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At least 199 records · Page 11Linked to original sources
PubMed1987

Effect of nitroglycerin during hemodynamic estimation of valve orifice in patients with mitral stenosis.

In patients with mitral stenosis, valve orifice calculations using pulmonary capillary wedge pressure as a substitute for left atrial pressure may overestimate the severity of disease. Previous studies have shown that mitral valve area determined from transseptal left atrial pressure measurements exceeds that area derived from pulmonary wedge pressure measurements. This is probably due to pulmonary venoconstriction, which is reversed by nitroglycerin. Nitroglycerin, 0.4 mg, was administered sublingually to 20 patients with mitral valve disease during preoperative cardiac catheterization using the pulmonary capillary wedge pressure as the proximal hydraulic variable. At the time of a peak hypotensive effect, 3 to 5 minutes after nitroglycerin administration, the mean pulmonary capillary wedge pressure decreased from 23 +/- 2 (mean +/- SEM) to 19 +/- 2 mm Hg (p less than 0.005). The mean diastolic transmitral pressure gradient (12.6 +/- 1.2 mm Hg before and 11.5 +/- 1.0 mm Hg after nitroglycerin; p = NS) and cardiac output (4.0 +/- 0.3 to 4.1 +/- 0.3 liters/min; p = NS) did not change significantly. Nevertheless, the hemodynamic mitral orifice area, calculated using the Gorlin formula, increased from 0.8 +/- 0.1 to 1.1 +/- 0.2 cm2 (p less than 0.05). In 12 patients with isolated mitral stenosis, without regurgitation, the mitral valve orifice area after nitroglycerin was 0.4 +/- 0.2 cm2 larger than it was before drug administration (p less than 0.05). Administration of nitroglycerin during evaluation of mitral stenosis eliminates pulmonary venoconstriction, which raises the pulmonary capillary wedge pressure above the left atrial pressure in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

[Valve replacement for congenital mitral stenosis associated with double orifice mitral valve: a case report and a review of Japanese literatures].

A 3-year-old girl with congenital mitral stenosis (CMS) associated with double mitral orifice valve (DOMV) underwent successfully mitral valve replacement (MVR). DOMV is a rare form of congenital cardiovascular anomaly. To our knowledge, our patient is the first infant case of CMS due to DOMV in Japan. We present an infant case of CMS associated with DOMV who needed MVR, and discuss our patient with a review of Japanese literatures.

Cardiac Surgical Procedures↗
PubMed1992

Left ventricular ejection performance in mitral stenosis, and effects of successful percutaneous transvenous mitral commissurotomy.

Impaired left ventricular ejection performance was reported in pure mitral stenosis. The speculative mechanisms included insufficient preload, increased wall stress, high right ventricular pressure and unknown myocardial factors, but no definitive mechanism has been established. Fifteen patients with tight mitral stenosis who underwent successful percutaneous transvenous mitral commissurotomy were studied to ascertain whether ejection performance would improve with sufficient blood filling. The indexes of preload (end-diastolic volume) and ejection performance (stroke volume, ejection fraction, and mean systolic and mean normalized ejection rates) were calculated angiographically before and immediately after mitral commissurotomy. Improved blood filling (the result of successful mitral commissurotomy) produced an increase in end-diastolic volume (mean +/- SD 99.0 +/- 30.2 to 112.1 +/- 30.1 ml/m2; p less than 0.05). All 4 indexes of ejection performance also improved. There was good correlation between end-diastolic and stroke volumes before intervention (stroke volume = 0.476 x end-diastolic volume + 16.77; r = 0.76), and the relation between them showed no change even after mitral commissurotomy. It is concluded that both left ventricular preload and ejection performance improved after successful percutaneous transvenous mitral commissurotomy. Insufficient preload could affect ejection performance in patients with tight mitral stenosis.

Adult↗
PubMed1987

Balloon dilation of mitral stenosis in adult patients: postmortem and percutaneous mitral valvuloplasty studies.

