Advertisement

Repair of rheumatic mitral valve incompetence: surgical challenges and clinical results

  • C.A. Yankah
  • H. Siniawski
  • R. Hetzer

Abstract

Rheumatic heart valve disease (RHVD) is one of the sequelae of rheumatic fever (RF) triggered by autoimmune humoral and cellular responses and remains the predominant heart valve disease in developing countries. It is seen in epidemic proportions in the preschool and school age groups but is also found in patients in their teens and early twenties. The youngest patient reported was 2 years old. In addition, a number of patients present during adulthood at a mean age of 40 years in developing countries and in their early 50s and 60s in developed countries. Rheumatic heart valve disease has become rare, virtually nonexistent in most affluent populations, but remains uncontrolled in developing countries with an incidence of 1.6/1000 in Liberia, 2.2/1000 in Cambodia, and 2.3/1000 in Mozambique, as determined by clinical diagnosis without echocardiograhic support. The global burden is estimated to be 15.6 million and about 282,000 new cases are registered each year with an annual mortality of 233,000.

Keywords

Mitral Valve Mitral Regurgitation Rheumatic Fever Rheumatic Heart Disease Mitral Valve Repair 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Binotto MA, Guilherme L, Tanaka AC (2002) Rheumatic fever. Images Paediatric Cardiol 11:12–15Google Scholar
  2. 2.
    Guilherme L, Ramasawmy R, Kalil J (2007) Rheumatic fever and rheumatic heart disease: Genetics and pathogenesis. Scand J Immunol 66:199–207PubMedCrossRefGoogle Scholar
  3. 3.
    Ayoub EM (1992) Resurgence of rheumatic fever in the United States. The changing picture of a preventable illness. Postgrad Med 92:133–136,139–142Google Scholar
  4. 4.
    Yankah AC, Marshall R, Van Reken D, Boakye E, Sasraku SD (1981) Cardiovascular diseases in Liberia. Cardiologie Tropicale, Tropical cardiology 7:15–20Google Scholar
  5. 5.
    Marijon E, Ou P, Celermajer DS, Ferreira B, Mocumbi AO, Jani D, Paquet C, Jacob S, Sidi D, Jouven X (2007) Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 357:470–476PubMedCrossRefGoogle Scholar
  6. 6.
    Carapetis JR, Steer AC, Mulholland EK, Weber M (2005) The global burden of group A streptococcal diseases. Lancet Infect Dis 5:685–694PubMedCrossRefGoogle Scholar
  7. 7.
    Antunes MJ, Magalhaes MP, Colsen PR, Kinsley RH (1987) Valvuloplasty for rheumatic mitral valve disease. A surgical challenge. J Thorac Cardiovasc Surg 94:44–56PubMedGoogle Scholar
  8. 8.
    Bernal JM, Rabasa JM, Olalla JJ, Carrión MF, Alonso A, Revuelta JM (1996) Repair of chordae tendineae for rheumatic mitral valve disease. A twenty-year experience. J Thorac Cardiovasc Surg 111:211–217PubMedCrossRefGoogle Scholar
  9. 9.
    Kumar AS, Talwar S, Saxena A, Singh R, Velayoudam D (2006) Results of mitral valve repair in rheumatic mitral regurgitation. Interact Cardiovasc Thorac Surg 5:356–361PubMedCrossRefGoogle Scholar
  10. 10.
    Talwar S, Rajesh MR, Subramanian A, Saxena A, Kumar AS (2005) Mitral valve repair in children with rheumatic heart disease. J Thorac Cardiovasc Surg 129:875–879PubMedCrossRefGoogle Scholar
  11. 11.
    Phan KP, Nguyen vP, Pham NV, Dao HT, Dang tT, Le HD, Chu TH, Tri Ho HQ, Carpentier A (1999) Mitral valve repair in children using Carpentier’s techniques. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2:111–120PubMedGoogle Scholar
  12. 12.
    Ho HQ, Nguyen VP, Phan KP, Pham NV (2004) Mitral valve repair with aortic valve replacement in rheumatic heart disease. Asian Cardiovasc Thorac Ann 12:341–345PubMedGoogle Scholar
  13. 13.
