DOCSLIB.ORG

Mitral Valve Replacement and Remodeling of the Left Ventricle in Dilated Cardiomyopathy with Mitral Regurgitation. Initial Results

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Mitral Valve Replacement and Remodeling of the Left Ventricle in Dilated Cardiomyopathy with Mitral Regurgitation. Initial Results Original Article Mitral Valve Replacement and Remodeling of the Left Ventricle in Dilated Cardiomyopathy with Mitral Regurgitation. Initial Results Luiz Boro Puig, Fábio Antonio Gaiotto, José de Lima Oliveira Júnior, Mirian Magalhães Pardi, Fernando Bacal, Charles Mady, Fábio Fernandes, Giovanni Bellotti, José Antonio Franchini Ramires, Sérgio Almeida de Oliveira São Paulo, SP Objective - This study evaluated the effects of a new Functional mitral insufficiency (FMI) is not a rare com- method of mitral valve replacement on left ventricular plication of advanced dilated cardiomyopathy (DCM). It re- (LV) remodeling and heart failure functional class. flects changes in left ventricular (LV) geometry, the subval- vular apparatus, the mitral valve area and transvalvular Methods - Eight patients (6 men) with severe mitral pressures. Patients with DCM and FMI have refractory con- regurgitation from end-stage dilated cardiomyopathy gestive heart failure and high mortality when in functional underwent surgery. Five patients were in functional class class (FC) III or IV. Blondhein et al 1 reported survival rates (FC) IV, 2 were in FC III and 1 was in FC III/IV. Age ranged over 32 months of 59% in patients with DCM without FMI, from 33 to 63 years. Both the anterior and posterior leaflets 26% in those with DCM and discrete FMI, and 17% in of the mitral valve were divided into hemileaflets. The patients with DCM and moderate-to-severe FMI. resultant 4 pedicles were displaced under traction toward Although heart transplantation is the standard treat- the left atrium and anchored between the mitral annulus ment for advanced DCM, the few available donor hearts are and an implanted valvular prosthesis. The beating heart insufficient to supply all patients awaiting the organ. Ste- facilitated ideal chordae tendineae positioning. venson et al 2 reported a mortality rate of 46% per year in patients with an indication for cardiac transplantation who Results - All patients survived and were discharged were waiting for a donor. Others are excluded from the organ from the hospital. After a mean follow-up period of 6.5 mon- waiting list because of advanced age or clinical contraindi- ths (1-12 m), 5 patients were in FC I; 2 in FC I/II; and 1 in cations. FC II. The preoperative ejection fraction ranged from 19% Alternatives to heart transplantation have been propo- to 30% (mean: 25.7±3.4 %), and the postoperative ejection sed to improve quality of life and decrease mortality in these fraction ranged from 21% to 40% (mean: 31.1± 5.8%). patients. FMI reflects the worst clinical evolution of DCM, Doppler echocardiography showed evidence of LV remode- and 2 techniques have been used to correct it. The first te- ling in 4 patients, including lateral wall changes and a ten- chnique, mitral valve reconstruction, was proposed by Bol- dency of the LV cavity to return to its elliptical shape. ling et al 3. This technique involves reduction of the dilated mitral annulus, thus, LV remodeling because of a decrease in Conclusion - This technique of mitral valve replace- the base diameter. The second technique, mitral valve repla- ment, involving new positioning of the chordae tendineae, cement, was proposed by Buffolo et al 4. This technique allowed LV remodeling and improvement in FC during corrects valvular insufficiency and decreases LV base dia- this brief follow-up period. meter. It involves implanting a small-diameter prosthesis and anchoring the 2 anterior valve hemileaflets, with their Key words: dilated cardiomyopathy, left ventricular remo- respective chordae tendineae, to the mitral annulus to as- deling, mitral valve replacement sist the remodeling