• Journal of Chest Surgery
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• v.37 no.8
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• pp.722-725
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• 2004

Mitral valve surgery is most commonly performed through the left atriotomy via the inter-atrial groove or trans-septal approach. An alternative method for approaching to the mitral valve is via the dome of the left atrium located between the ascending aorta and superior vena cava. Although this approach was described 30 years ago, it has not been popularized in mitral valve surgery. We introduce our recent experiences with mitral valve surgery carried out through the dome of the left atrium with brief review of literature.

• Journal of Chest Surgery
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• v.26 no.3
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• pp.191-195
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• 1993

Among 25 consecutive cases having undergone mitral valve surgery between March 1991 and June 1992 in Gill General Hospital, 11 patients[44%] who had undergone mitral valve reconstruction using prosthetic rings is evaluated and presented. Patients` mean age is 43 + 19 years[range:16-72], and they are consisted with 4 males and 7 females. Mitral valve insufficiency is due to degenerative disease in 6 cases[55%] and rheumatic disease in 5 patients[45%]. Carpentier`s functional classification I is 2 cases, II is 6 cases, and III is 2 cases. Surgical techniques include prosthetic ring annuloplasty[11 patients, 100%], chorda shortening[6, 55%], leaflet mobilization[4,36%], new chorda formation[2, 18%], chorda transposition[1, 9%] commissurotomy[3, 27%], and papillary muscle splitting[3, 27%]. Average number of mitral anatomic lesions per patient are 2.7 and we used average 2.8 procedures upon mitral valve apparatus per patient. There were no surgical mortality and no late valve related admission during the mean follow up period of 17 months. The mean functional class[NYHA] is 2.81 preoperatively and improved to 1.10 postoperatively. Doppler echocardiography showed much improvement from grade II MR [1 case], grade III MR [1 case] and 9 cases of grade IV MR to 6 cases of patients showed no MR, only trace MR in 4 cases, and grade I MR was found only in one patient with NYHA functional class II postoperatively. The postoperative mean mitral valve area is $2.10+0.28cm^2$. We conclude that mitral reconstruction is a predictable and stable operation.

• Journal of Chest Surgery
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• v.26 no.12
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• pp.909-914
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• 1993

Complete and optimal visualization of the mitral apparatus is a prerequisite for accurate repair or replacement of the mitral valve. A vertical left atriotomy just posterior to the interatrial groove is the most commonly used approach. However,exposure can be difficult under certain circumstances,such as small left atrium or reoperation. Other approaches have been advocated to deal with this difficult situations. We used an extended transseptal approach in 10 patients and good clinical results and excellent educational effects were obtained. The extended transseptal approach combines two semicircular atrial incisions circumscribing the tricuspid and mitral annuli anteriorly and superiorly,allowing exposure of the mitral valve by deflecting the ventricular side using stay sutures. The right atrium is opened anteriorly along the atrioventricular sulcus. The atrial septum is incised vertically through the fossa ovalis. Right atrial and septal incisions are joined at the superior end of the interatrial septum and extended across the dome of the left atrium to the left atrial appendage. The mitral valve was replaced in all 10 patients. Four of 10 patients had other simultaneous valve procedure: one had aortic valve replacement: 2 underwent tricuspid annuloplasty: 1 had aortic valve replacement and tricuspid annuloplasty. There was no hospital death and complication. Among the 5 patients who had atrial fibrillation preoperatively,4 had atrial fibrillation postoperatively,1 converted to sinus rhythm. The five patients who were in normal sinus rhythm preoperatively remained in sinus rhythm after replacement. A review of our results with this approach confirms the efficacy and safty of this method. So we recommanded this approach for routine mitral valve procedure,especially difficult situations,such as a small left atrium or the redo operation.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.10-15
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• 1999

Background: Mitral valve replacement with chordal preservation in patients with mitral regurgitation has been proved to be beneficial for left ventricular function and for reduction of postoperative complication. However, in patients with mitral stenosis, the effectiveness of the technique is controversial. It is not easy to insert prosthetic valve without left ventricular outflow tract obstruction and prosthetic valve leaflet motion hinderance. Material and Method : Five patients with mitral stenosis and seven patients with mitral stenoinsufficiency underwent mitral valve replacement with preservation of mitral subvalvular apparatus. Thickened and calcified leaflets are made thin by peeling off the thickened and calcified part. Commissurotomy was done and anterior leaflet was incised 2 mm apart from the annulus and then divided into two segments. Anterolateral and posteromedial segments including strut chordae, were reattached to mitral commissural area, respectively. Result: There was no evidence of prosthetic valve dysfunction, paravalvular leakage, left ventricular outflow tract obstruction, complications and operative or late deaths. Conclusion: We conclude that mitral vlave replacement with chordal preservation was safe and effective technique for the patients with mitral stenotic disease.

• Journal of Chest Surgery
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• v.27 no.9
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• pp.752-758
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• 1994

