Special Issues

Special Issue Title: The treatment of mitral regurgitation in the 21st Century

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· Deadline for manuscript submissions: 01 November 2021

Special Issue Editor

Guest Editor

        Dr. Francesco Nappi

        Department of Translational Medicine, University of Ferrara, Italy

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Interests: Valve surgery; Coronary surgery; Aortic surgery; Cardiac biomechanics; Tissue biomodeling tissue engineering and regenerative medicine

       Dr. Spadaccio Cristiano

       Lancashire Cardiac Center, Blackpool Victoria Hospital

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Interests: Valve surgery; Coronary surgery; Aortic surgery; Tissue engineering and regenerative medicine

Dr. Christos Mihos

Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL

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Interests: Heart Valve; Echocardiography 

Prof. Massimo Chello

Cardiovascular surgery, Università Campus Bio-Medico di Roma, 00128, Rome, Italy

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Interests: Valve surgery; Coronary surgery; Aortic surgery; Tissue engineering and regenerative medicine 

Special Issue Information

Dear Colleagues,

In the recent year mitral valve treatment underwent a significant evolution. The emerging technology of transcatheter mitral valve replacement (TMVR) has deeply influenced the scenario of the surgical management of mitral regurgitation. At the same time, new concepts in mitral disease based on the relation between of the left ventricle, subvalvular apparatus and mitral valve as a functional unit, have been proposed.
Established and more modern surgical techniques have been further developed, with a renovated interest to surgery of the subvalvular apparatus. Progresses have been made in the field of minimally invasive and robotic surgery, opening the way to new paradigms in mitral valve surgery.
In this special issue, the most recent developments and trends in mitral surgery will be discussed. Original articles, reviews, commentaries, case reports and “how-to-do it” contributions will be taken into consideration for this issue. The aim is to provide a realistic and updated status of mitral regurgitation treatment based on the most recent evidence in this field. 

Dr. Francesco Nappi, Dr. Spadaccio Cristiano, Dr. Christos Mihos and Prof. Massimo Chello

Guest Editors


Manuscript Submission Information

Manuscripts should be submitted online at https://rcm.imrpress.org by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a double-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Reviews in Cardiovascular Medicine is an international peer-reviewed open access quarterly journal published by IMR Press.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is $1950. Submitted papers should be well formatted and use good English.


Mitral valve surgery; Transcatheter mitral valve replacement; Minimally invasive surgery; Robotic surgery

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Planned Papers

Title: Nuclear magnetic resonance of the heart for the optimal assessment of ventricular remodeling in secondary mitral regurgitation
Author(s): Timofeeva I

Title: Transcatheter mitral valve repair for secondary mitral regurgitation. An update of randomized clinical trials.
Author(s): Nappi F

Title: Endocarditis of the Intervalvular fibrosa after Transcatheter Aortic Valve
Author(s): Iervolino A and Nappi F

Title: Guidelines on  management of secondary mitral regurgitation: a review comparing American Heart Association/American College of Cardiology and European Society of Cardiology guidelines
Author(s): Chello M

Title: Transcatheter Mitral Valve Repair for Primary Mitral Regurgitation
Author(s): Faza NN et al.

Title: Mitral annular disjunction; a distinct substrate and trigger of ventricular arrhythmias and sudden cardiac death
Author(s): Karangelis D

