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At least 307 records · Page 17Linked to original sources
PubMed1986

A critical appraisal of M-mode echocardiography in mitral stenosis.

The reliability of M-mode echocardiography in confirming mitral stenosis and in assessing its severity was tested in 39 patients with mitral stenosis. None of the conventional echocardiographic signs of mitral stenosis is absolutely reliable. Unless at least 2 signs are combined, the diagnosis is not conclusive (sensitivity = 0.97, specificity = 1.00). Of a number of echocardiographic parameters and equations recommended (as tools) to determine the severity of mitral stenosis, the early diastolic velocity of anterior leaflet opening (EF) is the only one with a statistically significant relationship to the mitral valve area (MVA) calculated by Gorlin (r = 0.712, p less than 0.001), and this only in uncomplicated unoperated mitral stenoses, but not in mitral restenoses and combined mitral defects. Even the recently published Seitz's equation for calculating MVA from echocardiographic data is not reliable. M-mode echocardiography is an excellent technique for the primary diagnosis of mitral stenosis. However, it is not suitable to even an approximate assessment of its haemodynamic severity.

Calcinosis↗
PubMed2003

[Anesthetic management for cesarian section in a patient with mitral stenosis and severe pulmonary hypertension].

Mitral stenosis is one of the complicating cardiac diseases during pregnancy. We experienced cesarean section in a patient with mitral stenosis and severe pulmonary hypertension (94/41 mmHg). During surgery, complete analgesia below T 4 level was obtained by epidural anesthesia with two catheters inserted at L 3-4 and T 11-12 interspaces. By epidural anesthesia, pulmonary arterial pressure decreased to 60/30 mmHg and other hemodynamic variables were stable. A baby (BW:1880 g) was intubated because of tachypnea although Apgar scores were 6-8-8. The anesthetic course of the patient was uneventful.

Adult↗
PubMed1993

Rheumatic mitral stenosis. On the rise again.

Rheumatic mitral stenosis remains an important cause of exertional dyspnea, pulmonary congestion, atrial fibrillation, and stroke. Detection rests on careful auscultatory examination and detailed review of chest films. Diagnosis is confirmed by echocardiographic examination; cardiac catheterization is important in symptomatic patients to evaluate the severity of stenosis and associated lesions. Treatment of pulmonary congestion and control of heart rate in patients with atrial fibrillation remain major medical goals. Percutaneous balloon commissurotomy is preferred for most patients with predominant mitral stenosis and for those with contraindications to valve replacement. Implantation of a prosthetic valve is best for patients with significant mitral regurgitation, multivalve disease, associated coronary artery disease that requires bypass, or mitral valve deformity too severe to allow adequate balloon commissurotomy.

Atrial Fibrillation↗
PubMed1981

Functional mitral stenosis in patients with massive mitral annular calcification.

Mitral insufficiency with mitral annular calcification occurring predominantly in elderly females has been described. We studied six patients with mitral diastolic obstruction associated with mitral annular calcification without stenosis of the mitral leaflets. Three were males and three were females, aged 43-77 years. All had significant diastolic gradients across the mitral valve (mean gradient 16 mm Hg) recorded at catheterization. Two patients had aortic and three had mitral valve replacement. No patient had retraction of the mitral leaflets, diffuse thickening or fusion of the commissures at surgery or pathologic examination. Three patients had severe mitral insufficiency, one associated with voluminous prolapsing mitral leaflets and one as a result of ruptured chordae tendineae. The left ventricle was dilated in three patients, two with mitral regurgitation and one with mixed aortic valve disease. Active mitral annular motion is a normal event and is necessary for normal valvular function; severe calcification of the ring interferes with its normal diastolic relaxation and this alone may explain the holodiastolic mitral gradient found in these patients.

Acute Disease↗
PubMed1986

[Follow-up study of atrial fibrillation associated with mitral stenosis after D-C cardioversion following open mitral commissurotomy].

We studied cardiac rhythm in 167 patients with mitral stenosis following open mitral commissurotomy in the last 7 years. After surgery 76 patients (72%) out of 106 patients who presented atrial fibrillation before surgery were reverted back to sinus rhythm by D-C cardioversion. Forty-three patients (41%) maintained sinus rhythm at the time of discharge from hospital, and 30 patients (28%) maintained it for 2.5 years (average) after surgery. The actuarial maintenance rate of sinus rhythm was 50 + 11% 7 years after surgery in these 43 patients. Ninety-three% of the 30 patients who reverted to and maintained sinus rhythm improved to class I (New York Heart Association criteria), whereas 47% of the 78 patients who retained atrial fibrillation remained in class II or III after surgery. In 30 patients who reverted back to sinus rhythm and maintained it late postoperatively, the preoperative duration of atrial fibrillation was up to 5 years, and 35% of the patients had had atrial fibrillation for more than 1 year. Also, in 40% of these 30 patients, the preoperative cardiothoracic ratio was more than 60%. Therefore, in the patients who reverted to atrial fibrillation immediately after surgery, secondary D-C cardioversion should be performed under stable hemodynamic conditions 10 to 14 days after surgery, even if their preoperative duration of atrial fibrillation was more than 1 year or their preoperative cardiothoracic ratio was more than 60%.

Adult↗
PubMed1997

The "proximal isovelocity surface area" method in assessing mitral valve area in patients with mitral stenosis and associated aortic regurgitation.

BACKGROUND: This study compares the mitral valve area determined by Doppler color mapping of the proximal isovelocity surface area (PISA) and by Doppler pressure half-time with that obtained by two-dimensional planimetry in patients affected by mitral stenosis, with and without associated aortic regurgitation. Pressure half-time frequently overestimates the mitral valve area in patients with mitral stenosis and associated aortic regurgitation. PISA is an alternative method for determining mitral valve area in mitral stenosis and is not influenced by regurgitant lesions. METHODS: We studied 76 patients with mitral stenosis; aortic regurgitation > or = 2 was present in 24 patients. The PISA was recorded from the apex and the transmitral maximal flow rate, Q (ml/s), was calculated using the hemispheric equation Q = 2 pi R2 x AV x alpha/180, where R (cm) is the maximal radius of the PISA, AV (cm/s) is the aliasing velocity and alpha/180 is a correction factor accounting for the alpha inflow angle formed by the mitral leaflets. Mitral valve area, A (cm2), was calculated by continuity equation A = Q/V, where V (cm/s) is the peak transmitral flow velocity measured by continuous wave Doppler. RESULTS: The mitral valve area by two-dimensional planimetry (range 0.5-2.4 cm2; mean 1.33 +/- 0.41 cm2) was consistent with both PISA (r = 0.83; SEE 0.23 cm2) and pressure half-time (r = 0.79; SEE 0.25 cm2) methods. Similar agreement was found for the 36 patients with mitral regurgitation and for the 30 patients in atrial fibrillation. However, in patients with aortic regurgitation > or = 2, pressure half-time overestimated two-dimensional and PISA determined mitral valve areas by 0.24 +/- 0.25 cm2 (p < 0.01). CONCLUSIONS: In patients with mitral stenosis and significant aortic regurgitation, the PISA method is more accurate than pressure half-time in assessing mitral valve area. This method may be a reliable alternative when pressure half-time is affected by aortic regurgitation and two-dimensional planimetry images are unsuitable for anatomic evaluation.

Adolescent↗
PubMed1987

Percutaneous balloon valvotomy for patients with severe mitral stenosis.

Thirty-five patients with severe mitral stenosis underwent percutaneous mitral valvotomy (PMV). There were 29 female and six male patients (mean age 49 +/- 3 years, range 13 to 87). After transseptal left heart catheterization, PMV was performed with either a single- (20 patients) or double- (14 patients) balloon dilating catheter. Hemodynamic and left ventriculographic findings were evaluated before and after PMV. There was one death. Mitral regurgitation developed or increased in severity in 15 patients (43%). One patient developed complete heart block requiring a permanent pacemaker. PMV resulted in a significant decrease in mitral gradient from 18 +/- 1 to 7 +/- 1 mm Hg (p less than .0001) and a significant increase in both cardiac output from 3.9 +/- 0.2 to 4.6 +/- 0.2 liters/min (p less than .001) and in mitral valve area from 0.8 +/- 0.1 to 1.7 +/- 0.2 cm2 (p less than .0001) Effective balloon dilating diameter per square meter of body surface area correlated significantly with the decrease in mitral gradient but did not correlate with the degree of mitral regurgitation. There was no correlation of age, prior mitral commissurotomy or mitral calcification with hemodynamic results. PMV is an effective nonsurgical procedure for patients with mitral stenosis, including those with pliable valves, those with previous commissurotomy, and even those with mitral calcification.

Adolescent↗
PubMed2006

Acute myocardial infarction in a patient with severe unrecognized mitral stenosis.

BACKGROUND: Acute myocardial infarction is a rare complication of mitral stenosis. Acute myocardial infarction in the setting of severe unrecognized mitral stenosis has not been described. CASE REPORT: A 47-year-old-woman was admitted to our department for chest pain typical of myocardial infarction. Electrocardiogram showed ST segment elevation in leads II, III, and aVF and atrial fibrillation. Creatine kinase level was elevated to 268 U/L. The diagnosis of acute myocardial infarction of the inferior wall was established. The patient reported breathlessness after physical exertion over the last 2 years; however, she had not sought medical help and was unaware of her heart disease. Transthoracic echocardiography showed severe mitral stenosis (surface mitral valve area <1 cm2) and inferior wall akinesia. CONCLUSIONS: We present a case of acute myocardial infarction in a patient with unrecognized severe mitral stenosis and atrial fibrillation. Our suggestion is that acute myocardial infarction in this patient with no risk factors for coronary atherosclerosis was of thromboembolic origin, from left atrial thrombi.

Analgesics↗
PubMed1998

Newer advances in the diagnosis and treatment of mitral stenosis.

There have been significant changes in presentation, diagnosis, and therapy of patients with mitral stenosis. Both the prevalence of mitral stenosis, as well as the type of patient now with mitral stenosis, have changed significantly over the past few decades. In patients with mitral stenosis two-dimensional and Doppler echocardiography have become the diagnostic modalities of choice. The advent of percutaneous mitral balloon valvotomy now provides a nonsurgical approach for the treatment of selected patients with mitral stenosis.

Blood Flow Velocity↗
PubMed1991

Balloon valvuloplasty for mild mitral stenosis.

Of a total number of 288 patients with mitral stenosis treated by percutaneous balloon valvuloplasty, 21 patients had a basal mitral area equal to or greater than 1.5 cm2, as measured hemodynamically. The immediate hemodynamic results of this particular group of patients with mild mitral stenosis are described, as well as the clinical and echo doppler findings at follow-up (22 +/- 12 mo). Patients with mild mitral stenosis (group I) had more pliable valves (p less than 0.01), as assessed by echo, and higher incidence of sinus rhythm (p less than 0.02) than that observed in the remaining 267 patients (group II). After valvuloplasty the valve area increased in group I from 1.7 +/- 0.2 to 3.1 +/- 0.7 cm2 (p less than 0.0001). This mean final area was significantly different (p less than 0.0001) than that observed in group II (1.98 +/- 0.6 cm2). No patients with mild mitral stenosis developed progression of mitral regurgitation, and none had any other major complications. Most of them reached a grade I final functional status. At echo doppler follow-up studies we did not observe significant changes in the mean mitral gradient as compared with the immediate hemodynamic results. These findings suggest that early mitral balloon valvuloplasty could be an alternative in trying to favorably influence the natural course of the rheumatic mitral disease in selected patients.

Adult↗
PubMed1979

Echocardiographic assessment of mitral stenosis by the left atrial emptying index.

Echocardiograms were performed in 35 patients prospectively with mitral stenosis to determine the usefulness of the left atrial emptying index (AEI) in estimating mitral valve orifice area (MVOA). Twnety-five control patients without evidence of cardiac disease had an AEI of 0.91 +/- 0.01. In the mitral stenosis group, the mean AEI was 0.47 +/- 0.09, with Gorlin and Gorlin calculated MVOAs of 1.44 +/- 0.56. There was close correlation between the AEI and MVOA (r = 0.93). The AEI did not correlate well with the left atrial size (r = 0.10), or the EF slope of the mitral valve (r = 0.20). The AEI was useful in separating patients with mitral stenosis into mild, moderate, and severe groups. Twelve out of 12 patients with severe mitral stenosis (MVOA less than or equal to 1.0 sq cm) had an AEI of less than or equal to 0.42. Ten out of 13 patients with moderate mitral stenosis (MVOA of 1.1--1.5 sq cm) had an AEI of 0.43 to 0.51. Eight out of ten patients with mild mitral stenosis (MVOA greater than or equal to 1.6 sq cm) had an AEI of greater than or equal to 0.52. The overall predictive value of the AEI in subclassifying the severity of mitral stenosis was 86 percent. In conclusion, the AEI appears to be a sensitive index in estimating MVOA in mitral stenosis.

Adult↗
PubMed1997

Mid-term results of mitral valve replacement combined with chordae tendineae replacement in patients with mitral stenosis.

BACKGROUND AND AIMS OF THE STUDY: Although many studies have found that preservation of the continuity between the mitral annulus and the papillary muscles during mitral valve replacement improves postoperative left ventricular performance in patients with mitral regurgitation, much less research has been done in this respect in patients with mitral stenosis. We reviewed our experience with mitral valve replacement combined with chordae tendineae replacement in 29 patients with mitral disease, 26 of whom had mitral stenosis. METHODS: During mitral valve replacement, continuity between the papillary muscle and annulus was restored with expanded polytetrafluoroethylene (ePTFE) mattress sutures, which were threaded into the compact portion of each papillary muscle and placed at the 2, 4, 8 and 10 o'clock positions in the mitral annulus. Postoperatively, the patients were followed by echocardiographic assessment and exercise (stress) radionuclide angiography testing. The stress test results were compared with those in patients who had undergone traditional mitral valve replacement, and also those in normal people. RESULTS: There were no hospital deaths, complications, or cardiac deaths or events during a median follow up of two-and-a-half years. Echocardiography showed no postoperative cardiac dilatation. The stress tests found no significant differences between the ejection fraction in mitral stenosis patients who underwent conventional mitral valve replacement and in those who had valve replacement combined with ePTFE chordae tendineae replacement. CONCLUSIONS: A direct advantage of chordae-preserving mitral valve replacement over conventional replacement with respect to postoperative global left ventricular performance in patients with mitral valve stenosis has not been demonstrated. However, postoperative regional left ventricular contraction in patients with mitral stenosis has been observed to be better among those who have undergone the chordae-preserving procedure. Additional investigations are needed to elucidate the effects of this procedure in mitral stenosis, but we believe that the technique improves left ventricular performance and may decrease the risk of left ventricular rupture.

Adult↗
PubMedDate not supplied

[Relationship of mitral valve area to hemostatic condition in rheumatic mitral stenosis].

The influence of mitral valve area (MVA) on hemostatic conditions was assessed in patients with rheumatic mitral stenosis (MS) without atrial thrombus who underwent percutaneous mitral valvuloplasty (PMV). The Doppler-derived MVA and hemostatic variables were obtained before and 2-3 months after PMV. Hemostatic tests included measurements of beta-thromboglobulin and platelet factor 4 levels as indexes of platelet activation, fibrinopeptide A and thrombin-antithrombin complex as markers of fibrin generation, and D-dimer and plasmin-alpha 2-plasmin inhibitor complex as indexes of active fibrinolysis. Thirty-three measurements in 17 MS patients were subdivided into three groups: group A, 16 samples when MVA was < 1.5 cm2, group B, 12 samples obtained when MVA was 1.5 - < 2.0 cm2, and group C, 5 samples obtained when MVA was > or = 2.0 cm2. The mean level of beta-thromboglobulin was significantly lower in group C (43.6 +/- 32.4 ng/ml) than in group A (142.5 +/- 132.5 ng/ml) or B (163.8 +/- 179.8 ng/ml) (p < 0.05). The incidence of abnormal beta-thromboglobulin was also significantly lower in group C (20%) than in group A (67%) or B (73%) (p < 0.05). Other mean values or incidence of abnormal values of other hemostatic parameters did not differ between the groups. The hemostatic change induced by PMV was examined in 15 MS patients with no change in cardiac rhythm after PMV therapy. The patients were divided into suboptimal (MVA widening < 0.5 cm2, n = 7) and optimal (> or = 0.5 cm2, n = 8) groups. No favorable hemostatic changes were achieved by PMV in the suboptimal group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[A case of mitral valve replacement with autologous pulmonic valve in congenital mitral stenosis].

A one-year-old infant with congenital mitral stenosis and pulmonary hypertension underwent by mitral valve replacement with his pulmonic valve autograft and pulmonary tract reconstruction with heterogeneous pericardial conduit. His postoperative hemodynamics data showed that left atrial pressure decreased and pulmonary hypertension continued. Echocardiography showed that the implanted autograft functioned properly. On the seventh postoperative day, he died of pulmonary hypertension. In case with congenital mitral stenosis with the small mitral annulus and the small left ventricular cavity, it is difficult to perform mitral valve replacement by commercially available mechanical or tissue valves. Because these valves are not suitable for the small mitral annulus. The mitral valve replacement with pulmonic valve autograft is recommended in such a case with the congenital mitral stenosis.

Female↗
PubMed2003

[Impaired left ventricular systolic function in mitral stenosis].

OBJECTIVES: Left ventricular dysfunction is known in patients with mitral stenosis, but the incidence and cause remain unclear. The incidence and the factors related to left ventricular dysfunction were investigated in strictly selected patients with isolated mitral stenosis. METHODS: This study investigated 33 patients (5 males, 28 females) with isolated mitral stenosis aged 56 +/- 9 years. Left atrial dimension, left ventricular diastolic and systolic dimensions, mitral valve area, and mean transmitral pressure gradient were measured by echocardiography. Left ventricular ejection fraction was measured by Simpson's method. Patients were divided into two groups according to the ejection fraction (< 50%, > or = 50%). RESULTS: Seven patients (21%) had decreased left ventricular contraction and 26(79%) had normal contraction. The incidence of patients with atrial fibrillation in the low ejection fraction group was significantly higher than in the normal ejection fraction group(86% vs 31%, p < 0.01). There were no significant differences in the severity of mitral stenosis or other echocardiographic indices between the two groups. CONCLUSIONS: Low ejection fraction was present in 21% of patients with mitral stenosis. Since atrial fibrillation was more common in patients with low ejection fraction than those with normal ejection fraction, the rhythm disturbance may be related to the decreased left ventricular contraction.

Echocardiography, Doppler↗
PubMed1953

MITRAL stenosis.

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Humans↗
PubMed1976

Mitral stenosis with pulmonary hypertension. Long-term results after mitral valvotomy.

Ten patients suffering from tight mitral stenosis with severe pulmonary hypertension were operated on and followed up for one to nine years after operation. There was no operative or postoperative mortality. Postoperative hemodynamic studies were performed on seven of the 10 patients. One patient was evaluated twice--one month and seven months after surgery. The condition of all patients improved after operation and regression of severe to extreme pulmonary hypertension was documented in the seven patients on whom the hemodynamic studies were repeated. Hemodynamic and clinical improvement was greatest in young patients with a shorter duration of disease and a normal sinus rhythm prior to operation. The results indicate that a severe degree of pulmonary vascular resistance in mitral stenosis is largely reversible, provided that the obstruction is adequately relieved.

Adolescent↗
PubMed1980

Echocardiographic evaluation of mitral stenosis using diastolic posterior left ventricular wall motion.

The slope of the posterior left ventricular wall motion in diastole (LVDS) was determined by echocardiography in 25 normal subjects and 21 patients with mitral stenosis. Patients with mitral stenosis had reduced LVDS that was related to the degree of mitral stenosis determined by calculated mitral valve area (r = 0.92). The mitral valve area correlated more closely with the LVDS than with the left atrial emptying index derived from the posterior aortic wall motion. Three patients with mitral stenosis had an increased LVDS after mitral valvotomy or mitral valve replacement. One patient with a stenotic mitral valve prosthesis had reduced LVDS. The results of this study suggest that analysis of the LVDS would be useful in predicting the severity of mitral stenosis and may be beneficial in evaluating patients with suspected prosthetic mitral valve malfunction.

Blood Pressure↗