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PubMed1981

Right ventricular performance in mitral stenosis.

Until recently, the dynamic geometry and pump function of the pressure-overloaded right ventricle in patients with mitral stenosis and pulmonary hypertension had not been well defined. With use of a recently developed method for calculating right ventricular volume in human beings, seven normal subjects and eight patients with mitral stenosis and pulmonary hypertension had right ventricular performance assessed from computer-analyzed biplane right ventriculograms. Patients with mitral stenosis has elevated values for systolic right ventricular pressure (mean +/- standard error of the mean 25 +/- 2 for normal subjects, 57 +/- 6 mm Hg for patients with mitral stenosis), but normal values for right ventricular end-diastolic volume index (normal 95 +/- 11, patients 81 +/- 9 ml/m2) and ejection fraction (normal 0.49 +/- 0.02, patients 0.58 +/- 0.04). Comparison of right ventricular function using group performance curves of stroke work versus end-diastolic volume revealed the slope of the mitral stenosis line to be significantly greater than the normal line. A plot of right ventricular stroke volume versus end-diastolic volume, which removes pressure from the performance index, revealed that the two groups have similar performance. Left ventricular function measured by ejection fraction was reduced in mitral stenosis. These data suggest that the right ventricle performs normally in patients with mitral stenosis with moderate pulmonary hypertension and maintains normal size and ejection fraction.

Blood Pressure↗
PubMed1979

The value of echocardiography in assessing the severity of mitral stenosis.

In a group of 24 patients having pure mitral stenosis, the relation between the echo parameters of the mitral valve and pressures in the pulmonary circulation was studied. On the basis of the authors' results, it was concluded that the sensitivity of one-dimensional echocardiography for the assessment of the severity of mitral stenosis can be further improved by measuring not only the widely accepted parameters, such as the diastolic closing velocity and the motion amplitude of the AML, but also by taking into account the echodiameter of the mitral orifice. Besides, careful observation of the motion pattern of the PML might be of use for distinguishing between a mild and moderate degree of mitral stenosis.

Adult↗
PubMed1995

Progression to calcific mitral stenosis in end-stage renal disease.

A 59-year-old man with end-stage renal disease and on hemodialysis had neither mitral stenosis nor mitral calcification on echo-Doppler examination in 1989, but had extensive mitral calcification and definite mitral stenosis on conventional and transesophageal echocardiography in 1994. The left ventricle had marked concentric hypertrophy. To our knowledge this is the first documentation of the development of calcific mitral stenosis in end-stage renal disease revealed by serial echo-Doppler studies.

Calcinosis↗
PubMed1977

Mitral valve prolapse in rheumatic mitral stenosis.

Four adult women with histories of rheumatic fever and clinical findings of mitral stenosis and regurgitation had echocardiograms demonstrating moderately severe mitral stenosis (EF slope less than 20 mm/sec, mean left atrial size 3.0 cm/m2, mean anterior mitral leaflet excursion 25 mm) as well as typical mitral valve prolapse. Three patients underwent cardiac catheterization which confirmed the presence of mitral stenosis, as well as systolic prolapse and excessive scalloping of the mitral valve with no visible mitral calcium and no coronary artery disease. One patient had associated mild aortic stenosis and regurgitation. Two patients underwent mitral valve surgery which revealed anterior and posterior commissural fusion consistent with rheumatic disease and intact chordal apparatus. Both leaflets were large and the anterior leaflets were redundant. There were no vegetations. Pathology revealed myxomatous degeneration of the valve leaflets. In the absence of heavy calcification and thickening, the presence of mitral stenosis with commisural fusion does not exclude the possibility of a redundant mitral valve. When these entities coexist, systolic clicks may be absent.

Aged↗
PubMed1988

Percutaneous balloon mitral valvuloplasty in a pregnant woman with mitral stenosis.

