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Guidelines suggest using a regurgitant fraction of 50% and regurgitant volume of 60 ml for determination of severe mitral insufficiency. Recent MRI data has suggested that a regurgitant fraction of 40% defines severe primary mitral insufficiency. We sought to determine whether there were gender differences in primary mitral regurgitant volumes for regurgitant fractions of 40% and 50%. A database search identified 394 patients that had MRI with a mitral regurgitant volume ≥ 10 ml or a study indication of mitral insufficiency. Chart review identified 97 patients with primary mitral insufficiency. Of these patients, 53 (54%) were women. Men had significantly larger left ventricular volumes, myocardial mass, stroke volumes and mitral regurgitant volumes (37 ± 25 ml vs. 24 ± 12 ml). The difference in regurgitant fraction between genders was not significant (27 ± 14% vs. 24 ± 11%; p-value = 0.24). Regurgitant fraction and regurgitant volume had a strong linear correlation in both men (r =.95) and women (r =.92). Despite similar linear correlations, the slope-intercept equations differed significantly between men and women (p <.001). A regurgitant fraction of 40% correlated with a regurgitant volume of 59 ml in men and 39.5 ml in women, while a regurgitant fraction of 50% correlated with a regurgitant volume of 76.2 ml in men and 49.6 ml in women. Regurgitant fraction, determined by cardiac MRI, provides a gender independent assessment of primary mitral insufficiency, and suggests that regurgitant volume thresholds for severe primary mitral insufficiency may be lower in women. [ABSTRACT FROM AUTHOR]

Introduction: Valvular heart diseases (VHD) are becoming a significant problem in the Polish population. Coexistence of chronic kidney disease (CKD) in patients with VHD increases the risk of death and affects further therapeutic strategy. Aim: Analysis impact of CKD on long-term prognosis in patients with VHD. Material and methods: The inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ± 1454 days. Results: The average age of the studied population was 66.75 (SD = 10.34), male gender was dominant 56% (N = 579). Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CKD occurred in 37.1% (N = 380) patients mostly with mitral stenosis (50%, N = 16) and those with severe MVI (44.8%, N = 94). During the observational period, 52.7% (N = 540) deaths were noted. Increased risk of mortality was associated mostly with age (OR: 1.02, 95% CI: 1.00–1.03, p < 0.001), creatinine (OR:1.27, 95% CI: 1.12–1.43, p < 0.001), CKD (OR: 1.30, 95% CI: 1.17–1.44, p < 0.001), reduced ejection fraction (EF) (OR: 0.98, 95% CI: 0.97–0.99, p = 0.01) and coexisting of AVS (OR: 1.19, 95% CI: 1.04–1.35, p = 0.01). Conclusions: Mitral valve defects more often than aortic valve defects coexist with chronic kidney disease. Regardless of the stage, chronic kidney disease is an additional factor affecting the prognosis in patients with heart defects. Factors increasing the risk of death were age, creatinine concentration and reduced EF. The monitoring of renal function in patients with VHD should be crucial as well as the implementation of treatment at an early stage. [ABSTRACT FROM AUTHOR]

Rigorous clinical trials have demonstrated the safety and efficacy of Transcatheter Edge-to-Edge Repair to treat severe secondary mitral regurgitation (MR) in adults with primary cardiomyopathy who have failed guideline-directed medical therapy, as well as those with primary MR at high surgical risk. To date, there are only three case reports describing this procedure in the pediatric population. We report a case series of four pediatric patients, including the youngest and smallest reported, who underwent this procedure. [ABSTRACT FROM AUTHOR]

Current echocardiographic data reporting the impact of concomitant mitral regurgitation (MR) on outcome in patients who undergo transcatheter aortic valve replacement (TAVR) are conflicting. Using cardiovascular magnetic resonance (CMR) imaging, this study aimed to assess the impact of MR severity on cardiac reverse remodeling and patient outcome. 85 patients undergoing TAVR with CMR pre- and 6 m post-TAVR were evaluated. The CMR protocol included cines for left (LV) and right ventricular (RV) volumes, flow assessment, and myocardial scar assessment by late gadolinium enhancement (LGE). Patients were dichotomised according to CMR severity of MR fraction at baseline ('non-significant' vs 'significant') and followed up for a median duration of 3 years. Forty-two (49%) patients had 'significant MR' at baseline; they had similar LV and RV size and function compared to the 'non-significant MR' group but had greater LV mass at baseline. In those with significant MR at baseline, 77% (n = 32) had a reduction in MR post-TAVR, moving them into the 'non-significant' category at 6-months, with an overall reduction in MR fraction from 34 to 17% (p < 0.001). Improvement in MR was not associated with more favourable cardiac reverse remodeling when compared with the 'non-improvers'. Significant MR at baseline was not associated with increased mortality at follow-up. Significant MR is common in patients undergoing TAVR and improves in the majority post-procedure. Improvement in MR was not associated with more favourable LV reverse remodeling and baseline MR severity was not associated with mortality. [ABSTRACT FROM AUTHOR]

