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Balloon dilatation of congenital mitral stenosis in a critically ill infant

Abdul Aziz B, Alwi M

Catheter Cardiovasc Interv, 1999 Oct;48(2):191-3.
PMID: 10506777

We report a case of a 14-month-old-infant with severe congenital mitral stenosis who presented with pulmonary oedema, acute renal failure and haemodynamic instability. Balloon dilatation was successfully performed under fluoroscopic and transesophageal echocardiographic guidance. Cathet. Cardiovasc. Intervent. 48:191-193, 1999.

Matched MeSH terms: Mitral Valve Stenosis/congenital*; Mitral Valve Stenosis/diagnosis; Mitral Valve Stenosis/therapy
Pulmonary edema of an unexpected cause

Abdullah HN, Khairina WW

South. Med. J., 2008 Oct;101(10):1035-7.
PMID: 18791521 DOI: 10.1097/SMJ.0b013e31817fbeb8

Atrial myxoma is rarely seen in practice. We report a 67-year-old female who presented with acute cardiac insufficiency and pulmonary edema. Cardiac murmur was not detected on precordial examination. Urgent echocardiography, however, revealed atrial myxoma causing mitral valve obstruction. We point out that a normal cardiac examination does not exclude atrial myxoma. The diagnosis may be delayed until significant myocardial dysfunction occurs, as reported here. The clinical presentation of cardiac myxoma is discussed, along with appropriate investigations and treatment.

Matched MeSH terms: Mitral Valve Stenosis/complications; Mitral Valve Stenosis/etiology; Mitral Valve Stenosis/ultrasonography
Biomechanical assessment of surgical repair of the mitral valve

Al-Atabi M, Espino DM, Hukins DW, Buchan KG

Proc Inst Mech Eng H, 2012 Apr;226(4):275-87.
PMID: 22611868

Repair of the mitral valve is defined (loosely) as a procedure that alters the valve structure, without replacement, enabling the natural valve itself to continue to perform under the physical conditions to which it is exposed. As the mitral valve is driven by flow and pressure, it should be feasible to analyse and assess its function, failure and repair as a mechanical system. This article reviews the current state of mechanical evaluation of surgical repairs of the failed mitral valve of the heart. This review describes the anatomy and physiology of the mitral valve, followed by the failure of the mitral valve from a mechanical point of view. The surgical methods used to repair failed valves are introduced, while the use of engineering analysis to aid understanding of mitral valve repair is also reviewed. Finally, a section on recommendations for development and future uses of engineering techniques to surgical repair are presented.

Matched MeSH terms: Mitral Valve/physiopathology*; Mitral Valve/surgery*; Mitral Valve Insufficiency/physiopathology*; Mitral Valve Insufficiency/surgery*; Mitral Valve Annuloplasty/instrumentation*; Mitral Valve Annuloplasty/methods
Fulltext Cardiac surgery in General Hospital, Kuala Lumpur: review of all open-heart operations. April 1982 to February 1987

Awang Y, Haron A, Sallehuddin A

Med J Malaysia, 1987 Jun;42(2):81-5.
PMID: 3503194

The Cardiothoracic Department, General Hospital, Kuala Lumpur which was set up in April 1982, deals with a wide range of cardiac disease, general thoracic and also vascular cases. A total of 2,450 operations were performed from April 1982 to February 1987, and 79.3% of these were for cardiac cases (open and closed heart). This paper reports a review of the 1,110 consecutive open heart operations performed by the Department during the stated period.