process. We used mitral valve replacement to treat patients with Instituto do Coração do Hospital das Clínicas - FMUSP DCM and FMI in this study. Our primary objective was to Mailing address: Luiz Boro Puig – InCor - Av. Dr. Enéas C. Aguiar, 44 - evaluate the short-term effects of valve replacement with 05403-000 - São Paulo, SP – Brazil - [email protected] new positioning of the chordae tendineae on LV remodeling Received for publication on 8/30/01 Accepted on 10/17/01 and FC. First, we altered the subvalvular apparatus to isola- te 4 pillars with chordae tendineae, 2 from the anterior leaflet Arq Bras Cardiol, volume 78 (nº 2), 224-9, 2002 Arq Bras Cardiol Puig et al 2002; 78: 224-9. Mitral valve replacement and remodeling of LV in dilated cardiomyopathy and 2 from the posterior leaflet. Then we anchored these 4 mitral insufficiency and LV function in all patients. Transeso- pillars and their associated chordae tendineae, under tensi- phageal echocardiography was performed during the on, to the mitral annulus to facilitate LV remodeling by the operations. Hemodynamic parameters were derived from a traction of papillary muscles on the ventricular wall. We Swan-Ganz catheter before and after the cardiopulmonary compared pre- and postoperative echocardiographic and bypass and on the 2nd and 3rd postoperative days. Patients clinical data to determine the clinical utility of this technique. were only using intermittent vasodilator and diuretics drugs and no more than 5 mcg/kg.min of dobutamine at these times. Methods Measures were compared via simple univariate sta- tistical analysis, using the Student t test, and, when neces- Eight consecutive patients with severe LV systolic sary, the chi-square test. A p value of <0.05 was con- dysfunction, DCM, and FMI, who were receiving optimal sidered statistically significant. medical therapy, underwent surgery at the Heart Institute of Surgical technique - The patients were operated on via the Medicine Faculty Clinic’s Hospital of São Paulo Univer- median thoracotomy. Normothermic cardiopulmonary by- sity from July 2000 to July 2001. All patients provided infor- pass was established using membrane oxygenators. Myo- med consent and the study was conducted in accordance cardial protection was achieved with anterograde normo- with institutional guidelines. A prospective analysis was thermic sanguineous cardioplegia associated with corona- carried out using clinical and echocardiographic data from ry reperfusion, whenever the surgical time permitted. their postoperative course. In most cases, the mitral valve was accessed via incisi- Six patients (75%) were male and 2 (25%) were female. on of the right atrium, roof of the left atrium and atrial sep- The mean patient age was 51 years (range: 33 to 63 years). tum, as described by Guiraudon et al 6. The mitral anterior Upon hospital admission, 5 patients (62.5%) were in heart leaflet was sectioned in half from the valve annulus to the failure functional class (FC) IV, 2 (25%) were in FC III and 1 commissural areas. The resulting hemileaflets constituted 2 (12.5%) was in FC III/IV. All patients included in this study pillars with all of the chordae tendineae of the anterolateral had left ventricular ejection fraction (EF) £30%. and posteromedial papillary muscles. The other 2 pillars, Six patients were being followed for idiopathic cardio- formed by fragments of the sectioned posterior leaflet, had myopathy, one for postpartum cardiomyopathy and one for the most important chordae tendineae of the 2 papillary coronary artery disease. Two patients were excluded from muscles (fig. 1). the transplantation wait list because of renal failure requi- The suture lines helped to anchor the prosthesis and ring dialysis (cases 2 and 3) and/or a psychiatric distur- the 4 pillars in a convenient position that was in accordance bance (case 3) (tab. I). The number of hospital admissions with the direction of the papillary muscles and would allow due to congestive heart failure for these