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Chinese Medical Journal ; (24): 2299-2305, 2021.
Article in English | WPRIM | ID: wpr-921156


BACKGROUND@#Functional mitral regurgitation (FMR) is common in critically ill patients and may cause left atrial (LA) pressure elevation. This study aims to explore the prognostic impact of synergistic LA pressure elevation and FMR in patients with shock.@*METHODS@#We retrospectively screened 130 consecutive patients of 175 patients with shock from April 2016 to June 2017. The incidence and impact of FMR and early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio (E/e') ≥ 4 within 6 h of shock on the prognosis of patients were evaluated. Finally, the synergistic effect of FMR and E/e' were assessed by combination, grouping, and trend analyses.@*RESULTS@#Forty-four patients (33.8%) had FMR, and 15 patients (11.5%) had E/e' elevation. A multivariate analysis revealed FMR and E/e' as independent correlated factors for 28-day mortality (P = 0.043 and 0.028, respectively). The Kaplan-Meier survival analysis revealed a significant difference in survival between patients with and without FMR (χ2 = 7.672, P = 0.006) and between the E/e' ≥ 14 and E/e' < 14 groups (χ2 = 19.351, P < 0.010). Twenty-eight-day mortality was significantly different among the four groups (χ2 = 30.141, P < 0.010). The risk of 28-day mortality was significantly higher in group 4 (E/e' ≥ 14 with FMR) compared with groups 1 (E/e' < 14 without FMR) and 2 (E/e' < 14 with FMR) (P = 0.001 and 0.046, respectively).@*CONCLUSIONS@#Patients with shock can be identified by the presence of FMR. FMR and E/e' are independent risk factors for a poor prognosis in these patients, and prognosis is worst when FMR and E/e' ≥ 14 are present. It may be possible to improve prognosis by reducing LA pressure and E/e'.@*TRIAL, NCT03082326.

Humans , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency/diagnostic imaging , Prognosis , Retrospective Studies , Shock
Arch. cardiol. Méx ; 90(4): 406-414, Oct.-Dec. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1152814


Resumen Introducción y objetivos: La insuficiencia valvular mitral provoca el vaciado simultáneo hacia la aorta y la aurícula izquierda durante la sístole ventricular, lo que produce una disminución del volumen hacia la circulación sistémica. En este estudio se busca obtener un dato preciso del porcentaje de volumen expulsado en sentido anterógrado en pacientes con insuficiencia mitral. Métodos: Se aplica una fórmula ecocardiográfica de “corrección” de la fracción de expulsión del ventrículo izquierdo (FEVI) en 114 pacientes con insuficiencia mitral, con base en la medición de la fracción regurgitante. Resultados: La corrección de la FEVI demostró que el 44.7% de los casos (n = 51) debe reclasificarse en cuanto a la calidad de su función sistólica ventricular izquierda. De 79 sujetos con FEVI normal (≥ 50%) sólo se mantuvieron 32 en la misma categoría; en el grupo con FEVI moderadamente reducida (intervalo intermedio, 40-49.9%) se pasó de 6 a 23 casos y, en aquéllos con FEVI reducida (< 40%), el grupo aumentó de 29 a 59; el subgrupo de pacientes con FEVI < 30% se incrementó de 21 a 41 sujetos. Conclusiones: Puesto que en la mayoría de las guías de tratamiento la FEVI se usa para estratificar riesgos e indicaciones terapéuticas, los autores creen que la ponderación de la insuficiencia mitral puede incrementar la precisión del tratamiento y la posibilidad de incluir a pacientes que no están considerados en esos tratamientos en el momento actual.

