) and multiple organ failure (n = 2). Hospital mortality in AVR with MK plasticity MV plasty was 0.9%, which once again emphasizes the importance of traumatic intervention compared with combined mitral-aortic prosthetics, where mortality is 3 times higher. It decreased from 2.9% (2006–2012, n = 128) to 0.3% (2013–2019, n = 301), which indicates the effectiveness of the method with a significant increase in the number of operated patients.
 After correction, MV regurgitation decreased from +2.4 ± 0.3 to +0.4 ± 0.03. Coaptation of the sash Mk MV leaflets after correction was 7.4 ± 0.6 mm.
 At the hospital stage there was a decrease in the diastolic peak gradient on the MV from 19.4 ± 4.8 mm Hg to 6.4 ± 0.8 mm Hg. In the remote period, 82.6% of the discharged patients (n = 351) in the period of were followed for 9.3 ± 2.4 years. Better indicators were noted in group of patients with functional class III than those with functional class IV (p <0.05). Fatal outcomes due to thromboembolic complications (n = 29) were caused by the presence of a mechanical aortic prosthesis and partial non-compliance with the protocol of anticoagulant therapy. Unsatisfactory result in the group with changes in the MV was due to the activity of the rheumatic process and progressive heart failure with prolonged atrial fibrillation (n = 37).
 The etiology of the defect affected the long-term outcome. The activity of the rheumatic process in patients with functional class IV determined changes in the MV leaflets in the long term and worsened the result.
 MV regurgitation increased from +0.08 ± 0.03 (5 years after surgery) to +1.2 ± 0.3 (10 years after surgery). In the long term there was an increase in the diastolic peak gradient on the MV from 9.4 ± 0.4 mm Hg (5 years after surgery) to 13.4 ± 3.2 mm Hg (10 years after surgery). MV replacement was performed in 4 patients 6, 9, 10, 11 years after surgery.
 Conclusions. Given the available clinical experience, it is advisable to recommend reconstructive interventions on the MV to correct CMAVD and improve the level of survival and stability of good results.
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Di Pino, Alfredo, Placido Gitto, Antonio Silvia, and Innocenzo Bianca. "Congenital quadricuspid aortic valve in children." Cardiology in the Young 18, no. 3 (2008): 324–27. http://dx.doi.org/10.1017/s1047951108002205.
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AbstractQuadricuspid aortic valves are rare congenital anomalies, usually diagnosed in adult patients affected by severe aortic regurgitation. We have now encountered three such valves in children undergoing transthoracic echocardiography. All children were asymptomatic. The first child possessed a valve with two larger leaflets, and smaller leaflets of equal size. In the second child, 3 leaflets were of equal size, with 1 small accessory leaflet. The third child had a valve with four leaflets of approximately equal size. In one child, the aortic valve was functioning normally, and came to attention because of mitral valvar prolapse causing mild regurgitation. In the remaining two children, central mild aortic regurgitation was detected using colour flow analysis, and associated dilation of the aortic root was revealed by measurements of the cross-sectional images.
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Ozdemir, Ahmet Coskun, Bilgin Emrecan, and Ahmet Baltalarli. "Bileaflet versus Posterior-Leaflet-Only Preservation in Mitral Valve Replacement." Texas Heart Institute Journal 41, no. 2 (2014): 165–69. http://dx.doi.org/10.14503/thij-13-3164.
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In the present study of mitral valve replacement, we investigated whether complete preservation of both leaflets (that is, the subvalvular apparatus) is superior to preservation of the posterior leaflet alone. Seventy patients who underwent mitral valve replacement in our clinic were divided into 2 groups: MVR-B (n=16), in whom both leaflets were preserved, and MVR-P (n=54), in whom only the posterior leaflet was preserved. The preoperative and postoperative clinical and echocardiographic findings were evaluated retrospectively. No signs of left ventricular outflow tract obstruction were observed in either group. In the MVR-B group, no decrease was observed in left ventricular ejection fraction during the postoperative period, whereas a significant reduction was observed in the MVR-P group (P=0.003). No differences were found between the 2 groups in their need for inotropic agents or intra-aortic balloon pump support, or in cross-clamp time, duration of intensive care unit or hospital stays, postoperative development of new atrial fibrillation, or mortality rates. Bileaflet preservation prevented the decrease in left ventricular ejection fraction that usually followed preservation of the posterior leaflet alone. However, posterior leaflet preservation alone yielded excellent results in terms of decreased left ventricular diameter. Bileaflet preservation should be the method of choice to prevent further decreases in ejection fraction and to avoid death in patients who present with substantially impaired left ventricular function.
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Kunzelman, K. S., D. R. Einstein, and R. P. Cochran. "Fluid–structure interaction models of the mitral valve: function in normal and pathological states." Philosophical Transactions of the Royal Society B: Biological Sciences 362, no. 1484 (2007): 1393–406. http://dx.doi.org/10.1098/rstb.2007.2123.
