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Ota T, Murakami Y, Kozuka Y, Ohshiro C, Kihara N, Gunji Y, Hattori S, Noguchi K. P224 Valvuloplasty treatment and three-dimensional analysis for isolated cleft of the anterior mitral valve leaflet: a case report. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction: Isolated cleft of the anterior mitral valve leaflet is a very rare congenital disease and a cause of mitral regurgitation
not associated with atrioventricular septal defect. In this case, we report our experience in valvuloplasty treatment for mitral regurgitation with this rare aetiology.
Case description
23-year-old Russian women. Although cardiac murmur was pointed out in her childhood and she was diagnosed as mitral regurgitation, she refused treatment. After getting married with a Japanese man and moving to Japan, her symptoms had worsened and she visited our hospital for treatment. Preoperative transthoracic echocardiography (TTE) had indicated the regurgitation from the central part of the mitral valve. Preoperative transoesophageal echocardiography (TOE) had pointed out the isolated cleft of the anterior mitral valve.
Surgical mitral valvuloplasty was scheduled, and the TOE after anaesthetic induction showed the isolated cleft of the anterior mitral valve the same as in the preoperative period and pointed out the posterior leaflet billowing. The operative finding was also similar to TOE: the largely bisected central anterior mitral valve and billowing, P2 billowing, shortening of P1 and P3, P2-3 cleft. There were no chords at the anterior cleft. The valvuloplasty was performed including five-time pump runs in total: 1) Continuous suture for the anterior cleft and ring annuloplasty were performed, and the regurgitation was seemed to be almost controlled at the water-leak test and the ink test; 2) Artificial chordae and leaflet plications were added to residual regurgitation from the posterior region; 3)The residual regurgitation was controlled to Mild but it became a lateral jet toward the ring; 4)Mild remnant flow was pointed out: the regurgitation seemed to be from the posterior cleft, where immediately below the ring suture; 5) Pericardium patch was added and the remnant flow was almost eliminated. The pump was weaned and the operation was finished without any problems.
Discussion
The cause of difficulty in this valvuloplasty was thought to be caused by the difficulty in evaluating the mitral valve morphology. It was evident that the anterior leaflet of the mitral valve was largely bisected. However, it was difficult to evaluate the coaptation line and area due to the absence of chordal cords in the anterior cleft and the billowing or shortening of the posterior leaflet. Although preoperative three-dimensional analysis helped evaluating the isolated cleft and the regurgitation was almost controlled in the evaluation in the operation field, nevertheless, a residual regurgitation occurred and indicated in the TOE after re-beating.
Conclusion
It is important and necessary to use fine evaluation of coaptation is needed in valvuloplasty for isolated cleft of the anterior mitral valve leaflet; not only apply three-dimensional analysis but also apply two-dimensional echocardiogram.
Abstract P224 Figure.
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Affiliation(s)
- T Ota
- Shonan Kamakura General Hospital, Anesthesiology, Kamakura, Japan
| | - Y Murakami
- Shonan Kamakura General Hospital, Cardiac Ultrasound Laboratory, Kamakura, Japan
| | - Y Kozuka
- Shonan Kamakura General Hospital, Cardiac Ultrasound Laboratory, Kamakura, Japan
| | - C Ohshiro
- Shonan Kamakura General Hospital, Cardiac Ultrasound Laboratory, Kamakura, Japan
| | - N Kihara
- Shonan Kamakura General Hospital, Cardiac Ultrasound Laboratory, Kamakura, Japan
| | - Y Gunji
- Shonan Kamakura General Hospital , Cardiovascular Surgery, Kamakura, Japan
| | - S Hattori
- Shonan Kamakura General Hospital , Cardiovascular Surgery, Kamakura, Japan
| | - K Noguchi
- Shonan Kamakura General Hospital , Cardiovascular Surgery, Kamakura, Japan
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Ota T, Murakami Y, Kozuka Y, Ohshiro C, Kihara N, Takagi Y. P662 Synchrony between the right and left heart systems is recovered after TAVI in patients with severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Young Investigator Grant of Japanese Society of Cardiovascular Anesthesia
Background / Introduction
Evidences have shown that cardiac function decline and systolic phase change are caused by massive afterload of the stenosed aortic valve in patients with severe aortic valve stenosis. As a result of the reduction of the left ventricular afterload by valve replacement, the cardiac function recovers. However, it has not been clarified yet how the changes in cardiac function affect the relationship between the right and left heart systems, as well as the systole phase.
