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An unusual instance of mitral valve prolapse in endomyocardial fibrosis  [cached]
Dalal J,Vengsarkar A,Mondkar A,Kinare Suman
Journal of Postgraduate Medicine , 1978,
Abstract: This is a report of an unusual case showing a mitral valve prolapse in the presence of a biventricular endomyocardial fibrosis (EMF). The EMF was strongly suspected on left ventricular angiography and later proved at autopsy. The prolapse of the mitral valve was detected at echocardiography. To the best of our knowledge this is the first report of a case of EMF associated with mitral valve prolapse.
Rheumatic Aortic Valve Disease with Mitral Stenosis—A Case Report  [PDF]
Ramachandran Muthiah
Case Reports in Clinical Medicine (CRCM) , 2016, DOI: 10.4236/crcm.2016.58046
Abstract: Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvement usually occurs in childhood and it is progressive leading to diffuse thickening and fibrosis at leaflet edges and thus differentiated from other patterns of valve damage. Background of this case report revealed the bicuspid nature of the aortic valve due to rheumatic commissural fusion and analysis of echocardiographic parameters in combined lesions of both aortic and mitral valves with severe LV (left ventricular) dysfunction. Left ventricular (LV) and left atrial (LA) dilations predisposing to the formation of smoke (SEC-spontaneous echo contrast) in LV and LA as a consequence of mitral and aortic valve disease are illustrated by 2D echocardiographic imaging in this 41-year-old male.
Clinical Significance of Markers of Collagen Metabolism in Rheumatic Mitral Valve Disease  [PDF]
Tanima Banerjee, Somaditya Mukherjee, Sudip Ghosh, Monodeep Biswas, Santanu Dutta, Sanjib Pattari, Shelly Chatterjee, Arun Bandyopadhyay
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0090527
Abstract: Background Rheumatic Heart Disease (RHD), a chronic acquired heart disorder results from Acute Rheumatic Fever. It is a major public health concern in developing countries. In RHD, mostly the valves get affected. The present study investigated whether extracellular matrix remodelling in rheumatic valve leads to altered levels of collagen metabolism markers and if such markers can be clinically used to diagnose or monitor disease progression. Methodology This is a case control study comprising 118 subjects. It included 77 cases and 41 healthy controls. Cases were classified into two groups- Mitral Stenosis (MS) and Mitral Regurgitation (MR). Carboxy-terminal propeptide of type I procollagen (PICP), amino-terminal propeptide of type III procollagen (PIIINP), total Matrix Metalloproteinase-1(MMP-1) and Tissue Inhibitor of Metalloproteinase-1 (TIMP-1) were assessed. Histopathology studies were performed on excised mitral valve leaflets. A p value <0.05 was considered statistically significant. Results Plasma PICP and PIIINP concentrations increased significantly (p<0.01) in MS and MR subjects compared to controls but decreased gradually over a one year period post mitral valve replacement (p<0.05). In MS, PICP level and MMP-1/TIMP-1 ratio strongly correlated with mitral valve area (r = ?0.40; r = 0.49 respectively) and pulmonary artery systolic pressure (r = 0.49; r = ?0.49 respectively); while in MR they correlated with left ventricular internal diastolic (r = 0.68; r = ?0.48 respectively) and systolic diameters (r = 0.65; r = ?0.55 respectively). Receiver operating characteristic curve analysis established PICP as a better marker (AUC = 0.95; 95% CI = 0.91?0.99; p<0.0001). A cut-off >459 ng/mL for PICP provided 91% sensitivity, 90% specificity and a likelihood ratio of 9 in diagnosing RHD. Histopathology analysis revealed inflammation, scarring, neovascularisation and extensive leaflet fibrosis in diseased mitral valve. Conclusions Levels of collagen metabolism markers correlated with echocardiographic parameters for RHD diagnosis.
