Pagano / Haverich Mitral Valve Surgery

Monographs in Cardiac Surgery
1. Auflage 2010
ISBN: 978-1-84996-426-5
Verlag: Springer-Verlag
Format: PDF
Kopierschutz: Wasserzeichen (»Systemvoraussetzungen)

E-Book, Englisch, 168 Seiten

Part of the Monographs in Cardiac Surgery Series - Introducing 'basic science into the cardiac operating room'. Fast systematic review of small areas of cardiac surgery including up-to-date information. This will allow more rapid publication than the alternative cardiac surgery 'tomes'. This entry into the series will provide readers with a complete review of the current understanding in mitral valve surgery and include extensive details on the diagnosis and surgical management of patients with mitral valve disease.

Autoren/Hrsg.

Pagano, Domenico

Haverich, Axel

Inhaltsverzeichnis

1;Mitral Valve Surgery;2
1.1;Copyright page;3
1.2;Series Preface;4
1.3;Contents;6
1.4;Contributors;8
1.5;Part I Anatomy, Pathology, and Natural Historyof Mitral Valve Disease;10
1.5.1;1: Surgical Anatomy of the Mitral and Tricuspid Valve;11
1.5.1.1;Introduction;11
1.5.1.2;Fibrous Skeleton of the Heart;11
1.5.1.3;Mitral Valve: The Functional Unit;13
1.5.1.3.1;The Structure of the Functional Unit;13
1.5.1.3.1.1;Mitral Valve Annulus;14
1.5.1.3.1.2;Mitral Valve Leaflets;15
1.5.1.3.1.3;Mitral Valve Chordae Tendinae;17
1.5.1.3.1.4;Mitral Valve Papillary Muscles;18
1.5.1.3.2;Physiology of the Functional Unit;18
1.5.1.3.2.1;Mitral Valve Annular Dynamics;18
1.5.1.3.2.2;Mitral Valve Leaflet Physiology;19
1.5.1.3.2.3;Mitral Valve Papillary Muscles;20
1.5.1.3.2.4;Left Ventricular Muscle;20
1.5.1.3.2.5;Summary of the Impact of Mitral Valve Physiology;20
1.5.1.3.3;Mitral Valve Functional Unit Co-location: Surgical Considerations;21
1.5.1.4;Tricuspid Valve: The Functional Unit;21
1.5.1.4.1;The Structure of the Functional Unit;21
1.5.1.4.1.1;Tricuspid Valve Annulus;22
1.5.1.4.1.2;Tricuspid Valve Leaflets;23
1.5.1.4.1.3;Tricuspid Valve Chordae Tendinae;24
1.5.1.4.1.4;Tricuspid Valve Papillary Muscles;24
1.5.1.4.2;Physiology of the Functional Unit;24
1.5.1.4.2.1;Tricuspid Valve Annular Dynamics;24
1.5.1.4.2.2;Tricuspid Valve Leaflet Physiology;25
1.5.1.4.2.3;Tricuspid Valve Papillary Muscle Physiology;25
1.5.1.4.3;Tricuspid Valve Functional Unit Co-location: Surgical Considerations;25
1.5.1.4.3.1;Right Coronary Artery;25
1.5.1.4.3.2;Conduction Tissue;25
1.5.1.4.3.3;Aortic and Mitral Valve;26
1.5.1.5;Summary;26
1.5.1.6;References;26
1.5.2;2: Pathology and Classification of Mitral Valve Disease;28
1.5.2.1;Introduction;28
1.5.2.2;Mitral Stenosis;28
1.5.2.2.1;Rheumatic Mitral Stenosis;28
1.5.2.2.2;Mitral Annular Calcification;29
1.5.2.2.3;Immune Mediated Mitral Stenosis;29
1.5.2.2.4;Carcinoid Heart Disease and Drug Induced Valvular Heart Disease;29
1.5.2.2.5;Congenital Mitral Valve Stenosis;30
1.5.2.3;Pathophysiology of Mitral Stenosis;30
