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Mitral regurgitation (MR) is the most prevalent form of valvular heart disease. Transcatheter mitral valve repair (TMVr) and transcatheter mitral valve replacement (TMVR) have recently emerged as alternatives to open heart surgical repair or replacement. However, studies on the comparative outcomes of TMVr and TMVR are limited. This study aims to compare the demographics, complications and outcomes of TMVr and TMVR based on a real-world investigation of the National Inpatient Sample (NIS) database. From 2016–2018 in the NIS database, a total of 210 and 3370 patients who underwent TMVR and TMVr, respectively, were selected. The mean age of the patients was 75.99 years (TMVr) and 69.6 years (TMVR) (p <0.01). The mortality of patients who received TMVR was higher compared to that of patients who were treated with TMVr (8.1 vs. 1.9%, p <0.01). The patients who underwent TMVR were more likely to suffer perioperative complications including blood transfusions (16.2 vs. 5.0%, p <0.01) and acute kidney injury (22.9 vs. 13.3%, p <0.01). The average cost of treatment was higher (USD $278864 vs. USD $216845, p <0.01), and the average duration of hospitalization was longer (8.73 vs. 4.17 d, p <0.01) for TMVR compared to TMVr. When taking into account perioperative comorbidities and other factors, TMVR was associated with a worse adjusted in-hospital mortality (odds ratio [OR], 3.307 [95% CI, 1.533–7.136]; p <0.01). TMVr is associated with lower mortality, peri-procedural morbidity, and resource use compared to TMVR. A patient-centered approach can help guide decision-making about the choice of intervention for the individual patient and more studies evaluating the long-term outcomes and durability of TMVR are needed at present. [ABSTRACT FROM AUTHOR]

Valvular heart disease (VHD) is a common organic heart disease, and its incidence gradually increases with age. With the cross-integration of artificial intelligence and medical field, artificial intelligence algorithm models have become effective tools for identifying a variety of heart diseases. Artificial intelligence-enabled ECG (AI-ECG) diagnostic models can identify VHD patients by analyzing their ECG features, which may become an auxiliary tool for the identification of VHD in clinical practice. This paper summarizes the research progress of AI-ECG diagnostic models in the identification of VHD. [ABSTRACT FROM AUTHOR]

In recent years, new interest is growing in the left atrium (LA). LA functional analysis and measurement have an essential role in cardiac function evaluation. Left atrial size and function are key elements during the noninvasive analysis of diastolic function in several heart diseases. The LA represents a "neuroendocrine organ" with high sensitivity to the nervous, endocrine, and immune systems. New insights highlight the importance of left atrial structural, contractile, and/or electrophysiological changes, introducing the concept of "atrial cardiomyopathy", which is closely linked to underlying heart disease, arrhythmias, and conditions such as aging. The diagnostic algorithm for atrial cardiomyopathy should follow a stepwise approach, combining risk factors, clinical characteristics, and imaging. Constant advances in imaging techniques offer superb opportunities for a comprehensive evaluation of LA function, underlying specific mechanisms, and patterns of progression. In this literature review, we aim to suggest a practical, stepwise algorithm with integrative multimodality imaging and a clinical approach for LA geometry and functional analysis. This integrates diastolic flow analysis with LA remodelling by the application of traditional and new diagnostic imaging techniques in several clinical settings such as heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), and mitral regurgitation (MR). [ABSTRACT FROM AUTHOR]

Objective: To compare the left ventricular configuration and systolic function between dilated cardiomyopathy (DCM) and mitral regurgitation (MI) based on three-dimensional echocardiography. Methods: A total of 100 patients with left ventricular (LV) dilatation who visited our hospital from January 2018 to July 2021 were collected, including 57 patients with DCM and 43 patients with MI. The LV size was roughly similar, DCM group (43±5) mm/m~2, MI group (42±5) mm/m~2. Another 50 healthy subjects during the same period were selected as the control group. All patients underwent conventional echocardiography and three-dimensional echocardiography, and the measurement indicators mainly included left ventricular size (LVID), left ventricular posterior wall thickness (PWT), left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic interventricular Septal thickness (IVS), left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), relative wall thickness (RWT), LV mass index (LVMI), three-dimensional left ventricular ejection fraction (3D-LVEF), three-dimensional End-diastolic blood velocity (3D-EDV), 2D or 3D echocardiographic sphericity index (2D-SI/3D-SI). Results: The LVEDD in the DCM group and MI group was greater than that in the control group, and the difference was statistically significant (P<0.05). The incidence of cardiac function grade III/IV and heart failure was higher in the DCM group than in the MI group, and the difference was statistically significant (P<0.05). The LVEDD, LVEDD index, LVEDV, LVEDV index, 3D-EDV and 3D-EDV index of patients in DCM group and MI group were all higher than those in control group, and the difference was statistically significant (P<0.05); however, there were differences between DCM group and MI group. No statistical significance (P>0.05). The LV length, LV length index and LVMI of patients in the DCM group and MI group were higher than those in the control group, and the difference was statistically significant (P<0.05); and the MI group was higher than the DCM group, and the difference was statistically significant (P<0.05). . The LVESV, LVESV index, 2D-SI and 3D-SI of patients in DCM group and MI group were higher than those in the control group, and the difference was statistically significant (P<0.05); and the DCM group was higher than the MI group, and the difference was statistically significant (P<0.05). P<0.05). The 3D-LVEF and RWT in the DCM group were lower than those in the control group and MI group, and the difference was statistically significant (P<0. 05). ROC analysis showed that 3D-SI was superior to other variables in assessing LV remodeling in patients with LV enlargement, the area under the ROC curve for 3D-SI was 0.875, 95% CI was 0.816-0.920, and 3D-SI > 0.62 for DCM The specificity (81.66%) and sensitivity (92.09%) of differentiating LV configuration from MI were higher. 3D-LVEF and 3D-SI were linearly negatively correlated in both DCM and MI patients (r=-0.719, P=0.000; r=-0.682, P=0.000). The area under the ROC curve of 3D-SI for detecting heart failure in both DCM and MI patients was larger than that of 3D-LVEF, and the difference was statistically significant (P=0.000). CONCLUSIONS: Compared with MI patients, DCM patients had a more spherical LV geometry and worse systolic function despite roughly similar LV size. Systolic function was significantly associated with 3D-SI, which well described LV remodeling and may be a strong indicator of heart failure in patients with LV dilation. [ABSTRACT FROM AUTHOR]

