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We describe the first reported case of acute methemoglobinemia associated with ochronotic valvular heart disease. A 79-year-old man with ochronotic valvular heart disease experienced decreased urinary output starting 9 days after an operation. Thereafter, the patient's methemoglobin concentration acutely increased, indicating systemic cyanosis, while the arterial partial oxygen pressure (PaO (2)) was maintained at around 200 mmHg. In patients with ochronotic valvular heart disease, acute methemoglobinemia may occur, as in cases of renal failure or oliguresis.

The case of a 64-year-old woman who underwent corrected transposition of the great arteries with significant systemic atrioventricular valve regurgitation and complete atrioventricular block is described. The patient underwent implantation of a DDD-type pacemaker and experienced relief of symptoms after discharge. Follow-up evaluation 30 months after the pacemaker implantation demonstrated a decrease in the cardiothoracic ratio on chest X-ray, the b-type natriuretic peptide level, and regurgitation at the systemic atrioventricular valve.

Background and Aims of the Study: Mitral annuloplasty has long been considered as the basic procedure for mitral regurgitation (MR). However, it is increasingly advisable to avoid foreign material and to use a method that provides greater adjustment for control of annular size. In this study, the semicircular suture annuloplasty (Paneth-Burr method) was evaluated for its efficacy and durability; the optimum size of the mitral annulus was also assessed., Methods: The Paneth-Burr method was modified using Gore-Tex suture, a crossing suture technique, and obturator for temporary annulus size adjustment. Between 1992 and 1994, 21 patients with an average age of 45 years (range: 8 months to 67 years) underwent such annuloplasty combined with various valvuloplasties and chordal reconstruction. The etiologies were degenerative in 11 patients, congenital in five, ischemic in three and endocarditis in two., Results: Mean MR grades (0-4) decreased from 3.3 +/- 0.6 to 0.2 +/- 0.4 after surgery. At an average 24 months follow up (range: 12 to 41 months), 16 patients showed no increase in MR, but five showed increased MR grades (all grade 3 or less: three grade 3 and two grade 2). Only one patient with ischemic MR required reoperation. Patients with increased MR grade during follow up had a larger intraoperative annular size (> 90% of normal), while those with < 90% of normal mitral annular size showed no increase in MR beyond grade 2, except one with ischemic etiology., Conclusions: A measured semicircular suture annuloplasty appears to be useful for MR, with acceptable efficacy and durability. In addition, the annular size to be adjusted at surgery is proposed to be < or = 90% of normal mitral annular diameter.

Plication of the leaflets or chordae reconstruction combined with annuloplasty cave been the standard procedure of the mitral valve repair for mitral regurgitation (MR). We have chosen the JH Kay's method for mitral annuloplasty. However, the long term results were not necessarily satisfactory because of various types of the mitral lesions. We have adopted the semicircular suture annuloplasty (Paneth-Burr's method) as the first choice for MR since May, 1991. In this paper, we demonstrate our modified operative procedure of the Paneth-Burr's method and the operative results. Also, to decide the optimal size of the annulus after annuloplasty, we evaluated the changes in size of the annulus and extent of mitral regurgitation before and about 16.3 months after surgery in 21 patients (pts) with MR undergoing Paneth-Burr's method, using Doppler echocardiography. On this annuloplasty, a double suture of EPTFE string (GORE-TEX) guarded with plegets was placed at the margin of the central fibrous body, sutured circumferentially around the annulus. Two rows of the suture were crossed in every several stitches to prevent cutting. A second suture was placed on the opposite side of the annulus in the same fashion. The MR patients were divided, by their size of the annulus after annuloplasty, into group A (less than 90% of normal annular diameter, 15 pts) and group B (more than 90% of normal annular diameter, 6 pts). In 14 of 15 pts of group A, mitral regurgitation was improved from grade 2-4 to grade 0-1 postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

