In-Hospital Outcomes in Minimally Invasive Mitral Valve Surgery: First Results in a Brazilian Single Center

Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel® program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m2, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.

Prognostic Role of Preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) in Mitral Valve Replacement (MVR) for Rheumatic Mitral Stenosis Patients

Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.

The Application Effect of Predictive Nursing on Cardiopulmonary Rehabilitation of Patients Undergoing Heart Valve Surgery with Extracorporeal Circulation

Objective:To evaluate the application effect of predictive nursing on patients undergoing heart valve surgery with extracorporeal circulation(ECC).Methods:92 ECC patients admitted to the hospital between July 2021 and July 2023 were selected and grouped by random number table method;the observation group practiced predictive nursing,while the reference group practiced conventional nursing.The cardiopulmonary rehabilitation and other indexes were compared between the groups.Results:The postoperative rehabilitation time of the observation group was shorter than that of the reference group,the treatment compliance was higher than that of the reference group,the cardiopulmonary function indexes were all better than that of the reference group,and the complication rate was lower than that of the reference group(P<0.05).Conclusion:The implementation of predictive nursing for ECC patients can promote postoperative rehabilitation,improve patients’treatment compliance,and enhance the cardiopulmonary rehabilitation effect,and nursing safety is high.

Minimally invasive valve surgery:pushing boundaries over the eighty

BACKGROUND Mean age of patients with valves diseases is significantly increasing,and,in the near future,cardiac surgeons will have to deal with a considerable number of patients aged more than 80 years.The remarkable results gained by the minimally invasive approach have encouraged its application in more complex and fragile patients,such as older people.This study aimed to identify the rate of early mortality and major complications,and independent predictors for mid-term mortality in octogenarians undergoing minimally invasive valve surgery.METHODS Octogenarian patients undergoing right mini-thoracotomy mitral and/or tricuspid valve surgery between 2006 and2020 were included.Primary endpoint was to identify independent predictors for mid-term mortality,and secondary endpoints were operative morality,stroke,independent predictors for early composite outcome,and quality of life at follow-up.RESULTS Analysis was performed on 130 patients.Stroke occurred in one patient(0.8%),while operative mortality was 6%(eight patients).One-year and five-year survival were 86% and 64%,respectively.Logistic regression identified age and creatinine level as independent predictors of mid-term mortality,survival analysis showed that age ≥ 84 years and creatinine level ≥ 1.22 mg/dL were the cut-off points for worst prognosis.Female gender and hypertension were found to be independent predictors of early composite outcome.CONCLUSIONS Results of the present study show that age alone should not be considered a contraindication for minimally invasive valve surgery.Identifying patients who are most likely to have survival and functional benefits after surgery is decisive to achieve optimal health outcomes and prevent futile procedures.

Importance of concomitant functional mitral regurgitation on survival in severe aortic stenosis patients undergoing aortic valve replacement

BACKGROUND Mitral regurgitation(MR)is commonly seen in patients with severe aortic stenosis(AS)undergoing aortic valve replacement(AVR).But the long-term implications of MR in AS are unknown.AIM To investigate MR’s impact on survival of patients undergoing surgical AVR for severe AS.METHODS Of the 740 consecutive patients with severe AS evaluated between 1993 and 2003,287 underwent AVR forming the study cohort.They were followed up to death or till the end of 2019.Chart reviews were performed for clinical,echocardiographic,and therapeutic data.MR was graded on a 1-4 scale.Mortality data was obtained from chart review and the Social Security Death Index.Survival was analyzed as a function of degree of MR.RESULTS The mean age of the severe AS patients who had AVR(n=287)was 72±13 years,46%women.Over up to 26 years of follow up,there were 201(70%)deaths,giving deep insights into the determinants of survival of severe AS who had AVR.The 5,10 and 20 years survival rates were 75%,45%and 25%respectively.Presence of MR was associated with higher mortality in a graded fashion(P=0.0003).MR was significantly associated with lower left ventricular(LV)ejection fraction and larger LV size.Impact of MR on mortality was partially mediated through lower LV ejection fraction and larger LV size.By Cox regression,MR,lower ejection fraction(EF)and larger LV end-systolic dimension were independent predictors of higher mortality(χ^(2)=33.2).CONCLUSION Presence of greater than 2+MR in patients with severe AS is independently associated with reduced survival in surgically managed patients,an effect incremental to reduced EF and larger LV size.We suggest that aortic valve intervention should be considered in severe AS patients when>2+MR occurs irrespective of EF or symptoms.

