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      Quantitative mitral valve anatomy and pathology

      review-article
      Author(s): , MD MA FRCP , , PhD
      Publication date (Electronic):
      Journal: Echo Research and Practice
      Publisher: Bioscientifica Ltd
      Keywords: mitral valve, quantification, morphology, echocardiography, 3D, repair

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          Abstract

          Quantitative analysis is an important part of the morphological assessment of the diseased mitral valve. It can be used to describe valve anatomy, pathology, function and the mechanisms of disease. Echocardiography is the main source of indirect quantitative data that is comparable with direct anatomic or surgical measurements. Furthermore, it can relate morphology with function. This review provides an account of current mitral valve quantification techniques and clinical applications.

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          Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice.

          Helmut Baumgartner, Judy Hung, Javier Bermejo … (2009)
          Article 0 comments Cited 183 times – based on 0 reviews     Review now
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            Degenerative mitral valve regurgitation: best practice revolution

            David Adams, Raphael Rosenhek, Volkmar Falk (2010)
            Degenerative mitral valve disease often leads to leaflet prolapse due to chordal elongation or rupture, and resulting in mitral valve regurgitation. Guideline referral for surgical intervention centres primarily on symptoms and ventricular dysfunction. The recommended treatment for degenerative mitral valve disease is mitral valve reconstruction, as opposed to valve replacement with a bioprosthetic or mechanical valve, because valve repair is associated with improved event free survival. Recent studies have documented a significant number of patients are not referred in a timely fashion according to established guidelines, and when they are subjected to surgery, an alarming number of patients continue to undergo mitral valve replacement. The debate around appropriate timing of intervention for asymptomatic severe mitral valve regurgitation has put additional emphasis on targeted surgeon referral and the need to ensure a very high rate of mitral valve repair, particularly in the non-elderly population. Current clinical practice remains suboptimal for many patients, and this review explores the need for a ‘best practice revolution’ in the field of degenerative mitral valve regurgitation.
            Article 0 comments Cited 58 times – based on 0 reviews     Review now
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              A near 100% repair rate for mitral valve prolapse is achievable in a reference center: implications for future guidelines.

              Javier Castillo, Anelechi Anyanwu, Valentin Fuster … (2012)
              Although mitral valve repair is the recommended treatment for severe mitral regurgitation of degenerative etiology, valve replacement remains common, particularly for complex lesions or anterior leaflet involvement. We sought to characterize the feasibility and outcomes of an "all comers" repair strategy applied systematically in all cases of degenerative mitral valve disease, regardless of age, complexity, or leaflet involvement. From January 2002 to December 2010, 744 consecutive patients (mean age, 58±13 years [range, 12-90]; mean LVEF, 55%±9%) with degenerative mitral valve regurgitation and prolapse (anterior leaflet: n=42, 6%; posterior leaflet: n=556, 75%; bileaflet: n=146, 19%) underwent mitral valve surgery. Annular, leaflet or chordal calcification was present in 27% of cases. All patients underwent mitral valve repair and received a concomitant annuloplasty with a median ring size of 32 mm (interquartile range, 30-36). There was 1 early valve replacement (99.9% repair rate) due to atrioventricular groove bleeding and 5 late re-repairs (0.7%) due to disease progression or infective endocarditis. In-hospital mortality and major stroke rates were 0.8% and 0.5%, respectively. Survival rates at 1 and 5 years were 99.2%±0.3% and 97.4%±0.8%, respectively. Seven-year freedom from reoperation was 97.1%±0.6%. The estimate of patients with <3+ mitral regurgitation at 4 and 7 years was 98% and 96%, respectively, and 95% and 91%, respectively, for <2+ mitral regurgitation. A systematic strategy of mitral valve repair that uses a variety of techniques allows repair of all degenerative valves in a reference center, with good short-term outcomes and mid-term durability. Further study is required to document the long-term efficacy of an "all comers" mitral valve repair strategy in degenerative subgroups with very complex valve morphology. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Echo Res Pract
                Journal ID (iso-abbrev): Echo Res Pract
                Journal ID (pmc): echo
                Journal ID (publisher-id): Echo Res Pract
                Title: Echo Research and Practice
                Publisher: Bioscientifica Ltd (Bristol )
                ISSN (Electronic): 2055-0464
                Publication date (Electronic): 7 July 2015
                Publication date (Print): 1 September 2015
                Volume: 2
                Issue: 3
                Pages: R63-R72
                Affiliations
                [1]King's Health Partners, King's College Hospital NHS Foundation Trust , London, UK
                Author notes
                Correspondence should be addressed to M Garbi Email: madalina.garbi@ 123456nhs.net
                Article
                Publisher ID: ERP150008
                DOI: 10.1530/ERP-15-0008
                PMC ID: 4676476
                PubMed ID: 26693344
                SO-VID: 78f1b5d9-fea2-47d3-a373-343c4919c137
                Copyright © © 2015 The authors
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                Date received : 18 June 2015
                Date accepted : 7 July 2015
                Categories
                Subject: Review

                Keywords: mitral valve,quantification,morphology,echocardiography,3d,repair
                Data availability:
                Keywords: mitral valve, quantification, morphology, echocardiography, 3d, repair

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