Skip to main content
SpringerLink
Log in
Book cover

Mitral Valve Repair pp 3–24Cite as

Perioperative echocardio graphic imaging of mitral valve incompetence

  • Chapter

  • 1063 Accesses

Abstract

The concept of using the echocardiography machine in the operating room fulfills the need for intraoperative diagnosis. Immediately after the completion of a surgical intervention the outcome can be verified and, if the initial results are not optimal, surgical correction may be performed. Examination by stethoscope in the operating room is not sufficient and it was discovered that patients were doing poorly after closed commissurotomy if a systolic murmur was present, whereas those without a systolic murmur did not suffer from hemodynamic problems and had satisfactory outcomes. Persistent mitral regurgitation after commissurotomy was recognized as a significant clinical problem that needs to be avoided. This fact probably triggered the surgeons’ desire for a precise intraoperative diagnostic method, and the requirements of such a method caused them to fix on echocardiography as the ideal tool for this function.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Goldman ME, Mindich BP, Teichholz LE, Burgess N, Staville K, Fuster V (1984) Intraoperative contrast echocardiography to evaluate mitral valve operations. J Am Coll Cardiol 4:1035–1040

    Article  PubMed  CAS  Google Scholar 

  2. Eguaras MG, Pasalodos J, Gonzalez V, Montero A, Garcia MA, Moriones I, Granados J, Valles F, Concha M (1985) Intraoperative contrast two-dimensional echocardiography: Evaluation of the presence and severity of aortic and mitral regurgitation during cardiac operations. J Thorac Cardiovasc Surg 89:573–579

    PubMed  CAS  Google Scholar 

  3. Czer LS, Maurer G, Bolger AF, DeRobertis M, Resser KJ, Kass RM, Lee ME, Blauche C, Chaux A, Gray RJ, Matloff JM (1987) Intraoperative evaluation of mitral regurgitation by Doppler color flow mapping. Circulation 76(Suppl III):III-108–116

    Google Scholar 

  4. Maurer G, Czer LSC, Chaux A, Bolger AF, DeRobertis M, Resser K, Kass RM, Lee ME, Matloff JM (1987) Intraoperative Doppler color flow mapping for assessment of valve repair for mitral regurgitation. Am J Cardiol 60:333–337

    Article  PubMed  CAS  Google Scholar 

  5. Feigenbaum H (1989) Personal communication, Indianapolis, Spring 1989

    Google Scholar 

  6. St. Goar FG, Fann JI, Komtebedde J, Foster E, Oz MC, Fogarty TJ, Feldman T, Block PC (2003) Endovascular edge-to-edge mitral valve repair: short-term results in a porcine model. Circulation 108:1990–1993

    Article  PubMed  Google Scholar 

  7. Levine HJ, Gaacsh WH (1996) Vasoactive drugs in chronic regurgitant lesions of the mitral and aortic valves J Am Coll Cardiol 28:1083–1091

    Article  PubMed  CAS  Google Scholar 

  8. Siniawski H, Weng Y, Hetzer R (1991) Decision-making aspects in the surgical treatment of ischemic mitral incompetence. In: Vetter HO, Hetzer R, Schmutzler H (eds) Ischemic mitral incompetence. Steinkopff, Darmstadt, pp 137–147.

    Google Scholar 

  9. Bulkley BH, Roberts WC (1975) Dilatation of the mitral annulus. A rare cause of mitral regurgitation. Am J Med 59: 457–463

    Article  PubMed  CAS  Google Scholar 

  10. Davies MJ, Moore BP, Baimbridge MV (1978) The floppy mitral valve: study of incidence, pathology and complications in surgical, necropsy and forensic material. Br Heart J 40:468–481

    Article  PubMed  CAS  Google Scholar 

  11. Komoda T, Hetzer R, Uyama C, Siniawski H, Maeta H, Rosendahl UP, Ozaki K (1994) Mitral annular function assessed by 3D imaging for mitral valve surgery. J Heart Valve Dis 3:483–490

    PubMed  CAS  Google Scholar 

  12. Komoda T, Hetzer R, Oellinger J, Siniawski H, Hofmeister J, Hübler M, Felix R, Uyama C, Maeta H (1997) Mitral annular flexibility. J Card Surg 12(2):102–109

    Article  PubMed  CAS  Google Scholar 

  13. David TE, Uden DE, Strauss HD (1986) The importance of the mitral apparatus in left ventricular function after correction of mitral regurgitation. Circulation 74:116–120