Preliminary reports have documented the utility of percutaneous balloon valvuloplasty of the mitral valve in adult patients with mitral stenosis, but the mechanism of successful valve dilation and the effect of mitral valvuloplasty on cardiac performance have not been studied in detail. Accordingly, mitral valvuloplasty was performed in five postmortem specimens and in 18 adult patients with rheumatic mitral stenosis, using either one (25 mm) or two (18 and 20 mm) dilation balloons. Postmortem balloon dilation resulted in increased valve orifice area in all five postmortem specimens, secondary to separation of fused commissures and fracture of nodular calcium within the mitral leaflets. In no case did balloon dilation result in tearing of valve leaflets, disruption of the mitral ring or liberation of potentially embolic debris. Percutaneous mitral valvuloplasty in 18 patients with severe mitral stenosis (including 9 with a heavily calcified valve) resulted in an increase in cardiac output (4.3 +/- 1.1 to 5.1 +/- 1.5 liters/min, p less than 0.01) and mitral valve area (0.9 +/- 0.2 to 1.6 +/- 0.4 cm2, p less than 0.0001), and a decrease in mean mitral pressure gradient (15 +/- 5 to 9 +/- 4 mm Hg, p less than 0.0001), pulmonary capillary wedge pressure (23 +/- 7 to 18 +/- 7 mm Hg, p less than 0.0001) and mean pulmonary artery pressure (36 +/- 12 to 33 +/- 12 mm Hg, p less than 0.01). Left ventriculography before and after valvuloplasty in 14 of the 18 patients showed a mild (less than or equal to 1+) increase in mitral regurgitation in five patients and no change in the remainder.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Evaluation of the degree of mitral stenosis : reassessment of the M mode echocardiographic index].

Fifty consecutive patients (32 female and 18 male) with mitral stenosis aged 11 to 60 years underwent cardiac catheterisation and echocardiography to determine the value of M mode in assessing the degree of stenosis. Mitral stenosis was pure in 47 cases; isolated in 31 cases; associated with minimal aortic regurgitation in 11 cases, with mild mitral incompetence in 3 cases and with tricuspid incompetence in 5 cases (all patients underwent aortography and left ventriculography). Mitral valve surface area (MSA) calculated from the Gorlin formula correlated well with the anatomical mitral valve area (r = 0.88) in the 30 operated patients and enabled the patients to be divided into three subgroups : Group I : 36 patients with severe mitral stenosis; MS less than 1.3 cm2 including 29 with very severe stenosis : MS less than 1.0 cm2; Group II : 9 cases of moderate stenosis (1.3 cm2 less than MS less than or equal to 1.8 cm2), and Group III : 8 cases of mild mitral stenosis (MS greater than 1.8 cm2). The indices correlating with haemodynamic MSA were, in decreasing order of significance : EF slope of early diastolic closure of the anterior leaflet (r = 0.74); maximal EE' diastolic separation of the two leaflets (r = 0.57); the ratio of left atrium/aortic root dimensions (r = 0.39) and the Q-mitral closure interval (r = 0.31). The left atrial emptying index, the mitral valve closure index and changes in the rapid phase of left ventricular filling did not correlate with the degree of stenosis. An EF slope of less than 15 mm/sec had a sensitivity of 77% and a specificity of 93% and was a satisfactory method for distinguishing patients in Group I from those in Group II.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1978

Echocardiographic analysis of posterior mitral leaflet movement in mitral stenosis.

Echocardiographic analysis of the movement of the posterior mitral valve leaflet in 60 patients with lone mitral stenosis, 35 patients with aortic stenosis, and 18 patients with aortic and mitral stenosis showed a spectrum of initial posterior mitral valve leaflet movement in early diastole. The classical anterior movement was seen in 36 out of 60 patients with mitral stenosis (60%), and 8 out of 16 patients with aortic and mitral stenosis (50%). Normal posterior movement was present in all patients with lone aortic stenosis but was also seen in 10 patients (17%) with mitral stenosis and 6 patients (33%) with aortic and mitral stenosis. The remaining patients with mitral stenosis or aortic stenosis and mitral stenosis showed a biphasic type of initial movement. Patients with anterior movement had a mean calculated mitral valve area from cardiac catheterisation significantly smaller than the rest (P less than 0.001), but neither biphasic nor posterior movement excluded severe mitral stenosis. The distinction between patients with mitral stenosis and initial movement of the posterior mitral valve leaflet and patients with left ventricular discompliance is possible when there is sinus rhythm. Late diastolic anterior movement of the posterior mitral valve leaflet during atrial contraction is diagnostic of true mitral stenosis.

Aortic Valve Stenosis↗
PubMed2002

Neurohormones in mitral stenosis before and after percutaneous balloon mitral valvotomy.

