1/409. Minimally invasive cardiac surgery with surgical ablation of atrial fibrillation.Surgical ablation for atrial fibrillation with mitral valve operations has been often performed in patients who have chronic atrial fibrillation associated with mitral valve disease. We describe a case of the combined operation through a small incision. A 49-year-old woman presented with a 1-month history of left hemiplegia. echocardiography confirmed mitral stenosis and electrocardiogram revealed atrial fibrillation. The duration of the atrial fibrillation before admission was 12 years. Mitral commissurotomy, removal of clots, and surgical ablation for atrial fibrillation was performed through an 8-cm right parasternal incision. The right femoral artery and vein were used for cannulation. Another cannula was inserted into the superior vena cava. The extended use of cryoablation was carried out instead of atriotomy or reanastomosis. The patient was extubated for 5 hours after the operation. atrial fibrillation was converted to a sinus rhythm. On the basis of our experience, this procedure seemed promising.- - - - - - - - - - ranking = 1keywords = valve (Clic here for more details about this article) |
2/409. Valvular deposition of antiphospholipid antibodies in the antiphospholipid syndrome: a clue to the origin of the disease.In this report we present an unusual case of a 45-year-old female patient with systemic lupus erythematosus (SLE) who was hospitalized for mitral valve replacement. In her childhood she presented with mitral stenosis and chorea on which grounds a preliminary diagnosis of rheumatic fever was established. After a quiescent period lasting two decades her disease erupted with mitral stenosis, thromboembolic phenomena, and nephritis. Due to severe malfunctioning of her mitral valve, the patient eventually underwent mitral valve replacement. The antibodies involved in the pathogenesis of our patient's valvular disease were studied by immunohistochemical analysis, applying rabbit polyclonal anti-human IgG and IgM anti-human C3c and anti-idiotypes to a mouse monoclonal naturally occurring polyspecific human monoclonal anti-cardiolipin antibody termed S2.9, and to the 16/6 Id which defines a common Id on anti-dna antibodies in patients with SLE. Immunoperoxidase staining using an anti-idiotype mAb to anti-cardiolipin antibodies demonstrated the deposition of these anti-bodies in the subendothelial layer of the valve. We believe that anti-phospholipid syndrome (APS) with SLE was the initial and primary disease in this patient. These findings clearly indicate that APS must be considered in the differential diagnosis of rheumatic fever, particularly in young female patients who present with mitral stenosis and chorea.- - - - - - - - - - ranking = 2keywords = valve (Clic here for more details about this article) |
3/409. Successful replacement of a thrombosed Bjork-Shiley mitral valve prosthesis.A case is presented in which 7 months after the first mitral valve replacement (MVR) the malfunction of a Bjork-Shiley valve prosthesis was supposed and the thrombosed valve prosthesis was 2 months later successfully replaced. For the detection of the malfunction of the valve prosthesis echocardiography was especially useful.- - - - - - - - - - ranking = 4keywords = valve (Clic here for more details about this article) |
4/409. Difficult mitral valvuloplasty: an "over the wire" modification of Inoue technique.Failure to cross the mitral valve remains an important cause of the technical failure in performing mitral valvuloplasty with the Inoue technique, especially during initial experience of the operator. We report two such cases where conventional methods failed and an "over the wire" modification of the Inoue technique had to be utilized. This particular modification can be beneficial in the rare cases where negotiating the Inoue balloon across the mitral valve is particularly difficult.- - - - - - - - - - ranking = 1keywords = valve (Clic here for more details about this article) |
5/409. Iatrogenic left main coronary artery stenosis.Iatrogenic left main coronary artery stenosis is a potentially life-threatening complication of cardiac valve replacement surgery due to injury by perfusion cannulas. This requires prompt clinical recognition and diagnosis by repeat coronary angiography, and treatment by early coronary artery bypass grafting. We present 3 patients who had normal coronary arteries prior to valve replacement surgery, and who developed severe left main coronary artery stenosis after surgery. Accelerating angina and refractory ventricular arrhythmia were presenting clinical manifestations. coronary artery bypass grafting was successfully performed in all 3 patients.- - - - - - - - - - ranking = 1keywords = valve (Clic here for more details about this article) |