    Google Scholar 

  14. Horstkotte D, Schulte HD, Birks W, Strauer BE (1993) The effect of chordal preservation on late outcome after mitral valve replacement: a randomized study. J Heart Valve Dis 2:150–158

    Google Scholar 

  15. Komeda M, Tirone ED, Rao V, Sun Z, Weisel RD, Burns RJ (1994) Late hemodynamic effects of the preserved papillary muscles during mitral valve replacement. Circulation 90(Suppl II):II190–II194

    PubMed  CAS  Google Scholar 

  16. Hetzer R, Bougioukas G, Franz M, Borst HG (1983) Mitral valve replacement with preservation of papillary muscles and chordae tendineae. Revival of a seemingly forgotten concept. I. Preliminary clinical report. Thorac Cardiovasc Surg 31:291–296

    Article  PubMed  CAS  Google Scholar 

  17. Rushmer RF (1956) Initial phase of ventricular systole: asynchronous contraction. Am J Physiol 184:188–194

    PubMed  CAS  Google Scholar 

  18. Lillehei CW, Levy MJ, Bonnabeau RC (1964) Mitral valve replacement with preservation of papillary ,muscles and chordae tendinae. J Thorac Cardiovasc 47: 532–543

    CAS  Google Scholar 

  19. Siniawski H, Warnecke H, Weng Y, Drews T, Hetzer R (1991) Perioperative echocardiographic assessment of the heart function in the patients treated by mitral reconstruction or replacement with complete papillaryannular continuity. Circulation 84(Suppl 2):II-577

    Google Scholar 

  20. David TE (2007) Outcomes of mitral valve repair for mitral regurgitation due to degenerative disease. Semin Thorac Cardiovasc Surg 19:116–120

    Article  PubMed  Google Scholar 

  21. Bonow RO, Carabello BA, Chatterjee K, et al. (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 48:e1–e148

    Article  PubMed  Google Scholar 

  22. Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint, Capps M, Nkomo v,Scott C, Schaff HV, Tajik AJ (2009) Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med 352:875–883

    Article  Google Scholar 

  23. Grayburn PA (2008) How to measure severity of mitral regurgitation. Heart 94(3):376–383

    PubMed  Google Scholar 

  24. Omoto R, Yokote Y, Takamoto S, Kyo S, Ueda K, Asano H, Namekawa K, Kasai C, Kondo Y, Koyano A (1984) The development of real-time two-dimensional Doppler echocardiography and its clinical significance in acquired valvular diseases: with special references to the evaluation of valvular regurgitation. Jpn Heart J 25:325–340

    Article  PubMed  CAS  Google Scholar 

  25. Miyatake K, Izumi S, Okamoto M, Kinoshita N, Asonuma H, Nakagawa H, Yamamoto K, Takamiya M, Sakakibara H, Nimura Y (1986) Semiquantitative grading of severity of mitral regurgitation by real-time two-dimensional Doppler flow imaging technique. J Am Coll Cardiol 7:82–88

    Article  PubMed  CAS  Google Scholar 

  26. Spain MG, Smith MD, Grayburn PA, Harlamert EA, DeMaria AN (1989) Quantitative assessment of mitral regurgitation by Doppler color flow imaging: angiographic and hemodynamic correlations. J Am Coll Cardiol 13:585–590

    Article  PubMed  CAS  Google Scholar 

  27. F Helmcke, NC Nanda, MC Hsiung, B Soto, CK Adey, RG Goyal, RP Gatewood, Jr (1987) Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation 75:175–183

    Article  PubMed  CAS  Google Scholar 

  28. Rokey R, Sterling LL, Zoghbi WA, et al. (1986) Determination of regurgitant fraction in isolated mitral or aortic regurgitation by pulsed Doppler two-dimensional echocardiography. J Am Coll Cardiol 7:1273–1278

    Article  PubMed  CAS  Google Scholar 

  29. Enriquez-Sarano M, Seward JB, Bailey KR, Tajik AJ (1994) Effective regurgitant orifice area: a noninvasive Doppler development of an old hemodynamic concept. J Am Coll Cardiol 23:443–451

    Article  PubMed  CAS  Google Scholar 

  30. Vandervoort PM, Rivera JM, Mele D, et al. (1993) Application of color Doppler flow mapping to calculate effective regurgitant orifice area: an in vitro study and initial clinical observations. Circulation 88:1150–1156