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Too much of a good thing in ischemic mitral: lessons for surgeons and cardiologists
Francesco Nappi, Cristiano Spadaccio, Christos Mihos
Reviews in Cardiovascular Medicine    2021, 22 (2): 259-261.   DOI: 10.31083/j.rcm2202030
Abstract288)   HTML30)    PDF(pc) (87KB)(172)       Save
No abstract present.
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The antegrade reperfusion test avoids the risk of mitral regurgitation recurrence optimizing valve repair
Amir Youssari, Jean-Paul Couetil, Mariantonietta Piscitelli, Céline Zerbib, Ophélie Brault-Meslin, Sanjeet Singh Avtaar Singh, Francesco Nappi, Antonio Fiore
Reviews in Cardiovascular Medicine    2021, 22 (3): 939-946.   DOI: 10.31083/j.rcm2203102
Abstract206)   HTML25)    PDF(pc) (2217KB)(232)       Save
Saline injection into the left ventricle trough mitral valve (saline test) is the most commonly used intraoperative assessment method in mitral valve repair. However, potential discrepancies between the saline test findings and intraoperative transesophageal echocardiography results after the weaning of cardiopulmonary by-pass, remain significant. Here, we describe a new antegrade reperfusion test, reproducing intraoperatively, the physiologic conditions of loaded and beating heart for direct transatrial evaluation of valve tightness. The proposed test is performed by perfusing warm oxygenated blood into the aortic root under cross-clamping. From February 2016 to December 2018, 91 patients (mean age: 63 ± 11 years) underwent mitral valve repair for mitral regurgitation. In all of them, the classic saline test was completed with the newly proposed antegrade test. We report our results with this combined approach. Data were obtained from the medical records and our mitral valve repair database. In 32 (35.1%) patients, evident or undetectable minor regurgitation at the saline test were respectively unconfirmed or detected by the antegrade reperfusion test leading to their complete correction. In only three patients (3.2%) major discrepancies was present between the intraoperative evaluation and the post-pump transesophageal echocardiography. Two of them (2.1%) required a second cardiopulmonary bypass run to fix the residual regurgitation. The antegrade reperfusion test is a simple dynamic intraoperative approach mimicking the physiological conditions of ventricular systole for mitral valve repair evaluation. Combined with the classic saline test, it seems to be a valuable additional intraoperative tool, enabling a more predictable repair result.
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Echocardiographic and clinical outcomes of patients undergoing septal myectomy plus anterior mitral leaflet extension for hypertrophic cardiomyopathy
Rafle Fernandez, Francesco Nappi, Sofia A. Horvath, Sarah A. Guigui, Christos G. Mihos
Reviews in Cardiovascular Medicine    2021, 22 (3): 983-990.   DOI: 10.31083/j.rcm2203107
Abstract36)   HTML5)    PDF(pc) (1342KB)(105)       Save
Septal myectomy is indicated in patients with obstructive hypertrophic cardiomyopathy (HCM) and intractable symptoms. Concomitant mitral valve (MV) surgery is performed for abnormalities contributing to systolic anterior motion (SAM), or for SAM-mediated mitral regurgitation (MR) with or without left ventricular outflow tract (LVOT) obstruction. One MV repair technique is anterior mitral leaflet extension (AMLE) utilizing bovine pericardium, stiffening the leaflet and enhancing coaptation posteriorly. Fifteen HCM patients who underwent combined myectomy-AMLE for LVOT obstruction or moderate-to-severe MR between 2009 and 2020 were analyzed using detailed echocardiography. The mean age was 56.6 years and 67% were female. The average peak systolic LVOT gradient and MR grade measured 73.4 mmHg and 2.3, respectively. Indications for myectomy-AMLE were LVOT obstruction and moderate-to-severe MR in 67%, MR only in 20%, and LVOT obstruction only in 13%. There was no mortality observed, and median follow-up was 1.2 years. Two patients had follow-up grade 1 mitral SAM, one of whom also had mild LVOT obstruction. No recurrent MR was observed in 93%, and mild MR in 7%. Compared with preoperative measures, there was a decrease in follow-up LV ejection fraction (68.2 vs 56.3%, p = 0.02) and maximal septal wall thickness (25.5 vs 21.3 mm, p < 0.001), and an increase in the end-diastolic diameter (21.9 vs 24.8 mm/m2, p = 0.04). There was no change in global longitudinal strain (–12.1 vs –11.6%, p = 0.73) and peak LV twist (7.4 vs 7.3°, p = 0.97). In conclusion, myectomy-AMLE is a viable treatment option for carefully selected symptomatic HCM patients with LVOT obstruction or moderate-to-severe MR.
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