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Results for “MITRAL VALVE STENOSIS”

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[Method of surgical treatment of mitral valve stenosis depending on the extent of its calcinosis].

On the basis of studying the immediate and long-term results of treatment of 329 patients with calcinated mitral stenosis, the progressive aggravation of the immediate outcome of the operation in II and III-IV degree of mitral valve calcinosis is demonstrated. The data have been confirmed by actuarial analysis of the patients' survival and stability of a good result. The authors consider it expedient to perform mitral commissurotomy only in patients without valvular calcinosis and I degree calcinosis. In more severe affection, mitral valve replacement is indicated.

Actuarial Analysis↗

[Detection of thrombosis of the left atrium in mitral valve stenosis. Particular value of transesophageal echography].

This retrospective study assessed the prevalence of left atrial thrombi in mitral stenosis and evaluated the diagnostic value ot the main means of investigation Five hundred and eighty-one patients underwent open heart surgery over a 10 year period. The prevalence of atrial thrombi was 7%, the majority (60%) being located in the left atrial appendage. The sensitivity of transthoracic echocardiography for detecting thrombi in the left atrial cavity was satisfactory (65%) but was very poor for detecting thrombi in the left atrial appendage (4%). The results of invasive investigations (atrial angiography and coronary angiography) are no better. Without any doubt, transoesophageal echocardiography, performed in 101 patients in this series, has transformed these results (sensitivity 83%, specificity 97%). False negatives in this study mainly concerned small thrombi adherent to the atrial wall. Under these conditions, it would seem reasonable to propose transoesophageal echocardiography to all patients with mitral stenosis complicated by an embolic event or for those for whom percutaneous commissurotomy is suggested.

Adolescent↗

[Role of percutaneous valvuloplasty in rheumatic mitral valve stenosis. Córdoba-Las Palmas cooperative study].

This article describes our findings on a prospective and cooperative study (Córdoba-Las Palmas) in 203 patients with mitral stenosis who underwent balloon valvuloplasty using a retrograde transarterial technique. We analyzed the immediate and mid-term results, and studied the factors determining an optimal result and those related to the new appearance or worsening of mitral incompetence after the procedure. On the other hand, we analyzed the results of mitral valvuloplasty in patients with previous mitral surgery, mild mitral stenosis and patients dilated while having an acute pulmonary edema. We observed a marked decrease in mean mitral gradient (17 +/- 7 to 6 +/- 3 mmHg; p less than 0.001) as well as a significant increase in mitral valve area (1.02 +/- 0.4 to 2.04 +/- 0.7 cm2; p less than 0.001). Echo-Doppler follow-up did not show significant changes in the residual mitral valve gradient. Multivariate analysis selected, as independent predictors of an optimal result, the presence of a pliable valve and the absence of basal mitral regurgitation. On the other hand, the presence of a lower ejection fraction, an older age and a higher baseline left ventricular endiastolic volume were independent factors determining progression of mitral regurgitation. In patients with previous mitral surgery, the clinical, echo and hemodynamic profiles, as well as the immediate results, were similar to those observed in patients with unoperated mitral stenosis. In the subgroup of mild mitral stenosis, we observed and optimal result in all cases, without major complications. Mitral valvuloplasty was dramatically effective in 8 patients treated during acute pulmonary edema.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Coronary embolism revealing mitral valve stenosis].

We report a case of myocardial infarction with normal coronary arteriography in a 39-year-old woman presenting with tight mitral stenosis complicated by atrial extrasystoles and spontaneous atrial contrast at echocardiography. The diagnosis of coronary embolism was most probable. Coronary embolism is a rare disease, usually due to a blood clot or, less frequently, to a vegetation of endocarditis starting in a heart valve. The left network is usually involved, with typical myocardial necrosis. Coronary arteriography is sufficient to make the diagnosis. Preventive treatment is essential.

Acenocoumarol↗

Pathomorphological aspects, aetiology and natural history of acquired mitral valve stenosis.

Commissural fusion, leaflet thickening and alteration of the subvalvular apparatus are dominant mechanisms causing clinically important mitral stenosis (MS) of rheumatic origin. Calcification and a consequent decrease in leaflet mobility are subsequent features in rheumatic MS and may be the primary mechanisms in MS of degenerative origin. In 1051 consecutive patients with pure or predominant MS requiring surgical intervention, aetiology was rheumatic in 76.9%, infective in 3.3%, degenerative (severe annular and leaflet calcification) in 2.7% and congenital (Lutembacher syndrome) in 1.2%; it was the result of systemic lupus erythematosus (n = 4), carcinoid heart disease (n = 2), endomyocardial fibrosis (n = 2) and rheumatoid arthritis (n = 2) in less than 1%, while in 14.5% of these patients aetiology remained unclassified. The natural history of rheumatic MS is characterized by an asymptomatic latent period, following the initial rheumatic fever (RF). In a prospective study of MS (n = 159) the mean interval between RF and the appearance of symptoms was 16.3 +/- 5.2 years. Twenty-five years after the initial RF 8% of the patients were still asymptomatic, 9% were class II (NYHA), 33% class III and 50% had been operated or were class IV. Progress from mild to severe disability took 9.2 +/- 4.3 years on average. When valve surgery was indicated but refused by the patients, survival with medical treatment was 0.44 +/- 0.06 after 5 years, 0.32 +/- 0.08 after 10 years and 0.19 +/- 0.09 after 15 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