Search

Objectives: Although risk factors for unsuccessful Maze procedure have been demonstrated, an appropriate patient selection is still controversial. In our institute, Maze procedure is indicated for those whom normal sinus rhythm (NSR) was reestablished by intraoperative direct cardioversion (DC) after ventricular unloading by total cardiopulmonary bypass. The purpose of this study was to evaluate the effectiveness of our indication criteria for Maze procedure in patients with mitral valve disease., Methods: Between October 2012 and October 2021, MAZE was indicated in 55 patients in whom normal sinus rhythm (NSR) was reestablished by intraoperative direct current cardioversion (DC). Three endpoints and predictors were examined: disappearance of atrial fibrillation (AF), NSR, and A-wave detection., Results: Restoration of NSR by intraoperative DC was confirmed in 43 patients, and these patients underwent MAZE. AF disappeared in 39 patients (90.7%), and F-wave ≥ 0.1 mV was a significant predictive factor (odds ratio (OR) 20.99, 95% CI 1.22-1079.06). NSR was reestablished in 36 patients (83.7%), and F-wave ≥ 0.1 mV (odds ratio 15.62, 95% CI 1.62-359.86) + AF history ≤ 3 years (OR 8.30, 95% CI 1.09-177.04) were significant predictors. A-wave detection was confirmed in 26 patients (60.5%), and left atrial diameter ≤ 55 mm was a significant predictor (OR 5.22, 95% CI 1.28-24.79)., Conclusions: Intraoperative DC after ventricular unloading resulted effective patient selection for concomitant Maze procedure. F-wave and AF history were predictive factor of electrical restoration of AF, and left atrial diameter was predictive factor of restoration of atrial function., (© 2024. The Author(s).)

Purpose: We studied the association between operative timing and the feasibility of mitral valve (MV) repair in active infective endocarditis (IE)., Methods: Forty-nine active IE patients who underwent MV operation were classified according to operative timing: within 48 hours (Term I: n = 7), between 3 and 14 days (Term II: n = 22), and ≥15 days (Term III: n = 20). Patient profiles, operative outcomes, and feasibility of MV repair were evaluated. Complexity score and severity score were used to define the feasibility of MV repair depending on the extent of infected lesion and technical difficulties., Results: There were no differences in basic profile in the three groups. Rate of major complications was higher in Term I (86%) than II (41%, p = 0.031) and III (25%, p = 0.005). In-hospital mortality was also higher in Term I (43%) than II (9%, p = 0.039) and III (5%, p = 0.015). The three groups did not differ by feasibility of MV repair calculated by the two-score system or by frequency of MV repair (I: 57%, II: 59%, and III: 55%)., Conclusions: Morbidity and mortality were high in urgent cases. Feasibility of MV repair is associated with the extent of infected lesion and technical difficulties, and not with operative timing.

According to the current guideline, early surgery is recommended in patients with infective endocarditis (IE). On the other hand, mitral valve plasty (MVP) became the preferred surgical option in patients with IE, because of its benefits in the preservation of left ventricular function and prevention of recurrence of infection. Feasibility of MVP is an important issue in surgical strategy, however, it might be associated with the timing of the operation:feasibility of MVP might be higher in healed IE than active IE, although there had been no clear evidence in previous studies. In order to develop scoring system to predict feasibility of MVP in patients with active IE, we have introduced "severity score".Severity score defined as the sum of valvular score which evaluates the extensiveness of the valvular destruction, and technical score which evaluates the complexity and durability of the repair. Probability of feasible MVP was high in severity score≤7 points and low in severity score≥9 points. MVP is basically selected in patients with severity score of 8 points, taking the benefit of patients and risks of longterm durability into consideration. We believe that severity score is valuable and reproducible scoring system in surgical decision making.

Objectives: Functional tricuspid regurgitation (FTR) is a significant negative prospective factor for long-term survival in patients with mitral valve disease. Tricuspid annuloplasty (TAP) for FTR is recommended as a concomitant procedure during left-sided valvular surgery. The MC3 annuloplasty ring is designed to restore the dilated tricuspid annulus to its natural three-dimensional shape, but selection of the optimal ring size during TAP is sometimes difficult. One solution is the septal adjustment technique (SAT), in which the point of fixation of the septal portion to the septal annulus is adjusted under confirmation with the water test. Here, we evaluated early outcomes with this new technique., Methods: Between January 2008 and September 2014, 56 patients (mean age 67.6 ± 9.0 years, male/female 28/28) with FTR underwent TAP with an MC3 ring. We retrospectively compared early outcomes, including mortality, morbidity and postoperative residual tricuspid regurgitation (TR), between patients undergoing TAP with the SAT (n = 19, Group A) and those undergoing TAP with the conventional technique (n = 37, Group C)., Results: Although preoperative TR grade was significantly higher in Group A than Group C (3.2 ± 0.6 vs. 2.8 ± 0.6, p = 0.032), postoperative TR grade was significantly lower in Group A than Group C (0.9 ± 0.6 vs. 1.4 ± 0.8, p = 0.039), and TR grade was significantly decreased in Group A compared to Group C (2.2 ± 0.9 vs. 1.4 ± 0.8, p = 0.004). TR area reduction was significantly larger in Group A than in Group C (5.21 ± 2.34 vs. 2.85 ± 3.09, p = 0.006)., Conclusions: The SAT for TAP with an MC3 ring provided better control of postoperative TR than the conventional technique.

