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Tirone E David - One of the best experts on this subject based on the ideXlab platform.
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long term outcomes of chordal replacement with expanded polytetrafluoroethylene sutures to repair mitral leaflet prolapse
The Journal of Thoracic and Cardiovascular Surgery, 2020Co-Authors: Tirone E David, Carolyn M David, Myriam Lafreniereroula, Cedric ManlhiotAbstract:Abstract Objectives This study examines the durability of mitral valve (MV) repair for mitral regurgitation using chordal replacement with expanded polytetrafluoroethylene sutures to correct leaflet prolapse. Methods Isolated chordal replacement was used to correct prolapse in 186 (24.9%) patients and combined with leaflet resection in 560 (75.1%). Patients were followed prospectively with periodical clinical and echocardiographic assessments for a median follow-up of 11 years (range, 7-16 years). Results Patients' median age was 58 years (range, 48-67 years) and 516 (69.2%) were men. Bileaflet prolapse was present in 63% of patients and advanced Myxomatous Degeneration was present in 32%. The number of neochords per repaired valve increased over time and was not associated with MV reoperation or recurrent mitral regurgitation. The cumulative incidence of MV reoperation with death as a competing risk was 4.2% (95% confidence interval [CI], 2.4-6.0) at 20 years. Multivariable analysis revealed that previous cardiac operations (hazard ratio, 5.70; 95% CI, 1.96-16.53; P = .001), and isolated anterior leaflet prolapse (hazard ratio, 3.92; 95% CI, 1.106-13.91; P = .034) were associated with increased hazard of MV reoperation. The probability of recurrent moderate or severe mitral regurgitation using repeated measures regression models was 14.1% (95% CI, 10.3-19.0) at 20 years. Variables associated with recurrent MR in multivariable regression analysis were left ventricular ejection Conclusions Chordal replacement with expanded polytetrafluoroethylene sutures provides stable MV function in most patients during the first 2 decades of follow-up.
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long term results of mitral valve repair for regurgitation due to leaflet prolapse
Journal of the American College of Cardiology, 2019Co-Authors: Tirone E David, Carolyn M David, Myriam Lafreniereroula, Wendy Tsang, Cedric ManlhiotAbstract:Abstract Background Mitral valve (MV) repair has become the standard therapy for mitral regurgitation (MR) due to degenerative diseases, but information on late outcomes is limited. Objectives The purpose of this study was to examine the late results of MV repair for MR in a large cohort of patients. Methods A total of 1,234 consecutive patients (median age 59 years; 70.4% men) had MV repair for MR due to leaflet prolapse and were followed prospectively for a median of 13 years (interquartile range: 8 to 34 years) with periodical echocardiographic studies. There were 163 patients still at risk at 20 years. Cumulative incidences of adverse events and associated factors were examined with death as a competing outcome. Results At 20 years, reoperation-free survival was 60.4% (95% confidence interval: 56.2% to 64.2%) and the cumulative incidence of cardiac and valve-related deaths was 12%, noncardiac deaths 21.3%, reoperation on the MV 4.6%, infective endocarditis 1.1%, thromboembolism 10.3%, and bleeding 6.4%. The probability of recurrent moderate or severe MR was 12.5%, persistent or new moderate or severe tricuspid regurgitation (TR) 20.8%, and new atrial fibrillation (AF) 32.4%. Multivariable analysis identified older age, complete heart block, MV repair without annuloplasty ring, and the degree of Myxomatous Degeneration of the MV to be associated with recurrent MR. The development of AF and TR was unrelated to recurrent MR. Conclusions MV reoperation was uncommon after MV repair, but there was an increasing incidence of recurrent MR, TR, and new AF over time.
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mitral regurgitation due to Myxomatous Degeneration combined with bicuspid aortic valve disease is often due to prolapse of the anterior leaflet of the mitral valve
The Annals of Thoracic Surgery, 2009Co-Authors: Vidyadhar Lad, Tirone E David, Annette VegasAbstract:Background This study examines the clinical, echocardiographic, surgical, and pathologic features of patients who had heart valve operations for combined congenital bicuspid aortic valve and mitral regurgitation due to degenerative disease of the mitral valve. Methods A retrospective review of 1595 patients who had procedures for mitral regurgitation due to degenerative disease of the mitral valve and 1820 patients who had procedures for congenital bicuspid aortic valve disclosed 29 patients who had combined diseases. Results The most common morphology of the bicuspid aortic valve was type 1 (fused right and left aortic cusps). Mitral regurgitation in 21 of 29 patients was caused by prolapse of the anterior leaflet, which was exceptionally large (mean height, 36.5 ± 6.6 mm). Patients with prolapsed anterior leaflet of the mitral valve were younger (48 ± 13 years vs 58 ± 16 years, p = 0.01) and 95% were men. The bicuspid aortic valve was incompetent in 19 of 21, and the aortic annulus exceeded 30 mm in 20 of 21 patients. Conclusions Patients with combined mitral regurgitation due to Myxomatous Degeneration and bicuspid aortic valve disease who require operations often have a large, prolapsing anterior leaflet of the mitral valve and dilated aortic annulus with aortic insufficiency due to cusp prolapse.
