Showing 11 results for Valve
A Kazemi Khaledi ,
Volume 57, Issue 2 (5-1999)
Abstract
Background: Percutaneous Transeptal Mitral Commisurotomy (PTMC) has been used in treating mitral stenosis with variable success, its main complication being mitral incompetence. There is a need to define the subgroup of the patients who benefit mostly from the procedure. Methods: We studied 110 patients (age 17 to 60 years mean 33.2) with mitral stenosis. PTMC was performed though femoral vein. All patients underwent echocardiographic evaluation, both before and after the procedure. Clinical, hemodynamic and echocardiographic data were gathered and used to predict the outcome. Results: PTMC was successful in all 110 patients in alleviating the stenosis (mean transmitral gradient before procedure was 17.1 mmHg after procedure 4.4 mmHg). There was no mortality or major complication other than occurrence of mitral regurgitation in 9 cases. In this group only one patient subsequently needed a mitral valve replacement operation. The following parameters were found to have a significant correlation with the success rate of PTMC: lower age, shorter duration of illness, functional class III and IV, larger EF slope, smaller EPSS, smaller amplitude of valve motion, limitation of the posterior leaflet motion and negative history for open commisurotomy. The incidence of mitral regurgitation after procedure was found to be correlated with: atrial fibrillation rhythm before PTMC, lower age, longer duration of illness, more frequent relapse of rheumatic fever, functional class III and IV, less EF slope, limitation of the valve motion, larger left atrium, calcification of posterior leaflet and subvalvular extension. Conclusions: Balloon Mitral Valvuloplasty is an effective and relatively safe procedure in the management of the mitral stenosis. With the proper selection of the patients with the favorable outcome parameters, the rate of complication can be reduced.
Radmehr H, , ,
Volume 59, Issue 2 (5-2001)
Abstract
Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement) from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female). The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A) Valvular complications (female/male=3/1), B) Non valvular complications (female/male=1/3). The most common nonvalvular complication was bleeding (66.6 percent). The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915) the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.
Radmehr H,
Volume 59, Issue 3 (6-2001)
Abstract
Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement) from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female). The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A) Valvular complications (female/male=3/1), B) Non valvular complications (female/male=1/3). The most common nonvalvular complication was bleeding (66.6 percent). The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915) the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.
Kazemi Khaledi A, Rahmani Reaza,
Volume 61, Issue 1 (4-2003)
Abstract
Prosthetic valve re-operation has greater mortality and morbidity than primary valve replacement. By recognition of factors influencing on causes of redo operation and preoperative survival, one can select appropriate prosthesis at primary valve replacement and when operation performed at appropriate time, surgical risk can be reduced.
Methods and Materials: Two hundred patients that underwent prosthetic valve re-operation from October 1991 through November 2001 were included in this study. There were 68 men and 132 women with the mean age of 42:tl 1.8 years. Structural failure was the commonest cause of bio-prosthesis replacement (93%). Valve thrombosis was the common cause of mechanical valve replacement (32%). Age younger Than 50 (P= 0.01) and interval after the first implantation more than 10 years (P= 0.01) affected bio-prosthesis degeneration.
Results: Atrial fibrillation (P<0.01), Older age especially more than 40 (P<0.05) and mitral position (P<0.01) affected mechanical valve thrombosis. Cross clamp time (P= 0.005), Tricuspid insufficiency (P = 0.001), NYHA IV (P = 0.005) and emergent operation (P= 0.001) were independent determinants of hospital mortality.
Conclusion: In conclusion, in patients with more than 10-years life expectancy and age younger than 50, mechanical valve can be selected for primary valve replacement. If operation performed before patients reach deteriorated condition, preoperative survival would be excellent.
Shahrjerdi Sh, Smolenski A.v,
Volume 65, Issue 2 (3-2008)
Abstract
Background: Cardiac connective tissue dysplasia syndrome consists of mitral valve prolapse (MVP), anomalously located chordae tendinae of the left ventricle, or a combination of the two. MVP is marked by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. The nonclassic form of MVP carries a low risk of complications. Patients with severe classic MVP can suffer from mitral regurgitation (MR), infective endocarditis, and, infrequently, sudden death from cardiac arrest. Anomalously located left ventricular chordae tendinae are fibrous or fibromuscular bands that stretch across the left ventricle from the septum to the free wall. They have been associated with murmurs and arrhythmias. The purpose of this study is to assess the performance, as measured by the physical working capacity (PWC170) and maximal oxygen consumption (VO2 max), in athletes with cardiac connective tissue dysplasia syndrome.