patients in the past equal dispersion of forces. In this position, the pillars were 12 months was 5.6±3.8 (range: 3 to 10). Three patients were held between the annulus and the prosthesis. The length of in the intensive care unit (ICU) in cardiogenic shock at the excess chordae was exteriorized to the left atrium while time of surgery. traction and adequate tension on the papillary muscles Pre- and postoperative transthoracic echocardiogra- were maintained (fig. 2). The beating heart facilitated ideal phic examinations were performed to evaluate the degree of chordae tendineae positioning, which was designed to maintain tension on the papillary muscles. Table I - Patient characteristics Sex Age (y) FC EF % N° of previous Etiology hospital admissions M 51 IV 24 6 Idiopathic cardiomyopathy F 57 IV 25 5 Idiopathic cardiomyopathy M 60 III 25 4 Idiopathic cardiomyopathy M 42 IV 19 6 Ischemic heart disease M 63 IV 30 7 Idiopathic cardiomyopathy M 46 IV 28 10 Idiopathic cardiomyopathy F 33 III 29 4 Postpartum cardiomyopathy M 56 III/IV 26 3 Idiopathic cardiomyopathy FC- heart failure functional class (NYHA); EF- left ventricular ejection Fig. 1 - Schematic presentation of the surgical technique. A) Mitral valve. B) Mitral fraction; y- years. valve observed through the left atrium, showing the place of the section of the cusps. C) The 4 pillars. D) Mitral prosthesis on mitral ring with the 4 pillars. 225 Puig et al Arq Bras Cardiol Mitral valve replacement and remodeling of LV in dilated cardiomyopathy 2002; 78: 224-9. ranged from 5.7 to 6.9 (mean: 6.22±0.4) L/min (p=0.0001). The EF ranged from 19% to 30% (mean: 25.7±3.4%) preoperatively and from 21% to 40% (mean: 31.1±5.8%) postoperatively (p=0.003) (tab. III) (fig. 3). In regard to geometry, a tendency toward reduction in the LV end-diastolic diameter was observed. This diameter ranged from 64 to 84 (mean: 71±6.6) mm preo- peratively and from 62 to 81(mean: 69±7.2) mm postope- ratively (p=0.081) (tab. III). The LV end-systolic diameter significantly decreased after the surgery, ranging from 53 to 75 (mean: 61.8±7.3) mm preoperatively and from 46 to 68 (mean: 57.2±8.2) mm postoperatively (p=0.0008) (tab.
Load more

Recommended publications
  • Surgical Management of Transcatheter Heart Valves
    Corporate Medical Policy Surgical Management of Transcatheter Heart Valves File Name: surgica l_management_of_transcatheter_heart_valves Origination: 1/2011 Last CAP Review: 6/2021 Next CAP Review: 6/2022 Last Review: 6/2021 Description of Procedure or Service As the proportion of older adults increases in the U.S. population, the incidence of degenerative heart valve disease also increases. Aortic stenosis and mitra l regurgita tion are the most common valvular disorders in adults aged 70 years and older. For patients with severe valve disease, heart valve repair or replacement involving open heart surgery can improve functional status and qua lity of life. A variety of conventional mechanical and bioprosthetic heart valves are readily available. However, some individuals, due to advanced age or co-morbidities, are considered too high risk for open heart surgery. Alternatives to the open heart approach to heart valve replacement are currently being explored. Transcatheter heart valve replacement and repair are relatively new interventional procedures involving the insertion of an artificial heart valve or repair device using a catheter, rather than through open heart surgery, or surgical valve replacement (SAVR). The point of entry is typically either the femoral vein (antegrade) or femora l artery (retrograde), or directly through the myocardium via the apical region of the heart. For pulmonic and aortic valve replacement surgery, an expandable prosthetic heart valve is crimped onto a catheter and then delivered and deployed at the site of the diseased native valve. For valve repair, a small device is delivered by catheter to the mitral valve where the faulty leaflets are clipped together to reduce regurgitation.
