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PubMedDate not supplied

Simultaneous echocardiographic and catheterisation gradients and mitral valve area during balloon mitral valvuloplasty.

This study was aimed at estimating mean transmitral gradients by simultaneous Doppler echocardiography and cardiac catheterisation and determining mitral valve area by pressure half time, Gorlin's formula and two-dimensional echocardiography so as to assess the relative accuracy of these methods before and after balloon mitral valvuloplasty in patients with rheumatic mitral stenosis. Left atrium-left ventricular, pulmonary artery wedge-left ventricular and echo gradients were simultaneously recorded in 18 patients undergoing balloon mitral valvuloplasty. Mitral valve area was estimated by pressure half time, Gorlin's equation and two-dimensional echocardiography. The correlation between left atrium-left ventricular and echo mean gradient before balloon mitral valvuloplasty was 0.96 (p < 0.03). Between pulmonary artery wedge-left ventricular and echo mean gradient, it was 0.95 (p < 0.04). The correlations between left atrium-left ventricular and pulmonary artery wedge-left ventricular mean gradient were also good. After balloon mitral valvuloplasty, similar good correlations were seen. On subgrouping the patients into those with high and low pulmonary artery pressure, good correlation persisted both before and after balloon mitral valvuloplasty. Mitral valve area by all the methods were similar before balloon mitral valvuloplasty. After balloon mitral valvuloplasty, mitral valve area by pressure half time was the least and by two-dimensional echocardiography, the maximum. All the three methods are equally accurate in estimating transmitral gradients and mitral valve area in mitral stenosis before balloon mitral valvuloplasty. Two-dimensional echocardiography is the best to estimate mitral valve area after balloon mitral valvuloplasty. Echocardiography can replace haemodynamic measurement of gradients and mitral valve area before and after balloon mitral valvuloplasty. But pressure half time is not recommended for measuring mitral valve area immediately after balloon mitral valvuloplasty where two-dimensional echocardiography mitral valve area is to be employed.

Adolescent↗
PubMed2006

Morphological findings in 192 surgically excised native mitral valves.

INTRODUCTION: Mitral valve disease (MVD) is a significant clinical problem that is becoming more common in the 21st century. The pathogenesis of MVD seems to be changing and is not well understood. PATIENTS AND METHODS: The present study details the morphological findings in 192 native mitral valves excised over a one-year period at the Toronto General Hospital, Toronto, Ontario. The mean patient age was 59.7+/-12.3 years at operation. RESULTS: There were 106 men (55.2%) and 86 women (44.8%) in the present study. The most frequent changes in the surgically excised valvular leaflets were fibrosis (78.6%) and thickening (66.2%). Fusion (32.3%) and calcification (25.2%) were common changes at the commissures. Chordae tendineae most often showed evidence of thickening (47.9%) and fibrosis (37.0%). In total, 110 valves showed mitral incompetence (57.3%), 72 showed mitral stenosis (37.5%), and 10 showed a combination of stenosis and incompetence (5.2%). CONCLUSIONS: In the present series, MVD was most frequently caused by postinflammatory (rheumatic) valve disease (RVD) (35.9%), followed by myxomatous degeneration (33.3%). Patients with RVD were usually female (66.7%), while those with myxomatous degeneration were more likely to be male (76.6%). RVD remains a significant problem even though the incidence of acute rheumatic fever with cardiac involvement has declined in Canada. This most likely reflects the current sociodemographic composition of the referral population.

Adolescent↗
PubMed1979

The echocardiographic association of mitral valve prolapse and mitral anulus calcification.

Mitral anulus calcification (MAC) and mitral valve prolapse (MVP) are frequently diagnosed conditions. We studied two patients with mild or moderate mitral regurgitation who demonstrated both MAC and MVP on angiography and echocardiography. M-mode echocardiography is probably the definitive test for confirming the presence of MVP. Echocardiography is moderately sensitive in the diagnosis of cardiac calcification, such as MAC, but M-mode echocardiography may not detect the MAC in the majority of patients with both MVP and MAC demonstrated by angiography.

Calcinosis↗
PubMed2002

[Cox/maze III procedure combined with mitral valve replacement in treatment of rheumatic mitral valve disease with atrial fibrilation].

