Slovo úvodem

Petr Kala, Jan Vojáček

Interv Akut Kardiol. 2023;22(1):7  

Pathophysiology of mitral regurgitation

Petr Lokaj

Interv Akut Kardiol. 2023;22(1):8-11 | DOI: 10.36290/kar.2023.001  

Mitral regurgitation is among the most common acquired valvular diseases in adulthood in developed countries. In terms of etiology, mitral regurgitation can be divided into a primary cause and a secondary cause. Pathophysiologically, it is an imbalance between tethering and closing forces. Regurgitant flow of blood from the left ventricle into the left atrium results in cyclic volume overload of the left ventricle. The significance of mitral regurgitation is dependent on preload, afterload, and cardiac output. First, there is an eccentric hypertrophy of the left ventricle, an increase in end-diastolic volume and, subsequently, also in end-systolic...

Surgical treatment of mitral incompetence as a gold standard

Pavel Žáček

Interv Akut Kardiol. 2023;22(1):12-16 | DOI: 10.36290/kar.2023.002  

Reconstructive surgery for mitral regurgitation was initiated already in the early 1970s. A systematic assessment of a regurgitant mitral valve and a comprehensive portfolio of surgical interventions have been valuable contributions by A. Carpentier. Crucial elements are annular remodelling by means of an annuloplasty ring, unrestricted mobility of the valve leaflets, and creation of a large zone of coaptation. These principles have been shown to be consistently valid and mitral repair is nowadays performed extensively with excellent results. Over the years, some additional refinements in the surgical technique have been introduced and, currently,...

Minimally invasive and robotic mitral valve surgery

Štěpán Černý

Interv Akut Kardiol. 2023;22(1):17-26 | DOI: 10.36290/kar.2023.003  

Surgical treatment for mitral regurgitation has undergone dramatic development in the last four decades. To preserve the patient's native valve and restore its proper function with conserving surgery is currently a clear priority in the surgical setting. This procedure is typically referred to as mitral valve repair. Currently, less invasive surgical approaches to the mitral valve are increasingly used that offer patients, in addition to being less invasive, stability and predictability of classic surgical repair based on the principles of modern mitral valve surgery. Video-assisted right-sided mini-thoracotomy or robotic surgery are the most commonly...

Transcatheter treatment of mitral regurgitation

Michael Želízko, Vladimír Pořízka, Martin Kotrč, Theodor Adla, Jiří Malý

Interv Akut Kardiol. 2023;22(1):27-34 | DOI: 10.36290/kar.2023.004  

Mitral regurgitation is the second most frequent valve disease in the adult population. Until recently, surgical repair or replacement were the only therapeutic options, leaving many patients untreated and even underdiagnosed, most frequently due to a presumably high surgical risk, particularly in those with secondary mitral regurgitation. Over the last few years, there has been exponential growth in the number of catheter-based procedures, with most of them using the transcatheter edge-to-edge repair (TEER) technique. Furthermore, the evolution of other systems is under way that preferentially use the transseptal approach, are more comprehensive,...

Current options of transcatheter mitral valve implantation

David Zemánek, Jaroslav Hlubocký, Tomáš Paleček, Tomáš Kovárník

Interv Akut Kardiol. 2023;22(1):35-39 | DOI: 10.36290/kar.2023.005  

Transcatheter mitral intervention is one of the most dynamic areas of cardiology. Although the dominant treatment for patients with mitral disease is still cardiac surgery or transcatheter "edge-to-edge" repair, transcatheter mitral valve implantation is an option available for selected patients. The article describes the main anatomical limitations of this method, its current possibilities, as well as perspectives for future development. In the end section, we present the case report of our patient treated successfully with transcatheter implantation of a mitral bioprosthesis.

Paravalvular leak on mitral valve: catheter closure

Jaroslav Januška, Miroslav Hudec, Libor Gajdušek, Jan Hečko, Miroslav Dorda, Libor Škňouřil

Interv Akut Kardiol. 2023;22(1):40-43 | DOI: 10.36290/kar.2023.006  

Paravalvular leak (PVL) on a surgically implanted mitral valve (mitral valve replacement, MVR) is a relatively common complication. Repeat surgery was the only possibility of its management in the past. Gradually, however, catheterisation procedures have been developed to allow closure without a conventional surgical approach. Catheter closure of PVL reduces the duration of procedure, the length of hospital stay, and the number of complications including death. We report the indications, diagnostic methods, catheterisation procedures, materials used, and clinical outcomes of PVL closure after MVR.

Catheter-based treatment of residual mitral regurgitation after MitraClip implantation: a case report

Jaroslav Januška, Miroslav Hudec, Libor Gajdušek, Miroslav Dorda, Martin Urban, Leoš Derych, Libor Škňouřil

Interv Akut Kardiol. 2023;22(1):44-48 | DOI: 10.36290/kar.2023.007  

Residual mitral regurgitation after MitraClip implantation is a progressively increasing problem. Progression of left ventricular dysfunction, deterioration of valvular and subvalvular function, or suboptimal MitraClip implantation all increase the risk of progression of residual regurgitation. In this case report, we describe a patient with severe degenerative mitral regurgitation managed with repeated implantation of MitraClips followed by implantation of Amplatzer Vascular Plugs between the clips, with a significant reduction in regurgitation and functional normalization of the patient's complaints.

Cangrelor and its use in a patient with acute coronary syndrome

Martin Hudec, Petr Jeřábek, Lenka Šujáková

Interv Akut Kardiol. 2023;22(1):49-51 | DOI: 10.36290/kar.2023.008  

Nowadays, cangrelor is still the only intravenous antiplatelet drug that belongs to the P2Y₁₂ inhibitors family. Its unique characteristics are possibilities of intravenous application and rapid onset and offset of action. In this case, we would like to present a patient with acute myocardial infarction in whom percutaneous coronary intervention could be very dangerous without the use of cangrelor. The reason was very high ischemic risk during complex coronary intervention. In addition to this indication, cangrelor could be very useful in other situations, when intravenous administration is the only way to inhibit platelets.

Doc. MUDr. Jiří Endrys, CSc., died

doc. MUDr. Josef Šťásek, Ph.D.

Interv Akut Kardiol. 2023;22(1):53-54