The mechanisms, diagnosis and management of mitral regurgitation in mitral valve prolapse and hypertrophic cardiomyopathy

Popa, M; Irimia, Ana Maria; Papagheorghe, Mihai Nicolae; Vasile, Elena Miruna; Tîrcol, Simona Andreea; Negulescu, Raluca Andreea; Toader, Corneliu; Adam, Robert; Dorobantu, Lucian; Caldararu, Cristina; Alexandrescu, M; Onciul, Sebastian

doi:10.15190/d.2016.8

Cited by 4 publications

(4 citation statements)

References 167 publications

(170 reference statements)

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“…LVOTO is caused by systolic anterior motion (SAM) of the mitral valve (MV). SAM is caused by elongation of the anterior and posterior MV leaflets along with anterior displacement of the papillary muscles 4 . The anterior mitral valve leaflet (AML) moves into the LVOT and during systole comes into contact (in severe cases) with the hypertrophied basal septum and affects blood flow through the LVOT, thus creating haemodynamic instability (Figure 1).…”

Section: Left Ventricular Outflow Tract Obstructionmentioning

confidence: 99%

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Alcohol septal ablation: A useful tool in our arsenal against hypertrophic obstructive cardiomyopathy

Savarimuthu

Harky

2020

J Card Surg

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Objective Affecting 1 in 500 individuals; hypertrophic cardiomyopathy is an autosomal dominant cardiovascular disorder which is prevalent throughout the world. Surgical myectomy (SM) and alcohol septal ablation (ASA) are two methods currently used for the management of drug refractory hypertrophic obstructive cardiomyopathy (HOCM). ASA may prove to be a useful, less invasive treatment in patients with HOCM Methods Electronic literature search was conducted to identify articles that discussed methods to treat drug refractory HOCM. No limits were placed on timing of the publication or the type of article. Keywords and MeSH terms were used and the results were summarized in the relevant section. Results Current evidence suggests that alcohol septal ablation is a safe and effective procedure in treating patients with HOCM with similar short‐ and long‐term outcomes when compared with SM. Conclusion ASA has been shown to be a safe and reliable procedure; imaging techniques and dedicated multi‐disciplinary teams can be used to select patients with HOCM. Though SM is recommended as gold standard treatment for drug refractory HOCM, ASA may play an increasing role in the near future due an ageing population; both ASA and SM can have a beneficial role in treating those who are affected by HOCM when the appropriate group of patients are selected for each intervention.

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Section: Left Ventricular Outflow Tract Obstructionmentioning

confidence: 99%

“…SM has been shown to reduce to decrease LVOTO and improve MR grade 4 . Yu et al studied the effect of SM in patients with HOCM without independent MV disease with varying degrees of MR.…”

Section: Surgical Myectomymentioning

confidence: 99%

Alcohol septal ablation: A useful tool in our arsenal against hypertrophic obstructive cardiomyopathy

Savarimuthu

Harky

2020

J Card Surg

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“…The hydrogels show a local tissue environment to forms significant efforts to forming biological and biochemical new functions. 11 - 13 The hydrogels involved the formation of polymeric, ceramic, nanotubes, graphene, and metallic nanostructures. Accordingly, the hydrogels are used for the cell encapsulation, transplantation, and various fields for the tissue application process, for intense the cells reorganized ligand exchange for the cellular matrix to interacts the cellular membrane proteins in the forms of various cell types.…”

Section: Introductionmentioning

confidence: 99%

Synergistic Fabrication of Dose–Response Chitosan/Dextran/β-Glycerophosphate Injectable Hydrogel as Cell Delivery Carrier for Cardiac Healing After Acute Myocardial Infarction

