1/130. Chordal rupture: a common complication of myxomatous degeneration of the mitral valve.In two patients with a clinical picture of acute mitral insufficiency, the presence of chordal rupture secondary to myxomatous degeneration of the mitral valve was disclosed during surgery. There was no evidence of previous rheumatic valvulitis, subacute bacterial endocarditis or other etiologies. It appears from the literature and from the cases described that ruptured chorda tendinea is a not uncommon complication of myxomatous transformation of the mitral valve. While this fact has been mentioned in anatomophological reports, clinicians are less aware of the association. In the absence of supportive evidence for a rheumatic or arteriosclerotic etiology, a clinical picture of acute mitral insufficiency should suggest ruptured chorda tendinea secondary to myxomatous degeneration of the mitral apparatus. This is particularly true in older patients, especially among those followed for a midsystolic click-late systolic murmur or an apical pansystolic murmur of pure mitral regurgitation.- - - - - - - - - - ranking = 1keywords = rupture (Clic here for more details about this article) |
2/130. String-plucking as a mechanism of chordal rupture during balloon mitral valvuloplasty using inoue balloon catheter.Percutaneous transvenous mitral commissurotomy using the Inoue technique was performed in a 59-year-old female with mitral stenosis and a severely calcified mitral leaflets. Although not entrapped in the subvalvular apparatus, the balloon catheter was deviated away from the mitral orifice-apex axis of the left ventricle during the inflation of the proximal balloon, which plucked and severed the chordae tendineae of the posterior mitral leaflet and resulted in severe mitral regurgitation.- - - - - - - - - - ranking = 0.57142857142857keywords = rupture (Clic here for more details about this article) |
3/130. Acute mitral regurgitation due to chordal rupture in a patient with neonatal marfan syndrome caused by a deletion in exon 29 of the FBN1 gene.The neonatal marfan syndrome is an autosomal dominantly inherited disease with an extremely poor prognosis. This report gives a clinical and echocardiographic description of an infant with a mutation in exon 29 of the fibrillin-1 gene (FBN1), a region in which this severe form of marfan syndrome seems to cluster. The infant died at the age of 3 months due to severe acute mitral regurgitation leading to intractable heart failure.- - - - - - - - - - ranking = 0.57142857142857keywords = rupture (Clic here for more details about this article) |
4/130. Posterior myocardial infarction complicated by rupture of the posteromedial papillary muscle.A 61-year-old man was admitted with acute posterior myocardial infarction and, on physical examination, was shown to have a mitral regurgitation (MR) murmur. Transthoracic echocardiography (TTE) showed severe hypokinesis of the posterior wall and severe MR by color flow. Right heart catheterization with a balloon-tipped catheter revealed a pulmonary artery wedge pressure of 30 mmHg. No 'step-up' was seen in blood samples from the right atrium and right ventricle. On angiography, a subtotal occlusion of the mid circumflex artery was found which was angioplastied and stented. As the patient's clinical condition did not improve, he underwent transesophageal echocardiography (TEE) for further evaluation. This showed complete rupture of the posteromedial papillary muscle. The patient underwent urgent surgery with successful mitral valve replacement. The postoperative course was uncomplicated, and clinical improvement seen. This case report underscores the value of TEE in accurate preoperative diagnosis of papillary muscle rupture by providing preoperative anatomic details of the mitral valve apparatus and surrounding structures.- - - - - - - - - - ranking = 0.85714285714286keywords = rupture (Clic here for more details about this article) |
5/130. Catheter entrapment by atrial suture during minimally invasive port-access cardiac surgery.PURPOSE: The port-access approach allows surgeons to perform heart operations through small intercostal openings, or "ports". This technique requires new skills for anesthesiologists. A pulmonary artery venting (PAV) catheter and, in some cases, a coronary sinus catheter (for administration of retrograde cardioplegia) are positioned with the aid of fluoroscopy and transesophageal echography (TEE). Both catheters have a wider diameter than the more commonly used conventional PA catheter and present distinctive features. We report a case in which a pulmonary artery venting catheter was entrapped by a suture during a port-access procedure. CLINICAL FEATURES: A 35-yr-old man with severe mitral valve insufficiency was scheduled for valve repair. After a successful bypass procedure, resistance