By Larry R. Kaiser, MD, Irving L. Kron, MD and Thomas L. Spray, MD
Chapter 41: Mitral Valve Repair: Ischemic
David H. Adams, Farzan Filsoufi, Lishan Aklog, and Sacha P. Salzberg
Pages 369-377
Excerpt:
“Mitral valve repair is the procedure of choice for correction for type IIIb ischemic mitral regurgitation. The main goal of valve repair is to restore a large surface of coaptation by aggressively reducing the septolateral dimension of the valve with a downsized remodeling (complete, rigid, or semirigid ring) annuloplasty.”
By Frank Sellke, MD, Scott Swanson, MD and Pedro J. del Nido, MD
Chapter 74: Acquired Disease of the Mitral Valve
Farzan Filsoufi, Sacha P. Salzberg, Lishan Aklog, David H. Adams
Pages 1299-1334
Excerpt:
“Mitral valve repair is the procedure of choice for correction of severe mitral regurgitation. The goals of valve repair include preserving leaflet mobility, restoring a large surface of coaptation, and stabilizing the results with a remodeling annuloplasty. Current surgical techniques allow surgeons to perform reconstructive surgery in almost all patients with mitral regurgitation, provided there is an adequate amount of pliable and mobile leaflet tissue. A systematic approach to reconstructive surgery include the determination of the exact mechanism of mitral regurgitation by intraoperative inspection and valve analysis; meticulous application of standard techniques of repair, including remodeling annuloplasty; and evaluation of the quality of repair by saline test and TEE.”
Chapter 86: Ischemic Mitral Regurgitation
Lishan Aklog, Farzan Filsoufi, David H. Adams
Pages 1525-1548
Excerpt:
“Patients with type I or IIIB ischemic MR typically present with one of two clinical scenarios. The more common scenario is a patient with symptomatic multivessel coronary artery disease, with or without associated congestive heart failure symptoms, who is referred for surgical or percutaneous revascularization and who is noted to have mild to moderate MR on preoperative echocardiography or ventriculography. The other scenario is a patient with moderate to severe MR and primarily congestive heart failure symptoms who is referred for mitral valve surgery and who is noted to have multivessel coronary artery disease on preoperative catheterization.
We have proposed a set of criteria to use to define ischemic MR. Some of the clinical literature about ischemic MR is difficult to interpret because of imprecise definitions that lead to etiological and physiological heterogeneity within the patient population. We feel strongly that a relatively simple-but precise-definition of ischemic MR is critical to the presentation of a relatively homogenous group of patients for analysis.”
 Cardiac Surgery in the Adult
By Lawrence H. Cohn, MD and L. Henry Edmunds, Jr., MD
Chapter 39: Surgical Treatment of Mitral Valve Endocarditis
Farzan Filsoufi, David H. Adams
Pages 987-997
Excerpt:
“Infective endocarditis is a well-established cause of valvular heart disease and carries a high risk of morbidity and mortality. During the last 50 years, the introduction and wide use of antimicrobial therapy have significantly changed the course of this disease. The majority of patients can be successfully treated medically with total eradication of the disease process. In certain clinical presentations, however, surgical intervention remains an indispensable adjunct to the management of acute and subacute endocarditis.” Read more...
Braunwald's Heart Disease, 7th Edition
By Douglas P. Zipes, MD, MACC, Peter Libby, MD, Robert O. Bonow, MD and Eugene Braunwald, MD, MD (hon), ScD (hon), FRCP
Chapter 76: Medical Management of the Patient Undergoing Cardiac Surgery
David H. Adams, Farzan Filsoufi, Elliott M. Antman
Pages 1993-2020
Excerpt:
“Continued advances in cardiac surgery make operative repair of a variety of cardiac lesions a viable therapeutic alternative for numerous patients with cardiovascular disease. ... However, the profile of patients referred for surgery has also changed and includes more patients with advanced age, depressed left ventricular function, multiple comorbidities, prior revascularization operations or multiple percutaneous interventions, and failed acute interventional procedures, which has led to higher mortality rates in tertiary care referral centers that are called on to operate on such patients with greater frequency.
This chapter summarizes the information required by the cardiologist, whose important responsibilities include collaboration with the surgical team for both preoperative and postoperative care, especially care of the medical complications that may develop.”
By Joel A. Kaplan, MD, David L. Reich, MD, Carol L. Lake, MD, MBA, MPH and Steven N. Konstadt, MD, MBA, FACC
Chapter 4: The Future of Cardiac Surgery and Anesthesia - The Future of Cardiac Surgery
Anelechi Anyanwu, David H. Adams
Pages 59-64
Excerpt:
“The future of cardiac surgery is closely related to the future of cardiology (see Chapter 3). Because of advances in diagnosis, better medical management, and changing epidemiology and prognosis of cardiovascular disease, the indications for surgical therapy have evolved considerably since the 1980s. However, the greatest determinant of future cardiac surgical practice is the rapidly expanding arena of interventional cardiology. Several diseases that were the domain of surgery can now be managed with percutaneous interventions. The scope and practice of cardiac surgery have evolved considerably since the 1950s (see Chapters 1 and 2) and will continue to evolve in response to these changes in epidemiology and cardiac diagnosis and management. New surgical procedures are being developed while some procedures have become obsolete. For example, in the 1980s, endoventricular resections formed the mainstay of treatment for intractable ventricular arrhythmias, but these procedures are rarely used and have been superseded by new pharmacologic agents and implantable defibrillators. In contrast, chronic atrial fibrillations (AF) encountered in surgical patients, which was regarded as untreatable in the 1980s, is now treated with surgical ablation (see Chapter 13). Changes in surgical practice have obvious implications for cardiac anesthesiology. The developments in cardiac surgery that are most likely to impact on the cardiac anesthesiologist are the changing demand, changing patients, evolution of new surgical techniques, and reduced invasiveness of surgery.”
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