As life expectancy increases,valvular heart disease is becoming more common.Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to ...As life expectancy increases,valvular heart disease is becoming more common.Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to the elderly population.Recent years have brought a progression of surgical treatments toward less invasive strategies.This has given rise to percutaneous approaches for the correction of valvular heart disease.Percutaneous mitral valve repair using the MitraClip system (Abbott Vascular,Santa Clara,CA,USA) creates a double orifice and has been successfully used in selected patients with mitral regurgitation.We review the rationale,procedural aspects,and clinical data thus far available for the MitraClip approach to mitral regurgitation.展开更多
Surgical repair has been the standard therapy for severe mitral regurgitation causing symptoms or left ventricular dysfunction.Percutaneous mitral valve repair has become an appealing alternative approach for patients...Surgical repair has been the standard therapy for severe mitral regurgitation causing symptoms or left ventricular dysfunction.Percutaneous mitral valve repair has become an appealing alternative approach for patients who are not suitable for surgery.However,clinical trial data are not available on the institutional impact of a percutaneous mitral valve repair program on mitral valve surgery.The current study retrospectively evaluated the impact of the MitraClip program on the mitral valve surgery volume and outcomes.Patient data were retrieved from the 2 years before and the 2 years after initiation of the MitraClip program.The volume of MitraClip procedures increased from eight cases in 2015 to 91 cases in 2017.Since the initiation of the MitraClip program in 2015,the volume of both mitral valve replacement and mitral valve repair also increased(43 vs.60 and 110 vs.154,respectively).Importantly,we observed improved surgical outcomes,including fewer perioperative complications and lower operative mortality and in-hospital mortality.Data from our single-institution experience indicate that the introduction of the MitraClip program is associated with increased mitral valve surgery volume and improved outcomes.The establishment of the MitraClip program enables the hospital to provide higher quality of care and potentially become a referring center for structural heart patients.展开更多
Chronic renal failure is strongly related to poor outcomes, in cardiovascular system, such as: cardiac dilatation, left ventricular dysfunction and mitral valve regurgitation. Mitral calcification and regurgitation pl...Chronic renal failure is strongly related to poor outcomes, in cardiovascular system, such as: cardiac dilatation, left ventricular dysfunction and mitral valve regurgitation. Mitral calcification and regurgitation play an important role in prediction of morbidity and mortality in patients on dialysis. Percutaneous mitral valve repair (MVR) with the MitraClip system, which has begun to be used in severe mitral insufficiency patients with multiple comorbid medical conditions, including renal disease, is a new, alternative method. This intervention is not associated with cardiopulmonary bypass, thus;it has been proven to be safe and effective in risky patients. In this report, we would like to share our anesthetic experience in successful mitral valve repair by MitraClip system in a patient who had undergone renal transplantation twice.展开更多
BACKGROUND The use of percutaneous transcatheter edge-to-edge repair(TEER)for mitral regurgitation(MR)has increased,including an increased application to older,frailer,and higher risk patients.CASE SUMMARY A 74 year-o...BACKGROUND The use of percutaneous transcatheter edge-to-edge repair(TEER)for mitral regurgitation(MR)has increased,including an increased application to older,frailer,and higher risk patients.CASE SUMMARY A 74 year-old woman with severe MR,a left ventricular ejection fraction of 45%,and a small circumferential pericardial effusion underwent TEER of the mitral valve.After the placement of two MitraClips,the MR was assessed as mild to moderate.Within 10-20 minutes after the completion of the case,the patient was dyspneic and hypotensive despite volume resuscitation.Point-of-care ultrasound(POCUS)showed no changes in cardiac contractility,valve function,or the pericardial space.The right heart chambers appeared small with right atrial(RA)diastolic collapse.There was no evidence of venous congestion.Further exam showed a large right pleural fluid collection.Given the clinical scenario of dyspnea,hypotension,and diastolic RA collapse,low-pressure tamponade was suspected.A thoracentesis expelled 1200 mL of blood with immediate hemodynamic improvement.The patient made an uneventful recovery.CONCLUSION The application of POCUS is crucial for detecting,diagnosing,and properly managing cardiac dysfunction and procedural complications associated with TEER.While tamponade is classically associated with a pericardial effusion and vena caval plethora,their absence does not dismiss the suspicion or diagnosis of tamponade.This case highlights the value of POCUS in assessing low-pressure tamponade caused by a large,pressurized pleural effusion.Clinical suspicion,supported by POCUS findings,was confirmed by a thoracentesis that resulted in immediate hemodynamic improvement.展开更多
Growing evidence indicates that severe tricuspid regurgitation(TR)is independently associated with adverse clinical outcomes.The prognostic benefit of isolated TR surgery remains unclear,and medical therapy for decomp...Growing evidence indicates that severe tricuspid regurgitation(TR)is independently associated with adverse clinical outcomes.The prognostic benefit of isolated TR surgery remains unclear,and medical therapy for decompensated right heart failure alone cannot delay disease progression.TR assessment and management have substantially evolved in recent years.Currently,minimally invasive catheter-based techniques have emerged as a feasible and effective option for TR treatment in high-risk surgical patients.Transcatheter tricuspid valve edge-to-edge repair(T-TEER)has been proposed and applied as an interventional treatment for TR,and has yielded promising preliminary results.This review provides an overview of the current state of T-TEER.展开更多
文摘As life expectancy increases,valvular heart disease is becoming more common.Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to the elderly population.Recent years have brought a progression of surgical treatments toward less invasive strategies.This has given rise to percutaneous approaches for the correction of valvular heart disease.Percutaneous mitral valve repair using the MitraClip system (Abbott Vascular,Santa Clara,CA,USA) creates a double orifice and has been successfully used in selected patients with mitral regurgitation.We review the rationale,procedural aspects,and clinical data thus far available for the MitraClip approach to mitral regurgitation.