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Successful mitral valve repair is dependent upon a full understanding of normal and abnormal mitral valve anatomy and function. Computational analysis is one such method that can be applied to simulate mitral valve function in order to analyse the roles of individual components and evaluate proposed surgical repair. We developed the first three-dimensional finite element computer model of the mitral valve including leaflets and chordae tendineae; however, one critical aspect that has been missing until the last few years was the evaluation of fluid flow, as coupled to the function of the mitral valve structure. We present here our latest results for normal function and specific pathological changes using a fluid–structure interaction model. Normal valve function was first assessed, followed by pathological material changes in collagen fibre volume fraction, fibre stiffness, fibre splay and isotropic stiffness. Leaflet and chordal stress and strain and papillary muscle force were determined. In addition, transmitral flow, time to leaflet closure and heart valve sound were assessed. Model predictions in the normal state agreed well with a wide range of available in vivo and in vitro data. Further, pathological material changes that preserved the anisotropy of the valve leaflets were found to preserve valve function. By contrast, material changes that altered the anisotropy of the valve were found to profoundly alter valve function. The addition of blood flow and an experimentally driven microstructural description of mitral tissue represent significant advances in computational studies of the mitral valve, which allow further insight to be gained. This work is another building block in the foundation of a computational framework to aid in the refinement and development of a truly non-invasive diagnostic evaluation of the mitral valve. Ultimately, it represents the basis for simulation of surgical repair of pathological valves in a clinical and educational setting.
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Ayme-Dietrich, Estelle, Sylvia Da Silva, Ghina Alame Bouabout, et al. "Characterization of the spontaneous degenerative mitral valve disease in FVB mice." PLOS ONE 16, no. 9 (2021): e0257022. http://dx.doi.org/10.1371/journal.pone.0257022.
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Background The development of new non-surgical treatments dedicated to mitral valve degeneration is limited by the absence of relevant spontaneous and rapidly progressing animal experimental models. Animals We characterized the spontaneous mitral valve degeneration in two inbred FVB mouse strains compared to C57BL/6J and investigated a contribution of the serotonergic system. Methods Males and females FVB/NJ and FVB/NRj were compared to the putative C57BL/6J control at 12, 16, 20 and 24 weeks of age. Body weight, systolic blood pressure, heart rate, urinary 5-hydroxyindoleacetic acid (5-HIAA), whole blood and plasma serotonin, tail bleeding time, blood cell count, plasma TGF-β1 and plasma natriuretic peptide concentrations were measured. Myocardium and mitral valves were characterized by histology. mRNA mitral expression of 5-HT2A and 5-HT2B receptors was measured in the anterior leaflet. Cardiac anatomy and function were assessed by echocardiography. Results Compared to C57BL/6J, FVB mice strains did not significantly differ regarding body weight increase, arterial blood pressure and heart rate. A progressive augmentation of plasma pro-ANP was observed in FVB mice. Nevertheless, no cardiac hypertrophy or left-ventricular fibrosis were observed. Accordingly, plasma TGF-β1 was not different among the three strains. Conversely, FVB mice demonstrated a high prevalence of fibromyxoid highly cellularized and enriched in glycosaminoglycans lesions, inducing major mitral leaflets thickening without increase in length. The increased thickness was correlated with urinary 5-HIAA and blood platelet count. Whole blood serotonin concentration was similar in the two strains but, in FVB, a reduction of plasma serotonin was observed together with an increase of the bleeding time. Finally, echocardiography identified left atrial and left ventricular remodeling associated with thickening of both mitral leaflets and mitral insufficient in 30% of FVB mice but no systolic protrusion of mitral leaflets towards the atrium. Conclusion The FVB mouse strain is highly prone to spontaneous mitral myxomatous degeneration. A contribution of the peripheral serotonergic system is suggested.
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Mukhamadiyarov, R. A., and A. G. Kutikhin. "Ultrastructural mitral valve abnormalities in infective endocarditis." Cardiovascular Therapy and Prevention 20, no. 3 (2021): 2742. http://dx.doi.org/10.15829/1728-8800-2021-2742.
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Aim. Using an original method based on backscattered scanning electron microscopy, to study the structural features of the mitral valve leaflets in infective endocarditis.Material and methods. We examined 9 mitral valves extracted during surgical interventions due to structural malfunction in patients with infective endocarditis (IE). The samples were fixed in buffered paraformaldehyde with osmium tetraoxide postfixation. After dehydration by increasing alcohol concentration and acetone, the samples were placed in epoxy resin. After the resin has polymerized, the samples were ground and then polished to the desired depth. To increase the electronic contrast, the samples were treated with a uranyl acetate alcohol solution during dehydration and with Reynolds' lead citrate after polishing the epoxy blocks. The samples were visualized by backscattered scanning electron microscopy at an accelerating 15-kV voltage.Results. Structural leaflet injuries caused by IE were most pronounced in the central part and the base. Necrotic areas were extensive electron-dense formations located in the central leaflet layers, or displaced towards the ventricular surface. The electron-dense material in the necrotic area was poorly structured and contained individual cells and bacteria. Bacteria were also present outside the necrotic area. Necrotic areas were surrounded by a layer of a modified extracellular matrix, usually covered with a fibrin layer. Among the extracellular matrix fibers, the macrophages, smooth myocytes and fibroblasts was noted. The fibrin layer, in addition to these cells, contained a large number of blood vessels and was often covered with endothelium.Conclusion. Infection of the mitral valve leaflets causes a simultaneous inflammatory response and regeneration activation. Without adequate regulatory factors, the processes of inflammation and connective tissue creation lead to structural and functional leaflet failure. Specific causes may be overgrowth of necrotic and inflammatory areas, edema and fiber orientation disorder, as well as leaflet rupture.