Plástica da valva mitral: resultados tardios de doze anos de experiência e evolu??o das técnicas
Pomerantzeff, Pablo M. A;Brand?o, Carlos M. A;Monteiro, Ana Cristina M;Nersessian, Ana Carolina;Zeratti, Antonio E;Stolf, Noedir A. G;Barbero-Marcial, Miguel;Oliveira, Sérgio A;Verginelli, Geraldo;Jatene, Adib D;
Revista Brasileira de Cirurgia Cardiovascular , 1994, DOI: 10.1590/S0102-76381994000100002
Abstract: from january 1980 to december 1992, 301 patients underwent mitral valve repair in heart institute of hcfmusp. mean age of the patients was 37.96 years, with standard deviation of 21.4 years and 151 (50.2%) were males. one hundred and twenty eight (42.52) patients presented symptons of rheumatic fever disease, 78 (25.91%) had degenerative valve disease, 21 (6.97%) were congenital, 18 (5.98%) were ischemic, 9 (2,99) had endomyocardial fibrosis, 8 (2.65%) had bacterial endocardis, 5 (1.66%) had chronic valvulitis, and 34 (11.29%) had no defined ethiology. two hundred and four (67.8%) patients had mitral insufficiency and 97 (32.2%) double mitral lesion. associated procedures were performed in 45% of the patients, the most frequent was aortic valve replacement in 41 (13%) patients. merendino type annuloplasty was performed in 97 (30.99%) patients. carpentier ring annuloplasty in 93 (29.71 %), and posterior sling in 76 (24.28%) patients. there were 12 operative deaths (3.9%). three (0.9%) patients were reoperated upon in the immediate postoperative period due to valve disfunction. linearilized rates of thromboembolism, late death, re-repair, and valve replacement were 0.2%; 0.5%; 1.0%; and 1.1% per patient/years, respectively. the actuarial survival rate at 12 years was 83.6% and the actuarial freedom from reoperation was 83%. seventy nine percent of the patients were in nyha class i at the last follow-up (evolution time was 10077 months/patients). we concluded that patients submitted to mitral valve repair presented satisfactory clinical evoluation.
An unusual instance of mitral valve prolapse in endomyo-cardial fibrosis  [cached]
Dalal J,Vengsarkar A,Mondkar A,Kinare S
Journal of Postgraduate Medicine , 1979,
Abstract: This is a report of an unusual case showing a mitral valve pro-lapse in the presence of a biventricular endomyocardial fibrosis (EMF). The EMF was strongly suspected on left ventricular angio-graphy and later proved at autopsy. The prolapse of the mitral valve was detected at echocardiography. To the best of our knowledge this is the first report of a case of EMF associated with mitral valve prolapse.
Posterior leaflet preservation during mitral valve replacement for rheumatic mitral stenosis  [PDF]
?uki? P.L.,Obrenovi?-Kir?anski B.B.,Vrane? M.R.,Ko?ica M.J.
Acta Chirurgica Iugoslavica , 2006, DOI: 10.2298/aci0601013d
Abstract: Mitral valve replacement with posterior leaflet preservation was shown beneficial for postoperative left vetricular (LV) performance in patients with mitral regurgitation. Some authors find it beneficial even for the long term LV function. We investigated a long term effect of this technique in patients with rheumatic mitral stenosis. We studied 20 patents with mitral valve replacement due to rheumatic mitral stenosis, in the period from January 1988. to December 1989. In group A (10 patients) both leaflets and coresponding chordal excision was performed, while in group B (10 patients) the posterior leaflet was preserved. In all patients a Carbomedics valve was inserted. We compared clinical pre and postoperative status, as well as hemodynamic characteristics of the valve and left ventricle in both groups. Control echocardiographyc analysis included: maximal (PG) and mean (MG) gradients; effective valve area (AREA); telediastolic (TDV) and telesystolic (TSV) LV volume; stroke volume (SV); ejection fraction (EF); fractional shortening (FS) and segmental LV motion. The mean size of inserted valve was 26.6 in group A and 27.2 in group B. Hemodynamic data: PG (10.12 vs 11.1); MG (3.57 vs 3.87); AREA (2.35 vs 2.30); TDV 126.0 vs 114.5); TSV (42.2 vs 36.62); SV (83.7 vs 77.75); EF (63.66 vs 67.12); FS (32.66 vs 38.25) Diaphragmal segmental hypokinesis was evident in one patient from group A and in two patients from group B. In patients with rheumatic stenosis, posterior leaflet preservation did not have increased beneficial effect on left ventricular performance during long-term follow-up. An adequate posterior leaflet preservation does not change hemodynamic valvular characteristics even after long-term follow-up.