Severe aortic valve stenosis (AVS) and mitral valve regurgitation (MVR) often coexist. Although a fully percutaneous treatment for the two conditions, by means of transcatheter aortic valve implantation (TAVI) followed by MitraClip, can be appealing in selected high-risk candidates, critical and strategical reasoning should be applied. In a 3-year period we have developed a single-centre experience of 14 patients who were managed with a staged percutaneous approach to treat severe AVS and MVR. The average interval from TAVI to MitraClip repair was 101 ± 12 days. Success for TAVI was 100% and 92.9% (13/14) for MitraClip. At late follow-up, 3 patients developed MVR 3+. Estimated 1-year survival was 66.5%. Freedom from 1-year endpoint (death, stroke, major bleeding, myocardial infarction, and cardiac re-hospitalisation) was 57.9%. In our view, a fully transcatheter approach for mitro-aortic pathology is feasible and should be performed only as a staged procedure in those patients that remain symptomatic, in spite of successful TAVI. It should be emphasised that although the periprocedural success rate is satisfactory, follow-up mortality and re-hospitalisation rates remain high, even at mid-term follow-up. This most probably results from the advanced clinical picture at time of referral for treatment. [ABSTRACT FROM AUTHOR]

Ischemic mitral regurgitation (IMR) is a frequent complication after a myocardial infarction (MI), which doubles mortality. Transcatheter mitral repairs are emerging as alternative treatment options to open heart surgery for IMR, but animal models to test them are lacking. We report a percutaneous swine model of IMR. Seventeen swine were randomized to (group 1, n = 12) MI causing IMR, and (group 2, n = 5) controls. In group 1, MI was induced via percutaneous ethanol injection into the obtuse marginal branches of the left circumflex artery, resulting in ST elevating myocardial infarction. Nine animals were survived to 8-10 weeks with weekly echocardiograms and three swine were survived to 16-20 weeks with MRI at termination. In group 1 animals, average IMR fraction at termination was 26.6 ± 2.3% in the echo group, and 24.51 ± 0.41% in the MRI group. None of the animals in group 2 had IMR. Left ventricular dysfunction and significant dilatation were evident in group 1 animals, compared to the controls. In conclusion, a reproducible model of IMR is reported for use in pre-clinical testing of new mitral technologies. [ABSTRACT FROM AUTHOR]

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Background: Percutaneous mitral valve repair (MVR) with the MitraClip system in patients with mitral regurgitation (MR) is known to reduce symptoms and to improve cardiac morphology and function. MitraClip has been approved for cardiac magnetic resonance imaging (MRI). To date, however, no systematic analysis exists on cardiac MRI in patients undergoing the MitraClip procedure. Objective: The aim of this study was to (1) prove feasibility and robustness of cardiac MRI and (2) visualize effects of the procedure on cardiac morphology and function by cardiac MRI. Methods: 27 consecutive patients (age 77.5 ± 7.6 years) with symptomatic moderate to severe MR undergoing the MitraClip procedure were prospectively included. Cardiac MRI at 1.5 T was performed before and at 3 months after intervention. Cardiac morphology and function were evaluated using steady-state free precession (SSFP) cine sequences by assessment of left ventricular enddiastolic and endsystolic diameters (LVEDD, LVESD) and volumes (EDV, ESV), ejection fraction (LVEF) and stroke volume (SV), diameter of mitral annulus, and myocardial mass (MM). Planimetry of the left atrium (LA) was performed in identical slices in a four-chamber view. Results: Around the clip an extinction artifact was observed which did not disturb the evaluation of cardiac morphology and function. At follow-up, we observed significant decreases of LVEDD (58.0 to 53.3 mm, p < 0.0001), EDV (167 to 159 mL, p = 0.0006) and ESV (101 to 89 mL, p < 0.0001), diameter of mitral annulus (41.4 to 37.9 mm, p < 0.0001), myocardial mass (148.4 to 144.5 g, p = 0.0004) and LA size (40.2 to 37.6 cm, p < 0.0001). LVEF improved (43.3 to 46.7 %, p = 0.0041). Conclusions: Cardiac MRI is feasible and robust in patients with MitraClips. The clinical benefit of a successful MitraClip intervention is paralleled by significant improvements of cardiac morphology and function which can be monitored and validated using MRI in clinical follow-up examinations. [ABSTRACT FROM AUTHOR]

