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At least 181 records · Page 10Linked to original sources
PubMed1991

Correlation between the position of transducers and mitral valve gradient in mitral stenosis.

To assess the severity of mitral stenosis related to the level of transducers, the mitral valve gradient using pulmonary wedge and left ventricle was obtained from 15 patients. The mitral gradient was obtained with both transducers at mid chest level. Then, the level of each transducer was realigned with the catheter tip in the pulmonary capillary wedge and in the left ventricle using lateral fluoroscopy and the mitral gradient was re-measured. At the mid chest level, the mean mitral valve gradient was 14 +/- 6.2 mm Hg with a mitral valve area of 1.3 +/- 0.6 cm2. With the adjusted level of transducers, the mitral valve gradient was 18.7 +/- 6.8 mm Hg with a valve area of 1.0 +/- 0.5 cm2. The difference was that the level of catheter tip in the wedge was 3.5 cm below the mid chest level and the one in the left ventricle was 2.5 cm higher than the mid chest level. This result suggested that the mitral valve gradient obtained at mid chest level underestimated the severity of mitral stenosis.

Cardiac Catheterization↗
PubMed2002

Intraoperative transesophageal echocardiographic assessment of acute prosthetic aortic valve regurgitation after mitral valve replacement: value of the deep transgastric long-axis view.

The transesophageal echocardiographic assessment of prosthetic aortic valve function is made more difficult by the presence of a mechanical mitral valve prosthesis because echocardiographic views conventionally used to assess the aortic valve function are obscured by acoustic shadowing and artifacts. We report the use of intraoperative transesophageal echocardiography in a patient who developed severe prosthetic aortic valve regurgitation after implantation of a mechanical mitral valve, in whom conventional multiplane midesophageal views failed to reveal aortic regurgitation owing to acoustic shadowing and artifacts from the prosthetic mitral valve. We report the value of the deep transgastric long-axis view of the aortic valve that provided an unobstructed view of the left-ventricular outflow tract, and clearly demonstrated severe aortic regurgitation as a result of interference with the prosthetic aortic valve mechanism by the implanted mitral valve prosthesis. This case also emphasizes the importance of a comprehensive intraoperative transesophageal examination, including that of surrounding structures, to detect iatrogenic complications during mitral valve replacement.

Acute Disease↗
PubMed1977

End-diastolic amplitude of mitral valve echogram in mitral stenosis.

By using simultaneous recordings of the mitral valve echogram and apex cardiogram, the mitral echogram amplitude was measured at the onset of left ventricular isovolumic contraction (MAIC). Twenty normal subjects and 68 patients with a reduced diastolic closure rate in the mitral valve echogram were studied. Of these patients, 53 had mitral stenosis, 6 aortic valvar stenosis, and 9 hypertrophic obstructive cardiomyopathy. In the normal subjects the MAIC ranged between 2 and 4 mm, average 2-7 mm, in the patients with aortic valvar stenosis or hypertrophic obstructive cardiomyopathy between 2 and 4 mm, average 2-9 mm, and in the patients with mitral stenosis between 6 and 17 mm, average 11-3 mm. The DE/MAIC ratio, where DE represents the opening amplitude of the mitral valve in early diastole, was between 3-3 and 6-5, average 5-1, in normal subjects; in the patients with aortic stenosis or hypertrophic obstructive cardiomyopathy the DE/MAIC ratio was between 2-7 and 6-5, average 4-2, and in the patients with mitral stenosis between 0-7 and 1-5, average 1-1. An excellent correlation was found between the DE/MAIC ratio and mitral valve area in the patients with mitral stenosis (r = 0-84, P less than 0-01) while the correlation between the diastolic closure rate and valve area was less satisfactory (4 = 0-62, P less than 0-01). These findings suggest that in cases with a reduced diastolic closure rate for reasons other than mitral stenosis, error can be avoided by using the DE/MAIC ratio.

Adolescent↗
PubMed1996

Measurement of mitral valve area in mitral stenosis: four echocardiographic methods compared with direct measurement of anatomic orifices.