Mitral Valve Abnormalities during Hypertrophic Cardiomyopathy: Study on a Cohort in Dakar

INTRODUCTION: Mitral valve abnormalities in hypertrophic cardiomyopathy (HCM) are becoming increasingly well defined, and their role in intra-ventricular obstruction is well defined. The aim of this study was to evaluate mitral valve abnormalities in patients with HCM. PATIENTS AND METHODS: We conducted a descriptive cross-sectional study from May 1 to July 1, 2022 in the Cardiology Department of Aristide Le Dantec Hospital. All patients with HCM aged at least 18 years old were included. The parameters studied concerned mainly the mitral valvular apparatus (papillary muscles abnormalities, leaflet length, mitral insufficiency). RESULTS: A total of 10 patients were included. Mean age was 58.3. On Doppler echocardiography, mean interventricular septal thickness was 20.6 mm. The mean maximum intra-ventricular gradient was 21.06 mmHg. Two patients had significant intraventricular obstruction. The mean length of the anterior mitral valve leaflet was 28.7 ± 3.55 mm, with extremes of 22 and 33 mm. The posterior mitral leaflet averaged 14.8 ± 3.16 mm. Nine (9) out of 10 patients had an elongated anterior valve leaflet. Elongation of the posterior leaflet was noted in 6 patients. With regard to papillary muscle position, 6 patients had an anterolateral ascending pillary muscle. These patients had a mean intra-ventricular gradient of 25 mmHg, compared with 16.5 mmHg in the others cases. We found no direct insertion on the mitral valve. Mitral insufficiency was noted in 9 patients, including 5 with mild insufficiency and 4 with moderate one. CONCLUSION: Mitral valve abnormalities in HCM appear to be frequent. They should be analyzed for a better diagnostic and therapeutic approach.

Prevalence of Preoperative Anemia in Elective Rheumatic Valve Surgery at a Tertiary Care Center in Nepal

Background: Rheumatic Valvular Heart disease (RVHD) is common in developing countries often associated with anemia;however its burden is often overlooked. Anemic patients undergoing surgery are likely to receive blood transfusion, increasing morbidity and mortality. Prevalence of anemia in cardiac surgical patients are studied extensively, however its burden in RVHD is lacking. This study attempted to investigate the prevalence of preoperative anemia in RVHD and its effect on blood transfusion, morbidity and mortality in patients undergoing valve surgery. Methods: This is a retrospective observational study conducted at a tertiary care hospital in Nepal. We considered 340 patients who underwent Rheumatic valve replacement surgery from 2014 January to December 2016 and data on their socio-demographic and clinical characteristics were extracted from the patient’s records. The analyses meeting the study objectives were conducted using IBM SPSS v25 for Windows (IBM Statistical Package for Social Sciences, 2015IBM Corporation, New York, United States). Results: The prevalence of no anemia, mild, moderate, and severe anemia was 34.1%, 57.7%, 39.6%, 2.5%, respectively. The units of Red Blood Cell used for transfusion were 1.2 units, 2.0 units, 2.3 units, and 1.6 units in patients without anemia, and those with mild, moderate and severe anemia respectively. The incidence of reexploration was higher in patients with severe anemia as compared to the non anemic with an incidence of 66.6%. A proportion of the patients with no anemia, mild, moderate and severe anemia with less than 7 days stay in the intensive care unit were 89%, 82%, 84.7% and 100% respectively. The length of hospital stay more than 10 days was seen in 58.9%, 71.6%, 63% and 100% in patients with no anemia, mild, moderate and severe anemia. An overall incidence of mortality in anemic patients was 11% while in non anemic patients was 5.3%. Conclusions: The prevalence of anemia was high in the Nepalese patients with Rheumatic valvular heart disease planned for elective surgery. There was an increased incidence of blood transfusion, longer hospital stay, and increased mortality in anemic patients compared to their non anemic counterparts.