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mitral valve repair for advanced Myxomatous Degeneration with posterior displacement of the mitral annulus
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Andrew E Newcomb, Tirone E David, Jerzy Bobiarski, Susan Armstrong, Manjula MagantiAbstract:Objective This study examines the outcomes of mitral valve repair in a defined group of patients with mitral regurgitation caused by advanced Myxomatous Degeneration. Methods Advanced Myxomatous Degeneration of the mitral valve was defined as a degenerative process whereby both leaflets are voluminous and aneurysmal and the mitral annulus diameter exceeds 40 mm and has posterior displacement, as determined by means of echocardiographic analysis. Over a 16-year period, we identified 183 patients who underwent valve repair in this subgroup of Myxomatous Degeneration. The repair consisted of relocating the posterior mitral annulus to the endocardium of the left ventricle at the atrioventricular junction, correction of leaflet prolapse, and annuloplasty. Analysis of perioperative variables and postoperative outcomes were undertaken. The mean follow-up was 5.9 ± 4.2 years and complete. Results The patients' mean age was 52 years, and 118 were men. All patients had mitral regurgitation preoperatively. There were no early and only 8 late deaths (2 valve-related deaths). The survival at 10 years was 92% ± 3%. Six patients required reoperation on the mitral valve, 5 for recurrent severe mitral regurgitation. The freedom from reoperation at 10 years was 93% ± 3%. Six patients had severe and 21 had moderate mitral regurgitation. The freedom from recurrent moderate or severe mitral regurgitation at 10 years was 80% ± 5%. We could not identify independent predictors of recurrent mitral regurgitation. Conclusions Mitral valve repair for advanced Myxomatous Degeneration on the mitral valve provides excellent early functional results, but late recurrent regurgitation is common, despite correction of dilated and displaced mitral annulus and leaflet prolapse.
Annette Vegas - One of the best experts on this subject based on the ideXlab platform.
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mitral regurgitation due to Myxomatous Degeneration combined with bicuspid aortic valve disease is often due to prolapse of the anterior leaflet of the mitral valve
The Annals of Thoracic Surgery, 2009Co-Authors: Vidyadhar Lad, Tirone E David, Annette VegasAbstract:Background This study examines the clinical, echocardiographic, surgical, and pathologic features of patients who had heart valve operations for combined congenital bicuspid aortic valve and mitral regurgitation due to degenerative disease of the mitral valve. Methods A retrospective review of 1595 patients who had procedures for mitral regurgitation due to degenerative disease of the mitral valve and 1820 patients who had procedures for congenital bicuspid aortic valve disclosed 29 patients who had combined diseases. Results The most common morphology of the bicuspid aortic valve was type 1 (fused right and left aortic cusps). Mitral regurgitation in 21 of 29 patients was caused by prolapse of the anterior leaflet, which was exceptionally large (mean height, 36.5 ± 6.6 mm). Patients with prolapsed anterior leaflet of the mitral valve were younger (48 ± 13 years vs 58 ± 16 years, p = 0.01) and 95% were men. The bicuspid aortic valve was incompetent in 19 of 21, and the aortic annulus exceeded 30 mm in 20 of 21 patients. Conclusions Patients with combined mitral regurgitation due to Myxomatous Degeneration and bicuspid aortic valve disease who require operations often have a large, prolapsing anterior leaflet of the mitral valve and dilated aortic annulus with aortic insufficiency due to cusp prolapse.
Aidan A. Raney - One of the best experts on this subject based on the ideXlab platform.
