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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003E\u201cMyxoid changes are the leading cause of mitral valve (MV) prolapse and regurgitation,\u201d according to Brian Griffin, MD, Cleveland Clinic. Myxoid chordae in MR have \u0026lt;25% of normal load bearing capacity, Dr. Griffin noted. \u201cBut are these myxomatous changes genetically programmed or maladaptative?\u201d Dr. Griffin asked. \u201cMore studies are needed to help answer this question\u201d\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Evalvular\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003E\u201cMyxoid changes are the leading cause of mitral valve (MV) prolapse and regurgitation,\u201d according to Brian Griffin, MD, Cleveland Clinic. Myxoid chordae in MR have \u0026lt;25% of normal load bearing capacity, Dr. Griffin noted. \u201cBut are these myxomatous changes genetically programmed or maladaptative?\u201d Dr. Griffin asked. \u201cMore studies are needed to help answer this question\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ETiming of Surgery\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ETimely\u2014but appropriate\u2014surgical intervention has become the key to better outcomes. Raphael Rosenhek, MD, Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria, asked: \u201cWhen should we operate in MR?\u201d Considerations include pre-op determinants of post-op outcomes, and the likelihood of success in repair vs. replacement, Dr. Rosenhek noted.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/24\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1070371670\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/24\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/24\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/24\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16094\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EA key pre-op factor is ejection fraction (EF). \u201cEF \u0026gt;60% bodes well for operative success,\u201d said Dr. Rosenhek. \u201cBut EF \u0026lt;50% is not so encouraging.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EDr. Rosenhek recommended surgery when symptoms appear, or in asymptomatic patients with LV dilation or falling EFs. \u201cOtherwise, watchful waiting is acceptable.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EA complementary presentation by Robert O. Bonow, MD, Chief, Division of Cardiology, Northwestern University Medical School, said that U.S. guidelines were essentially similar. \u201cThere is a paucity of data regarding MR, so expert consensus is the principal basis for guidelines.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe key is operating early enough to preclude deteriorating symptoms and early death, observed Dr. Bonow, \u201cbut late enough to justify risks of surgical intervention.\u201d In Dr. Bonow\u0027s view, the natural history of MR now favors early intervention. \u201cOne must continue to weigh the anticipated outcome of surgery against the expected outcome of either watchful waiting or medical management alone.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPecutaneous MV Repair\u003C\/h2\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EAllan Schwartz, MD, Chief, Division of Cardiology, Columbia University, reviewed surgical alternatives. \u201cThe Alfieri approach was first used about 10 years ago,\u201d he said. \u201cThis is an edge-to-edge method that brings together the middle scallops of the mitral leaflets to create a double orifice.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EThe technique has gained popularity over the last decade, and has extended indications for mitral valve repair.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003E\u201cBut percutaneous approaches are gaining ground and may ultimately prove the best option for repair in many patients,\u201d said Dr. Schwartz.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EDr. Schwartz cited EVEREST II, which he termed \u201ca pivotal study of percutanous techniques in MV surgery.\u201d EVEREST II evaluated a percutaneous method to create the same type of repair as the Alfieri method using the \u201cmitra-clip.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EDr. Schwartz shared vivid animated imagery demonstrating the mitra-clip\u0027s insertion and placement in the left atrium. The clip is then centered over the valve orifice, passed just beyond into the left ventricle and pulled back to grasp the mitral leaflets. After verification that MR is reduced, the clip is released.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EIn EVEREST II clips were placed in 24 patients. In 13 of 14 patients with reduction of MR to \u0026lt;\/= 2+ at 30 days post-clip, the clip repair was intact at 6 months.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EEVEREST II demonstrated that percutaneous edge-to-edge mitral valve repair can be performed safely. \u201cIf you can get out to 3 months post-clip without problems, the odds are good it will stick,\u201d said Dr. Schwartz.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2006 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/6\/1\/24.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzl59d\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl59d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}