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Hamandi, Mohanad, Karim Al-Azizi, Alexander Crawford, Joy Fan, J. Michael DiMaio, and Robert L. Smith. "Robotic Repair of a Congenital Isolated Cleft of Anterior Tricuspid Valve Leaflet." Journal of Investigative Medicine High Impact Case Reports 7 (January 2019): 232470961882380. http://dx.doi.org/10.1177/2324709618823809.
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Congenital isolated tricuspid valve (TV) cleft in the anterior leaflet is a rare occurrence, while clefts of the mitral valve leaflets are more common and are usually associated with other congenital heart diseases. In this article, we report a case of TV regurgitation in a young adult female due to an isolated congenital cleft in the anterior TV leaflet, which was surgically repaired using a minimally invasive robotic approach.
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Kuralay, Erkan. "Partial Resection of Mitral Leaflets during Mitral Valve Replacement." Asian Cardiovascular and Thoracic Annals 18, no. 4 (2010): 384–85. http://dx.doi.org/10.1177/0218492310375868.
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Ross, Colton J., Devin W. Laurence, Jacob Richardson, et al. "An investigation of the glycosaminoglycan contribution to biaxial mechanical behaviours of porcine atrioventricular heart valve leaflets." Journal of The Royal Society Interface 16, no. 156 (2019): 20190069. http://dx.doi.org/10.1098/rsif.2019.0069.
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The atrioventricular heart valve (AHV) leaflets have a complex microstructure composed of four distinct layers: atrialis, ventricularis, fibrosa and spongiosa. Specifically, the spongiosa layer is primarily proteoglycans and glycosaminoglycans (GAGs). Quantification of the GAGs' mechanical contribution to the overall leaflet function has been of recent focus for aortic valve leaflets, but this characterization has not been reported for the AHV leaflets. This study seeks to expand current GAG literature through novel mechanical characterizations of GAGs in AHV leaflets. For this characterization, mitral and tricuspid valve anterior leaflets (MVAL and TVAL, respectively) were: (i) tested by biaxial mechanical loading at varying loading ratios and by stress-relaxation procedures, (ii) enzymatically treated for removal of the GAGs and (iii) biaxially mechanically tested again under the same protocols as in step (i). Removal of the GAG contents from the leaflet was conducted using a 100 min enzyme treatment to achieve approximate 74.87% and 61.24% reductions of all GAGs from the MVAL and TVAL, respectively. Our main findings demonstrated that biaxial mechanical testing yielded a statistically significant difference in tissue extensibility after GAG removal and that stress-relaxation testing revealed a statistically significant smaller stress decay of the enzyme-treated tissue than untreated tissues. These novel findings illustrate the importance of GAGs in AHV leaflet behaviour, which can be employed to better inform heart valve therapeutics and computational models.
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Music, Ljilja, Bozidarka Knezevic, Ljiljana Jovovic, and Nebojsa Bulatovic. "Double orifice mitral valve: A case report." Vojnosanitetski pregled 73, no. 5 (2016): 496–99. http://dx.doi.org/10.2298/vsp141223036m.
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Introduction. Double orifice mitrol valve (DOMV) is a very rare congenital heart defect. Case report. We reported 20-year-old male referred to our center due to evaluation of his cardiologic status. He was operated on shortly after birth for a tracheoesophageal fistula. Accidentally, echocardiography examination at the age of 4 years revealed double orifice mitral valve (DOMV) without the presence of mitral regurgitation, as well as mitral stenosis, with normal dimensions of all cardiac chambers. The patient was asymptomatic, even more he was a kick boxer. His physical finding was normal. Electrocardiography showed regular sinus rhythm, incomplete right bundle branch block. Transthoracic echocardiography (TTE) examination revealed the normal size of the left atrial, mitral leaflets were slightly more redundant. The left and right heart chambers, aorta, tricuspid valve and pulmonary artery valve were normal. During TTE examination on a short axis view two asymmetric mitral orifices were seen as a double mitral orifice through which we registered normal flow, without regurgitation and mitral stenosis. Transesophageal echocardiography (TEE) examination from the transgastric view at the level of mitral valve, showed 2 single asymmetric mitral orifices separated by fibrous tissue, mitral leaflet with a separate insertion of hordes for each orifice. Conclusion. The presented patient with DOMV is the only one recognized in our country. The case is interesting because during 16-year a follow-up period there were no functional changes despite the fact that he performed very demanded sport activities. This is very important because there is no information in the literature about that.
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Alavi, S. Hamed, Aditi Sinha, Earl Steward, Jeffrey C. Milliken, and Arash Kheradvar. "Load-dependent extracellular matrix organization in atrioventricular heart valves: differences and similarities." American Journal of Physiology-Heart and Circulatory Physiology 309, no. 2 (2015): H276—H284. http://dx.doi.org/10.1152/ajpheart.00164.2015.