    PubMed  CAS  Google Scholar 

  31. Dujardin KS, Enriquez-Sarano M, Bailey KR, Nishimura RA, Seward JB, Tajik AJ (1997) Grading of mitral regurgitation by quantitative Doppler echocardiography: calibration by left ventricular angiography in routine clinical practice. Circulation 96:3409–3415

    PubMed  CAS  Google Scholar 

  32. Hall SA, Brickner ME, Willett DL, Irani WN, Afridi I, Grayburn PA (1997) Assessment of mitral regurgitation severity by Doppler color flow mapping of the vena contracta. Circulation 95:636–642

    PubMed  CAS  Google Scholar 

  33. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777–802

    Article  PubMed  Google Scholar 

  34. Irvine T, Li XK, Sahn DJ, Kenny A (2002) Assessment of mitral regurgitation. Heart 88(Suppl 4):iv11–iv19

    PubMed  Google Scholar 

  35. Dujardin KS, Enriquez-Sarano M, Bailey KR, Nishimura RA, Seward JB, Tajik AJ (1997) Grading of mitral regurgitation by quantitative Doppler echocardiography: calibration by left ventricular angiography in routine clinical practice. Circulation 96:3409–3415

    PubMed  CAS  Google Scholar 

  36. Enriquez-Sarano M, Tajik A, Schaff H, Orszulak T, Bailey K, Frye R (1994) Echocardiographic prediction of survival after surgical correction of organic mitral regurgitation. Circulation 90:830–837

    PubMed  CAS  Google Scholar 

  37. Bech-Hanssen O, Ryden T, Schersten H, Oden A, Nilsson F, Jeppsson A (2003) Mortality after mitral regurgitation surgery: importance of clinical and echocardiographic variables. Eur J Cardiothorac Surg 24:723–730

    Article  PubMed  Google Scholar 

  38. Anyanwu AC, Adams DH (2009) Why do mitral valve repairs fail? J Am Soc Echocardiogr 22:1265–1268

    Article  PubMed  Google Scholar 

  39. Adams DH, Rosenhek R, Falk V (2010) Degenerative mitral valve regurgitation: best practice revolution. Eur Heart Journal 31:1958–1967

    Google Scholar 

  40. Hausmann H, Siniawski H, Hotz H, Hofmeister J, Chavez T, Schmidt G, Hetzer R (1997) Mitral valve reconstruction and mitral valve replacement for ischemic mitral insufficiency. J Card Surg 12:8–14

    Article  PubMed  CAS  Google Scholar 

  41. Bouchard D, Demers P, Coutu M, Pellerin M, Carrier M, Perrault LP, Cartier R, Pegé P, Cossete P, Basmadijan AJ (2006) Is a good perioperative echocardiographic result predictive of durability in ischemic mitral incompetence? J Thorac Cardiovasc Surg 131:565–573

    Article  PubMed  Google Scholar 

  42. Keele KD (1973) The application of the physics and sounds to 19th century cardiology: with the particular reference to the part played by CJB Williams and James Hope. Clio Med 8:191–221

    PubMed  CAS  Google Scholar 

  43. Vander Veer JB (1958) Mitral insufficiency. Historical and clinical aspects. Am J Cardiol 2:1–6

    Article  Google Scholar 

  44. Read RC, Thal AP, Wendt VE (1965) Symptomatic valvular myxomatous transformation (the floppy valve syndrome). A possible forme fruste of the Marfan syndrome. Circulation 897–910

    Google Scholar 

  45. McKay R, Yacoub MH (1973) Clinical and pathological finding in patients with »floppy« valve treated surgically. Circulation 47(Suppl):63–73

    Google Scholar 

  46. Demaria AN, King JF, Bogren HG,Lies JE, Mason DT (1974) The variable spectrum of echocardiographic manifestations of the mitral valve prolapse syndrome. Circulation 50:33–41

    PubMed  CAS  Google Scholar 

  47. Grigioni F, Detaint D, Avirinos JF (2005) Contribution of ischemic mitral regurgitation to congestive heart failure after myocardial infarction. J Am Coll Cardiol 45:260–267

    Article  PubMed  Google Scholar 

  48. Rankin JS, Hickey MSJ, Smith LR, et al. (1989) Ischemic mitral regurgitation. Circulation 79(Suppl I):I-116–I-121

    CAS  Google Scholar 

  49. Frater RWM, Cornelissen P, Sisto D (1991) Mechanisms of ischemic mitral insufficiency and their surgical correction. In: Vetter HO, Hetzer R, Schmutzler H (eds) Ischemic Mitral Incompetence. Springer, New York, NY, pp 117–130