Balloon Mitral Valvuloplasty in Rheumatic Double Orifice Mitral Valve  [PDF]
Mayur Jain, Neerav Panchani, No Bansal, Bhanu Duggal
World Journal of Cardiovascular Diseases (WJCD) , 2015, DOI: 10.4236/wjcd.2015.510033
Abstract: We are reporting four cases of acquired double orifice mitral valve (DOMV) of rheumatic etiology (rare) presenting as significant mitral stenosis (MS) treated successfully by percutaneous intervention. All four patients are young (3 males, 1 female) who presented with dyspnea of Newyork heart association (NYHA) class II with mean duration of 1.3 years. Typical clinical findings of MS were present in all. Echocardiography confirmed the diagnosis of moderate to severe MS of rheumatic etiology with double orifice of mitral valve of Trowitzsch incomplete bridge variety [1], giving appearance of two equal (like a pair of spectacles in one patient) or unequal size orifices (in three patients) in parasternal short axis view. Color Doppler examination revealed separate jets originating from each orifice, determined severity of the lesion and evaluated the eligibility for balloon mitral valvuloplasty (BMV). BMV was carried out under transeosophagial echo (TEE) guidance (for perfect septal puncture and crossing the separate orifices) using Inoue balloon of appropriate size (in accordance with patient’s height) with intention to break central fibrous strand converting into a single orifice. All four patients underwent successful BMV (clinical & ECHO criteria) after dilating the separate orifices (except case 4) but the fibrous strand could not be broken. Hence, this study shows that good results can be obtained in acquired double orifice mitral valve with significant MS with BMV even without breaking the fibrous strand. Considering rarity of isolated DOMV cases and rheumatic etiology being very rare, this report of four rheumatic acquired DOMV cases with successful BMV done with good result is significant.
Our Results of Rheumatic Mitral Valve Replacement With Preservation of Subvalvular Apparatus
Trakya Universitesi Tip Fakultesi Dergisi , 2007,
Abstract: Objectives: We evaluated the results of rheumatic mitral valve replacement with preservation of subvalvular apparatus.Patients and Methods: Mitral valve replacement, isolated or in combination with other procedures, was performed in 36 patients (31 females, 5 males; mean age 37.7±14 years; range 14 to 66 years) between January 1996 and 2000. Mitral insufficiency alone or in combination with mitral stenosis was present in 44.4% and 50%, respectively. Concomitant procedures were performed in 44% for associated cardiac lesions. Subvalvular apparatus was preserved in all patients by different techniques. Posterior leaflet was retained in 27 patients, anterior leaflet was retained in one patient, both anterior and posterior leaflets were retained in eight patients. The follow-up period ranged between 13 to 16 months.Results: NYHA classification score was 2.61±0.54 preoperatively and 1.63±0.76 postoperatively (p<0.05). Left ventricular end diastolic diameter and left atrial diameter decreased at the end of the postoperative first year. Mortality, valvular thrombosis, or left ventricular outflow obstruction were not observed during the follow-up period.Conclusion: Some reconstructive techniques can be performed in patients with severe rheumatic mitral stenosis and regurgitation. However, a second operation, usually mitral valve replacement, is required after some period in most of these patients.This condition brings an additional economical burden and an operational risk to the patient, as well. Therefore, whenever repair techniques are not sufficient due to advanced disease, we recommend mitral valve replacement with preservation of subvalvular apparatus.
Rheumatic Mineralization of Aortic Valve and Anterior Mitral Leaflet—A Case Report  [PDF]
Ramachandran Muthiah
Case Reports in Clinical Medicine (CRCM) , 2017, DOI: 10.4236/crcm.2017.64009
Abstract: Aim: To present the heterotopic ossification of left-sided heart valves due to rheumatic inflammation and biomineralization. Introduction: Calcification in the region of mitral-aortic continuity is significant at its origin and etiopathogenesis. The etiology of valvular calcification may be divided into 3 groups, namely, inflammation, degeneration and metabolic disturbances. Calcification of cardiac valve leaflets is most often due to rheumatic etiology in tropical nations. Case Report: A 52-year-old male developed sudden onset of light-headedness and palpitations due to atrial fibrillation. Transthoracic 2D echocardiography revealed calcification of anterior mitral leaflet and aortic valve which resembles a bone-like structure and the patient was advised double valve replacement. Conclusion: It was known that the cellular mechanisms play an important role in its genesis and therapeutic strategies are targeted to reverse this process by understanding its biological mediators.
Isolated Rheumatic Pulmonary Valve Disease—Case Reports  [PDF]
Ramachandran Muthiah
Case Reports in Clinical Medicine (CRCM) , 2016, DOI: 10.4236/crcm.2016.56039
Abstract: Rheumatic heart disease (RHD) is the most common cause of acquired heart disease in children and young adults worldwide and particularly developing countries continuing to experience a high incidence of this disease. The unexpected increase in the incidence of the disease in certain areas may explain the clinical and epidemiological characteristics of this disease. The key manifestation of RHD is the cardiac valvular abnormalities characterized principally by deforming the layered and avascular leaflet architecture due to inflammation and subsequent diffuse fibrosis. Mitral valve is mostly involved and pulmonary valve is rarely affected. Background of these case reports highlighted the increased incidence of rheumatic pulmonary valve disease in Thoothukudi region of India in Tamil Nadu state.
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