1.5.2.4;Mitral Regurgitation;31
1.5.2.4.1;Ischemic and Functional Mitral Regurgitation;32
1.5.2.4.2;Mitral Valve Prolapse;32
1.5.2.4.3;Rheumatic Mitral Regurgitation;33
1.5.2.4.4;Mitral Annular Calcification;33
1.5.2.4.5;Infective Endocarditis;33
1.5.2.4.6;Congenital Mitral Regurgitation;34
1.5.2.5;Pathophysiology of the Mitral Valve Regurgitation;34
1.5.2.6;Prosthetic Heart Valves;34
1.5.2.7;Prosthetic Valve Endocarditis;35
1.5.2.8;Structural Dysfunction;35
1.5.2.9;Nonstructural Dysfunction;35
1.5.2.10;References;35
1.5.3; 3: Chronic Mitral Regurgitation;37
1.5.3.1;Anatomy of the Mitral Valve Apparatus;37
1.5.3.2;Mechanisms of Chronic Mitral Regurgitation;38
1.5.3.3;Pathophysiology;39
1.5.3.3.1;Determinants of Regurgitant Volume;39
1.5.3.3.2;LV Mechanics in MR;39
1.5.3.3.3;LV Compensation;39
1.5.3.3.4;LV Decompensation;40
1.5.3.4;Epidemiology;40
1.5.3.5;Symptoms;40
1.5.3.6;Physical Examination;41
1.5.3.7;Laboratory Investigations;41
1.5.3.7.1;Electrocardiography;41
1.5.3.7.2;Chest Roentgenogram;41
1.5.3.7.3;Echocardiography;41
1.5.3.7.4;Etiology;42
1.5.3.7.5;Repairability;44
1.5.3.7.6;Cardiac Catheterization;44
1.5.3.8;Natural History;44
1.5.3.9;Indications for Mitral Valve Surgery;44
1.5.3.10;Surgical Considerations;46
1.5.3.11;References;46
1.5.4; 4: Chronic Ischemic Mitral Regurgitation;49
1.5.4.1;Introduction;49
1.5.4.2;Prevalence and Prognostic Impact;49
1.5.4.3;Mechanisms of Ischemic MR;49
1.5.4.3.1;Impaired Contractile Function;50
1.5.4.3.2;Increased Leaflet Tethering;50
1.5.4.3.3;Annular Dilatation;51
1.5.4.3.4;Dynamic Nature of Ischemic MR;52
1.5.4.4;Evaluation of Patients with Ischemic MR;53
1.5.4.4.1;Echocardiography;53
1.5.4.4.2;Stress Echocardiography;53
1.5.4.4.3;Magnetic Resonance Imaging;54
1.5.4.4.4;Coronary Angiography;54
1.5.4.5;Management of Patients with Ischemic MR;54
1.5.4.5.1;Myocardial Revascularization;54
1.5.4.5.2;Cardiac Resynchronization Therapy;54
1.5.4.5.3;Medical Treatment;54
1.5.4.5.4;Surgical Approaches;55
1.5.4.5.4.1;Mitral Valve (MV)Repair;55
1.5.4.5.4.2;Mitral Valve Replacement;55
1.5.4.6;Indications for Mitral Valve Surgery;55
1.5.4.7;References;55
1.5.5; 5: Asymptomatic Mitral Valve Regurgitation: Watchful Wait or Early Repair? Review of the Current Evidence;58
1.5.5.1;Introduction;58
1.5.5.2;Severe Mitral Regurgitation;58
1.5.5.2.1;Existing Guidelines;58
1.5.5.2.2;Current State of Valve Repair;59
1.5.5.3;What Is the Outcome of Patients with Asymptomatic Severe Mitral Regurgitation?;59
1.5.5.4;Echocardiographic Assessment;60
1.5.5.4.1;Severity of Mitral Regurgitation;60
1.5.5.4.2;Etiology and Mechanism;61
1.5.5.4.3;Left Ventricular Function;61
1.5.5.4.4;Other Abnormalities;61
1.5.5.4.5;The Place of Exercise Testing and Exercise Echocardiography;61
1.5.5.4.6;Frequency of Review;62
1.5.5.5;Studies on Improving Mitral Services;62
1.5.5.6;IS There a Need for a Randomized Study?;62