Over the last two decades, transcatheter devices have been developed to repair or replace diseased mitral valves (MV). Transcatheter mitral valve repair (TMVr) devices have been proven to be efficient and safe, but many anatomical structures are not compatible with these technologies. The most significant advantage of transcatheter mitral valve replacement (TMVR) over transcatheter repair is the greater and more reliable reduction in mitral regurgitation. However, there are also potential disadvantages. This review introduces the newest TMVr and TMVR devices and presents clinical trial data to identify current challenges and directions for future research. [ABSTRACT FROM AUTHOR]

Background: The use of thiazide diuretics is recommended in the American College of Veterinary Internal Medicine guidelines for advanced heart failure due to mitral insufficiency (MI) in dogs. However, there are no large-scale reports of the use of thiazide diuretics in dogs with advanced heart failure. Aim: This retrospective study evaluated the therapeutic effect of concomitant hydrochlorothiazide (HTCZ) with loop diuretics in dogs with heart failure. Methods: The study included 14 dogs diagnosed with advanced pulmonary edema with MI at two facilities. In all cases, high-dose loop diuretics (torsemide; 0.78-4 mg/kg/day) did not improve pulmonary edema. The results of the echocardiography and renal function tests before and after the administration of HTCZ (0.2-0.84 mg/kg/day) in addition to torsemide were statistically compared. Results: The echocardiographic data demonstrated significant improvement in relation to cardiac stress; left atrium to the aorta ratio, normalized left ventricular internal dimension in diastole, and E wave velocity (m/s) after HTCZ administration. However, blood urea nitrogen and creatinine levels increased, and potassium levels decreased, indicating a decline in renal function following HTCZ administration. Conclusion: This study suggests that the administration of HTCZ in combination with loop diuretics may be beneficial during advanced heart failure due to MI in dogs. The results can also be extended to patients who are resistant to loop diuretics, resulting in the improvement of cardiac function. However, as the combination of HTCZ and loop diuretics can deteriorate renal function, caution should be exercised prior to making recommendations regarding its use, and renal function should be monitored. [ABSTRACT FROM AUTHOR]

Background: The present study is based on the World Heart Federation (WHF) echocardiographic criteria to assess the prevalence of subclinical rheumatic heart disease (RHD) and elucidate evolution of the disease when the cases were placed on appropriate antibiotic prophylaxis and regular follow‐up. The prevalence of subclinical RHD reported by previous active surveillance studies among asymptomatic school children is not comparable to our study because of major differences in screening methods. Methods: A random inclusion strategy was adopted to recruit urban and rural school children of Bikaner district in the state of Rajasthan, India. The diagnosis of RHD was based on the echocardiographic criteria proposed by the WHF. All studies were reported on‐site by a single experienced cardiologist and the digitally preserved studies were reported by a second cardiologist off‐site. The final diagnosis was made by consensus. The second echocardiogram was performed for cases diagnosed with RHD after two years from start of study to document early evolution of the disease with ongoing antibiotic prophylaxis. Results: A high prevalence of subclinical RHD was observed in the study population. Pathological mitral and/or aortic valve regurgitation was the commonest lesion, and a significant proportion of cases improved while on regular antibiotic prophylaxis. No case showed fixity of leaflets/ stenosis. Conclusion: The prevalence of subclinical RHD is high in the study population, and the disease seems to regress over time in the presence of appropriate antibiotic prophylaxis. [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]

Objective To summarize and evaluate the effcte of annuloplasty ring （Carpentier-Edwards PhysioⅡ） as an alternative surgical approach to treat mitral valve prolapse. Methods We analyzed 18 patients with mitral valve prolaspe and not closing properly who were treated in our department between June 2018 and July 2019. 8 patients with tricuspid insufficiency underwent tricuspid angioplasty. LA， LVEDD and LVEF were measured by transthoracic ultrasound before surgery， 6 months and 12 months after surgery. The changes in various values were observed so as to evaluate the effect of treatment．Results Among the 18 subjects， 8 were males at the age between （46 ±9） . There were 2 cases of Barlow， 4 cases of degenerative diseases and 12 cases of Rheumatic diseases. 8 cases had mitral regurgitation accompanied with tricuspid regurgitation. 18 carpentier-Edwards PhysioⅡ rings were used， and 8 Edwards MC3 rings were used. LA and LVEDD at 6 and 12 months after surgery were reducedCompared to before （ ＜0.05）， and LVEF did not change significantly （ ＞ 0.05） . Conclusion After the Carpentier-Edwards PhysioⅡ was inserted， the LA and LVEDD inner diameters were significantly reduced， and cardiac remodeling was relieved. From the perspective of mechanics and bionics，the shape of the double saddle ring fits better into the physiological state mitral valve ring. While treating mitral regurgitation， it can stabilize the normal anatomy of the heart. We will follow up and analyze the effect chronically. [ABSTRACT FROM AUTHOR]

Introduction: Echocardiography has been found to be a much better screening tool compared to clinical examination for the detection of rheumatic heart disease (RHD) in asymptomatic school children living in the RHD endemic areas. Recently, World Heart Federation (WHF) published echocardiographic criteria for the diagnosis of RHD. The present study was done to compare the performance of the newer proposed, quantitative diagnostic score against the qualitative WHF criteria in a field survey of asymptomatic school children belonging to the district having high prevalence of RHD. Methods: 3000 asymptomatic school children studying in rural and urban schools of Bikaner district were screened both by clinical examination and echocardiography performed in parallel. The WHF criteria and the proposed diagnostic score were applied simultaneously for the diagnosis of RHD. Results: A high prevalence of subclinical RHD was found. There was complete agreement between the two sets of criteria for the diagnosis of RHD. However, there was discrepancy in grading the severity of disease. The diagnostic score proved superior to the WHF criteria in grading the disease severity accurately. Conclusions: Diagnostic score captures the disease spectrum of RHD better than WHF criteria and reduces the subjectivity in the diagnosis of RHD. [ABSTRACT FROM AUTHOR]