From July 1983 to December 1992, 145 patients with mitral valvular disease underwent open heart surgery at Chonbuk National University Hospital. Of these patients, 89 patients[61.4%] required mitral valve replacement. 56 patients [38.6 %] had mitral valve repair. There were 32 women and 24 men and the mean age was 34.3 years[range 6 years to 62 years].There were 23 cases of pure mitral stenosis, 19 cases of mitral regurgitation and 14 cases of mixedmitral valvular disease. The mean duration of symptom was 4.53 years and mean mitral valvularorifice diameter[in cases of pure stenosis and mixed mitral valvular lesion] was 0.96 cm. According to the NYHA classification, the distribution of patients preoperatively was as follows; class IIa, 15 patients; class lib, 17 patients; class III, 22 patients; class IV, 2 patients. Four patients[7%] had an embolic history preoperatively. 24 patients[ 43 %] were in atrial fibrillation. In cases of pure mitral stenosis, the technique used included open mitral commissurotomy[21atients], open mitral commissurotomy with mitral annuloplasty[2 patients]. In mixed mitral valvular disease, open mitral commissurotomy[ll patients] and open mitral commissurotomy with mitral annuloplasty[l patient] were performed. In cases of mitral regurgitation, mitral annuloplasty[5 patients], mitral valvuloplasty[6 patients], mitral annuloplasty with valvuloplasty [3 patients] and ring annuloplasty [5 patients] were performed.There was one perioperative death related to acute renal failure and sepsis. One late death was occurred related to heart failure after 10 months postoperatively. One patient required reoperation due to restenosis and no embolic episode was occured. After operation, 34 patients were in NYHA functional class I, 20 patients were in class IIa.

• Journal of Chest Surgery
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• v.13 no.4
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• pp.405-413
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• 1980

A total of 63 patients [42 males and 21 females] underwent multiple valve replacement with artificial valves between January 1975 and August 1980 at Seoul National University Hospital. There were 38 patients with aortic and mitral valve replacement, 22 with mitral and tricuspid, and 3 with aortic, mitral and tricuspid valve replacement. The valve lesions varied from trivial to severe and most aortic and mitral valves had mixed stenosis and insufficiency, while tricuspid valves had only insufficiency. The patients were severely symptomatic in majority of the cases, and belonged to the Classes III and IV [III:45, IV:16] of the NYHA functional criteria. Hemodynamic studies were performed on all the patients. The mean pulmonary wedge pressure was remarkably increased to 19.8 mmHg in aortic and mitral valve lesions and 18.0 mmHg in mitral and tricuspid valve lesions. The mean pulmonary arterial pressure was also increased, while the cardiac index was reduced. In 1977, the average perfusion time was 245.5 minutes for aortic and mitral valve replacement and 181.6 minutes for mitral and tricuspid valve replacement. It has progressively declined to 169.2 minutes for aortic and mitral valve replacement and 123 minutes for mitral and tricuspid valve replacement in 1980. The average period of aortic occlusion also declined after the use of cardioplegic solution. Twenty deaths occurred among the 63 patients operated upon, an overall mortality rate of 30.8%. The operative mortality has declined with successive year from a level of 66.7% before 1977 to 21.1% in 1980. Fourteen patients suffered from a list of postoperative complications, which eventually resolved with adequate treatment. All the survivors were enjoying the levels of daily life activities greater than those existing before the operation.

• Journal of Chest Surgery
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• v.17 no.2
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• pp.171-176
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• 1984

Successful correction of the partial form of atrioventricular[AV] canal is now readily achievable. The most challenging technical features of this anomaly are the associated mitral valvular deformity and the frequent inability to obtain mitral competence. Residual mitral incompetence after repair of mitral cleft figures importantly in the causes of early and late failure. So, accurate and complete repair of the mitral valve cleft might be important. Determination of residual severe mitral regurgitation after repair is desirable to permit mitral valve replacement at the time. We have experienced one case of severe mitral regurgitation which was occurred 6 months after repair of partial form of A-V canal [ASD primum] in 22 years old virgin. Pre-op. left ventriculogram revealed severe mitral regurgitation in this patient. We preferred to perform mitral valve replacement with St. Jude valve in this patient at March 1984. Post-op. course was uneventful to now for 5 months and we report this case, review and discuss the literatures.

• Journal of Chest Surgery
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• v.50 no.6
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• pp.467-470
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• 2017

Extensive mitral annulus calcifications are considered a contraindication for valve surgery. We describe the case of a 76-year-old female with severe mitral and aortic stenosis associated with extensive calcifications of the heart. The patient underwent an open mitroaortic valve replacement using transcatheter aortic valve implantation with an Edwards SAPIEN XT valve (Edwards Lifesciences Corp., Irvine, CA, USA) in the mitral position. The aortic valve was replaced using a stentless valve prosthesis (LivaNova S OLO; LivaNova PLC, London, UK). Postoperative echocardiography showed that the prosthetic valve was in the correct position and there were no paravalvular leaks. A bailout open transcatheter valve implantation can be considered a safe and effective option in selected cases with an extensively calcified mitral valve.

• Journal of Chest Surgery
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• v.51 no.2
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• pp.149-152
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• 2018

A 76-day-old infant weighing 3.4 kg was referred for surgical intervention for severe mitral valve stenoinsufficiency caused by leaflet fibrosis and calcification. He had ex perienced a cerebral infarction in the left middle cerebral artery territory, which was deemed attributable to an embolism of a calcified particle from the dysmorphic mitral valve. Because mitral valve replacement using a prosthetic valve was not feasible in this small baby, mitral valve replacement with a pulmonary autograft was performed. After a brief period of extracorporeal membrane oxygenation (ECMO) support, he was weaned from ECMO and was discharged home without further cardiovascular complications.

• Journal of Veterinary Clinics
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• v.33 no.6
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• pp.368-371
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• 2016

A four month-old intact female Maltese (weighing 1.8 kg) was present with major complaints of severe coughing and dyspnea. Diagnostic imaging studies revealed abnormally elongated chordae tendineae attached to anterior leaflet and shortened chordae tendineae attached to posterior leaflet of mitral valve causing mitral insufficiency and regurgitant blood flow into left atrium, indicating congenital mitral valve dysplasia. Therapy was directed to control existing clinical signs and to prevent further deterioration of cardiac enlargement using conventional cardiac medications. The dog is currently survived and being monitored at regular interval. This is the first case report describing mitral valve dysplasia causing mitral insufficiency of dog in Korea.