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Background: Mitral valvuloplasty (MVP) is a surgical procedure for treating severe mitral regurgitation in dogs. Although MVP is considered highly invasive, the extent of myocardial injury, postoperative complications, and recovery has not been evaluated. Aim: This study examined the degree of MVP invasiveness, the extent of myocardial damage, postoperative complications, cardiomyocyte recovery, and timing of hospital discharge. Methods: Cardiac troponin I (cTnI) was used to investigate the myocardial damage caused by cardiac arrest associated with a surgical approach to the myocardium in 13 patients with MVP and 5 controls with patent ductus arteriosus who underwent similar anesthesia and thoracotomy. Results: The level of cTnI peaked 1 day after surgery and was significantly higher in the MVP group (median, 19.90 ng/mL) than in control group (median, 1.50 ng/mL P < 0.001). At day 7, the cTnI level was significantly higher in the MVP group (1.9 ng/mL) than in control group (0.1 ng/mL) (P < 0.001), and recovery to the preoperative level took 10 days in the MVP group but returned to the preoperative level at day 7 in control group. Although the mean arterial pressure of cardiopulmonary bypass at the time of use was 42.92 mmHg, the peak cTnI levels in the two patients who exhibited a temporary decrease of 20 mmHg or less (46.03 ng/mL) were significantly higher than in the other 11 patients (19.70 ng/mL) (P < 0.05). Preoperative cTnI levels were correlated with the severity of postoperative complications (P = 0.03, F = 0.71). Conclusion: The results showed that MVP caused temporary greater myocardial tissue damage than thoracotomy, but postoperative recovery was smoother. A high preoperative cTnI level requires relatively more careful postoperative management, and measuring the level of cTnI over time after surgery can provide information about the extent of myocardial damage and recovery from surgery and help determine the time of discharge. [Open Vet J 2024; 14(7.000): 1625-1633]

Background: Moderate/severe aortic regurgitation (AR) with concomitant mitral regurgitation (MR) is a common multiple valve disease for which treatment strategies are controversial. The current study explored long-term outcomes of concomitant MR after AR surgery and the effect of combined mitral valvuloplasty. Methods: A total of 506 patients with moderate/severe AR and concomitant MR undergoing aortic valve surgery between January 2013 and December 2021 in our cardiac center were enrolled. Risk factors for early mortality, late mortality and persistent MR were identified by logistic regression and generalized linear mixed model. Results: At least one follow-up record was available for 96.3% patients up to May 2022 and 264 (66.8%) patients had no or trivial MR, 112 (28.4%) had mild MR, 16 (4.1%) had moderate MR and 3 (0.8%) patients had severe MR. Persistent MR was recorded for 92 (23.3%) patients during follow-up. Combined mitral valvuloplasty (odds ratio: 0.23; 95% confidential interval: 0.08–0.64; p = 0.005) and better left ventricular reverse remodeling (odds ratio: 0.99; 95% confidential interval: 0.986–0.996); p < 0.001) were found likely to reduce the possibility of persistent MR during follow-up. Conclusions: Most patients with moderate/severe AR and concomitant MR had a good long-term post-surgical outcome for MR. However, a few had persistent MR during follow-up. Combined mitral valvuloplasty and better left ventricular reverse remodeling reduced the possibility of long-term persistent MR. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the structure of the mitral valve in patients undergoing mitral valvuloplasty (MVP) using real‐time three‐dimensional transesophageal echocardiography (RT‐3D‐TEE). The main objective was to study the relationship between intraoperative annuloplasty ring size and mitral valve structure dimensions, with a focus on exploring the application value of RT‐3D‐TEE in MVP. Methods: A total of 28 patients with degenerative mitral regurgitation (DMR), who underwent MVP between February and September 2022, as well as 12 normal control cases, were enrolled in this study. The MV annulus and leaflets were quantitatively analyzed using MVN software. Results: The DMR group exhibited significantly greater dimensions in various parameters of the mitral valve, including the anterolateral‐to‐posteromedial diameter (DAlPm), anterior‐to‐posterior diameter (DAP), annulus height (HA), three‐dimensional annulus circumference (CA3D), two‐dimensional annulus area (AA2D), anterior leaflet area (Aant), posterior leaflet area (Apost), anterior leaflet length (Lant), posterior leaflet length (Lpost), and tenting volume (Vtent) compared to the control group. Conclusion: Real‐time three‐dimensional transesophageal echocardiography provides valuable insights into the morphological structure of the mitral valve and lesion location. It can aid in surgical decision‐making, validate the success of MVP, and potentially reduce mortality and complications associated with mitral valve repair procedures. [ABSTRACT FROM AUTHOR]