Abstract Introduction and objectives: Mitral valve regurgitation causes simultaneous emptying to the aorta and left atrium during ventricular systole, generating a decrease in volume supply to the systemic circulation. In this study we seek to obtain an accurate data on the percentage of volume expelled in the anterograde direction in patients with mitral regurgitation. Methods: An echocardiographic formula for “correction” of the left ventricular ejection fraction (LVEF) was applied in 114 patients with mitral regurgitation, based on the measurement of the regurgitant fraction. Results: Correction of the LVEF showed that 44.7% of cases (n = 51) should be reclassified in terms of the quality of their left ventricular systolic function. Of 79 subjects with normal LVEF (≥ 50%) only 32 remained in the same category; in the group with moderately reduced LVEF (medium range, 40-49.9%) it went from 6 to 23 cases and, in those with reduced LVEF (< 40%), the group increased from 29 to 59; the subgroup of patients with LVEF < 30% increased from 21 to 41 subjects. Conclusions: Given that in most treatment guidelines LVEF is used to stratify risks and therapeutic indications, the authors believe that the weighting of mitral regurgitation can increase the accuracy of treatment, and the possibility of including patients who, at this current moment, are not considered for these therapies.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Stroke Volume/physiology , Echocardiography , Ventricular Dysfunction, Left/diagnostic imaging , Mitral Valve Insufficiency/physiopathology , Ventricular Function, Left/physiology , Ventricular Dysfunction, Left/physiopathology , Mitral Valve Insufficiency/diagnostic imaging
Arq. bras. cardiol ; 115(6): 1201-1204, dez. 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1152930


Resumo Apresentamos o relato de caso de uma paciente com mixoma valvar mitral infectado e uma revisão da literatura sobre o assunto. Uma mulher de 33 anos apresentou histórico de febre e dispneia com evolução de alguns dias. Na hospitalização, ela apresentava uma síndrome semelhante ao lúpus, com hemoculturas positivas para Haemophilus spp . O ecocardiograma revelou uma massa gigante envolvendo ambos os folhetos mitrais associada à regurgitação grave, necessitando de troca valvar mitral biológica. A microscopia revelou mixoma infectado e a paciente recebeu alta assintomática após o término da antibioticoterapia. Ela apresentou bons resultados no seguimento. Este é o sexto caso de mixoma valvar mitral infectado relatado na literatura e o terceiro caso de mixoma cardíaco infectado pelo grupo HACEK. Devido à alta incidência de eventos embólicos, a antibioticoterapia precoce aliada à pronta intervenção cirúrgica são decisivos para a redução da morbimortalidade. O tempo para o diagnóstico foi muito mais breve do que o geralmente relatado em casos de endocardite por HACEK. A troca valvar foi a intervenção mais comum e todos os pacientes em relatos de caso anteriores apresentaram bons resultados no seguimento.

Abstract We present a case report of a patient with an infected mitral valve myxoma and a literature review on the subject. A 33-year-old female presented with a history of fever and dyspnea evolving over a few days. On admission, she had a lupus-like syndrome with positive blood cultures for Haemophilus species . Echocardiogram revealed a giant mass involving both mitral leaflets causing severe regurgitation, requiring biological mitral valve replacement. Microscopy showed an infected myxoma and the patient was discharged asymptomatic upon completion of antibiotics. She did well on follow-up. This is the sixth case of an infected mitral valve myxoma reported in the literature and the third case of a cardiac myxoma infected by the HACEK group. Exceedingly high incidence of embolic events makes prompt imaging, antibiotic therapy and surgery crucial for better outcomes. Time to diagnosis was much briefer than usually reported in other cases of HACEK endocarditis. Valve replacement was the most common surgical procedure and all patients from previous reports did well on follow-up.

Humans , Female , Adult , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation , Endocarditis/surgery , Endocarditis/diagnostic imaging , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve/surgery , Mitral Valve/diagnostic imaging
Clinics ; 75: e2428, 2020. tab, graf
Article in English | LILACS | ID: biblio-1142784