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Tricuspid valve disease
Current problems in cardiology, 2008Co-Authors: Pravin M. Shah, Aidan A. RaneyAbstract:The normal tricuspid valve anatomy and function have several dissimilarities to the corresponding mitral valve in the left heart, in part, based on lower pressures in the right heart chambers. The functional abnormalities resulting from tricuspid valve disease are classified as primary and secondary. Primary valve disease is any associated intrinsic valve pathology. The list of responsible conditions includes congenital, rheumatic, infective endocarditis, carcinoid heart disease, toxic effects of chemicals, tumors, blunt trauma, and Myxomatous Degeneration. The secondary tricuspid valve disease does not involve intrinsic anatomic abnormalities of the valve apparatus, aside from tricuspid annular dilation secondary to right ventricular dilation and dysfunction. The most common cause of tricuspid valve disease is secondary to left heart disease, either myocardial, valvular, or mixed. Although bedside diagnosis of advanced tricuspid valve disease is feasible, echocardiography provides valuable clues to the presence and severity of tricuspid valve stenosis and/or regurgitation with considerable accuracy. The tricuspid regurgitation signal using Doppler techniques is utilized for estimation of right ventricular systolic pressure, which, in the absence of right ventricular outflow obstruction, corresponds to pulmonary arterial systolic pressure. This is clinically useful since nearly 80 to 90% of patients exhibit some degree of tricuspid regurgitation. The treatment of tricuspid valve disease is guided by underlying etiology and pathology. Tricuspid valve repair is increasingly advocated for patients with advanced tricuspid regurgitation, especially when combined with surgery on the left heart pathology. Primary tricuspid valve disease is often treated by surgical approach specific to the underlying pathology.
Vidyadhar Lad - One of the best experts on this subject based on the ideXlab platform.
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mitral regurgitation due to Myxomatous Degeneration combined with bicuspid aortic valve disease is often due to prolapse of the anterior leaflet of the mitral valve
The Annals of Thoracic Surgery, 2009Co-Authors: Vidyadhar Lad, Tirone E David, Annette VegasAbstract:Background This study examines the clinical, echocardiographic, surgical, and pathologic features of patients who had heart valve operations for combined congenital bicuspid aortic valve and mitral regurgitation due to degenerative disease of the mitral valve. Methods A retrospective review of 1595 patients who had procedures for mitral regurgitation due to degenerative disease of the mitral valve and 1820 patients who had procedures for congenital bicuspid aortic valve disclosed 29 patients who had combined diseases. Results The most common morphology of the bicuspid aortic valve was type 1 (fused right and left aortic cusps). Mitral regurgitation in 21 of 29 patients was caused by prolapse of the anterior leaflet, which was exceptionally large (mean height, 36.5 ± 6.6 mm). Patients with prolapsed anterior leaflet of the mitral valve were younger (48 ± 13 years vs 58 ± 16 years, p = 0.01) and 95% were men. The bicuspid aortic valve was incompetent in 19 of 21, and the aortic annulus exceeded 30 mm in 20 of 21 patients. Conclusions Patients with combined mitral regurgitation due to Myxomatous Degeneration and bicuspid aortic valve disease who require operations often have a large, prolapsing anterior leaflet of the mitral valve and dilated aortic annulus with aortic insufficiency due to cusp prolapse.
Pablo Maria Alberto Pomerantzeff - One of the best experts on this subject based on the ideXlab platform.
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Infectious agents is a risk factor for Myxomatous mitral valve Degeneration: A case control study
BMC Infectious Diseases, 2017Co-Authors: Marcos Gradim Tiveron, Pablo Maria Alberto Pomerantzeff, Maria Lourdes Higuchi, Marcia Martins Reis, Jaqueline Jesus Pereira, Joyce Tieko Kawakami, Renata Nishiyama Ikegami, Carlos Manuel Almeida Brandao, Fabio Biscegli JateneAbstract:Background The etiology of Myxomatous mitral valve Degeneration (MVD) is not fully understood and may depend on time or environmental factors for which the interaction of infectious agents has not been documented. The purpose of the study is to analyze the effect of Mycoplasma pneumoniae (Mp), Chlamydophila pneumoniae (Cp) and Borrelia burgdorferi (Bb) on Myxomatous mitral valve Degeneration pathogenesis and establish whether increased in inflammation and collagen degradation in Myxomatous mitral valve Degeneration etiopathogenesis. Methods An immunohistochemical test was performed to detect the inflammatory cells (CD20, CD45, CD68) and Mp, Bb and MMP9 antigens in two groups. The in situ hybridization was performed to detect Chlamydophila pneumoniae and the bacteria study was performed using transmission electron microscopy. Group 1 ( n = 20), surgical specimen composed by Myxomatous mitral valve Degeneration, and group 2 ( n = 20), autopsy specimen composed by normal mitral valve. The data were analyzed using SigmaStat version 20 (SPSS Inc., Chicago, IL, USA). The groups were compared using Student’s t test, Mann-Whitney test. A correlation analysis was performed using Spearman’s correlation test. P values lower than 0.05 were considered statistically significant. Results By immunohistochemistry, there was a higher inflammatory cells/mm2 for CD20 and CD45 in group 1, and CD68 in group 2. Higher number of Mp and Cp antigens was observed in group 1 and more Bb antigens was detected in group 2. The group 1 exhibited a positive correlation between the Bb and MVD percentage, between CD45 and Mp, and between MMP9 with Mp. These correlations were not observed in the group 2. Electron microscopy revealed the presence of structures compatible with microorganisms that feature Borrelia and Mycoplasma characteristics. Conclusions The presence of infectious agents, inflammatory cells and collagenases in mitral valves appear to contribute to the pathogenesis of MVD. Mycoplasma pneumoniae was strongly related with Myxomatous mitral valve Degeneration. Despite of low percentage of Borrelia burgdorferi in MD group, this agent was correlated with Myxomatous Degeneration and this may occour due synergistic actions between these infectious agents likely contribute to collagen degradation.