OBJECTIVE: To compare the curative effect of Cox/maze III procedure combined with mitral replacement and that of mitral valve replacement (MVR). METHODS: Fifty-six patients suffering from rheumatic heart disease with atrial fibrillation (AF) were treated by Cox/maze III procedure combined with MVR (maze group). Another 56 age, sex, and heart function-matched patients with the same diagnosis underwent MVR alone during the same period. Warfarin was administered after operation in both groups. Comparison of operative complication and curative effects was made. RESULTS: The aortic cross-clamp time and cardio pulmonary bypass time (CPB) were longer in maze group than in MVT group (75 +/- 22 min vs 41 +/- 11 min, P < 0.05 and 124 +/- 40 min VS 68 +/- 19 min, P < 0.05). Bleeding happened after the heart reatored beating in 2 patients in maze group and in one patient in MVT group, all these 3 patients responding satisfactorily to hemostasis. The early post-operative mortality was 1.79% (1/56) in both groups. In maze group, AF disappeared in all patients but one who had node rhythm. Normal sinus rhythm was restored in 98.18% of the patients (54/55). Atrial contractility was restored in all patients with sinus rhythm. One year after operation, 98.18% patients' cardiac function changed to grade and 1.82% changed to grade II. In MVR group AF disappeared after operation temporarily for 24 hours in 7 patients and re-appeared, and AF disappeared in one patients for 2 years so far. One year after operation, the cardiac function of 94.6% patients in MVR group changed to grade I, of 3.6% patients to grade II, and of 1.8% patients to grade III. No serious hemorrhage relate d to anticoagulant therapy happened. One patient in MVR group suffered from hemiplegia due to cerebral embolism. The late mortality was 1.8% on maze group amd 3.6% in MVR group. CONCLUSION: Cox/maze III procedure combined with NVR is safe and effective in treating rheumatic heart disease with AF.

Adult↗
PubMed1976

Abnormal motion of the mitral valve with pericardial effusion: Pseudo-prolapse of the mitral valve.

The echocardiograms of seven patients with large pericardial effusions were found to show posterior motion of the mitral leaflets in systole as seen in prolapse of the mitral valve. Repeat echocardiograms after resolution of the effusion revealed normal mitral valve motion. None of the patients had clinical evidence of prolapsed mitral valve. We postulate that a posterior swing of the heart within the pericardial fluid occurring in late systole causes posterior displacement of the mitral valve simulating a prolapsed valve.

Diagnosis, Differential↗
PubMed1986

[Doppler sonography quantification of mitral valve stenosis in patients with and without mitral valve insufficiency].

Fifty-three patients with mitral stenosis (MS) were examined by two dimensional (2DE) and Doppler echocardiography (Dop). Twenty-nine of them also had mitral insufficiency (MI) as judged by Dop. The mitral valve area (MVA) was calculated from Doppler using the "pressure half time" and was compared with MVA by 2 DE. There was a good correlation between both methods in all 53 patients (r = 0.88; SEE = 0.34 cm2) but also in the subgroups with pure MS (r = 0.86; SEE = 0.29 cm2) and MS + MI respectively (r = 0.90; SEE = 0.38 cm2). The accuracy and the reproducibility of the Doppler method was highly dependent on the severity of the stenosis. In 19 cases with mild MS (MVA by 2 DE greater than 1.5 cm2) the absolute difference between MVA 2 DE and Dop averaged 0.39 cm2. The difference between the maximal and minimal Doppler MVA which reflects the variability of this method averaged 0.65 cm2 in this group. In cases with significant MS (MVA by 2 DE less than or equal to 1.5 cm2) the average difference 2 DE -Dop and Dop max-Dop min was only 0.20 cm2 and 0.27 cm2 respectively. In patients with comparable degrees of stenosis additional MI did not adversely affect the accuracy of the Doppler method. We conclude that Doppler echo allows an accurate quantitation of mitral stenosis even in patients with associated MI.

Adolescent↗
PubMed2004

Reversible mitral valve prolapse and mitral regurgitation in children with Graves' disease.

An association between mitral valve prolapse (MVP) and hyperthyroidism has been described in adults. However, the long-term prognosis when associated with significant mitral regurgitation remains unclear. Three consecutive children with Graves' disease were found to have a loud mitral regurgitation murmur (grade III/VI) and echocardiographic evidence of MVP with moderate mitral regurgitation. The cardiac manifestations included palpitations, exertional dyspnea, and exercise intolerance. The electrocardiograms at presentation were sinus tachycardia in all cases. All had hyperthyroidism and positive thyroid antibodies. Exophthalmos occurred in two and appeared later than the cardiac symptoms in one. The cardiac murmur disappeared in all patients when antithyroid agents controlled the hyperthyroidism. Follow-up echocardiography showed normal in one and MVP with mild mitral regurgitation in two. We conclude that MVP and significant mitral regurgitation can occur in children with hyperthyroidism, especially those with Graves' disease. The prognosis is good after adequate medical control of the hyperthyroidism.

Adolescent↗
PubMed2006

Ventricular fibrillation due to severe mitral valve prolapse.

Mitral valve prolapse usually has a good prognosis. However, an association between mitral valve prolapse and atrial and ventricular arrhythmias has been described. This case presents a patient who was admitted after cardiac resuscitation due to ventricular fibrillation. A severe mitral valve prolapse was the only pathology found.