OBJECTIVES: The aim of this study was to analyze mitral annulus (MA) dynamics using cardiac magnetic resonance (CMR) in patients with degenerative mitral insufficiency who underwent mitral valve repair (MVR). METHODS: Mitral valve imaging was performed by CMR in twenty-nine patients with degenerative mitral insufficiency who underwent MVR between July 2014 and August 2016, with quadrangular resection of the posterior leaflet without ring annuloplasty. They were prospectively followed up from the preoperative period up to 2 years postoperatively. RESULTS: We observed a significant reduction in all measurements of the MA after surgery. The mean systolic circumference of the MA was reduced from 13.28±1.95 cm to 11.50±1.59 cm, and the diastolic circumference was reduced from 12.51±2.01 cm to 10.66±2.09 cm in the immediate postoperative period, measures that remained stable 2 years after MVR (p<0.001). The mean maximum area of the MA was significantly reduced from 14.34±4.03 to 10.45±3.17 cm2 when comparing the immediate postoperative period and the 2 year follow-up (p<0.001). The same occurred with the mean minimum area of the MA, which was reduced from 12.53±3.68 cm2 to 9.23±2.84 cm2 in the same period, and this reduction was greater in the antero-posterior diameter than in the mid-lateral diameter. The mobility of the MA was preserved after surgery, ranging between 19.6% and 25.7% at 2-year follow-up. CONCLUSION: We observed a significant reduction in the MA size after MVR, with preservation of the MA mobility at the 2-year follow-up.

Humans , Heart Valve Prosthesis Implantation , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/diagnostic imaging , Magnetic Resonance Spectroscopy , Follow-Up Studies , Treatment Outcome , Diastole , Mitral Valve/surgery , Mitral Valve/diagnostic imaging
Arch. cardiol. Méx ; 88(5): 347-353, dic. 2018. graf
Article in Spanish | LILACS | ID: biblio-1142141


Resumen Introducción y objetivos: La fibrilación auricular puede producir remodelado de la aurícula izquierda e inducir insuficiencia mitral funcional. El objetivo de este estudio es establecer qué características del anillo mitral están relacionadas con la regurgitación mitral funcional auricular. Método: Restrospectivamente se reclutaron 29 pacientes en fibrilación auricular persistente y 36 en ritmo sinusal. Las características del anillo mitral mediante ecocardiografía transesofágica tridimensional fueron analizadas en ambos grupos. Los parámetros ecocardiográficos 2D y 3D fueron correlacionados con el orificio regurgitante efectivo. Resultados: Los pacientes con fibrilación auricular presentaron mayor volumen de aurícula izquierda, diámetro anteroposterior al final de la diástole y disminución de su porcentaje de cambio (p: 0.015, 0.019 y < 0.001 respectivamente). En el análisis de regresión multivariante el índice de elipticidad (ˇ: −0.756, p: 0.004) y el ratio altura/diámetro anterolateral posteromedial (ˇ: −0.704, p: 0.003) fueron parámetros independientes correlacionados con el orificio regurgitante efectivo (R2: 0.699, p: 0.019) en pacientes con fibrilación auricular. Conclusiones: La fibrilación auricular produce cambios en el tamaño y dinámica del diámetro anteroposterior, lo que provoca un anillo mitral circular. Los mayores determinantes de la insuficiencia mitral funcional auricular en el grupo de fibrilación auricular resultaron el índice de elipticidad y el ratio altura/diámetro anterolateral-posteromedial.

Abstract Introduction and objectives: Atrial fibrillation can lead to left atrium remodelling and induce functional mitral regurgitation. The aim of this study is to establish those features of the mitral annulus that are related to atrial functional mitral regurgitation. Methods: A total of 29 patients with persistent atrial fibrillation and 36 controls in sinus rhythm were retrospectively enrolled. The characteristics of the mitral annulus were analysed by three-dimensional transoesophageal echocardiography in both groups. The 2D and 3D echocardiographic parameters were correlated with the effective regurgitant orifice. Results: Patients with atrial fibrillation had a larger left atrium volume, anteroposterior diameter at end-diastole, and lower percentage of change in this diameter (P = .015, P = .019 and P < .001, respectively). In the multiple regression analysis, the ellipticity index (ˇ: −0.756, P = .004) and height-anterolateral-posteromedial diameter ratio (ˇ: −0704, P = .003) were independent parameters that correlated with the effective regurgitant orifice (R2: 0.699, P = .019) in patients with atrial fibrillation. Conclusions: Atrial fibrillation leads to atrial dilation and alterations in the size and dynamics of the anteroposterior diameter, producing a circular mitral annulus. The independent determining factors of atrial functional mitral regurgitation in the atrial fibrillation group were the ellipticity index and the height-anterolateral-posteromedial diameter ratio.