Purpose: To examine pregnancy and perinatal outcomes in patients with mitral valve disorders [mitral valve prolapse and/or mitral regurgitation; mitral valve disorders (MVD)]. Methods: A retrospective comparative study was conducted comparing all singleton deliveries, during the years 1988-2010, of women with and without known MVD. Women lacking prenatal care were excluded. Stratified analysis using logistic regression was performed to control for confounds. Results: Out of 233,194 singleton deliveries that occurred during the study period, 390 deliveries occurred in women with MVD. Using a multivariate analysis, advanced maternal age (OR = 1.06; 95 % CI 1.05-1.08; P < 0.001), recurrent abortions (OR = 1.62; 95 % CI 1.15-2.28; P = 0.005), hypertensive disorders (OR = 1.62; 95 % CI 1.17-2.26; P = 0.004) and Jewish ethnicity (OR = 2.21; 95 % CI 1.76-2.79; P < 0.001) were found to be significantly associated with MVD. Since cesarean sections (CS) were significantly higher in deliveries of patients with MVD (17.9 vs. 14 %; P = 0.025), another multivariate analysis was constructed, with CS as the outcome variable. MVD was not found to be an independent risk factor for CS (OR = 1.05; 95 % CI 0.79-1.37; P = 0.74). Conclusions: MVD associated with advanced maternal age, recurrent abortions, Jewish ethnicity and hypertensive disorders were not found to be an independent risk factor for CS. [ABSTRACT FROM AUTHOR]

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Elderly women are at risk for aortic and mitral valve disease that may be challenging to manage because of co-morbidities. Many reports focus on the evaluation and management of elderly patients, but only limited information that is directed specifically at women is available. Until more research can be completed, current guidelines offer updated recommendations for the diagnosis and treatment of significant valvular lesions. On-line and point-based risk assessment instruments are valuable tools for guiding treatment decisions in individual patients. [ABSTRACT FROM AUTHOR]

Myxomas are the commonest primary benign cardiac tumors. Approximately 75 % of these tumors arise from the left atrium and 18-20 % from the right atrium. Left atrial myxomas usually present with features of mitral stenosis and occasionally with distal embolism, bacterial endocarditis, or constitutional symptoms. Mitral insufficiency is a rare presenting feature. They are most frequently soft and friable without microscopic signs of calcification. We report a case of giant fibrocalcific left atrial myxoma causing moderate-to-severe mitral regurgitation and presenting as a congestive cardiac failure in a 49-year-old female. The diagnosis was made by transthoracic echocardiography and cineangiography. She underwent successful removal of the left atrial myxoma with repair of mitral valve using annuloplasty ring. Postoperative course was stormy, but the recovery was complete and postoperative echocardiography revealed no residual myxoma and only mild mitral regurgitation. [ABSTRACT FROM AUTHOR]

The incidence of significant valvar insufficiency at late (>6 month) follow-up was retrospectively evaluated in 27 young patients (age 4.0–18.0 years) undergoing 29 ablation procedures via the retrograde aortic approach for left-sided accessory connections in whom pre-ablation and post-ablation echocardiograms were available for review. Valvar insufficiency was graded using color flow techniques as absent, trivial, mild, moderate, or severe by blinded reviewers. Ablation was acutely successful via the retrograde approach in 25 of 29 procedures among these 27 patients. Successful ablation was ultimately achieved in all 27 patients. At baseline, 7 patients had evidence of trivial or mild mitral insufficiency, and no patient had aortic insufficiency. Three patients had evidence of impaired left ventricular systolic performance in the presence of manifest pre-excitation. At follow-up, pre-existing mitral insufficiency resolved in 5/7 patients, and persisted in 2 patients. New mitral insufficiency was evident in 3 patients, and new aortic insufficiency was transiently evident in 1 patient following ablation (all trivial). Institutional experience (mean rank 10 cases vs. 33 cases, p < .0005), and lower patient weight (29.7 vs. 56.3 kilograms, p = .01) were the only factors associated with the development of new valvar insufficiency. Valvar insufficiency could not be detected by careful auscultation in any patient and was deemed clinically insignificant in all patients. We conclude that ablation of left-sided accessory connections can be performed via the retrograde aortic approach without creating clinically significant valvar insufficiency. [ABSTRACT FROM AUTHOR]