Matched MeSH terms: Mitral Valve Stenosis/surgery
Effect of spatial inlet velocity profiles on the vortex formation pattern in a dilated left ventricle

Chan BT, Lim E, Ong CW, Abu Osman NA

Comput Methods Biomech Biomed Engin, 2015;18(1):90-6.
PMID: 23521137 DOI: 10.1080/10255842.2013.779683

Despite the advancement of cardiac imaging technologies, these have traditionally been limited to global geometrical measurements. Computational fluid dynamics (CFD) has emerged as a reliable tool that provides flow ﬁeld information and other variables essential for the assessment of the cardiac function. Extensive studies have shown that vortex formation and propagation during the filling phase acts as a promising indicator for the diagnosis of the cardiac health condition. Proper setting of the boundary conditions is crucial in a CFD study as they are important determinants, that affect the simulation results. In this article, the effect of different transmitral velocity profiles (parabolic and uniform profile) on the vortex formation patterns during diastole was studied in a ventricle with dilated cardiomyopathy (DCM). The resulting vortex evolution pattern using the uniform inlet velocity profile agreed with that reported in the literature, which revealed an increase in thrombus risk in a ventricle with DCM. However the application of a parabolic velocity profile at the inlet yields a deviated vortical flow pattern and overestimates the propagation velocity of the vortex ring towards the apex of the ventricle. This study highlighted that uniform inlet velocity profile should be applied in the study of the filling dynamics in a left ventricle because it produces results closer to that observed experimentally.

Matched MeSH terms: Mitral Valve/physiopathology
Left ventricular flow propagation velocity measurement: Is it cast in stone?

Chan BT, Yeoh HK, Liew YM, Aziz YFA, Sridhar GS, Hamilton-Craig C, et al.

Med Biol Eng Comput, 2017 Oct;55(10):1883-1893.
PMID: 28321684 DOI: 10.1007/s11517-017-1639-5

This study aims to investigate the measurement of left ventricular flow propagation velocity, V p, using phase contrast magnetic resonance imaging and to assess the discrepancies resulting from inflow jet direction and individual left ventricular size. Three V p measuring techniques, namely non-adaptive (NA), adaptive positions (AP) and adaptive vectors (AV) method, were suggested and compared. We performed the comparison on nine healthy volunteers and nine post-infarct patients at four measurement positions, respectively, at one-third, one-half, two-thirds and the conventional 4 cm distances from the mitral valve leaflet into the left ventricle. We found that the V p measurement was affected by both the inflow jet direction and measurement positions. Both NA and AP methods overestimated V p, especially in dilated left ventricles, while the AV method showed the strongest correlation with the isovolumic relaxation myocardial strain rate (r = 0.53, p

Matched MeSH terms: Mitral Valve/physiology
Fulltext Invasive pyogenic infection and infective endocarditis due to Streptococcus anginosus: A case report

Cheng CW, Feng CM, Chua CS

Medicine (Baltimore), 2019 Nov;98(48):e18156.
PMID: 31770258 DOI: 10.1097/MD.0000000000018156

RATIONALE: Streptococcus anginosus mostly colonizes the digestive and genitourinary system, including the oropharyngeal region. It commonly causes invasive pyogenic infection, but less likely causes infective endocarditis (IE).
PATIENT CONCERNS: An 18-year-old woman who had an underlying mitral valve prolapse without mitral regurgitation presented to our hospital with low-grade fever, left leg weakness, and left abdominal pain. She was diagnosed with brain infarction and microabscess as well as IE. The patient totally recovered after the 6-week course of intravenous antibiotics.
DIAGNOSIS: Brain magnetic resonance imaging revealed brain infarction and microabscess. Abdominal computed tomography revealed splenic and left renal infarction. Three sets of blood culture were positive for S anginosus. Transthoracic echocardiogram identified mitral valve prolapse with moderate eccentric mitral valve regurgitation, and a 0.3 × 0.6-cm vegetation was found on the left mitral valve. All of these results meet the modified Duke criteria.
INTERVENTIONS: The abdominal pain and left leg weakness were improving after 2 weeks of intravenous antibiotics treatment. No neurological sequelae were noted after completing the 6-week course of medical treatment.
OUTCOMES: The patient was successfully treated and discharged after completing the 6-week intravenous antibiotics treatment.
LESSONS: IE should be considered in young patients with native valve disease who have prolonged fever. Though S anginosus commonly causes invasive pyogenic infection, patients with native valve disease should be checked for IE.