OBJECTIVES: This study sought to compare the mitral valve areas of patients with rheumatic mitral valve stenoses as determined by means of four echocardiographic and Doppler methods with those obtained by direct anatomic measurements. BACKGROUND: There has been no systemic comparison between Doppler-determined valve areas and the true anatomic orifice in a single cohort. METHODS: In 30 patients with mitral stenosis, the mitral valve areas determined by two-dimensional echocardiographic planimetry, pressure half-time, flow convergence region and flow area were compared with the values directly measured on the corresponding excised specimen by means of a custom-built sizer. RESULTS: The correlation coefficient was r = 0.95 (SE 0.06, p < 0.0001) for two-dimensional planimetry; r = 0.80 (SE 0.09, p < 0.0001) for pressure half-time; r = 0.87 (SE 0.09, p < 0.0001) for flow convergence region; and r = 0.54 (SD 0.1, p < 0.002) for flow area. Two-dimensional echocardiographic planimetry, pressure half-time, flow convergence region and flow area overestimated the actual anatomic orifice by > 0.3 cm2 in 2, 1, 6 and 0 patients, respectively, and underestimated it by > 0.3 cm2 in 0, 4, 1 and 8 patients, respectively. CONCLUSIONS: Mitral valve areas determined by two-dimensional planimetry, pressure half-time and proximal flow convergence region reliably correlated with size of the anatomic orifice. The flow area method provided a less reliable correlation.

Adult↗
PubMed1988

The multifactorial etiology of mitral valve prolapse, a new entity of postinflammatory mitral valve prolapse.

As etiologic factors for mitral valve prolapse, papillary muscle dysfunction due to coronary artery disease, hypertrophic obstructive cardiomyopathy, atrial septal defect and trauma have been reported. Connective tissue diseases such as Marfan's syndrome. Ehlers-Danlos syndrome or Turner's syndrome may also result in mitral valve prolapse. In the majority of patients with mitral valve prolapse, however, the etiology is unknown, in which case the condition is considered primary or idiopathic. We evaluated 33 consecutive surgically-excised mitral valves removed from patients with regurgitant prolapsing mitral valves and congestive heart failure. On microscopic examination, myxomatous degeneration was observed in 14 cases, postinflammatory changes, however, were seen in the other 19 cases and included diffuse vascularization with thick-walled vessels, round-cell infiltration and destruction of valve architecture. These valves showed a varying degree of doming and/or interchordal hooding as well as an increased surface area. Elongated chordae tendineae were seen in 37%, chordal rupture in 16% of the patients. Slightly fused chordae tendineae, minimal commissural fusion and/or fibrous thickening of cusps were also observed, findings which simulate closely rheumatic valvulitis. Patients with postinflammatory mitral valve prolapse were younger at the time of operation and at the onset of symptoms, had smaller surface areas of the anterior mitral leaflet and more marked leaflet thickening than patients with myxomatous mitral valve prolapse. The results of the study show that mitral valve prolapse in patients with severe mitral regurgitation can be attributed to postinflammatory changes; we suggest, therefore, the term "postinflammatory valve prolapse". Postinflammatory mitral valve prolapse may be due to manifest or subclinical rheumatic fever.(ABSTRACT TRUNCATED AT 250 WORDS)

Chordae Tendineae↗
PubMed1996

Mitral valve repair for mitral regurgitation with ventricular septal defect in children.

BACKGROUND: We examined the results of intermediate and long-term follow-up of 25 patients aged 3 months to 11 years (mean, 2.6 +/- 2.3 years) who initially underwent conservative mitral valve repair for mitral regurgitation associated with ventricular septal defect between April 1973 and March 1991. METHODS: The preoperative degree of mitral regurgitation was 2+ in 3, 3+ in 17, and 4+ in 5 patients, and the major causes of mitral regurgitation were annular dilatation and prolapse of the anterior leaflet. Annuloplasty was performed in all except 2 patients, suturing of the cleft was done in 3 patients, and posterior mitral leaflet advancement was done in 2 patients. In addition, the papillary muscle was incised and adhesive chordae were removed in 1 patient, and adhesive fused chordae were detached from a leaflet in 1 other patient. RESULTS: There were no early deaths. Two patients with residual mitral regurgitation with or without mitral stenosis underwent reoperation for mitral valve replacement 2 months and 6 years after the mitral repair, respectively. Late death occurred in 2 patients, and the actuarial survival rate was 92.0% at 15 years after operation. The freedom from reoperation was 91.3% at both 10 and 15 years after the initial operation. Postoperative color Doppler flow imaging was performed in 22 of the 23 survivors, and results showed no mitral regurgitation in 4, mild regurgitation in 14, and moderate regurgitation in 4 patients. Four patients presently have mitral stenosis, with a mean transmitral pressure gradient greater than 10 mm Hg. The residual lesion of moderate mitral regurgitation with or without mitral stenosis developed in 6 of 11 patients in whom bilateral mitral annuloplasty was applied after the initial operation. Nineteen of the 22 survivors without reoperation were in New York Heart Association class I, and 3 were in class II. CONCLUSIONS: Clinical improvement was observed after conservative mitral repair in most pediatric patients with ventricular septal defect. However, careful follow-up for growth potential still appears to be needed to detect changes in mitral regurgitation and the development of mitral stenosis after valve repair, especially after bilateral annuloplasty.