    Google Scholar 

  50. Hider CF, Taylor DEM, Wade JD (1965) The effect of papillary muscle damage on atrioventricular valve function in the left heart. Q J Exp Physiol 50:15–22

    CAS  Google Scholar 

  51. Tsakiris AG, Rastelli GC, Amorim D, et al. (1970) Effect of experimental papillary muscle damage on mitral valve closure in intact anesthetized dogs. Mayo Clin Proc 45:275–285

    PubMed  CAS  Google Scholar 

  52. Mittal AK, Langston M Jr, Cohn KE, et al. (1971) Combined papillary muscle and left ventricular wall dysfunction as a cause of mitral regurgitation: an experimental study. Circulation 44:174–180

    PubMed  CAS  Google Scholar 

  53. Kaul S, Spotnitz WD, Glasheen WP, et al. (1991) Mechanism of ischemic mitral regurgitation: an experimental evaluation. Circulation 84:2167–2180

    PubMed  CAS  Google Scholar 

  54. Burch GE, De Pasquale NP, Phillips JH (1963) Clinical manifestations of papillary muscle dysfunction. Arch Intern Med 59:508–520

    Google Scholar 

  55. Phillips JH, Burch GE, De Pasquale NP (1963) The syndrome of papillary muscle dysfunction. Ann Intern Med 59:508–520

    PubMed  CAS  Google Scholar 

  56. Godley RW, Wann LS, Rogers EW, et al. (1981) Incomplete mitral leaflet closure in patients with papillary muscle dysfunction. Circulation 63:565–571

    Article  PubMed  CAS  Google Scholar 

  57. Kisanuki A, Otsuji Y, Kuroiwa R, et al. (1993) Two-dimensional echocardiographic assessment of papillary muscle contractility in patients with prior myocardial infarction. J Am Coll Cardiol 21:932–938

    Article  PubMed  CAS  Google Scholar 

  58. Inoue M, McCarthy P, Popovic Z (2004) The Coapsys device to treat functional mitral regurgitation: in vivo long-term canine study. J Thorac Cardiovasc Surg 127:1068 –1077

    Article  PubMed  Google Scholar 

  59. Langer F, Kunihara T, Hell K, Schramm R, Schmidt KI, Aicher D, Kindermann M, Schäfers HJ (2009) RING+STRING: successful repair technique for ischemic mitral regurgitation with severe leaflet tethering. Circulation 120:S85–S91

    Article  PubMed  Google Scholar 

  60. Miller DC (2001) Ischemic mitral regurgitation redux–to repair or to replace? J Thorac Cardiovasc Surg 122:1059–1062

    Article  PubMed  CAS  Google Scholar 

  61. Rankin JS, Feneley MP, Hickey MSTJ, et al (1988) A clinical comparison of mitral valve repair versus valve replacement in ischemic mitral regurgitation. J Thorac Cardiovasc Surg 95:166–177

    Google Scholar 

  62. Rankin JS, Hickey MSTJ, Smith LR, et al (1991) Current concepts in the pathogenesis and treatment of ischemic mitral regurgitation. In: Vetter HO, Hetzer R, Schmutzler H (eds) Ischemic Mitral incompetence. Spinger Verlag, New York, NY, pp 157–178

    Google Scholar 

  63. Fischer GW, Anyanwu AC, Adams DH (2009) Intraoperative classification of mitral valve dysfunction: the role of the anesthesiologist in mitral valve reconstruction. J CardiothoracVasc Anesth 23:531–543

    Article  Google Scholar 

  64. Siniawski H, Weng Y, Hetzer R, et al (1991) Decision making aspects in the surgical treatment of ischemic mitral incompetence. In: Vetter HO, Hetzer R, Schmutzler H (eds) Ischemic Mitral Incompetence. Springer Verlag, New York, pp 137–147

    Google Scholar 

  65. Chao K, Moises VA, Shandas R, Elkadi T, Sahn DJ, Weintraub R (1992) Influence of the Coanda effect on color Doppler jet area and color encoding in vitro studies using color Doppler flow mapping. Circulation –341

    Google Scholar 

  66. Saners PJ, Neubuerger KT, Ravin A (1957) Rupture of papillary muscles: occurrence of rupture of the posterior muscle in posterior myocardial infarction. Dis Chest 36:166–177

    Google Scholar 

  67. Stevenson RR, Tunrer WJ (1935) Rupture of a papillary muscle in the heart as a cause of sudden death. Bull John Hopkins Hosp 57:235.95