    Fedakar A, Sasmazel A, Bugra O, Sarikaya S, Büyükbayrak F, Erdem H, Baysal A, Zeybek R (2010) Results of mitral valve repair in rheumatic mitral lesions. Heart Surg Forum 13:E86–E90PubMedCrossRefGoogle Scholar
  14. 14.
    Kim JB, Kim HJ, Moon DH, Jung SH, Choo SJ, Chung CH, Song H, Lee JW (2010) Long-term outcomes after surgery for rheumatic mitral valve disease: valve repair versus mechanical valve replacement. Eur J Cardiothorac Surg 37:1039–1046PubMedCrossRefGoogle Scholar
  15. 15.
    Kalangos A, Christenson JT, Beghetti M, Cikirikcioglu M, Kamentsidis D, Aggoun Y (2008) Mitral valve repair for rheumatic valve disease in children: midterm results and impact of the use of a biodegradable mitral ring. Ann Thorac Surg 86:161–169PubMedCrossRefGoogle Scholar
  16. 16.
    Alsoufi B, Manlhiot C, McCrindle BW, Al-Halees Z, Sallehuddin A, Al-Oufi S, Saad E, Fadel B, Canver CC (2010) Results after mitral valve replacement with mechanical prostheses in young children. J Thorac Cardiovasc Surg 139:1189–1196PubMedCrossRefGoogle Scholar
  17. 17.
    Alsoufi B, Manlhiot C, McCrindle BW, Canver CC, Sallehuddin A, Al-Oufi S, Joufan M, Al-Halees Z (2009) Aortic and mitral valve replacement in children: is there any role for biologic and bioprosthetic substitutes? Eur J Cardiothorac Surg 36:84–90PubMedCrossRefGoogle Scholar
  18. 18.
    von Oppell UO, Zilla P (2001) Prosthetic heart valves: why biological? J Long Term Eff Med Implants 11:105–113PubMedGoogle Scholar
  19. 19.
    Skoularigis J, Sinovich V, Joubert G, Sareli P (1994) Evaluation of the long-term results of mitral valve repair in 254 young patients with rheumatic mitral regurgitation. Circulation 90:II167–II174PubMedGoogle Scholar
  20. 20.
    Chopra P, Bhatia ML (1992) Chronic rheumatic heart disease in India: a reappraisal of pathologic changes. J Heart Valve Dis 1:92–101PubMedGoogle Scholar
  21. 21.
    Brunton L (1902) Preliminary note on the possibility of treating mitral stenosis by surgical methods. Lancet 1:352CrossRefGoogle Scholar
  22. 22.
    Ross FP (1979) Master surgeon, teacher, soldier, and friend: Elliott Carr Cutler, MD (1888–1947). Am J Surg 137:428–432PubMedCrossRefGoogle Scholar
  23. 23.
    Gibbons JH Jr (1954) The application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med 37:171–174Google Scholar
  24. 24.
    Hill JD. John H. Gibbon, Jr. (1982) Part I. The development of the first successful heart-lung machine. Ann Thorac Surg 34:337–341PubMedCrossRefGoogle Scholar
  25. 25.
    Lillehei CW, Gott VL, De Wall RA, Varco RL (1957) Surgical correction of pure mitral insufficiency by annuloplasty under direct vision. Lancet 77:446–449Google Scholar
  26. 26.
    Gott VL (2005) Lillehei, Lewis, and Wangensteen: the right mix for giant achievements in cardiac surgery. Ann Thorac Surg 79:S2210–S2213PubMedCrossRefGoogle Scholar
  27. 27.
    Carpentier A (1983) Cardiac valve surgery – the »French correction«. J Thorac Cardiovasc Surg 86:323–337PubMedGoogle Scholar
  28. 28.
    Carpentier A, Deloche A, Dauptain J (1971) A new reconstructive operation for correction of mitral and tricuspid insufficiency. J Thorac Cardiovasc Surg 61:1–13PubMedGoogle Scholar
  29. 29.
    Duran CG, Pomar JL, Revuelta JM (1980) Conservative operation for mitral insufficiency: critical analysis supported by postoperative hemodynamic studies of 72 patients. J Thorac Cardiovasc Surg 79:326–337PubMedGoogle Scholar
  30. 30.