Cardiopulmonary Resuscitation↗
PubMed1985

Underestimation of prosthetic mitral valve areas: role of transseptal catheterization in avoiding unnecessary repeat mitral valve surgery.

In patients with symptoms of heart failure after mitral valve replacement, identification of a stenosed prosthesis may be difficult. Twelve such patients were evaluated, presenting at a mean of 8.4 years after mitral valve replacement (four mechanical, eight porcine). Transvalvular pressure gradients were obtained using both indirect (pulmonary capillary wedge) and direct (transseptal catheterization) measurements of left atrial pressure. In all 12 patients, the diastolic gradient across the prosthetic valve was overestimated when pulmonary wedge rather than transseptal measurements were used. Calculated mitral valve prosthetic area was underestimated by the pulmonary wedge determinations. These findings may be caused by either the phase delay of the pulmonary wedge V wave relative to the transseptal V wave, resulting in a higher diastolic mean left atrial pressure, or the faulty wedge determinations in the setting of pulmonary hypertension, or both. In patients being considered for repeat mitral valve replacement because of prosthetic valve stenosis, transseptal catheterization allows for more accurate determination of prosthetic valve area and more accurately defines the need for repeat mitral valve surgery.

Aged↗
PubMed1997

Echocardiography in mitral valve repair for mitral regurgitation: the surgeon's needs.

Mitral valve repair has become the operation of choice for mitral regurgitation. It is often technically more demanding than valve replacement. The role of echocardiography has now extended beyond the identification of severe mitral regurgitation that would benefit from surgical correction. It helps the surgeon to assess valve reparability preoperatively, to assess the need for valve surgery in equivocal cases of ischemic mitral regurgitation, to plan the operation, and to assess valve function after repair. This article aims to discuss the role of echocardiography in providing the information needed by the surgeon for successful mitral valve repair. The echocardiographer must understand the surgeon's needs, while surgeons should understand both the benefits and limitations of echocardiography.

Diagnosis, Differential↗
PubMed1999

Preliminary study on the new self-closing mechanical mitral valve.

Anatural mitral valve starts closing before systole. Conventional mechanical mitral valves start their closing motion after systole. In order to let the mechanical mitral valves start closing before systole, we propose a new self-closing valve by adjusting the center of gravity of the leaflet. As a first step, we adjusted the center of gravity by attaching a block of lead to the leaflet of a CarboMedics bileaflet valve and evaluated it using a pulse duplicator and an x-ray high-speed video camera. Comparative study was conducted under 60 bpm and 4 L/min as the mean flow rate. It was clarified that the self-closing valve started closing before systole, no influence on inflow volume was found, the final closing speed of the self-closing valve just before complete closure was slower than the conventional valve (1.9-0.34 m/s), a design strategy of a self-closing valve (sewing ring diameter 29 mm) was obtained from the experiment that momentum of inertia of the leaflet should be less than 14.9 x 10-9 kg.m2 and the torque caused by gravity should be more than 4.2 x 10-6 N. m, and only one leaflet should be designed as self-closing, and surgeons need to pay attention to the positioning of the two leaflets. In conclusion, the preliminary study showed the ability of starting to close before systole and the design strategy for future prototyping.

Biocompatible Materials↗
PubMed2003

Mitral valve surgery for mitral regurgitation in patients with advanced dilated cardiomyopathy.

BACKGROUND: Unfortunately, mitral valve surgery for mitral regurgitation (MR) in patients with advanced dilated cardiomyopathy is generally associated with a high operative risk and a poor outcome. Some authors believe that only heart transplantation is the really effective surgical treatment. We analyzed our clinical and echocardiographic results after mitral repair or replacement in this difficult subset of patients. METHODS: From September 1998 to May 2001, 24 consecutive patients (mean age 65.7 +/- 11.0 years) with MR > 2+ and advanced dilated cardiomyopathy (left ventricular ejection fraction < 0.35) underwent mitral repair (n = 11) or replacement (n = 13). The cause of left ventricular dysfunction was ischemic in 17 patients and idiopathic in 7. Myocardial revascularization was performed in all patients with ischemic disease. NYHA functional class IV was present in 21 patients (87.5%) and urgent surgical priority in 14 (58.3%). The mean follow-up was 26.7 +/- 11.8 months. RESULTS: One patient died (4.2%) of myocardial infarction 5 days after operation. The mean hospital stay was 10.6 +/- 3.7 days. During follow-up, two deaths (8.7%) due to heart failure occurred. In survivors, NYHA functional class improved from 3.9 +/- 0.4 preoperatively to 2.2 +/- 0.4 at follow-up (p = 0.0037) and left ventricular ejection fraction from 0.24 +/- 0.05 to 0.30 +/- 0.05 (p = 0.0035) in patients with ischemic dilated cardiomyopathy, and from 0.23 +/- 0.04 to 0.26 +/- 0.05 (p = NS) in patients with idiopathic dilated cardiomyopathy. CONCLUSIONS: Mitral surgery in advanced left ventricular dysfunction can be accomplished with an acceptable operative risk. It offers a durable functional improvement. In ischemic dilated cardiomyopathy concomitant myocardial revascularization procures a significant amelioration in the left ventricular performance as evaluated at echocardiography.

