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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Mitral valvuloplasty has become an increasingly accepted alternative to valve replacement, although the strong learning curve attached to the procedure has deterred many surgeons from adopting it. Since it was developed in the late 1960s by Carpentier, comprehensive valvuloplasty has undergone modifications and additions dictated by the experiences thus acquired, which have contributed to make it a more reproducible and predictable procedure. Mitral valve disease, especially that of rheumatic origin, has a multifactorial pathogenesis, as all the components of the valve apparatus are usually involved. Consequently, valvuloplasty requires a combination of multiple techniques, each one directed at correcting each affected component. The excellent median-term results observed by some of the more experienced groups have contributed to change the indications for surgery, and patients are being referred earlier and in a lower functional class. Hence, in mitral valve prolapse surgery is currently offered to asymptomatic patients with significant regurgitation, before dysfunction of the myocardium and dilatation of the cardiac chambers occur. Valve repair has been possible and successful in virtually all patients with this pathological condition. On the other hand, surgeons are becoming more aggressive towards ischaemic mitral regurgitation of mild or moderate severity. More recently, valvuloplasty has also been performed in some patients with infective endocarditis, with good results. By contrast, the long-term results in rheumatic disease appear favourable, especially in children and young patients with acute carditis. Nevertheless, they have still been proven better than those of valve replacement in these population groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Mitral valve repair into the 1990s. 138 72

From 1976 to 1989, 122 patients underwent isolated mitral valve replacement with a bioprosthesis for non-ischaemic mitral insufficiency. There were 76 women and 46 men, with a mean age of 52 years. Mitral valve disease was of rheumatic origin in 71 (58%), due to myxomatous degeneration in 50 (41%), and congenital in one. Early mortality was 3.3% (4 pts). The 10-year survival was 65 +/- 7%. A follow-up was available for all 122 patients, averaging 78 months, for a total of 763 patient-years. Valve-related (VR) complications included: 16 thromboembolic episodes in 13 patients (2.1% pt-yr), 3 endocarditis in 2 patients (0.4% pt-yr), and 20 reoperations (2.6% pt-yr), 19 of which were due to intrinsic structural deterioration of the tissue valve. There was no haemorrhagic episode. Overall, 32 patients suffered a VR complication (4.2% pt-yr). The 10-year freedom rates from haemorrhage, endocarditis, thromboembolism, and reoperation were 100%, 98%, 87%, and 64% respectively. After 10 years, 87% of the patients were free from VR mortality, 84% were free from VR mortality and permanent disability, and 52% remained free from all VR complications. While 69% of the patients (84 pts) were in functional class III or IV preoperatively, 89% (102 pts) of the survivors were in class I or II after operation. Excellent survival and clinical results have been obtained with the use of bioprostheses in this disease. However, because durability beyond 10 years appears to be limited and the cause of major morbidity, tissue valves are now used more selectively.
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PMID:Valve replacement with bioprostheses for non-ischaemic mitral insufficiency. 193 23

We have reviewed the risks and benefits of anticoagulation for cardiac valve disease before and after valve surgery. Though the absence of standardized reporting of complications and the paucity of well-designed comparative studies mandate careful consideration of the variables of individual cases, we have made the following general recommendations: Unoperated patients with rheumatic mitral valvular disease and atrial fibrillation should be chronically treated with warfarin, regardless of the hemodynamic severity of their valvular lesion. The presence of right- or left-sided heart failure is an indication for warfarin treatment, in the absence of significant contraindications. There is emerging evidence that platelet-suppressant therapy may be of benefit in diminishing the thromboembolic risk of at least a subset of patients with rheumatic valvular disease and decreased platelet survival. Until platelet-survival studies are more readily available and larger-scale studies can be performed, however, we do not recommend routine treatment with platelet-active agents. We recommend chronic warfarin anticoagulation in all patients with mechanical prostheses in either the aortic or mitral position, regardless of cardiac rhythm or prosthesis model. We do not routinely add platelet-active agents except in the case of embolism despite adequate anticoagulation with warfarin. Patients with aortic bioprostheses generally do not require warfarin treatment for more than 3 months following valve replacement. The presence of atrial fibrillation and marked depression of postoperative ventricular function are indications for chronic anticoagulation. In the case of mitral bioprostheses, we recommend indefinite warfarin treatment for patients with atrial fibrillation, depressed ventricular function, or low cardiac output. We consider a preoperative history of embolism or an operative finding of left atrial thrombus to be an additional indication for anticoagulation, in the absence of significant contraindications. Patients on anticoagulant therapy should be followed closely--when possible in specialized anticoagulation clinics--to minimize the risks of treatment. Specific recommendations are made for management of anticoagulation during infective endocarditis, pregnancy, and noncardiac surgery.
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PMID:Anticoagulation in valvular heart disease preoperatively and postoperatively. 672 54