Prolapse of mitral valve leaflets is a frequent disorder and the most common cause of severe mitral regurgitation in western countries. However, little is known about the effects of altitude on mitral valve prolapse. We studied the prevalence and echocardiographic characteristics of mitral valve prolapse at moderately high altitude and sea level.
Histopathological characteristics and oxidative injury secondary to atrial fibrillation in the left atrial appendages of patients with different forms of mitral valve disease.
- Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology
- Published over 5 years ago
BACKGROUND: The prevalence of atrial fibrillation (AF) and the frequency cardioversion of AF postoperatively are different in different forms of mitral valve disease. We hypothesized that these differences would relate to different extent of histopathological characteristics and oxidative injury in different forms of mitral valve diseases. METHODS: Left atrial appendages were obtained from 24 patients of mitral valve disease with or without AF undergoing mitral valve surgery. Control data were obtained from left appendages of 4 persons in normal sinus rhythm (SR) died of traffic accident. Histopathology, immunohistochemistry, Western blotting and enzyme kinetics examination were performed to assess the extent of histopathological characteristics and oxidative injury. RESULTS: The average cross-sectional diameter of atrial myocyte of mitral stenosis (MS)+AF, MS+SR, mitral regurgitation (MR)+AF, MR+SR and control was 25.62±7.56 μm, 20.20±9.34 μm, 21.69±7.00 μm, 13.93±4.32 μm and 9.81±2.34 μm, respectively. Significantly statistical difference was found between each group (P<.05). Increased degree of atrial interstitial fibrosis was seen both in MS and MR with AF patients compared to other groups (P<.05), and the extent of fibrosis was more remarkable in MR patients compared to MS patients (P<.05). The extent of 3-nitrotyrosine (3-NT) immunoreactivity significantly increased in the patients with MS and AF compared to those of MR and AF (P<.05), and the immunoprevalence of 3-NT was significantly increased in patients of MS and SR compared to those of MR and SR (P<.05). Correlation analysis demonstrated a negative correlation between creatine kinase (CK) activity and extent of 3-NT immunoreactivity in atrial tissues (r=-0.382, P<.05). Significant decreases in CK activity were observed in myocardium from all patients of mitral valve disease with or without AF compared to controls (P<.05). Western blotting demonstrating an increased prevalence of 3-NT formation in CK-MM was detected compared to control group (P<.05). Correlation analysis demonstrated a negative correlation between CK-MM activity and extent of CK-MM tyrosine nitration (r=-0.446, P<.05). CONCLUSIONS: In different forms of mitral valve disease with different cardiac rhythm, the extent of histopathological characteristics and oxidative injury are different. Histopathological characteristics and oxidative injury not only relate to mitral valve disease but also relate to the development and sustain of AF.
Alterations of normal mitral valve (MV) function lead to mitral insufficiency, i.e., mitral regurgitation (MR). Mitral repair is the most popular and most efficient surgical intervention for MR treatment. An annuloplasty ring is implanted following complex reconstructive MV repairs to prevent potential reoccurrence of MR. We have developed a novel finite element (FE)-based simulation protocol to perform patient-specific virtual ring annuloplasty following the standard clinical guideline procedure. A virtual MV was created using 3D echocardiographic data in a patient with mitral annular dilation. Proper type and size of the ring were determined in consideration of the MV apparatus geometry. The ring was positioned over the patient MV model and annuloplasty was simulated. Dynamic simulation of MV function across the complete cardiac cycle was performed. Virtual patient-specific annuloplasty simulation well demonstrated morphologic information of the MV apparatus before and after ring implantation. Dynamic simulation of MV function following ring annuloplasty demonstrated markedly reduced stress distribution across the MV leaflets and annulus as well as restored leaflet coaptation compared to pre-annuloplasty. This novel FE-based patient-specific MV repair simulation technique provides quantitative information of functional improvement following ring annuloplasty. Virtual MV repair strategy may effectively evaluate and predict interventional treatment for MV pathology.
- Journal of cardiovascular medicine (Hagerstown, Md.)
- Published over 4 years ago
The aim of the study is to determine the impact of the underlying etiology (Barlow’s disease or fibroelastic deficiency) on left ventricular function in patients with degenerative mitral valve disease and severe mitral regurgitation.
Due to the increased life expectancy and continual improvements in cardiological treatment options, diseases of the tricuspid valve, in particular tricuspid valve insufficiency will become increasingly more recognized as an interventional target. While tricuspid stenosis is rare and can be effectively treated with balloon valvuloplasty, no effective transcatheter approach to tricuspid regurgitation (TR) has yet been established. As the tricuspid annulus is a complex and highly dynamic structure that offers little resistance, orthotopic long-term fixation of transcatheter valves with the current techniques is challenging and has not yet been performed in human patients. Alternative treatment concepts include transcatheter caval valve implantation (CAVI) to address the regurgitation of blood into the caval veins, which has resulted in hemodynamic improvement and is currently undergoing further clinical investigation. Other interventional treatment concepts are aimed at tricuspid valve repair, e.g. by annular plication with the Mitralign™ device or the TriCinch™ system. In the medium-term it can be assumed that percutaneous systems and therapy options will become available for these indications whereby the functional and prognostic effects of these treatment procedures will be corroborated in the appropriate patient groups by corresponding studies.
- Clinical research in cardiology : official journal of the German Cardiac Society
- Published almost 2 years ago
We assessed the prevalence of moderately severe or severe mitral regurgitation (MR) justifying edge-to-edge mitral valve (MV) repair (MitraClip(®)) in patients attending the University Hospital Wuerzburg, a tertiary care centre located in Wuerzburg, Germany.
Transoral esophagogastric fundoplication (TF) can decrease or eliminate features of gastroesophageal reflux disease (GERD) in some patients whose symptoms persist despite proton pump inhibitor (PPI) therapy. We performed a prospective, sham-controlled trial to determine if TF reduced troublesome regurgitation to a greater extent than PPIs in patients with GERD.
Severe tricuspid regurgitation is associated with poor prognosis; however, there are limited class 1 indications for intervention, and high-surgical risk patients may go untreated. We report the first-in-human successful transcatheter tricuspid valve repair for severe tricuspid regurgitation.
A 33-year-old woman who had received a diagnosis of tricuspid valve endocarditis caused by MRSA was evaluated for replacement of the tricuspid valve. Videos show giant systolic pulsations during jugular venous examination and severe tricuspid regurgitation during transthoracic ECG.
The treatment of mitral regurgitation has changed in recent years due to the advent of interventional techniques, mostly the percutaneous edge-to-edge repair, and, more recently, annuloplasty and chordal replacement. In the future, more advances are expected from further development of interventional techniques, careful evaluation and better patient selection.