To elucidate the limitation of mitral valve reconstruction, 53 mitral disease patients (Mitral stenosis: 29, Mitral regurgitation: 24) undergoing reoperation late after valve reconstruction were studied, taking account of valvular lesions at initial operation. Reoperation rate after open mitral commissurotomy for mitral stenosis was higher in the patients with valvular regurgitation at initial operation than in those with severe subvalvular lesions or calcified valve. Reoperation rate for mitral regurgitation after mitral valvuloplasty was higher in the patients with stenotic fibrous degeneration or dilated annulus at initial operation than in those with torn chorda. Thus, these findings suggest that combined lesion of stenosis and regurgitation at initial operation may affect the reoperation rate in patients undergoing mitral valve reconstruction for either mitral stenosis or mitral regurgitation. Different approaches to the mitral valve through the left atrium and various techniques of the atriotomy have been practiced according to the need for a particular patients. The left atrium and the mitral valve can be exposed through median sternotomy followed by biatrial atriotomy or transplant approach. A correct approach and good exposure plays a key role in the success of redo surgical procedure for mitral valve disease.

To reevaluate the postoperative contractile state and survival, 34 patients (19 men and 15 women; average age 45 years, range 23 to 65) undergoing conventional mitral valve replacement between 1980 and 1990 were studied. There were 5 cardiac deaths (2 early and 3 late). Four of 5 deaths occurred in patients who had a preoperative left ventricular end-systolic volume index > 100 ml/m2. Sixteen patients with an end-systolic volume index < 100 ml/m2 (group I), and 5 with an index > 100 ml/m2 (group II) underwent repeat catheterization 8 months (range 4 to 17) after surgery. The ratio of end-systolic wall stress to end-systolic volume index increased significantly after surgery in group I, whereas it remained reduced in group II. The postoperative end-systolic wall stress/volume index ratio correlated significantly with the preoperative end-systolic volume index (p < 0.001). In the relation between end-systolic wall stress and ejection fraction, all patients in group II had values that were less than the 95% confidence limits for the normal relation. In conclusion, patients with a preoperative end-systolic volume index > 100 ml/m2 appeared to be at high risk of incurring irreversible depressed myocardial contractility, with a high postoperative mortality.

Background: In surgery for chronic mitral regurgitation, the mitral subvalvular apparatus, including annulus, may play an important role in preserving left ventricular (LV) performance. The suture annuloplasty for mitral regurgitation allows annular contraction of the mitral valve. The potential effects of suture annuloplasty on the postoperative LV performance have not been fully defined., Methods and Results: Global and regional LV function in 12 patients with suture annuloplasty were compared with 12 patients with conventional mitral valve replacement (MVR). Cineangiography and echocardiography were obtained before and 10.8 months after surgery. End-diastolic volume index and end-systolic volume index decreased significantly in both groups after surgery (p < 0.01). Ejection fraction remained unchanged in the suture annuloplasty group, whereas it decreased significantly in the MVR group after surgery (p < 0.01). There was a significant inverse relation between ejection fraction and end-systolic wall stress in the two groups after surgery (suture annuloplasty group, r = -0.69, p = 0.01; MVR group, r = -0.60, p = 0.04). The intercept on the y axis was significantly (p < 0.005) higher in the suture annuloplasty group than in the MVR group. In the suture annuloplasty group, cross-sectional area ejection fraction at the mitral valve level and at the papillary muscle level by LV two-dimensional echocardiography remained unchanged after surgery. In the MVR group, they decreased significantly after surgery (p < 0.01). There was a significant correlation between the cross-sectional area ejection fraction and the global ejection fraction at both levels after surgery. Therefore, the improvement of the regional wall motion can be attributed to the improvement of the global LV performance after suture annuloplasty., Conclusions: These data suggest that suture annuloplasty can provide more desirable postoperative LV systolic performance than conventional MVR by preserving both the contraction of the mitral annulus and the mitral valvular-ventricular interaction.