MyMedR

Segasothy M

Med J Malaysia, 1982 Sep;37(3):221-2.

Left atrial myxoma almost always arises in the inter-atrial septum. A case is described where it arose from the posterior wall of the left atrium. Clinical presentation was suggestive of mitral stenosis and sub-acute bacterial endocarditis and diagnosis was arrived at necropsy.

Matched MeSH terms: Mitral Valve Stenosis/diagnosis

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

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*

An accessory mitral valve leaflet causing left ventricular outflow tract obstruction and associated with severe aortic incompetence

Tamin SS, Dillon J, Aizan K, Kadiman S, Latiff HA

Echocardiography, 2012 Feb;29(2):E34-8.

PMID: 22044509 DOI: 10.1111/j.1540-8175.2011.01543.x

This case report describes a 20-year-old woman with Turner's syndrome who presented with reduced effort tolerance limited by dyspnea. She had previously been on pediatric cardiology follow-up for congenital subvalvular aortic stenosis first diagnosed at age 7. Unfortunately she defaulted after two visits before any intervention could be done. Transthoracic echocardiography demonstrated severe aortic incompetence (AI) with a membrane-like structure in the left ventricular outflow tract (LVOT). The mean pressure gradient across the LVOT on continuous wave Doppler was 41 mmHg. The membranous interventricular septum appeared aneurysmal and it was observed that the "subaortic membrane" had a connection to the anterolateral papillary muscle via a strand of chordal tissue. Further images were captured using two-dimensional and three-dimensional transthoracic and transesophageal echocardiography (iE33, Philips Medical Systems, Andover, MA, USA). After a review of the literature it was concluded that this appeared to be an accessory mitral valve (AMV) leaflet causing LVOT obstruction associated with AI. AMV tissue is a rare congenital malformation causing LVOT obstruction. Because it is so unusual, it may not be immediately recognizable even in a high volume echocardiography laboratory. The clue which helped with the diagnosis was the strand of chordal tissue which connected the mass to the papillary muscle. This anomaly is often associated with LVOT obstruction.

Matched MeSH terms: Mitral Valve/abnormalities*; Mitral Valve/surgery; Mitral Valve/ultrasonography

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

Fulltext Barlow's Repair: Light in the Dark Tunnel: A Case Report Could Omit 'Light in A Dark Tunnel'

Mohd Alkaf AL, Simon V, Taweesak C, Abdul Rahman I

Med J Malaysia, 2015 Apr;70(2):106-7.

PMID: 26162389

Barlow's disease has a complex pathology requiring reconstructive surgery. Despite the complicated surgery it holds a positive outcome. We report a successful case of Barlow's disease who underwent mitral valve reconstructive surgery at our centre. Post-operative echocardiography shows a well-functioning repaired mitral valve without significant mitral regurgitation.

Matched MeSH terms: Mitral Valve; Mitral Valve Insufficiency

Fulltext Beneficial effects of ACE inhibitors in severe mitral stenosis

Sebastian VJ, Bhattacharya S, Ray S, Jaafar SM

Med J Malaysia, 1989 Dec;44(4):291-5.

PMID: 2562442

There are several reports of beneficial effects of ACE inhibitors in both primary and secondary pulmonary hypertension. However the effect of ACE inhibitors in mitral stenosis is not documented. The authors report three patients with severe mitral stenosis in whom surgery was delayed. They had initial symptomatic improvement with diuretics and sodium restriction, but had recurrence of their symptoms while on treatment. Enalapril not only relieved their symptoms in particular exertional dyspnoea and haemoptysis but prevented recurrence and improved their effort tolerance without causing excessive fall of blood pressure or impairment of renal function.

Matched MeSH terms: Mitral Valve Stenosis/drug therapy*

Fulltext Biatrial thrombi resembling myxoma regressed after prolonged anticoagulation in a patient with mitral stenosis: a case report

Lu HT, Nordin R, Othman N, Choy CN, Kam JY, Leo BC, et al.

J Med Case Rep, 2016 Aug 10;10(1):221.

