1 / 33

Mitral Valve Repair Case Study Deborah Jeanne Warner November 10, 2010

Mitral Valve Repair Case Study Deborah Jeanne Warner November 10, 2010. Heart Valves. -Four valves control the direction of blood flow -System of one-way doors assure unidirectional flow through chambers -AV valves control flow of oxygen depleted blood from body to lungs

tryna
Télécharger la présentation

Mitral Valve Repair Case Study Deborah Jeanne Warner November 10, 2010

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Mitral Valve Repair Case Study Deborah Jeanne Warner November 10, 2010

  2. Heart Valves -Four valves control the direction of blood flow -System of one-way doorsassure unidirectional flow through chambers -AV valves control flow of oxygen depleted blood from body to lungs -SL valves control flow of oxygen rich blood from lungs to body

  3. The Mitral Valve -Mitral valve: between left atrium & ventricle -Diastole: blood leaves the atria, flows through open mitral valve and into ventricle -Pressure in ventricle increases, closing MV -Prevents blood leaking back into the atrium during systole -Assures the blood in left ventricle will be ejected through aortic valve into aorta to supply oxygenated blood to body

  4. Mitral Valve Anatomy -Annulus: Fibrous ring -Two leaflets: Valvular tissue -Chordae tendineae -Papillary muscles

  5. Mitral Regurgitation -Regurgitation/Insufficiency -Result of incompetent valve-Doesn't close completely -Blood leaks back into atriumduring systole -MR increases the workload of the heart -Complications-Cardiac arrhythmias -CHF-Irreversible heart damage

  6. Causes of MR -Rheumatic fever-Annulus dilatation-Mitral annular calcification-Leaflets that are flail, prolapse and/or stenotic-Endocarditis-Chordae tendineae elongation or rupture-Papillary muscle fibrosis, calcification, or rupture-Prior myocardial infarction-Prosthetic valve dysfunction-Congenital anomalies-Age related wear and tear

  7. Signs and Symptoms Will depend on the severity and cause: -Fatigue-Decreased exercise capacity-Dyspnea-Orthopnea-Supraventricular arrhythmias (Atrial Fib)-Palpitations-Lightheadedness-High pitched systolic murmur

  8. Diagnostic Studies -Transthoracic Echocardiogram -Transesophageal Echocardiogram -Chest X-Ray -EKG -Holter monitor -Cardiac Catheterization

  9. Treatment for Mitral Regurgitation -Surgery is the only proven treatment -Preferred surgery is repair of the native valve -Advantages of MV repair over replacement-Lower mortality at the time of operation -Significantly lower risk of stroke, and lower rate of infection -Improved long term survival -Better preservation of heart function -Blood thinners not required -Same survival curve as normal population -Improved quality of life

  10. Mitral Valve RepairAnnuloplasty -Annuloplasty: Technique that repairs annulus -If annulus is dilated, leaflets unable to coapt -Result is MR -Sutures sewn round ring -Annuloplasty ring provides additional support

  11. Case StudyPatient Information -Age/Gender: 76 year old male -Hospital Admission on 5/27/10 -Current Symptoms: -Dyspnea on exertion

  12. Physical Examination -5/27/2010: -Blood Pressure: 157/86 -Heart Rate: 48 -Respiratory Rate: 16 -Lungs: Clear -Heart: Grade II/VI systolic murmur heard, cardiac sounds and S2 are normal -Abdomen: Soft, non-tender -Extremities: No edema

  13. Patient History -Medical History: -Coronary Artery Disease:1/2009-Stent placed in RCA -Dyslipidemia -Hypertension -Episodes of bradycardia and ventricular ectopy -Mild COPD -Previous echocardiogram (TTE) on 1/21/2009:Preserved systolic function with mild mitral leaflet calcification, moderate mitral regurgitation, left atrium moderately enlarged.

  14. Patient History -Medications at Admission: -Aspirin 325 mg. daily -Lotrel 5/10 one tablet daily -Lipitor 20 mg. daily

  15. Diagnostic StudyTransesophaegeal Echo Findings on 5/28/10:-Left Ventricle: Chamber size, wall motion, contractility and LV function are normal-Left Atrium: Moderately enlarged-Right Ventricle: Chamber size and function normal-Right Atrium: Cavity size is normal-Mitral Valve: Mild mitral leaflet calcification. Severe mitral regurgitation observed. The mitral valve venacontracta is 0.9 cm. No evidence of mitral stenosis.Conclusions: Mitral valve appears repairable and annulus is dilated. MR is severe in several views.