Child↗
PubMed1987

[Relationship of two-dimensional echocardiographic mitral valve prolapse to mitral regurgitation assessed by color Doppler flow imaging].

Although two-dimensional echocardiography is a standard for diagnosing mitral valve prolapse, the diagnostic criteria are controversial. Regardless of valve ballooning we have used our criteria which are based on the dislocation of the mitral valve coaptation. The purpose of this study was to clarify the relationship between the location and the degree of mitral valve prolapse assessed by two-dimensional echocardiography and those of mitral regurgitation evaluated by color Doppler flow imaging, which enables us detailed analysis of regurgitation. Twenty-three patients with idiopathic mitral valve prolapse diagnosed by our criteria were studied. They were 14 men and nine women, ranging in age from 19 to 72 years (mean 44.7). In any patients, prolapse of either the anterior or posterior leaflet does not satisfy the Gilbert's criteria. Twenty of the 23 patients had mitral regurgitation by color Doppler flow imaging, and the grade was II, III or IV in 16 of these 20 patients. In 19 of 20 patients, the localization of the regurgitant jet flow from the mitral orifice coincided with the two-dimensional echocardiographic site of dislocation of mitral valve coaptation. Therefore, it was concluded that the dislocation of mitral leaflet coaptation detected by two-dimensional echocardiography is an abnormal finding regardless of the protrusion of the valve beyond the mitral ring.

Adult↗
PubMed1993

[A case of double mitral valve with severe mitral regurgitation detected by transesophageal echocardiography].

A 66-year-old woman with double mitral valve (bridge type) and severe mitral regurgitation by spontaneous ruptured chordas is reported. The case with this combination has not been reported in the literature. She had not any other congenital heart diseases. The mitral valve was clearly shown by two-dimensional Doppler transesophageal echocardiography. Mitral valve replacement with Medtronic-Hall valve was carried out successfully.

Aged↗
PubMed2006

Genomic expression patterns of mitral valve tissues from dogs with degenerative mitral valve disease.

OBJECTIVE: To evaluate global genome expression patterns of mitral valve tissues from dogs with degenerative mitral valve disease (DMVD). SAMPLE POPULATION: Anterior mitral valve leaflets of 4 dogs with severe DMVD and 4 healthy control dogs. PROCEDURES: Transcriptional activities of 23,851 canine DNA sequences were determined by use of an oligonucleotide microarray. Genome expression patterns of tissue from dogs with DMVD were evaluated by measuring the relative amount of complementary RNA hybridization to the microarray probes and by comparing it with gene expression from healthy control dogs. RESULTS: 229 transcripts were differentially expressed (>or= 2-fold change). In dogs with DMVD, expression of 159 transcripts was upregulated and expression of 70 transcripts was downregulated. Of the 229 transcripts, 152 genes could be specifically identified. These genes were grouped into 1 of 9 categories on the basis of their primary physiologic function. Grouping revealed that pathways involving cell signaling, inflammation, extracellular matrix, immune function, cell defense, and metabolism were generally upregulated. Inflammatory cytokines and the serotonin-transforming growth factor-beta pathway were identified as contributory to the pathophysiologic aspects of DMVD. CONCLUSIONS AND CLINICAL RELEVANCE: Evaluation of global expression patterns provides a molecular portrait of mitral valve disease, yields insight into the pathophysiologic aspects of DMVD, and identifies intriguing genes and pathways for further study.

Animals↗