TAPSE and MAPSE are known as indices of simple cardiac function evaluation by measuring the movement distance of the atrioventricular annulus. We obtained these indices (i.e. TAPSE, MAPSE) within the same heartbeat using speckle tracking analysis of the atrioventricular annulus and evaluated the changes in cardiac function and phase between the right and left heart systems.
Purpose
To reveal the relationship of cardiac function and time phase between the right and left heart systems by evaluating the maximum movement distance and time of the atrioventricular annulus within the same heartbeat and the same view in patients with severe aortic valve stenosis before and after TAVI.
Methods
A prospective cohort study was conducted. We recruited and analyzed 44 patients with severe aortic valve stenosis who received TAVI treatment, able to record baseline before treatment and follow-up 6 months and 12 months after treatment at our hospital from March 2017 to May 2019. Patients were excluded if more than 2 degree of atrioventricular valve regurgitation or incomplete data. The apical four-chamber view was used for speckle tracking analysis with the origin of the apical extension and region of interest (ROI) of the mitral annulus and tricuspid annulus. For each patient before treatment, at 6 months and 12 months after treatment, the maximum contraction distance (DM), maximum contraction time (TM) of the mitral valve annulus, maximum contraction distance (DT) and maximum contraction time (TT) of the tricuspid annulus were measured. Maximum contraction distance ratio (DM/ DT) and maximum contraction time ratio (TM/ TT) were calculated. For statistical analysis, t-test and ANOVA were used, and a significance threshold of p <0.05 was applied.
Results
TM/ TT decreased at 12 months after TAVI, and DM/ DT increased significantly at 6 months and 12 months after TAVI when compared to baseline before treatment.
Conclusions
In patients with severe aortic valve stenosis, the correction of cardiac function difference between the right and left heart systems occurs from 6 months after TAVI. Moreover, the correction of contraction phase difference between the right and left heart systems at 12 months after TAVI. Thus, the synchrony between the right and left heart system is recovered 12 months after TAVI.
Abstract P662 Figure.
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Affiliation(s)
- T Ota
- Shonan Kamakura General Hospital, Anesthesiology, Kamakura, Japan
| | - Y Murakami
- Shonan Kamakura General Hospital, Cardiac Ultrasound Laboratory, Kamakura, Japan
| | - Y Kozuka
- Shonan Kamakura General Hospital, Cardiac Ultrasound Laboratory, Kamakura, Japan
| | - C Ohshiro
- Shonan Kamakura General Hospital, Cardiac Ultrasound Laboratory, Kamakura, Japan
| | - N Kihara
- Shonan Kamakura General Hospital, Cardiac Ultrasound Laboratory, Kamakura, Japan
| | - Y Takagi
- Shonan Kamakura General Hospital, Anesthesiology, Kamakura, Japan
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Ota T, Senaratne DNS, Preston NK, Ferrara F, Djikic D, Villemain O, Takahashi L, Niki K, Patrascu N, Benyounes N, Popa E, Diego Bellavia DB, Sundqvist M, Wei-Ting C, Papachristidis A, Djordjevic-Dikic A, Volpi C, Reis L, Nieto Tolosa J, Nishikawa H, D'angelo M, Testuz A, Mo YJ, Hashemi N, Toyota K, Nagamine K, Koide Y, Nomura T, Kurata J, Murakami Y, Kozuka Y, Ohshiro C, Thomas K, Townsend C, Wheeler S, Jacobson I, Elkington A, Balkhausen K, Bull S, Ring L, Gargani L, Carannante L, Russo V, D'alto M, Marra AM, Cittadini A, D'andrea A, Vriz O, Bossone E, Mujovic N, Dejanovic B, Peric V, Marinkovic M, Jankovic