Mitral valve replacement with

Medical treatment of mitral regurgitation with afterload reduction and diuresis can effectively alleviate symptoms, but has not been shown to prolong survival. The currently recommended treatments for severe mitral regurgitation are surgical mitral valve repair or replacement. Mitral valve replacement with either a bioprosthetic or mechanical valve has the inherent drawbacks of a potential increase in periprocedural... 

Patients at greatest risk for developing potassium chloride-induced Gl lesions include The elderly, the immobile and those with scleroderma, diabetes mellitus, mitral valve replacement, cardiomegaly, or esophageal stricture/compression. 

In October, 1981, a 39-year-old man with mitral stenosis was hospitalized for mitral valve replacement. 

In addition, a recent publication described the feasibility of placing a transcatheter bioprosthetic valve at the site of a surgical mitral valve replacement in a bovine model (37). This type of approach may eventually be used in lieu of repeat open surgical replacement for patients with a failing mitral valve bioprosthesis. 

Girard, G., Lehot, J.-J., Pannetier, J.-C., Filley, S., Ffrench, P., and Estanove, S. (1992). Inhaled nitric oxide after mitral valve replacement in patients with chronic pulmonary artery hypertension. Anesthesiology 77, 880-883. 

Mitral regurgitation is a typical complication of dilated heart disease in which backflow of the blood from the ventricle into the atrium further contributes to the excessive volume load and progression of the disease. Mitral valve replacement or repair is thus one of the most common operations in advanced cardiac failure and is performed either alone or in combination with other procedures. While MDCT does not allow visualization of the regurgitant jet, it can provide basic information on the morphology of the valve structures and movement of the leaflets (Fig. 19.7). 

Masamoto H, Uehara H, Mekaru K, Uezato T, Sakumoto K, Aoki Y. Warfarin-associated fetal intracranial hemorrhage in woman with mitral valve replacements a case report. Am J Peri-natol 2009 26(8) 597-600. 

Kunimoto, R, Aral, K., Isa, Y., Koyano, T., Kadoi, Y., Saito, S., Goto, R (1997). A comparative study of the vasodilator effects of prostaglandin El in patients with pulmonary hypertension after mitral valve replacement and with adult respiratory distress syndrome. Anesthesia Analgesia, 85, 507—513. 

According to the 2006 ACC/AHA guidelines for the management of patients with valvular heart disease, mitral valve replacement (MVR) is recommended for patients with moderate to severe mitral stenosis (M VA <1.5 cm ), if the patient is not suitable for percutaneous mitral balloon valvulotomy and is not a high-risk candidate [17]. For chronic mitral regurgitation, MVR is only recommended if a patient with LV dysfunction (ejection fraction <0.60 and/or end systolic dimension >40 mm) is deemed not suitable for mitral valve repair. 

Implantable valves, particularly mechanical valves which continue to encroach on tissue valves, are unique. Methods such as valvuloplasty, mitral valve repair, or use of ultrasound are unlikely to reduce the number of valve replacements into the twenty-first century. Valve selection remains in the hands of the surgeon because of the critical nature of the procedure. If anything goes wrong, the result can be catastrophic to the patient. Cost of a valve, from 3000— 4000, is a relatively small part of the cost of open-heart surgery which can mn as high as 30,000. Growth of the cardiovascular valve market has slowed in the United States with the decline of the threat of rheumatic fever. 

In the past, rheumatic heart disease was a prevalent risk factor for IE, but the incidence of this disease continues to decline. The risk of IE in persons with mitral valve prolapse and regurgitation is small however, because the condition is prevalent, it is an important contributor to the overall number of IE cases. Prosthetic valve endocarditis occurs in 1 % to 4% of patients undergoing valve replacement surgery. ... 

Treatment strategies for progressive pulmonary venous hypertension should focus on treatment of the underlying disease. For patients with advanced decompensated systolic heart failure and secondary pulmonary hypertension, it is essential to reduce the pulmonary vascular resistance prior to heart transplantation to prevent acute RV failure of the donor heart. The use of continuous milrinone, occasionally nesirit-ide, and earlier intervention with mechanical circulatory device support (19) as a bridge to cardiac transplantation is considered a standard approach for this group of patients. Earlier intervention with valve repair or replacement for patients with mitral valve disease and aortic valve disease with associated pulmonary hypertension is recommended. 

Currently, about 90,000 valve replacement procedures are conducted in the United States, with about 280,000 such procedures conducted around the world [13]. The world population is expected to increase from 6.1 billion in 2000 to 8.9 billion in 2050, with the percentage of people of the population over 65 years increasing from 6.9% of the world population in 2000 to 15.9% in 2050 [14]. This aging population of patients requiring heart valve replacement is estimated to triple by 2050, from -290,000 in 2003, to over 850,000 by 2050 [15,16]. The most commonly used valve replacements in the developed world are mechanical bileaflet valves and bioprosthetic valves. In developing countries, tilting disk and ball-and-cage valves continue to be used due to lower costs. Across all valves, aortic valves are most widely replaced, followed by the mitral valve, pulmonary valve, and tricuspid valve. 

Brown et al. [18] documented statistics of isolated AVR in North America for 108,687 patients during the period from January 1, 1997 to December 31, 2006, compiled from the Society of Thoracic Surgeons National Database. The number of isolated AVR surgeries increased from about 10,000 to over 16,000 procedures per year. Although the specific percentage of mechanical versus bioprosthetic valves implanted is a topic of debate, almost 98% of all AVR procedures used one of these two alternatives. The STS Executive Summary Adult Cardiac Surgery Database provides statistics of valve replacement procedures up to December 2010 in North America [19], In 2010, over 25,000 isolated AVRs were performed, in addition to over 18,000 replacements along with coronary artery bypass (CAB). About 1500 patients underwent combined aortic (AV) and mitral valve (MV) replacement. 

There also has been an explosion of therapeutic possibilities both medical and surgical. Witness the growth of closed heart surgery from closure of a patent ductus arteriosus and repair of coarctation of the aorta and mitral valvulotomy, profound hypothermia for atrial septal defect closure and pulmonary stenosis, open heart surgery, with cross-circulation and later extracorporeal circulation for valve repair and replacement, repair of complex congenital malformations and coronary artery bypass surgery and more recently the development of less invas-... 

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