Impact of MitraClip Program on the Volume and Outcomes of Mitral Valve Surgery:A Single-Center Retrospective Study

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.

Long-Term Outcomes Comparing Minimally Invasive Mitral Valve Repair versus Conventional Mitral Valve Surgery

Objectives: To compare the long term outcomes between minimally invasive mitral valve repair (MiMVR) and conventional surgery. Current retrospective comparisons between the techniques frequently report echocardiographical (echo) outcomes early after surgery and rarely report them later. Methods: Patients were selected for MiMVR by the surgical multi-disciplinary meeting from June 2008-March 2013. Patients included had at least two transthoracic post-operative echocardiograms. Echocardiographic parameters including left ventricular size and systolic function, degree of mitral regurgitation (MR) and mean mitral valve gradient were recorded. Clinical outcomes including all-cause mortality, re-operation, recurrence of at least moderate MR and elevated mean mitral valve gradients > 5 mmHg were recorded and compared using Kaplan-Meier survival analysis. Results: 223 patients were screened, 96 (43%) met the criteria and were included. Thirty-seven patients underwent conventional surgery and 59 underwent MiMVR. Mean clinical follow-up was 6.3 years and echo follow up was 3.2 years. There was a significantly higher recurrence of moderate MR in the conventional group (38% (n = 19) versus 17% (n = 10)). The mean LV end-diastolic diameter was 4.8 cm (conventional) versus 5.0 cm (MiMVR). The incidence of elevated PG was 26% (n = 13, conventional) and 23% (n = 14, MiMVR). There was no significant difference in incidence in re-operation (conventional 12% (n = 6), MiMVR 8.3% (n = 5)). Long-term mortality was higher in the conventional group (1.7% vs. 18% p = 0.004) although the logistic Euroscore was significantly higher 6.8% ± 5.4 vs. 3.6% ± 1.6. Conclusions: Minimally invasive mitral valve surgery is safe and feasible in selected patients with good medium and long-term echocardiographic follow-up.

Source, Triggers and Clinical Implications of Hyperlactemia in Patients Undergoing Mitral Valve Surgery Using Custodiol Cardioplegia

Background: Postoperative blood hyperlactaemia is an indicator of organ anaerobic metabolism and is associated with morbidity after cardiac surgery. This prospective study aims to explore the source, triggers and clinical implications for hyperlactaemia in patients undergoing mitral valve surgery using Custodiol cardioplegia. Methods: Twenty consecutive elective patients undergoing open-heart surgery for mitral valve repair/replacement using Custodiol (based on Bretschneider’s HTK-solution) cardioplegia were recruited. A serial measurement of arterial blood lactate was performed. Pre-, intra-and post-operative clinical data were obtained and cardiac injury was determined by serial plasma measurement of postoperative release of CK-MB. Results: There were no in-hospital deaths. Most of the patients (n = 16) needed intraoperative direct current cardioversion to treat ventricular arrhythmias or post-operative vasopressors (n = 13) to treat vasoplegia. There was significant cardiac injury as determined by the marked increase of serum CK-MB (p 0.05). A significant (p 0.05) increase in blood lactate was found to follow a biphasic profile. The first peak (from 0.54 ± 0.03 to 1.3 ± 0.07 mM) was observed immediately following the release of the aortic cross-clamp and remained high for 1 hour. This was followed by a second peak at 12 hours post-operatively (1.9 ± 0.2 mM). The second rise in lactate was seen only in patients that required post-operative vasopressors (1.3 ± 0.2 vs 2.2 ±0.3 mM, p 0.05), in whom a significant late decrease in CVP was also observed (12.2 ± 1.0 to 7.7 ± 1.0 for 1 and 12 hours postoperative, respectively). Hyperlactaemia did not correlate with any other variables including CK-MB levels, cross-clamp or cardiopulmonary bypass time. Conclusions: In patients undergoing mitral valve surgery with Custodiol cardioplegia there is marked cardiac injury and a biphasic release of blood lactate. The initial peak in lactate occurs immediately following unclamping the aorta and is likely to be of organ (e.g. heart and lungs) origin. A second peak is only seen in patients requiring postoperative vasopressors to treat vasoplegia. Hyperlactaemia following mitral valve surgery with Custodiol cardioplegia does not seem to be related to myocardial injury as expressed by CK-MB release.