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The extracellular matrix of the atrioventricular (AV) valves' leaflets has a key role in the ability of these valves to properly remodel in response to constantly varying physiological loads. While the loading on mitral and tricuspid valves is significantly different, no information is available on how collagen fibers change their orientation in response to these loads. This study delineates the effect of physiological loading on AV valves' leaflets microstructures using Second Harmonic Generation (SHG) microscopy. Fresh natural porcine tricuspid and mitral valves' leaflets ( n = 12/valve type) were cut and prepared for the experiments. Histology and immunohistochemistry were performed to compare the microstructural differences between the valves. The specimens were imaged live during the relaxed, loading, and unloading phases using SHG microscopy. The images were analyzed with Fourier decomposition to mathematically seek changes in collagen fiber orientation. Despite the similarities in both AV valves as seen in the histology and immunohistochemistry data, the microstructural arrangement, especially the collagen fiber distribution and orientation in the stress-free condition, were found to be different. Uniaxial loading was dependent on the arrangement of the fibers in their relaxed mode, which led the fibers to reorient in-line with the load throughout the depth of the mitral leaflet but only to reorient in-line with the load in deeper layers of the tricuspid leaflet. Biaxial loading arranged the fibers in between the two principal axes of the stresses independently from their relaxed states. Unlike previous findings, this study concludes that the AV valves' three-dimensional extracellular fiber arrangement is significantly different in their stress-free and uniaxially loaded states; however, fiber rearrangement in response to the biaxial loading remains similar.
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Bade, Arun Shivajirao, Vishal Patil, Shakil Shaikh, Hemant Khemani, Gurkirat Singh, and Narender Omprakash Bansal. "Parachute mitral valve with late presentation: rare case reports." International Journal of Research in Medical Sciences 6, no. 8 (2018): 2850. http://dx.doi.org/10.18203/2320-6012.ijrms20182935.
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Congenital mitral stenosis involves the annulus, the zone immediately above and contiguous with the annulus, the leaflets, the chordae tendineae, and the papillary muscles. In a parachute mitral valve (PMV), all chordae tendineae which are usually shorter and thicker than normal type, inserted into this single papillary muscle. This condition restricts the motion of leaflets and obstructs the blood flow into the left ventricle during diastole. Here we present two cases of severe congenital mitral stenosis with severe pulmonary hypertension due to parachute mitral valve that allowed survival into adulthood without any specific treatment.
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Martìn-Suàrez, Sofia, Luca Botta, Andrea Dell'Amore, et al. "Mitral valve myxoma involving both leaflets." Cardiovascular Pathology 16, no. 3 (2007): 189–90. http://dx.doi.org/10.1016/j.carpath.2006.11.007.
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Timek, Tomasz A., David T. Lai, Paul Dagum, et al. "Ablation of mitral annular and leaflet muscle: effects on annular and leaflet dynamics." American Journal of Physiology-Heart and Circulatory Physiology 285, no. 4 (2003): H1668—H1674. http://dx.doi.org/10.1152/ajpheart.00179.2003.
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Mitral annular (MA) and leaflet three-dimensional (3-D) dynamics were examined after circumferential phenol ablation of the MA and anterior mitral leaflet (AML) muscle. Radiopaque markers were sutured to the left ventricle, MA, and both mitral leaflets in 18 sheep. In 10 sheep, phenol was applied circumferentially to the atrial surface of the mitral annulus and the hinge region of the AML, whereas 8 sheep served as controls. Animals were studied with biplane video fluoroscopy for computation of 3-D mitral annular area (MAA) and leaflet shape. MAA contraction (MAACont) was determined from maximum to minimum value. Presystolic MAA (PS-MAACont) reduction was calculated as the percentage of total reduction occurring before end diastole. Phenol ablation decreased PS-MAACont (72 ± 6 vs. 47 ± 31%, P = 0.04) and delayed valve closure (31 ± 11 vs. 57 ± 25 ms, P = 0.017). In control, the AML had a compound sigmoid shape; after phenol, this shape was entirely concave to the atrium during valve closure. These data indicate that myocardial fibers on the atrial side of the valve influence the 3-D dynamic geometry and shape of the MA and AML.
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SHARIFIKIA, DANIAL, and MASOUD ASGARI. "DYNAMIC ANALYSIS OF HEALTHY AND EDGE-TO-EDGE REPAIRED MITRAL VALVE BEHAVIOR SUBJECTED TO HIGH G ACCELERATIONS." Journal of Mechanics in Medicine and Biology 17, no. 02 (2017): 1750032. http://dx.doi.org/10.1142/s0219519417500324.
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As the mitral leaflets have the greatest area among heart valves and bear the highest pressure load during systole, high G accelerations may result in mitral valve dysfunctions and it might affect the cardiovascular system drastically. In this study, dynamic behavior of healthy and repaired human mitral valves have been numerically simulated during the Early Systolic Phase and the Rapid Filling Phase in a cardiac cycle in high G accelerated environments. The aim of this study is to investigate the effects of accelerations on the stress and strain patterns and the configuration of human mitral valve. The geometrical model of the mitral valve has been developed based on in vivo and ex vivo anatomical measurements and the anisotropic nonlinear behavior of mitral leaflets has been modeled by a discrete constitutive approach. Mitral valve behavior has been simulated using an explicit dynamic finite element method to take into account inertial effects and dynamic responses. Analysis results reveal beside different stress–strain patterns generated on mitral leaflets, abnormal deformed configurations result from accelerations which can affect the circulation and the cardiovascular system. It is observed that situations similar to mitral diseases could rise from high G accelerated environments even though the valve maintains its normal physiological structure.
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Ari, Ashok, and Nemani Lalitha. "A Rare Case of Spontaneous Mitral Leaflet Perforation Leading to Severe Mitral Regurgitation." Indian Journal of Cardiovascular Disease in Women WINCARS 01, no. 02 (2016): 025–27. http://dx.doi.org/10.1055/s-0038-1656391.
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AbstractSpontaneous mitral leaflet perforations are rare. We are reporting a 60 year old hypertensive female patient admitted with pulmonary edema with clinically short systolic murmur at apex without ischemic changes on ECG. There is no h/o chest pain, fever, blunt trauma of chest. TTE no RWMA, good bi- ventricular function, a posteriorly directed eccentric moderate – severe mitral regurgitation, normal LA, LV, no vegetation or prolapsed. TEE after stabilization showed whole in body of AML at its midpoint leading to severe regurgitant jet in to LA with Vena contracta of 0.8 mm. All the papillary muscles were intact and there is no prolapse of leaflets and no vegetation. Cardiac catheterization revealed increased LVEDP and PCWP with mild PAH with normal coronary arteries.
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Mohd Adib, Mohd Azrul Hisham, Faradila Naim, Nur Hazreen Mohd Hasni, and Kahar Osman. "Prediction on Behaviour of Blood Velocity and Mitral Leaflet Displacement in the Different Shapes of Heart Valve during Cardiac Cycle." Journal of Biomimetics, Biomaterials and Tissue Engineering 17 (June 2013): 79–85. http://dx.doi.org/10.4028/www.scientific.net/jbbte.17.79.
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The number of cases for heart diseases is increasing every day, even though medication technologies are always improving and moving forward. In this paper, the objectives of the study are to investigate the effect of blood flow velocity and leaflet displacement using different shapes of simplified two dimensional heart valve leaflets in the diastole condition. Four different shapes of heart valve were created and the simulation was performed by using Fluid Structure Interaction (FSI). From the results obtained, the triangle shaped leaflet showed it had the highest blood velocity changes and leaflets displacement changes in a one second period when compared to the other three shapes. The outcome simulation result shows that a large vortex formed behind the leaflet and leaflet deformed when the blood flow into left ventricle is agreed with the results in literature. In conclusion, four different shapes of two dimensional model of mitral valve has been developed and investigated for applying the most suitable shape in future artificial valve design.
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Dent, J. M., W. D. Spotnitz, S. P. Nolan, A. R. Jayaweera, W. P. Glasheen, and S. Kaul. "Mechanism of mitral leaflet excursion." American Journal of Physiology-Heart and Circulatory Physiology 269, no. 6 (1995): H2100—H2108. http://dx.doi.org/10.1152/ajpheart.1995.269.6.h2100.
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The factors that influence the extent of mitral leaflet opening (MLO) and closure (MLC) have not been defined. We hypothesized that left ventricular (LV) systolic function determines the rate of increase of the early diastolic left atrial (LA)-LV pressure gradient, which is responsible for the extent of MLO, and also the rate of change of the early systolic LV-LA pressure gradient, which determines the degree of MLC. Accordingly, global LV function was changed by altering left main coronary artery flow with LA pressure held relatively constant. LV end-systolic dimension and peak positive LV rate of pressure development (dP/dt) correlated best with the degrees of MLO and MLC, with average correlation coefficients of 0.88 and 0.68, and 0.86 and 0.72, respectively. Although transsecting the submitral apparatus resulted in flailing of the mitral leaflets during normal LV systolic function, the extents of MLO and MLC during LV systolic dysfunction were still influenced by LV systolic function. It is concluded that LV systolic function determines the extent (both opening and closure) of mitral leaflet excursion.
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Hassani, Kamran, Alireza Karimi, Ali Dehghani, Ali Tavakoli Golpaygani, Hamed Abdi, and Daniel M. Espino. "Development of a fluid-structure interaction model to simulate mitral valve malcoaptation." Perfusion 34, no. 3 (2018): 225–30. http://dx.doi.org/10.1177/0267659118811045.
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Object: Mitral regurgitation (MR) is a condition in which the mitral valve does not prevent the reversal of blood flow from the left ventricle into the left atrium. This study aimed at numerically developing a model to mimic MR and poor leaflet coaptation and also comparing the performance of a normal mitral valve to that of the MR conditions at different gap junctions of 1, 3 and 5 mm between the anterior and posterior leaflets. Results: The results revealed no blood flow to the left ventricle when a gap between the leaflets was 0 mm. However, MR increased this blood flow, with increases in the velocity and pressure within the atrium. However, the pressure within the aorta did not vary meaningfully (ranging from 22 kPa for a ‘healthy’ model to 25 kPa for severe MR). Conclusions: The findings from this study have implications not only for understanding the changes in pressure and velocity as a result of MR in the ventricle, atrium or aorta, but also for the development of a computational model suitable for clinical translation when diagnosing and determining treatment for MR.
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Nassri Câmara, Edmundo J., Christiane Neubauer, Gabriel Ferreira Câmara, and Antonio Alberto Lopes. "Mechanisms of mitral valvar insufficiency in children and adolescents with severe rheumatic heart disease: an echocardiographic study with clinical and epidemiological correlations." Cardiology in the Young 14, no. 5 (2004): 527–32. http://dx.doi.org/10.1017/s1047951104005104.