Matched MeSH terms: Mitral Valve Insufficiency/diagnosis; Mitral Valve Insufficiency/etiology
Immigrant Health Study. 2. Clinical findings in migrant workers - a pilot study. [Abstract]

Chia YC, McCarthy S

JUMMEC, 1998;3:60-61.

This section only examines the clinical findings and some blood chemistly in these workers. A total of 222 men and 28 women were studied. Their ages ranged from 12 to 57 years, the mean being 30.1 (±7.4). Generally most of the physical examination was normal and no external features of infectious diseases were seen. The mean systolic and diastolic blood pressure was 120 (±13) and 76(±8.7) nun Hg respectively. About 8.4% of the population had elevated blood pressure of 140/90 mmHg or greater. About 12.4% of these man and women were underweight (Body mass index (EMI) less than 19 kg/m2) while 11.2% were either overweight or obese (BMI>25) with the mean being 21.8 (±2.7). Only 3 had BMI greater than 30. Three subjects had a lnitral regurgitation murmur thought to be due to mitral valve prolapse. Four others had tinea cruris, six had insignificant axillary lymph-nodes, five had cervical lymph-nodes of which one was due to carcinoma of the tonsil 30 with shotty inguinal lymph-nodes which was thought to of no pathological significance. Four subjects had crepitations and five had rhonchi in their lungs. A full blood count revealed that 16.65% of the man and 32.1°/o of the women had haemoglobin levels of less than 14gm/dl and 12gm/dl respectively. The most striking abnormality was the high prevalence of eosinophilia. 37% of the subjects had eosinophilia counts of greater than 450/dl. About 19.4% of this study population had fasting blood glucose of greater than 6mmol/l but only 1.3% with fasting blood glucose of greater than 7.8 mmo/l. About 22% of the urine examined revealed pro- teinuria but were otherwise unremarkable for the other parameters. This group of foreign workers was made up of a presumably fairly healthy young population. Attempts to look for infectious disease on physical examination, not surprisingly did not reveal any remarkable findings. It could be that the majority of these subjects already had a examination prior to coming into the country and another one soon after arrival. However an indirect measurement of infectious diseases via the eosinophilic count revealed a high prevalence of parasitic infestations. Attempts to examine the end results of social hardship, be it intrinsic before or appearing after arrival indirectly shoved some degree of suffering. There was a fairly high prevalence of anaemia, especially amongst the women. The body mass index also revealed this population to be generally less obese than other populations. The value of medical check-ups has been debated, especially if it were done as a pre-employment procedure. This pilot study has shown that it is not cost-effective to do physical examination or blood chem- istry and urine analysis in hying to identify infectious diseases in the migrant workers. In the light of the paucity of clinical findings in this pilot study, it would be prudent to review the strategy for examining the health status of migrant workers. Perhaps the physical examination can be dispensed with, and blood andurine analysis beveryfocused and directedin order to maximise the cost- effectiveness of this programme. Certainly the high prevalence of eosinophilia needs further evalua- tion.

Matched MeSH terms: Mitral Valve
Fulltext A forgotten clinical sign making a comeback

Chiam KH, A Hing CT, Low LL

Med J Malaysia, 2014 Feb;69(1):40-1.
PMID: 24814630 MyJurnal

We report a case of Staphylococcus aureus infective endocarditis in a patient presenting with fever and rare cutaneous manifestations of Osler Nodes and Janeway Lesions. There had not been any distinct risk factors. His echocardiography subsequently revealed vegetation at the anterior mitral valve leaflet. As Staphylococcus aureus infective endocarditis is of utmost significance in morbidity and mortality, a sharp clinical acumen and follow up investigations is required alongside a prolonged course of antibiotics. Our patient was then started on intravenous cloxacillin for 28 days and gentamicin for 5 days to which he made good progress and recovery.