Methods: Of the 183 male athletes studied, 158 had cardiac connective tissue dysplasia syndrome and 25 were normal, healthy controls. Their mean age was 16.23 (± 5.48) years and mean training time was 5.2 (±- 4.6) years. Athletes with cardiac connective tissue dysplasia syndrome were divided to four groups. Group 1 consisted of those with MVP Group 2 had patients with an additional cord in left ventricle Group 3 was made up of athletes with a combination of MVP and additional cord Group 4 contained athletes with a combination of MVP and MR. All sportsmen were studied by echocardiograph, veloergometer, and those with arrhythmias were studied and recorded using a Holter monitor.
Results: The most common form of this syndrome in our study groups was MVP. The PWC170and VO2 max among the athletes with the combination of MVP+MR (Group 4) was lower than that of athletes in other groups (P<0.05). The most common arrhythmia among the athletes with anomalously located left ventricular chordae, Group 2, was Wolf-Parkinson-White (WPW) syndrome and early repolarization syndrome. The PWC170 and VO2 max in athletes with WPW syndrome, was lower than the other athletes who did not have WPW syndrome (P<0.05).
Conclusion: The lowest PWC170 and VO2 max were in those athletes with a progressive abnormality. However, the PWC170 and VO2 max among athletes with anomalously located left ventricular chordae was normal. Therefore, among athletes with a combination of anomalously located left ventricular chordae and disruption of rhythm, the PWC170 and VO2 max are lower than normal.
Aarabi M.u, Meraji M, Mortezaeian H,
Volume 65, Issue 4 (7-2007)
Abstract
Background: Tetralogy of Fallot is the most common cyanotic congenital heart disease. The systolic and diastolic function in both ventricles is altered even after successful corrective surgery for this defect with a transannular patch. Pulmonary regurgitation, a common complication after this treatment, is usually well tolerated in childhood. The aim of this study was to assess the combined diastolic and systolic function of both ventricles using the Doppler-derived myocardial performance index (Tei index) in patients who underwent surgical repair of tetralogy of Fallot using a transannular patch. In this article we discuss the impact of pulmonary regurgitation on right ventricular function and clinical outcome, the role of echocardiographic imaging, and current management strategies for patients with pulmonary regurgitation after this treatment.
Methods: Sixty eight patients with tetralogy Fallot were studied in Shahid Rajaie referral Cardiovascular Center during 2003-2005. The studied population, 36 male and 32 female with a mean age of 7.5±4 years and a history of corrective surgery for tetralogy of Fallot using a transannular patch. These patients were randomly selected and assessed by Doppler echocardiography.
Results: Fifty-seven patients (84%) had mild to moderate pulmonary regurgitation, whereas 11 patients (16%) had severe pulmonary regurgitation. Right ventricular Tei index was significantly increased in patients with severe pulmonary regurgitation compared those with mild to moderate pulmonary regurgitation (0.54±0.18 vs 0.24±0.11, P<0.01). Left ventricular Tei index was increased in patients with severe pulmonary regurgitation compared those with mild to moderate pulmonary regurgitation (0.46±0.22 vs 0.32±0.14, P<0.05).
Conclusions: The findings of this study suggest that pulmonary regurgitation is a serious complication after repair of tetralogy of Fallot with a transannular patch. Delaying surgery in such patients risks irreversible ventricular function.
Moradmand S, Shaeri H.r., Gharooni M, Rostamian A, Akbari Z, Mirkhani S.z., Bagheri A,
Volume 66, Issue 8 (11-2008)
Abstract
Background: Mitral valve prolapse is a relatively common valvular abnormality in most communities and joint hypermobility (JHM) is also seen in many healthy people as well as in certain clinical disorders, such as Marfan syndrome. The present study was designed to investigate the association between joint hypermobility and mitral valve prolapse (MVP) in an Iranian population sample.
Methods: Fifty-seven patients with nonrheumatic and isolated mitral anterior leaflet prolapse (24 men and 33 women, mean age 23.5 +/-2.3) and 51 healthy subjects (20 men and 31 women, mean age 22.9+/-2.3) were studied. The presence of JHM was evaluated according to the Carter-Wilkinson & Beighton criteria. Echocardiographic examination was performed in all subjects and the correlation between the echocardiographic features of the mitral valve and the hypermobility score were investigated.