    Duran CM, Gometza B, De Vol EB (1991) Valve repair in rheumatic mitral disease. Circulation 84(Suppl):III125–III132PubMedGoogle Scholar
  31. 31.
    Duran CM, Gometza B, Balasundaram S, al Halees Z (1991) A feasibility study of valve repair in rheumatic mitral regurgitation. Eur Heart J 12 (Suppl B):34–38Google Scholar
  32. 32.
    Siniawski H, Grauhan O, Hofmann M, Pasic M, Weng Y, Yankah C, Lehmkuhl H, Hetzer R (2004) Factors influencing the results of double-valve surgery in patients with fulminant endocarditis: the importance of valve selection. Heart Surg Forum 7:E405–E410PubMedCrossRefGoogle Scholar
  33. 33.
    Akins CW, Miller DC, Turina MI, Kouchoukos NT, Blackstone EH, Grunkemeier GL, Takkenberg JJ, David TE, Butchart EG, Adams DH, Shahian DM, Hagl S, Mayer JE, Lytle BW; Councils of the American Association for Thoracic Surgery; Society of Thoracic Surgeons; European Assoication for Cardio-Thoracic Surgery; Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity (2008) Guidelines for reporting mortality and morbidity after cardiac valve interventions. J Thorac Cardiovasc Surg 135:732–738PubMedCrossRefGoogle Scholar
  34. 34.
    Leyh RG, Jakob H (2006) Current aspects of mitral valve repair in the surgical treatment of mitral valve insufficiency. Herz 31:47–52PubMedCrossRefGoogle Scholar
  35. 35.
    Hillman ND, Tani LY, Veasy LG, Lambert LL, Di Russo GB, Doty DB, McGough EC, Hawkins JA (2004) Current status of surgery for rheumatic carditis in children. Ann Thorac Surg 78:1403–1408PubMedCrossRefGoogle Scholar
  36. 36.
    Erez E, Kanter KR, Isom E, Williams WH, Tam VK (2003) Mitral valve replacement in children. J Heart Valve Dis 12:25–29PubMedGoogle Scholar
  37. 37.
    Padala M, Powell SN, Croft LR, Thourani VH, Yoganathan AP, Adams DH (2009)Mitral valve hemodynamics after repair of acute posterior leaflet prolapse: quadrangular resection versus triangular resection versus neochordoplasty. J Thorac Cardiovasc Surg 138:309–315PubMedCrossRefGoogle Scholar
  38. 38.
    Acar C, de Ibarra JS, Lansac E (2004) Anterior leaflet augmentation with autologous pericardium for mitral repair in rheumatic valve insufficiency. J Heart Valve Dis 13:741–746PubMedGoogle Scholar
  39. 39.
    El Oumeiri B, Boodhwani M, Glineur D, De Kerchove L, Poncelet A, Astarci P, Pasquet A, Vanoverschelde JL, Verhelst R, Rubay J, Noirhomme P, El Khoury G (2009) Extending the scope of mitral valve repair in rheumatic disease. Ann Thorac Surg 87:1735–1740PubMedCrossRefGoogle Scholar
  40. 40.
    Frater RW, Berghuis J, Brown AI, Jr, Ellis FH Jr (1965) The experimental and clinical use of autogenous pericardium for the replacement and extension of mitral and tricuspid vave cusps and chordae. J Cardiovasc Surg 6:214–228Google Scholar
  41. 41.
    Frater RW, Gabbay S, Shore D (1983) Reproducible replacement of elongated or ruptured mitral valve chordate. Ann Thorac Surg 35:14–28PubMedCrossRefGoogle Scholar
  42. 42.
    Vetter HO, Burack JH, Factor SM, Maculso F, Frater RWM (1986) Replacement of chordate tendinae of the mitral valve using the new expanded PTFE suture in sheep. In: Bodnar E, Yacoub M (eds) Biologic and bioprosthetic valves. York Medical Books, New York, pp 772–785Google Scholar
  43. 43.
    Frater RW, Vetter HO, Zussa C, Dahm M (1990) Chordal replacement in mitral valve repair. Circulation 82(Suppl):IV125–IV130PubMedGoogle Scholar
  44. 44.