    [Show full text]
  • Severe Aortic Stenosis and the Valve Replacement Procedure
    Severe Aortic Stenosis and the Valve Replacement Procedure A Guide for Patients and their Families If you’ve been diagnosed with severe aortic stenosis, you probably have a lot of questions and concerns. The information in this booklet will help you learn more about your heart, severe aortic stenosis, and treatment options. Your heart team will recommend which treatment option is best for you. Please talk with them about any questions you have. Table of Contents 4 About Your Heart 5 What Is Severe Aortic Stenosis? 5 What Causes Severe Aortic Stenosis? 7 What Are the Symptoms of Severe Aortic Stenosis? 8 Treatment Options for Severe Aortic Stenosis 10 Before a TAVR Procedure 12 What Are the Risks of TAVR? 2 3 About Your Heart What Is Severe See the difference between healthy and The heart is a muscle about the size of your fist. It is a pump that works nonstop to Aortic Stenosis? diseased valves send oxygen-rich blood throughout your entire body. The heart is made up of four The aortic valve is made up of two or three chambers and four valves. The contractions (heartbeats) of the four chambers push Healthy Valve the blood through the valves and out to your body. tissue flaps, called leaflets. Healthy valves open at every heart contraction, allowing blood to flow forward to the next chamber, and then close tightly to prevent blood from backing Pulmonic controls the flow of Aortic controls the flow of blood up. Blood flows in one direction only. This is Valve blood to the lungs Valve out of your heart to the important for a healthy heart.
    [Show full text]
  • Surgery for Acquired Heart Disease
    View metadata, citation and similar papers at core.ac.uk brought to you byCORE provided by Elsevier - Publisher Connector SURGERY FOR ACQUIRED HEART DISEASE EARLY RESULTS WITH PARTIAL LEFT VENTRICULECTOMY Patrick M. McCarthy, MD a Objective: We sought to determine the role of partial left ventriculectomy in Randall C. Starling, MD b patients with dilated cardiomyopathy. Methods: Since May 1996 we have James Wong, MBBS, PhD b performed partial left ventriculectomy in 53 patients, primarily (94%) in Gregory M. Scalia, MBBS b heart transplant candidates. The mean age of the patients was 53 years Tiffany Buda, RN a Rita L. Vargo, MSN, RN a (range 17 to 72 years); 60% were in class IV and 40% in class III. Marlene Goormastic, MPH c Preoperatively, 51 patients were thought to have idiopathic dilated cardio- James D. Thomas, MD b myopathy, one familial cardiomyopathy, and one valvular cardiomyopathy. Nicholas G. Smedira, MD a As our experience accrued we increased the extent of left ventriculectomy James B. Young, MD b and more complex mitral valve repairs. For two patients mitral valve replacement was performed. For 51 patients the anterior and posterior mitral valve leaflets were approximated (Alfieri repair); 47 patients also had ring posterior annuloplasty. In 27 patients (5!%) one or both papillary muscles were divided, additional left ventricular wall was resected, and the papillary muscle heads were reimplanted. Results: Echocardiography showed a significant decrease in left ventricular dimensions after resection (8.3 cm to 5.8 cm), reduction in mitral regurgitation (2.8+ to 0), and increase in forward ejection fraction (15.7% to 32.7%).
    [Show full text]
  • Leapfrog Hospital Survey Hard Copy
    Leapfrog Hospital Survey Hard Copy QUESTIONS & REPORTING PERIODS ENDNOTES MEASURE SPECIFICATIONS FAQS Table of Contents Welcome to the 2016 Leapfrog Hospital Survey........................................................................................... 6 Important Notes about the 2016 Survey ............................................................................................ 6 Overview of the 2016 Leapfrog Hospital Survey ................................................................................ 7 Pre-Submission Checklist .................................................................................................................. 9 Instructions for Submitting a Leapfrog Hospital Survey ................................................................... 10 Helpful Tips for Verifying Submission ......................................................................................... 11 Tips for updating or correcting a previously submitted Leapfrog Hospital Survey ...................... 11 Deadlines ......................................................................................................................................... 13 Deadlines for the 2016 Leapfrog Hospital Survey ...................................................................... 13 Deadlines Related to the Hospital Safety Score ......................................................................... 13 Technical Assistance.......................................................................................................................