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We carried out a detailed clinical, epidemiological, and echocardiographic study in 41 patients ≤14 years of age who were admitted in a public hospital in Salvador, Brazil, with severe rheumatic heart disease.Mitral insufficiency was severe in 90%, and moderate in 10%, of the patients. A posteriorly directed jet was seen in 93% of the patients. We identified three mechanisms producing the regurgitation: prolapse of the aortic leaflet of the mitral valve in 13 (32%) patients, rupture of tendinous cords in 14 (34%), and a retracted, non-coapting mural leaflet in 14 (34%). The mean ages, with standard deviations, for these three groups were 7.0 (1.6) years, 7.9 (2.2) years, and 10.5 (2.4) years, respectively (p < 0.001). Rheumatic activity was diagnosed in 58.5% of them. Evidence of previous rheumatic fever was present in 54% of patients with prolapse, in all patients with rupture, and in 93% of those with non-coapting leaflets (p = 0.002).Prolapse of the aortic leaflet, rupture of tendinous cords, and a retracted, non-coapting mural leaflet are the mechanisms responsible for mitral valvar insufficiency in children and adolescents with severe rheumatic heart disease. Prolapse seems to be an early phenomenon in the natural history of rheumatic heart disease, while rupture and non-coaption of the leaflets were associated with older age and signs of chronic rheumatic disease.
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Shahid, Kazi Tanzeem, and Ioannis Schizas. "Unsupervised Mitral Valve Tracking for Disease Detection in Echocardiogram Videos." Journal of Imaging 6, no. 9 (2020): 93. http://dx.doi.org/10.3390/jimaging6090093.
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In this work, a novel algorithmic scheme is developed that processes echocardiogram videos, and tracks the movement of the mitral valve leaflets, and thereby estimates whether the movement is symptomatic of a healthy or diseased heart. This algorithm uses automatic Otsu’s thresholding to find a closed boundary around the left atrium, with the basic presumption that it is situated in the bottom right corner of the apical 4 chamber view. A centroid is calculated, and protruding prongs are taken within a 40-degree cone above the centroid, where the mitral valve is located. Binary images are obtained from the videos where the mitral valve leaflets have different pixel values than the cavity of the left atrium. Thus, the points where the prongs touch the valve will show where the mitral valve leaflets are located. The standard deviation of these points is used to calculate closeness of the leaflets. The estimation of the valve movement across subsequent frames is used to determine if the movement is regular, or affected by heart disease. Tests conducted with numerous videos containing both healthy and diseased hearts attest to our method’s efficacy, with a key novelty in being fully unsupervised and computationally efficient.
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Lee, Sahmin, Hyo-Sook Hwang, Naaleum Song, et al. "Effect of Neprilysin Inhibition for Ischemic Mitral Regurgitation after Myocardial Injury." International Journal of Molecular Sciences 22, no. 16 (2021): 8598. http://dx.doi.org/10.3390/ijms22168598.
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Angiotensin receptor neprilysin inhibitor (ARNI) treatment reduces functional mitral regurgitation (MR) to a greater extent than angiotensin receptor blocker (ARB) treatment alone, but the mechanism is unclear. We evaluated the mechanisms of how ARNI has an effect on functional MR. After inducing functional MR by left circumflex coronary artery occlusion, male Sprague Dawley rats (n = 31) were randomly assigned to receive the ARNI LCZ696, the ARB valsartan, or corn oil only (MR control). Excised mitral leaflets and left ventricle (LV) were analyzed, and valvular endothelial cells were evaluated focusing on molecular changes. LCZ696 significantly attenuated LV dilatation after 6 weeks when compared with the control group (LV end-diastolic volume, 461.3 ± 13.8 µL versus 525.1 ± 23.6 µL; p < 0.05), while valsartan did not (471.2 ± 8.9 µL; p > 0.05 to control). Histopathological analysis of mitral leaflets showed that LCZ696 strongly reduced fibrotic thickness compared to the control group (28.2 ± 2.7 µm vs. 48.8 ± 7.5 µm; p < 0.05). Transforming growth factor-β and downstream phosphorylated extracellular-signal regulated kinase were also significantly lower in the LCZ696 group. Consequently, excessive endothelial-to-mesenchymal transition (EndoMT) was mitigated in the LCZ696 group compared to the control group and leaflet area was higher (11%) in the LCZ696 group than in the valsartan group. Finally, the MR extent was significantly lower in the LCZ696 group and functional improvement was observed. In conclusion, neprilysin inhibitor has positive effects on LV reverse remodeling and also attenuates fibrosis in MV leaflets and restores adaptive growth by directly modulating EndoMT.
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Jorbenadze, Rezo, Johannes Patzelt, Meinrad Gawaz, Peter Seizer, and Harald F. Langer. "Sequential Venous Percutaneous Transluminal Angioplasty and Balloon Dilatation of the Interatrial Septum during Percutaneous Edge-to-Edge Mitral Valve Repair." Case Reports in Cardiology 2017 (2017): 1–3. http://dx.doi.org/10.1155/2017/3652413.