    David TE, Bos J, Rakowski H (1991) Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg 101:495–501PubMedGoogle Scholar
  45. 45.
    Salvador L, Mirone S, Bianchini R, Regesta T, Patelli F, Minniti G, Masat M, Cavarretta E, Valfrè C (2008) A 20-year experience with mitral valve repair with artificial chordae in 608 patients. J Thorac Cardiovasc Surg 135:1280– 1287PubMedCrossRefGoogle Scholar
  46. 46.
    Zussa C, Polesel E, Da Col U, Galloni M, Valfré C (1994) Seven-year experience with chordal replacement with expanded polytetrafluoroethylene in floppy mitral valve. J Thorac Cardiovasc Surg 108:37–41PubMedGoogle Scholar
  47. 47.
    Kalangos A, Sierra J, Vala D, et al. (2006) Annuloplasty for valve repair with a new biodegradable ring: an experimental study. J Heart Valve Dis 15:783–790PubMedGoogle Scholar
  48. 48.
    Minami K, Kado H, Sai S, Tatewaki H, Shiokawa Y, Nakashima A, Fukae K, Hirose H (2005) Midterm results of mitral valve repair with artificial chordae in children. J Thorac Cardiovasc Surg 129:336–342PubMedCrossRefGoogle Scholar
  49. 49.
    Hetzer R, Delmo Walter EB, Hübler M, Alexi-Meskishvili V, Weng Y, Nagdyman N, Berger F (2008) Modified surgical techniques and long-term outcome of mitral valve reconstruction in 111 children. Ann Thorac Surg 86:604–613PubMedCrossRefGoogle Scholar
  50. 50.
    Scrofani R, Moriggia S, Salati M, Fundaro P, Danna P, Santoli C (1996) Mitral valve remodeling: long-term results with posterior pericardial annuloplasty. Ann Thorac Surg 61:895–899PubMedCrossRefGoogle Scholar
  51. 51.
    Rankin JS, Sharma MK, Teague SM, McLaughlin VW, Johnston TS, McRae AT (2008) A new approach to mitral valve repair for rheumatic disease: preliminary study. J Heart Valve Dis 17:614–619PubMedGoogle Scholar
  52. 52.
    Adams DH, Anyanwu AC, Rahmanian PB, Filsoufi F (2006) Current concepts in mitral valve repair for degenerative disease. Heart Fail Rev 11:241–257PubMedCrossRefGoogle Scholar
  53. 53.
    Virmani R, Chun PK, Parker J, McAllister HA (1982) Suture obliteration of the circumflex coronary artery in three patients undergoing mitral valve operation: role of left dominant or nondominant coronary artery. J Thorac Cardiovasc Surg 84:773–778PubMedGoogle Scholar
  54. 54.
    Tavilla G, Pcini D (1998) Damage to the circumflex coronary artery during mitral valve repair with sliding leaflet technique. Ann Thorac Surg 66:2090–2093CrossRefGoogle Scholar
  55. 55.
    Shah PM, Ranney AA (2001) Echocardiographic correlates of left ventricular outflow obstruction and systolic anterior motion following mitral valve repair. J Heart Valve Dis 10:302–306PubMedGoogle Scholar
  56. 56.
    Rankin JS (2010) Mitral valve repair for Barlow’s syndrome using adjustable artificial chordal replacement. http://www.ctsnet.org/sections/clinicalresources/videos/vg2010_RankinS_ACR_Barlows.html(Accessed: Nobember 29, 2010)
  57. 57.
    Butany J, Collins MJ, David TE (2004) Ruptured synthetic expanded polytetrafluoroethylene chordae tendineae. Cardiovasc Pathol 13:182–184PubMedCrossRefGoogle Scholar
  58. 58.
    Farivar RS, Shernan SK, Cohn LH (2009) Late rupture of polytetrafluoroethylene neochordae after mitral valve repair. J Thorac Cardiovasc Surg 137:504–506PubMedCrossRefGoogle Scholar
  59. 59.
    Yau TM, El-Ghoneimi YAF, Armstrong S, Ivanov J, David TE (2000) Mitral valve repair and replacement for rheumatic disease. J Thorac Cardiovasc Surg 119:53–61PubMedCrossRefGoogle Scholar
  60. 60.