In patients with left atrial myxoma, mitral valve regurgitation is often encountered. However, preoperative assessment of the mitral valve is difficult in cases with giant left atrial myxoma occupying the left atrial cavity. We experienced a patient with giant left atrial myxoma who underwent tumor excision and mitral valve repair. A 40-year-old woman was transferred to the emergency room due to respiratory failure. On admission, her hemodynamic status was unstable and percutaneous cardiopulmonary support was immediately started. Transesophageal echocardiography was performed, which showed giant left atrial tumor with the pedicle on the atrial septum with mitral valve regurgitation, but the severity of regurgitation was unclear. After excision of left atrial myxoma with atrial septum, the mitral valve was examined. The anterior leaflet( A3 scallop) prolapse due to a torn chordae was found. The mitral valve was repaired with leaflet resection and prosthetic ring annuloplasty. Postoperative course was uneventful and postoperative echocardiography showed no residual mitral valve regurgitation. The mitral valve should be carefully inspected intraoperatively after resection of left atrial myxoma, especially when the tumor is gigantic.

We report on a successful mitral valve (MV) repair and modified Cox maze procedure in a 35-year-old male patient with acromegaly, associated with severe mitral regurgitation and atrial fibrillation. He underwent a transsphenoidal adenomectomy, 7 months after the cardiac operation, and IGF-I level was normalized postoperatively. Valvular disease in patients with acromegaly is associated with hormonal activity, and control of growth hormone and insulin-like growth factor I excesses is important in the long-term durability of mitral valve repair.

Open heart operations for patients with myelodysplastic syndrome (MDS) are associated with infective and bleeding complications. We report a 67-year-old woman with rheumatic, severe mitral regurgitation and mitral stenosis associated with MDS who underwent a mitral valve (MV) repair. Commissurotomy was performed in the anterior commissure. Autologous pericardial patch treated with glutaraldehyde solution was prepared. The anterior leaflet was completely detached from the posterior to the anterior commissure. The anterior leaflet was augmented by autologous pericardial patch treated with glutaraldehyde solution and three pairs of artificial chordae were implanted. Postoperative transesophageal echocardiography showed an increase in the MV orifice and less than trivial mitral regurgitation. Two years after the operation, the patient has normal sinus rhythm with no deterioration of the MV lesion by transthoracic echocardiography. Although the feasibility of MV repair is low in patients with restrictive pathology due to rheumatic disease, MV repair may be preferred in patients with MDS.

Objective: This study investigated the feasibility of mitral valve (MV) repair in patients with active or healed infective endocarditis (IE) with mitral regurgitation and evaluated effects on left ventricular (LV) function and structure., Methods: Subjects comprised 19 patients who underwent MV operations for IE between December 2004 and September 2007. MV repair was performed for acute IE in 10 of 15 patients (67%) and for healed IE in 4 of 4 patients (100%)., Results: No early or late postoperative deaths were encountered. One patient underwent redo MV repair owing to severe mitral regurgitation 1 month postoperatively. Postoperative echocardiography after MV repair demonstrated less than trivial (acute IE in seven, healed IE in three) or mild (acute IE in three, healed IE in one) mitral regurgitation. In patients with MV replacement, the postoperative left atrial dimension (LAD) was decreased (51.5 +/- 39.2 vs. 39.2 +/- 1.9 mm, P = 0.007); however LV end-diastolic dimension (LVDD) and LV end-systolic dimension were unchanged. In patients with MV repair, LVDD (57.5 +/- 6.5 vs. 46.0 +/- 5.6 mm, P < 0.001), LV end-systolic dimension (36.1 +/- 5.2 vs. 32.4 +/- 6.2 mm, P = 0.04), LAD (43.1 +/- 8.1 vs. 33.6 +/- 7.7 mm, P = 0.003) were reduced. Postoperative ejection fraction (55.3 +/- 13.5% vs. 41.8% +/- 10.0%, P = 0.03) and fraction shortening (30.1% +/- 9.2% vs. 20.7% +/- 5.5%, P = 0.03) were better in patients with MV repair than those with MV replacement., Conclusions: MV repair is feasible in patients with both active and healed IE. MV repair preserves better LV function and structure postoperatively.