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A 77-year-old woman who had severe symptomatic aortic stenosis and was a high risk for conventional surgery underwent transcatheter aortic valve implantation by means of the transfemoral approach. The prosthesis migrated and became embolized in the left ventricle after inflation, causing interference with the mitral valve and also partial outflow tract obstruction. The patient was emergently transferred to the operating room. Vertical aortotomy was performed under cardiopulmonary bypass, and the calcified native leaflets were removed. The migrated Edwards SAPIEN XT valve was extracted and subsequently successfully sewn into the annulus after examination for leaflet and stent competence. The hemodynamic performance of the implanted valve was surprisingly more favorable than that of the conventional tissue prosthesis., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: We used a modified technique of a composite graft by moving the valve prosthesis away from the end into the inside of the tube and compared the effectiveness of this surgical method with the standard valved conduits., Methods: Through a prospective nonrandomized clinical study between March 2011 and June 2012, we performed replacement of the aortic valve and ascending aorta in 30 consecutive patients using a valved composite graft with a mechanical valve prosthesis. A modified self-assembled valved composite graft was employed in 20 patients (Modified group), while the remaining 10 patients received the standard composite graft (Control group)., Results: There was significantly less bleeding in the patients with modified grafts (184 vs. 415 mL, p < 0.05). Moreover, the mean transvalvular gradient of the composite graft patients was lower in the modified group than in the control group (9 vs. 14 mmHg, respectively, p < 0.05)., Conclusions: The modified valve composite graft technique results in good hemodynamics and appears to limit blood loss., (© 2014 Wiley Periodicals, Inc.)

We present a 17-year-old woman with a 5-year history of systemic lupus erythematosus (SLE). The patient referred to us with the rheumatic involvement of the mitral valve and was treated with mitral valve repair by ring annuloplasty and anterior leaflet augmentation with autologous pericardium. Follow-up, however, disclosed precocious calcification of the valve, necessitating mitral valve replacement.

Transcatheter aortic valve implantation has become an established alternative treatment method for patients with symptomatic aortic stenosis who are at high risk for conventional aortic valve replacement. Problems, however, persist when using this technique in patients with associated coronary artery disease. We describe a successful case of valve implantation via the transaortic route with simultaneous full revascularization., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: The aim of this study was to investigate the feasibility of performing papillary muscle repositioning (PMR) for subvalvular-sparing mitral valve replacement procedures in patients with ischemic mitral regurgitation and to determine the early and late effects of this procedure on the clinical outcome and left ventricular mechanics., Methods: We prospectively randomly allocated 50 patients with severe ischemic mitral regurgitation and left ventricle dysfunction who were candidates for coronary artery bypass graft surgery and mitral valve replacement into a total chordal-sparing mitral valve replacement group or a PMR group. Echocardiography was performed preoperatively, at discharge, and after 3 years to determine the left ventricular dimensions, shape, and function., Results: The reduction in the left ventricle volumes and sphericity index in the PMR group was more significant than that in the other group. With regard to the left ventricular end-systolic and left ventricular end-diastolic volumes, sphericity index, and ejection fraction, the PMR group showed better results (p < 0.05), but the difference in New York Heart Association functional class after 3 years was not statistically significant between the two groups (p > 0.05)., Conclusions: The PMR technique described herein can dramatically help ischemic patients by affecting the left ventricular shape and function more efficiently compared with the complete retention of the mitral subvalvular apparatus if the mitral valve is to be replaced., (Copyright 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

A young man with a history of subvalvular aortic valve stenosis repair performed in childhood presented to our center with chest pain. Computed tomography and angiography demonstrated obstruction of the left main coronary artery. The obstruction was believed to result from the cannulation of coronary arteries during antegrade cardioplegia in his previous cardiac surgery.

Background: Ischemic mitral regurgitation (IMR) is a complex lesion to repair, and its successful management requires an understanding of its mechanism and severity. Ring annuloplasty, currently the surgical treatment of choice for IMR, has failure rates as high as 30% in patients with functional IMR. We sought to study the variables that can predict IMR recurrence after ring annuloplasty., Methods: This is a prospective study of 114 patients with 3+ to 4+ IMR who underwent coronary artery bypass grafting and mitral valve annuloplasty with acceptable results at an approximately 2-year follow-up. Variables were compared in a failure group, comprising patients with 2+ or higher MR and a nonfailure group, consisting of those with less than +2 MR., Results: There were five postoperative in-hospital deaths. During follow-up, 14 patients died and 95 patients were evaluated. After a mean follow-up of 22.2 +/- 4.6 months for the nonfailure group and 18.6 +/- 5.6 months for the failure group, 23 patients (24.4%) exhibited annuloplasty failure. Some variables had an effect in our univariate analysis, but only interpapillary muscle distance had a relationship with recurrent MR in the multivariate analysis. Mean preoperative interpapillary muscle distance was 15.0 +/- 4.0 and 26.5 +/- 2.9 in the nonfailure group and failure group, respectively (p < 0.0001)., Conclusions: Interpapillary muscle distance, as a reliable index of dysfunctional subvalvular apparatus in patients with IMR, can predict late postrepair MR and indicate the need for a procedure complementary to annuloplasty.

We present a practical and accurate way to measure artificial chordae length in mitral valve repair. During preoperative transesophageal echocardiography, the distance between the head of the posterior papillary muscle and the mitral annulus plane at the coaptation of the leaflets is measured; this is the length of the new chorda. Every millimeter of braided 4-0 Gore-Tex (W.L. Gore & Assoc, Flagstaff, AZ) contains two tight reverse knots; therefore, the number of the knots determines the accurate length of the artificial chorda.

Background: The aim of this study was to investigate the feasibility of performing papillary muscle repositioning for mitral valve replacement procedures in patients with left ventricular dysfunction and to determine the early and late effects of this procedure on clinical outcome and left ventricular mechanics., Methods: One hundred patients with ejection fraction less than 40, who were candidates for isolated surgical correction of mitral insufficiency, had mitral valve replacement and were prospectively randomly assigned to either total chordal-sparing or papillary muscle repositioning. Fifty subjects underwent papillary muscle repositioning (PMR group), and the remaining 50 had complete preservation of all chordal structures with mitral valve replacement (CMVR group). Echocardiography was performed preoperatively, at discharge, and after 2 years to determine dimensions, left ventricular shape, and function., Results: End-diastolic and -systolic volumes decreased in both groups initially and continued to decline. Decreasing volumes, however, were more significant in the PMR group, in which the significant decrease in the sphericity index continued for another 2 years. In contrast, the sphericity index in the CMVR group had no significant changes at discharge and at 2 years. In terms of systolic performance, ejection fraction had no significant changes in the CMVR group, whereas ejection fraction significantly increased in the PMR group., Conclusions: Papillary muscle repositioning may result in more favorable left ventricular remodeling compared with complete retention of the mitral subvalvular apparatus during mitral valve replacement. It confers a significant early and late advantage by causing significant reductions in the left ventricular chamber volume, sphericity index, and systolic performance.