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Views Total views. Actions Shares. Embeds 0 No embeds. No notes for slide. Plastia mitral 1. Cardiotomy and valvulotomy for mitral stenosis. Experimental observations and clinical notes concerning an operated case with recovery. Boston Med. Surg J. Henry S. Souttar, en Londres, ; realiza la primera comisurotomia mitral transatrial. The surgical treatment of mitral stenosis. The surgical treatment of mitral stenosis mitral commissurotomy.

Dis Chest, , 15, 6. Dwight Emary Harken. Realiza la primera valvuloplastia. New Engl.

Valvulotomy for mitral stenosis: report of six successful cases. Brit Med J ; 8. Dominic, Zacek. Heart valve surgery: An illustrated guide. Robert, Frater. The Lancet, Cardiac valve surgery--the "French correction". J Thorac Cardiovasc Surg.

Valvular heart disease

Anuloplastia Mitral1. Jude Medical— Seguin. Carpentier - Edwards Physio. Carpentier— Edwards rigid. Anuloplastia MitralAdjustable annuloplasty ring St. Anteroposterior distance of the mitral annulus is reduced and the P2 zone is elevated in the ring. This ring has a significantly longer anteroposterior diameter and saddle-like elevation in the area of P2.

J Thorac Cardiovasc Surg —81 J Thorac Cardiovasc Surg — It is generally advocated to use noneverting stitches for all prosthesis in the mitral position to identify and confirm proper seating. Leaflet mobility should be assessed to ascertain no entrapment by subvalvular structures.

Introduction

It is generally recommended that mechanical prosthesis should be oriented in an anti-anatomic fashion 36 and bioprosthetic strut location oriented such that contact with the ventricular wall and impingement on the left ventricular outflow tract are avoided. Immediate recognition and replacement of the valve with dissection tract incorporation is required. Thromboembolism is the most common postoperative complication of both bioprosthetic and mechanical valves and occurs at a rate of 1.

Carbomedics, Medtronic Hall, St. The presence of one or more patient risk factors requires a target INR level increase by 0. The low level of evidence pertaining to current bioprosthetic anticoagulation management is reflected by reports that suggest similar thromboembolic incidence for vitamin K antagonists and acetylsalicylic acid. The addition of low-dose aspirin should be considered in patients with concomitant atherosclerotic disease and in patients with a mechanical prosthesis after thromboembolism despite adequate INR.

In case of valve thrombosis, thrombolytics may be used to treat mitral prosthetic thrombosis in the absence of cardiogenic shock. If thrombolysis fails, or if there is hemodynamic compromise, valve replacement is required. Prosthetic valve endocarditis risks are similar for both types and are reported to be 1. Long-term endocarditis risk is 0. Endocarditis prophylaxis and management of prosthetic valve endocarditis are extensively described in specialized guidelines.

Prosthetic valve degeneration is the most significant complication of bioprosthetic valves.

Reoperation is warranted in symptomatic patients with severe regurgitation or significant transprosthetic gradient increase and should be considered in asymptomatic patients with significant prosthetic dysfunction, provided that they are at low risk of perioperative complications. Percutaneous balloon interventions should be avoided in the treatment of stenotic left-sided bioprostheses. Treating bioprosthetic failure by transcatheter valve-in-valve implantation is feasible in patients considered to be inoperable or at high risk 57 but is not an established alternative to surgery.

Patient prosthesis mismatch can occur when the indexed geometric orifice area is less than 1. Paravalvular leak is reported to occur in 1. The use of pledgeted, noneverting mattress sutures and reinforcing the annulus with Teflon strips are reported. Transcatheter closure is feasible, but reports that confirm consistent efficiency are limited at present. The rapid development of catheter-based replacement devices and the continuous changes in patient expectations provide exciting prospects for the future treatment of mitral valve disease.

Heart Valve Surgery

These valves consist of nitinol self-expanding frames, bovine pericardial leaflets Tendyne, however, is porcine , and a fabric-sealing skirt CardiAQ consists of a pericardial skirt and are delivered through direct transapical access. CardiAQ can also be delivered by transfemoral-transseptal access. The role of mitral valve replacement is under continuous reevaluation and is at present limited to irrepairable valves or patients at high risk for future reinterventions.

Successful outcomes are determined by meticulous perioperative risk assessment, prosthesis selection, anticoagulation management, and long-term clinical surveillance in well-informed and compliant patients. Endoscopic and robotic surgical approaches introduced attractive alternatives to conventional sternotomy access and are progressively becoming favored as the preferred surgical approaches by heart teams worldwide.

Transcatheter mitral valve implantations are now a clinical reality and will undoubtedly redefine the role of mitral valve replacement in the near future. Peer review: Three peer reviewers contributed to the peer review report. Author Contributions: Both authors contributed equally to this manuscript and apply the principles outlined in their daily mitral valve practices. National Center for Biotechnology Information , U. Open J Cardiovasc Surg. Published online Jul Johan van der Merwe and Filip Casselman. Author information Article notes Copyright and License information Disclaimer.

Email: eb. Received Nov 10; Accepted Jun This article has been cited by other articles in PMC. Abstract The favorable outcomes achieved with modern mitral valve repair techniques redefined the role of mitral valve replacement. Keywords: Mitral valve replacement.

Introduction

Introduction The rapid development, favorable impact, and simplification of durable mitral valve repair techniques redefined the modern role of mitral valve replacement. Indications for Mitral Valve Replacement Current guidelines limit mitral valve replacement to irrepairable valve pathology that will result in poor durability outcomes, especially in patients unlikely to tolerate future reinterventions.

Current Prosthesis Types and Selection The surgical replacement of a stenotic or insufficient mitral valve is based on the premise that the prosthesis type chosen will have a beneficial impact on cardiac function and quality of life within the context of perioperative risks and long-term prosthesis complications. Table 1. Current Food and Drug Administration—approved mitral valve prostheses. Open in a separate window. Figure 1. Figure 2. Future Perspectives: Transcatheter Mitral Valve Replacement The rapid development of catheter-based replacement devices and the continuous changes in patient expectations provide exciting prospects for the future treatment of mitral valve disease.

Figure 3. Conclusions The role of mitral valve replacement is under continuous reevaluation and is at present limited to irrepairable valves or patients at high risk for future reinterventions. Footnotes Peer review: Three peer reviewers contributed to the peer review report.

Understanding options for patients helps you be a more effective caregiver.

References 1. Results of mitral valve reconstruction. Lawrie GM. Mitral valve repair vs.