Metastatic involvement of cardiac valve and pericardium mimicking a cardiac valve pathology accompanied with cardiac tamponade is a rare phenomenon. These metastases commonly arise from the lymphoreticular system, the pulmonary system, and breast. Metastatic spread of breast carcinoma to the cardiac valve is exceedingly rare, and only two case reports have been detected in English literature so far. We report a rare case of a patient with adenocarcinoma of the breast, which presented with severe mitral valve regurgitation and pericardial effusion which was managed urgently with mitral valve replacement. Our case shows the probability of combined metastatic pericardial and valve involvement in patients with breast adenocarcinoma. The patient was treated with mitral valve replacement and intrapericardial infusion of cisplatinum drug to control possible recurrent effusion.

Background: Ischemic mitral regurgitation is a major source of morbidity and mortality of myocardial infarction. Surgical intervention for significant ischemic mitral regurgitation at the time of coronary artery bypass grafting (CABG) is controversial and has always presented a great challenge. The purpose of this study was to describe the current surgical options for ischemic mitral incompetency and to discuss when mitral valve repair via the Kay method may be favored over mitral valve replacement. Methods: Twelve patients candidated for the Kay mitral valve repair plus CABG were recruited. The efficacy of mitral valve repair was echocardiographically recorded at follow-up. To validate the diagnosis of ischemic mitral regurgitation, we conducted a detailed chart review— which included all preoperative cardiac imaging tests at the first, sixth, and 12th postoperative months, as well as the operative records and pathology reports. Results: Twelve patients (5 male and 7 female) underwent CABG plus the Kay mitral valve repair. All the patients had significant mitral valve incompetency, which was resolved in all of them (P<0. 05). There was no preoperative or postoperative mortality. No further postoperative mortality was reported at 1 year’ s follow-up. The Kay technique for mitral valve repair had a desirable result insofar as 8 (72. 7%) patients had only mild mitral regurgitation and 4 (33. 3%) had mild-to-moderate mitral regurgitation. Conclusions: In the current era and in Iran, mitral valve repair— especially via the Kay method— has been proven to confer improved short and long-term survival, decreased valve-related morbidity, and enhanced left ventricular function. Future randomized prospective clinical trials are needed to compare this cost-effective surgical technique with its counterparts.

Background: The aim of this study was to investigate the feasibility of performing papillary muscle repositioning (PMR) for subvalvular-sparing mitral valve replacement procedures in patients with ischemic mitral regurgitation and to determine the early and late effects of this procedure on the clinical outcome and left ventricular mechanics.Methods: We prospectively randomly allocated 50 patients with severe ischemic mitral regurgitation and left ventricle dysfunction who were candidates for coronary artery bypass graft surgery and mitral valve replacement into a total chordal-sparing mitral valve replacement group or a PMR group. Echocardiography was performed preoperatively, at discharge, and after 3 years to determine the left ventricular dimensions, shape, and function.Results: The reduction in the left ventricle volumes and sphericity index in the PMR group was more significant than that in the other group. With regard to the left ventricular end-systolic and left ventricular end-diastolic volumes, sphericity index, and ejection fraction, the PMR group showed better results (p<0.05), but the difference in New York Heart Association functional class after 3 years was not statistically significant between the two groups (p>0.05).Conclusions: The PMR technique described herein can dramatically help ischemic patients by affecting the left ventricular shape and function more efficiently compared with the complete retention of the mitral subvalvular apparatus if the mitral valve is to be replaced.

Background: The presence of concomitant Mitral Regurgitation (MR) and Pulmonary Hypertension (PH) is a common issue in patients undergoing Transcatheter Aortic Valve Replacement (TAVR). Transthoracic echocardiography plays a role in detecting MR severity and PH before and after TAVR. Objectives: This study aimed to investigate the impact of TAVR on MR severity and PH and to detect the predictors of their improvement. Methods: Totally, 111 patients underwent TAVR at Rajaee Heart Center, Tehran, Iran from December 2012 to January 2021. In this retrospective study, these patients were evaluated for MR and PH improvement after TAVR. The final analysis was performed separately on 32 patients who had moderate or more severe baseline MR and 56 patients with any grade of PH at baseline. Group comparisons based on the MR severity, PH severity, and improvement of MR and PH were analyzed using student t-test for continuous variables and chi-square or Fisher’, s exact test for categorical ones. Finally, the percentage of the patients with improved MR or PH as well as the factors associated with the improvements were determined. Results: Moderate or more severe baseline MR improved by at least one grade one year post-TAVR in 56. 2% of the cases, and TAVR with a balloon-expandable valve was associated with a higher probability of MR improvement. Baseline left ventricular ejection fraction was significantly lower in patients with a higher degree of PH than in those with lower degrees (43% vs. 30%, P < 0. 001). In addition, right ventricular dysfunction was more prevalent in patients with a higher degree of PH. Post-TAVR reduction in systolic pulmonary pressure (at least 10 mmHg) was observed in 77% of the patients after one year. Conclusions: TAVR positively affected MR and PH and reduced their severity in most patients. Tricuspid native aortic valve (in comparison with bicuspid), normal sinus rhythm (in comparison with atrial fibrillation), left ventricular ejection fraction improvement, and absence of left atrial enlargement were associated with a greater MR improvement after TAVR. Left ventricular ejection fraction improvement and TAVR with a balloon-expandable valve were also significantly associated with PH improvement post TAVR.