N, Orbovic B, Simic D, Sitefane F, Pernot M, Malekzadeh-Milani G, Baranger J, Bonnet D, Boudjemline Y, Uejima T, Nishikawa H, Semba H, Sawada H, Yamashita T, Sugawara M, Kayanuma H, Inoue K, Yagawa M, Takamisawa I, Umemura J, Yoshikawa T, Tomoike H, Mihalcea DJ, Mihaila S, Lungeanu L, Trasca LF, Bruja R, Neagu MS, Albu S, Cirstoiu M, Vinereanu D, Van Der Vynckt C, Gout O, Cohen A, Enache R, Jurcut R, Coman IM, Badea R, Platon P, Calin A, Beladan CC, Rosca M, Ginghina C, Popescu BA, Sonia Dell'oglio SD, Attilio Iacovoni AI, Calogero Falletta CF, Giuseppe Romano GR, Sergio Sciacca SS, Lissa Sugeng LS, Joseph Maalouf JM, Michele Pilato MP, Michele Senni MS, Cesare Scardulla CS, Francesco Clemenza FC, Salman K, Tornvall P, Ugander M, Chen ZC, Wang JJ, Fisch S, Liao RL, Roper D, Casar Demarco D, Papitsas M, Tsironis I, Byrne J, Alfakih K, Monaghan MJ, Boskovic N, Rakocevic I, Giga V, Tesic M, Stepanovic J, Nedeljkovic I, Aleksandric S, Kostic J, Beleslin B, Altman M, Annabi MS, Abouchakra L, Cucchini U, Muraru D, Badano LP, Ernande L, Derumeaux G, Teixeira R, Fernandes A, Almeida I, Dinis P, Madeira M, Ribeiro J, Puga L, Nascimento J, Goncalves L, Cambronero Sanchez FJ, Pinar Bermudez E, Gimeno Blanes JR, De La Morena Valenzuela G, Uejima T, Takahashi L, Semba H, Sawada H, Yamashita T, Lopez Fernandez T, Irazusta Cordoba FJ, Rosillo Rodriguez SO, Dominguez Melcon FJ, Meras Colunga P, Gemma D, Moreno Gomez R, Moreno Yanguela M, Lopez Sendon JL, Nguyen V, Mathieu T, Kerneis C, Cimadevilla C, Kubota N, Codogno I, Tubiana S, Estrellat C, Vahanian A, Messika-Zeitoun D, Ondrus T, Van Camp G, Di Gioia G, Barbato E, Bartunek J, Penicka M, Johnsson J, Gomez A, Alam M, Winter R. Poster Session 3The imaging examination and quality assessmentP626Value of mitral and tricuspid annular displacement to assess the interventricular systolic relationship in severe aortic valve stenosis : a Pilot studyP627Follow-up echocardiography in asymptomatic valve disease: assessing the potential economic impact of the European and American guidelines in a dedicated valve clinic, compared to standard care.P628The tricuspid valve: identification of optimal view for assessing for prolapseP629Right atrial volume by two-dimensional echocardiography in healthy subjectsP630Disturbance of inter and intra atrial conduction assessed by tissue doppler imaging in patients with medicaly controlled hypertension and prehypertension.P631Liver stiffness by shear wave elastography, new noninvasive and quantitative tool for acute variation estimation of central venous pressure in real-time?P632Weak atrial kick contribution is associated with a risk for heart failure decompensationP633Usefulness of wave intensity analysis in predicting the response to cardiac resynchronization therapyP634Early subclinical left ventricular systolic and diastolic dysfunction in gestational hypertension and preeclampsiaP635Clinical comparison of three different echocardiographic methods for left ventricular ejection fraction and LV end diastolic volume measurementP636Assessment of right ventricular-arterial coupling parameters by 3D echocardiography in patients with pulmonary hypertension receiving specific vasodilator therapyP637Prediction of right ventricular failure after left ventricular assist device implant: assessing usefulness of standard and strain echocardiographyP638Kinematic analysis of diastolic function using the novel freely available software Echo E-waves - feasibility and reproducibilityP639Evaluation of coronary flow velocity by Doppler echocardiography in the treatment of hypertension with the ARB: correlation to