• Journal of Veterinary Clinics
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• v.35 no.1
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• pp.10-12
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• 2018

Mitral regurgitation is the most frequent cause of cardiac disability and death in dogs. A wide range of medical and surgical treatments have been used for mitral regurgitation. Surgical treatments for complete correction of mitral regurgitation include valve repair and valve replacement, which have the advantages of eliminating or correcting the primary cause. Surgical treatments approach the mitral valve via right- or left-side thoracotomy. Aortic root exposure is needed for cardiopulmonary bypass. To compare right-side and left-side approaches, 10 dog cadavers were used in this study. Subsequently, the left-side surgical approach was used in vivo and in conjunction with cardiopulmonary bypass and cardioplegic arrest. Based on the results, and considering ease of access to the aortic root, valve incision site, and visualization of the surgical field, a left-side approach is recommended.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.292-298
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• 2009

Background: Surgery for mitral valve disease in children carries both technical and clinical difficulties that are due to both the wide spectrum of morphologic abnormalities and the high incidence of associated cardiac anomalies. The purpose of this study is to assess the outcome of mitral valve surgery for treating congenital mitral regurgitation in children. Material and Method: From 1997 to 2007, 22 children (mean age: 5.4 years) who had congenital mitral regurgitation underwent mitral valve repair. The median age of the patients was 5.4 years old and four patients (18%) were under 12 months of age. 15 patients (68%) had cardiac anomalies. There were 13 cases of ventricular septal defect, 1 case of atrial septal defect and 1 case of supravalvar aortic stenosis. The grade of the preoperative mitral valve regurgitation was II in 4 patients, III in 15 patients and IV in 3. The regurgitation was due to leaflet prolapse in 12 patients, annular dilatation in 4 patients and restrictive leaflet motion in 5 patients. The preoperative MV Z-value and the regurgitation grade were compared with those obtained at follow-up. Result: MV repair was possible in all the patients. 19 patients required reduction annuloplasty and 18 patients required valvuloplasty that included shortening of the chordae, papillary muscle splitting, artificial chordae insertion and cleft closure. There were no early or late deaths. The mitral valve regurgitation after surgery was improved in all patients (absent=10, grade I=5, II=5, III=2). MV repair resulted in reduction of the mitral valve Z-value ($2.2{\pm}2.1$ vs. $0.7{\pm}2.3$, respectively, p<0.01). During the mid-term follow-up period of 3.68 years, reoperation was done in three patients (one with repair and two with replacement) and three patients showed mild progression of their mitral reguration. Conclusion: our experience indicates that mitral valve repair in children with congenital mitral valve regurgitation is an effective and reliable surgical method with a low reoperation rate. A good postoperative outcome can be obtained by preoperatively recognizing the intrinsic mitral valve pathophysiology detected on echocardiography and with the well-designed, aggressive application of the various reconstruction techniques.

• Journal of Chest Surgery
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• v.24 no.3
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• pp.265-270
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• 1991

Since advent of the prosthetic cardiac valve replacement, much efforts for accurate assessing value function in-vivo have been attempted. To evaluate the postoperative functional and morphological status of the replaced cardiac valve prosthesis, 33 patients with valve replacement were studied by transthoracic and transesophageal 2-dimensional echocardiac imaging as well as by color Doppler flow velocity imaging. Twenty four patients had mitral valve replacement. 6 patients had aortic valve replacement and 3 patients had both mitral and aortic valve replacement. There were 34 mechanical and 2 biological prosthesis. Comparing to transthoracic echocardiography, transesophageal approach showed transvalvular regurgitant jet flow amid the prosthetic mitral valve ring during. systole and much clear visualization of cardiac chamber behind prosthesis which could give shadowing effect to ultrasound beam. According to the quantitative grading by the length and area of mitral regurgitant flow, 24 out of 27 mitral valves revealed mild degree regurgitation considered as physiological after prosthetic bileaflet valve replacement and the other 3 valves including 2 biological prosthesis had moderate degree regurgitation which was regarded as pathologic one. 2 cases of left atrial thromboses and 1 case of paravalvular leakage which were not visible by transthoracic approach were identified by transesophageal echocardiography in patients with mitral valve replacement and patients with aortic valve replacement respectively. We conclude that in patients with prosthetic mitral valve replacement, transesophageal 2-dimensional imaging with color Doppler can suggest reliable information beyond that available from the transthoracic access even though it gives patient some discomfort to proceed.

• 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.27 no.3
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• pp.234-237
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• 1994

We report a case of double orifice mitral valve complicating a partial atrioventricular septal defect.The preoperative diagnosis was suggested by a characteristic angiographic and echocardiographic findings but the correct diagnosis of double orifice mitral valve itself was proven by open heart surgery. The smaller accessory mitral orifice was located in the left lateral leaflet and was left untouched. The A-V septal defect was closed with Gore-Tex patch and localized tricuspid annuloplasty was done using Gore-Tex tubular graft for correction of severe tricuspid regurgitation. The anterior mitral cleft left intact had mild mitral regurgitation on postoperative echocardiography.Postoperative course was uneventful and the patient was discharged 2 weeks later.