Matched MeSH terms: Mitral Valve
Fulltext Cardiac imaging in valvular heart disease

Choo WS, Steeds RP

Br J Radiol, 2011 Dec;84 Spec No 3:S245-57.
PMID: 22723532 DOI: 10.1259/bjr/54030257

The aim of this article is to provide a perspective on the relative importance and contribution of different imaging modalities in patients with valvular heart disease. Valvular heart disease is increasing in prevalence across Europe, at a time when the clinical ability of physicians to diagnose and assess severity is declining. Increasing reliance is placed on echocardiography, which is the mainstay of cardiac imaging in valvular heart disease. This article outlines the techniques used in this context and their limitations, identifying areas in which dynamic imaging with cardiovascular magnetic resonance and multislice CT are expanding.

Matched MeSH terms: Mitral Valve Insufficiency/diagnosis; Mitral Valve Stenosis/diagnosis
Congenital cyanotic heart disease with situs inversus totalis: an autopsy case report

Dayapala A, Kumar V

Am J Forensic Med Pathol, 2009 Jun;30(2):171-4.
PMID: 19465810 DOI: 10.1097/PAF.0b013e3181875a79

Sudden deaths because of congenital heart diseases are infrequently referred to the forensic pathologist for autopsy. Many of such deaths, if already diagnosed are released directly from the hospital without autopsy. Even forensic pathologists face a few difficulties in performing the autopsy on such infrequent cases, as they are not always updated with the anatomy of anomalies. While dealing with such cases, the concerned forensic pathologist is compelled to refer literature and textbooks again to understand the nature of developmental defects. This is especially so when dealing with cases of situs inversus accompanied by transposition of great arteries and other congenital cardiac abnormalities and variants such as single ventricle, double outlet right ventricle, Taussig-Bing variety etc. In the present case also, situs inversus with transposition of great vessels and other anomalies have been noted and studied.

Matched MeSH terms: Mitral Valve Stenosis/pathology
Comparative long-term results of mitral valve repair in adults with chronic rheumatic disease and degenerative disease: is repair for "burnt-out" rheumatic disease still inferior to repair for degenerative disease in the current era?

Dillon J, Yakub MA, Kong PK, Ramli MF, Jaffar N, Gaffar IF

J. Thorac. Cardiovasc. Surg., 2015 Mar;149(3):771-7; discussion 777-9.
PMID: 25308120 DOI: 10.1016/j.jtcvs.2014.08.066

Mitral valve repair is perceived to be of limited durability for advanced rheumatic disease in adults. We aim to examine the long-term outcomes of repair for rheumatic disease, identify predictors of durability, and compare with repair for degenerative disease.

Matched MeSH terms: Mitral Valve/physiopathology; Mitral Valve/surgery*; Mitral Valve/ultrasonography; Mitral Valve Insufficiency/diagnosis; Mitral Valve Insufficiency/mortality; Mitral Valve Insufficiency/physiopathology; Mitral Valve Insufficiency/surgery*
Leaflet extension in rheumatic mitral valve reconstruction

Dillon J, Yakub MA, Nordin MN, Pau KK, Krishna Moorthy PS

Eur J Cardiothorac Surg, 2013 Oct;44(4):682-9.
PMID: 23407161 DOI: 10.1093/ejcts/ezt035

Type IIIa mitral regurgitation (MR) due to rheumatic leaflet restriction often renders valve repair challenging and may predict a less successful repair. However, the utilization of leaflet mobilization and extension with the pericardium to increase the surface of coaptation may achieve satisfactory results. We reviewed our experience with leaflet extension in rheumatic mitral repair with emphasis on the technique and mid-term results.

Matched MeSH terms: Mitral Valve/surgery*; Mitral Valve Insufficiency/surgery*
A stitch too far: The circumflex artery in jeopardy during mitral valve repair

Dillon J

J. Thorac. Cardiovasc. Surg., 2017 11;154(5):1621-1623.
PMID: 29042042 DOI: 10.1016/j.jtcvs.2017.06.056
Matched MeSH terms: Mitral Valve; Mitral Valve Insufficiency*
Hypertrophic obstructive cardiomyopathy: the mitral valve could be the key