文摘Surgical repair has been the standard therapy for severe mitral regurgitation causing symptoms or left ventricular dysfunction.Percutaneous mitral valve repair has become an appealing alternative approach for patients who are not suitable for surgery.However,clinical trial data are not available on the institutional impact of a percutaneous mitral valve repair program on mitral valve surgery.The current study retrospectively evaluated the impact of the MitraClip program on the mitral valve surgery volume and outcomes.Patient data were retrieved from the 2 years before and the 2 years after initiation of the MitraClip program.The volume of MitraClip procedures increased from eight cases in 2015 to 91 cases in 2017.Since the initiation of the MitraClip program in 2015,the volume of both mitral valve replacement and mitral valve repair also increased(43 vs.60 and 110 vs.154,respectively).Importantly,we observed improved surgical outcomes,including fewer perioperative complications and lower operative mortality and in-hospital mortality.Data from our single-institution experience indicate that the introduction of the MitraClip program is associated with increased mitral valve surgery volume and improved outcomes.The establishment of the MitraClip program enables the hospital to provide higher quality of care and potentially become a referring center for structural heart patients.
文摘Chronic renal failure is strongly related to poor outcomes, in cardiovascular system, such as: cardiac dilatation, left ventricular dysfunction and mitral valve regurgitation. Mitral calcification and regurgitation play an important role in prediction of morbidity and mortality in patients on dialysis. Percutaneous mitral valve repair (MVR) with the MitraClip system, which has begun to be used in severe mitral insufficiency patients with multiple comorbid medical conditions, including renal disease, is a new, alternative method. This intervention is not associated with cardiopulmonary bypass, thus;it has been proven to be safe and effective in risky patients. In this report, we would like to share our anesthetic experience in successful mitral valve repair by MitraClip system in a patient who had undergone renal transplantation twice.
文摘BACKGROUND The use of percutaneous transcatheter edge-to-edge repair(TEER)for mitral regurgitation(MR)has increased,including an increased application to older,frailer,and higher risk patients.CASE SUMMARY A 74 year-old woman with severe MR,a left ventricular ejection fraction of 45%,and a small circumferential pericardial effusion underwent TEER of the mitral valve.After the placement of two MitraClips,the MR was assessed as mild to moderate.Within 10-20 minutes after the completion of the case,the patient was dyspneic and hypotensive despite volume resuscitation.Point-of-care ultrasound(POCUS)showed no changes in cardiac contractility,valve function,or the pericardial space.The right heart chambers appeared small with right atrial(RA)diastolic collapse.There was no evidence of venous congestion.Further exam showed a large right pleural fluid collection.Given the clinical scenario of dyspnea,hypotension,and diastolic RA collapse,low-pressure tamponade was suspected.A thoracentesis expelled 1200 mL of blood with immediate hemodynamic improvement.The patient made an uneventful recovery.CONCLUSION The application of POCUS is crucial for detecting,diagnosing,and properly managing cardiac dysfunction and procedural complications associated with TEER.While tamponade is classically associated with a pericardial effusion and vena caval plethora,their absence does not dismiss the suspicion or diagnosis of tamponade.This case highlights the value of POCUS in assessing low-pressure tamponade caused by a large,pressurized pleural effusion.Clinical suspicion,supported by POCUS findings,was confirmed by a thoracentesis that resulted in immediate hemodynamic improvement.
文摘Growing evidence indicates that severe tricuspid regurgitation(TR)is independently associated with adverse clinical outcomes.The prognostic benefit of isolated TR surgery remains unclear,and medical therapy for decompensated right heart failure alone cannot delay disease progression.TR assessment and management have substantially evolved in recent years.Currently,minimally invasive catheter-based techniques have emerged as a feasible and effective option for TR treatment in high-risk surgical patients.Transcatheter tricuspid valve edge-to-edge repair(T-TEER)has been proposed and applied as an interventional treatment for TR,and has yielded promising preliminary results.This review provides an overview of the current state of T-TEER.