• Journal of Chest Surgery
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• v.24 no.4
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• pp.323-330
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• 1991

Residual significant tricuspid regurgitation after mitral valve operation may significantly increase postoperative morbidity and mortality. However, routine techniques to detect tricuspid regurgitation preoperatively and postoperatively are not accurate. Doppler echocardiography was performed preoperatively and postoperatively to assess its ability to evaluate and quantify the severity of tricuspid regurgitation. In 34 patients with tricuspid regurgitation secondary to mitral valvular disease the tricuspid regurgitations were semiquantified on a scale of 1 to 3+. The 34 patients were divided into two groups on the basis of severity of tricuspid regurgitation as assessed by preoperative Doppler echocardiography. Group I [8 patients] had mild[1+] regurgitation, and group II [26 patients] had moderate to severe[2 ~ 3%] tricuspid regurgitation. In all studied patients, preoperative Doppler echocardiographic studies for the degree of tricuspid regurgitation were correlated with clinical symptoms[including NYHA class] and hemodynamics[JVP and right ventricular systolic pressure], and used as the indicator to determine whether tricuspid annuloplasty should be performed or not. Patients with significant tricuspid regurgitation[group II ] had greater preoperative right ventricular systolic pressures and NYHA classes, although there was no correlation between them. The 8 patients with mild[1+] tricuspid regurgitation[group I ] didn`t undergo any procedure for the tricuspid regurgitation and their postoperative Doppler echocardiographic studies showed the less than mild[0 ~ 1+] tricuspid regurgitation, and the 26 patients with significant[>2+] tricuspid regurgitation, and the 26 patients with significant[>2+] tricuspid regurgitation[group II ] underwent tricuspid annuloplasty for the tricuspid regurgitation and the postoperative Doppler echocardiographic studies showed the findings similar to group I except 1 patient who underwent Carpentier`s ring annuloplasty and had severe right ventricular failure. Therefore, preoperative Doppler echocardiography can accurately assess the relative severity of tricuspid regurgitation. Importantly, postoperative Doppler echocardiography could conveniently determine the effect of tricuspid annuloplasty for the patients with significant tricuspid regurgitation. Doppler echocardiography may be an important diagnostic method both for evaluating the degree of residual tricuspid regurgitation after left heart operation as well as for determining which patients should undergo tricuspid valve repair.

• Journal of Chest Surgery
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• v.18 no.1
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• pp.92-96
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• 1985

A cleft in the anterior mitral valve leaflet is commonly associated with atrioventricular septal defects, but may occur as an isolated phenomenon. The cleft mitral valve can cause regurgitation, and surgical treatment of the cleft leaflet should conserve the existing valve if possible. But if satisfactory hemodynamic security cannot be obtained with a reconstructive procedure, the valve should be replaced. We present one case of an isolated cleft in the anterior mitral valve leaflet. The patient showed marked mitral regurgitation in the preoperative left ventriculogram. We managed him successfully by interrupted suture repair of the cleft, and he was discharged uneventfully.

• Journal of Chest Surgery
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• v.51 no.1
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• pp.61-63
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• 2018

We report the case of a patient with mitral regurgitation complicated by type B dissection and Marfan syndrome (MFS) who was managed successfully with minimally invasive mitral valve repair. Without type A aortic dissection or aortic root dilation, MFS patients may develop mitral valve regurgitation, as in this case, and need valve surgery to improve their symptoms and long-term survival. However, it is not clear that a full sternotomy and prophylactic aortic surgery are necessary. Although retrograde perfusion to the dissected aorta is controversial, our approach minimizes the risk of future anticipated aortic surgery in MFS patients.

• Journal of Chest Surgery
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• v.21 no.4
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• pp.757-760
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• 1988

Double mitral valve orifice is an unusual congenital abnormality, and is rarely of clinical importance. That abnormality not produce hemodynamic deficits, but it has been associated with other congenital heart diseases, especially atrioventricular canal defects, and so it is surgically important condition. After the first report by M.S. Greenfield in 1876, there are only a few reported cases all over the world. We experienced two cases of double mitral valve orifice with atrioventricular canal defect. The small accessory mitral orifice was placed in anterior mitral leaflet as a hole type in both cases. The A-V canal defects are corrected with a one patch technique, but the accessory orifices are left unclosed because there were no mitral regurgitations through the orifice. On the 4th postoperative day, the patients have been performed echocardiography; both had no mitral regurgitation. Both of patients are now being follow-up and we find no specific problems. A small accessory mitral orifice may be left unclosed and rarely produce significant regurgitation, conclusively.

• Journal of Chest Surgery
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• v.37 no.5
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• pp.401-409
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• 2004

Background: As the rupture of chordae and/or papillary muscle became the main cause of mitral valve regurgitation, mitral reconstructive surgery has a very important role. In this regard, we analyzed the clinical result and postoperative early result of operative treatment performed in our hospital, Material and Method: For this analysis, forty nine patients (male 26, female 23, mean age 49.0$\pm$16.5) who underwent mitral valve operation caused by the rupture of chordae and/or papillary muscle from August 1991 to April 2002 were reviewed. Among forty nine patients, twenty two (44.9%) received mital valve reconstruction and twenty seven (59.2%) received mitral valve replacement. Result: As to the pathological etiology of rupture of mitral and papillary muscle, twenty five cases (51.0%) were nonspecific degeneration, eleven cases (22.4%) were myxomatous degeneration, seven cases (14.3%) were subacute bacterial endocarditis. Three patients suffered mortality after operation (6.1%) and valve replacement was performed again on one patient because of remnant mitral insufficiency after valve reconstruction. The 5-year survival rate after operation for the entire mitral valve regurgitation patients was 81 .4%. We have also compared and analyzed the operation results of a group of patients who underwent valve reconstruction and the other group of patients who underwent valve replacement from thirty six patients who had suffered from mitral valve regurgitation caused by degenerative disease. The mortalities were 0% and 14.3%, respectively and the 5-year survival rates were 90.2% and 64.3%, respectively, but there were no statistical significance. Conclusion: The most common pathological etiology of mitral valve regurgitation caused by rupture of chordae and/or papillary muscle was nonspecific degeneration, In case of degenerative disease is the cause of mitral valve regurgitation, valve reconstruction showed better long-term effects in many respects and better operation results compared to valve replacement.