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rheumatic heart disease and Myxomatous Degeneration differences and similarities of valve damage resulting from autoimmune reactions and matrix disorganization
PLOS ONE, 2017Co-Authors: Carlo De Oliveira Martins, Jorge Kalil, Edecio Cunhaneto, Lea Maria Macruz Ferreira Demarchi, Frederico Moraes Ferreira, Pablo Maria Alberto Pomerantzeff, Carlos Rodrigues Brandao, Roney Orismar Sampaio, Guilherme Sobreira Spina, Luiza GuilhermeAbstract:Autoimmune inflammatory reactions leading to rheumatic fever (RF) and rheumatic heart disease (RHD) result from untreated Streptococcus pyogenes throat infections in individuals who exhibit genetic susceptibility. Immune effector mechanisms have been described that lead to heart tissue damage culminating in mitral and aortic valve dysfunctions. In Myxomatous valve Degeneration (MXD), the mitral valve is also damaged due to non-inflammatory mechanisms. Both diseases are characterized by structural valve disarray and a previous proteomic analysis of them has disclosed a distinct profile of matrix/structural proteins differentially expressed. Given their relevance in organizing valve tissue, we quantitatively evaluated the expression of vimentin, collagen VI, lumican, and vitronectin as well as performed immunohistochemical analysis of their distribution in valve tissue lesions of patients in both diseases. We identified abundant expression of two isoforms of vimentin (45 kDa, 42 kDa) with reduced expression of the full-size protein (54 kDa) in RHD valves. We also found increased vitronectin expression, reduced collagen VI expression and similar lumican expression between RHD and MXD valves. Immunohistochemical analysis indicated disrupted patterns of these proteins in Myxomatous Degeneration valves and disorganized distribution in rheumatic heart disease valves that correlated with clinical manifestations such as valve regurgitation or stenosis. Confocal microscopy analysis revealed a diverse pattern of distribution of collagen VI and lumican into RHD and MXD valves. Altogether, these results demonstrated distinct patterns of altered valve expression and tissue distribution/organization of structural/matrix proteins that play important pathophysiological roles in both valve diseases.
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Distinct Mitral Valve Proteomic Profiles in Rheumatic Heart Disease and Myxomatous Degeneration
'SAGE Publications', 2014Co-Authors: Carlo De Oliveira Martins, Jorge Kalil, Frederico Moraes Ferreira, Pablo Maria Alberto Pomerantzeff, Roney Orismar Sampaio, Guilherme Sobreira Spina, Keity Souza Santos, Priscila Camillo Teixeira, Carlos M. A. Brandão, Luiza GuilhermeAbstract:Rheumatic heart disease (RHD) affects heart-valve tissue and is the most serious consequence of group A Streptococcus infection. Myxomatous Degeneration (MXD) is the most frequent valvopathy in the western world. In the present work, key protein expression alterations in the heart-valve tissue of RHD and MXD patients were identified and characterized, with controls from cadaveric organ donors. Proteins were separated by two-dimensional (2D)-electrophoresis and identified by mass spectrometry. We found 17 differentially expressed protein spots, as compared to control samples. We observed an increased expression of ASAP-2 in the RHD patients’ valves, while collagen-VI, haptoglobin-related protein, prolargin, and cartilage oligomeric protein showed reduced expression. Valve tissue of MXD patients, on the other hand, presented lower expression of annexin-Al and A2, septin-2, SOD (Cu/Zn), and transgelin. Tissue samples from both valvopathies displayed higher expression of apolipoprotein-Al. Biglycan was downexpressed in both diseases. Vimentin and lumican showed higher expression in RHD and lower in MXD. These results suggest that key pathogenetic mechanisms are intrinsically distinct in RHD and MXD