Results: The frequency of JHM in patients with MVP was found to be significantly higher than that of controls (26.3% vs. 7.8%), with mean JHM scores of 3.1+/-2.2 and 1.9+/-1.7, respectively. The patients in the MVP group had significantly increased the anterior mitral leaflet thickness (AMLT, 3.4+/-0.4 mm vs. 3.0+/-0.3 mm p<0.0005) and maximal leaflet displacement (MLD, 2.4+/-0.3 mm vs. 1.5+/-0.2 mm p<0.0005) compared to the controls.
Conclusions: We detect a statistically significant relationship between isolated MVP and joint hypermobility as well as between the severity of JHM and echocardiographic features of the mitral leaflets. These results suggest a common etiology for MVP and JHM, which should be investigated in future well-conducted studies.
Radmehr H, Shahzadi M, Bakhshandeh Ar, Torfi Y,
Volume 67, Issue 5 (8-2009)
Abstract
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Background: Surgical
methods for treatment of tricuspid valve (TV) endocarditis include repair, replacement and partial
or complete exicion. The aim of this study was to assess the results of these
different techniques.
Methods: Sixty seven patients were enrolled in this retrospective
study. This study was carried-out between April 1997 and July 2007 in Imam
Khomeini hospital. Decision of methods of choice for surgery was according to
intraoperative findings.
Results: The mean age was 25.52±7.35 years and 74.36% were male. The most common bacteria was
Staphylococcus areus (62.30%). Most of patients (74.60%) were IV drug abuser. The most common treatment modality was TV reconstruction
(56.72%) and after that was TV replacement (29.85%) and the last one was complete TV excision (13.43%). Eight
patients (11.94%) needed emergent TV replacement. The morbidity rate was 28.36% and the
mortality rate was 13.51%. Thirty seven patients were followed. In follow-up
period it was shown that postoperative Ejection Fraction (EF) and End-Diastolic Right Ventricle
Diameters (EDRVD) values did not differ from
preoperative values, but Pulmonary Artery (PA) pressure and
Tricuspid Regurgitation (TR) severity were significantly lower compared with
preoperative values. The postoperative function class did not show any changes
compared with peroperative values.
Conclusion: Considering the specific epidemiology of patients with
infective endocarditis, who are suffering from TV regurgitation, in some patients, it would be better
to consider replacement instead of repair. This could be due to sever
deformities and diffuse damage of TV leaflets from infection in our patients.
Sattarzadeh Badkoobeh R, Derakhshan L, Farhang Zand Parsa A, Pasha Meysamie A, Khosravi B, Grayly B, Jabari Sm,
Volume 70, Issue 8 (11-2012)
Abstract
Background: Measurements of mitral valve area (MVA) are essential to determine the severity of mitral stenosis (MS) and adopt the best management strategies. The aim of the present study was to compare MVA determined by two-dimensional (2D) planimetry to MVA measured by continuity equation (CE) in patients with moderate to severe MS.
Methods: We evaluated 73 consecutive patients with the diagnosis of MS scheduled for balloon mitral valvuloplasty or with moderate to severe rheumatic MS admitted at the echocardiography clinic of Imam Khomeini Hospital in 2010. Using 2D images of mitral valve obtained from paraesternal short axis view, 2D planimetry of the mitral orifice area was performed by an experienced cardiologist. MVA by CE was calculated from aortic forward stroke volume divided by transmitral time-velocity integral.
Results: The mean value of MVA by 2-D planimetry was 1.0±0.3 cm2. The average values of MVA measured by PHT and CE were 1.0±0.3 cm2 and 0.9±0.4 cm2, respectively. The MVA determined by planimetry correlated well with CE (r=0.832, standard error of estimation [SEE]= 0.166, P<0.001). The mean values of MVA calculated by CE highly correlated with those calculated by 2-D planimetry in patients presenting with both non-significant (r=0.701) and significant (r=0.761) AIs.
Conclusion: When planimetry is not feasible, such as in severe calcification of mitral valve or after percutaneous balloon valvuloplasty, CE could be an alternative method for MVA measurement in comparison with PHT.