Abstract Objective This study aimed to investigate the structure of the mitral valve in patients undergoing mitral valvuloplasty (MVP) using real‐time three‐dimensional transesophageal echocardiography (RT‐3D‐TEE). The main objective was to study the relationship between intraoperative annuloplasty ring size and mitral valve structure dimensions, with a focus on exploring the application value of RT‐3D‐TEE in MVP. Methods A total of 28 patients with degenerative mitral regurgitation (DMR), who underwent MVP between February and September 2022, as well as 12 normal control cases, were enrolled in this study. The MV annulus and leaflets were quantitatively analyzed using MVN software. Results The DMR group exhibited significantly greater dimensions in various parameters of the mitral valve, including the anterolateral‐to‐posteromedial diameter (DAlPm), anterior‐to‐posterior diameter (DAP), annulus height (HA), three‐dimensional annulus circumference (CA3D), two‐dimensional annulus area (AA2D), anterior leaflet area (Aant), posterior leaflet area (Apost), anterior leaflet length (Lant), posterior leaflet length (Lpost), and tenting volume (Vtent) compared to the control group. Conclusion Real‐time three‐dimensional transesophageal echocardiography provides valuable insights into the morphological structure of the mitral valve and lesion location. It can aid in surgical decision‐making, validate the success of MVP, and potentially reduce mortality and complications associated with mitral valve repair procedures.

Background: Pulmonary arterial wave reflection provides novel information about pulmonary artery hemodynamics in pulmonary hypertension (PH). PH is common in dogs with myxomatous mitral valve disease (MMVD), though research examining the relationship between pulmonary arterial wave reflection and MMVD with PH is lacking.Hypothesis/Objective: This study investigated conventional echocardiographic parameters and pulmonary artery wave reflection parameters before and after mitral valvuloplasty in canine patients with PH due to MMVD. The parameters were backward pressure (Pb), forward pressure (Pf), and the reflection coefficient calculated as the ratio of peak Pb to peak Pf (RC).Animals: The study subjects were 10 client-owned dogs receiving mitral valvuloplasty for MMVD with PH.Methods: Conventional echocardiographic parameters and pulmonary artery wave reflection parameters were measured before and after mitral valvuloplasty. The relationships between pulmonary artery wave reflection parameters and echocardiographic parameters, estimation of pulmonary artery systolic pressure, and right atrium pressure (RAP) gained by catheter in mitral valvuloplasty were also investigated. Post-operative echocardiography and the measurement of pulmonary arterial wave reflection were performed 2 weeks after mitral valvuloplasty.Results: The parameters of normalized left ventricular internal diameter at end-diastole (LVIDDN), E velocity, and the estimation of pulmonary artery systolic pressure were significantly reduced post-operatively compared with baseline measurements (p < 0.05). Post-operative Pb decreased significantly compared with pre-operative measurements (8.8 ± 5.9 to 5.0 ± 3.2 mmHg, p = 0.037) as did RC (0.37 ± 0.15 to 0.22 ± 0.11, p < 0.01). A statistically significant positive correlation existed between wave reflection parameters and RAP, an estimation of pulmonary artery systolic pressure.Conclusions: Results demonstrate that mitral valvuloplasty can be used to treat secondary PH caused by MMVD, resulting in the improvement of post-operative echocardiographic and wave reflection parameters and a decrease in the right afterload. In some patients, some degree of vascular admittance mismatch persisted, despite the improvement of left atrial pressure. This may be indicative of residual pulmonary arterial disease, which may continue to adversely affect interactions between the right ventricle and the vasculature.

