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Your search keyword '"Mitral insufficiency"' showing total 2 results
2 results on '"Mitral insufficiency"'

1. The Effect of Depth of Anaesthesia on the Severity of Mitral Insufficiency by Transesophageal Echocardiography.

Author

Abd El Aziz Fahmy, Nabila Mohamed, Hussein, Wael Reda, and Khamis Al Hanash, Ehab Essam

Subjects
*MITRAL valve insufficiency, *TRANSESOPHAGEAL echocardiography, *MITRAL valve, *ANESTHESIA, *ELECTIVE surgery, *CARDIAC surgery
Abstract

Background: The assessment of mitral regurgitation (MR) is complex and complicated by the dynamic nature of this valvular abnormality. Intraoperative transesophageal echocardiography (TEE) is a well-established tool that is used to assess the mitral regurgitation (MR) before and after mitral valve reconstruction. Objectives: This study conducted in the National Heart Institute in Cairo aimed at assessing the effect of depth of anaesthesia guided by bispectral index on the severity of mitral insufficiency as measured by transesophageal echocardiography. Patients and Methods: This study was conducted in the National Heart Institute in Cairo. The study was conducted for a period of about six months after the approval from Ethical committee. Informed oral consent for every patient was obtained. Prospective observational cross-sectional study with a random sample of 20 patients at National Heart Institute. A sample size of at least 15 data pairs achieves 80% power to reject the null hypothesis of zero effect size when the population effect size is 0.80 and the significance level (alpha) is 0.05 using a two-sided paired ttest. Adult patients undergoing elective cardiac surgery in National Heart Institute. Results: The MR severity decreased at a deeper anaesthesia at low BIS than at a shallower anaesthesia at high BIS in patients with organic MR. Eight patients out of twenty patients (40% with organic MR) showed aþ1 grade of improvement in MR grade, by semi-quantitively measuring maximal JA and VC width. Improvement in mitral regurge severity thought to be secondary to unloading effect of general anaesthesia on left ventricle causing a decrease in afterload, preload, and left ventricular dimensions. This study demonstrated that, a comparison between deep anaesthesia and shallow anaesthesia using BIS showed there is a significant reduction in multiple parameters of MR severity assessment secondary to unloading effect of general anaesthesia on left ventricle caused by a decrease in both afterload and preload. Conclusion: This reduction in MR severity appeared to be significant enough to modify intraoperative decisions regarding valve surgery by underestimation of valve severity. Thus, strong consideration should be given to thorough preoperative assessment of MR severity, rather than relying on intraoperative findings. [ABSTRACT FROM AUTHOR]

Published
2021

2. Reversion of Severe Mitral Insufficiency in Peripartum Cardiomyopathy Using Levosimendan

Author

Daniel Molano Franco, Albert Alexander Valencia Moreno, Yamil Elias Jaller Bornacelli, Anacaona Martinez Del Valle, Victor Hugo Nieto Estrada, and José Antonio Rojas Gambasica

Subjects
medicine.medical_specialty, Peripartum cardiomyopathy, business.industry, Levosimendan, Cardiomyopathy, Diastole, Case Report, General Medicine, Tricuspid insufficiency, Cardiorespiratory Medicine and Haematology, medicine.disease, Pulmonary hypertension, Medical and Health Sciences, Pregnancy, Internal medicine, Heart failure, Anesthesia, medicine, Cardiology, Dobutamine, business, Mitral insufficiency, medicine.drug
Abstract

Idiopathic peripartum cardiomyopathy presenting with heart failure is a true diagnostic and treatment challenge. Goal oriented clinical management aims at the relapse of left ventricular systolic dysfunction. A 35-year-old patient on her 12th day post-delivery presents progressive signs of heart failure. Transthoracic echocardiography showed severe mitral insufficiency, mild left ventricular dysfunction, mild tricuspid insufficiency, severe pulmonary hypertension, and right atrial enlargement. With wet and cold heart failure signs, the patient was a candidate for inodilator cardiovascular support and volume depletion therapy. As the patient presented a persistent tachycardia at rest, levosimendan was chosen over dobutamine. Levosimendan was administered at a dose of 0.2 µg/kg/min during a period of 24 hours. After inodilator therapy, the patient's signs and symptoms of heart failure began to decrease, showing improvement of dyspnea, mitral murmur grade went from IV/IV to II/IV, filling pressures and systemic and pulmonary resistance indexes decreased, arterial blood gases improved, and an echocardiography performed 72 h later showed non-dilated cardiomyopathy, mild cardiac contractile dysfunction, mild mitral insufficiency, type I diastolic dysfunction and improvement of pulmonary hypertension. Cardiovascular function in peripartum cardiomyopathy tends to go back to normality in 23-41% of the cases, but in a large group of patients, severe ventricle dysfunction remains months after initial symptoms. This article describes the diagnostic process of a patient with peripartum cardiomyopathy and a successful reversion of a severe case of mitral insufficiency using levosimendan as a new therapeutic strategy in this clinical context.

Published
2015

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