Valve Surgery at the Turn of the Millennium by Daniel I. Simon, Campbell Rogers

By Daniel I. Simon, Campbell Rogers

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Eur Heart J 1991; 12S:30-33 Rankin JS, Hickey MS, Smith LR et al: Ischemic mitral regurgitation. Circulation 1989; 79: 1621 van Dantzig JM, Delemarre BJ, Koster RW, Bot H, Visser CA;Pathogenesis of mitral regurgitation in acute myocardial infarction: importance of changes in left ventriculra shape and regional function. Am Heart J 1996; 131:865-871 Sharma SK, Seckler J, Israel DH, Borrico S, Ambrose JA: Clinical, angiographic and anatomic findings in acute severe ischemic mitral regurgitation. Am J Cardiol 1992;70:277-280 Kaul S, Spotnitz WD, Glasheen WP, Touchstone DA: Mechanism of ischemic mitral regurgitation: an experimental evaluation.

Acute immobilization of a mechanical prosthesis disc (so called sticking disc) is a rare but life-threatening complication often caused by chord remnants or stitches. This can be easily visualized by TEE. A high transprosthetic gradient despite a normally functioning prosthetic valve may occur after implantation of a valve prosthesis that is too small for the patient’s body surface area (Valve Prosthesis – Patient mismatch). This is discussed in another chapter. Prosthetic valve leakage Prosthetic valves can be divided in mechanical and bioprosthetic valves.

Furthermore attention has to be payed to complications as paravalvular abcess and fistula formation. MR onset in these patients usually is sudden and poorly tolerated when severe thus leading to urgent surgery because of hemodynamic deterioration. Depending on the stage of the infectious disease in which the patient has to be operated and the degree of valve tissue destruction valve repair can be done. 17 Ischemic MR accounts for a large amount of patients undergoing mitral valve surgery, around 30 percent4.

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