Mehdi Ghaderian , Mahmood Meraji , Mohammad-Yoosef Arabi Moghadam, Mojtaba Keikha,
Volume 72, Issue 5 (8-2014)
Abstract
Background: Pulmonary valve stenosis (PS) is one of the most common congenital heart disease in children. Isolated pulmonary stenosis is the most common form of pulmonary stenosis. Isolated Pulmonary stenosis is responsible for 8 to 10 percent of congenital heart disease. Balloon valvuloplasty is the choice of treatment for this cardiac disease. One of the most important complications of this disease is pulmonary regurgitation in follow-up. The purpose of this study was to characterize the status of pulmonary regurgitation on follow-up after pulmonary valvuloplasty by balloon. Methods: We studied pulmonary regurgitation after balloon valvuloplasty retrospectively in children less than 14 years old age and isolated pulmonary stenosis. These patients had not complex congenital heart disease and admitted for balloon valvuloplasty during period of September 2001 to September 2011 in Shahid Rajaee Cardiovascular
Research Center. The mean time of follow-up was 7±2.5 years.
Results: Four hundred and fifty-eight patients with mean age of 10.3±8.6 months were studied. Two hundred and fifty-five patients were male and 230 were female. Right ventricular pressure was decreased from 82.3±42.2 mmHg before procedure to 45.2±22.4 mmHg after procedure (P= 0.043). Pressure gradient between right ventricle and pulmonary artery was decreased from 75.4±18.2 mmHg to 25.7±15.13 mmHg during procedure (P= 0.032). The day after procedure, 180 (37.1%) patients had no pulmonary regurgitation echocardiographic evaluation, 175 (36.08%) had mild, and 118
(24.3%) had moderate pulmonary regurgitation. In patients with moderate pulmonary regurgitation, 7 (0.14%) of those improve to severe pulmonary regurgitation. In echocardiographic exam, 12 (2.4%) patients had severe regurgitation the day after balloon valvuloplasty. During long-term follow-up (7±2.5 years) for 3 patient pulmonary valve replacement were performed. In our study, balloon to annulus ratio in three groups of pulmonary regurgitation (mild, moderate and sever) had significant correlation (P=0.012).
Conclusion: Pulmonary regurgitation was seen after balloon valvuloplasty in some patients.In most patients it had no symptoms and long-term follow-up is necessary
Manouchehr Hekmat , Hamid Ghaderi , Seyedeh Adeleh Mirjafari , Shahram Rajaei Behbahani , Mehran Shahzamani , Gholamreza Masoumi ,
Volume 75, Issue 9 (12-2017)
Abstract
Background: Tetralogy of Fallot (TOF) refers to a condition in which left ventricular volume is normal or slightly less than normal. Given the differences observed in some Asian patients with TOF, the present study was conducted to investigate left heart by determining Z-scores for the mitral valve in Iranian patients with TOF.
Methods: Eligible subjects in this prospective descriptive study comprised all patients with TOF presenting to Shahid Modarres Hospital in Tehran from March 2012 to March 2015 and diagnosed as the candidates for surgery. After determining the need for surgery and the therapeutic method required, the mitral valve size and Z-scores were calculated. We analyzed sex, age, body surface area (BSA), mitral size (in 2-chamber and 4-chamber view), mitral Z-score, other cardiac anomalies, number of surgery and previous surgery.
Results: Of a total of 80 patients included in the study over 3 years, 29 (36.3%) were male and 51 (63.8%) were female. The mean age of the patients was 7.15±3.37 years and their mitral size was found to be 10-27 mm (16.2±5.99 mm) using echocardiography. Z-scores of the mitral valve were also obtained as -3.09±2.11, ranging between -7.1 SD and +1.3 SD. 58 (72.5%) patients have only TOF and 22 (27.5%) with other cardiac anomalies. 45 patients were for first time underwent surgery and 22 patients for second time, 12 patients for three time and 1 for forth. Of a total of 35 patients had previous surgery, the most common were shunt 15 (42.9%) and then tetralogy of Fallot total correction (TFTC) in 12 (34.3%). Of a total of 80 patients, 59 (73.8%) underwent TFTC, 17 (21.3%) under pulmonary valve replacement and 4 (5%) shunt.
Conclusion: Z-scores of the mitral valve were found to be significantly below the normal value, (i.e. 0±2 SD), in the study patients, suggesting the risk of hypoplastic left heart syndrome in Iranian patients with TOF, nevertheless, the type of TOF examined in these patients might have been different from those observed in other races and regions.