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Percutaneous edge-to-edge mitral valve repair (PMVR) is widely used for selected, high-risk patients with severe mitral valve regurgitation (MR). This report describes a case of 81-year-old woman presenting with severe and highly symptomatic mitral valve regurgitation (MR) caused by a flail of the posterior mitral valve leaflet (PML). PMVR turned out to be challenging in this patient because of a stenosis and tortuosity of both iliac veins as well as sclerosis of the interatrial septum, precluding the vascular and left atrial access by standard methods, respectively. We managed to achieve atrial access by venous percutaneous transluminal angioplasty (PTA) and balloon dilatation of the interatrial septum. Subsequently, we could advance the MitraClip® system to the left atrium, and deployment of the clip in the central segment of the mitral valve leaflets (A2/P2) resulted in a significant reduction of MR.
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Morbach, Caroline, Diego Bellavia, Pramod Bonde, et al. "SEGMENTAL ANALYSIS OF MITRAL VALVE LEAFLETS IN ISCHEMIC MITRAL REGURGITATION." Journal of the American College of Cardiology 61, no. 10 (2013): E1100. http://dx.doi.org/10.1016/s0735-1097(13)61100-6.
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Ben Zekry, Sagit, Jeff Freeman, Aarti Jajoo, et al. "Effect of Mitral Valve Repair on Mitral Valve Leaflets Strain." JACC: Cardiovascular Imaging 11, no. 5 (2018): 776–77. http://dx.doi.org/10.1016/j.jcmg.2017.07.017.
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Djukic, P. L., B. B. Obrenovic-Kircanski, M. R. Vranes, et al. "Posterior leaflet preservation during mitral valve replacement for rheumatic mitral stenosis." Acta chirurgica Iugoslavica 53, no. 1 (2006): 13–17. http://dx.doi.org/10.2298/aci0601013d.
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Mitral valve replacement with posterior leaflet preservation was shown beneficial for postoperative left vetricular (LV) performance in patients with mitral regurgitation. Some authors find it beneficial even for the long term LV function. We investigated a long term effect of this technique in patients with rheumatic mitral stenosis. We studied 20 patents with mitral valve replacement due to rheumatic mitral stenosis, in the period from January 1988. to December 1989. In group A (10 patients) both leaflets and coresponding chordal excision was performed, while in group B (10 patients) the posterior leaflet was preserved. In all patients a Carbomedics valve was inserted. We compared clinical pre and postoperative status, as well as hemodynamic characteristics of the valve and left ventricle in both groups. Control echocardiographyc analysis included: maximal (PG) and mean (MG) gradients; effective valve area (AREA); telediastolic (TDV) and telesystolic (TSV) LV volume; stroke volume (SV); ejection fraction (EF); fractional shortening (FS) and segmental LV motion. The mean size of inserted valve was 26.6 in group A and 27.2 in group B. Hemodynamic data: PG (10.12 vs 11.1); MG (3.57 vs 3.87); AREA (2.35 vs 2.30); TDV 126.0 vs 114.5); TSV (42.2 vs 36.62); SV (83.7 vs 77.75); EF (63.66 vs 67.12); FS (32.66 vs 38.25) Diaphragmal segmental hypokinesis was evident in one patient from group A and in two patients from group B. In patients with rheumatic stenosis, posterior leaflet preservation did not have increased beneficial effect on left ventricular performance during long-term follow-up. An adequate posterior leaflet preservation does not change hemodynamic valvular characteristics even after long-term follow-up.
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Howsmon, Daniel P., Bruno V. Rego, Estibaliz Castillero, et al. "Mitral valve leaflet response to ischaemic mitral regurgitation: from gene expression to tissue remodelling." Journal of The Royal Society Interface 17, no. 166 (2020): 20200098. http://dx.doi.org/10.1098/rsif.2020.0098.
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Ischaemic mitral regurgitation (IMR), a frequent complication following myocardial infarction (MI), leads to higher mortality and poor clinical prognosis if untreated. Accumulating evidence suggests that mitral valve (MV) leaflets actively remodel post MI, and this remodelling increases both the severity of IMR and the occurrence of MV repair failures. However, the mechanisms of extracellular matrix maintenance and modulation by MV interstitial cells (MVICs) and their impact on MV leaflet tissue integrity and repair failure remain largely unknown. Herein, we sought to elucidate the multiscale behaviour of IMR-induced MV remodelling using an established ovine model. Leaflet tissue at eight weeks post MI exhibited significant permanent plastic radial deformation, eliminating mechanical anisotropy, accompanied by altered leaflet composition. Interestingly, no changes in effective collagen fibre modulus were observed, with MVICs slightly rounder, at eight weeks post MI. RNA sequencing indicated that YAP-induced genes were elevated at four weeks post MI, indicating elevated mechanotransduction. Genes related to extracellular matrix organization were downregulated at four weeks post MI when IMR occurred. Transcriptomic changes returned to baseline by eight weeks post MI. This multiscale study suggests that IMR induces plastic deformation of the MV with no functional damage to the collagen fibres, providing crucial information for computational simulations of the MV in IMR.
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Kibria, Golam Mohammad. "The morphometric measurements of the gross structural changes of mitral valve in valvular stenosis with or without regurgitation." Faridpur Medical College Journal 9, no. 1 (2015): 7–11. http://dx.doi.org/10.3329/fmcj.v9i1.23615.
