Abstract： Compared with mitral valve replacement, there areseveral advantages in mitral valvuloplasty, so recently more and more sights are caught on mitral valve repair. According to different etiology, the surgeon can apply annuloplasty, triangular resection, quadrangular resection, replacement or transposition of chordae tendineae and so on to treat mitral regurgitation(MR). With the development of minimally invasive surgical technology, robotic mitral valve reconstruction evolve rapidly and percutaneous interventional therapy also commence from lab to bedside.We believe surgeons can repair MR safely and successfully in the majority of patients with proficiency in the basic techniques.
Objective To compare long-term outcomes following mitral valvuloplasty (MVP) and mitral valve replacement (MVR) for native valve endocarditis (NVE). Methods Between November 1993 and August 2016, consecutive 101 patients with NVE underwent mitral surgery in our department, MVP for 52 patients and MVR for 49 patients. There were 69 males and 32 females at age of 38.1±14.9 years. The mean follow-up was 99.4±75.8 months. Results There was no statistical difference in cardiopulmonary bypass time, aortic cross-clamp time, in-hospital mortality, duration of mechanical ventilation, ICU stay or hospital stay after surgery between the two groups. Survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 97.6%, 97.6%, 97.6% for MVP, and 93.5%, 84.3%, 84.3%, 66.2% for MVR with a statistical difference between the two groups (P=0.018). There was no stroke in the patients with MVP during follow-up periods. However, stroke-free survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 93.9%, 89.4%, 70.2% for MVR patients with a statistical difference between the two groups (P=0.023). There was no statistical difference in recurrence of infection, perivalvular leakage and reoperation between the two groups. Composite endpoint-free survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 97.6%, 92.9%, 92.9% for MVP, and 91.3%, 79.6%, 75.8%, 51.0% for MVR with a statistical difference (P=0.006). Conclusion MVP is associated with better outcomes than MVR in the patients with NVE; generalizing MVP technique in the patients with NVE is needed.
Mitral stenosis includes mitral stenosis due to rheumatic fever and non-rheumatic valve stenosis characterized by degenerative changes. Rheumatic mitral stenosis is common in developing countries and occurs in young adults, while degenerative mitral stenosis is common in developed countries and increases in incidence with aging. Mitral stenosis of different etiologies can lead to changes in heart structure and function, which affects the quality of life and prognosis of patients, so lifelong management of mitral stenosis is crucial. This article provides a comprehensive reference for clinicians in the management of mitral stenosis, with a detailed overview of the emerging prevalence features, imaging diagnosis, and treatment methods.
Abstract： Objective To summarize the experiences and analyze the efficacy of mitral valvuloplasty in treating anterior leaflet prolapse. Methods A total of 152 consecutive nonrheumatic heart disease patients including 96 males and 56 females with anterior leaflet prolapse who underwent mitral valvuloplasty from February 1997 to March 2007 were analyzed retrospectively. The age of these patients ranged from 10 to 73 years old (38.54±17.22 years). There were 119 cases of mitral degenerative prolapse or chordae rupture, 24 of ongenital heart disease, 3 of ischemic mitral insufficiency, and 6 of native valve endocarditis. Echocardiography before operation showed the degree of mitral regurgitation was severe in 19, moderate to severe in 63, and moderate in 70 patients. Among the patients, 87 had anterior prolapse and 65 had bilateral prolapse. All patients underwent mitral valve repair under standard cardiopulmonary bypass. Results During the operation, transesophageal echocardiography and saline injection test showed satisfying results in all the patients. No early death occurred after operation. Followup was done to 135 patients for 3 months to 8.5 years with a followup rate of 88.82%. During the follow up, 93 patients were in New Yoke Heart Association（NYHA）class Ⅰ, 35 in Class Ⅱ, 3 in class Ⅲ and 4 in class Ⅳ. The Echocardiography showed that postoperative left atrium diameter (41.09±10.40 mm vs. 45.32±10.07 mm, t=4.186, P=0.000) and left ventricular enddiastolic dimension (52.04±7.74 mm vs. 60.70±7.72 mm,t=9.676, P=0.000) were significantly smaller than that before operation. No or trace mitral regurgitation (MR) was found in 36 patients, mild MR in 45 patients, mild to moderate MR in 38 patients, moderate MR in 9 patients, and moderate to severe MR in 7 patients. Mitral valve replacement was performed in 5 patients after valvuloplasty. Three died during the follow-up. Two of them died of heart failure and one of unknown cause. Conclusion In spite of the complexity, the longterm results of mitral valve repair for anterior leaflet prolapse are satisfactory if the best surgery method is chosen.