A 39-year-old woman with symptomatic mitral stenosis underwent percutaneous mitral valvuloplasty at the end of her first trimester of pregnancy. Balloon dilatation utilizing a double 18-20 mm balloon technique resulted in improvement in mean mitral gradient (16 to 7 mmHg) and in calculated mitral valve area (1.4 to 2.4 cm2), without significant complications and with an estimated radiation exposure to the fetus of less than 0.2 rads. The procedure resulted in disappearance of symptoms of congestive heart failure and allowed for discontinuation of diuretics. The subsequent course of gestation was uncomplicated and a normal baby boy was delivered in the 36th wk. We conclude that percutaneous mitral valvuloplasty may produce successful palliation of symptoms in patients with mitral stenosis during pregnancy.

Adult↗
PubMed1998

Effects of balloon mitral valvuloplasty on left atrial function in mitral stenosis as assessed by pressure-area relation.

OBJECTIVES: This study sought to investigate the changes induced on the pressure-area relation of the left atrium in patients with mitral stenosis after percutaneous balloon mitral valvuloplasty. BACKGROUND: Left atrial (LA) function is influenced by changes in LA afterload. The latter is increased in mitral stenosis as a result of increased resistance to blood flow imposed by the stenotic mitral valve. METHODS: We studied the effects of acute alterations of LA afterload induced by retrograde nontransseptal balloon mitral valvuloplasty (RNBMV) on LA function in patients with mitral stenosis. LA pressure-area relations were obtained in 15 patients with mitral stenosis (8 with sinus rhythm, 7 with atrial fibrillation) before and after valvuloplasty, as well as in 15 normal subjects. LA pressure was recorded by a catheter-tipped micromanometer introduced retrogradely into the left atrium while LA area was recorded simultaneously using acoustic quantification. The areas of the A and V loops of the pressure-area relation as well as the LA chamber stiffness constant were calculated. RESULTS: Balloon valvuloplasty resulted in a significant increase in mitral valve area (p < 0.001) and a substantial reduction of the mean transmitral pressure gradient (p < 0.001) and mean LA pressure (p < 0.001). The area of the A loop in patients with sinus rhythm and the area of the V loop in those with atrial fibrillation increased significantly after completion of the procedure (p < 0.001). Furthermore, LA stiffness decreased in both groups. CONCLUSIONS: After RNBMV, there is a significant increase in LA pump function in patients with sinus rhythm, a significant increase in LA reservoir function in patients with atrial fibrillation and a significant reduction in LA stiffness in all patients. Marked alterations of the configuration of the LA pressure-area relation occur immediately after successful RNBMV in patients with mitral stenosis.

Adult↗
PubMed1985

Noninvasive detection of aortic insufficiency in patients with mitral stenosis by pulsed Doppler echocardiography.

In patients with mitral stenosis, routine noninvasive techniques are insensitive for the detection of coexistent aortic insufficiency. The ability of pulsed Doppler echocardiography to detect the presence or absence of angiographically demonstrated aortic insufficiency was evaluated in 45 patients with rheumatic mitral stenosis. Pulsed Doppler echocardiography correctly identified the presence of aortic insufficiency in 97% of the 35 patients with documented aortic regurgitation. More important, pulsed Doppler echocardiography disclosed aortic insufficiency in all 7 patients in whom it was not suspected on physical examination and in 28 of the 29 patients in whom it was not suspected by M-mode echocardiography. Pulsed Doppler echocardiography also demonstrated excellent specificity, correctly detecting the absence of aortic insufficiency in 9 of the 10 patients who had no angiographic evidence of aortic insufficiency. It is concluded that in patients with mitral stenosis, pulsed Doppler echocardiography is a useful noninvasive diagnostic test for evaluating the presence of aortic insufficiency, even when this lesion is not detectable by physical examination or M-mode echocardiography.

Adult↗
PubMedDate not supplied

Heart rate variability in patients with mitral stenosis: a study of 20 cases from King Abdulaziz University Hospital.