Introduction: Valvular heart diseases (VHD) are a significant problem in the Polish population. Coexistence of coronary artery disease (CAD) in patients with VHD increases the risk of death and affects the further therapeutic strategy. Aim: Analysis of atherosclerotic plaque burden distribution in coronary arteries and long-term prognosis among patients with VHD. Material and methods: Inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ±1454 days. Results: Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CAD with severe angiographic stenoses was noted in 42.3% (n = 434). Among patients with severe MVI, CAD was noted in 47.1% of cases, and prior acute coronary syndromes (ACS) in 27.1% of patients (n = 58). In severe AVS patients, significant angiographic atherosclerotic changes were observed in 29.6% (n = 86), and prior ACS in 7.6% (n = 22) of patients. During the observation 52.7% of patients died, including 62.9% of patients with severe MVI and 51.6% of those with severe AVS. Age (OR = 1.038; 95% CI: 1.005-1.072; p = 0.022) and coexisting aortic valve insufficiency (AVI) (OR = 2.39, 95% CI: 5.370-11.065, p = 0.035) increased the mortality rate. Conclusions: Severe AVS is starting to be the most prevalent VHD. CAD is one of the most significant factors deteriorating prognosis of patients with VHD. AVI and age were significant risk factors for mortality. The worst prognosis was observed in severe MVI, which may result from more frequent occurrence of CAD in this group. A lesser burden of CAD and ACS in the group of patients with severe AVS did not affect survival. [ABSTRACT FROM AUTHOR]

Background: Diverging guideline definitions for the quantitative assessment of severe secondary mitral regurgitation (sMR) reflect the lacking link of the sMR spectrum to mortality and has introduced a source of uncertainty and continuing debate.Objectives: The current study aimed to define improved risk-thresholds specifically tailored to the complex nature of sMR that provide a unifying solution to the ongoing guideline-controversy.Methods: This study enrolled 423 heart failure patients under guideline-directed medical therapy and assessed sMR by effective regurgitant orifice area (EROA), regurgitant volume (RegVol), and regurgitant fraction (RegFrac).Results: Measures of sMR severity were consistently associated with 5-year mortality with a hazard ratio of 1.42 for a 1-SD increase (95% confidence interval [CI]: 1.25 to 1.63; p < 0.001) for EROA, 1.37 (95% CI: 1.20 to 1.56; p < 0.001) for RegVol, and 1.50 (95% CI: 1.30 to 1.73; p < 0.001) for RegFrac. Results remained statistically significant after bootstrap- or clinical confounder-based adjustment. Spline-curve analyses showed a linearly increasing risk enabling the ability to stratify into low-risk (EROA <20 mm2 and RegVol <30 ml), intermediate-risk (EROA 20 to 29 mm2 and RegVol 30 to 44 ml), and high-risk (EROA ≥30 mm2 and RegVol ≥45 ml) groups. In the intermediate-risk group, a RegFrac ≥50% as indicator for hemodynamic severe sMR was associated with poor outcome (p = 0.017). A unifying concept based on combined assessment of the EROA, the RegVol, and the RegFrac showed a significantly better discrimination compared with the currently established algorithms.Conclusions: Risk-based thresholds tailored to the pathophysiological concept of sMR provide a unifying solution to the ongoing guideline controversy. An algorithm based on the combined assessment of the unifying cutoffs for EROA, RegVol, and RegFrac improves risk prediction compared with currently established grading. [ABSTRACT FROM AUTHOR]

Sacubitril/valsartan was shown to be effective in improving the clinical outcome and reducing hospitalization rate and mortality in patients with heart failure (HF) and reduced left ventricular ejection fraction (HFrEF). Here we report a case series of three patients with HFrEF associated with mitral insufficiency (case #1), dilated cardiomyopathy (case #2) and chronic ischaemia (case #3). The first case was a 49 year old male and the further two were 70 year old male patients. After previous ineffective treatment, the administration of sacubitril/valsartan led to a rapid and marked improvement of the clinical conditions in all three cases. Moreover, in two patients, angiotensin receptor-neprilysin inhibitor (ARNI) therapy avoided a surgical intervention for the insertion of an implantable cardioverter defibrillator. In the third patient, sacubitril/valsartan interrupted a long series of hospitalizations for acute HF. Based on our experience, we conclude that treatment with ARNI allows better treatment optimization with a positive impact on the control of HF and related comorbidities. [ABSTRACT FROM AUTHOR]

Current left ventricular assist devices (LVADs) differ with respect to their pump characteristics as described by the pump characteristic curve (also called HQ‐curve). Pressure sensitive LVADs depict a flat characteristic curve while most available LVADs have a steep, less pressure sensitive characteristic curve. This in vitro study investigated the effect of LVAD pressure sensitivity with a focus on the afterload of the right ventricle (RV) which is one out of many factors influencing right heart failure (RHF). To this end, two laboratory pumps differing in pressure sensitivity were tested as LVAD in an established, active mock circulation loop (MCL). The MCL represented patients with left heart failure and mitral insufficiency as another contributing factor to RV afterload. The results show that the pressure‐volume loop (PV‐loop) of the left ventricle (LV) undergoes a leftward and thus somewhat of a downward‐shift for highly pressure sensitive support. Consequently, the LV is unloaded to a higher degree at comparable arterial blood pressure and identical cardiac output, pulmonary and systemic vascular resistance and ventricular contractility. This causes a concomitant decrease of RV afterload. This effect seems to be due to increased unloading during systole. In case of a severe concomitant mitral insufficiency and looking at left atrial pressure, the difference is 18.5%. Without mitral insufficiency, the difference is reduced to 10.2%. [ABSTRACT FROM AUTHOR]

