BACKGROUND: Chordal replacement techniques are progressively used to treat posterior mitral valve leaflet (PMVL) prolapse while leaflet resection remains commonly in use to address excessive... Show moreBACKGROUND: Chordal replacement techniques are progressively used to treat posterior mitral valve leaflet (PMVL) prolapse while leaflet resection remains commonly in use to address excessive leaflet tissue. For excessive tissue in height, shortening neochords can be used alternatively. Use of chordal replacement techniques has been suggested to result in lower diastolic transvalvular gradients, higher freedom from reoperation and improved left ventricular function.METHODS: From 1/2005 to 12/2016, 150 patients underwent valve repair for isolated PMVL prolapse with excessive tissue. Excessive tissue in height was treated by leaflet resection (N.=99) or shortening neochords (N.=51). Excessive tissue in width was always resected. Logistic regression was used to generate propensity scores for risk-adjusted comparison.RESULTS: Two patients died postoperatively. In the Neochords group, resection of excessive tissue in width was still needed in 28 (55%) cases. Postoperative echocardiography demonstrated residual (>= 2+) mitral regurgitation in 2/150 patients (Resect group). No differences in anuloplasty ring size, postoperative diastolic transralvular gradients or left ventricular function were observed. Median clinical follow-up duration was 4.4 (IQR 2.0-7.0; 98% complete) years. There was no inter-group difference in overall survival or freedom from reintervention. Mean echocardio-graphic follow-up was 3.0 (IQR 1.2-5.4: 93% complete) years. In the matched population, the 6-year freedom from recurrent mitral regurgitation rates were 91.3% (95% CI: 81.9-100%) and 97.2% (95% CI: 91.9-100%) for the Resect and Neochords group, respectively (P=0.43).CONCLUSIONS: Both leaflet resection and shortening neochords provide a valuable tool to address excessive PMVL height. Repair durability is excellent regardless of the technique utilized. Show less
Atashi, A.; Verburg, I.W.; Karim, H.; Miri, M.; Abu-Hanna, A.; Jonge, E. de; ... ; Eslami, S. 2018
Aim The aim of this study was to assess the diagnostic accuracy of the Doppler derived maximal systolic acceleration (ACC(max)) as a novel technique for evaluating peripheral arterial occlusive... Show moreAim The aim of this study was to assess the diagnostic accuracy of the Doppler derived maximal systolic acceleration (ACC(max)) as a novel technique for evaluating peripheral arterial occlusive disease (PAOD) in patients with diabetes mellitus, who are known for a falsely elevated ankle-brachial index (ABI). Methods. In this retrospective analysis ACC(max) was measured at ankle level in a series of 163 consecutive patients referred to the vascular laboratory for initial assessment of PAOD. Patients were classified according to the presence or absence of diabetes. In the non-diabetic patients PAOD was defined as ABI <= 0.90. This group was used to establish the association between ACC(max) and ABI in a linear regression model. The result was then used to predict the presence or absence of PAOD in the diabetic patients. Results. The authors examined 301 lower limbs. The study group consisted of 166 limbs of patients without diabetes and 135 limbs of patients with diabetes. PAOD was present in 52% of limbs in the nondiabetic group versus 59% of limbs in the diabetic group (ABI <= 0.90, or in case of non-compliant vessels toe-brachial index (TBI) <= 0.70). An ACC(max) cut-off value of >10 m/s(2) was found to be highly predictive for the exclusion of PAOD (negative predictive value 95%). In addition, the ACC(max) cut-off value of <6.5 m/s(2) was highly predictive for the detection of PAOD (positive predictive value 99%). A strong quadratic association was found between ACC(max) and ABI in the non-diabetic group (R-2=0.85). In the diabetic patients R-2 values were 0.81 and 0.79 after ABI and TBI measurement respectively. Conclusion. DUS-derived ACC(max) an accurate marker that could offer significant benefits for the diagnosis of PAOD, especially in diabetic patients. Show less