PMID: 27510438 DOI: 10.1186/s13256-016-1018-0

BACKGROUND: Many cases of cardiac masses have been reported in the literature, but in this case report we described a rare case of biatrial cardiac mass that represented a challenge for diagnosis and therapy. The differentiation between cardiac masses such as thrombi, vegetations, myxomas and other tumors is not always straightforward and an exact diagnosis is important because of its distinct treatment strategy. Transthoracic/esophageal echocardiography and cardiac magnetic resonance play an important role in establishing the diagnosis of cardiac masses. However, no current noninvasive diagnostic tool has the ability to absolutely diagnose cardiac masses; obtaining a pathological specimen by surgical resection of cardiac masses is the only reliable method to diagnose cardiac masses accurately. Our case report is an exception in that the final diagnosis was affirmed by empirical anticoagulation therapy based on clinical judgment and noninvasive characterization of biatrial mass.

CASE PRESENTATION: We described a 54-year-old Malay man with severe mitral stenosis and atrial fibrillation who presented with a biatrial mass. Transthoracic/esophageal echocardiography and cardiac magnetic resonance detected a large, homogeneous right atrial mass typical of a thrombus, and a left atrial mass adhering to interatrial septum that mimicked atrial myxoma. The risk factors, morphology, location, and characteristics of the biatrial cardiac mass indicated a diagnosis of thrombi. However, our patient declined surgery. As a result, the nature of his cardiac masses was not specified by histology. Of note, his left atrial mass was completely regressed by long-term warfarin, leaving a residual right atrial mass. Thus, we affirmed the most probable diagnosis of cardiac thrombi. During the course of treatment, he had an episode of non-fatal ischemic stroke most probably because of a thromboembolism.

CONCLUSIONS: Noninvasive characterization of cardiac mass is essential in clarifying the diagnosis and directing treatment strategy. Anticoagulation is a feasible treatment when the clinical assessment, risk factors, and imaging findings indicate a diagnosis of thrombi. After prolonged anticoagulation therapy, complete resolution of biatrial thrombi was achievable in our case.

Matched MeSH terms: Mitral Valve Stenosis/complications; Mitral Valve Stenosis/drug therapy*; Mitral Valve Stenosis/physiopathology

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 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

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

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*

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*

Complete heart block in young adult with acute rheumatic fever

Nor Hidayah ZA, Azerin O, Mohd Nazri A

Med J Malaysia, 2018 10;73(5):323-325.

PMID: 30350813 MyJurnal

Acute Rheumatic fever (ARF) is commonly associated with ECG abnormalities particularly atrioventricular block. However, third degree atrioventricular block or complete heart block is a rare manifestation. Most cases occurred in children. We reported a 25 year old man who developed complete heart block during an acute episode of ARF. He presented to hospital with five days history of fever, malaise and migrating arthralgia, followed by pleuritic chest pain. One day after admission his electrocardiogram (ECG) revealed complete heart block. Transthoracic echocardiography showed good left ventricular function with thickened, mild mitral regurgitation with minimal pericardial effusion. ASOT titer was positive with elevated white blood count and acute phase reactant. A temporary pacemaker was inserted in view of symptomatic bradycardia. The complete heart block resolved after medical therapy. He was successfully treated with penicillin, steroid and aspirin. He was discharged well with oral penicillin. The rarity of this presentation is highlighted.

Matched MeSH terms: Mitral Valve Insufficiency

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

Congenital limb reduction defects: report of two cases

Malik AS, Ram SP, Seng QB, Noor AR

Ann Acad Med Singap, 1994 Nov;23(6):914-6.

PMID: 7741513

We describe two Malay male term neonates with congenital limb reduction defects. The first neonate had hypodactyly of limbs associated with micrognathia, microstomia, glossopalatine ankylosis and congenital mitral stenosis. He developed gram-negative septicaemia and died on day 14 of life. The second neonate had tetraperomelia without any other associated congenital abnormality. He developed staphylococcal skin infection which was treated conservatively. Very few cases of congenital limb reduction defects have been reported in the Asian population and we are not aware of any other reports describing Malay infants with the congenital abnormalities described in this report.

Matched MeSH terms: Mitral Valve Stenosis/congenital

Fulltext Coughing Shih Tzu dog due to myxomatous mitral valve disease stage C2

Khor, K.H., Jessie-Bay, J.X.