Humans , Male , Female , Middle Aged , Aged , Atrial Fibrillation/complications , Echocardiography, Transesophageal/methods , Echocardiography, Three-Dimensional/methods , Mitral Valve Insufficiency/diagnostic imaging , Regression Analysis , Retrospective Studies , Mitral Valve Insufficiency/etiology
Arq. bras. cardiol ; 108(4): 339-346, Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-838721


Abstract Fundamento: The role of papillary muscle function in severe mitral regurgitation with preserved and reduced left ventricular ejection fraction and the method of choice to evaluate PM have still been the subjects of controversy. Objectives: To evaluate and compare papillary muscle function in and between patients with severe degenerative and functional mitral regurgitation by using the free strain method. Methods: 64 patients with severe mitral regurgitation - 39 patients with degenerative mitral regurgitation (DMR group) and 25 patients with severe functional mitral regurgitation (FMR group) - and 30 control subjects (control group) were included in the study. Papillary muscle function was evaluated through the free strain method from apical four chamber images of the anterolateral papillary muscle (APM) and from apical three chamber images of the posteromedial papillary muscle (PPM). Global left ventricular longitudinal and circumferential strains were evaluated by applying 2D speckle tracking imaging. Results: Global left ventricular longitudinal strain (DMR group, -17 [-14.2/-20]; FMR group, -9 [-7/-10.7]; control group, -20 [-18/-21] p < 0.001), global left ventricular circumferential strain (DMR group, -20 [-14.5/-22.7]; FMR group, -10 [-7/-12]; control group, -23 [-21/-27.5] p < 0.001) and papillary musle strains (PPMS; DMR group, -30.5 [-24/-46.7]; FMR group, -18 [-12/-30]; control group; -43 [-34.5/-39.5] p < 0.001; APMS; DMR group, (-35 [-23.5/-43]; FMR group, -20 [-13.5/-26]; control group, -40 [-32.5/-48] p < 0.001) were significantly different among all groups. APMS and PPMS were highly correlated with LVEF (p < 0.001, p < 0.001; respectively), GLS (p < 0.001, p < 0.001; respectively) and GCS (p < 0.001, p < 0.00; respectively) of LV among all groups. No correlation was found between papillary muscle strains and effective orifice area (EOA) in both groups of severe mitral regurgitation. Conclusions: Measuring papillary muscle longitudinal strain by the free strain method is practical and applicable. Papillary muscle dysfunction plays a small role in severe MR due to degenerative or functional causes and papillary muscle functions in general seems to follow left ventricular function. PPM is the most affected PM in severe mitral regurgitation in both groups of DMR and FMR.

Resumo Fundamento: O papel da função do músculo papilar na regurgitação mitral grave com fração de ejeção do ventrículo esquerdo preservada e reduzida e o método de escolha para avaliar PM ainda são objetos de controvérsia. Objetivos: Avaliar e comparar a função dos músculos papilares entre pacientes com insuficiência mitral funcional e degenerativa pelo método free strain. Métodos: 64 pacientes com insuficiência mitral grave - 39 pacientes com insuficiência mitral degenerativa grave (grupo IMD) e 25 com insuficiência mitral funcional grave (grupo IMF) - e 30 indivíduos controle (grupo controle) foram incluídos no estudo. A função dos músculos papilares foi avaliada pelo método free strain a partir de imagens apicais quatro-câmaras do músculo papilar anterolateral (MPA) e imagens apicais três-câmaras do músculo papilar posteromedial (MPP). Strains circunferenciais e longitudinais globais do ventrículo esquerdo foram avaliados por meio de imagens bidimensionais a partir do rastreamento de conjunto de pontos de cinza (speckle tracking). Resultados: O strain longitudinal global do ventrículo esquerdo (grupo IMD, -17 [-14,2/-20]; grupo IMF, -9 [-7/-10,7]; grupo controle, -20 [-18/-21] p < 0,001); strain circunferencial global do ventrículo esquerdo (grupo IMD, -20 [-14,5/-22,7]; grupo IMF, -10 [-7/-12]; grupo controle, -23 [-21/-27,5] p < 0,001) e strains de músculos papilares (MPP; grupo IMD, -30,5 [-24/-46,7]; grupo IMF, -18 [-12/-30]; grupo controle; -43 [-34,5/-39,5] p < 0,001; MPA; grupo IMD, (-35 [-23,5/-43]; grupo IMF, -20 [-13,5/-26]; grupo controle, -40 [-32,5/-48] p < 0,001) mostraram-se significativamente diferentes nos grupos. MPA e MPP mostraram-se altamente correlacionados com a FEVE (p < 0,001, p < 0,00; respectivamente), SLG (p < 0,001, p < 0,001; respectivamente) e SCG (p < 0,001, p < 0,001; respectivamente) do VE entre todos os grupos. Não foi encontrada correlação entre os strains de músculos papilares e área eficaz do orifício (AEO) nos grupos de insuficiência mitral grave. Conclusões: A medição do strain longitudinal de músculos papilares pelo método free strain é prática e aplicável. A disfunção dos músculos papilares tem um papel pequeno em IM grave devido a causas degenerativas e funcionais, e a função dos músculos papilares, em general, parece seguir a função ventricular esquerda. O MPP é o MP mais afetado na insuficiência mitral em ambos os grupos, IMD e IMF.

