The Experts below are selected from a list of 16356 Experts worldwide ranked by ideXlab platform
Carmelo A Milano - One of the best experts on this subject based on the ideXlab platform.
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impact of Mitral Valve Regurgitation evaluated by intraoperative transesophageal echocardiography on long term outcomes after coronary artery bypass grafting
Circulation, 2005Co-Authors: Jacob N Schroder, Matthew L Williams, Jonathan A Hata, Lawrence H Muhlbaier, Madhav Swaminathan, Joseph P Mathew, Donald D Glower, Christopher M Oconnor, Peter K Smith, Carmelo A MilanoAbstract:Background— It is unclear if mild or moderate Mitral Valve Regurgitation (MR) should be repaired at the time of coronary artery bypass grafting (CABG). We sought to determine the long-term effect of uncorrected MR, measured by intraoperative transesophageal echocardiography (TEE), in CABG patients. Methods and Results— Between May 1999 and September 2003, data were gathered for 3264 consecutive patients who underwent isolated CABG and had MR graded by intraoperative TEE. MR was graded on the following 5 levels: none, trace, mild, moderate, and severe. Patients who had severe MR or who underwent Mitral Valve surgery were eliminated from the analysis. The remaining patients were combined into the following 3 groups: none or trace, mild, and moderate MR. Preoperative and follow-up data were 99% complete. The median length of follow-up was 3.0 years. Multivariable analysis controlling for important preoperative risk factors was performed to determine predictors of death and death/hospitalization for heart failure. Increasing MR was a risk factor for death [hazard ratio (HR), 1.44; P <0.001] and death/heart failure hospitalization (HR, 1.34; P <0.01). When patients with moderate MR were eliminated from the analysis, mild MR was a risk factor for death (HR, 1.34; P =0.011) and death/hospitalization for heart failure (HR, 1.34; P <0.001). Conclusions— Even mild MR, identified by intraoperative TEE, predicts worse outcomes after CABG. Revascularization alone did not eliminate the negative long-term effects of mild MR. CABG patients with uncorrected mild or moderate MR are at increased risk for death and heart-failure hospitalization; consideration for surgical repair or more aggressive medical management and follow-up is warranted.
Saeedeh Farajzadeh - One of the best experts on this subject based on the ideXlab platform.
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A new cardiac manifestation associated with woolly hair: report of two cases of woolly hair, palmoplantar keratoderma, and Mitral Valve Regurgitation
International Journal of Dermatology, 2007Co-Authors: Soodabeh Zandi, Saeedeh FarajzadehAbstract:Two siblings (a 24-year-old woman and a 14-year-old girl) with congenital woolly hair, epidermolytic palmoplantar keratoderma, and Mitral Valve Regurgitation are described. An interesting additional feature in one of the patients (the 14-year-old girl) was posterior subcapsular cataract. The association of woolly hair and Mitral Valve Regurgitation has not been reported previously. The occurrence of cataract in one of our patients is also a new ophthalmologic finding in this hair shaft anomaly.
Jacob N Schroder - One of the best experts on this subject based on the ideXlab platform.