Chen

Liu

Hua³

et al. 2020

Dose-Response

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The human mesenchymal stem cells (hMSCs) therapy offering an encouraging the new methods to establish the conveying on the chitosan (C)/dextran (D)/β-glycerophosphate (β-GP) loaded with hMSCs to enhance the acute myocardial infarctions. The synthesized hMSCs-CD@β-GP system displayed the ratio of determination modules, size of the pore, absorbency, and the swellings ratio in the assortment of the 65 ka, 149 ± 39.8 µm, 92.2%, 42 ± 1.38, and 29 ± 1.9, respectively. The fabricated hMSCs-CD@β-GP was highly stable and physicochemical investigated and confirmed the suitability of the materials for cardiac regeneration applications. The in vitro examinations of the injectable hydrogels with hMSCs-CD@β-GP have recognized that the improved survival rate of the cells, increased the pro-inflammatory expressions factors, pro-angiogenic factors analysis confirmed the promising results of the ejection of fractions, fibrosis area, vessel density with decreased infractions size, with suggesting that the remarkable improvement of the heart regenerative function after myocardial infarctions. The new synergistic approach of the injectable hydrogels with hMSCs could able appropriate for the effective treatment of cardiac therapies after acute myocardial infarctions.

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“…The majority of MVP cases involves the posterior middle scallop. The most common segment involved in MVP is the P2 segment [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Isolated Flailed P3 Scallop of the Mitral Valve Leaflet in the Setting of Newly Diagnosed Heart Failure With Preserved Ejection Fraction

Noain¹,

Mizrahi²,

Zheng³

et al. 2020

Cureus

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Mitral valve prolapse (MVP) is characterized by typical fibromyxomatous changes in the mitral leaflet tissue with superior displacement of one or both leaflets into the left atrium. An echocardiogram is a fundamental study required for the diagnosis of MVP with a flail leaflet and grading of mitral regurgitation (MR) severity. Most patients with MVP have a risk of cardiovascular morbidity and mortality similar to that of the general population, though moderate to severe MR and left ventricular (LV) ejection fraction less than 50% have been postulated to increase the risk of adverse cardiac events. In this case report, we present an isolated flailed P3 scallop of the mitral valve leaflet leading to severe MR and acute congestive heart failure. A 54-year-old African-American male with a medical history of hypertension, hyperlipidemia, and transient ischemic attack, presented to the emergency department (ED) for evaluation of dyspnea on exertion. The patient reported that his dyspnea started one week prior to ED visit and was associated with intermittent chest pain. He also endorsed mild orthopnea and lightheadedness, though he denied any syncopal event. Vital signs were found within normal limits on arrival. He clinically appeared to be volume overloaded which improved quickly with IV furosemide. Transesophageal echocardiogram (TEE) with 3D image acquisition showed significant for hyper-dynamic LV function and evidence of isolated flailed P3 scallop of the mitral valve (MV) leaflet resulting in a severe eccentric, anteriorly directed MR jet. The MV leaflets did not appear thickened, and there was no evidence of mitral or aortic stenosis. Cardiac catheterization showed multivessel disease for which the patient underwent coronary artery bypass grafting and MV repair. This patient presented with new-onset congestive heart failure secondary to severe MR associated with undiagnosed MVP. Commonly, the middle scallop (P2) of the posterior leaflet is more prone to prolapse due to its redundancy and variable thickness with the impact of greater systolic pressure. However, in this case of acute severe MR, we identified an isolated flail of the P3 segment. We believe that this rare TEE finding was associated with a torn chordae or ruptured papillary muscle secondary to ischemic disease as the posteromedial papillary muscle has a single blood supply and is particularly prompted to injury from myocardial infarction.

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The mechanisms, diagnosis and management of mitral regurgitation in mitral valve prolapse and hypertrophic cardiomyopathy

Cited by 4 publications

References 167 publications

Alcohol septal ablation: A useful tool in our arsenal against hypertrophic obstructive cardiomyopathy

Alcohol septal ablation: A useful tool in our arsenal against hypertrophic obstructive cardiomyopathy

Synergistic Fabrication of Dose–Response Chitosan/Dextran/β-Glycerophosphate Injectable Hydrogel as Cell Delivery Carrier for Cardiac Healing After Acute Myocardial Infarction

Isolated Flailed P3 Scallop of the Mitral Valve Leaflet in the Setting of Newly Diagnosed Heart Failure With Preserved Ejection Fraction

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