Surgical Pathology of the Mitral Valve: Gross and Histological Study of 1288 Surgically Excised Valves (original) (raw)

Rheumatic mitral valve surgery: about 1025 cases

Rheumatic mitral valvulopathy remains a disease frequent in our country and poses a public health problem. 1 It is often associated with other valvulopathies. In this study we will attempt to evaluate the clinical and therapeutic characteristics of rheumatic mitral valve disease. 2 METHODS This study provides a retrospective analysis of 1025 cases involving patients who underwent mitral valve surgery at Ibn Sina Hospital in Rabat, Morocco between the dates of January 2, 2001 and April 5, 2012. These data were obtained by medical staff within the Department of Cardiovascular Surgery ("B") at Ibn Sina Hospital. Excluded from the study are the following groups: • Patients diagnosed with mitral valve disease but in a pre-operative state. • Patients diagnosed with congenital mitral valve disease. • Patients operated on for only plasty in a closed mitral valve surgical procedure. Statistical analysis was performed using the SPSS (v17.0) software program. Quantitative variables are analyzed in terms of means and standard deviations. Qualitative variables are analyzed in terms of percentages and frequencies. RESULTS The average age of subjects in our study was 43.94 (±12.74). The average age of females was 43.65 (8, 82%). The average age of males was 44.45 (8, 79%).

Quantitative study of the mitral valve in chronic rheumatic heart disease

International Journal of Cardiology, 1987

HL. Quantitative study of the mitral valve in chronic rheumatic heart disease. Int J Cardiol 1987;16:271-284. A quantitative study of the mitral valve and its tension apparatus was carried out in 54 cases of pure mitral stenosis, 13 cases of mitral stenosis with incompetence, both diseased groups due to rheumatism, and 25 normals. In the group with pure mitral stenosis, the annular size was unaltered but the annular attachment of the mural leaflet was decreased. The average circumference of the orifice was 27 mm. The leaflet length increased by 24%. In the group with mitral stenosis with incompetence, the annular size was increased by 18%. The average circumference of the orifice was 39 mm, but no significant increase in the length of the leaflets was found. The rough zone of the aortic leaflet in pure mitral stenosis is disproportionately increased, indicating greater apposition during closure. In pure mitral stenosis, the cords were severely affected as compared to combined lesion. They were totally absent in 18.5% of cases while this lesion was restricted to the aortic leaflet in 37%. The commissural, paracommissural and paramedial cords were not seen in 75, 60, and 72%. The main cords were not seen in 50% of cases. In the combined lesion, cords attached to the aortic leaflet only were absent in 7.69%. The commissural, paracommissural and paramedial cords were absent in 33, 39, and 23%, respectively. The main cords were absent in only 19%. The reduction in lengths of the cords is more marked in cases with pure stenosis. We conclude that the mitral valve is better preserved in the group having stenosis with incompetence, the incompetence being the result of a larger annulus and orifice with normal leaflets and shorter tendinous cords. In pure mitral stenosis, the incompetence through a small orifice is prevented by the longer leaflets, particularly the aortic.

Morphological findings in 192 surgically excised native mitral valves

Canadian Journal of Cardiology, 2006

M itral valve disease (MVD) affects 1% to 2% of the adult population, resulting in nearly 3000 deaths in the United States annually (1). The mitral valve apparatus consists of the leaflets, commissures, annulus, chordae tendineae, papillary muscles and the atrial and ventricular myocardium (2). The two leaflets, anterior and posterior, are connected to each other by the commissures. Although the anterior leaflet is longer (base to free margin), the posterior leaflet is wider (side to side) (2,3). The leaflets are supported by the chordae tendineae, which are attached to the papillary muscles. Histologically, the mitral valve consists of three layers (from atrial to ventricular surfaces): the atrialis (fibroelastic layer), the spongiosa (largely myxoid tissue) and the fibrosa (strong collagenous layer) (3). A number of different processes can lead to MVD that can manifest as stenosis, incompetence or a combination of both. Mitral stenosis (MS) is most frequently postinflammatory and almost invariably due to rheumatic disease, an immune-mediated manifestation of streptococcal pharyngitis (3,4). Immune responses, resulting from streptococcal antigens produced during acute rheumatic fever, likely lead to a reaction in endocardial tissue, such as valvular tissue, which leads to progressive commissural fusion and leaflet scarring. Altered blood flow CLINICAL STUDIES

Long-Term (29 Years) Results of Reconstructive Surgery in Rheumatic Mitral Valve Insufficiency

Circulation, 2001

Background-Results of conservative surgery are well established in degenerative mitral valve (MV) insufficiency. However, there are controversies in rheumatic disease. This study is the evaluation of one center for rheumatic MV insufficiency based on a functional approach. Methods and Results-From 1970 to 1994, 951 patients with rheumatic MV insufficiency were operated on with the reconstructive techniques elaborated by Alain Carpentier. Aortic valve diseases were excluded. Mean age was 25.8 years (4 to 75), and sinus rhythm was present in 63%. The functional classification used was type I, normal leaflet motion, 71 patients (7%); type II, prolapsed leaflet, 311 patients (33%); and type III, restricted leaflet motion, 345 patients (36%). The combined lesion of prolapse of the anterior leaflet and restriction of the posterior was present in 224 patients (24%). Surgical techniques used were implantation of a prosthetic ring in 95%, shortening of the chords and leaflet enlargement with autologous pericardium, and commissurotomy. Hospital mortality rate was 2%. The mean follow-up was 12 years (maximum, 29 years): 8618 patients per year. Actuarial survival was 89Ϯ19% at 10 years and 82Ϯ18% at 20 years. The rate of thromboembolic events was 0.4% patients per year (33 events), with 3 deaths. Freedom from reoperation was 82Ϯ19% at 10 years and 55Ϯ25% at 20 years. The main cause (83%) of reoperation was progressive fibrosis of the MV. The actuarial rate of reoperation was 2% patients per year and was correlated to the degree of preoperative fibrosis. Conclusions-Conservative surgery of rheumatic MV insufficiency has a low hospital mortality rate and an acceptable rate of reoperation. The results are excellent regarding the minimal risk of thromboembolic events. (Circulation. 2001; 104[suppl I]:I-12-I-15.

Valve repair for rheumatic mitral disease

The Journal of heart valve disease, 2001

Mitral valve repair is the standard reparative technique for degenerative mitral disease, but results of valve repair in rheumatic disease are also encouraging. The outcomes after mitral valve repair for rheumatic disease at young age was evaluated for suitability of repair. A total of 319 patients (246 females, 73 males; mean age 31.3+/-0.5 years) underwent mitral valve repair for rheumatic mitral disease at the authors' institution between 1991 and 1998. Mean follow up was 51.9+/-1.2 months (range: 9-98 months), and was 88.7% complete. Preoperatively, 47.6% of patients were in NYHA classes III and IV. Mitral stenosis was present in 87.5%, insufficiency in 5.3%, and stenosis/insufficiency in 7.2%. Concomitant procedures were performed in 32% of patients who had associated cardiac lesions. The intraoperative mortality, reoperation and reoperation mortality rates were 0.9%, 6.7% and 0%, respectively. During follow up there were 10 late deaths (3.5%), six of which were cardiac dis...