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impact of Mitral Valve Regurgitation evaluated by intraoperative transesophageal echocardiography on long term outcomes after coronary artery bypass grafting
Circulation, 2005Co-Authors: Jacob N Schroder, Matthew L Williams, Jonathan A Hata, Lawrence H Muhlbaier, Madhav Swaminathan, Joseph P Mathew, Donald D Glower, Christopher M Oconnor, Peter K Smith, Carmelo A MilanoAbstract:Background— It is unclear if mild or moderate Mitral Valve Regurgitation (MR) should be repaired at the time of coronary artery bypass grafting (CABG). We sought to determine the long-term effect of uncorrected MR, measured by intraoperative transesophageal echocardiography (TEE), in CABG patients. Methods and Results— Between May 1999 and September 2003, data were gathered for 3264 consecutive patients who underwent isolated CABG and had MR graded by intraoperative TEE. MR was graded on the following 5 levels: none, trace, mild, moderate, and severe. Patients who had severe MR or who underwent Mitral Valve surgery were eliminated from the analysis. The remaining patients were combined into the following 3 groups: none or trace, mild, and moderate MR. Preoperative and follow-up data were 99% complete. The median length of follow-up was 3.0 years. Multivariable analysis controlling for important preoperative risk factors was performed to determine predictors of death and death/hospitalization for heart failure. Increasing MR was a risk factor for death [hazard ratio (HR), 1.44; P <0.001] and death/heart failure hospitalization (HR, 1.34; P <0.01). When patients with moderate MR were eliminated from the analysis, mild MR was a risk factor for death (HR, 1.34; P =0.011) and death/hospitalization for heart failure (HR, 1.34; P <0.001). Conclusions— Even mild MR, identified by intraoperative TEE, predicts worse outcomes after CABG. Revascularization alone did not eliminate the negative long-term effects of mild MR. CABG patients with uncorrected mild or moderate MR are at increased risk for death and heart-failure hospitalization; consideration for surgical repair or more aggressive medical management and follow-up is warranted.
Volkmar Falk - One of the best experts on this subject based on the ideXlab platform.
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Degenerative Mitral Valve Regurgitation: Best practice revolution
European Heart Journal, 2010Co-Authors: David H. Adams, Raphael Rosenhek, Volkmar FalkAbstract:Degenerative Mitral Valve disease often leads to leaflet prolapse due to chordal elongation or rupture, and resulting in Mitral Valve Regurgitation. Guideline referral for surgical intervention centres primarily on symptoms and ventricular dysfunction. The recommended treatment for degenerative Mitral Valve disease is Mitral Valve reconstruction, as opposed to Valve replacement with a bioprosthetic or mechanical Valve, because Valve repair is associated with improved event free survival. Recent studies have documented a significant number of patients are not referred in a timely fashion according to established guidelines, and when they are subjected to surgery, an alarming number of patients continue to undergo Mitral Valve replacement. The debate around appropriate timing of intervention for asymptomatic severe Mitral Valve Regurgitation has put additional emphasis on targeted surgeon referral and the need to ensure a very high rate of Mitral Valve repair, particularly in the non-elderly population. Current clinical practice remains suboptimal for many patients, and this review explores the need for a 'best practice revolution' in the field of degenerative Mitral Valve Regurgitation.
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Degenerative Mitral Valve Regurgitation: Best Practice
2010Co-Authors: David H. Adams, Raphael Rosenhek, Volkmar FalkAbstract:Degenerative Mitral Valve disease often leads to leaflet prolapse due to chordal elongation or rupture, and resulting in Mitral Valve Regurgitation. Guideline referral for surgical intervention centres primarily on symptoms and ventricular dysfunction. The recommended treatment for degenerative Mitral Valve disease is Mitral Valve reconstruction, as opposed to Valve replacement with a bioprosthetic or mechanical Valve, because Valve repair is associated with improved event free survival. Recent studies have documented a significant number of patients are not referred in a timely fashion according to established guidelines, and when they are subjected to surgery, an alarming number of patients continue to undergo Mitral Valve replacement. The debate around appropriate timing of intervention for asymptomatic severe Mitral Valve Regurgitation has put additional emphasis on targeted surgeon referral and the need to ensure a very high rate of Mitral Valve repair, particularly in the non-elderly population. Current clinical practice remains suboptimal for many patients, and this review explores the need for a 'best practice revolution' in the field of degenerative Mitral Valve Regurgitation.
Raffi Bekeredjian - One of the best experts on this subject based on the ideXlab platform.
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Percutaneous repair of severe Mitral Valve Regurgitation secondary to chordae rupture in octogenarians using MitraClip.
