J Heart Valve Dis
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Functional ischemic mitral regurgitation (MR) can occur secondary to coronary artery disease. Controversy exists regarding management of these patients. Mitral valve annuloplasty in conjunction with coronary artery bypass grafting (CABG), accepted as the best treatment for severe MR, has been disputed for lesser degrees of regurgitation due to higher mortality. The results of a combined procedure approach were reviewed. ⋯ Functional ischemic MR remains a difficult problem to treat, and has a poor long-term outcome. Ring annuloplasty for functional ischemic MR with coronary artery disease achieves immediate valve competence. However, a significant number of patients develop recurrent MR at intermediate follow up.
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Valve selection for the small aortic root is a multifactorial process. Considerations include the effective orifice (EOA) of the implanted valve, annular size, body surface area (BSA), and valvular outflow tract of each patient. To decide if a valve is adequate for a patient, the valve EOA and patient BSA are used to calculate the indexed EOA (EOA/BSA). ⋯ Pledgetted sutures can draw tissue underneath the valve and reduce the EOA. In conclusion, multiple factors must be evaluated when deciding which valve to use as a replacement in the small aortic root. These include patient age, lifestyle, pregnancy status, and drug compliance, as well as the indexed EOA of available prosthetic valves and the surgical procedure required for implant.
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The value of routine transesophageal echocardiography (TEE) was confirmed by the detection of rare and potentially serious complications in four of 136 patients (2.9%) undergoing valvular surgery. In case 1, one leaflet of a St. Jude Medical (SJM) valve implanted in the mitral position was stuck in the closed position; normal valve function was restored by 90 degrees rotation of the prosthesis. ⋯ In case 4, a foreign body was observed in the left atrium after aortic valve replacement for calcified aortic stenosis. The left atrium was re-opened, and a free-floating portion of the calcified native aortic valve was identified and removed. Routine intraoperative TEE in valve surgery permits the identification and management of potentially serious complications before discontinuing cardiopulmonary bypass.