RESUMEN
Transcatheter mitral valve replacement is increasingly being used as a treatment for high-risk patients who have native mitral valve disease; however, no comprehensive studies on its effectiveness have been reported. We therefore searched the literature for reports on patients with native mitral valve disease who underwent transcatheter access treatment. We found 40 reports, published from September 2013 through April 2017, that described the cases of 66 patients (mean age, 71 ± 12 yr; 30 women; 30 patients with mitral stenosis, 34 with mitral regurgitation, and 2 mixed) who underwent transcatheter mitral valve replacement. We documented their baseline clinical characteristics, comorbidities, diagnostic imaging results, procedural details, and postprocedural results. Access was transapical in 41 patients and transseptal in 25. The 30-day survival rate was 82.5%. The technical success rate (83.3% overall) was slightly but not significantly better in patients who had mitral regurgitation than in those who had mitral stenosis. Transapical access procedures resulted in fewer valve-in-valve implantations than did transseptal access procedures (P=0.026). These current results indicate that transcatheter mitral valve replacement is feasible in treating native mitral disease. The slightly higher technical success rate in patients who had mitral regurgitation suggests that a valve with a specific anchoring system is needed when treating mitral stenosis. Our findings indicate that transapical access is more reliable than transseptal access and that securely anchoring the valve is still challenging in transseptal access.
Asunto(s)
Bioprótesis , Cateterismo Cardíaco/métodos , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Prótesis Valvulares Cardíacas , Válvula Mitral/cirugía , Humanos , Diseño de PrótesisRESUMEN
We report the case of a 44-year-old pregnant woman who was diagnosed with symptomatic severe mitral stenosis that did not respond to optimal medical therapy and balloon valvuloplasty. After a multidisciplinary team discussion on the timing and risks of interventions and postoperative optimization of peripartum anticoagulation, the patient underwent mechanical mitral valve replacement during the 2nd trimester of pregnancy. The outcome was excellent for the mother and the infant. This case emphasizes the importance of a multidisciplinary approach in managing unusual cases.
Asunto(s)
Valvuloplastia con Balón/métodos , Estenosis de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Complicaciones Cardiovasculares del Embarazo/cirugía , Segundo Trimestre del Embarazo , Adulto , Femenino , Humanos , Recién Nacido , Embarazo , Resultado del EmbarazoRESUMEN
Left ventricular assist devices and percutaneous valve interventions have radically changed the treatment of advanced heart disease and minimized surgical morbidity in patients with end-stage heart failure who would not survive conventional surgery. We describe a successful approach to the simultaneous placement of a percutaneous left ventricular assist device and mitral valvuloplasty in a decompensated patient with end-stage ischemic cardiomyopathy, severe peripheral arterial disease, porcelain aorta, and severe mitral and aortic disease.
Asunto(s)
Valvuloplastia con Balón , Insuficiencia Cardíaca/terapia , Corazón Auxiliar , Estenosis de la Válvula Mitral/terapia , Válvula Mitral/fisiopatología , Función Ventricular Izquierda , Ecocardiografía Transesofágica , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/diagnóstico , Estenosis de la Válvula Mitral/fisiopatología , Diseño de Prótesis , Resultado del TratamientoRESUMEN
Mitral stenosis in children often has a fulminant and rapid course. Percutaneous transvenous mitral commissurotomy is accepted as the treatment of choice for mitral stenosis not only in adults, but also in younger patients who have pliable valves. Balloon mitral valvotomy has yielded good immediate and long-term results. Herein, we report successful Inoue balloon mitral valvotomy in a 4-year-old boy who had severe, symptomatic rheumatic mitral stenosis. To our knowledge, our patient is the youngest to have undergone this procedure. In addition to the case description, we discuss the features of juvenile rheumatic mitral stenosis and several technical aspects of performing the Inoue balloon mitral valvotomy procedure in children.
Asunto(s)
Cateterismo , Estenosis de la Válvula Mitral/terapia , Cardiopatía Reumática/terapia , Cateterismo/instrumentación , Preescolar , Ecocardiografía Doppler en Color , Diseño de Equipo , Hemodinámica , Humanos , Masculino , Estenosis de la Válvula Mitral/diagnóstico , Estenosis de la Válvula Mitral/fisiopatología , Cardiopatía Reumática/diagnóstico , Cardiopatía Reumática/fisiopatología , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
During percutaneous mitral balloon valvuloplasty, the Inoue method leaves patients with an iatrogenic atrial septal defect. In this study, we evaluated the factors affecting the development of iatrogenic atrial septal defect and searched for the possible influence of this defect on long-term outcomes.We reviewed the medical records of 267 patients who had undergone successful percutaneous mitral balloon valvuloplasty for symptomatic moderate or severe mitral stenosis from January 2000 through March 2004. Sixty-three of the 267 patients were enrolled in a face-to-face follow-up study. We noted their clinical and demographic characteristics. All included patients were asked for the endpoints of repeat percutaneous mitral balloon valvuloplasty or mitral valve surgery, cerebrovascular accident or transient ischemic attack, and the need of intervention for the iatrogenic atrial septal defect. They underwent standard 2-dimensional and Doppler echocardiographic examination. The presence of iatrogenic atrial septal defect was evaluated via the color-Doppler technique in the subcostal view and via contrast echocardiography.Patients were subclassified in accordance with the presence (n = 15) or absence (n = 48) of echocardiographically proven persistent iatrogenic atrial septal defect. When we compared the 2 groups, there were no significant differences in baseline demographic characteristics or in pre- and postprocedural echocardiographic data.We conclude that the presence of persistent iatrogenic atrial septal defects might not be predicted from echocardiographic or demographic data in patients undergoing percutaneous mitral balloon valvuloplasty. Fortunately, these defects are small in size and low in shunt ratio. They appear not to be associated with serious long-term outcomes.