6/409. Combined aortic and mitral stenosis in mucopolysaccharidosis type I-S (Ullrich-Scheie syndrome).The genetic mucopolysaccharidosis syndromes (MPS) are autosomal recessive inborn errors of metabolism. heart valve involvement in MPS is not uncommon but only a few case reports of successful cardiac surgery are available. In particular, reports of combined aortic and mitral stenosis associated with MPS type I-S are very rare. Both type I and type VI MPS are associated with significant left sided valvar heart disease that requires surgical valve replacement because of irregular valve thickening, fibrosis, and calcification. A 35 year old man had severe mitral valve stenosis after successful surgical replacement of a stenotic aortic valve. Valvar heart disease was investigated by cardiac ultrasound and left heart catheterisation. Histomorphological characterisation of the affected mitral valve was performed. The case illustrates typically associated clinical features of cardiac and extracardiac abnormalities found in MPS type I-S.- - - - - - - - - - ranking = 3keywords = valve (Clic here for more details about this article) |
7/409. Possibility of focal activation around the left upper pulmonary vein during chronic atrial fibrillation with mitral valve disease.Focal regular activations were sometimes observed during chronic atrial fibrillation (AF) associated with mitral valve disease. We present a 58 year-old male diagnosed with mitral valvular stenosis and regurgitation with chronic atrial fibrillation. Intraoperative mapping of both atria was performed during mitral valvular surgery. Regular and repetitive activations around the left superior pulmonary vein were observed, in contrast to irregular and chaotic activations of the right atrium. This regular activation was supposed to be the focus of chronic AF. Surgical ablation of the posterior left atrium was successfully performed and eliminated the chronic AF, concomitant with mitral valve replacement.- - - - - - - - - - ranking = 3keywords = valve (Clic here for more details about this article) |
8/409. Perinatal mitral valve interventions: a report of 10 cases.BACKGROUND: Rheumatic mitral valve stenosis is still an endemic disease in some parts of the world and may complicate pregnancy and perinatal period. During the 10-year period between January 1988 and December 1997, 10 pregnant women with mitral stenosis were operated on. methods: Combined cesarean delivery and closed mitral valvulotomy (CMV) were performed on 6 patients, combined cesarean delivery and Mitral Valve Replacement (MVR) were performed on 1 patient, and 3 patients had CMV during their third trimester. RESULTS: There was 1 stillbirth. All other patients and delivered babies were healthy. MVR was necessary for mitral restenosis in one patient 5 years after her CMV. Three of the remaining patients had some degree of restenosis but did not require reoperation. CONCLUSION: CMV when indicated during pregnancy can be performed with low risk. For symptomatic patients responding to medical therapy, a combined approach of cesarean section and CMV will prevent possible complications that may arise on perinatal period due to hemodynamic fluctuation.- - - - - - - - - - ranking = 2.5keywords = valve (Clic here for more details about this article) |
9/409. Co-existing left atrial thrombus and myxoma in mitral stenosis--a diagnostic challenge.We report an unusual case of an adult who underwent a mitral valve replacement with concomitant excision of the left atrial myxoma and thrombus. echocardiography showed the presence of a large "thrombus" within the left atrial appendage, body and atrial septum. There was difficulty in trying to distinguish between the atrial thrombus and myxoma due to their morphological similarities. At time of surgery, frozen section confirmed the atrial septal component of the thrombus to be an atrial myxoma and the atrial septum was excised to obtain a clear margin.- - - - - - - - - - ranking = 0.5keywords = valve (Clic here for more details about this article) |
10/409. Malfunction of a Bjork-Shiley prosthetic heart valve in the mitral position producing an abnormal echocardiographic pattern.This report presents an echocardiographic study of a patient with fibrous ingrowth about the sewing ring and hinges of a Bjork-Shiley valve in the mitral position. The valve was obstructed and produced a distinct motion pattern. In addition to having a rounded diastolic motion, the disk excursion was decreased.- - - - - - - - - - ranking = 3keywords = valve (Clic here for more details about this article) |
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