was felt while attempting to withdraw the PAV catheter. On fluoroscopy, fixation of the catheter at the heart level was established and perforation by suture was confirmed after injection of a contrast agent. Because of the risk of cardiac wall rupture and tamponade, the thorax was reopened. After release of some atrial sutures, the catheter could be withdrawn easily. Transfixion by a suture was confirmed by visual examination. CONCLUSION: The more frequent use of a PAV catheter in minimally invasive cardiac surgery with the port-access technique should remind the anesthesiologist of the higher risk of entrapment by surgical sutures. Surgeons should be aware of the risk of accidentally transfixing this catheter during closure of the atriotomy via the port.- - - - - - - - - - ranking = 0.14285714285714keywords = rupture (Clic here for more details about this article) |
6/130. Left ventricular rupture after mitral valve replacement in a patient with osteogenesis imperfecta tarda.We describe the case of a patient with osteogenesis imperfecta tarda (Lobstein's syndrome) and mitral valve insufficiency. The course after mitral valve replacement was complicated by rupture of the left ventricular posterior wall, which caused massive bleeding and sudden death. The pathologic findings and the operative problems are discussed.- - - - - - - - - - ranking = 0.71428571428571keywords = rupture (Clic here for more details about this article) |
7/130. Acute mitral regurgitation from ruptured chordae tendineae in systemic lupus erythematosus.A patient with systemic lupus erythematosus developed acute mitral regurgitation due to ruptured chordae tendineae, requiring mitral valve replacement. Typical changes of Libman-Sacks endocarditis were observed in the excised mitral valve. Immunofluorescent studies revealed antinuclear antibody and deposits of immunoglobulins and complement within small vessels.- - - - - - - - - - ranking = 0.71428571428571keywords = rupture (Clic here for more details about this article) |
8/130. Left atrial diverticulum associated with severe mitral regurgitation.diverticulum of the atrium is a rare and controversial clinical entity, and in the present case a left atrial diverticulum was associated with severe mitral regurgitation (MR). A 68-year-old female with the diagnosis of MR was referred for further cardiac evaluation. echocardiography revealed severe MR and an accessory cavity behind an enlarged left atrium. She underwent surgical valve replacement, but excision of the diverticulum was not done because its rupture seemed unlikely. A follow-up computed tomography performed 8 months postoperatively demonstrated disappearance of the diverticulum. The etiology of this atrial diverticulum is not clear, but the patient's MR may have played a role in its development.- - - - - - - - - - ranking = 0.14285714285714keywords = rupture (Clic here for more details about this article) |
9/130. Coronary arteriovenous fistula with papillary muscle rupture.We describe a patient who had a coronary arteriovenous fistula (CAVF) and whose mitral valve papillary muscle ruptured from chronic ischemia due to a coronary steal phenomenon. He was treated surgically with ligation of the CAVF (left circumflex to coronary sinus), coronary artery bypass grafting, and mitral valve replacement. This is the first report of papillary muscle rupture related to CAVF.- - - - - - - - - - ranking = 0.85714285714286keywords = rupture (Clic here for more details about this article) |
10/130. Anaemia, osteogenesis imperfecta and valve diseases. The preoperative treatment with epoetin-alpha to increase haematocrit and haemoglobin levels in patients with high risk of perioperative bleeding.The case of a patient with osteogenesis imperfecta is reported who underwent surgery for mitral valve replacement. osteogenesis imperfecta is a hereditary disease of the connective tissue, associated with bone fragility, bluish colouring of the sclerae, loss of hearing and dental anomalies. osteogenesis imperfecta is included in a group of hereditary pathologies with ehlers-danlos syndrome, Hurler syndrome, pseudoxanthoma elasticum and marfan syndrome. In the literature there are few cases of patients with osteogenesis imperfecta operated for mitral valve disease secondary to such disease. The patient also has a positive family history and a severe anaemia: this was treated with epoetin-alpha and ferrous sulphate during the three weeks before surgery. The response to epoietin treatment was good while clinical outcome was poor due to rupture of the posterior ventricular wall in the 12th postoperative hour. The use of epoietin-alpha is discussed.- - - - - - - - - - ranking = 0.14285714285714keywords = rupture (Clic here for more details about this article) |
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