1.5.5.7;References;63
1.6;Part II Mitral Valve Repair and ReplacementTechniques;64
1.6.1; 6: Mitral Valve Prosthesis Insertion with Preservation of the Sub-Valvar Apparatus;65
1.6.1.1;Introduction;65
1.6.1.2;Surgical Strategies for Preservation of the Atrio-Ventricular Loop During Insertion of a Mitral Prosthesis;67
1.6.1.3;Surgical Techniques;67
1.6.1.4;Annular Calcification;69
1.6.1.5;References;71
1.6.2; 7: How I Assess and Repair the Barlow Mitral Valve: The Respect Rather Than Resect Approach;72
1.6.2.1;Definition;72
1.6.2.2;Valve Assessment;73
1.6.2.2.1;Echocardiographic Analysis;73
1.6.2.2.2;Surgical Valve Analysis;73
1.6.2.2.2.1;Free Edge Mobility;73
1.6.2.2.2.2;Excess of Tissue;74
1.6.2.2.2.3;Mucoid Degeneration;74
1.6.2.3;Surgical Strategy;74
1.6.2.3.1;Repair of the Posterior Leaflet;76
1.6.2.3.1.1;Leaflet Mobility;76
1.6.2.3.1.2;The Goal of a Smooth and Vertical Surface of Coaptation;77
1.6.2.3.1.3;Intermediary Surgical Test;77
1.6.2.3.2;Repair of the Anterior Leaflet;77
1.6.2.3.3;Ring Annuloplasty;77
1.6.2.4;Control of the Result;78
1.6.2.4.1;Surgical Control;78
1.6.2.4.2;Echocardiographic Control;78
1.6.2.5;References;79
1.6.3; 8: How I Assess and Repair the Barlow Mitral Valve: The Edge-to-Edge Technique;80
1.6.3.1;Introduction;80
1.6.3.2;The Edge-to-Edge Technique for Bileaflet Prolapse in Barlow’s Disease;80
1.6.3.2.1;Surgical Technique and Results;81
1.6.3.3;The Edge-to-Edge Technique for Anterior Leaflet Prolapse;84
1.6.3.4;The Edge-to-Edge Technique for Commissural Prolapse;84
1.6.3.5;The Minimally Invasive Approach Option;85
1.6.3.6;Edge-to-Edge Repair and Annuloplasty;85
1.6.3.7;Double Orifice Edge-to-Edge Repair and Hemodynamics;86
1.6.3.8;Edge-to-Edge Repair and the Risk of Functional Mitral Stenosis;86
1.6.3.9;References;87
1.6.4; 9: How I Assess and Repair the Barlow Mitral Valve;88
1.6.4.1;Valve Assessment;91
1.6.4.2;Surgical Exposure;93
1.6.4.3;Strategies for Surgical Repair;94
1.6.4.4;References;98
1.6.5;10: Ischemic Mitral Regurgitation;99
1.6.5.1;Introduction;99
1.6.5.1.1;Definitions and Mechanisms;99
1.6.5.1.2;Consequences of Ischemic Mitral Regurgitation;99
1.6.5.1.3;Surgical Treatment of Ischemic Mitral Regurgitation;101
1.6.5.1.4;Alternative Surgical Strategies;102
1.6.5.1.5;Outcome of Surgical Treatment;102
1.6.5.2;References;104
1.6.6;11: Minimally Invasive Mitral Valve Surgery;106
1.6.6.1;Introduction;106
1.6.6.2;Minimally Invasive Surgical Approaches;106
1.6.6.2.1;Right Mini-Thoracotomy;106
1.6.6.2.2;Robotically Assisted Right Thoracic Approach;109
1.6.6.2.3;Partial Sternotomy;109
1.6.6.3;Minimally Invasive Approaches: Comparison of Technical Considerations and Patient Selection;109
1.6.6.4;Results of Minimally Invasive Mitral Valve Surgery;110
1.6.6.4.1;Valve Repair;110
1.6.6.4.2;Mortality and Morbidity;110
1.6.6.4.3;Benefits of Minimally Invasive Mitral Valve Surgery;111