Journal of Interventional Cardiology, 2017Co-Authors: Nicolas Geis, Hugo A. Katus, Raffi Bekeredjian, Philip Raake, Derliz Mereles, Emmanuel Chorianopoulos, Gábor Szabó, Sven T. PlegerAbstract:Objectives The aim of this study was to assess feasibility and clinical effectiveness of the MitraClip device in octogenarians suffering from severe Mitral Valve Regurgitation due to chordae rupture. Background The MitraClip procedure is a suitable technique in high-risk surgical patients to achieve safe and effective percutaneous repair of Mitral Valve Regurgitation. Octogenarians show cumulative risk and social aspects hindering Mitral Valve surgery. No data exists regarding the use of the MitraClip device in high-risk octogenarians suffering from Mitral Valve chordae rupture. Methods Between October 2009 and March 2017 98 high-risk octogenarians (society of thoracic surgeons score [STS]: 9.7% ± 0.8) with Mitral Valve prolapse and consecutively chordae rupture were treated with the MitraClip after interdisciplinary discussion. Results Successful Mitral Valve repair was achieved in 91% of the octogenarians. Repair of the Mitral Valve caused immediate and significant reduction of dyspnoea (NYHA class: 3.5 ± 0.4 vs 2.0 ± 0.3; P
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Percutaneous and surgical treatment of Mitral Valve Regurgitation.
Deutsches Aerzteblatt Online, 2011Co-Authors: Joerg Seeburger, Hugo A. Katus, Sven T. Pleger, Ulrike Krumsdorf, Friedrich-wilhelm Mohr, Raffi BekeredjianAbstract:Diseases of the Mitral Valve are the second-most common clinically significant form of valvular defect in adults. Mitral Valve Regurgitation in particular occurs with increasing frequency as part of degenerative changes in the course of aging. The annual incidence of degenerative Mitral Valve disease in industrialized nations is estimated at around 2% to 3% (1, 2), although there are no data as to the relative percentages of symptomatic and asymptomatic patients with Mitral Valve Regurgitation. In addition to degenerative changes, other causes of clinically significant Mitral Valve Regurgitation include cardiac ischemia, spontaneous detachment of the chordae tendineae, and widening of the Mitral Valve annulus in the setting of a dilated left ventricle with severely restricted left ventricular pump function (2, 3). Severe insufficiency of the Mitral Valve leads to exertional dyspnea and may be accompanied by left atrial dilation, atrial fibrillation, and raised pulmonary arterial pressure. Medication alone in symptomatic Mitral Valve disease typically does not result in adequate or lasting improvement of clinical symptoms, and in patients with high-grade Mitral Valve Regurgitation it is associated with an annual mortality of about 6% to 7%. Data on the disease course with purely conservative treatment exist mainly in relation to asymptomatic patients with high-grade Mitral Regurgitation. In this group, during a 5-year study period a cardiac-related mortality of 22% was seen and 51% of patients required Mitral Valve surgery (4). The treatment of choice is surgical reconstruction of the Mitral Valve, for which a minimally invasive technique may be used (5– 7). The percentage of reconstructions among Mitral Valve operations in Germany has markedly increased and they are now performed more frequently than Mitral Valve replacement operations (8). The recommendations relating to Mitral Valve surgery are subdivided according to patient symptoms (Table) (9). Unfortunately no data exist as to how many patients with Mitral Valve Regurgitation actually have an indication for surgery. Likewise, there are no large, randomized, controlled studies on the operative treatment of Mitral Regurgitation. Table Guidelines of the German Cardiac Society on the indication for surgery in patients with severe chronic Mitral Valve Regurgitation In recent years, however, new interventional techniques have been developed in the cardiac catheterization laboratory that result in a reduction in Mitral Valve Regurgitation. These techniques are based either on direct reconstruction of the Mitral Valve or on modification of the Mitral Valve annulus. The Mitral clip technique in particular is becoming increasingly well regarded among interventional cardiologists. This review presents the surgical developments of recent years. In addition, the still relatively young technique of percutaneous clip implantation as a nonsurgical therapeutic option is explained and discussed along with the limited literature that exists to date on this technique. Our account is based on a selective literature search on treatment for Mitral Valve Regurgitation in PubMed and on the personal experiences and data of the authors.