Introduction: Transcatheter mitral valve-in-valve (ViV) & valve-in-ring (ViR) are relatively novel therapeutic alternatives for patients with degenerated bioprostheses or failed annuloplasty rings whose reoperative risk is too high. The predominant procedural access for both procedures is transapical or transseptal. However, whether there are differences in outcomes of this procedure using transseptal versus transapical access has not yet been defined. Methods: We conducted a systematic review of all published articles from MEDLINE and EMBASE to explore the outcomes of these two procedural approaches. Results: A total of 55 studies including 183 patients (154 ViV and 29 ViR) were included. Patients that underwent ViV (101 transapical and 53 transseptal) using the transseptal approach required more iatrogenic atrial septal defect (ASD) closure (19% versus 0. 0 %; P < 0. 001) and hence had a lower device success rate (68% versus 89%; P = 0. 001). However, there was no significant difference between the two groups in procedural success and all-cause mortality at 30 days. Overall severe bleeding complications (major or life threatening) were not different the two groups (3. 7% versus 7. 9%; P = 0. 321). In the ViR group (19 transapical and 10 transseptal), no difference in procedural success, device success or 30-day outcomes were identified between transseptal and transapical groups, although sample size was small. Conclusion: In conclusion, mitral ViV and ViR using the two different procedural approaches appear to confer equal and reasonable 30-day outcomes.

A 44-year old man was referred to our hospital because of right hemianopsia for three months. Physical examination was unremarkable except for left leg amputation because of trauma backed to last year. Laboratory studies including WBC count, BUN, creatinine, liver function test, ECG and chest x ray were normal.

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.

Infective endocarditis (IE) is lethal complications inspite of advanced antibiotics. Prosthetic valve endocarditis (PVE) complications are dehiscence, paravalvular leak, perivalvular abscess, heart failure, persistent fever, positive blood culture and presence of vegetation. Therefore, the diagnosis is confirmed by clinical findings, blood cultures, and echo data according to Duke’, s criteria. Surgery in those cases are life-saving when indicated, despite it carries high risk mortality especially after stroke.

Primary heart tumors are not common. Although myxoma is the most common tumor of the heart, mitral valve myxoma is extremely rare. The patient is a 55 years old woman who had atypical retrosternal pain, retinal artery emboli and visual deficit. In transesophageal echocardiography a (4x3x3) cm mass was detected in posterior leaflet of mitral valve. The posterior leaflet of mitral valve was totally resected and the mitral valve was successfully replaced with prosthetic mechanical valve. Histopathology result confirmed myxoma.

Myxoma is the most common type of primary tumors of the heart. It is a rare tumor with an estimated incidence of 0.5 per million populations per year. Most cardiac myxomas originate in the atrial septum in the area of the fossa ovalis and 75% occur in the left atrium. Valvular myxomas are very rare: the tricuspid valve is the most frequently involved location, followed by the mitral, pulmonic, and aortic valves.Our case was a 24-year-old male with mitral valve myxoma and a history of progressive dyspnea.After diagnosis was confirmed by 2-dimensional echocardiography, he underwent cardiac surgery, the tumor was successfully excised from the posterior leaflet of the mitral valve, and the mitral valve defect was repaired with direct suture.  

Aim. The purpose of this study was to report a case of mitral valve thrombosis. Background. Cardiac valve diseases are among the most important diseases, which is widespread despite many treatments. Among the wide range of treatments, replacement or repair of the valve are among the standard treatments. This treatment has many side effects that can be prevented by adhering to a proper diet. The present reports a rare case of mitral valve thrombosis. Case Report. A 50-year-old female patient undergoes mitral valve replacement (mechanical) and tricuspid valve replacement (mechanical) dated 2018. After discharge, she was treated with 5 mg Warfarin and 80 mg ASA. She returned to the hospital due to progressive shortness of breath. A rare complication of mitral valve thrombosis was diagnosed. Conclusion. Mitral mechanical valve thrombosis is a rare but dangerous complication. Although thrombosis is closely associated with anticoagulant drug use, this study and similar studies have shown that there is usually no clear relationship between INR and thrombosis.

Introduction: Mitral valve prolapse (MVP) is a known benign entity. However, in certain instances it may ensue cerebrovascular complication with ominous prognosis. This study was under taken in the past 9 years and 12 cases with mitral valve prolapse and cerebrovascular complications were diagnosed and their medical data were recorded. The main goals of this study were to try ana detect the possible risk factors and predisposing symptoms of stroke (including vertigo amorosis fugax faint and convulsion) in those patients, and to explore the possibility of prevention.Methods: MVP was diagnosed by physical examination and echocardiographic findings. The cases were divided clinically into two groups; group one which was hospitalized with cerebrovascular accident (CVA) as well paralysis. They include 6 cases aged between 18 and 42 years (average 33.5 years) with a male over female ratio was 2/4. Five out of 6 cases having had mitral regurgitation. Group 2 as the control group with 6 cases who were followed for 10-66 months at the cardiac clinic. Their age range was between 17 to 30 years (average age 22.5 years) one out of 6 had mitral regurgitation. The male to female ratio was 1/5. These cases with symptoms of risk factors as mentioned above were placed on Propranolol dipyridamol and aspirin with follow up of 10-66months (averaging 31 months).Results: In group 1 CT and MRI revealed embolic stroke in 4 cases and hemorrhage CVA in 2 cases, whereas in group 2 MRI and CT revealed ischemic changes without necrosis in 4 cases and normal pattern in 2 cases.Discussion: The conclusion of this study points to the fact that cases of MVP and true stroke as well as paralysis are older and patients with high risk symptoms such as faint, vertigo, convulsion, amorosis fugax, in combination with MVP which warrant the administration of anti thrombotic agents including aspirin dipyridamol while they are on Propranolol. The same is in cases with MVP associated with mitral insufficiency P.F.O. and migraine headache.