BACKGROUND: Left atrial enlargement in mitral stenosis predisposes to atrial fibrillation (AF). Analysis of heart rate variability (HRV) prior to the onset of an arrhythmia may show alterations in autonomic balance that are known to predispose to the development of AF. The aim of this study was to determine whether HRV in patients with rheumatic mitral stenosis (MS) is abnormal in comparison to normal controls, and to find the relationship between left atrial size and HRV in patients with MS in sinus rhythm and in AF. SUBJECTS AND METHODS: A series of 24-hour ambulatory Holter electrocardiogram recordings were obtained for 10 consecutive, newly diagnosed untreated subjects with pure mitral stenosis in sinus rhythm, 10 with mitral stenosis complicated by atrial fibrillation and 10 age-matched normal controls. Digitized records were processed using time domain and power spectral analysis. RESULTS: In patients with mitral stenosis in sinus rhythm, we observed significant decrease of the standard deviation of the RR intervals (SDRR), as well as of the root mean square of successive RR interval differences (RMSSD) and Edinburgh index (sNN50), while in patients with AF, the RMSSD and sNN50 were much larger than those in normal. The areas under all spectral bands were markedly increased in patients with AF compared with normal. Furthermore, the high low frequency/high frequency (HLF/HF ratio) ratio was very small compared to normal. HRV measures were independent of atrial size in both groups. CONCLUSION: Decreased HRV in mitral stenosis patients with sinus rhythm suggests increased sympathetic activity in patients prone to atrial fibrillation, while marked increased of HRV in patients with AF may indicate that parasympathetic activity modulates the intrinsic behavior of the atrioventricular node during atrial fibrillation. The evaluation of HRV may be a useful tool for the identification of patients predisposed to AF.

Journal Article↗
PubMedDate not supplied

The correlation between Doppler data and effort capacity in mitral stenosis.

UNLABELLED: The data concerning the relation between mitral valve area (MVA), estimated invasively or by 2 D-echo and effort capacity in mitral stenosis (MS) are still controversial. Consequently we have studied the same relation, using the Doppler indices. METHODS: 19 patients with MS were submitted to a Doppler examination--MVA, pressure half time (PHT), mean pressure gradient (MPG)--and to a symptoms limited exercise testing on cycloergometer--effort intensity (Watts, METs) functional aerobic impairment (FAI), myocardial aerobic impairment (MAI). The "r" correlation index between these parameters was calculated. The results show no significant correlation between Doppler estimated severity of mitral stenosis and the effort capacity of the patients, even if a weak negative correlation ("r" = - 0.32) is noted between effort intensity and MPG and a weak positive correlation ("r" = + 0.41) between FAI and PHT. The conclusion is that effort capacity of patients with mitral stenosis cannot predict the severity of the disease which is to be established through other methods.

Adult↗
PubMed1995

Effects of chronic beta-blockade on rest and exercise hemodynamics in mitral stenosis.

beta-blocker therapy for mitral stenosis is controversial. This study compares right and left heart hemodynamics at rest and supine submaximal exercise in patients (n = 7) receiving chronic beta-antagonists with untreated patients (n = 17) matched for age (mean +/- SD = 51 +/- 12 years) and valve area (0.7 +/- 0.2 cm2/m2). Little benefit was observed with treatment at rest. Although pulmonary capillary wedge pressures (PCWP) were lower during exercise in the beta-blocker group (22 +/- 4 vs. 31 +/- 9 mmHg; P < 0.05), exercise performance was not enhanced and cardiac output response during exercise was reduced (control = 41% increase vs. 12% for beta-blockade). PCWP rose rapidly when diastolic filling periods were < 300 msec in both groups. Pulmonary capillary wedge pressure was found to be a nonlinear functions (P < 0.001) of diastolic filling period (PCWP = 15.9 + 5.84 x 10(5)/dfp2). These data suggest that there is a critical heart rate in patients with mitral stenosis above which hemodynamic compromise rapidly occurs.

Adrenergic beta-Antagonists↗
PubMed2000

Rheumatic Mitral Stenosis.