Mitral regurgitation (MR) occurs when any of the valve and ventricular mitral apparatus components are disturbed. As MR progresses, left ventricular remodelling occurs, ultimately causing heart failure when the enlarging left ventricle (LV) loses its conical shape and becomes globular. Heart failure and lethal ventricular arrhythmias may develop if the left ventricular end-systolic volume index exceeds 55 ml/m2. These adverse changes persist despite satisfactory correction of the annular component of MR. Our goal was to describe this process and summarize evolving interventions that reduce the volume of the left ventricle and rebuild its elliptical shape. This ‘valve/ventricle’ approach addresses the spherical ventricular culprit and offsets the limits of treating MR by correcting only its annular component. [ABSTRACT FROM AUTHOR]

Inflammatory substances such as interleukins (IL), tumor necrosis factor alpha (TNF-α) and C-reactive protein (CRP) have been demonstrated to play a role in heart failure progression. The aims of this study were two-fold: to investigate the concentration of circulating cytokines in dogs with myxomatous mitral valve disease (MMVD) in different stages, and to assess the relationship between these substances and cardiac morphology and function. For this purpose, twelve dogs with MMVD (7 stage-B2; 5 stage-C) and nine healthy controls underwent a transthoracic echocardiogram and had their serum concentrations of IL-1β, 4, 6, 10, TNF-α and CRP assessed. Data was submitted to Shapiro-Wilk normality test, groups were compared with ANOVA or Krukal-Wallis test according to distribution, and correlation coefficients were obtained with Spearman test. The IL-1β levels were different (P: 0.0056) between groups. Also, a positive correlation existed between IL-1β and left ventricular end-diastolic diameter (R: 0.56), left atrium-to-aorta ratio (R: 0.63) and echocardiography congestion surrogates. Similarly, IL-4 exhibited moderate-to-strong positive correlation with parameters of cardiac remodeling and congestion, while IL-6 was negatively correlated with the shortening fraction (R: -0.49). As the main conclusion, IL-1(3 levels increases in dogs with MMVD, and even higher levels are observed in overtly symptomatic animals. [ABSTRACT FROM AUTHOR]

Background Association between antiphospholipid syndrome in systemic lupus erythematosus ( SLE) and valvular heart disease ( VHD) is well reported, but relatively few studies have been carried out to establish the linkage between VHD and SLE itself. We aimed to investigate link between VHD and SLE and to evaluate the association of diverse factors with VHD among these patients in a large-scale population-based study. Materials and methods We used the databases of the largest state-mandated health service organization in Israel. All SLE patients were included ( n = 5018) as well as their age and sex-matched controls ( n = 25 090), creating a cross-sectional population-based study. Medical records of all subjects were analysed for documented VHD and the presence of antiphospholipid antibodies ( aPLs). A logistic regression model was carried out to evaluate the diverse factors including SLE and aPLs as independent risk factors for VHD. Results Valvular heart disease were found to be more frequent among SLE group when compared to controls (aortic stenosis, 1·08% vs. 0·35% respectively, P < 0·001; aortic insufficiency, 1·32% vs. 0·29% respectively, P < 0·001; mitral stenosis, 0·74% vs. 0·21% respectively, P < 0·001; mitral insufficiency, 1·91% vs. 0·39% respectively, P < 0·001). Male sex, hypertension, aPLs and SLE were found to be significant independent risk factors for VHD. Conclusion All VHD are more prevalent among SLE patients when compared to controls. SLE and aPLs are independent risk factor for VHD ( OR of 2·46 and 1·7, respectively). Physicians must be aware of such significant association, and routine echocardiography should be considered in SLE patients regardless of their aPL status. [ABSTRACT FROM AUTHOR]

Background and Aims The differential diagnosis of a right upper lobe pulmonary opacity in an elderly afebrile patient includes infectious and malignant etiology. However, unilateral lung edema should also be included in the differential diagnosis. Methods Case report of an 80-year-old afebrile patient who presented with cough, dyspnea and blood-tinged sputum and had an isolated right upper lobe infiltrate on chest X-ray on whom a diagnostic work-up including computed tomography scan of the chest and echocardiography was performed. Results Bilateral alveolar opacities and pleural effusions, not apparent on the chest X-ray, and a flail posterior leaflet with severe mitral valve regurgitation were revealed. His symptoms and findings responded to diuretic treatment. Conclusion Pulmonary edema should be considered in a patient with mitral valve regurgitation presenting with a unilateral lung infiltrate. Chest computed tomography scan findings consistent with heart failure and echocardiography demonstrating mitral valve regurgitation are the main clues to the diagnosis. Diuretic therapy should cause a rapid improvement of the radiologic and clinical findings. [ABSTRACT FROM AUTHOR]

In patients with relevant mitral regurgitation (MR), transcatheter edge-to-edge repair (also called Mitra-Clip) provides an alternative treatment option especially for inoperable or high-risk patients. In preparation for the procedure, echocardiography is the method of choice for assessment of mitral valve (MV) morphology and function and thus provides important information if successful treatment of MR can be accomplished by MitraClip. This review article provides structured and detailed guidance how to systematically assess functional and degenerative MR and MV pathology by echocardiography in order to select eligible patients for this procedure. Furthermore, it highlights state-of-the-art echocardiographic methods and potential pitfalls in patient selection. [ABSTRACT FROM AUTHOR]

Impedance cardiography (ICG) is a non-invasive tool for assessing the hemodynamic parameters. It has been used for diagnosing several cardiovascular diseases, such as heart failure, cardiomyopathy, and valvular diseases. Particularly, the valvular heart disease is characterized by the damage in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary valves. The mitral valve insufficiency and the aortic valve stenos are the most frequent valve diseases in the world. In this paper, we propose to diagnosis the mitral valve insufficiency using the impedance cardiography technique. The study group consisted of 40 subjects (20 control subjects and 20 patients with mitral insufficiency). A parameter "I" is calculated from the impedance cardiogram waveform and it is used to differentiate control subjects from patients with mitral insufficiency. The parameter "I" was related significantly to the abnormalities of the impedance cardiogram waveform. For patients with mitral insufficiency, "I" was higher than for the healthy subjects with a difference ratio of 89% (p<0.001). To improve the diagnosis, we determined the stroke volume, cardiac output, and other hemodynamic parameters for the two groups of subjects. Finally, we concluded that we could identify, easily, patients with mitral insufficiency based on the abnormalities of the impedance cardiogram tracings and a characteristic parameter "I". [ABSTRACT FROM AUTHOR]