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Rheumatic mitral stenosis is still a cardiac problem in developing countries. Reconstructive and replacement surgery of the diseased valves are often needed. Most of the studies on stenotic mitral valves are echocardiographic one. Morphometric measurements of the stenotic mitral valve and comparison with that in the normal mitral valve is done in this study. Thirty seven hearts of normal adult-male unclaimed dead-bodies from the mortuary of Forensic Medicine, Dhaka Medical College, Dhaka; and twelve surgically excised stenotic mitral valves of the adult-male cardiac patients from the National Institute of Cardiovascular Diseases, Dhaka, Bangladesh were studied in fresh condition. The detail morphometric findings were compared between two groups. Though the total annular circumference was similar in both groups, yet the effective orifice area reduced significantly in stenotic valves. The anterior leaflet-area was increased, but the posterior leaflet-area was decreased in the stenotic valves. The thickness of the stenotic leaflets and chordae tendineae were increased compared to that in normal valves. The knowledge of the pathological changes of the valves would help to understand the exact pathophysiological mechanisms involved in the cardiac valve diseases.Faridpur Med. Coll. J. 2014;9(1): 7-11
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Chauvaud, Sylvan M., Serban A. Milhaileanu, Julian A. R. Gaer, and Alain C. Carpentier. "Surgical treatment of congenital mitral valvar insuffciency: “The Hôpital Broussais” experience." Cardiology in the Young 7, no. 1 (1997): 5–14. http://dx.doi.org/10.1017/s1047951100005801.
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AbstractThere are many congenital malformations of the mitral valve which produce valvar insufficiency. From a surgical point of view, systems based exclusively on anatomic analysis are not always entirely appropriate for assessment of these lesions. With this in mind, Carpentier proposed a functional approach for analysis based upon the motion of the valvar leaflets. From 1969 to 1994, 135 children under the age of 12 (mean age: 5.8 + 3.15 Y, 0.6–12Y) underwent surgery in our department, basing treatment on such analysis. Since motion of the leaflets during the operation is compromised by cardioplegia, and sometimes exposure can be however difficult, preoperative echocardiography was a mandatory part of the diagnostic cascade.Normal motion of the leaflets was present in 41 patients, with deformation of the annulus in 14, a cleft in 21, and partial agenesis in 6. Prolapse of leaflets was present in 42 patients. Leaflet motion was restricted in 28 patients. These were divided in two groups, one with normal papillary muscles and commissural fusion or short cords. The other with abnormal papillary muscles producing a parachute arrangement in 6 and a hammock valve in 9. Associated lesions were present in 47% of the patients. Conservative surgical procedures following the precepts developed by Carpentier were used in 127 patients. Valvar replacement was necessary in 8 patients. Operative mortality was 4%. Mean follow up was 8.4 ± 5.3 years (1–23Y). Actuarial survival at 5 years was 90 ± 6% and, at this time, was stable. No thromboembolic events occurred after conservative surgery. The reoperation rate was 5% for those undergoing repair (6 patients). We conclude that the functional classification developed by Carpentier is a reliable and robust approach to these complex lesions. Conservative surgery is feasible in most of the cases presenting with congenital mitral valvar insufficiency. Results are stable and reliable. Surgery should be undertaken before the onset of left ventricular deterioration.
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Packer, Milton, and Paul A. Grayburn. "Contrasting Effects of Pharmacological, Procedural, and Surgical Interventions on Proportionate and Disproportionate Functional Mitral Regurgitation in Chronic Heart Failure." Circulation 140, no. 9 (2019): 779–89. http://dx.doi.org/10.1161/circulationaha.119.039612.
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Two distinct pathways can lead to functional mitral regurgitation (MR) in patients with chronic heart failure and a reduced ejection fraction. When remodeling and enlargement of the left ventricle (LV) cause annular dilatation and tethering of the mitral valve leaflets, there is a linear relationship between LV end-diastolic volume and the effective regurgitant orifice area of the mitral valve. These patients, designated as having proportionate MR, respond favorably to treatments that lead to reversal of LV remodeling and a decrease in LV volumes (eg, neurohormonal antagonists and LV assist devices), but they may not benefit from interventions that are directed only at the mitral valve leaflets (eg, transcatheter mitral valve repair). In contrast, when ventricular dyssynchrony causes functional MR attributable to unequal contraction of the papillary muscles, the magnitude of regurgitation is greater than that predicted by LV volumes. These patients, designated as having severe but disproportionate MR, respond favorably to treatments that are directed to the mitral valve leaflets or their supporting structures (eg, cardiac resynchronization or transcatheter mitral valve repair), but they may derive little benefit from interventions that act only to reduce LV cavity size (eg, pharmacological treatments). This novel conceptual framework reflects the important interplay between LV geometry and mitral valve function in determining the clinical presentation of patients, and it allows characterization of the determinants of functional MR to guide the most appropriate therapy in the clinical setting.
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Anderson, Robert H. "How many leaflets in the mitral valve?" Journal of Thoracic and Cardiovascular Surgery 152, no. 2 (2016): e53-e54. http://dx.doi.org/10.1016/j.jtcvs.2016.04.056.
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Krawczyk-Ożóg, Agata, Mateusz K. Hołda, Danuta Sorysz, et al. "Morphologic variability of the mitral valve leaflets." Journal of Thoracic and Cardiovascular Surgery 154, no. 6 (2017): 1927–35. http://dx.doi.org/10.1016/j.jtcvs.2017.07.067.
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