Dulguerov F, Marcacci C, Alexandrescu C, Chan KM, Dreyfus GD

Eur J Cardiothorac Surg, 2016 Jul;50(1):61-5.
PMID: 26792931 DOI: 10.1093/ejcts/ezv473

OBJECTIVES: As we strongly believe that treating the mitral valve abnormalities is a key feature of hypertrophic obstructive cardiomyopathy (HOCM), we have systematically corrected both the anterior and posterior leaflet (PL) size and geometry. We have analysed our immediate results and at mid-term follow-up.
METHODS: From March 2010 until June 2015, 16 patients with HOCM underwent surgical correction of obstruction. The mean age was 51 years old (range, 32-72 years). All were symptomatic being New York Heart Association (NYHA) class 3 (n = 4) or 4 (n = 12). All had systolic anterior motion at echocardiogram with severe mitral regurgitation (MR). Intraventricular gradient preoperatively was 73.5 mmHg (range, 50-120 mmHg). All patients underwent a double-stage procedure: first septal resection through (i) the aortic valve and (ii) the detached anterior leaflet (AL) of the mitral valve and at second, mitral valve repair by (i) reducing PL height (leaflet resection or artificial neochordae) (ii) increasing AL height with pericardial patch.
RESULTS: There was no in-hospital or late death. All patients were Class 1 NYHA at latest follow-up. Control echocardiography showed no MR, mean rest intraventricular gradient was 15 mmHg (range, 9-18 mmHg).
CONCLUSIONS: Our good mid-term results support the concept that HOCM is not only a septal disease and that the mitral valve pathology is a key component that should be addressed. For most patients, the ideal surgical treatment should consist in a two-step procedure. It is even necessary to be studied whether treating the mitral valve alone could not suffice.

Matched MeSH terms: Mitral Valve Insufficiency/complications*; Mitral Valve Insufficiency/diagnosis; Mitral Valve Insufficiency/surgery
Fulltext The trans-septal approach to the mitral valve

Eng JB

Med J Malaysia, 2001 Jun;56(2):236-9.
PMID: 11771086

To assess the efficacy of the trans-septal approach to the mitral valve, 40 patients who underwent mitral valve surgery via this approach were compared to 37 patients who underwent surgery via the standard left atriotomy. Concomitant procedures included tricuspid annuloplasty, aortic valve replacement, closure of atrial septal defect, coronary artery bypass grafting and aortic valve repair. There was one (1.2%) operative mortality. No patients required pacemaker implantation. Follow-up of up to 18 months showed that all patients were in NYHA classes I and II. One third of the patients who had trans-septal approach to the mitral valve achieved conversion from atrial fibrillation to sinus rhythm while none of the patients who underwent conventional left atriotomy had conversion (p < 0.02). The trans-septal approach to the mitral valve is a useful approach in selective patients requiring mitral valve surgery.
Comment in: Lim KG. The trans-septal approach to the mitral valve. Med J Malaysia. 2001 Dec;56(4):513

Matched MeSH terms: Mitral Valve/surgery*
Closed mitral valvotomy in pregnancy--a Malaysian experience

Goon MS, Raman S, Sinnathuray TA

Aust N Z J Obstet Gynaecol, 1987 Aug;27(3):173-7.
PMID: 3435354

Our experience from 1968 to 1985 in 12 women requiring closed mitral valvotomy during pregnancy is reviewed. All patients had severe mitral stenosis and were in functional class 3 (2 patients) or class 4 (10 patients). Mitral valvotomy was performed between the 18th and the 30th week of pregnancy using a transventricular dilator. Improvement in functional class was noted in all patients postoperatively. One patient had postvalvotomy mitral regurgitation and heart failure, which responded to diuretics; the subsequent course was uneventful. Eleven patients had normal deliveries; whilst one patient had a Caesarean section for an obstetric indication. All babies were normal and there was no maternal death. This series confirms that closed mitral valvotomy can be performed with an acceptable degree of safety during pregnancy, when indicated.