The MitralClip (MC) is used for intervention therapy in serious mitral regurgitation. It is a metal implant with two arms, aimed at joining together the middle scallops of the mitral valve cusps and thus reduce the mitral mouth area, and thereby also the serious nature of mitral regurgitation. Surgery treatment of patients with isolated serious functional mitral insufficiency bears a high risk. The EVEREST II study confirmed that cardio-surgery for these patients is not superior to the intervention procedure. The less risky MC intervention can be more suitable in such cases and nevertheless also less effective. A successful intervention process depends on the quality of three-dimensional trans-esophageal echo-cardiography (3D TEE). Development of 3D TEE hardware and software will enable further improvement of MC methodology. This overview article related to intervention therapy of mitral insufficiency with MC is aimed at providing the latest information to readers. [ABSTRACT FROM AUTHOR]

Background: In EVEREST II (Endovascular Valve Edge-to-Edge Repair Study), treatment of mitral regurgitation (MR) with a novel percutaneous device showed superior safety compared with surgery, but less effective reduction in MR at 1 year.Objectives: This study sought to evaluate the final 5-year clinical outcomes and durability of percutaneous mitral valve (MV) repair with the MitraClip device compared with conventional MV surgery.Methods: Patients with grade 3+ or 4+ MR were randomly assigned to percutaneous repair with the device or conventional MV surgery in a 2:1 ratio (178:80). Patients prospectively consented to 5 years of follow-up.Results: At 5 years, the rate of the composite endpoint of freedom from death, surgery, or 3+ or 4+ MR in the as-treated population was 44.2% versus 64.3% in the percutaneous repair and surgical groups, respectively (p = 0.01). The difference was driven by increased rates of 3+ to 4+ MR (12.3% vs. 1.8%; p = 0.02) and surgery (27.9% vs. 8.9%; p = 0.003) with percutaneous repair. After percutaneous repair, 78% of surgeries occurred within the first 6 months. Beyond 6 months, rates of surgery and moderate-to-severe MR were comparable between groups. Five-year mortality rates were 20.8% and 26.8% (p = 0.4) for percutaneous repair and surgery, respectively. In multivariable analysis, treatment strategy was not associated with survival.Conclusions: Patients treated with percutaneous repair more commonly required surgery for residual MR during the first year after treatment, but between 1- and 5-year follow-up, comparably low rates of surgery for MV dysfunction with either percutaneous or surgical therapy endorse the durability of MR reduction with both repair techniques. (EVEREST II Pivotal Study High Risk Registry; NCT00209274). [ABSTRACT FROM AUTHOR]

Apoptosis occurs in atrial cardiomyocytes in mitral and tricuspid valve disease. The purpose of this study was to examine the respective roles of the mitochondrial and tumor necrosis factor-α receptor associated death domain (TRADD)-mediated death receptor pathways for apoptosis in the atrial cardiomyocytes of heart failure patients due to severe mitral and moderate-to-severe tricuspid regurgitation. This study comprised eighteen patients (7 patients with persistent atrial fibrillation and 11 in sinus rhythm). Atrial appendage tissues were obtained during surgery. Three purchased normal human left atrial tissues served as normal controls. Moderately-to-severely myolytic cardiomyocytes comprised 59.7 ± 22.1% of the cardiomyocytes in the right atria and 52.4 ± 12.9% of the cardiomyocytes in the left atria of mitral and tricuspid regurgitation patients with atrial fibrillation group and comprised 58.4 ± 24.8% of the cardiomyocytes in the right atria of mitral and tricuspid regurgitation patients with sinus rhythm. In contrast, no myolysis was observed in the normal human adult left atrial tissue samples. Immunohistochemical analysis showed expression of cleaved caspase-9, an effector of the mitochondrial pathways, in the majority of right atrial cardiomyocytes (87.3 ± 10.0%) of mitral and tricuspid regurgitation patients with sinus rhythm, and right atrial cardiomyocytes (90.6 ± 31.4%) and left atrial cardiomyocytes (70.7 ± 22.0%) of mitral and tricuspid regurgitation patients with atrial fibrillation. In contrast, only 5.7% of cardiomyocytes of the normal left atrial tissues showed strongly positive expression of cleaved caspase-9. Of note, none of the atrial cardiomyocytes in right atrial tissue in sinus rhythm and in the fibrillating right and left atria of mitral and tricuspid regurgitation patients, and in the normal human adult left atrial tissue samples showed cleaved caspase-8 expression, which is a downstream effector of TRADD of the death receptor pathway. Immunoblotting of atrial extracts showed that there was enhanced expression of cytosolic cytochrome c, an effector of the mitochondrial pathways, but no expression of membrane TRADD and cytosolic caspase-8 in the right atrial tissue of mitral and tricuspid regurgitation patients with sinus rhythm, and right atrial and left atrial tissues of mitral and tricuspid regurgitation patients with atrial fibrillation. Taken together, this study showed that mitochondrial pathway for apoptosis was activated in the right atria in sinus rhythm and in the left and right atria in atrial fibrillation of heart failure patients due to mitral and tricuspid regurgitation, and this mitochondrial pathway activation may contribute to atrial contractile dysfunction and enlargement in this clinical setting. [ABSTRACT FROM AUTHOR]

Mitral regurgitation secondary to accessory mitral valve (MV) chordae of the left atrium is an extremely rare congenital disease. A 85‐year‐old female (NYHA I–II) was hospitalized for investigations. An echocardiogram showed calcification of the MV with mild stenosis and moderate regurgitation. Transesophageal three‐dimensional echocardiogram revealed a band‐like structure extending from the distal third of the anterior wall of the left atrium to the MV. This accessory chordae determined severe systolic regurgitation and mild mitral stenosis. The patient was referred for consideration of cardiac surgery but was refused for comorbidities and anatomy. Usually aberrant chordae determinant valvulopathies are detected and treated at a much younger age. The delay of the symptoms could be explained in our case with the progressive growth and dilatation of the left atrium causing traction of the aberrant chord resulting in an increase in the leaflet prolapse and regurgitation. [ABSTRACT FROM AUTHOR]