Background: Mitral valvuloplasty (MVP) is a surgical procedure for treating severe mitral regurgitation in dogs. Although MVP is considered highly invasive, the extent of myocardial injury, postoperative complications, and recovery has not been evaluated., Aim: This study examined the degree of MVP invasiveness, the extent of myocardial damage, postoperative complications, cardiomyocyte recovery, and timing of hospital discharge., Methods: Cardiac troponin I (cTnI) was used to investigate the myocardial damage caused by cardiac arrest associated with a surgical approach to the myocardium in 13 patients with MVP and five controls with patent ductus arteriosus (PDA) who underwent similar anesthesia and thoracotomy., Results: The level of cTnI peaked 1 day after surgery and was significantly higher in the MVP group (median, 19.90 ng/ml) than in the control group (median, 1.50 ng/ml p < 0.001). At day 7, the cTnI level was significantly higher in the MVP group (1.9 ng/ml) than in the control group (0.1 ng/ml) ( p < 0.001), and recovery to the preoperative level took 10 days in the MVP group but returned to the preoperative level at day 7 in the control group. Although the mean arterial pressure of cardiopulmonary bypass (CPB) at the time of use was 42.92 mmHg, the peak cTnI levels in the two patients who exhibited a temporary decrease of 20 mmHg or less (46.03 ng/ml) were significantly higher than in the other 11 patients (19.70 ng/ml) ( p < 0.05). Preoperative cTnI levels were correlated with the severity of postoperative complications ( P = 0.03, F = 0.71)., Conclusion: The results showed that MVP caused temporary greater myocardial tissue damage than thoracotomy, but postoperative recovery was smoother. A high preoperative cTnI level requires relatively more careful postoperative management, and measuring the level of cTnI over time after surgery can provide information about the extent of myocardial damage and recovery from surgery and help determine the time of discharge., Competing Interests: The authors declare that there is no conflict of interest.

Objective: To investigate whether tendon reconstruction during mitral valve repair can be effectively guided by transesophageal echocardiography (TEE), using the mid-esophageal bi-commissure view, bicaval view and the aortic valve–mitral valve transition short-axis view.Methods: A total of 40 patients that underwent mitral valve repair with artificial tendineae were recruited. Before the operation, conventional transthoracic echocardiography was used to determine whether mitral valve repair would be possible. Following intraoperative anesthesia, two-dimensional and three-dimensional TEE reconstructions were used to assess the state of the valve and tendon and to make a repair plan.Results: TEE accurately diagnosed single functional tendon rupture and predicted single artificial tendon implantation in 88% of cases (23/26). TEE accurately diagnosed single functional tendon rupture and predicted the implantation of two artificial tendons in 100% of cases (4/4). TEE accurately diagnosed two or more functional tendon ruptures and predicted the implantation of two artificial tendons in 100% of cases (5/5). The length of the tendon cord predicted by TEE (2.45 ± 0.15 mm) was not significantly different (P > 0.05) from the length of the cord that was actually implanted (2.31 ± 0.11 mm). TEE also accurately predicted the size of the annuloplasty ring in 86% of cases (33/38), with differences of 2 mm or less compared to the size of the ring that was actually implanted.Conclusion: Both the mid-esophageal bi-commissure view, bicaval view and the short-axis view of the aortic valve–mitral valve transition can reduce the difficulty of tendon reconstruction by helping to determine what length of tendon and what size of artificial annulus are required.

Cardiac surgery using cardiopulmonary bypass (CPB) generates severe inflammatory reactions secondary to hemodilution and surgical stress. This study was conducted to evaluate whether modified ultrafiltration (MUF) could be performed safely and to clarify its effects during mitral valve repair in dogs in terms of hemodilution and the status of inflammatory cytokines. We retrospectively studied 38 dogs with mitral valve disease who underwent MUF immediately after mitral valve repair under CPB. To determine the effect of MUF, we measured the pre- and post-MUF blood dilution and blood cytokine levels. The levels of red blood cells, hematocrit (HCT), and albumin were significantly increased after MUF, whereas interleukin (IL)-6 levels were significantly increased from 24.3 (range 9.6–54.6) to 32.3 (15.9–65.1) pg/ml. The levels of IL-8 and IL-10 declined significantly after MUF, from 368.2 (246.1–669.4) and 45.4 (28.6–76.1) to 272.2 (174.1–414.4) and 28.8 (18.8–44.5) pg/ml, respectively. Our results demonstrated that MUF can be applied in dogs undergoing CPB and is effective in achieving hemoconcentration. Moreover, MUF may be useful for the removal of cytokines. Further studies are needed to validate these findings and clarify the effects of inflammatory cytokines after CPB. [ABSTRACT FROM AUTHOR]