ObjectiveTo research the procedure for creating an animal model of mitral regurgitation by implanting a device through the apical artificial chordae tendineae, and to assess the stability and dependability of the device. MethodsTwelve large white swines were employed in the experiments. Through a tiny hole in the apex of the heart, the artificial chordae tendineae of the mitral valve was inserted under the guidance of transcardiac ultrasonography. Before, immediately after, and one and three months after surgery, cardiac ultrasonography signs were noted. Results All models were successfully established. During the operation and the follow-up, no swines died. Immediately after surgery, the mitral valve experienced moderate regurgitation. Compared with preoperation, there was a variable increase in the amount of regurgitation and the values of heart diameters at a 3-month follow-up (P<0.05). ConclusionIn off-pump, the technique of pulling the mitral valve leaflets with chordae tendineae implanted transapically under ultrasound guidance can stably and consistently create an animal model of mitral regurgitation.
ObjectiveTo summarize clinical outcomes of mitral valve replacement (MVR) with modified anterior leaflet preservation technique,improve therapeutic effects and reduce postoperative mortality and morbidity. MethodsFrom May 2005 to December 2012,128 patients underwent MVR with modified anterior leaflet preservation technique (modified group) in Beijing Anzhen Hospital,among whom 14 patients received concomitant aortic valve replacement. There were 49 male and 79 female patients in the modified group with their age of 45.0±12.3 years. Another 128 patients who underwent routine MVR during the same period were also included in this study as the control group,including 55 male and 73 female patients with their age of 48.0±8.4 years. There was no statistical difference in preoperative clinical characteristics between the 2 groups (P>0.05). ResultsIn the modified group,there was no perioperative death. Postoperatively,6 patients received reexploration for bleeding,4 patients had low cardiac output syndrome,5 patients had pulmonary infection,1 patient received tracheostomy,and 3 patients had acute kidney failure (AKI). In the control group,5 patients died postoperatively including 3 patients with left ventricular rupture and 2 patients with severe low cardiac output syndrome. Postoperatively,5 patients received reexploration for bleeding,12 patients had low cardiac output syndrome,4 patients had pulmonary infection,and 6 patients had AKI. Echocardiography at 6th month during follow-up showed that left ventricular ejection fraction (LVEF) left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD) of modified group patients were improved compared with control group patients. There was statistical difference in LVEF and LVESD between the 2 groups (P<0.05). There was no statistical difference in LVEDD between the 2 groups (P>0.05). LVEF,LVEDD and LVESD of modified group patients during follow-up were statistically different from preoperative values (P<0.05). LVEDD of control group patients during follow-up was statistically different from preoperative LVEDD (P<0.05). LVEF and LVESD of control group patients during follow-up was not statistically different from preoperative values (P>0.05). ConclusionMVR with modified anterior leaflet preservation technique is simple to perform with satisfactory short-term results. This technique is suitable for various types of mitral valve diseases especially degenerative mitral valve disease and infective endocarditis.
ObjectiveTo evaluate the safety and efficacy of transapical mitral valve repair with moderate-to-severe or severe mitral regurgitation (MR) by using LifeClip system. Methods We retrospectively analyzed the clinical data of 7 symptomatic patients with moderate-to-severe or severe MR who received transapical mitral valve repair by using the LifeClip system in our hospital from July to November 2021. There were 5 males and 2 females with an average age of 76.0±7.5 years. ResultsThere were 2 patients with degenerative MR and 5 patients with functional MR. All of the procedures were successful and 6 patients received 1 LifeClip while the other one patient received 2. The operation time was 135.7±46.9 min, the mechanical ventilation time was 12 (3, 14) h, and the hospital stay time was 18.1±4.1 d. No serious complications or death occurred during the perioperative or follow-up period. MR reduction by ≥2 grades was achieved in all the patients at the one-month follow-up. The classification of cardiac function was improved in varying degrees. Conclusion Transapical mitral valve repair using the LifeClip system shows good safety and efficacy for severe MR patients, and MR degree is significantly improved at early follow-up. However, the benefit of LifeClip should be validated in a larger sample size of Chinese population and through long-term follow-up.