Intermediate-term results of a nonresectional dynamic repair technique in 662 patients with mitral valve prolapse and mitral regurgitation

ObjectiveA nonresectional technique has been developed for repair of mitral leaflet prolapse causing mitral regurgitation. Polytetrafluoroethylene chordae are used for correction of edge misalignment of the prolapsed mitral leaflet. New chordal length is adjusted during progressive left ventricular inflation to systolic pressure. Annular sizing is determined dynamically after leaflet edge alignment is accomplished to produce an optimal zone of predefined leaflet apposition. The aim of this study was to document the 8- to 10-year durability of this nonresectional approach.MethodsFrom 1983 through 2008, 1121 consecutive patients had mitral valve repair on one service. Of these, 662 had repair of mitral leaflet prolapse. From 1983 until 1998, standard quadratic leaflet resection/plication was used in 72 (11.1%) patients, similar but smaller resection in 93 (14.1%) patients, and then smaller resection and polytetrafluoroethylene chordae in 24 (3.7%) patients. All received Puig–Massana fully flexible rings (Shiley, Inc, Irvine, Calif). After 1998, no leaflet resections or valve replacements have been performed regardless of leaflet size in 566 consecutive patients. Of the 662 patients, the mean age was 62.6 ± 14.1 years, and 424 (64.1%) patients were male. Coronary artery disease was present in 147 (22.2%) patients and 33 (5.0%) had prior coronary artery bypass. Leaflets corrected were as follows: anterior, 152 (23.0%) patients; posterior, 427 (64.5%); and both, 83 (12.5%) Common pathologic characteristics of prolapsing valves were as follows: myxomatous, 332 (50.2%) patients, degenerative, 83 (12.5%), ischemic, 31 (4.7%), and rheumatic, 29 (4.4%).ResultsPerioperative mortality was 2.9% (19/662) overall and 0.49% (2/414) for isolated repair. Freedom from reoperation at 10 years (Kaplan–Meier) was 90.1% and freedom from significant mitral regurgitation (echocardiography) was 93.9%.ConclusionsThis study confirms that mitral regurgitation from mitral leaflet prolapse can be repaired in all cases by a nonresectional technique provided that accurate dynamic evaluation of chordal length and annular sizing is achieved. The intermediate-term results are durable

Surgical management of children and young adults with the Wolff-Parkinson-White syndrome

The Wolff-Parkinson-White syndrome, as originally described, includes palpitations, tachycardia, and an abnormal electrocardiogram (short PR interval and wide QRS complex). The clinical manifestations are dependent upon a reentrant tachycardia supported by an accessory connection bridging the atrioventricular junction and frequently appear during the first two decades of life. Palpitations are the usual symptoms; less frequently, severe symptoms, such as syncope and sudden death, may result from very rapid atrioventricular conduction across the accessory connection during atrial fibrillation. We report the surgical management of 30 young patients with this syndrome, including 6 with life-threatening tachycardia. Surgical interruption of the accessory connection(s) was curative in 90% (27/30) of the patients; life-threatening symptoms were eliminated in the other three. Based on the limited knowledge of the natural history of the Wolff-Parkinson-White syndrome, the individual patient symptoms, and the electrophysiologic properties of each patient's accessory pathway(s), an algorithm is presented outlining the treatment options. This experience strongly suggests that surgical treatment of the Wolff-Parkinson-White syndrome is safe, effective, and possibly the preferred treatment for this disorder in selected young symptomatic patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41585/1/380_2005_Article_BF02058591.pd

Genomic Dissection of Bipolar Disorder and Schizophrenia, Including 28 Subphenotypes

publisher: Elsevier articletitle: Genomic Dissection of Bipolar Disorder and Schizophrenia, Including 28 Subphenotypes journaltitle: Cell articlelink: https://doi.org/10.1016/j.cell.2018.05.046 content_type: article copyright: © 2018 Elsevier Inc

GWAS meta-analysis of intrahepatic cholestasis of pregnancy implicates multiple hepatic genes and regulatory elements

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder affecting 0.5–2% of pregnancies. The majority of cases present in the third trimester with pruritus, elevated serum bile acids and abnormal serum liver tests. ICP is associated with an increased risk of adverse outcomes, including spontaneous preterm birth and stillbirth. Whilst rare mutations affecting hepatobiliary transporters contribute to the aetiology of ICP, the role of common genetic variation in ICP has not been systematically characterised to date. Here, we perform genome-wide association studies (GWAS) and meta-analyses for ICP across three studies including 1138 cases and 153,642 controls. Eleven loci achieve genome-wide significance and have been further investigated and fine-mapped using functional genomics approaches. Our results pinpoint common sequence variation in liver-enriched genes and liver-specific cis-regulatory elements as contributing mechanisms to ICP susceptibility