  16. Transesophageal Echo05/28/10

  17. Transesophageal Echo05/28/10

  18. Transesophageal Echo05/28/10

  19. Diagnostic StudiesLeft heart catheterization -Coronary angiogram on 6/9/10: • Left main trunk is normal • Left anterior descending has mild disease of 40% in the mid LAD • Circumflex ostial 50% narrowed followed by 100% occlusion of the circumflex • Right Coronary artery - mild plaquing of 20% in the proximal to mid segment • Conclusion: Mild to Moderate coronary disease

  20. Mitral Valve Repair -Diagnosis: Severe Mitral Regurgitation -6/10/10: Patient had surgery to repair MV -Intraoperative TEE confirmed severe MR -Intraoperative inspection of the mitral valve -Surgical repair of mitral valve via ring annuloplasty was performed. Anterior leaflet sized to a 28 mm St. Jude ring. -Excellent coaptation of the anterior-posterior leaflet upon completion of repair. -Postoperative TEE – no residual MR

  21. Pre and Post Op – TEE06/10/10

  22. Pre and Post Op - TEE06/10/10

  23. Hospital Course -Mitral valve repair with ring annuloplasty -Thoracentesis of right pleural effusion -Burst of atrial fibrillation -Nephrology consult for renal dysfunction -Discharge medications:-Aspirin 325 mg daily (Anti-thrombotic)-Plavix 75 mg daily (Anti-platelet) -Furosemide 40 mg. Daily (Loop diuretic)-Metoprolol 25 mg b.i.d. (Beta Blocker)

  24. Follow-upChest X Ray -08/05/10 -PA and LAT views of chest -Impression:1) There is mild cardiomegaly.2) Overall improvement of the bilateral pulmonary infiltrates most likely related to pneumonia or asymmetric pulmonary edema.3) Stable bilateral pleural effusions.

  25. Follow-up Echo08/05/10 Findings: -Left ventricle chamber size and systolic function are normal. -Moderate bilateral atrial enlargement. -Right ventricle cavity size and systolic function are normal. -Mild aortic leaflet calcification is visualized. -Mitral valve leaflets are mildly thickened. (mitral valve has been repaired previously) There is mild mitral regurgitation observed with no evidence of mitral stenosis.

  26. Follow-up Echo08/05/10 - PLAX

  27. Follow-up Echo08/05/10 – PSAX & MV Zoom

  28. Follow-up Echo08/05/10 – Apical 2C

  29. Follow-up Echo08/05/10 – Apical 4C

  30. Follow-up Echo08/05/10

  31. Before & After MV Repair

  32. References • DeWitt, S. 2009, Echocardiography...From a Sonographer'sPerspective (6th Edition), Camden Printing, St. Marys, GA • Drugs.com, “Prescription Drugs, Information, Interactions and Side Effects.”http://www.drugs.comAccessed 24 October 2010 • MedicineNet.com, “Health and Medical Information.”http://www.medicinenet.comAccessed 24 October 2010 • Wikipedia, “The Free Encyclopedia.”http://www.wikipedia.org/wiki/Mitral_valve; http://wikipedia.org/wiki/File:Heart_short_axis_view_papillary.jpgAccessed 22 October 2010 • Pick, A., “The Patient's Guide to Heart Valve Surgery.”http://www.heart-valve-surgery.com/heart-valve-repair-valvuloplasty-annuloplasty.phpAccessed 29 October 2010 • Mitral Valve Repair Center at The Mt. Sinai Hospital.http://www.mitralvalverepair.orgAccessed 30 October 2010 • University of Maryland Medical Center, “Mitral Valve Repair Surgery.”http://umm.edu/heart/mitral.htmAccessed 31 October 2010 • Cleveland Clinic, “Heart and Vascular Health.”http://my.clevelandclinic.org/heart/disorders/valve/mvrepair.aspxAccessed 30 October 2010 • E-cardiography Journal, “Vena Contracta.”http://rwjms1.umdnj.edu/shindler/venacontracta.htmlAccessed 1 Novermber 2010

More Related