    Shahin GM, van der Heijden GJ, Kelder JC, Boulaksil M, Knaepen PJ, Six AJ (2006) Long-term follow-up of mitral valve repair: a single-center experience. Med Sci Monit 12:308–314Google Scholar
  61. 61.
    Talwalkar NG, Earle NR, Earle EA, Lawrie GM (2004) Mitral valve repair in patients with low left ventricular ejection fractions: early and late results. Chest 126:709–715PubMedCrossRefGoogle Scholar
  62. 62.
    Shahian DM, O’Brien SM, Filardo G, Ferraris VA, Haan CK, Rich JB, Normand SL, DeLong ER, Shewan CM, Dokholyan RS, Peterson ED, Edwards FH, Anderson RP (2009) The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 3–valve plus coronary artery bypass grafting surgery. Society of Thoracic Surgeons Quality Measurement Task Force. Ann Thorac Surg 88(Suppl):S43–S62PubMedCrossRefGoogle Scholar
  63. 63.
    Adams DH, Anyanwu A (2006) Pitfalls and limitations in measuring and interpreting the outcomes of mitral valve repair. J Thorac Cardiovasc Surg 131:565–573CrossRefGoogle Scholar
  64. 64.
    Shuhaiber J, Anderson RJ (2007) Meta-analysis of clinical outcomes following surgical mitral valve repair or replacement. Eur J Cardiothorac Surg 31:267–275PubMedCrossRefGoogle Scholar
  65. 65.
    Farivar RS, Shernan SK, Cohn LH (2009) Late rupture of polytetrafluoroethylene neochordae after mitral valve repair. J Thorac Cardiovasc Surg 137:504–506PubMedCrossRefGoogle Scholar
  66. 66.
    Yacoub MH, Kilner PJ, Birks EJ, Misfeld Ml (1999) The aortic outflow and root: a tale of dynamism and crosstalk. Ann Thorac Surg 68:S37–S43PubMedCrossRefGoogle Scholar
  67. 67.
    Yacoub MH, Cohn LH (2004) Novel approaches to cardiac valve repair: from structure to function: Part II. Circulation 109:1064–1072PubMedCrossRefGoogle Scholar
  68. 68.
    DiBardino DJ, ElBardissi AW, McClure RS, Razo-Vasquez OA, Kelly NE, Cohn LH (2010) Four decades of experience with mitral valve repair: analysis of differential indications, technical evolution, and long-term outcome. J Thorac Cardiovasc Surg 139:76–83PubMedCrossRefGoogle Scholar
  69. 69.
    Rankin JS, Burrichter CA, Walton-Shirley MK, Whiteside JH, Teague SM, McLaughlin VW, Sharma MK, Johnston TS, McRae AT, Myers PR (2009) Trends in mitral valve surgery: a single practice experience. J Heart Valve Dis 18:359–366PubMedGoogle Scholar
  70. 70.
    Rankin JS, Sharma MK, Teague SM, McLaughlin VW, Johnston TS, McRae AT (2008) A new approach to mitral valve repair for rheumatic disease: preliminary study. J Heart Valve Dis 17:614–619PubMedGoogle Scholar
  71. 71.
    Romano MA, Patel HJ, Pagani FD, Prager RL, Deeb GM,Bolling SF (2005) Anterior leaflet repair with patch augmentation for mitral regurgitation. Ann Thorac Surg 79:1500–1504PubMedCrossRefGoogle Scholar
  72. 72.
    Aubert S, Flecher E, Rubin S, Acar C, Gandjbakhch I (2007) Anterior mitral leaflet augmentation with autologous pericardium. Ann Thorac surg 83:1560–1561PubMedCrossRefGoogle Scholar
  73. 73.
    von Oppell UO, Mohr FW (2000) Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops. Ann Thorac Surg 70:2167–2168Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • C.A. Yankah
    • 1
  • H. Siniawski
    • 2
  • R. Hetzer
    • 2
  1. 1.Consultant Cardiothoracic & Vascular Surgeon Deutsches Herzzentrum BerlinCharité Medical University BerlinBerlinGermany
  2. 2.Deutsches Herzzentrum BerlinCharité Medical University BerlinBerlinGermany

Personalised recommendations