Patch valvuloplasty in patients with posterior chordae rupture
Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12, Hwayang-dong, Gwangjin-gu, Seoul 143-729, South Korea International journal of cardiology
(Impact Factor: 4.04).
11/2011; 154(2):206-7. DOI: 10.1016/j.ijcard.2011.10.063
Available from: Jin Woo Chung
- "The mitral valve was exposed by making incision on the interatrial groove for all patients, and cryothermy ablation was performed using the left-sided Cox-Maze IV procedure (Figure 1). In cases of mitral regurgitation, patch obliteration technique  for posterior leaflet prolapsed and artificial chordae formation techniques for anterior leaflet prolapse were employed. Annuloplasty was performed by using the Mitra-strip (ScienCity, Inc. "
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Atrial fibrillation (AF) is a life-threatening arrhythmia that carries the high risk of thromboembolic complication. Stroke often develops in patients who undergo successful Cox Maze procedure, despite the fact that the procedure has shown a high rate of success in sinus conversion from AF. This study examined the preoperative risk factors predictive of stroke following Cox Maze procedure in patients with mitral valve disease.
240 patients with the mean age of 57 years underwent Cox-Maze IV procedure with mitral valve repair from November 2007 through December 2010. All patients were available during the follow-up period with the mean duration of 23.6 months. This study excluded those patients who had undergone mitral valve replacement because of maintenance of warfarin medication
Sixteen patients had an ischemic stroke. Of these sixteen patients, six had a transitional ischemic accident while the remaining ten had cerebral infarction. Twelve of sixteen showed sustained sinus rhythm, three showed AF and one had pacing rhythm. Univariate analysis showed that only preoperative stroke history was associated with postoperative stroke (p = 0.03). High CHA2DS2-VASc score, rheumatic etiology, large left atrium (LA), preoperative or postoperative LA thrombus, age, sex, hypertension, and concomitant surgery were not associated with predictive risks for stroke.
In the group of patients who underwent the Cox-Maze procedure with mitral valve repair, having a stroke history was the only preoperative risk factor that could lead to a stroke event after surgery. Accordingly, patients with affliction of ischemic stroke, albeit sustained sinus rhythm, may require prophylactic anticoagulation.
Available from: Seong-Hyop Kim
- "For correction of MR, three technical manoeuvers are mainly applied; 1) lifting annuloplasty , 2) artificial chordae formation for anterior chordae problem and 3) patch valvuloplasty for posterior or lateral chordae problems . "
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We hypothesized that mitral valve areas (MVAs) with echocardiography, using 3D planimetry technique (measured at one point at maximal opening of mitral valve) versus pressure half-time technique (PHT, measured during entire diastolic phase) in mitral valve repair surgery (MVR) would be different.
Patients who had undergone MVR were retrospectively reviewed, and two different observers measured the MVAs using PHT and 3D planimetry technique. The MVAs derived from recorded medical data, using PHT and 3D planimetry technique were abbreviated to MVA-PHT1 and MVA-3D1, and data from the PHT and 3D planimetry techniques by observer A and observer B were determined as MVA-PHT2 and MVA-3D2, and MVA-PHT3 and MVA-3D3, respectively. The MVA derived by post-operative transthoracic echocardiography using the PHT technique was determined as MVA-TTE.
Intraclass correlation coefficients were 0.90 for the intra-operative PHT technique and 0.78 for the intra-operative 3D planimetry technique. MVA-3D1 (2.91 ± 0.65 cm2), MVA-3D2 (3.00 ± 0.63 cm2) and MVA-3D3 (2.97 ± 0.88 cm2) were significantly larger than MVA-TTE (2.40 ± 0.59 cm2), but intra-operative MVAs-PHT were not. The biases and precisions were larger, and the correlation coefficients were lower in 3D planimetry technique compared with PHT technique.
MVA measured by 3D planimetry technique with TEE at the intra-operative post-MVR period was seemed to be larger than that measured by the PHT technique with TTE at the post-operative period. However, it did not mean that the 3D planimetry technique was inaccurate but needs cautions at determination of MVA using different techniques.
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