BACKGROUND AND AIM OF THE STUDY: The hormonal response to percutaneous balloon mitral valvotomy (PBMV) has been described in patients in sinus rhythm (SR) and with atrial fibrillation (AF). The study aim was to evaluate the effect of hemodynamic parameters and PBMV on atrial natriuretic factor (ANF) secretion and plasma renin activity (PRA) in mitral stenosis in SR and AF. METHODS: Thirty-one patients (26 females, five males; mean age 50.5+/-14 years) with pure rheumatic mitral stenosis underwent PBMV. Fourteen patients had AF, and 17 were in SR. PRA and ANF were measured 24 h before, and at 30 and 60 min, 24 h and one month after PBMV, after resting in a supine position for > or =2 h. Digitalis and diuretics were withdrawn 48 h before sampling; neither had patients received ACE inhibitors or beta-blockers during the previous month. RESULTS: PBMV was successful in all cases, without complication. Mitral valve area was increased and wedge pressure decreased in both groups after PBMV. In AF patients, neither PRA nor ANF were significantly affected before and after PBMV; in SR patients, ANF was decreased and PRA increased significantly, notably 24 h after PBMV. The cardiac index was increased in both groups, but was distinctly lower in AF patients both before and after PBMV. CONCLUSION: Despite similar hemodynamic results, reversal of the hormonal pattern after PBMV occurred only in SR patients, most likely because in AF patients a low cardiac index elicits a hormonal response similar to heart failure. This abnormal hormonal pattern may limit functional recovery after PBMV; hence, PBMV is best attempted while patients are still in SR.

Adolescent↗
PubMed2006

Comparison of findings in patients with versus without atrial fibrillation just before isolated mitral valve replacement for rheumatic mitral stenosis (with or without associated mitral regurgitation).

Among 104 patients with mitral stenosis (MS) severe enough or symptomatic enough to warrant mitral valve replacement (MVR), 47 (45%) had atrial fibrillation (AF) and 57 (55%) had sinus rhythm just before the MVR. Of the latter 57 patients, 21 (37%) had had previous episodes compatible with AF. If these 21 patients were included with the 47 patients with electrocardiographic documentation of AF just before MVR, a total of 68 (65%) would have had > or =1 presumed episodes of AF before MVR. The 13 patients with previous mitral commissurotomy had a frequency of AF similar to that of the 91 whose first operation was MVR. Compared with the patients with sinus rhythm just before MVR, those with AF had more heart failure (functional class III or IV preoperatively, 79% vs 62%), larger left atria (6.0 vs 5.2 cm), larger left ventricles in peak systole (4.0 vs 2.6 cm), and more had 2 or 3 coronary arteries narrowed >50% in diameter (23% vs 10%).

Adult↗
PubMedDate not supplied

Percutaneous transseptal mitral commissurotomy in pregnant women with critical mitral stenosis.

BACKGROUND: Percutaneous transseptal mitral commissurotomy has been successfully performed in selected pregnant patients with severe symptomatic mitral stenosis. Its safety and efficacy needs to be evaluated in a large number of cases. METHODS AND RESULTS: Percutaneous transseptal mitral commissurotomy was performed in 85 severely symptomatic (New York Heart Association functional class III or IV) pregnant women aged 22.7+/-4.1 years (range 18-39 years) with critical mitral stenosis at 24.8+/-4.7 weeks (range 20-34 weeks) of gestation. Percutaneous valvotomy was performed using a flow-guided Inoue balloon in all the patients. The procedure was considered successful in 80 (94%) patients. The hemodynamic mean end-diastolic gradient decreased from 26.7+/-6.8 mm Hg (range 16-35 mmHg) to 4.5+/-3.8 mmHg (range 0-14 mmHg) (p<0.001). The mean diastolic gradient decreased from 29.1+/-9.1 mmHg (range 18-38 mmHg) to 7.2+/-4.1 mmHg (range 4.1-18 mmHg) (p<0.001). The mean mitral valve area assessed by echocardiography increased from 0.75+/-0.5 cm2 (range 0.4-1.0 cm2) to 2.0+/-0.5 (range 1.0-2.7 cm2) (p<0.001). The mean fluoroscopy time was 3.6+/-3.2 minutes. The results of the mitral valvotomy were considered suboptimal in 4 patients. Mitral regurgitation increased by 1 grade in 16 patients and more than 2 grades in 2 patients. One patient developed pericardial tamponade during the procedure and was managed by catheter drainage. Percutaneous mitral valve dilatation was then successfully performed in this patient. No fetal abortion occurred after the procedure. CONCLUSIONS: The results of this study indicate that percutaneous transseptal mitral commissurotomy is a safe and effective procedure for severe symptomatic mitral stenosis in pregnancy.