Humans , Male , Female , Adult , Middle Aged , Aged , Papillary Muscles/physiopathology , Mitral Valve Insufficiency/physiopathology , Papillary Muscles/diagnostic imaging , Stroke Volume/physiology , Echocardiography/instrumentation , Echocardiography/methods , Prospective Studies , Ventricular Function, Left/physiology , Mitral Valve Insufficiency/diagnostic imaging
Arq. bras. cardiol ; 106(5): 367-372, May 2016. tab, graf
Article in English | LILACS | ID: lil-784170


Abstract Background: Isolated cleft mitral valve (ICMV) may occur alone or in association with other congenital heart lesions. The aim of this study was to describe the profile of cardiac lesions associated with ICMV and their potential impact on therapeutic management. Methods: We conducted a descriptive study with data retrieved from the Congenital Heart Disease (CHD) single-center registry of our institution, including patients with ICMV registered between December 2008 and November 2014. Results: Among 2177 patients retrieved from the CHD registry, 22 (1%) had ICMV. Median age at diagnosis was 5 years (6 days to 36 years). Nine patients (40.9%) had Down syndrome. Seventeen patients (77.3%) had associated lesions, including 11 (64.7%) with accessory chordae in the left ventricular outflow tract (LVOT) with no obstruction, 15 (88.2%) had ventricular septal defect (VSD), three had secundum atrial septal defect, and four had patent ductus arteriosus. Thirteen patients (59.1%) required surgical repair. The decision to proceed with surgery was mainly based on the severity of the associated lesion in eight patients (61.5%) and on the severity of the mitral regurgitation in four patients (30.8%). In one patient, surgery was decided based on the severity of both the associated lesion and mitral regurgitation. Conclusion: Our study shows that ICMV is rare and strongly associated with Down syndrome. The most common associated cardiac abnormalities were VSD and accessory chordae in the LVOT. We conclude that cardiac lesions associated with ICMV are of major interest, since in this study patients with cardiac lesions were diagnosed earlier. The decision to operate on these patients must take into account the severity of both mitral regurgitation and associated cardiac lesions.

