1,721,278 research outputs found
Re: Spratt J. Non-resectional repair of myxomatous mitral valve disease: the 'American Correction'
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La chirurgia riparativa della valvola mitrale in soggetti con bassa frazione d’eiezione.
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Mitral valve repair for functional mitral regurgitation: is annuloplasty alone enough?
No full textPurpose of review To outline indications and contraindications to mitral valve surgery in the clinical context of dilated cardiomyopathy and the surgical principles to follow in performing an undersized annuloplasty. Moreover, we will describe the characteristics of the patients for whom an annuloplasty alone is unlikely to provide an effective result and for whom, therefore, some other procedures or mitral valve replacement should be preferred. Recent findings In functional mitral regurgitation, competence of the mitral valve can be restored by using a restrictive annuloplasty. This procedure leads to symptomatic improvement and reverse left ventricular remodeling in a substantial proportion of patients. However, the failure rate of undersized annuloplasty is still high and is mainly due to inappropriate patient selection and to technical issues that have been progressively identified. Summary In the treatment of functional mitral regurgitation, annuloplasty alone should only be carried out in the early phase of the disease before the occurrence of advanced left ventricular remodeling and echocardiographic predictors of unfavorable outcome should be taken into account. Under certain circumstances, surgery should include additional procedures apart from annuloplasty to enhance the durability of the repair. Mitral valve replacement should be considered when unsatisfactory results are expected with mitral valve repair due to advanced left ventricular remodeling and long-lasting heart failure.Purpose of review To outline indications and contraindications to mitral valve surgery in the clinical context of dilated cardiomyopathy and the surgical principles to follow in performing an undersized annuloplasty. Moreover, we will describe the characteristics of the patients for whom an annuloplasty alone is unlikely to provide an effective result and for whom, therefore, some other procedures or mitral valve replacement should be preferred. Recent findings In functional mitral regurgitation, competence of the mitral valve can be restored by using a restrictive annuloplasty. This procedure leads to symptomatic improvement and reverse left ventricular remodeling in a substantial proportion of patients. However, the failure rate of undersized annuloplasty is still high and is mainly due to inappropriate patient selection and to technical issues that have been progressively identified. Summary In the treatment of functional mitral regurgitation, annuloplasty alone should only be carried out in the early phase of the disease before the occurrence of advanced left ventricular remodeling and echocardiographic predictors of unfavorable outcome should be taken into account. Under certain circumstances, surgery should include additional procedures apart from annuloplasty to enhance the durability of the repair. Mitral valve replacement should be considered when unsatisfactory results are expected with mitral valve repair due to advanced left ventricular remodeling and long-lasting heart failure
Edge-to-edge Alfieri technique for mitral valve repair: which indications?
No full textPURPOSE OF REVIEW: To outline the current indications to the edge-to-edge technique for mitral valve repair. Indeed, after its introduction in the early 1990s, criteria for appropriate patient selection and technical issues of this approach have been progressively refined over the years and are now rather standardized.
RECENT FINDINGS: The long-term results (up to 17 years) of this approach in the setting of degenerative mitral regurgitation with bileaflet and anterior leaflet prolapse have been recently reported and confirm the important role of this method in the surgical armamentarium of mitral valve reconstruction. In addition, recent data support the use of this method in new special situations and settings (systolic anterior motion prevention/treatment, congenital atrioventricular valve incompetence, as a 'rescue' procedure in case of suboptimal conventional repair).
SUMMARY: In mitral regurgitation competence of the mitral valve can be restored by using a 'functional' rather than a conventional 'anatomical' repair. This 'functional' repair is realized by means of the edge-to-edge technique that consists in suturing together the facing portions of the anterior and posterior mitral valve leaflets in correspondence to the location of the regurgitant jet. The edge-to-edge technique was introduced in the early 1990s and has provided a useful contribution to the surgical armamentarium of mitral valve repair. Appropriate indications and awareness of the important technical aspects of the procedure are prerequisites for a good outcome. In this review the present role of the edge-to-edge repair, particularly in terms of indications and contraindications, will be outlined and discussed
Trattamento chirugico dei mixomi cardiaci: via di accesso, resezione dei mixomi atriali, resezione dei mixomi ventricolari.
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