Introduction: The current study was sought to assess the immediate effect of percutaneous balloon mitral valvuloplasty (PBMV) on right ventricular (RV) and pulmonary functions using speckle tracking echocardiography (STE) and spirometry respectively. Methods: Two-dimensional speckle tracking and doppler studies for strain and strain rate imaging of RV were performed before PBMV, after 48h and 15 days of PBMV using echocardiography and spirometry. Mitral valve area, peak and mean mitral valve transannular pressure gradients, late filling velocities, Wilkins score, Systolic pulmonary artery pressure, TAPSE, RV end-diastolic and end-systolic areas, RV fractional area change and Tei index were measured. Results: There was a significant rise in peak RV global longitudinal strain (GLS) from baseline to 48h post PBMV and at 15 days post PBMV. Segmental RV strain at basal septum, mid septum, apical septum and basal RV free wall showed considerable improvement from baseline to 48h post PBMV and 15 days post PBMV. RV longitudinal strain rate parameters did not show significant improvement after PBMV and remained low at follow-up. Post PBMV all patients showed restrictive features on pulmonary function test. The mean FEV1 (% predicted), mean FVC (% predicted), mean PEFR improved from baseline to 48h PBMV and 15 days post PBMV. Though the mean FEV1/FVC increased post PBMV at 15 days follow-up, but it was statistically insignificant. Conclusion: RV performance in MS was decreased mainly due to increase in RV afterload which improves after PBMV. Patients with severe MS have impaired pulmonary function which is of restrictive type and successful PBMV improves pulmonary function. [ABSTRACT FROM AUTHOR]

Background/aim: This study aimed to evaluate the effect of successful percutaneous mitral balloon valvuloplasty (PMBV) on left ventricular systolic functions using strain and strain rate echocardiography in moderate-severe mitral stenosis (MS) patients with normal left ventricular systolic function confirmed by conventional echocardiography. Materials and methods: Patients with moderate-severe MS who had undergone successful PMBV were included. Conventional echocardiographic parameters were evaluated before and after PMBV. Peak systolic strain and strain rate values of basal, mid, and apical segments of the left ventricular anterior, inferior, septum, and lateral walls were determined. Results: After PMBV, significant decreases were determined in the peak and mean gradients of the mitral valve and pulmonary artery pressure, but a significant increase in the mitral valve area. Significant increases (improvement) were determined in the peak systolic strain and strain rate in the basal, mid, and apical segments of the left ventricular septum, lateral, anterior, and inferior walls and in the left ventricular global peak systolic strain (-17.32 ± 0.58% vs. -12.38 ± 1.06%) and strain rate (-1.65 ± 0.07 vs. -1.22 ± 0.12). Conclusion: Strain and strain rate echocardiography can be used for quantitative evaluation of the effect of PMBV on the left ventricular systolic functions in moderate-severe MS patients. [ABSTRACT FROM AUTHOR]

Data are limited on outcomes associated with mitral valve surgery in infants. Prior studies report high mortality and increased risk for late cardiac failure particularly for those with mitral stenosis. We sought to evaluate outcomes in patients with mitral stenosis (MS) or regurgitation (MR) who had mitral valvuloplasty or replacement in the first year of life. A retrospective analysis of all patients in a single institution who underwent mitral valvuloplasty or replacement in their first year of life from 2004 to 2016 (n = 25), excluding patients with single ventricle pathology or those undergoing surgery for atrioventricular canal defect, was carried out. Median age and weight at surgery were 76.5 days (range 2–329) and 4.5 kg (range 3.0–10.1), respectively. The primary mitral pathology was MR in 16 and MS in 9 patients. Median follow-up among living patients was 4 years (range 106 days–12.3 years). Overall survival was 96% at 30 days and 87.8% at 1, 5, and 10 years. There were three early deaths (12%), all within 6 weeks of surgery. There were no late deaths. Three patients required valve replacement, 1 of which had a primary mitral valve replacement and died within 30 days of surgery. Re-intervention-free survival (surgical and catheter based) was 83.8%, 73.3%, and 48.9% at 1, 5, and 10 years per Kaplan–Meier estimates. There was no difference in re-intervention-free survival between patients with MR versus MS. No risk factors for death or re-intervention were identified. Mitral valvuloplasty and replacement can be performed in infants under 1 year of age with acceptable survival and need for re-intervention. [ABSTRACT FROM AUTHOR]

