A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Mild-to-moderate mitral regurgitation (MR) often coexists with severe aortic stenosis and has been reported to be presented in up to 2/3 patients requiring aortic valve replacement (AVR). MR in patients with aortic stenosis is often functional in nature although organic mitral disease may coexist. Increased afterload and left ventricular remodeling have been implicated to explain the functional MR in patients with aortic valve stenosis. Furthermore, remodeling observed after AVR may impact the outcome of MR postoperatively. However, the clinical outcome of persistent MR after AVR is uninvestigated. On the other hand, concomitant replacement of the aortic and mitral valves is associated with an increased morbidity and mortality compared to an isolated AVR. This study aims to assess the change in MR severity following AVR for severe AS and to determine the factors associated with the MR improvement. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The clinical and surgical characteristics were compared in a cohort of 149 consecutive patients who underwent isolated AVR in Aleppo University Hospital for cardiac surgery. R Re es su ul lt ts s: : Non-severe functional mitral valve regurgitation was detected prior to surgery in 25.5% of the patients. These patients were older (p = 0.007), more often had ventricular dysfunction (p = 0.02) and pulmonary hypertension (p = 0.04), and had been admitted more frequently for heart failure (0.008), with fewer of them conserving sinus rhythm (p = 0.003). In addition, the pre-surgery existence of MR was associated with greater morbidity and mortality (5.2% vs. 3.7%; p = 0.025). The MR disappeared or improved prior to hospital discharge in 56.2% and 15.6%, respectively. Independent factors predicting this improvement were the presence of coronary lesions (OR 3.74, p = 0.03), and the absence of diabetes (OR 0.28, p = 0.005) as well as pulmonary hypertension (OR 0.34, p = 0.01). C Co on nc cl lu u--s si io on n: : In this study, MR decreased or disappeared in a high percentage of patients after AVR surgery. Independent factors predicting this improvement included the presence of prior coronary lesions, although the improvement is influenced by the diabetic status of the patient, as well as pulmonary hypertension. K Ke ey y W Wo or rd ds s: : Cardiac valve annuloplasty; cardiomegaly; cardiac resynchronization therapy; vascular stiffness; venous valves; thoracic surgery Ö ÖZ ZE ET T A Am ma aç ç: : Hafiften ılımlıya mitral regürjitasyonda (MR) genellikle şiddetli aort stenozu (AS) birlikte bulunur ve başvuran hastaların 2/3'ünden fazlasında aort kapağı replasmanı (AVR) gerektiği bildirilmiştir. Aort stenozlu MR olguları sıklıkla işlevsel yapıda olmalarına rağmen, organik mitral kapak hastalığı eş zamanlı bulunabilir. Aortik kapak stenozlu fonksiyonel MR hastalarında artmış ard yük ve sol ventrikülün yeniden şekillenmesi söz konusudur. Hatta, AVR sonrası gözlenen bu yeniden şekillenme, postop MR sürecini etkileyebilir....

Preoperative RD was significantly and independently associated with more red blood cell transfusions and longer hospital stay (median 9 vs. 8 days, p<0.001). Mortality was similar in both groups (3.4% vs. 2.3%, p=0.43). Preoperative mild RD in patients undergoing cardiac valve surgery is an independent marker of postoperative morbidity.

Background Accessory mitral valve tissue is a rare congenital anomaly that is commonly diagnosed in early childhood and rarely in adulthood. It is usually asymptomatic. However, it may cause left ventricular outflow tract obstruction in a way that mimics various other causes of obstruction. Case summary A 72-year-old Caucasian man complained of chest discomfort and exertional dyspnea for 3 months. There were no specific findings from a physical examination except systolic murmur. Transthoracic echocardiography demonstrated a mass on the mitral valve extending to the intraventricular septal, raising the pressure gradient flow across the aortic valve. Transesophageal echocardiography showed parachute-like tissue connected to the anterior leaflet of the mitral valve causing left ventricular outflow tract obstruction. During the surgery preparation period, he underwent coronary angiography and computed tomography to study the anatomy surrounding the mass. After surgery, biopsy showed non-specific findings. Conclusion When facing a case of aortic valve stenosis, accessory mitral valve tissue should be kept in mind as one of the possible underlying causes despite its rarity. Although it is simple and noninvasive, echocardiography remains the best diagnostic procedure to make the correct decision about management and to define the golden time for surgical intervention. Electronic supplementary material The online version of this article (10.1186/s13256-019-2110-z) contains supplementary material, which is available to authorized users.

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