Adult↗
PubMed1991

[Intensity of tone and opening snap, and morphology of the bicuspid valve in patients with mitral valve disease].

The purpose of this study was to investigate the correlation between mitral valve morphology and amplitude of the first heart sound and the opening snap. The material consisted of 21 women and 19 men with mitral valve disease. They ranged in age from 24 to 56 years. 36 patients had pure or dominant mitral stenosis and 4 patients had combined mitral valve disease with dominant regurgitation. Phonocardiograms were recorded in all patients before mitral valve replacement. We analyzed the presence and the amplitude of opening snap and the amplitude of the first heart sound at the apex. The amplitude of the opening snap was expressed in mm and as a ratio to the maximal vibration of the second sound in the same cycle. The amplitude of the first sound was expressed in mm and as a ratio of the maximal vibration of the first sound to the maximal vibration of the first sound to the maximal vibration of the second sound in the same cycle. All amplitude measurements were made in 10 consecutive cardiac cycles and were then averaged. Then we studied all mitral valves removed in a uniform manner by one surgeon. Excised valves were fixed in 5% solution of formaline. The extent of calcification was determined by radiographs (fig. 1). The mitral valve area and calcification area were estimated by planimetry of radiographs. Then we analyzed the localization of calcification and we calculated the ratio of calcification area to valve area. Valves were divided into three groups according to the degree of the fusion of subvalvular structures ("a funnel") (fig. 2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1975

Orifice-view roentgenography of the mitral valve.

The mitral valve can be visualized as if looking directly into the valvular orifice by obtaining roentgenograms directed obliquely through the heart at a 25 degree superior elevation, with the patient rotated 60 degrees in the right anterior oblique direction. This view was based upon trigonometrical calculations of the spatial orientation of the annulus of prosthetic mitral valves in 25 patients. Calculations based upon measurement in these patients indicate that the area of the orifice of the mitral valve can be shown with less than ten percent error due to distortion of the projected image in 80 percent of patients. During the injection of contrast material into the left ventricle, orifice-view roentgenorgram serve as a useful adjunct to satndard ventriculograms. Such views permit assessment of the size of the mitral annulus and the degree of stenosis. Plain orifice-view roentgenograms of heavily calcified mitral valves permit measurement of the area circumscribed by calcium in such patients. The measurements indicate an upper limit of the possible size of the functional orifice. Therefore, this roentgenographic technique serves in a practical fashion as a non-invasive method for the assessment of the severity of mitral stenosis in such individuals.

Aortic Valve Stenosis↗
PubMed1988

A histological study of the atrioventricular junction in hearts with normal and prolapsed leaflets of the mitral valve.

The mitral annulus is the point at which the atrial and ventricular walls meet the base of the mitral valve cusps. The suggestion that a variant of this arrangement termed "disjunction" was associated with prolapse of the leaflets prompted examination of the mitral atrioventricular junctions in seven normal hearts and six with prolapse owing to floppy mitral valves. A complete cord-like ring of connective tissue that encircled the atrioventricular junction and into which the three components were inserted at the same point was found in only one heart. The remaining hearts all showed a mixture of segments in which either the three components were inserted into a cord or simply met. Disjunction, defined as a separation of the atrial wall-mitral valve junction from the other component, the left ventricular wall, can occur both with and without a cord-like annulus. There was no significant difference in the number of segments around the left atrioventricular junction which showed disjunction in hearts with normal or prolapsing leaflets. The feature termed disjunction is an anatomical variation of the normal morphological characteristics of the left atrioventricular junction.

Aged↗
PubMed2006

[Mitral valve repair for mitral regurgitation].

We analyzed the results of mitral valve repair in 81 consecutive patients with severe mitral regurgitation. Of these patients, 66.6% had myxomatous degeneration, 11% ischemic disease, 8% chordal rupture, 5% congenital disease, and 3.7% endocarditis. Repair could not be achieved in five patients, and valve replacement was necessary. Six died during surgery (mortality 7%). During follow-up (mean 30 [8] months), there was one death due to refractory ischemic heart failure and mitral regurgitation (>or= 2/4) was observed in 11 patients. A good result (i.e., survival without a prosthesis, major complications, or mitral regurgitation >1/4) was obtained in 78% of patients with myxomatous degeneration versus 48% of those with other etiologies (P=.023). A good result was obtained more frequently in cases of isolated posterior cusp degeneration than in those involving degeneration of both cusps (85% vs 70%; P=.03).

Adolescent↗