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

15 biopsies of dilated and hypertrophied human left ventricles in mitral insufficient hearts were morphometrically investigated. On light and electron microscopical level the results were compared with those received from normally loaded human left ventricles and from hypertrophied human left ventricles found in hearts with aortic valve disease. The results demonstrate alterations when compared with the results from normally loaded left ventricles. The differences between normally loaded and volume loaded left ventricles are smaller than those in pressure loaded left ventricles from aortic valve diseased hearts. [ABSTRACT FROM AUTHOR]

On 121 consecutive patients with coronary heart disease coronary angiography and quantitative left ventricular angiography was done with the view to aortocoronary bypass surgery. 24 (20%) had mitral regurgitation (MR) by angiographic criteria, 20 of them had MR grade I/IV, four had MR II/IV. In 23 out of 24 patients with MR quantitative left ventriculography revealed localized contraction disorders. MR was clinically diagnosed in 15 out of 24 patients. In eleven patients (48%) contraction abnormalities were localized in the inferior wall, in five cases (22%) in the anterior wall and in seven cases (30%) both in the anterior and posterior wall. Of the latter group patients with MR showed a significantly lower ejection fraction than patients without MR ( p<0,05). Furthermore the MR-group showed larger akinetic areas, preferentially located in the inferior segments 0°-240° and in the anterolateral segments 60°-90°. Three vessel disease was more frequent in this group (43%) than in the group without MR (23%). Patients with inferior wall asynergy frequently showed combined stenosis or occlusion of the right and circumflex coronary artery. In conclusion, MR in coronary heart disease is most often associated with localized contraction disorders of the left ventricle; posterior wall infarctions, multiple vessel disease and large akinetic areas are more frequent. However, the hemodynamic significance of MR in patients with chronic myocardial infarction is usually insignificant. [ABSTRACT FROM AUTHOR]

In order to evaluate the acute effects of pharmacological blockade of the renin-angiotensinogen system in patients with chronic left ventricular volume overload, 50 mg of the converting enzyme inhibitor captopril were administered to 4 patients with aortic insufficiency and 5 patients with mitral regurgitation. Mean aortic pressure decreased from 108±17 to 89±18 mmHg ( P<0.001) and systemic vascular resistance decreased from 2,300±1,087 to 1,540±547 dyn s cm ( p<0.01). Left ventricular filling pressures decreased significantly. This resulted in an increase in cardiac index from 2.6±0.8 to 2.9±0.7 1/min/m ( p<0.001) and an increase in the forward stroke volume index from 31±7 to 37±7 ml/m ( p<0.001). Left ventricular end-diastolic and end-systolic volumes decreased significantly ( p<0.05). No changes in left ventricular ejection fractions and heart rate were observed. Regurgitant stroke volume was reduced from 58±27 to 32±9 ml/m ( p<0.01) and the regurgitant fraction from 64±13 to 46±8% ( p<0.001). Coronary sinus blood flow decreased from 174±57 to 144±58 ml/min ( p<0.05); coronary vascular resistance remained constant. Myocardial oxygen consumption was reduced from 26±11 to 21±12 mlO/min ( p<0.05). Captopril, therefore, has benefical hemodynamic effects in patients with chronic left ventricular volume overload due to aortic or mitral incompetence. Cardiac performance is increased at reduced metabolic costs. [ABSTRACT FROM AUTHOR]