Predictor Analysis of Mid-Term Left Atrial Reverse Remodeling after Mitral Valve Surgery

Objective: The aim of this study was to predict mid-term left atrial reverse remodeling after mitral valve surgery. Patients and Methods: Echocardiographic data was obtained preoperatively and at follow-up from 105 patients who underwent mitral valve surgery. Left atrial volume (LAV) was decreased by >30% from baseline in 43 patients (group A), but not in 62 patients (group B). Results: Patients in group A were younger (p = 0.0029). Male was more (p = 0.05) and prosthesis size was bigger in group A (p = 0.005). Only age was a predictor of left atrial reverse remodeling in a logistic regression model (OR = 0.93, 95% CI 0.88 - 0.99;p = 0.03). Late mean trans-mitral pressure gradient was lower in group A than in group B (p = 0.01). There was a weak correlation between the change in left ventricular end-diastolic diameter (LVDd) and LAV (correlation coefficient 0.27, 95% CI 0.07 - 0.45;p = 0.008). Survival and freedom from major adverse cardiac events did not differ between the groups (p = 0.31 and p = 0.87 by log-rank test). Conclusions: Age was the only predictor of left atrial reverse remodeling. There was a weak correlation between changes in LVDd and LAV.

Mitral Valve Surgery for Functional Regurgitation: Insights into Heart Failure and Readmission

Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitral valve replacement (MVR) is the alternative procedure typically reserved for patients who are at higher risk or refractory to MVr. The present study aims to determine which of the two procedures is more effective in the surgical treatment of FMR. Methods: 344 charts of FMR patients who received either MVr (n = 263) or MVR (n = 81) from 2004-2016 at our institution were reviewed. Treatment efficacy was assessed based on heart failure (HF)-readmission and survival rates within 5 years from discharge. Propensity score approach with inverse probability weighting and Cox regression models were employed to evaluate procedural impact on survival and rehospitalizations, respectively. Follow-up echocardiographic data from the original cohort was assessed for differences in metrics between procedural groups at >6 months (MVr: n = 75;MVR: n = 23) and 1 year (MVr: n = 75;MVR: n = 18) post-op. Results: MVR patients had a lower risk of being readmitted for HF within 5 years compared to the MVr group (HR-adj (95% CI): 0.60 (0.41 - 0.88), p = 0.008). MVR patients also had a higher overall risk of death (HR-adj (95% CI): 1.82 (1.05 - 3.16), p = 0.034) but this was borderline significantly different at 5 years cut-off (p = 0.057). Conclusions: Higher HF readmission in MVr patients than in sicker, higher surgical-risk MVR patients reflects the inadequacy of MVr to treat FMR. Novel approaches to MVR may be necessary to adequately manage FMR.

Staged Surgery for Bronchobiliary Fistula and Incidental Finding of Mitral Valve Disease

Bronchobiliary fistula (BBF) is defined as abnormal passage between bronchial system and the bile tree which often manifests as presence of bile in the sputum (biloptysis). BBF is a serious complication which requires early diagnosis and well-planned management strategy to avoid the high morbidity and mortality rate. The hydatid cystic disease is still the leading cause of the BBF. In this paper we present a case of 32-year-old man with BBF who was incidentally found to have a mitral valve disease for which he underwent mitral valve replacement during his management course.