    [Show full text]
  • Transcatheter Aortic Valve Replacement
    What is TAVR? Cardiac Catheterization: Important things to know that will help you get ready Transcatheter Aortic Valve Replacement (TAVR) is a procedure Your doctor will tell if you need to stop eating or drinking to fix the aortic valve without taking out the old valve. A TAVR before your procedure. Your doctor also will tell you if you does not need open heart surgery and the heart does not need must stop taking any medications before the procedure. to be stopped. Catheterization Lab In the Pre-Operative (Pre-Op) Room before your The surgeon puts a catheter (thin tube) into an artery in your Cardiac Catheterization upper leg or through a small cut in your chest. The catheter will • You will wear a hospital gown. We will ask you to take off all Transcatheter Aortic Valve carry a new valve to your heart. your clothing (even underwear), jewelry, dentures, glasses, Replacement (TAVR) hearing aids, etc. • An intravenous line (IV) may be put into a vein in your arm • We will prepare and clean the catheter site (where the catheter goes into your body). We will clean your skin with a special wash that kills germs. We may need to trim body hair. • We will ask you to empty your bladder (pee) before your procedure After Your Cardiac Catheterization • You may be on bed rest (lying flat) for 2 to 6 hours. To lower the risk of bleeding, we do not want you to bend your body at the catheter site (where the catheter went into your body) • Your nurse will often check your vital signs (blood pressure, heart rate, temperature) and catheter site • You must use a urinal or bed pan until you can safely stand and walk to the bathroom • While you are healing, do not do strenuous exercise (such as running or lifting weights).
    [Show full text]
  • About Mitral Valve Repair
    About Mitral Valve Repair What It Is What To Expect Definition Prior to Procedure The mitral valve is on the left side of the heart. It allows Your doctor will likely do the following: blood to flow from the left upper chamber into the left • Physical exam lower chamber. When the valve is not working well, it • Chest X-ray may need to be repaired. • Lab work • Echocardiogram Reasons for Procedure • Electrocardiogram (ECG, EKG) Mitral valve repair is the best option for many patients • Cardiac catheterization with degenerative mitral valve disease leading to regurgitation (leakage). Compared to valve replacement, Talk to your doctor about your medicines, herbs, or mitral valve repair provides better outcomes leaving supplements. You may be asked to stop taking some normally functioning tissue, which resists infection more medicines up to one week before the procedure, such as: effectively and usually eliminates the need for long-term • Blood-thinning drugs, such as warfarin (Coumadin) use of blood thinners. • Anti-platelet drugs, such as clopidogrel (Plavix) • Diabetes medications, such as metformin Possible Complications (Glucophage) If you are planning to have a mitral valve repair, your doctor will review a list of possible complications, which Your doctor may also ask you to: may include: • Eat a light meal the night before. Do not eat or drink • Infections anything after midnight. • Bleeding • Arrange for a ride to and from the hospital. • Stroke • Arrange for help at home after the procedure. • Damage to other organs, such as the kidneys Anesthesia • Irregular heart rhythm You will have a general anesthetic. You will be asleep • Death during the procedure.
    [Show full text]
  • Heart Valve Disease
    Treatment Guide Heart Valve Disease Heart valve disease refers to any of several condi- TABLE OF CONTENTS tions that prevent one or more of the valves in the What causes valve disease? .................................. 2 heart from functioning adequately to assure prop- er circulation. Left untreated, heart valve disease What are the symptoms of heart valve disease? ....... 5 can reduce quality of life and become life-threat- How is valve disease diagnosed? ............................ 6 ening. In many cases, heart valves can be surgi- What treatments are available? .............................. 8 cally repaired or replaced, restoring normal func- What are the types of valve surgery? ...................... 9 tion and allowing a return to normal activities. What can I expect before and after surgery? .......... 13 Cleveland Clinic’s Sydell and Arnold Miller How can I protect my heart valves? ...................... 17 Family Heart & Vascular Institute is one of the largest centers in the country for the diagnosis and treatment of heart valve disease. The decision to prescribe medical treatment or proceed with USING THIS GUIDE surgical repair or replacement is based on the Please use this guide as a resource as you examine your type of heart valve disease you have, the severity treatment options. Remember, it is every patient’s right of damage, your age and your medical history. to ask questions, and to seek a second opinion. To make an appointment with a heart valve specialist at Cleveland Clinic, call 216.444.6697. CLEVELAND CLINIC | HEART VALVE DISEASE TREATMENT GUIDE About Valve Disease The heart valves How the Valves Work Heart valve disease means one of the heart valves isn’t working properly because The heart has four valves — one for of valvular stenosis (narrowing of the valves) or valvular insufficiency (“leaky” valve).
