{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T16:18:49Z","timestamp":1782058729833,"version":"3.54.5"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T00:00:00Z","timestamp":1719360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Some patients affected by mitral valve (MV) prolapse (MVP) are at higher risk of ventricular arrhythmias (VAs), but the underlying pathogenesis, as well as the effects of surgery on VA, remain not fully understood. Mitral valve repair, however, represents a privileged point of view to deepen the understanding of arrhythmogenesis in this context. Hence, we report an interesting case of MV re-repair.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 52-year-old man was referred to our institution for severe mitral regurgitation (MR) due to P2 prolapse in the context of myxomatous MV degeneration. Pre-operative imaging showed systolic mitral annular disjunction, left ventricular (LV) wall curling, Pickelhaube\u2019s sign, and a prolapsing tricuspid valve (TV) with only mild regurgitation. Twenty-four-hour electrocardiogram (ECG) Holter revealed a significant burden of premature ventricular contractions (PVCs), most of them originating from anterior papillary muscle (APM), posterior papillary muscle (PPM), and mitral annulus (MA). Quadrangular resection of P2 and mitral annuloplasty were performed. One year later, relapse of severe MR due to a residual P2M1 prolapse occurred. Twenty-four-hour ECG Holter showed no PVCs from PPM and MA, while those from APM persisted. A central edge-to-edge repair was effectively used to fix the residual prolapse. After 1 year from REDO surgery, a third ECG Holter confirmed the absence of any remaining LV PVCs, but still few ectopic beats originating from TV were recorded.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Here, we report a case of VA resolution after specific, anatomical triggers addressing surgical gestures. Our experience confirms that MV surgery may have a role in MVP patients\u2019 arrhythmias correction.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae305","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T10:56:21Z","timestamp":1719399381000},"source":"Crossref","is-referenced-by-count":2,"title":["When annuloplasty is not enough: a case report of ventricular arrhythmias stepwise abolition after mitral valve re-repair"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5525-1638","authenticated-orcid":false,"given":"Nicol\u00f2","family":"Azzola Guicciardi","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery-Valve Center\u2014IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Via Olgettina 60, 20132 Milan , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7727-0573","authenticated-orcid":false,"given":"Guido","family":"Ascione","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery-Valve Center\u2014IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Via Olgettina 60, 20132 Milan , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1065-8052","authenticated-orcid":false,"given":"Ottavio","family":"Alfieri","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery-Valve Center\u2014IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Via Olgettina 60, 20132 Milan , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Maisano","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery-Valve Center\u2014IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Via Olgettina 60, 20132 Milan , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9329-7437","authenticated-orcid":false,"given":"Michele","family":"De Bonis","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery-Valve Center\u2014IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Via Olgettina 60, 20132 Milan , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,6,26]]},"reference":[{"key":"2024073119501852300_ytae305-B1","doi-asserted-by":"crossref","first-page":"2158","DOI":"10.1161\/CIRCULATIONAHA.113.006702","article-title":"Epidemiology and pathophysiology of mitral valve prolapse: new insights into disease progression, genetics, and molecular basis","volume":"129","author":"Delling","year":"2014","journal-title":"Circulation"},{"key":"2024073119501852300_ytae305-B2","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1136\/hrt.30.2.203","article-title":"Late systolic murmurs and non-ejection (\u201cmid-late\u201d) systolic clicks. An analysis of 90 patients","volume":"30","author":"Barlow","year":"1968","journal-title":"Br Heart J"},{"key":"2024073119501852300_ytae305-B3","doi-asserted-by":"crossref","first-page":"96","DOI":"10.31083\/j.rcm2303096","article-title":"Genetic background of mitral valve prolapse","volume":"23","author":"Azzola Guicciardi","year":"2022","journal-title":"Rev Cardiovasc Med"},{"key":"2024073119501852300_ytae305-B4","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1093\/europace\/euac125","article-title":"EHRA expert consensus statement on arrhythmic mitral valve prolapse and mitral annular disjunction complex in collaboration with the ESC Council on Valvular Heart Disease and the European Association of Cardiovascular Imaging endorsed by the Heart Rhythm Society, by the Asia Pacific Heart Rhythm Society, and by the Latin American Heart Rhythm Society","volume":"24","author":"Sabbag","year":"2022","journal-title":"Europace"},{"key":"2024073119501852300_ytae305-B5","doi-asserted-by":"crossref","first-page":"3121","DOI":"10.1093\/eurheartj\/ehad491","article-title":"Arrhythmic mitral valve prolapse and mitral annular disjunction: pathophysiology, risk stratification, and management","volume":"44","author":"Essayagh","year":"2023","journal-title":"Eur Heart J"},{"key":"2024073119501852300_ytae305-B6","first-page":"ivad073","article-title":"The impact of mitral valve surgery on ventricular arrhythmias in patients with Barlow\u2019s disease: preliminary results of a prospective study","volume":"36","author":"Ascione","year":"2023","journal-title":"Interdiscip Cardiovasc Thorac Surg"},{"key":"2024073119501852300_ytae305-B7","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1161\/CIRCULATIONAHA.120.050214","article-title":"Replacement myocardial fibrosis in patients with mitral valve prolapse: relation to mitral regurgitation, ventricular remodeling, and arrhythmia","volume":"143","author":"Constant Dit Beaufils","year":"2021","journal-title":"Circulation"},{"key":"2024073119501852300_ytae305-B8","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1161\/CIRCULATIONAHA.118.034075","article-title":"Mitral valve prolapse, ventricular arrhythmias, and sudden death","volume":"140","author":"Basso","year":"2019","journal-title":"Circulation"},{"key":"2024073119501852300_ytae305-B9","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1016\/j.jcmg.2021.01.028","article-title":"Tricuspid annulus disjunction: novel findings by cardiac magnetic resonance in patients with mitral annulus disjunction","volume":"14","author":"Aabel","year":"2021","journal-title":"JACC Cardiovascular Imaging"},{"key":"2024073119501852300_ytae305-B10","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1136\/heartjnl-2018-314269","article-title":"Left ventricular mechanical dispersion predicts arrhythmic risk in mitral valve prolapse","volume":"105","author":"Ermakov","year":"2019","journal-title":"Heart"},{"key":"2024073119501852300_ytae305-B11","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.ipej.2016.10.009","article-title":"The effect of mitral valve surgery on ventricular arrhythmia in patients with bileaflet mitral valve prolapse","volume":"16","author":"Naksuk","year":"2016","journal-title":"Indian Pacing Electrophysiol J"}],"container-title":["European Heart Journal - 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