Jurnal Veterinar Malaysia, 2018;30(1):15-19.

MyJurnal

Myxomatous Mitral Valve Disease is a degenerative condition of the mitral valves leaflets. A 10-year-old
male castrated Shih Tzu was presented with primary complaint of coughing. Clinical examination revealed normal
heart rate, respiratory rate and rectal temperature. Systolic murmur Grade IV/VI was heard at the left heart apex.
Thoracic radiographic findings were cardiomegaly with the vertebral heart score of 11.0 and had evidence of
cardiogenic pulmonary edema. Echocardiographic examination revealed thickening mitral valves with evidence of
moderate regurgitation observed. Based on the findings obtained, the dog was diagnosed with Myxomatous Mitral
Valve disease stage C2. Dog was treated with benazepril (0.5mg/kg), pimobendan (0.2mg/kg) with a combination of
furosemide (2mg/kg). Frusemide was gradually removed from the treatment regime as coughing improved over time.
The dog was no longer lethargy and even gained weight.

Matched MeSH terms: Mitral Valve

Dizzy spells in pregnancy: successful antenatal removal of a huge left atrial myxoma with mitral valve obstruction

Shahbuddin HMA, Hussin SA, W Isa WYH, Mamat AZ, Marzuki A, Yusof Z

BMJ Case Rep, 2024 Mar 07;17(3).

PMID: 38453227 DOI: 10.1136/bcr-2024-259675

Diagnosing atrial myxoma in pregnancy is challenging because patients may present with non-specific symptoms that might be overlooked. The timing of non-obstetric operation usually depends on the nature of the disease, after careful consideration of feto-maternal safety, including the use of cardiopulmonary bypass and placental transfer of anaesthetic drug. A woman in her 30s at 18 weeks of pregnancy presented with recurring dizziness. She underwent successful myxoma excision at 20 weeks under general anaesthesia and cardiopulmonary bypass. The 6×5 cm myxoma was histologically confirmed as myxoma. Early detection of atrial myxoma in pregnancy is crucial, and a clinician has to consider the diagnosis of left atrial myxoma with mitral valve obstruction as a cause of severe dizziness. Optimal outcomes require multidisciplinary management. In this case, surgery during the second trimester of pregnancy enabled a full-term pregnancy with the patient's and foetal well-being and normal postprocedural echocardiography.

Matched MeSH terms: Mitral Valve/surgery

Doppler-echocardiographic assessment of Carbomedics prosthetic values in the mitral position

Soo CS, Ca M, Tay M, Yeoh JK, Sim E, Choo M

J Am Soc Echocardiogr, 1994 3 1;7(2):159-64.

PMID: 8185960

We prospectively studied 37 consecutive patients implanted with the Carbomedics prosthetic heart value in the mitral position (without clinical evidence of prosthetic valve dysfunction) with two-dimensional and Doppler echocardiography. The peak mitral prosthetic gradient ranged from 4.60 to 14.63 (mean 8.97 +/- 2.29) mm Hg; mean mitral prosthetic gradient ranged from 1.67 to 6.18 (mean 3.24 +/- 0.95) mm Hg; pressure half-time derived mitral valve area ranged from 1.67 to 5.30 (mean 2.70 +/- 0.80) cm2. These values compare favorably with that of another bileaflet valve (i.e., the St. Jude Medical valve). There was a wide overlap in peak and mean transmitral gradients, even with the valves of the same size, with a significant but weak inverse relationship between peak mitral gradients and valve size (p = 0.03, r = -0.36). The performance index showed a smaller range of values, again with a significant but weak inverse relationship with valve size (p = 0.001, r = -0.54). The inverse relationship between valve size and peak mitral gradient and performance index should be borne in mind when analyzing Doppler hemodynamic data.

Matched MeSH terms: Mitral Valve

Double orifice mitral valve: a case report and review of management

Majid AA

J Cardiovasc Surg (Torino), 1991 Nov-Dec;32(6):837-9.

PMID: 1836465

This paper reports a case of double orifice mitral valve which was treated conservatively. A new scheme of classification of this entity linked to the accepted lines of surgical treatment is introduced.

Matched MeSH terms: Mitral Valve/abnormalities*

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