The Mitral Valve
Theo Kofidis in Minimally Invasive Cardiac Surgery, 2021
Patient is placed supine on the operating table with an inflatable cushion under the chest to elevate the right hemi-thorax and to open up the intercostal spaces. A single dose of cardioplegia is preferable as most repairs and/or replacements will be done with one dose of cardioplegia and as the exposure of the mitral valve with the left atrial retractor may lead to less efficient subsequent cardioplegia delivery. The smaller the access ports, the more their position and their angle towards the valve are important to have a good enough visualization of the mitral valve. Mitral valve repair surgery should be a discipline that is done on a very regular basis, as only in centers with enough volume, will the rates of repair and the long-term outcomes be good enough. Minimally invasive mitral valve surgery has been adopted by many heart surgery centers throughout the globe.
Chest Pain in Pregnancy: Cardiac Causes
Tony Hollingworth in Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
Chest pain is the commonest presenting complaint in accident and emergency, but fortunately it is not common in pregnancy. Mitral valve prolapse (MVP) is the most common congenital heart lesion, and the diagnosis is frequently made in young women of childbearing age. It carries a low risk in pregnancy and rarely requires intervention. MVP usually presents with atypical chest pain and mid-systolic murmur associated with a mid-systolic click. Thoracic aortic dissection is a sudden event in which a tear in the intimal wall of the aorta allows blood to escape from the true lumen of the vessel, rapidly separating the inner layer from the outer layer of the tunica media. Aortic dissection is rare in pregnancy and may be initially overlooked because its manifestations are similar to those for early labour. Pregnant women often experience epigastric discomfort that they may interpret as burning in the chest.
Oedema, Haemorrhage and Thrombosis
Jeremy R. Jass in Understanding Pathology, 2020
The natural philosophers of ancient Greece believed that ‘pneuma’ (roughly equivalent to spirit or air) was endowed with the properties of life and intelligence. Oedema describes the abnormal collection of fluid within the extracellular compartment. Such collections will occur within the body cavities (as effusions in the pleural and pericardial cavities or ascites in the peritoneal cavity), within loose and relatively acellular connective tissue (dermis of skin, subcutaneous tissue or submucosa of gut), within the brain or within the alveolar spaces of the lungs. When swollen oedematous tissue is viewed microscopically, one sees only a widening of the clear space between cells. Pulmonary congestion and oedema is caused by left heart failure, but is most marked when there is stenosis (narrowing) of the mitral valve resulting in compensatory work hypertrophy of the muscular wall of the left atrium.
Minimally invasive robotic mitral valve surgery
Published in Expert Review of Medical Devices, 2011
Over the past two decades, significant advances have been made in mitral valve surgery. Cardiac surgeons have successfully repaired degenerative and ischemic regurgitant mitral valves via a traditional midline sternotomy. In recent years, alternate incisions have yielded minimally invasive approaches to the mitral valve. Technological advances have made robotically assisted minimally invasive mitral valve surgery feasible. Decreased pain, more rapid return to work, diminished blood loss and reduced length of hospitalization have been witnessed following robotic mitral valve surgery when compared with a traditional sternotomy. Equivalent long-term mortality and freedom from recurrent mitral regurgitation are evident between mitral valve repair performed via a traditional sternotomy and minimally invasive and robotic techniques. As a result, an increasing number of patients and referring cardiologists are seeking minimally invasive approaches to mitral valve surgery.
Review of the endovascular approach to mitral valve disease
Published in Minimally Invasive Therapy & Allied Technologies, 2015
Jacob Bergsland, Peyman Mirtaheri, Nikolai Hiorth, Erik Fosse
The first interventional attempts at relieving mitral valve disease were in a sense minimally invasive, using relatively small incisions and introduction of instruments or a finger to open stenotic valves on the beating heart. The development of reliable cardiopulmonary bypass (CPB) made exact anatomic repair of mitral pathology possible with improved results. Mitral valve surgery on an arrested heart has been the mainstay of treatment for decades. Modifications and minimalization of the surgical approach using videoscopic or robotic instruments have made less invasive procedures possible. Such procedures demand excellent technical skills and are still not widely adopted. More recently, attempts have been made to repair mitral valves using endovascular access on the beating heart, guiding the repair process with real-time imaging. We are presenting a review of available and developing techniques for endovascular repair of the mitral valve. A device developed by our group will be briefly described.
Recurrent mitral valve regurgitation with neutrophil infiltration in a patient with multiple aseptic abscesses
Published in Modern Rheumatology, 2014
Shin Fukuda, Toshihiro Nanki, Tomohiro Morio, Hisanori Hasegawa, Ryuji Koike, Nobuyuki Miyasaka
Aseptic abscess (AA) is characterized by accumulation of neutrophils without evidence of infection, no response to antibiotics, and rapid response to corticosteroids. We report a case of multiple abscesses in the subcutaneous tissues and joints, and severe mitral valve regurgitation. Although AA did not respond to antibiotic therapy, it improved dramatically with corticosteroid treatment. However, repeated valvuloplasty was required for the mitral valve regurgitation. The mitral valve tissue showed neutrophil infiltration without any bacterial invasion. This is the first case of AA to show involvement of cardiac valves, indicating the importance of systematic examination for patients with AA and cardiac valve involvement.
Related Knowledge Centers
- Aorta
- Heart Atria
- Heart Valves
- Heart Ventricles
- Blood
- Pulmonary Arteries
- Heart Valve