the histological cardiac fibrosisP640The clinical significance of limited apical ischaemia and the prognostic value of stress echocardiography - A contemporary study from a high volume centerP641Effects of intermediate stenosis of left anterior descending coronary artery on survival in patients with chronic total occlusion of right coronary arteryP642Left ventricular remodeling after a first myocardial infarction in patients with preserved ejection fraction at dischargeP643Left atrial size and acute coronary syndromes. Let is make simple.P644Influence of STEMI reperfusion strategy on systolic and diastolic functionP645Aortic valve resistance risk-stratifies low-gradient severe aortic stenosisP646Does permanent pacemaker implantation complicate the prognosis of patients after transcatheter aortic valve implantation?P647Influence of metabolic syndrome and diabetes on progression of calcific aortic valve stenosis - The COFRASA - GENERAC StudyP648Low referral for aortic valve replacement accounts for worse long-term outcome in low versus high gradient severe aortic stenosis with preserved ejection fractionP649The impact of right ventricular function from aortic valve replacement: A randomised study comparing minimally invasive aortic valve surgery and conventional open heart surgery. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nagata K, Takasu N, Akamine H, Ohshiro C, Komiya I, Murakami K, Suzawa A, Nomura T. Urinary iodine and thyroid antibodies in Okinawa, Yamagata, Hyogo, and Nagano, Japan: the differences in iodine intake do not affect thyroid antibody positivity. Endocr J 1998; 45:797-803. [PMID: 10395237 DOI: 10.1507/endocrj.45.797] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Excess iodine intake may affect the development of Hashimoto's thyroiditis. Kelp consumption is very high in Okinawa. We expected a high prevalence of Hashimoto's thyroiditis in Okinawa. We studied urinary iodine excretion and the positivities of anti-thyroglobulin antibodies (TGAb) and anti-thyroid peroxidase antibodies (TPOAb) in the residents of Nishihara in Okinawa, Yamagata in Yamagata, Kobe in Hyogo, and Hotaka in Nagano, Japan. TGAb and/or TPOAb were positive in 142 (13.7%) of 1039 subjects in Nishihara, in 16 (16.0%) of 100 subjects in Yamagata, in 31 (13.4%) of 232 subjects in Kobe, and in 35 (13.9%) of 252 subjects in Hotaka; TGAb and/or TPOAb positivity was about the same in these 4 areas. One tenth of the subjects with positive TGAb and/or TPOAb had hypothyroidism; the frequencies of hypothyroidism in those with positive TGAb and/or TPOAb were about the same in Nishihara, Yamagata, Kobe, and Hotaka. The iodine concentration in samples of morning urine correlated well with the 24-h urine iodine excretion. The urinary iodine excretion was 1.5 mg/day in Nishihara. There were no differences between Nishihara and Yamagata in the urinary iodine concentration, but the urinary iodine concentrations in Kobe and Hotaka were less than those in Nishihara or Yamagata. The amounts of iodine excretion in Kobe and Hotaka were moderate, and less than those in Nishihara or Yamagata. The amounts of iodine intake in Kobe and Hotaka were less than those in Nishihara or Yamagata, but TGAb and/or TPOAb positivity was about the same in Nishihara, Yamagata, Kobe, and Hotaka. The differences in dietary iodine intake do not affect TGAb and/or TPOAb positivity.
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Affiliation(s)
- K Nagata
- Second Department of Internal Medicine, University of the Ryukyus School of Medicine, Okinawa, Japan
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