Background: Pulmonary hypertension is a common complication of rheumatic mitral stenosis (MS). Patients with similar mitral valve (MV) areas may have different pulmonary artery pressures. Net atrioventricular compliance (Cn) was found to play an important role in the development of pulmonary hypertension. Aim: To test the value of Cn in predicting persistent pulmonary artery hypertension (PPAH) after percutaneous mitral balloon commissurotomy (PMBC). Patients and Methods: Eighty patients with severe MS, suitable for PMBC were included in the study. We excluded patients with contraindication to PMBC, atrial fibrillation, failure of PMBC, and restenosis. All patients had undergone electrocardiography, echocardiography with measurement of MV area, systolic pulmonary artery pressure (SPAP), and Cn, PMBC, and follow-up echocardiography. Results: Patients were divided into two groups: Group I: Cn

Objective: To investigate the clinical efficacy and safety of mitral valve plasty (MVP) and mitral valve replacement (MVR) in the treatment of severe mitral valvular closure. Methods: 60 patients with mitral valve plasty or mitral valve biological flap replacement were selected in our hospital from January 2014 to January 2019 due to severe closure of rheumatic mitral valve. There were 27 patients in the group (MVP group) and 33 patients in the mitral valve biopsy group (MVR group). The perioperative indicators of the two groups were compared, and the cardiac function indexes (left ventricular ejection fraction, left atrium diameter, left ventricular systolic end diameter, left ventricular diastolic end diameter) and mitral valve reflux were detected before and after treatment, and the postoperative complications were compared. Results: The operation time and extracorporeal circulation time of MVP group were longer than that in the MVR group (P<0.05), while the intraoperative blood loss, ventilator use time and hospitalization time were lower than that in the MVR group (P<0.05). Before operation, there was no significant difference in cardiac function between the two groups (P> 0.05). After operation, the LVEF and LVEDD levels in the MVP group were higher than that in the MVR group, while the LAD and LVESD levels were lower than that in the MVR group (P<0.05). The incidence of mitral valve reflux in the MVP group was not statistically significant compared with that in the MVR group before and at the last follow-up (P>0.05). The incidence of postoperative complications in the MVP group was lower than that in the MVR group (P<0.05). Conclusion: The clinical efficacy and safety of mitral valvuloplasty for the treatment of severe rheumatic mitral regurgitation is better than that of mitral valve bioprosthetic replacement, and the postoperative cardiac function and other indexes are better and have fewer complications. However, the surgeon must strictly control the surgical indications of MVP. [ABSTRACT FROM AUTHOR]

Acute severe mitral regurgitation (MR) is the commonest indication for emergency surgery following a balloon mitral valvuloplasty (BMV). It results in hemodynamic compromise with cardiogenic shock and or acute pulmonary edema. These patients deteriorate fast and often require respiratory and critical care support, followed by urgent mitral valve replacement (MVR). We analyzed the data of 1224 BMV procedures done over the 18-year period. We had 85 patients (6.9%) with acute severe MR and cardiogenic shock. The clinical profile, echocardiographic features and operative findings were studied. The echocardiography scores were compared for association with occurrence of MR. The immediate and long-term clinical outcomes of these acutely sick patients were studied. Of the 85 patients, 84 underwent MVR. Anterior mitral leaflet tear was observed in 65 (75%) cases, para-commissural with annular tear in 8 (9.4%), Chordal injury in 7 (8%) and torn posterior leaflet in 5 (5.8%). We documented severe MR in 88 patients (7.1%), with 85 (6.9%) among them developing features of cardiogenic shock. None of the echocardiographic scoring systems were predictive of the occurrence of MR. The 30-day mortality was 4.7%. The mean clinical follow-up period after discharge was 9.3 ± 0.9 years (range 2.2–17.8) with no late mortality. Acute severe MR had an incidence of 7% in this study. Injury to the anterior mitral leaflet was the commonest cause. The long-term outcomes were good with timely intervention and valve replacement surgery despite the fact that the majority (96%) presented with cardiogenic shock. None of the present valve scoring systems could predict the occurrence of severe MR. [ABSTRACT FROM AUTHOR]