Adolescent↗
PubMed2002

Efficacy and safety of percutaneous metallic mitral valvuloplasty in rheumatic mitral stenosis at Siriraj Hospital.

Mitral stenosis is an important problem that leads to heart failure and stroke in Thailand. The options of treatment at present are either surgical or balloon mitral commissurotomy. However, the cost of balloon is very expensive. To reduce the expense of the procedure, the authors prospectively did a study using a new device called the metallic valvulotome in symptomatic severe mitral stenosis to assess the safety, feasibility and immediate outcomes. Fifty-seven patients were included in the study. The successful outcome achieved by the metallic valvulotome was 96.2 per cent in patients in whom the procedure was actually performed. The mean transmitral gradient, left atrial pressure and pulmonary artery pressure were significantly decreased and the mitral valve area was also significantly increased. Three cases failed the procedure due to inappropriate position of the septal puncture. No death occurred in the study and complications of the procedure included only two cases of hemopericardium. In the future, it is believed that this new innovative device will provide improvement and reduce the cost of the procedure in patients with severe mitral stenosis.

Adult↗
PubMed1997

Percutaneous transluminal mitral valvuloplasty normalizes baroreflex sensitivity and sympathetic activity in patients with mitral stenosis.

BACKGROUND: In patients with mitral stenosis, reduced cardiac output or altered pulmonary hemodynamics may increase sympathetic nerve activity. However, the magnitude of the increase in sympathetic activity in such patients and the effect of valvuloplasty on this activity are unknown. METHODS AND RESULTS: We microneurographically measured muscle sympathetic nerve activity before and after mitral valvuloplasty in 10 patients (mean+/-SEM age, 48+/-2 years) with mitral stenosis and in 10 healthy volunteers (47+/-4 years); hemodynamic variables were also measured. Baroreflex sensitivity was assessed on the basis of the ratio of the change in heart rate or muscle sympathetic activity to the change in mean arterial pressure during intravenous infusion of sodium nitroprusside or phenylephrine. At baseline, muscle sympathetic activity was significantly higher in the patients with mitral stenosis than in the control subjects (42.1+/-3.2 versus 26.1+/-3.7 bursts/min, P<.05). However, there was no significant difference between the groups in sympathetic activity at 1 week after valvuloplasty. The reduction in sympathetic activity after valvuloplasty was maintained for > or = 6 months and correlated with the increase in cardiac index (r=.74, P<.05). Baroreflex sensitivity was significantly lower in the patients than in the control subjects, but after valvuloplasty there was no significant difference in baroreflex sensitivity between the groups. CONCLUSIONS: Sympathetic activity is increased in patients with mitral stenosis. Mitral valvuloplasty in such patients results in early and long-lasting normalization of sympathetic nerve activity, possibly because of an improvement in arterial baroreflex sensitivity.

Adult↗
PubMed1994

Two-dimensional transesophageal echocardiographic determination of mitral valve area in adults with mitral stenosis.

Two-dimensional transthoracic echocardiography has been shown to be a reliable and accurate method of measuring stenotic mitral valve orifice area. Little data exist on the role of two-dimensional transesophageal echocardiography for this purpose. Thus in 45 adult patients with mitral stenosis mitral valve area was determined by direct planimetry with the use of two-dimensional transesophageal and transthoracic echocardiography. Transesophageal was less feasible than transthoracic echocardiography in the 45 patients (69% vs. 89%, p < 0.025). In 14 patients, two-dimensional transesophageal echocardiography was not feasible, primarily because of leaflet dropout. In 30 patients, transesophageal and transthoracic echocardiography were feasible, and measurements of mitral valve area by the two techniques correlated well (r = 0.91, SEE = 0.33 cm2, p < 0.0001). Mean mitral valve orifice area determined by transesophageal echocardiography (1.54 +/- 0.75 cm2; range 0.56 to 3.49 cm2) and by transthoracic echocardiography (1.55 +/- 0.78 cm2; range 0.62 to 3.68 cm2) did not differ (p = NS). The absolute (0.24 +/- 0.22 cm2) and percent (19% +/- 21%) differences between mitral valve area determined by transesophageal versus transthoracic echocardiography were small. These data show that mitral valve area in patients with mitral stenosis can be accurately measured by direct planimetry with two-dimensional transesophageal echocardiography. Technical refinements such as lateral-gain-compensation features may improve the feasibility of two-dimensional transesophageal echocardiography for measurements of mitral stenosis area, and this technique may become an adjunct to transthoracic echocardiography in the assessment of severity of mitral stenosis.

Adult↗