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Mitral Valve Peravalvular (Periprosthetic) Leak. Incidence of Mitral Valve Peravalvular Leak. Reported frequency of 1.2-12.5% after mitral valve replacement Presenting symptoms 73.3% heart failure 16.2 % hemolysis 10.3%no symptoms Surgical results

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Presentation Transcript
incidence of mitral valve peravalvular leak
Incidence of Mitral Valve Peravalvular Leak
  • Reported frequency of 1.2-12.5% after mitral valve replacement
  • Presenting symptoms
    • 73.3% heart failure
    • 16.2 % hemolysis
    • 10.3%no symptoms
  • Surgical results
    • 40-60% of peravalvular leaks could be repaired primarily without replacement of valve
jacobs et al 1994
 Jacobs et al 1994
  • 116 mitral valve surgeries (46 MV, 57 MV/CABG, 13 MV/AVR)
  • 8 patients with MV peravalvular regurgitation
  • 2/8 moderate
    • both progressed to severe at 18 months
  • 6/8 mild:
    • 2/6 increased from mild to moderate
    • one with CHF treated medically
    • other symptom free
jacobs et al 19941
Jacobs et al 1994
  • Conclusion:
    • Moderate peravalvular leak should be corrected at time of valve replacement if can be performed without high operative risk.
    • Mild peravalvular leak should probably also be corrected if low risk and surgeon believes high likelihood of success
    • Serial follow-up of peravalvular leak is important.
plehn et al 2001
Plehn et al 2001
  • Found that people did well with trivial or mild peraprosthetic regurgitation.
risk factors for mv peravalvular leak
Risk factors for MV Peravalvular Leak
  • Strong
    • Endocarditis
    • Annular calcification
  •  Less Strong
    • Dilated cardiomyopathy.
    • Ischemic mitral regurgitation
leak location
  Leak location
  • Pathologic:
    • in region of high calcification
    • in region of endocarditis/abscess
  •  Physiologic stress .
    • Found occurring more commonly in anterolateral and posteromedial portion of the mitral annulus
echocardiographers role
 Echocardiographers role:
  • Define risk factors; annular calcium, infection
  • Search diligently for peravalvular leak post valve replacement.
  • Define location and severity.
case 2 mitral valve peravalvular leak
Case #2Mitral Valve Peravalvular Leak
  • 78 yr old woman presenting with severe Mitral Regurgitation.
  • 5 years prior, patient declined recommendation for repair.
  • On following echoes note severe mitral annular calcification.
  • Surgeon notified of risk of peravalvular leak secondary to calcification.
post bypass
Post Bypass
  • Status post placement bioprosthetic mitral valve
  • Note small peravalvular leak at anterior lateral portion of posterior mitral annulus
  • Note use of altering Nyquist to define location
  • Surgeon had optimized number and technique of annular stitches based on prebypass echo exam. Decision to accept surgical result.
reference
 Reference:
  • Movsowitz, Jacobs et al: Long-term Follow-up of Mitral Paraprosthetic Regurgitation by Transesophageal Echocardiography. J Am Soc Echocardiogr 1994;488-92.
  • O'Rourke, Plehn et al: Outcome of Mild Periprosthetic Regurgitation Detected by Intraoperative Transesophageal Echocardiography. J Am Coll Cardiol 2001;38:163-6.
  • De Cicco, Lorusso: Mitral valve periprosthetic leakage: anatomical observations in 135 patients from a multicentre study. Europ J Cardio Thorac Surg: 30 (2006) 887-891.
  • Akins, MacGillivray: Early and Late Results of the Surgical Correction of Cardiac Prosthetic Paravavlular Leaks. J Heart Valve Dis 2005;14:792-800.
  • Dhasmana, Kirklin, Kouchoukos. Factors Associated With Periprosthetic Leakage Following Primary Mitral Valve Replacement: With Special Consideration of the Suture Technique