Chronic ischemic mitral valve regurgitation and surgical perspectives

Chronic ischemic mitral valve regurgitation is a result of disturbed left ventricular geometry secondary to myocardial ischemia in the absence of intrinsic mitral valve pathology. It is a common complication after myocardial infarction, and patients who have ischemic mitral regurgitation(IMR) have a worse prognosis compared to patients who have ischemic heart disease alone, and this is directly related to the severity of IMR. Medical therapy has limited efficacy, and surgical options including various repair techniques and valve replacement had been tried with variable success. Still there is intense debate among surgeons whether to interfere with moderate degree IMR at the time of coronary artery revascularization.

Surgical management of moderate ischemic mitral valve regurgitation: Where do we stand?

Ischemic mitral regurgitation(IMR) represents a common complication after myocardial infarction. The valve is anatomically normal and the incompetence is the result of papillary muscles displacement and annular dilatation, causing leaflets tethering. Functionally the leaflets present a restricted systolic motion due to tethering forces that displaces the coaptation surface toward the left ventricle apex. The patients present poor left ventricular function at the time of surgery and the severity of the mitral regurgitation increases the risk of mortality. Currently there is general agreement to treat surgically severe IMR nevertheless strong evidences for patient with moderate insufficiency remains poor and proper treatment debated. The most effectivesurgical approach for the treatment of IMR remains debated. Some authors demonstrated that coronary artery bypass graft(CABG) alone is beneficial in patients with IMR. Conversely, in most patients, moderate IMR will persist or worsen after CABG alone which translate in higher long-term mortality as a function of residual mitral regurgitation severity. A probable reason for this unclear surgical management of functional MR is due to the contemporary suboptimal results of reparative techniques. The standard surgical treatment of chronic IMR is CABG associated with undersized annuloplasty using complete ring. Though, the recurrence of mitral regurgitation remains high(】 30%) because of continous left ventricle remodeling. To get better long term results, in the last decade, several subvalvular procedures in adjunct to mitral anuloplasty have been developed. Among them, surgical papillary muscle relocation represents the most appreciated option capable to restore normal left ventricle geometry. In the next future new preoperative predictors of increased mitral regurgitation recurrence are certainly needed to find an individual time period of treatment in each patient with moderate IMR.

A novel case of transcatheter mitral valve-in-valve replacement using Mi-thos^TM system

Transcatheter mitral valve replacement(TMVR)has become an alternative to surgical mitral valve replacement for the treatment of patients with severe mitral insufficiency(MI)who are at very high or prohibitive surgical risk.[1]Because of impaired left ventricular dysfunction and previous cardiac surgery,some aged patients with degenerated bioprosthetic mitral valve and mitral regurgitation were refused to redo surgery.[2]Increasing demand are required for minimally invasive treatment of these patients.Hundreds of patients worldwide have been treated with a transcatheter mitral valve-in-ring or valve-in-valve procedure using transcatheter aortic valve.[3]However,rare case of transcatheter mitral valve-in-valve/ring replacement using transcatheter mitral valve system was reported.Here,we reported a successfully case of transcatheter mitral“valve-in-valve”replacement for the treatment of bioprosthetic mitral valve degeneration and severe regurgitation with domestic Mithos^TM valve.

The first two cases of transcatheter mitral valve repair with ARTO system in Asia

BACKGROUND:MAVERIC(Mitral Valve Repair Clinical Trial)validates the safety and effi cacy of the ARTO system.We here report the fi rst two successful cases of utilizing the ARTO system in patients with symptomatic heart failure(HF)with functional mitral regurgitation(FMR)in Asia.METHODS:Two patients,aged 70 and 63,had severe HF with FMR.Transesophageal echocardiography confirmed that the left ventricular ejection fractions were less than 50%with severe mitral regurgitation(MR)in both patients.Optimizing drug treatment could not mitigate their symptoms.Therefore,we used the ARTO system to repair the mitral valve for these patients on March 5 and 6,2019,respectively.RESULTS:Mitral valve repairs using the ARTO system were successfully performed under general anaesthesia for these two patients.MR was decreased immediately after the procedures in both patients.The 30-day and 3-month transthoracic echocardiography(TTE)revealed a moderate to severe MR in both patients,and the New York Heart Association(NYHA)scales were also partially improved.CONCLUSION:The first two cases in Asia indicate that the ARTO system is feasible for patients with heart failure with FMR,and the patient selection appears to be crucial.