It has been suggested that oxygen free radicals (OFR) depress the excitation-contraction coupling in cardiac muscle. It is possible that a decrease in the cardiac contractility in the failing heart may be due to an increased OFR producing activity of polymorphonuclear (PMN) leukocytes. We studied the OFR producing activity (chemiluminescence) of PMN leukocytes from blood in dogs with heart failure due to chronic volume overload. The animals were divided into two groups: I) normal, (n = 10): II) dogs with mitral insufficiency (MI) of 6 to 9 months duration, (n = 10). Hemodynamic studies were done to establish the presence of heart failure. Blood samples were collected to measure PMN leukocyte chemiluminescence. There was a decrease in the cardiac index and index of myocardial contractility (dp/dt/IIP) and an increase in the left ventricular end-diastolic pressure in dogs with MI indicating left ventricular failure. The peak chemiluminescent activity of the PMN leukocytes in blood of dogs with failure was about four folds greater than that in the blood from normal dogs. These results suggest that there may be an increased OFR generation in dogs with volume overload heart failure. The decrease in the myocardial contractility in the failing heart might be due to an increase in the OFR produced by the PMN leukocytes. [ABSTRACT FROM AUTHOR]

Severe rheumatic mitral stenosis with or without mitral insufficiency is virtually unseen in children in the affluent countries of the western world, but is not uncommon in developing countries. Fifteen cases of rapidly progressive rheumatic mitral valve disease in children are presented to illustrate the value of echocardiography in the diagnosis and evaluation of this lesion. Cardiac catheterization was performed in nine and simply confirmed the diagnosis made noninvasively. Our experience demonstrates that thorough echocardiographic examination in these cases frequently enables the examiner to assess the need for surgical intervention without cardiac catheterization. [ABSTRACT FROM AUTHOR]

A female patient suffering from a bronchial neuroendocrine tumor with unilateral leftsided carcinoid heart disease is reported. Repeated x-ray films of the chest showed a slowly growing lung tumor in the left lower lobe. The patient refused any diagnostic or therapeutic procedure to define the type of the tumor. During the follow-up of 24 years she developed severe mitral and moderate to severe aortic insufficiency, both invasively quantified by thermodilution techniques. During surgery for double valve replacement the patient died from left ventricular heart failure. Necropsy revealed the typical pattern of a bronchial neuroendocrine tumor without metastases. Examination of the heart disclosed the characteristic deposits of fibrous tissue on the cusps of both the mitral and the aortic valves whereas the right heart showed no abnormalities. Review of the literature suggests the unilateral left-sided carcinoid heart disease to be a very rare finding, its pathogenesis remains to be elucidated. [ABSTRACT FROM AUTHOR]

Acute mitral insufficiency due to the rupture of chordae tendinae from papillary muscles is a rare but sometimes fatal condition in neonates and infants. Here, we report a 21-day-old neonate with sudden onset of mitral insufficiency due to rupture of the chordae tendinae. The baby was successfully rescued by appropriate diagnosis and emergency surgical operation with reconstruction of the ruptured chordae using autologous pericardium-reinforced mattress suture. Intraoperative findings revealed fibrous scar formation at the distal end of the posterior papillary muscle, indicating a remnant of a certain inflammatory reaction. Transplacental passage of maternal anti-SSA antibody could account for the fetal inflammation at the ruptured chordae and the papillary muscle. [ABSTRACT FROM AUTHOR]

We describe herein the case of a 49-year-old female patient with pulmonary sarcoidosis (stage II) with cardiac manifestation. This consisted of systolic dysfunction without dilatation of the left ventricle and severe mitral insufficiency, possibly due to thinning of the posteromedial left ventricular free wall, based on our echocardiographic observations. [ABSTRACT FROM AUTHOR]

A 4-year-old boy was diagnosed as having a chromosomal abnormality with trisomy 3p associated with a secundum atrial septal defect and a cleft of the anterior mitral leaflet. His craniofacial features showed microcephaly, micrognathia, ocular hypertelorism associated with epicanthus, and low-set ears. Moderate mental retardation and hypoplasia of the penis were also noted. A left ventriculogram demonstrated grade 2 mitral regurgitation according to the Sellers' classification with a prolapsing of the mitral leaflets. A cleft of the anterior mitral leaflet was detected at the time of operation. The secundum atrial septal defect was directly closed and the mitral cleft was repaired. This is the first report of trisomy 3p associated with an atrial septal defect and a mitral valve cleft. [ABSTRACT FROM AUTHOR]

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A two-month-old male infant with Kawasaki's disease, severe mitral insufficiency, and normal coronary arteries is described. We postulate the mitral insufficiency was secondary to Kawasaki's valvulitis, and that this occurred in the absence of other forms of cardiac involvement characteristic of Kawasaki's disease. [ABSTRACT FROM AUTHOR]