    [Show full text]
  • Aortic Valve Replacement in Rheumatoid Aortic Incompetence
    Thorax: first published as 10.1136/thx.33.5.612 on 1 October 1978. Downloaded from Thorax, 1978, 33, 612-615 Aortic valve replacement in rheumatoid aortic incompetence A B DEVLIN, P GOLDSTRAW, AND P K CAVES From the University Department of Cardiac Surgery, Royal Infirmary, Glasgow G4 OSF, UK Devlin, A B, Goldstraw, P, and Caves, P K (1978). Thorax, 33, 612-615. Aortic valve replacement in rheumatoid aortic incompetence. Rheumatoid aortic valve disease is uncommon, and there are few reports of valve replacement in this condition. Aortic valve replacement and partial pericardiectomy was performed in a patient with acute rheumatoid aortitis and aortic incompetence. Previous reports suggest that any patient with rheumatoid arthritis who develops cardiac symptoms should be carefully assessed for surgically treatable involvement of the pericardium or heart valves. The commonest symptomatic cardiac valvar were collapsing in character, and his blood pres- lesion in patients with rheumatoid arthritis is sure was 170/35 mmHg. Auscultation showed aortic incompetence, but aortic stenosis (Lassiter loud aortic systolic and diastolic murmurs. He had copyright. and Tassy, 1965) and mitral regurgitation (Car- "pistol-shot" femoral pulses. There was rheuma- penter et al, 1967) have been reported. Rupture toid arthritis of his elbow, wrist, knee, and ankle of the sinus of Valsalva with complete heart joints. block has also been described (Howell et al, 1972). His plain chest radiograph showed cardiomegaly This clinical experience contrasts with post- with pulmonary oedema. His electrocardiogram http://thorax.bmj.com/ mortem studies that show the similarity of rheu- showed left ventricular hypertrophy with strain, matoid and rheumatic cardiac disease with mitral, the cardiac rhythm varying between sinus tachy- aortic, tricuspid, and pulmonary valvar involve- cardia and atrial fibrillation.
    [Show full text]
  • Methods Series Report #2016-02
    HCUP Methods Series Contact Information: Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality 5600 Fishers Lane Room 07W17B Mail Stop 7W25B Rockville, MD 20857 http://www.hcup-us.ahrq.gov For Technical Assistance with HCUP Products: Email: [email protected] or Phone: 1-866-290-HCUP Recommended Citation: Gibson T, Casto A, Young J, Karnell L, Coenen N. Impact of ICD-10- CM/PCS on Research Using Administrative Databases. HCUP Methods Series Report # 2016- 02 ONLINE. July 25, 2016. U.S. Agency for Healthcare Research and Quality. Available: http://www.hcup-us.ahrq.gov/reports/methods/methods.jsp. TABLE OF CONTENTS 1. EXECUTIVE SUMMARY ..................................................................................................... I 2. INTRODUCTION ................................................................................................................ 1 3. DIFFERENCES BETWEEN ICD-9-CM AND ICD-10-CM/PCS CODING SYSTEMS ........... 4 Diagnosis Coding Systems ............................................................................................. 4 Procedure Coding Systems ............................................................................................ 7 Focus Areas in the Medical and Surgical Section: Root Operations and Approaches ....10 4. LESSONS FROM DUALLY CODED DATA ........................................................................14 Differences in the ICD-9-CM and ICD-10-CM/PCS Coding Systems .............................14 Changes in Coding Rules ..............................................................................................15
    [Show full text]
  • Antiarrhythmic Drugs in Out-Of-Hospital Cardiac Arrest