Resumo Fundamento: A fissura isolada da valva mitral (FIVM) pode ocorrer isoladamente ou em associação com outras lesões cardíacas congênitas. O objetivo deste estudo foi descrever o perfil das lesões cardíacas associadas à FIVM e o potencial impacto dessas lesões na terapêutica. Métodos: Realizamos um estudo descritivo com dados obtidos do registro unicêntrico Congenital Heart Disease (CHD) de nossa instituição incluindo pacientes com FIVM registrados entre dezembro de 2008 e novembro de 2014. Resultados: Entre 2177 pacientes identificados no registro CHD, 22 (1%) apresentavam FIVM. A mediana de idade ao diagnóstico foi de 5 anos (6 dias a 36 anos). Nove pacientes (40,9%) apresentavam síndrome de Down. Dezessete pacientes (77,3%) apresentavam lesões associadas, incluindo 11 (64,7%) com cordoalha acessória na via de saída do ventrículo esquerdo (VSVE) sem obstrução, 15 (88,2%) com comunicação interventricular (CIV), três com comunicação interatrial do tipo ostium secundum e quatro com persistência do canal arterial. Treze pacientes (59,1%) necessitaram reparo cirúrgico. A decisão de prosseguir com a cirurgia foi baseada principalmente na gravidade da lesão associada em oito pacientes (61,5%) e na gravidade da regurgitação mitral em quatro pacientes (30,8%). Em um paciente, a decisão por cirurgia foi baseada na gravidade tanto da lesão associada quanto da regurgitação mitral. Conclusão: Nosso estudo mostra que a FIVM é rara e está fortemente associada à síndrome de Down. As anormalidades cardíacas associadas mais comuns foram a CIV e cordoalha acessória na VSVE. Concluímos que as lesões cardíacas associadas à FIVM são de grande interesse, já que neste estudo, pacientes com lesões associadas foram diagnosticados mais precocemente. A decisão cirúrgica deve levar em conta a gravidade tanto da regurgitação mitral quanto das lesões cardíacas associadas.

Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Heart Defects, Congenital/complications , Mitral Valve/abnormalities , Mitral Valve Insufficiency/complications , Severity of Illness Index , Echocardiography, Doppler, Color , Heart Atria/abnormalities , Heart Defects, Congenital/surgery , Heart Septal Defects, Atrial/surgery , Mitral Valve/surgery , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/diagnostic imaging
Rev. chil. cardiol ; 35(2): 158-162, 2016. ilus, tab
Article in Spanish | LILACS | ID: lil-796803


Una mujer de 54 años sometida a una reparación mitral se presenta 2 meses después con anemia hemolítica. El mecanismo de ésta correspondió a dehiscencia de la cuadrantectomía y a falta de endotelización de un sector del anillo, que se evidenció mediante ecografía transesofágica y se confirmó por hallazgos operatorios. Se resecó el anillo mitral y se implantó una prótesis de Saint Jude, y no hubo recurrencia de la hemólisis. Se incluye una discusión con revisión de la literatura.

A 54 year old woman was subjected to a mitral valve repair of a mixomatous degenerative valve with severe mitral insufficiency. Quadrantectomy, mitral chords transfer from P2 to a A2 and implantation of a rigid Edwards 28 ring were performed. Two months later the patient was diagnosed with severe hemolytic anemia. Trans esophageal echocardiography revealed severe mitral insufficiency and at surgery a dehiscence at the base of the qudrantectomy in addition to a non endothelysed sector of the mitral ring were found. A Saint-Jude mitral prosthesis was inserted. At follow up, no recurrence of hemolysis occurred.

Humans , Female , Middle Aged , Anemia, Hemolytic/etiology , Mitral Valve Insufficiency/surgery , Postoperative Complications , Reoperation , Heart Valve Prosthesis , Echocardiography, Transesophageal/methods , Anemia, Hemolytic/surgery , Mitral Valve Insufficiency/diagnostic imaging
Rev. chil. cardiol ; 35(2): 163-168, 2016. ilus
Article in Spanish | LILACS | ID: lil-796804


Resumen Reportamos un caso de reparación de perforación valvular mitral en un joven de 18 años que consulta por disnea de esfuerzos y con el antecedente remoto de una artritis séptica de rodilla tratada. En el examen físico se encontró un soplo holosistólico 4/6 en el foco mitral. Se realizó un ecocardiograma transtorácico (ETT) que objetivó una insuficiencia mitral severa, con un jet de recorrido muy excéntrico originado desde anterior, sospechando una perforación del velo anterior, sin lograr caracterizarla por dicha técnica. Se complementó el estudio con un ecocardiograma transesofágico (ETE) en una plataforma EPIQ 7 cv (PHILIPS), que identificó en el cuerpo del segmento 2 del velo anterior mitral (A2) una posible perforación. El análisis de la válvula mediante ETE tridimensional (3D), confirmó una perforación circular de bordes netos, de dimensiones máximas 6x6 mm, localizada en el cuerpo de A2. El análisis 3D aportó valiosa información para programar la reparación valvular, la cual se efectuó mediante un parche de pericardio autólo-go fresco (sin fijación en glutaraldehido) y una anu-loplastía con un anillo rígido, con óptimo resultado y sin complicaciones.