    Google Scholar 

  68. Gula G, Yacoub MH (1981) Surgical correction of complete rupture of the anterior papillary muscle. Ann Thorac Surg 32:88–91

    Article  PubMed  CAS  Google Scholar 

  69. Stewart JA, Silimperi D, Harris P, Wise NK, Fraker TD Jr, Kisslo JA (1980) Echocardiographic documentation of vegetative lesions in infective endocarditis: clinical implications. Circulation 61:374–380

    PubMed  CAS  Google Scholar 

  70. Hetzer R, Deyerling W, Borst HG (1984) Herzklappenchirurgie bei aktiver infektiöser Endokarditis. In: Gahl K (ed) Infektiöse Endokarditis. Klinik, Diagnostik, Therapie. Steinkopff, Darmstadt, pp 148–176

    Google Scholar 

  71. Oakley CM, Hall RJC (2001) Endocarditis: problems of patients being treated for endocarditis and not doing well. Heart 85:470–474

    Article  PubMed  CAS  Google Scholar 

  72. Braimbridge MV (1969) Cardiac surgery and bacterial endocarditis. Lancet 1:1307–1309

    Article  PubMed  CAS  Google Scholar 

  73. Zegdi R, Debièche M, Latrémouille C et al. (2005) Long-term results of mitral valve repair in active endocarditis. Circulation 111:2532–2536

    Article  PubMed  Google Scholar 

  74. Hetzer R, Dalichau H, Borst HG (1975) Herzklappenchirurgie bei bakterieller Endocarditis. Thoraxchirurgie 23:427–430

    CAS  Google Scholar 

  75. Helmcke F, Nanda NC, Hsiung MC et al. (1987) Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation 74:175–183

    Article  Google Scholar 

  76. Personal communication from Professor Hetzer. Berlin 1989

    Google Scholar 

  77. Schwammenthal E, Nakatani S, He S, Hopmeyer J, Sagie A, Weyman AE, Lever H M, Yoganathan PA, Thomas JD, Levine RA (1998) Mechanism of mitral regurgitation in hypertrophic cardiomyopathy: mismatch of posterior to anterior leaflet length and mobility. Circulation 98:856–865

    PubMed  CAS  Google Scholar 

  78. Siniawski H, Lehmkuhl H, Weng Y, Hetzer R (2004) High pressure gradients in left ventricular outflow tract after aortic valve replacement. Acta Cardiologica 59(2):235–236

    PubMed  Google Scholar 

  79. GS Mintz, MN Kotler, BL Segal, WR Parry (1967) Systolic anterior motion of the mitral valve in the absence of asymmetric septal hypertrophy. Circulation 57:256–263

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Deutsches Herzzentrum Berlin, Charité Medical University Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    H. Siniawski MD, PhD & R. Hetzer MD, PhD (Chairman Professor of Surgery)

  2. Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    M. Hübler MD & A. Amiri MD

  3. Consultant Cardiothoracic & Vascular Surgeon Deutsches Herzzentrum Berlin, Charité Medical University Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    C.A. Yankah MD, PhD (Professor of Surgery)

Authors
  1. H. Siniawski MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Hübler MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Amiri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C.A. Yankah MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Hetzer MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Deutsches Herzzentrum Berlin, Charité Medical University Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Roland Hetzer MD, PhD (Chairman Professor of Surgery) (Chairman Professor of Surgery)

  2. Department of Cardiac Surgery, Vanderbilt University Medical Center, 320 Lynnwood Blvd., 37205, Nashville, TN, USA

    J. Scott Rankin MD (Associate Clinical Professor of Surgery) (Associate Clinical Professor of Surgery)

  3. Consultant Cardiothoracic & Vascular Surgeon Deutsches Herzzentrum Berlin, Charité Medical University Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Charles A. Yankah MD, PhD (Professor of Surgery) (Professor of Surgery)

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Siniawski, H., Hübler, M., Amiri, A., Yankah, C., Hetzer, R. (2011). Perioperative echocardio graphic imaging of mitral valve incompetence. In: Hetzer, R., Rankin, J., Yankah, C. (eds) Mitral Valve Repair. Steinkopff. https://doi.org/10.1007/978-3-7985-1867-4_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-7985-1867-4_1

  • Publisher Name: Steinkopff

  • Print ISBN: 978-3-7985-1866-7

  • Online ISBN: 978-3-7985-1867-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation