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At least 235 records · Page 13Linked to original sources
PubMed1986

Percutaneous transvenous balloon valvotomy in a patient with severe calcific mitral stenosis.

Percutaneous transvenous balloon mitral valvotomy was performed successfully in a 57 year old man with refractory congestive heart failure due to calcific mitral stenosis. Cardiac surgery was not an option because of other major medical problems. Balloon mitral valvotomy was performed using the transseptal technique. The interatrial septum was dilated with the use of an 8 mm balloon catheter to allow passage of larger balloon valvotomy catheters to the mitral anulus. The procedure resulted in a marked decrease in the diastolic transmitral gradient from 20 to 4 mm Hg. This decrease was associated with an increase in cardiac output from 3.4 to 5.7 liters/min. Mitral valve area increased from 0.7 to 2.5 cm2. Balloon valvotomy did not result in significant mitral regurgitation. This case indicates that further trials are warranted to evaluate percutaneous transseptal mitral valvotomy for the treatment of patients with mitral stenosis.

Calcinosis↗
PubMed1991

Treatment of mitral stenosis.

In patients with mitral stenosis the need for therapeutic intervention can be assessed by clinical and non-invasive data. Mitral valve replacement is indicated when marked dyspnoea on mild exertion, dyspnoea at rest or pulmonary oedema, haemoptysis, atrial fibrillation, recurrent systemic emboli or right ventricular failure occur in a patient with a mitral valve area of less than 1.5 cm2, as measured by Doppler echocardiography. This treatment will entail life-long anticoagulation in the majority of patients. Closed commissurotomy is no longer considered a valid therapeutic alternative due to its limited success rate but open commissurotomy and balloon valvotomy may be performed in patients with no significant calcification of valve cusps and no major concomitant mitral regurgitation. Preservation of the subvalvular apparatus and left ventricular geometry can be considered the most important advantages of these techniques. More severe chronic symptoms are generally required as indication for mitral valve replacement because of the additional long-term imponderabilities imposed by an implanted artificial device. Therefore, in patients with mitral stenosis different symptoms and clinical findings will eventually lead to different interventions.

Catheterization↗
PubMed1978

[Determination of the severity of mitral stenosis by hemodynamic and echocardiographic parameters].

M-Mode and two-dimensional echocardiographic examinations were performed in 70 patients with pure or prevailing mitral stenosis. Mitral valve excursion, mitral valve opening area (MVOAe) and diastolic E-F slope were determined and compared with the gradient across the valve and the opening area obtained during cardiac catheterization. Mitral valve excursion and E-F slope showed mean values of 1.71 cm and 1.98 cm/sec. respectively and were indicative of a stenosed mitral valve. Correlation between E-F slope and gradient with MVOAe was poor. The correlation coefficient was r = +0.56 and r = 0.34 resp. MVOAe compared favorably to the mitral valve area determined at cardiac catheterization (r = + 0.96) and the gradient across the mitral valve (r = 0.90)9 We conclude: 1. Determination of the mitral valve opening area by means of two-dimensional echocardiography represents a valuable addition in the assessment of the severity of mitral stenosis. 2. M Mode echocardiography indicates the presence, but not the severity of mitral stenosis. 3. Computerized planimetry is superior to the manually planimetered opening area and represents a reproducible, exact and time-saving procedure.

Adult↗
PubMed1997

[Surgery in mitral stenosis].

Commissurotomy of a stenotic mitral valve on the closed heart was the beginning of the cardiosurgery. It helped hundreds of thousands of patients. At present in mitral stenosis surgery with extracorporeal circulation is recommended. The idea to eliminate the stenosis of the mitral valve by the closed route was adopted in percutaneous transvenous commissurolysis. The author discusses the submitted paper the development of mitral stenosis surgery at the cardiosurgical department in Hradec Králové during 45 years since the first commissurotomy implemented in 1951 by academician Bedrna.

Extracorporeal Circulation↗
PubMedDate not supplied

An echocardiographic study of net atrioventricular compliance in juvenile and adult mitral stenosis.

BACKGROUND: Left atrial compliance is an important determinant of symptoms in mitral stenosis. About one-third of patients with mitral stenosis have reduced left ventricular compliance. We measured the net atrioventricular compliance in rheumatic mitral stenosis patients noninvasively and analyzed if there were any clinical, electrocardiographic, roentgenographic or echocardiographic correlates of net atrioventricular compliance. METHODS AND RESULTS: Seventy-six patients with mitral stenosis were analyzed and as many normal subjects were taken as control group. Patients were divided into two groups--those 20 years and below were grouped as juvenile mitral stenosis and those above 20 years as adult mitral stenosis patients. The net atrioventricular compliance in patients with mitral stenosis was significantly impaired compared to normal population. Mean compliance in juvenile group was 4.66+/-2.18 ml/mmHg (range 2.17-9.6) and in adult group it was 4.79+/-1.99 ml/mmHg (range 2.04-8.9) (p = ns). There was no difference in net atrioventricular compliance between the juvenile and adult patients with mitral stenosis. Mitral valve area showed an independent positive correlation with net atrioventricular compliance. CONCLUSIONS: The net atrioventricular compliance was significantly reduced in patients with rheumatic mitral stenosis; however, there was essentially no difference in the net atrioventricular compliance between the juvenile and adult patients with mitral stenosis. The net atrioventricular compliance may not be responsible for the more severe symptoms observed in juvenile mitral stenosis.

Adolescent↗
PubMed1984

Left ventricular performance in patients with coexistent mitral stenosis and aortic insufficiency.

Isolated mitral stenosis and isolated aortic insufficiency impose unique and opposite loading conditions on the left ventricle. To assess these combined effects, hemodynamic and angiographic factors were compared among normal subjects and patients with isolated mitral stenosis, isolated aortic insufficiency or combined mitral stenosis and aortic insufficiency. Left ventricular end-diastolic volume index was lower in patients with combined lesions and severe or moderate aortic insufficiency than in patients with isolated severe or moderate aortic insufficiency (138 +/- 19 versus 206 +/- 20 cc/m2 and 87 +/- 5 versus 145 +/- 22 cc/m2, respectively) (p less than 0.05 for both). Left ventricular end-diastolic and end-systolic volume indexes were normal in two-thirds of patients with combined lesions and moderate or severe aortic insufficiency, whereas these indexes were high in all but one patient with isolated moderate or severe aortic insufficiency. Among patients with moderate or severe aortic insufficiency, 8 of 14 with isolated insufficiency had a reduced ejection fraction or circumferential fiber shortening rate compared with 5 of the 9 patients with combined lesions. Among patients with isolated aortic insufficiency, left ventricular end-systolic wall stress and end-diastolic and end-systolic volume indexes were higher (p less than 0.05) in those with reduced ejection performance than in those with normal ejection performance. These variables did not differ between patients with reduced or normal ejection performance in the group with combined lesions. The contractile index (ratio of end-systolic wall stress to end-systolic volume index) was significantly depressed in patients with severe aortic insufficiency in the groups with isolated aortic insufficiency or combined lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Changes in clinical-instrumental parameters in patients with mitral stenosis after balloon catheterization valvuloplasty of the mitral valve].

The results of mitral valvuloplasty using a balloon catheter were presented for 104 patients with mitral stenosis. Instrumental measurements and clinical symptoms were evaluated before the operation, 6 and 12 months after it (62 and 42 patients, respectively). The balloon dilatation has increased mitral orifice from 120.5 +/- 5.8 to 333.88 +/- 7.45 mm2, transmitral diastolic pressure gradient decreased from 22 +/- 1 to 7.91 +/- 0.6 mm Hg. All the patients benefited clinically: cough, blood spitting, lower limb edemas, protodiastolic murmur disappeared, dyspnea noticeably reduced. NYHA functional class I-II was established in 85% of the patients. The highest effect was achieved in patients with isolated mitral stenosis.

Adult↗
PubMed2004

Treatment with epoprostenol of pulmonary arterial hypertension following mitral valve replacement for mitral stenosis.

Pulmonary hypertension frequently complicates mitral stenosis. Increased pulmonary artery pressure results from raised left atrial pressure, pulmonary arteriolar constriction, and obliterative changes in the pulmonary vascular bed, and usually responds to surgical relief of mitral stenosis. However, severe pulmonary hypertension may persist after surgical treatment of mitral stenosis. We describe a patient whose severe pulmonary hypertension following mitral valve replacement was treated successfully with continuous intravenous epoprostenol.

Antihypertensive Agents↗
PubMed2000

Treatment of severe mitral stenosis in pregnancy using multi-track mitral balloon dilatation: case report.

A case of 31-year old pregnant lady with severe mitral stenosis who benefited tremendously from multi-track balloon valvotomy is presented. She had history of cardiorespiratory arrest during delivery in the previous pregnancy and presented to the obstetrician pregnant again and symptomatic. After detailed cardiac evaluation, she was managed medically up to end of second trimester and then percutaneous balloon mitral valvotomy was done under fluoroscopy with total abdominal and pelvic shielding. The results were dramatic both in terms of haemodynamic changes and in the clinical outcome. The patient went on to give birth to a normal healthy baby. This case illustrates current management approach of mitral stenosis in pregnancy.

Adult↗
PubMed2000

Effects of balloon mitral valvuloplasty on systemic and regional left atrial levels of prothrombin fragment 1+2 in mitral stenosis.

A proportion of mitral stenosis patients with left atrial spontaneous echo contrast but without thrombus exhibit a regional hypercoagulable state, characterized by increased left atrial levels, but normal venous levels, of prothrombin fragment 1+2 (F1+2), a marker of thrombin generation. Valve dilatation by balloon mitral valvuloplasty has beneficial effects on left atrial spontaneous echo contrast, but its effect on left atrial thrombin generation is unknown. We examined the effects of balloon mitral valvuloplasty on venous and left atrial levels of F1+2 in 37 patients with mitral stenosis, divided into those with normal (group 1; n=22) and those with increased (group 2; n=15) regional left atrial thrombin generation, as described previously. The mitral valve area increased by a similar degree after the valvuloplasty procedure in the two groups. In group 1, the venous (P<0.005) and left atrial (P<0.0005) levels of F1+2 increased similarly after valvuloplasty, and as a result the left-atrial-venous F1+2 difference was unchanged. The venous F1+2 level also increased after valvuloplasty in group 2 (P<0.005); however, in contrast with group 1, the left atrial level decreased (P<0.03) and as a result the left-atrial-venous difference fell (P<0.05). These results show that balloon mitral valvuloplasty results in an immediate increase in thrombin generation, but a decrease in the left-atrial-venous F1+2 difference, in patients with increased left atrial thrombin generation. The divergent changes in venous and left atrial levels of F1+2 further highlight the limitations of assessing regional changes in coagulation activity by measuring venous levels of coagulation markers.

Adult↗
PubMed1977

Mitral valve closure index. Echocardiographic index of severity of mitral stenosis.

A new echocardiographic index of mitral valve diastolic closure, based on the rate of diastolic apposition of the anterior and posterior mitral leaflet echoes, was measured in 40 patients with mitral stenosis. This mitral valve closure index correlated highly significantly with the mitral valve orifice area (calculated from the Gorlin formula) (r = 0-87). Correlation between the diastolic closure rate (based) on the EF slope) and the calculated valve area was poor (r = 0-37). It is proposed that the mitral valve closure index excludes movement extraneous to the mitral apparatus and expresses the actual rate of valve closure, thus avoiding some of the factors known to contribute to the poor specificity of the diastolic closure rate. The better correlation of the mitral valve closure index with the calculated valve orifice area makes it possible to assess the severity of mitral stenosis by echocardiogram with greater accuracy and confidence.

Adult↗
PubMed1996

Percutaneous transvenous mitral commissurotomy in patients with mitral stenosis and coexistent hyperthyroidism.

Percutaneous transvenous mitral commissurotomy (PTMC) was performed successfully without complications in 3 patients with severe mitral stenosis and hyperthyroidism. All 3 patients had pliable, noncalcified mitral valves. One patient who had been treated with methimazole for 6 months was still in a hyperthyroid state when she presented with intractable congestive heart failure and was found to have severe mitral stenosis. The heart failure improved immediately after PTMC, but the patient remained in New York Heart Association functional class 2 until a euthyroid state was achieved with I131 therapy. In the other 2 patients, hyperthyroidism was unsuspected at the time of PTMC. Unexpectedly suboptimal symptom improvement led to the diagnosis of hyperthyroidism 1 month after the intervention. In all 3 patients, PTMC resulted in an immediate hemodynamic and clinical improvement. However, complete clinical improvement occurred only when euthyroid state was achieved after antithyroid treatment. The present study suggests that PTMC is a safe and effective intervention modality in patients with coexisting hyperthyroidism and severe mitral stenosis. The procedure may be considered a therapeutic option in patients with hyperthyroidism and severe mitral stenosis.

Adult↗
PubMed1994

[Does aortic insufficiency influence Doppler-derived calculation of the valvular area in patients with mitral stenosis?].

BACKGROUND: The evaluation of mitral valve area (MVA) in patients with mitral stenosis represents the main purpose of any diagnostic method, provided that MVA is a key parameter to indicate the need for valve surgery. The aim of this study was to assess whether the presence of aortic regurgitation associated with mitral stenosis affects the MVA measurement by left atrial pressure half time (PHT). METHODS: Eighty-nine patients with mitral valve stenosis (68 females and 21 males, mean age 53.6 +/- 12.1 years), were studied. Fourty-eight patients (36 females and 12 males) had a concomitant aortic regurgitation (AR group), whereas 41 patients (32 females and 9 males) did not reflect any aortic valve involvement (no-AR group). Aortic regurgitation was graded on the basis of color flow analysis. The majority of patients had a slight to moderate regurgitation. MVA determination was carried out using both Hatle formula (220/PHT) and planimetric measurement in parasternal short axis view. RESULTS: Statistical analysis demonstrated a good correlation between the 2 MVA measurement in both groups (IA group: r = 0.9, p < 0.0001, SSE = 0.21 cm2, y = 0.91x + 0.05; no-IA group r = 0.92, p < 0.0001, SSE = 0.22 cm2, y = 0.92x + 0.04). The concomitant aortic valve disease did not affect in any way the MVA measurement by means of the PHT method. CONCLUSIONS: The Doppler derived method appears to be reliable for estimating the mitral valve area in patients with mitral stenosis even in the presence of aortic regurgitation.

Adult↗
PubMed1975

The profile and surgical management of mitral stenosis in young patients.

Mitral stenosis in the younger age groups in India is a unique condition characterized by a short duration and a rapid progression of symptoms. The majority of patients with this lesion develop pulmonary hypertension at an accelerated pace, and about one third have associated congestive failure and functional tricuspid regurgitation. Five hundred consecutive patients with this condition were treated surgically, 493 with a closed valvotomy. The over-all hospital mortality rate of 5.8 per cent was related to the severity of the preoperative functional status. In the last 150 cases, the figure dropped to 2 per cent. Assessment during the first 5 years after surgery revealed an excellent functional status in 85 per cent. The incidence of restenosis was only 3.4 per cent in the first 5 year period and 11 per cent in a subsequent 6 to 10 year follow-up period. Twenty of the 21 subjects with restenosis had an excellent functional result following closed transventricular valvotomy, and this status has been maintained during the follow-up period. To our knowledge, there are no other reports of long-term follow-up data in young patients undergoing surgical treatment for mitral stenosis.

Adolescent↗
PubMed1985

Measurement of mitral valve area in mitral stenosis by Doppler ultrasound.

The mitral valve area in mitral stenosis was determined from Doppler velocity recordings and by cross-sectional echocardiography. There was good agreement (r = 0.93) between the two methods in 18 adult patients with mitral stenosis. The results confirm that the non-invasive continuous wave Doppler ultrasound technique is of diagnostic value in the assessment of mitral stenosis.

Adult↗
PubMed2004

Cardiopulmonary exercise testing and exhaled nitric oxide in the assessment of patients with mitral stenosis.

AIM: In patients with mitral stenosis, symptoms do not always correlate with echocardiographic data. The aims of the study were to evaluate the role of cardiopulmonary exercise testing in the assessment of patients with mitral stenosis and to quantify nitric oxide production at rest and at the end of exercise. METHODS: We evaluated 43 patients with moderate to severe mitral stenosis with a discrepancy between echocardiographic data and symptoms. Nitric oxide output was calculated by measuring nitric oxide concentration in the exhaled air at rest and at the end of exercise test. RESULTS: Patients were divided in 2 groups: group 1 with a functional capacity <75% at cardiopulmonary exercise test (VO2max in % of the predicted one) and group 2 with functional capacity >75%. Transvalvular gradient and pulmonary artery pressure were significantly higher in group 1 than in group 2 (respectively 9.07 +/- 2.11 mmHg vs 6.01 +/- 1.08 mmHg, p<0.001 and 42.8 +/- 7.2 mmHg vs 33.1 +/- 4.7 mmHg, p<0.001). Patients of group 1 had a lower nitric oxide output at the end of exercise compared to group 2 (231.4 +/- 96.6 nl/min vs 326.3 +/- 74.0 ml/min, p=0.01) and to normal subjects (511.15 +/- 180.1 nl/min, p<0.001). CONCLUSION: Cardiopulmonary exercise testing provides objective non invasive information in the evaluation of patients with discrepancy between symptoms and echocardiographic data. Different levels of nitric oxide output during exercise suggest the role of nitric oxide in regulating pulmonary vascular tone.

Adult↗