Current treatment of mitral regurgitation / UNI-MED Science (PDF)
(Sprache: Englisch)
Mitral regurgitation is today the second most common valvular pathology in industry countries. With changing demographics it will increase in prevalence in the next decades. Since the early days treatment of mitral regurgitation the area has undergone major...
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Mitral regurgitation is today the second most common valvular pathology in industry countries. With changing demographics it will increase in prevalence in the next decades. Since the early days treatment of mitral regurgitation the area has undergone major changes, and in the past 15 years we have experienced a dynamic evolution.
Minimally invasive approaches have entered clinical practice, and new surgical procedures are on the horizon. Most recently we have seen the development of interventional approaches to the disease, thus generating interest in the disease also by interventional cardiologists. Formerly a pure "surgical" disease, mitral regurgitation has developed into a multi-disciplinary area. These recent developments in treatment of heart valve disease emphasize the need for an integrated approach while keeping innovation in the context of the current state of the art.
This book focuses specifically on mitral regurgitation, integrating anatomical, physiological, cardiological, and surgical aspects in an updated form. It was written by a multidisciplinary team and offers a condensed but detailed overview, aiming at a broad spectrum of health care professionals.
Minimally invasive approaches have entered clinical practice, and new surgical procedures are on the horizon. Most recently we have seen the development of interventional approaches to the disease, thus generating interest in the disease also by interventional cardiologists. Formerly a pure "surgical" disease, mitral regurgitation has developed into a multi-disciplinary area. These recent developments in treatment of heart valve disease emphasize the need for an integrated approach while keeping innovation in the context of the current state of the art.
This book focuses specifically on mitral regurgitation, integrating anatomical, physiological, cardiological, and surgical aspects in an updated form. It was written by a multidisciplinary team and offers a condensed but detailed overview, aiming at a broad spectrum of health care professionals.
Inhaltsverzeichnis zu „Current treatment of mitral regurgitation / UNI-MED Science (PDF)“
1. Epidemiology 12 1.1. References 12 2. Medical basis - anatomy and echocardiography 14 2.1. Mitral valve anatomy and pathology 14 2.1.1. Introduction 14 2.1.2. General anatomy 14 2.1.3. Pathologies of mitral regurgitation 19 2.1.4. References 22 2.2. The diagnosis of mitral regurgitation 23 2.2.1. Introduction and general overview 23 2.2.2. Notes of clinical physiopathology mandatory for the diagnosis of mitral regurgitation 24 2.2.3. The diagnosis of mitral regurgitation and of its consequences 26 2.2.4. Anatomy and physiopathology by 2-D echocardiography 27 2.2.5. Assessment of mitral regurgitation severity by Doppler echocardiography 31 2.2.6. Magnetic resonance imaging 37 2.2.7. References 37 3. Prognosis, medical therapy and guidelines for surgical therapy 42 3.1. Natural history of chronic mitral regurgitation 42 3.2. Prognosis of chronic mitral regurgitation 42 3.2.1. Mortality 42 3.2.2. Morbidity 44 3.3. Outcome with surgery 44 3.3.1. Operative mortality 44 3.3.2. Late post-operative mortality 44 3.4. Medical management of chronic mitral regurgitation 45 3.5. Indications for mitral valve surgery 45 3.6. Indications for mitral valve surgery in asymptomatic patients 46 3.7. References 47 4. Surgical treatment 52 4.1. Surgical treatment of mitral regurgitation due to degenerative