Objective To investigate the short-term outcomes of coronary artery bypass grafting ( CABG) combined with mitral valvuloplasty ( MVP) in patients with moderate to severe ischemic mitral valve regurgitation ( IMR) and left ventricular enlargement. Methods Fifty-four selected patients were divided into three groups： group A ( mild) ： left ventricular end diastolic diameter ( LVEDD) 50-60 mm, (n = 16) ； group B ( moderate) ： LVEDD 60-70 mm, (n =30 )； group C ( severe) ： LVEDD greater than 70 mm, ( n =8). All patients were treated by CBAG + MVP at the same time with moderate-hypothermic cardiopulmonary bypass. The basic pathological changes of these three groups, such as cardiac function and coronary artery lesions before operation were compared. The clamp time, cardiopulmonary bypass time and recovery time of these three groups were recorded and compared. Echocardiography was performed for every patient before operation ,24 hours and 6 months after operation. The left ventricular end-diastolic diameter ( LVEDD)，left ventricular ejection fraction (LVEF) and mitral regurgitation area (MRA) were compared before and after operation. Meanwhile, the common complications of these three groups within 6 months after operation were compared. Results The incidence rate of left main and three vessel disease in the group C was higher than that in the groups A and B (P < 0. 05 ). The clamp time, recovery time，and cardiopulmonary bypass time in the group C were longer than that in the groups A and B (all P < 0. 05 ). The LVEDD of the group C was higher than that of group B and group A before operation and 24 hours after operation (P < 0. 01). The MRA of group C was higher than that of groups A and B before operation and 6 months after operation ( P < 0. 01). At 24 hours after operation, the LVEF of group C was lower than that of group A and group B (P < 0. 05 ). Conclusion We recommend CABG + MVP to IMR patients with moderate left ventricular enlargement, but the short-term results of CABG + MVP in IMR patients with severe left ventricular enlargement are not satisfied. [ABSTRACT FROM AUTHOR]

Julius I Ejiofor, Lawrence Cohn,† Tsuyoshi Kaneko Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA †Lawrence Cohn passed away on January 9, 2016 Abstract: Since the first mitral valvuloplasty in 1923, the technique of mitral valvuloplasty has matured over the years and now has become the first-line treatment, especially in patients with myxomatous mitral regurgitation (MR). We have highlighted some of the major problems that are encountered with the various etiologies of MR. We believe that repair is always the optimal surgical procedure for any of the above etiologies if it is consistent with a long-term result. However, replacement has shown to be a safer procedure in some instances such as severe functional MR or destructive endocarditis. Keywords: mitral regurgitation, mitral valvuloplasty, systolic anterior motion, functional mitral regurgitation, rheumatic valve disease

According to latest guidelines, percutaneous mitral commissurotomy (PMC) represents the first-line treatment for symptomatic severe mitral valve stenosis with favorable morphology. We report successful surgical treatment of a potential life-threatening complication occurred during PMC. Heart-team discussion and closed collaboration with centers are crucial for decision-making and cardiac surgery onsite should be ensured for high-risk procedures. [ABSTRACT FROM AUTHOR]

The EchoNavigator (EchoNav, Philips, The Netherlands) is a tool that fuses live X‐ray with three‐dimensional (3D) transesophageal echocardiogram (TEE) images allowing for enhanced precision and accuracy during interventional cardiac procedures. We present the first case of EchoNav utilization during balloon mitral valvuloplasty using the newest version (EchoNav 3.0.2). The benefits of the EchoNav application include improved procedural precision and safety due to improved demonstration of the relationship between the interventional equipment and neighboring cardiac structures. [ABSTRACT FROM AUTHOR]