Giant or Himalayan P waves are tall and peaked, the most prominent in lead II, and generally indicate enlargement of the right atrium. It has been rarely seen in clinical practice. The mechanism of Himalayan P wave formation is most likely related with prolonged conduction of electrical impulses through the enlarged right atrium. We describe the case of a patient with Himalayan P wave admitted for cardiac surgery. [ABSTRACT FROM AUTHOR]

Congenital defects involving anomalous chordae of the mitral valve with attachment in the left atrium are an extremely rare finding and may result in valvular insufficiency. Few cases have been reported in the literature with multiple variations in anatomical location and insertion of aberrant chordae within the left ventricle and left atrium. Reported cases have presented with cardiovascular symptoms leading to diagnosis of anomalous mitral valve chordae. We present a case of a young female in which an aberrant mitral valve chorda was an incidental finding on transesophageal echocardiography. [ABSTRACT FROM AUTHOR]

A 66‐year‐old woman with a history of exertional chest pain was admitted to our hospital. Transthoracic echocardiography displayed an ejection fraction of 71% without regional wall‐motion abnormalities. Transesophageal echocardiography revealed severe mitral regurgitation due to prolapse of P2 scallop with posteromedial papillary muscle (PPM) rupture. Coronary angiography showed 90% stenosis in the left circumflex artery (LCx), and myocardial ischemia without infarction in the lateral wall was observed by means of stress scintigraphy. The surgical inspection and histological finding confirmed diagnosis of P2 scallop prolapse with partial PPM rupture. PPM rupture due to only myocardial ischemia was extremely rare. [ABSTRACT FROM AUTHOR]

Summary Hammock mitral valve is a very rare congenital valve disorder. It may lead to mitral stenosis or insufficiency in the pediatric age group. These patients generally present with the symptoms of congestive heart failure or sometimes sudden death may occur. Our case was a three-month-old female infant who presented to our clinic with the symptoms of heart failure. Her cardiac evaluation revealed hammock mitral valve, left atrial dilatation, severe mitral valve insufficiency and atrial flutter. In contrast to adult patients, atrial flutter is a very rare type of cardiac aryhtmia in the pediatric age group. We present this case, because no such a case with atrial flutter resulting from hammock mitral valve has been reported in the literature. [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]

The prevalence of valvular heart disease is increasing as the population ages. In diagnosing individuals with valve disease, echocardiography is the primary imaging modality used by clinicians both for initial assessment and for longitudinal evaluation. However, in some cases cardiovascular magnetic resonance has become a viable alternative in that it can obtain imaging data in any plane prescribed by the scan operator, which makes it ideal for accurate investigation of all cardiac valves: aortic, mitral, pulmonic, and tricuspid. In addition, CMR for valve assessment is noninvasive, free of ionizing radiation, and in most instances does not require contrast administration. The objectives of a comprehensive CMR study for evaluating valvular heart disease are threefold: (1) to provide insight into the mechanism of the valvular lesion (via anatomic assessment), (2) to quantify the severity of the valvular lesion, and (3) to discern the consequences of the valvular lesion [ABSTRACT FROM AUTHOR]

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]

OBJECTIVES Ischaemic mitral valve regurgitation is associated with a significant reduction in survival and its treatment in patients undergoing surgical ventricular reconstruction is usually associated with higher perioperative morbidity and mortality. We evaluated our 11-year experience in this cohort of patients. METHODS Between January 2000 and December 2010, a total of 282 patients underwent surgical ventricular reconstruction, of which 45 (16%) had concomitant mitral valve surgery. The data was retrospectively analyzed to identify variables that could predict early mortality. RESULTS Overall in-hospital mortality was 6.4% (n = 18), of which 5.1% (n = 12) occurred in patients undergoing surgical ventricular reconstruction and 13.3% (n = 6) in patients undergoing surgical ventricular reconstruction + mitral valve surgery (P = 0.05). Patients undergoing surgical ventricular reconstruction + mitral valve surgery had poorer LV function (P < 0.01) and advanced NYHA class IV symptoms (P = 0.02) compared with patients undergoing surgical ventricular reconstruction. These patients had a higher requirement for postoperative inotropic (P < 0.01) and IABP support (P < 0.01) and were more likely to suffer from low cardiac output syndrome (P < 0.01). In patients undergoing surgical ventricular reconstruction + mitral valve surgery, 34 patients had mitral valve repair and 11 patients had mitral valve replacement. The mortality was 17.6% (n = 6) vs 0% (P = 0.31) in the mitral valve repair vs mitral valve replacement groups, respectively. The cohort of patients undergoing surgical ventricular reconstruction + mitral valve repair had poorer LV function and more advanced symptoms. CONCLUSIONS Patients undergoing surgical ventricular reconstruction have excellent early outcomes. However, there are patients that are at an increased operative risk, such as those with concomitant ischaemic mitral regurgitation that might be better served with other surgical modalities, such as ventricular assist device or heart transplantation. The suggested algorithm based on current evidence provides a stepwise approach when dealing with patients with ischaemic mitral regurgitation ± left ventricular remodelling. [ABSTRACT FROM AUTHOR]

The author reflects on the importance of the surgical ventricular restoration (SVR) in treating ischemic dilated cardiomyopathy. He cites the study conducted by Y. Cho and colleagues that explores the long-term results and mid-term features of the procedures that exemplify its significance to treat patients with ischaemic dilated cardiomyopathy. Its impact in remarkably changing the morbidity and mortality rates of ischaemic dilated cardiomyopathy is also highlighted.