disease 52 4.1.1. Background/history 52 4.1.2. Specific pathology/pathophysiology 52 4.1.3. Preoperative decision making 52 4.1.4. Frequency of lesions 53 4.1.5. Fundamentals of mitral valve reconstructive surgery 53 4.1.6. Postoperative echocardiographic control 56 4.1.7. Posterior leaflet prolapse 57 4.1.7.1. Leaflet resection 57 4.1.7.2. The respect approach 60 4.1.7.3. Annular calcifications 63 4.1.8. Anterior leaflet prolapse 64 4.1.8.1. Autologous techniques 64 4.1.8.2. Artificial chordae replacement 65 4.1.8.3. Surgical techniques for commissural prolapse 66 4.1.9. Results 66 4.1.10. References 68 4.2. Functional mitral regurgitation due to ischaemic or dilated cardiomyopathy
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70 4.2.1. General considerations 70 4.2.2. Pathophysiology 70 4.2.3. Surgical therapy 72 4.2.4. Annuloplasty 72 4.2.5. Results 72 4.2.6. Adjunctive techniques 73 4.2.7. How we do it 75 4.2.8. References 76 4.3. Surgical treatment of rheumatic mitral regurgitation 79 4.3.1. Introduction 79 4.3.2. Basic considerations 79 4.3.3. Benchmark studies in rheumatic mitral valve repair 80 4.3.4. Current approaches of rheumatic mitral valve repair 80 4.3.5. Associated problems 82 4.3.6. How we do it 83 4.3.7. Results 87 4.3.8. References 89 5. Results of mitral valve replacement and repair 92 5.1. Introduction 92 5.2. Results of mitral valve replacement 92 5.2.1. Peri-operative mortality and morbidity after mitral valve replacement 92 5.2.1.1. Peri-operative mortality 92 5.2.1.2. Peri-operative morbidity 93 5.2.2. Long-term outcome after mitral valve replacement for organic MR 94 5.2.2.1. Long-term post-operative mortality 94 5.2.2.2. Long-term post-operative morbidity 94 5.2.3. Mechanical versus biological prostheses 95 5.3. Results of mitral valve repair 97 5.3.1. Feasibility of repair 97 5.3.2. Peri-operative mortality and morbidity after repair of organic MR 98 5.3.2.1. Peri-operative mortality 98 5.3.2.2. Peri-operative morbidity 98 5.3.3. Long-term outcome after repair of organic MR 99 5.3.3.1. Long-term post-operative mortality 99 5.3.3.2. Long-term post-operative morbidity 99 5.3.3.3. Recurrence of mitral regurgitation 100 5.4. Mitral valve repair or replacement? 102 5.4.1. Superiority of repair 102 5.4.1.1. Post-operative left ventricular function 102 5.4.1.2. Peri-operative mortality and long-term outcome 103 5.4.1.3. Reoperation rates 104 5.4.2. The elderly patients 104 5.4.3. Subsequent mitral surgery after repair failure 106 5.4.4. Mitral repair: panacea of surgical treatment of organic MR? 106 5.4.5. Special considerations on functional-ischaemic MR 107 5.5. References 108 6. Percutaneous transcatheter approaches for the treatment of mitral regurgitation 114 6.1. Introduction 114 6.2. Transcatheter mitral valve repair 114 6.3. Mitral annuloplasty approaches 115 6.3.1. Indirect mitral annuloplasty approaches 115 6.3.2. Direct mitral annuloplasty approaches 120 6.4. Ventricular reshaping devices 121 6.5. Mitral valve repair approaches 123 6.6. Other mitral valve repair techniques 125 6.7. Future perspectives 125 6.8. Conclusion 126 6.9. References 126 7. Future developments in surgery for mitral regurgitation 130 7.1. Imaging: image-guided therapy 130 7.2. Devices for image-guided off-pump adjustment: dynamic rings and beating-heart implantable neochordae devices 132 7.3. Aetiology-specific rings 135 7.4. External compression devices 136 7.5. Biological solutions to correct mitral valve regurgitation 137 7.6. References 138 Index 142
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Bibliographische Angaben
- Autor: Hans-Joachim Schäfers
- 2010, 1. Auflage, 144 Seiten, Englisch
- Verlag: Uni-Med Verlag Ag
- ISBN-10: 3837452115
- ISBN-13: 9783837452112
- Erscheinungsdatum: 07.12.2010
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