Acute Severe Functional Mitral Regurgitation After Non-Mitral Valve Cardiac Surgery-Left Ventricular Dyssynchrony as a Potential Mechanism

In vivo mitral valve repair for the transplanted donor heart in orthotopic heart transplantation

A 53-year-old woman with the dilated phase of hypertrophic cardiomyopathy underwent orthotopic heart transplantation. The donor heart was evaluated as normal preoperatively without mitral regurgitation or the left atrium dilation, transplanted using the modified bicaval technique. Although the heart beat satisfactorily after aortic declamping, massive mitral regurgitation was observed without any prolapse or annular dilation. Because of the difficulty in weaning from cardiopulmonary bypass, a second aortic cross-clamp was applied, and we detached the inferior vena cava and the right side of the left atrial anastomosis to approach the mitral valve, obtaining a satisfactory exposure. No abnormalities were observed in the mitral valve leaflets, annulus or subvalvular apparatus. Subsequent in vivo mitral annuloplasty using prosthetic full ring successfully controlled the regurgitation, and the patient was easily weaned from cardiopulmonary bypass. She discharged to home with good mitral valve and cardiac functions. And the patient has been doing well without any recurrence of MR or heart failure for over a year after surgery.

Temporary worsening of mitral regurgitation due to conduction disturbance after transcatheter aortic valve implantation

Background

Mitral regurgitation after transcatheter aortic valve implantation (TAVI) can be caused by various etiologies.

Case presentation

An 81-year-old woman with mild mitral regurgitation and complete right bundle branch block was scheduled to undergo TAVI under general anesthesia. After the deployment of the prosthetic valve, electrocardiography depicted a wide QRS wave and bradycardia, suggestive of complete atrioventricular block. Although there was no lesion indicative of tissue injury to the valve itself, worsening of mitral regurgitation was identified on transesophageal echocardiography. The hemodynamic condition was stable, and no additional procedure was performed. Electrocardiography depicted a return to a narrow QRS wave 3 days after surgery, and the mitral regurgitation appeared comparable to the preoperative grade. We assumed that the worsening of mitral regurgitation was caused by dyssynchrony in the left ventricle due to the conduction disorder.

Conclusions

Mitral regurgitation after TAVI needs observation, including the determination of the etiology and treatment principle.

New or Worsened Mitral Regurgitation After Surgical Aortic Valve Replacement: A Systematic Review

BACKGROUND

New or worsened mitral regurgitation (MR) is an uncommon yet serious complication after surgical aortic valve replacement (SAVR). While there have been numerous reports of its occurrence, there is little consensus regarding its presentation and management. This systematic review summarizes the evidence in the current literature surrounding new or worsened MR after SAVR and analyzes its potential implications.

METHODS

Databases were examined for all articles and abstracts reporting on new or worsened MR after SAVR. Data collected included number of patients studied; patient characteristics; incidences of new or worsened MR; timing of diagnosis; and treatment.

RESULTS

Thirty-six full-text citations were included in this review. The prevalence of new or worsened MR after SAVR was 8.4%. Sixteen percent of new MR occurrences were from an organic etiology, and 83% of new MR occurrences were that of a functional etiology. Most diagnoses were made in the late or unspecified postoperative period using echocardiography (range: 0 minutes to 18 years postoperatively). While no patients died from this complication, 7.7% of patients (16 out of 207) required emergent procedural re-intervention.

CONCLUSIONS

This systematic review underscores the importance of identifying new or worsened MR following SAVR and accurate scoring of MR severity to guide treatment. It also outlines the associated clinical measures commonly documented following this complication, and the usefulness of transesophageal echocardiography for the detection of significant MR. These results reflect the current, limited state of the literature on this topic and warrant further investigation into MR detection and management strategies in SAVR patients.