Abstract: We present here the first literature description of a predominantly cardiac phenotype in a patient homozygous for missense mutation p.R152W in the N-acetylogalactosamine-4-sulfatase (arylsulfatase B, ARSB) gene. An adult Caucasian woman, who displayed very few symptoms up to her late thirties, was diagnosed with mucopolysaccharidosis type VI (MPS VI) after her hospitalization due to acute heart failure originating mainly from valve disease. In addition to her cardiac phenotype some musculoskeletal involvement without other MPS characteristic features were found. Despite the common pharmacologic treatment and implementation of enzyme replacement therapy with galsulfase the patient died at the age of 38years because of decompensation of chronic heart failure. [Copyright &y& Elsevier]

Aortic stenosis and mitral regurgitation are the most common valvular diseases in western countries. Surgical treatment, aortic valve replacement or mitral valve repair, is the treatment of choice. Innovative technologies could offer an alternative therapeutic option to the patients with increased operative risk. This article will report the early experience with these promising techniques as presented at the High-Tech 2004 meeting. [Copyright &y& Elsevier]

The right preoperative assessment of mitral valve insufficiency is essential for a successful therapy. But although significant progress has been made in the visualization and quantification of the regurgitant flow, clinicians may still misinterpret the severity of the insufficiency, particularly in rather light cases. In order to provide more reliable information, we aim to generate full 4D flow visualization from phase-contrast MRI data. In this paper, we present—as a first step—an analysis of the velocity field obtained from a particular MRI sequence. We acquire data from a small series of six pigs with surgically induced mitral insufficiency, which is subsequently noise filtered and transformed into a velocity field dataset. For analysis we use echocardiography-like red/blue velocity representations as well as 2D and 3D arrow (quiver) plots. We obtain clear and distinct flow patterns for both physiological and pathological flow. However, 3D representations require further pre-processing in order to reveal useful information. We conclude that MRI sequences measuring full 4D velocity fields are well suited for the analysis of mitral regurgitant flow. [Copyright &y& Elsevier]

Methylsergide maleate, an effective anti-migraine medication, has a well-documented association with left-sided cardiac valve dysfunction. Prior reports have described cardiac valve dysfunction in patients using methylsergide chronically for a minimum of 6 years, with surgical intervention consisting of valve replacement for patients with intractable congestive heart failure. We report a 51-year-old woman who developed severe mitral and aortic valvular dysfunction after taking methylsergide maleate for migraine headaches for a period of 19 months, and who subsequently underwent aortic and mitral valve repair with excellent short-term results. (ECHOCARDIOGRAPHY, Volume 20, April 2003). [ABSTRACT FROM AUTHOR]

Background: In patients who underwent transaortic myectomy for hypertrophic obstructive cardiomyopathy (HOCM), we evaluated the role of concomitant procedures for short and long term outcome. Methods: From 1985 to 2000, in 125 patients a myectomy according to Morrow was performed. A total of 75 patients (group I) had isolated HOCM: 37 females, 38 males, mean age 52.1 years (14–79). The 50 patients of group II – 22 females, 28 males, mean age 62.4 years (36–77)-had concomitant procedures: coronary artery bypass grafting (36), mitral valve repair (15), DeVega-plasty (1), ventricular septal infarction-closure (1). Follow-up data of a total of 680.9 years (mean 5.4) were analyzed. Results: Postoperatively, left ventricular outflow tract gradients at rest and after ventricular premature beats were significantly reduced (P<0.001). Mean performance of survivors (112/125=89.6%) improved significantly (P<0.001). Perioperative complication rates: 10.7/12.0% (groups I/II), early lethality: 1.3/2.0%. Survival rates after 5/10 years were 93±3/87±6 and 80±7/80±7% for groups I and II, respectively. Conclusion: Long term results after surgical treatment of HOCM are convincing also if concomitant procedures are performed. [Copyright &y& Elsevier]

The coronary sinus ( CS) has become a clinically important structure especially through its role in providing access for different cardiac procedures such as arrhythmia ablation, biventricular pacing and recently, percutaneous valvular interventions. Fluoroscopy with or without two-dimensional transesophageal echocardiography is the widely used method for guidance. A 78-year-old female patient undergoing percutaneous CARILLON mitral annuloplasty device therapy for chronic severe symptomatic mitral regurgitation. After insertion of the CS catheter through the right internal jugular vein, multiple trials for CS cannulation guided by fluoroscopy and two-dimensional transesophageal echocardiography were unsuccessful. So, real time three-dimensional zoom mode was used. Then, the volume was rotated to have the anatomically oriented enface view of the interatrial septum from the right atrial perspective. The CS ostium was identified adjacent to the eustachian valve. Then the catheter was reintroduced through the superior vena cava into the right atrium then easily navigated to cannulate the CS ostium. The position was confirmed by the fluoroscopically known course of the CS plus the pattern of the invasive pressure wave form. CS cannulation is not always feasible using fluoroscopy and/or two-dimensional Echocardiography guidance. Real time three-dimensional transesophageal echocardiography can be used to guide CS cannulation as it provides an anatomically oriented and informative enface view of the CS ostium. It can help reducing fluoroscopic radiation time. [ABSTRACT FROM AUTHOR]

Background: Auscultation of patients with mitral annular calcification on echocardiography revealed a particular constellation of findings.Objective: To test the hypothesis that a particular auscultatory constellation provides a high degree of certainty in diagnosing the combination of mitral annular calcification and aortic sclerosis so often found in the elderly.Methods: Two groups of patients were studied to evaluate the particular auscultatory constellation under consideration which consisted of: (1) a harsh ejection systolic murmur heard from the 2nd right interspace to the cardiac apex and usually loudest between the 3rd left interspace and the apex; (2) the murmur radiates from the apex towards the left axilla and radiates poorly or not at all from the 2nd right interspace to the neck, and (3) the 2nd heart sound at the cardiac base is normal in intensity, and no ejection clicks are present. Group 1 consisted of patients with mitral annular calcification on echocardiographic examination, and group 2 consisted of patients in whom the particular constellation of auscultatory findings was present and who were then referred for echocardiographic assessment.Results: The particular auscultatory constellation under investigation allowed the diagnosis of the presence of the combination of mitral annular calcification and aortic sclerosis with substantial accuracy.Conclusion: The findings in this exploratory study suggest that the pathologic combination of mitral annular calcification and aortic sclerosis can be diagnosed with a reasonably high degree of certainty in elderly patients, if the particular auscultatory configuration is identified. [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]