Matched MeSH terms: Mitral Valve Stenosis/surgery*
Tricuspid valve papillary fibroelastoma: a rare tumor with a diagnostic dilemma

Haron H, Yusof MR, Maskon O, Ooi J, Rahman MR

Heart Surg Forum, 2012 Feb;15(1):E59-60.
PMID: 22360910 DOI: 10.1532/HSF98.20111000

Papillary fibroelastoma is a rare primary tumor of the heart valves. This lesion can occur on any of the valves or endothelial surface of the heart and has been detected by echocardiography, by cardiac catheterization, during open heart operations for other conditions, and at autopsy. Because of the potential for comorbidities, this tumor should be removed. We present the case of an elderly man with a diagnosis of severe mitral valve regurgitation and moderate tricuspid valve regurgitation who was suspected to have a tricuspid valve vegetation. Mitral valve replacement, tricuspid valve repair, and excision of the lesion were performed successfully. A histologic examination of the vegetation confirmed it to be a papillary fibroelastoma. We present this case to emphasize the rarity of this tumor and the importance of a correct diagnosis to avoid delaying its prompt and definitive management.

Matched MeSH terms: Mitral Valve Insufficiency/pathology; Mitral Valve Insufficiency/surgery; Mitral Valve Insufficiency/ultrasonography
Fulltext Dynamic cervical lung lobe herniation in a shih tzu dog

Joanne, T.S.Y., Lim, M.L., Asnawi, O., Shamsul, M.A.H., Khor, K.H.

Jurnal Veterinar Malaysia, 2019;31(1):38-42.
MyJurnal

An 8-year-old spayed female Shih Tzu was referred to University Veterinary Hospital (UVH) with history of chronic coughing for more than a year duration. Dry, hacking cough was heard and bilateral wheezing lung sound was noted upon physical examination. Auscultation of heart revealed left apical systolic heart murmur Grade III/VI. A soft, intermittent swelling was observed at ventral neck, cranial to thoracic inlet (protruded upon expiration and collapsed upon inspiration). Thoracic radiography taken showed presence of apical radiolucency at cervical region and bronchial pattern at caudodorsal lungs with left atrium enlargement and right-sided heart enlargement. Echocardiographic examination revealed myxomatous mitral valve disease (MMVD) with mild regurgitation. Based on diagnostic imaging, this case was diagnosed as dynamic lung lobe herniation secondary to chronic coughing concurrent with myxomatous mitral valve disease. Other differential diagnosis that may lead to chronic cough such as of tracheal collapsed and bronchiectasis was not rule out.

Matched MeSH terms: Mitral Valve
Fulltext Rare cause of cardioembolic stroke and central retinal artery occlusion

Johari MI, Ismail MN, Mohamad F, Yusof MA

BMJ Case Rep, 2021 Jan 18;14(1).
PMID: 33461997 DOI: 10.1136/bcr-2020-236420

Primary cardiac valve tumours are rare. This is a case report of a 32-year-old non-smoker man with a history of stroke 1 year prior and no other cardiovascular risk factors. The patient was admitted to our acute stroke ward for recurrent left hemiparesis, slurring of speech, facial asymmetry and central retinal artery occlusion. Initial laboratory investigations and ECG were normal. An urgent CT brain showed a large hypodense area at the right frontal, parietal, temporal, occipital region with effaced sulci and right lateral ventricle with midline shift and cerebral oedema in keeping with acute infarction. We proceeded with CT angiography of the cerebral and carotid on the following day, which revealed no evidence of thrombosis, aneurysm or arteriovenous malformation. There were no abnormal beaded vessels to suggest vasculitis. Transthoracic echocardiography revealed a large mobile mass in the left atrium. Meanwhile, MRI cardiac confirmed a large ill-defined mobile solid mass attached to the mitral valve's inferoseptal component suggestive of mitral valve myxoma. This case report highlights the significance of considering a cardiogenic source of emboli in patients with large cerebral infarcts and other cardiac embolic phenomena. Imaging modalities such as echocardiography and cardiac MRI will help detect treatable conditions, such as valvular myxoma and prevent further complications.

Matched MeSH terms: Mitral Valve/pathology

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