Edge-to-edge mitral valve repair for isolated prolapse of the anterior leaflet caused by degenerative disease.

OBJECTIVE: The use of new techniques to correct mitral regurgitation due to prolapse of the anterior leaflet has been shown to expand the original surgical armamentarium and to improve postoperative outcome. We retrospectively analysed our experience with isolated prolapse of the anterior mitral leaflet repaired using the edge-to-edge technique. METHODS: From October 1986 to June 2004, 790 patients underwent mitral valve repair for mitral regurgitation at our institution. Isolated pathology of the anterior mitral leaflet, due to degenerative disease, was the cause of mitral regurgitation in 84 patients and, from 1991, 68 underwent edge-to-edge repair. RESULTS: There was no intraoperative death and one in-hospital death. Three patients died in the late follow-up period for a cumulative 13-year survival rate of 90 +/- 1.4%. No patient underwent early reoperation. Four patients underwent reoperation during the follow-up for a cumulative 13-year freedom from reoperation of 92.3 +/- 3.2%. At echocardiographic evaluation, mitral valve repair failure was associated with severe mitral regurgitation in four patients. Of the remaining 60 patients, 40 had no residual regurgitation, 18 had trivial residual regurgitation, and two had mild regurgitation. At follow-up, 49 patients are still in New York Heart Association (NYHA) class I, 14 in NYHA class II and only one in NYHA class III. CONCLUSIONS: Our study demonstrates that the 'edge-to-edge' technique is a reliable procedure to correct prolapsing leaflets. The addition of this technique to the surgical armamentarium has neutralized prolapse of the anterior leaflet as an incremental risk factor for reoperation.

A difficult diagnosis: right unilateral cardiogenic pulmonary edema. Usefulness of biochemical markers of heart failure for the correct diagnosis.

We describe a case of unilateral pulmonary edema occurring in a young woman affected by hypertrophic cardiomyopathy complicated by acute worsening of mitral regurgitation. The relevant role of biochemical markers of heart failure, such as brain natriuretic peptide and carbohydrate antigen 125, in clarifying the final diagnosis of cardiogenic pulmonary edema and modifying treatment accordingly is emphasized.

Acute myocardial infarction in a young woman with antiphospholipid syndrome and occasional cocaine abuse.

We describe a case of acute myocardial infarction in a 19-year-old woman reporting a history of occasional cocaine abuse with last exposure 4 days before symptom onset, otherwise at low cardiovascular risk. Coronary angiography showed thrombotic occlusion of anterior descending coronary artery without atherosclerotic plaques, and complete recanalization of the vessel after anticoagulation with enoxaparine. Hypercoagulability evaluation revealed the presence of antiphospholipid antibodies. We suppose that cocaine abuse may have had a delayed effect as trigger of acute myocardial infarction. This action may be due to cocaine-induced endothelial activation and to a synergic prothrombotic activity of cocaine and antiphospholipid antibodies.

Sustained torsade de pointes occurring early during oral sotalol therapy for atrial fibrillation recurrence prophylaxis in a patient without heart disease.

This report describes a 64 year-old female patient admitted to our department for recurrent and symptomatic episodes of atrial fibrillation. Antiarrhythmic therapy with sotalol at 240 mg/day was started, and after 48 h the patient experienced several episodes of sustained torsade de pointes, dramatic marked QT interval prolongation and negative T wave, in absence of overt cardiac disease, renal failure, electrolyte abnormalities or baseline QT interval prolongation. This case emphasizes the importance of hospitalization at the starting of sotalol therapy, especially in female patients, even in absence of predisposing factors for drug-induced tachyarrhythmias.

[Prognostic evaluation in patients with heart failure]. / Valutazione prognostica in pazienti affetti da insufficienza cardiaca.

The prevalence of heart failure has rapidly increased in the last decade and morbidity and mortality for this disease are high. Several predictors have a prognostic value in heart failure such as clinical, hemodynamic, functional, biochemical and electrophysiological patterns. The male sex, the old age and the etiology are known to be important clinical parameters and the left ventricular ejection fraction, the cardiac output and size and the pulmonary capillary wedge pressure represent important hemodynamic parameters. In recent years, exercise testing has been used for prognostic purposes and exercise capacity is an important component of the risk profile in heart failure by assessing the maximum oxygen consumption and the anaerobic threshold. Plasma levels of noradrenaline, renin, aldosterone and natriuretic peptides are related to the severity and prognosis of heart failure as well as heart rate variability, ventricular late potentials and T-wave alternans with regard to mortality due to arrhythmias.