Introduction: One of the most common causes of mitral chordae rupture is a myxomatous valve disease1,2 that causes acute volume overload and progressive heart failure. We present a patient with severe volume overload due to massive mitral regurgitation and acute glomerulonephritis. The key issue was to determine the precipitating event and which condition should be treated first. Case report: 60-year-old patient with known mitral valve prolapse (MVP) and mild mitral regurgitation (MR) presented himself in a local hospital as acute heart and renal failure. Two months prior hospitalization he had experienced intolerance to physical exertion, orthopnea, night sweats and fever up to 37.5 °C and has received antibiotics due to tonsillopharyngitis. At the time of admission, he was in functional NYHA IV status with acute nephritic syndrome that required intermittent hemodialysis. One week after, the patient was transferred to University Hospital Centre Zagreb in pulmonary edema, hemodynamically unstable, referred as a suspected endocarditis, although blood cultures were sterile. Three-dimensional transthoracic and transesophageal echocardiography revealed eccentric hypertrophy of the left ventricle with mild reduction of ejection fraction, left atrial enlargement (100ml), severe MR (regurgitant volume 65ml) from a ruptured chordae with complete inversion of the P1 (and prolapse of other segments). Vegetation as sign of endocarditis of the mitral were not found. Acute renal failure contributed to the volume overload of the left ventricle which caused a strain on the myxomatous mitral apparatus that primarily affected the chordae (Figure 1). Chordae rupture led to massive mitral regurgitation and acute heart failure. After initial stabilization, we tried to establish the cause of acute nephritic syndrome. Ultrasound examination of the kidneys found diffuse hyperechogenic thickening of the parenchyma. After serologic testing and renal biopsy, a rapidly progressive glomerulonephritis (GN) (pauci - immune cANCA positive) was diagnosed. Treatment included corticosteroid boluses, cyclophosphamide and plasmapheresis along with intermittent hemodialysis which significantly improved renal function so the patient was prepared for cardiac surgery. The patient underwent a mitral valve replacement with a mechanical valve. Postoperative period went uneventful, except paroxysmal atrial fibrillation successfully treated with electrocardioversion. Pathohistological analysis of the resected valve showed myxomatous degeneration without bacterial infiltration. A six months follow up revealed adequate patient recovery. Conclusion: Acute glomerulonephritis progressed into renal failure, severe volume overload caused chordae rupture of the previously myxomatously altered mitral valve with a consequent development of the “circulus vitiosus”. In order to preserve the renal and cardiac function, glomerulonephritis was treated first and after stabilization, cardiac surgery was performed with an excellent recovery of the patient. [ABSTRACT FROM AUTHOR]

Aberrant left atrial mitral valve chords are rare causes of mitral regurgitation (MR). An aberrant chord to the posterior mitral valve leaflet has not been reported. Transesophageal echocardiogram demonstrated a chord‐like structure from the left atrium to the middle (P2) scallop of the posterior mitral leaflet, causing focal P2 prolapse without typical myxomatous degeneration. Three‐dimensional images revealed that the chord terminated on a papillary muscle‐like structure within the left atrium. There was mild MR. Focal mitral leaflet prolapse without typical myxomatous change may herald the presence of an aberrant chord. [ABSTRACT FROM AUTHOR]

Abstract: Noncompaction of ventricular myocardium has been recognized as a distinct form of cardiomyopathy with its own clinical presentation and natural history. Concomitance of either valvular pathologies or complete atrioventricular block with noncompaction of ventricular myocardium has rarely been reported. Herein, we present a case with biventricular noncompaction with significant interventricular septum involvement presenting with complete atrioventricular block, who was formerly diagnosed to have mitral and aortic insufficiency. [Copyright &y& Elsevier]

Abstract: Background: Secondary mitral insufficiency is a strong risk factor for death in end-stage cardiomyopathy. The possible correction of mitral regurgitation has now been accepted as an alternative to cardiac transplantation in a special subset of patients. We propose a new surgical approach that consists of implantation of a mitral prosthesis that is smaller than the annulus, and preservation and traction of the papillary muscles to reduce sphericity of the left ventricle. Methods: Between December 1995 and September 2005, 116 patients with dilated cardiomyopathy underwent this procedure, with the following etiologic factors: ischemic (68), idiopathic (43), Chagas disease (3), viral (1), and postpartum (1). The patients were analyzed according to clinical criteria, echocardiographic findings, and morphology of left ventricle. Results: All patients were in an end-stage phase, requiring >2 hospital admissions over the past 3 months, despite receiving full medication. Furthermore, seven were in intensive care unit receiving intravenous drugs or intra-aortic balloon counterpulsation, and one was in cardiogenic shock. Hospital mortality was 16.3% (19/116), yet midterm follow-up showed a relatively flat late survival curve, with evidence of improved clinical status, better echocardiographic parameters, and reduction in ventricular sphericity. Conclusions: The high early mortality rate related to other clinical conditions at the time of surgery. However, the resultant flat survival after this early interval offers a promising long-term therapeutic alternative for the treatment of patients in refractory heart failure with cardiomyopathy that is associated with moderate or severe secondary mitral regurgitation. [Copyright &y& Elsevier]

Abstract: Cardiac lesions after blunt thoracic trauma are usually observed in two different clinical situations: during salvage thoracotomy or autopsy studies, then it is the rupture of the cardiac wall responsible for sudden death. Just after a trauma or later, because some of these injuries could be well tolerated temporarily or for a long time: myocardial contusion, valve lesion, ventricular septal rupture, pericardial rupture or coronary artery injury. These injuries are rare and could be associated together. They are usually due to traffic accidents and are consecutive to three mechanisms: direct trauma, indirect due to deceleration and hydraulic shock. They could be masked by other lesion especially during polytrauma, and it is mandatory to search then systematically during major trauma. [Copyright &y& Elsevier]