    RESEARCH HIGHLIGHTS Nature Reviews Cardiology | Published online 21 Apr 2016 IN BRIEF VALVULAR DISEASE Long-term superiority of TAVI in high-risk patients The CoreValve US Clinical Investigators report the superior 3‑year clinical outcomes with transcatheter aortic valve implantation (TAVI) compared with surgery in high‑risk patients with severe aortic stenosis. A total of 750 patients were randomly assigned to, and underwent, TAVI or surgical aortic valve replacement. After 3 years, TAVI was associated with significantly reduced all‑cause mortality and stroke (37.3% vs 46.7%; P = 0.006) and better aortic valve haemodynamics compared with surgery. No clinical evidence of valve thrombosis was reported in either group, and no significant differences existed in structural valve deterioration. “These findings,” conclude the researchers, “support the use of self‑expanding TAV[I] as the treatment of choice in patients suboptimal for surgery.” ORIGINAL ARTICLE Deeb, G. M. et al. Three‑year outcomes in high‑risk patients who underwent surgical or transcatheter aortic valve replacement. J. Am. Coll. Cardiol. http://dx.doi.org/10.1016/j.jacc.2016.03.506 (2016) VALVULAR DISEASE Mitral valve repair during CABG surgery In patients undergoing CABG surgery, the addition of mitral valve repair for moderate ischaemic mitral regurgitation does not lead to significant differences in left ventricular remodelling at 2 years. Investigators in the Cardiothoracic Surgical Trials Network randomly assigned 301 patients to undergo CABG surgery with or without mitral valve repair. After 2 years, the mean left ventricular end‑systolic volume index was not significantly different between the two groups. Mortality was also similar.
    [Show full text]
  • Heart Valve Surgery
    Department of Cardiothoracic Surgery Heart valve surgery Information for patients What is heart valve disease? Your heart contains four valves which make sure that when the chambers of the heart contract, the blood flows in the right direction. These valves can be damaged, for example by a heart attack or illness; heart valves may also be abnormal from birth. A defective valve can affect the flow of blood through the heart. There are two main types of valve problem: • The valve opening may be narrowed, which reduces the flow of blood through the valve - this is called stenosis. • The valve may leak, allowing blood to flow in the wrong direction - called regurgitation. Any of the four heart valves can be affected, but it is usually the Mitral (Inlet) or the Aortic (Outlet) valve that have problems. Both are located on the left side of the heart. These conditions can put an extra strain on the heart. They may also affect the drainage of blood from the lungs to the heart, causing a build up of fluid on the lungs, which may then result in breathlessness. The drainage of blood from the rest of the body to the heart may also be affected, causing swollen ankles. Occasionally patients may suffer from chest pain, palpitations, dizziness or blackouts. Surgical treatment has a very good success rate for severe valve disease and is the treatment of choice. page 2 Left atrium Mitral valve Right atrium Aortic valve Left ventricle Tricuspid Right ventricle valve cross section of a normal heart What the surgery involves There are two types of valve surgery: valve replacement and valve repair.
    [Show full text]
  • ICD-10-PCS Reference Manual
    ICD-10-PCS Reference Manual 3 Table of Contents Preface ............................................................................................ xi Manual organization ................................................................................................................. xi Chapter 1 - Overview ......................................................................................................... xi Chapter 2 - Procedures in the Medical and Surgical section ............................................. xi Chapter 3 - Procedures in the Medical and Surgical-related sections ............................... xi Chapter 4 - Procedures in the ancillary sections ............................................................... xii Appendix A - ICD-10-PCS definitions ................................................................................ xii Appendix B - ICD-10-PCS device and substance classification ........................................ xii Conventions used ..................................................................................................................... xii Root operation descriptions ............................................................................................... xii Table excerpts ................................................................................................................... xiii Chapter 1: ICD-10-PCS overview ......................................................... 15 What is ICD-10-PCS? .............................................................................................................
    [Show full text]