An 18 year-old man presented with shortness of breath and a remote history of a septic arthritis of the knee. Physical examination revealed a holosystolic mitral valve murmur. Transthoracic echocardiography showed a severe mitral regurgitation originating from de anterior mitral valve leaflet, but the exact mechanism was unclear. Transesophageal echocardiography (EPIQ 7v, Philips) suggested a perforation of the medial scallop of the anterior mitral valve leaflet (A2). 3-D trans esophageal echocardiography confirmed a 6x6 mm perforation at the A2 sector of the anterior leaflet. 3-D echo was also very helpful in guiding the surgical repair of this lesion, using a pericardial patch and rigid mitral valve ring.

Humans , Male , Adolescent , Echocardiography, Three-Dimensional , Endocarditis, Bacterial/complications , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/diagnostic imaging , Echocardiography, Transesophageal , Spontaneous Perforation , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency/etiology
Rev. chil. cardiol ; 34(3): 202-206, 2015. ilus
Article in Spanish | LILACS | ID: lil-775489


Reportamos el caso de una mujer de 55 años, que completo terapia antibiótica por una periodontitis con buena respuesta clínica. Posteriormente, presentó fiebre y dolor lumbar, hospitalizándose para estudio. Destacaban parámetros inflamatorios elevados y hemocultivos positivos para Streptococcus Viridans. Estudio de imágenes confirmaron espondilodiscitis de L5-S1. Se efectuó un Ecocardiograma transesogáfico (ETE), que mostró una válvula mitral de aspecto tricúspide, con prolapso del velo posterior (P2-P3) e insuficiencia severa, más una endocarditis mural auricular izquierda por lesión de jet. Se efectuó cirugía cardíaca con reparación mitral. Los hallazgos intraoperatorios mostraron el aparato subvalvular y músculos papilares habituales. Por lo tanto, el aspecto de la válvula mitral fue interpretado como una hendidura profunda del velo posterior.

We report the case of a 55 year old woman, previously treated with antibiotics for periodontitis. She was admitted with fever and lumbar pain. An elevated C reactive protein (CRP) and positive blood cultures for Streptococcus Viridans were found and infectious spondylodiscitis of L5-S1 was confirmed. Transeso-phageal echocardiography (TEE) was performed. A tri-leaflet mitral valve and prolapse of posterior leaflet (P2-P3) were found and severe mitral regurgitation was present on doppler examination In addition, a left atrial mural vegetation (jet lesion) was found. At cardiac surgery mitral valve repair and resection of the mural vegetations were performed. The papillary muscles were normal, and this tri-leaflet aspect of the mitral valve was interpreted as a deep posterior cleft with symmetrical distribution of all remaining segments.

Humans , Female , Middle Aged , Mitral Valve/abnormalities , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/diagnostic imaging , Echocardiography, Doppler , Echocardiography, Transesophageal , Mitral Valve/surgery
Ann Card Anaesth ; 2013 Apr; 16(2): 129-132
Article in English | IMSEAR | ID: sea-147243


A 50-year-old male presented with erysipelothrix rhusiopathiae (ER) endocarditis of the mitral valve, severe mitral regurgitation, and heart failure. The ER endocarditis destroyed the native mitral annulus therefore a new annulus was created for the suspension of the mitral bioprosthesis. Postoperative neoannulus dehiscence and leak prompted to redo surgery where transesophageal echocardiography (TEE) played an important role in pointing out the exact location of perineoannular leaks for repair.

Echocardiography, Transesophageal , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/diagnostic imaging , Erysipelothrix Infections/surgery , Erysipelothrix Infections/diagnostic imaging , Humans , Male , Middle Aged , Mitral Valve/surgery , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/diagnostic imaging