1.6.6.4.3.1;Cosmesis;111
1.6.6.4.3.2;Postoperative Pain;112
1.6.6.4.3.3;Hospital Length of Stay and Recovery;112
1.6.6.4.3.4;Transfusion;112
1.6.6.4.3.5;Wound Infection;112
1.6.6.4.3.6;Cost;112
1.6.6.4.3.7;Benefits: Summary;113
1.6.6.5;Repair Techniques;113
1.6.6.5.1;Posterior Prolapse;113
1.6.6.5.1.1;Triangular Resection;113
1.6.6.5.1.2;Folding Plasty;113
1.6.6.5.2;Anterior Prolapse;113
1.6.6.5.3;Commissural Prolapse;114
1.6.6.6;Recommendations;114
1.6.6.7;Future Directions;114
1.6.6.8;References;114
1.6.7;12: Mitral Stenosis;117
1.6.7.1;Etiology and Epidemiology;117
1.6.7.2;Pathology and Pathophysiology;117
1.6.7.3;Natural History;119
1.6.7.4;Clinical Features;120
1.6.7.5;Physical Exam and Diagnostic Tests;120
1.6.7.5.1;Electrocardiography;121
1.6.7.5.2;Chest X-Ray;121
1.6.7.5.3;Echocardiography;121
1.6.7.6;Intervention;121
1.6.7.6.1;Closed Surgical Commissurotomy;121
1.6.7.6.2;Open Surgical Commissurotomy;122
1.6.7.6.3;Percutaneous Mitral Balloon Valvuloplasty;123
1.6.7.7;Indication;125
1.6.7.8;References;127
1.7;Part III Other Conditions;130
1.7.1;13: Atrial Fibrillation: Non Surgical Management;131
1.7.1.1;Introduction;131
1.7.1.2;Pathophysiology and Electrophysiology;131
1.7.1.3;Clinical Classification;132
1.7.1.4;Pharmacological Agents;132
1.7.1.5;General Non surgical Management Strategies;133
1.7.1.5.1;Rate Control in Acute AF;133
1.7.1.5.2;Cardioversion in Acute AF;134
1.7.1.5.3;Paroxysmal AF;134
1.7.1.5.4;Persistent AF;135
1.7.1.5.5;Permanent AF;137
1.7.1.6;Nonpharmacological Treatments for AF;137
1.7.1.7;Antithrombotic Therapy;138
1.7.1.8;Future Perspectives;138
1.7.1.9;Conclusion;140
1.7.1.10;References;140
1.7.2;14: Ablation of Atrial Fibrillation with Cardiac Surgery;142
1.7.2.1;Introduction;142
1.7.2.2;Rationale for Surgical Ablation;142
1.7.2.2.1;AF Prevalence;142
1.7.2.2.2;AF Dangers;142
1.7.2.2.3;AF Mechanisms and Implications for Surgical Ablation;143
1.7.2.3;The Maze Procedure;143
1.7.2.4;New Approaches to Surgical Ablation of Atrial Fibrillation;145
1.7.2.4.1;Lesion Sets;145
1.7.2.4.2;A Review of the Available Energy Sources;145
1.7.2.5;The Left Atrial Appendage;147
1.7.2.6;Challenges and Future Directions;147
1.7.2.6.1;Reporting Results;147
1.7.2.6.2;Ablation Technology and Intraoperative Assessment;147
1.7.2.6.3;Minimally Invasive Approaches;147
1.7.2.7;Conclusions;148
1.7.2.8;References;148
1.7.3;15: Tricuspid Regurgitation: Natural History, Assessment, and Intervention;151
1.7.3.1;Natural History;151
1.7.3.2;Clinical Features;152
1.7.3.3;TR Assessment;152
1.7.3.4;Surgical Treatment;155
1.7.3.4.1;Patients with Annular Dilatation with or Without Regurgitation;157
1.7.3.4.2;Patients with Annular Dilatation with Moderate or Severe TR with Some Degree of Tethering;157
1.7.3.4.3;Patients with Annular Dilatation with Severe Tethering;157
1.7.3.5;Conclusion;158
1.7.3.6;References;158
1.8;Index;160