Objective: Percutaneous balloon mitral valvuloplasty (PBMV) is the treatment of choice in patients with isolated mitral stenosis. This study aimed to assess the feasibility of PBMV under echocardiography guidance only of isolated mitral stenosis (MS). Methods: From October 2016 to Dec 2017, 20 consecutive patients with severe MS underwent PBMV with echocardiography as the only imaging modality at a single center. Outpatient follow‐up including chest radiography, electrocardiography, and transthoracic echocardiography was conducted at 1, 3,6, and 12 months after the procedure. Results: All 20 patients successfully underwent PBMV under echocardiography guidance without radiation and contrast agent. Among them, 2 patients were pregnant, 5 had chronic renal failure, and 1 had history of allergy to contrast. Mitral transvalvular pressure gradient measured at catheterization dropped from 13.35 ± 2.85 mm Hg to 5.10 ± 1.17 mm Hg (P < .01). Mitral valve area increased from 0.82 ± 0.10 cm2 pre‐PBMV to 1.88 ± 0.24 cm2 post‐PBMV (P < .01). Mean balloon diameter was 26.63 ± 0.93 mm. Mild mitral regurgitation developed in 6 patients. Mean follow‐up duration was 6.27 ± 3.12 months. At last follow‐up, mitral valve area remained high (1.71 ± 0.14 cm2) and mean transmitral pressure gradient low (6.07 ± 1.03 mm Hg). No pericardial effusion or peripheral vascular complications occurred. Conclusion: In this small experience, PBMV could be successfully performed under only echocardiography guidance and appeared safe and effective while avoiding radiation and contrast agent use. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical value of real-time three-dimensional transthoracic echocardiography for detecting the left atrium (LA) function in mitral valvuloplasty (MVR). Methods: The maximum volume of LA(LAVmax), minimum volume(LAVmin), systolic volume(LAVp) and ejection fraction(LAEF), passive ejection fraction(LAPEF) and active ejection fraction(LAAEF) of 87 cases of patients with mitral regurgitation (case group) were examined by real time three-dimensional transthoracic echocardiography respec­tively before and at 1 week and 24 weeks after MVR, and compared with 80 healthy volunteers in the same period. Results: The preoper­ative LAVmaxI, LAVminI, LAVpI, LAEF, LAPEF and LAAEF values between the case group and the control group were statistically signifi­cant (P<0.05), the LAVmaxI, LAVminI, LAVpI, LAEF and LAPEF values from MVR lw to 24w were continuously improvement (P<0.05), while the LAPEF values showed no obvious change (P>0.05). At 24 weeks postoperation, the proportion of severe LA dilatation de­creased from 58.6 % to 12.6 %, and LA remodeling was found 67.8 % cases. Conclusions: Real time three-dimensional transthoracic ech­ocardiography showed LA volume and functional improvement after MVR, which was of some value in evaluating the curative effect of MVR. [ABSTRACT FROM AUTHOR]

Background The native mitral lesion of active infective endocarditis implies a poor prognosis and is associated with adverse short- or long-term results without surgical treatment. Both mitral valvuloplasty (MVP) and mitral valve replacement (MVR) have been performed in the treatment of active native mitral infective endocarditis (ANMIE). However, the outcomes of the two approaches remain unclear. The aim of this study was to systematically review the two procedures with mortality and survival as the primary endpoints. Methods A systematic review of the literature was conducted to identify all relevant studies with comparative data on MVP versus MVR for the treatment of ANMIE. Information on baseline characteristics of patients, operation method, quality of literature, follow-up, and so forth was abstracted using standardized protocols. Pooled odds ratio (OR) or hazard ratio (HR) was calculated and possible publication bias was tested. Results Nine comparative observational studies with a total of 633 patients (MVP = 265, MVR = 368) were identified for qualitative assessment, data extraction, and analysis. The summary OR for operative mortality, comparing repair with replacement, was 0.37 (95% CI 0.0.18–0.80; p = 0.0005). Summary 1- and 5-year HRs for event-free survival were 0.43 (95% CI 0.20–0.92; p = 0.03) and 0.44 (95% CI 0.25–0.77, p = 0.004), respectively (repair vs. replacement). Summary 1- and 5-year survival HRs were 0.51 (95% CI 0.24–1.08; p = 0.08) and 0.55 (95% CI 0.32–0.96; p = 0.004), respectively (repair vs. replacement). No heterogeneity was revealed between studies, and possible publication bias was insignificant. Conclusions This meta-analysis suggests that MVP may be associated with superior postoperative survival outcomes compared with MVR. MVP is desirable, if possible, as a durable alternative to replacement. However, we must consider the influence of different patient characteristics and surgeons' preferences on the choice of surgical approach, and additional powered clinical trials will be required to confirm these findings. [ABSTRACT FROM AUTHOR]