Outcomes of Ahmed valve surgery for refractory glaucoma in Dhahran, Saudi Arabia

AIM: To evaluate the outcomes of Ahmed glaucoma valve(AGV) implantation surgery for refractory glaucoma.METHODS: This one-armed historical cohort study was conducted in 2011. Refractory glaucoma was defined as eyes with an intraocular pressure(IOP) greater than21 mm Hg with maximally tolerated glaucoma medications, failed surgeries, or both. For all eyes with refractory glaucoma that underwent AGV implantation,data were collected on IOP, the best corrected visual acuity(BCVA) and glaucoma medications preoperatively and 4, 6, 12, 24 and 56 wk postoperatively. Logarithm values of IOP were calculated and compared. RESULTS: The study group was comprised of 30patients(30 eyes, 16 males and 14 females) with refractory glaucoma. Mean preoperative IOP was 39.3 ±13.8 mm Hg. Postoperative mean IOP was 15.7±7.1 mm Hg,19.6 ±12.8 mm Hg and 13.9 ±14.2 mm Hg at 12, 24 and56 wk respectively. BCVA was ≥6/60 in 11 eyes preoperatively, and five eyes had BCVA ≥6/60 at 56 wk postoperatively. Preoperatively, more than four medications were used to treat glaucoma in 21 eyes. At12 wk postoperatively, no medications were required to control IOP in 20 eyes. At 56 wk postoperatively, at least one medication was required to control IOP in 10 eyes.Over the entire follow up period, four eyes were treated with yttrium aluminium garnet(YAG) laser and 14 eyes required a second surgery. The AGV was removed in four eyes.CONCLUSION: AGV implantation reduced IOP and the number of medications required to control refractory glaucoma. However, there was a higher risk of decreased vision. Long-term follow up and prompt intervention are recommended.

Role of real-time three-dimensional transesophageal echocardiography in mitral valve repair

Background and objective Pre-operative assessment of mitral valve (MV) anatomy is essential to surgical design in patients undergoing MV repair.Although 2-dimensional (2D) echocardiography provides precise information regarding MV anatomy,RT-3D TEE could increase the understanding of MV apparatus and individual scallop identification.We aimed to investigate the value of RT- 3DTEE in MV repair.Methods RT-3DTEE was performed in six patients with mitral valve prolapse (MVP) by using Philips 1E33 with X7-2t probe.Preoperative RT-3DTEE studies were compared with surgical findings in patients undergoing surgical mitral valve repair,and quantitative evaluation was performed by QLab 6.0 software before and after surgical mitral valve repair.Results RT- 3DTEE could display dynamic morphology of MV,the location of prolapse,and spatial relation to the surrounding tissue.It could provide surgical views of the valves and the valvular apparatus.These results were consistent with surgical findings.The quantitative evaluation before and after surgical MV repair indicated that anterolateral to posteromedial diameter of annulus,anterior to posterior diameter of annulus,perimeter of annulus,and area of annulus in projection plane were significantly smaller after operation compared with those before operation (P【0.05).The length of posterior leaflet,the area of anterior and posterior leaflet,the maximal prolapse height,the volume of leaflet prolapse and the length of coaptation in projection plane were significantly reduced after operation (P【0. 05).Conclusion RT-3DTEE is a unique new modality for rapid and accurate evaluation ofmitral valve prolapse and mitral valve repair.

Echocardiographic Monitoring of Cardiac Parameters after Mitral Valve Replacement with the Preservation of Subvalvular Structures

To date many monitoring techniques have been used to determine the efficacy of surgical correction of mitral valve disease. The most common non-invasive method in use is echocardiography which can assess the myocardial and mitral valve function changes after mitral valve replacement procedures. In this study, we investigated the five-year follow-up echocardiographic results of 143 patients undergoing mitral valve replacement with preservation of subvalvular apparatus to analyze the recovery of myocardial and mitral valve functions.