Background: Most patients with mitral valve prolapse (MVP) are asymptomatic with a normal life expectancy; however, between 5% and 10% of them have progression to severe mitral regurgitation (MR). Because of this silent progression, the size and ejection fraction of the left ventricle are very important in decision-making for surgery in asymptomatic patients with MR. A 3D assessment of LV volumes and ejection fraction is preferred to 2D echocardiography because of its accuracy and reproducibility. Methods: Between April 3, 2018, and February 20, 2019, the present study enrolled 50 patients suffering from MVP with relatively severe MR undergoing transesophageal echocardiography at Rajaie Cardiovascular, Medical, and Research Center, affiliated with Iran University of Medical Sciences. The ejection fraction was analyzed via the visual 2D method, in addition to 3 other methods: the Simpson biplane, 3D full volume, and 3D heart model. Results: Of the 4 measurement methods, the 3D heart model had the highest agreement with the Simpson biplane method (ICC: 0. 859, 95% CI: 0. 745 to 0. 922). The agreement rate between the 3D heart model and the 3D full volume was 72% and between the 3D heart model and the visual 2D method was 64%. In the measurement of the end-diastolic volume, there was a remarkable agreement between the 3D heart model and both the Simpson biplane and 3D full-volume methods (98% and 95%, respectively). Similarly, in the measurement of the end-systolic volume, the rate of agreement between the 3D heart model and both the Simpson biplane and 3D full-volume methods was 91% and 92%, correspondingly. Conclusions: This study showed that the use of the 3D heart model and the Simpson biplane method was more accurate in the study of the left ventricular ejection fraction than that of the visual 2D and 3D full-volume methods. It appears that the use of all 3 methods (ie, the Simpson biplane, 3D full volume, and 3D heart model) in the measurement of the end-systolic and end-diastolic volumes is reliable.

Objective: Considering the importance of annular dynamics in the valvular and ventricular function, we sought to evaluate the effects of treated pericardial annuloplasty rings on mitral annular dynamics and left-ventricular (LV) function after mitral valve repair. The results were compared with the mitral annular dynamics and LV function in patients with rigid and flexible rings and also in those without any heart problems.Materials and Methods: One hundred and thirty-six consecutive patients with a myxomatous mitral valve and severe regurgitation were prospectively enrolled in this observational cohort study. The patients underwent comparable surgical mitral valve reconstruction; of these 100 received autologous pericardium rings (Group I), 20 were given flexible prosthetic rings (Group II), and 16 received rigid rings (Group III). Other repair modalities were also performed, depending on the involved segments. The patients were compared with 100 normal subjects in whom an evaluation of the coronary artery was not indicative of valvular or myocardial abnormalities (Group IV). At follow-up, LV systolic indices were assessed via two-dimensional echocardiography at rest and during dobutamine stress echocardiography.Mitral annular motion was examined through mitral annulus systolic excursion (MASE). Peak transmitral flow velocities (TMFV) and mitral valve area (MVA) were also evaluated by means of continuous-wave Doppler.Results: A postoperative echocardiographic study showed significant mitral regurgitation (>=2+) in one patient in Group I, one patient in Group II, and none in Group III. None of the patients died. There was a noteworthy increase in TMFV with stress in all the groups, the increase being more considerable in the prosthetic ring groups (Group I from 1.10±0.08 to 1.36±0.13 m/s, Group II from 1.30±0.11 to 1.59±0.19 m/s, Group III from 1.33±0.09 to 1.69±0.21 m/s, and Group IV from 1.08±0.08 to 1.21±0.12 m/s). Recruitment of LVEF reserve during stress was observed in the pericardial ring and normal groups (Group I from 54.6±6.2 to 64.6±7.3%, P<0.005; and Group IV from 55.3±5.7 to 66±6.2%, P<0.05), but no significant changes were detected in the prosthetic ring groups (Group II from 50.4±5 to 55.0±5.1, and Group III from 51.1±6.6 to 53.8±4.7). There was a significant MASE increase in both of the studied longitudinal segments at rest and during stress in Groups I and IV compared with the prosthetic ring groups. There was no calcification of the pericardial rings.Conclusions: The use of treated autologous pericardium rings for mitral valve annuloplasty yields excellent mitral annular dynamics, preserves LV function during stress conditions, and leaves no echocardiographic signs of degeneration.