Background Pulmonary hypertension is a common complication of rheumatic mitral stenosis (MS). Patients with similar mitral valve (MV) areas may have different pulmonary artery pressures. Net atrioventricular compliance (Cn) was found to play an important role in the development of pulmonary hypertension. Aim To test the value of Cn in predicting persistent pulmonary artery hypertension (PPAH) after percutaneous mitral balloon commissurotomy (PMBC). Patients and Methods Eighty patients with severe MS, suitable for PMBC were included in the study. We excluded patients with contraindication to PMBC, atrial fibrillation, failure of PMBC, and restenosis. All patients had undergone electrocardiography, echocardiography with measurement of MV area, systolic pulmonary artery pressure (SPAP), and Cn, PMBC, and follow-up echocardiography. Results Patients were divided into two groups: Group I: Cn < 4.2 mL/mmHg (36 patients), Group II: Cn ≥ 4.2 mL/mmHg (44 patients). Group I patients had significantly higher SPAP, and significantly lower SPAP reduction. Sensitivity of Cn < 4.2 mL/mmHg in prediction of PPAH was 88.9%, specificity was 88.6%, and accuracy was 88.8%. Independent predictors for PPAH were baseline Cn ( p = 0.0027), and Cn improvement after PMBC ( p = 0.0085). There was a significant negative correlation between Cn and baseline SPAP ( r = −0.349, p = 0.0015), and a significant positive correlation between Cn and percent SPAP reduction ( r = 0.617, p < 0.00001). Conclusion Measuring Cn can predict PPAH in MS patients after PMBC. It also may add value in evaluating MS patients undergoing PMBC and may help in predicting their prognosis. [ABSTRACT FROM AUTHOR]

MV repair in the rheumatic population is feasible with acceptable long-term results.1 Incidence of mitral stenosis (MS) following mitral valve (MV) repair for severe rheumatic mitral regurgitation (MR) and usefulness of percutaneous transluminal mitral valvuloplasty (PTMC) in these patients is not described in literature. We report a case of successful PTMC in severe MS following MV repair for severe rheumatic MR.

Balloon mitral valvotomy (BMV) performed by the conventional transfemoral approach can be difficult or even impossible in the presence of structural impediments such as severe kyphoscoliosis, gross cardiac anatomic distortion and inferior vena caval anomalies. A 25-year-old woman with severe thoracolumbar kyphoscoliosis due to poliomyelitis presented with symptomatic rheumatic mitral valve stenosis. After the failure of transfemoral BMV, the procedure was attempted from the right jugular access, using a modified septal puncture technique. The left atrium was entered from the jugular access and the mitral valve was crossed and dilated successfully using over the wire balloon technique. Transjugular BMV is an effective alternative in patients with kyphoscoliotic spine that preclude transfemoral approach. The detailed technique used for the procedure, its advantages as well as the other percutaneous treatment options are also discussed.

Se presenta el caso de una paciente de 31 años de edad, sin antecedentes patológicos, con un mixoma auricular izquierdo de 9 cm x 8 cm, el cual se manifestó clínicamente, de manera súbita, con sintomatología de tipo obstructiva, y cuyo diagnóstico requirió ecocardiografía transtorácica. Se realizó cirugía inmediata, en la que se logró la resección completa del tumor y durante la cual se evidenció insuficiencia de la válvula mitral severa que requirió plastia valvular. Fue dada de alta al sexto día post-quirúrgico.We report the case of a 31 years old female patient without pathological antecedents, with a left atrial mixoma that measured 9 cm x 8 cm. It manifested clinically by sudden cardiac obstructive symptoms and was diagnosed by transthoracic echocardiography. Immediate surgery was performed, achieving complete tumor resection. A severe mitral valve insufficiency that required valvuloplasty was evidenced. The patient was discharged on the sixth day after surgery.