Patients with symptomatic mitral stenosis should undergo evaluation with transthoracic and transesophageal echocardiography (Table 1). Those patients with suitable valve morphology should be treated with percutaneous transvenous mitral commissurotomy (PTMC). Randomized trials of catheter commissurotomy have shown no differences in long-term outcome compared with surgical commissurotomy; there is therefore no role for surgical commissurotomy in patients who are suitable candidates for balloon commissurotomy. Mitral valve replacement should be recommended for those patients with valve deformity too severe to undergo catheter therapy. Some older patients who are less-than-ideal candidates for catheter therapy nonetheless may benefit from it as a palliative alternative to otherwise high-risk valve surgery. Asymptomatic patients should be screened for the presence of pulmonary artery hypertension. Those who have pulmonary artery systolic pressure at rest of greater than 50 mm Hg or who develop pulmonary artery systolic pressure of greater than 60 mm Hg with exercise should be considered for PTMC.

Journal Article↗
PubMed1992

Preoperative and postoperative right ventricular function during exercise in patients with mitral stenosis.

To elucidate the effects of mitral valve surgery on right ventricular function in 11 patients with mitral stenosis, pre- and postoperative right ventricular function were quantified using gated equilibrium blood pool radionuclide ventriculography at rest and during exercise. The preoperative right ventricular ejection fraction was 39 +/- 4% at rest and 36 +/- 9% during exercise, which during exercise was lower than control values (51 +/- 5%) (p < 0.01). When the preoperative right ventricular ejection fraction was lower during exercise than at rest, postoperative right ventricular ejection fraction during exercise was lower than normal values (42 +/- 3% versus 51 +/- 5%) (p < 0.01). When the preoperative right ventricular ejection fraction did not decrease during exercise, the postoperative right ventricular ejection fraction was within normal limits during exercise (54 +/- 5%). In addition, postoperative right ventricular ejection fraction during exercise increased to normal values in patients whose preoperative right ventricular ejection fraction during exercise had been 40% or higher. Preoperative peak ejection rate was -1.81 +/- 0.19 EDV/sec at rest and -1.72 +/- 0.39 EDV/sec during exercise, which during exercise was lower than control values (-2.44 +/- 0.53 EDV/sec) (p < 0.01). Postoperatively, peak ejection rate during exercise (-2.50 +/- 0.37 EDV/sec) increased (p < 0.05) to normal levels. Preoperative peak filling rate was 1.61 +/- 0.47 EDV/sec at rest and 1.88 +/- 0.54 EDV/sec during exercise, which during exercise was lower than control values (2.58 +/- 0.62 EDV/sec) (p < 0.01). Postoperatively, peak filling rate during exercise (2.82 +/- 0.62 EDV/sec) increased (p < 0.05) to normal values in all patients. Preoperative changes in both right ventricular ejection fraction and peak ejection rate from rest to exercise inversely correlated with the preoperative pulmonary vascular resistance at rest (right ventricular ejection fraction, r = -0.79, p < 0.005; and peak ejection rate, r = -0.67, p < 0.05). In conclusion, right ventricular systolic function improved in about half of the patients with mitral stenosis, and diastolic function improved in all patients during exercise following surgery. When the preoperative pulmonary vascular resistance was elevated, the right ventricular systolic dysfunction persisted.

Adult↗
PubMed1978

Echocardiographic evaluation of left ventricular filling in mitral stenosis. Role of atrial contraction.

Echocardiographic evaluation of left ventricular volume change during rapid and atrial filling periods was made in patients with mital stenosis. The significant reduction of rapid filling volume was observed and the rate of rapid filling was approximately the half of normal in mitral stenosis. The rapid filling period showed a good correlation to the mitral valve area measured at operation. After surgical treatment, the rate of rapid filling was significantly increased but was still significantly smaller than normal. It was suggested that the remained structural abnormality of mitral apparatus depressed the inflow through the mitral valve in early diastole despite successful mitral valvotomy. Left ventricular filling during atrial contraction (atrial filling) was augmented twice as much as normal in patients with milder mitral stenosis, compensating the decreased early diastolic filling. In contrast, the atrial filling did not increase in severe mitral stenosis, resulting in the decreased cardiac output. Following mitral commissurotomy, the atrial filling in milder mitral stenosis was reduced but remained significantly larger than normal. There was no change of atrial filling in severe mitral stenosis postoperatively. This fact suggested the existence of impaired contraction of left atrium in cases with severe mitral stenosis. Our results show that the altered left atrial transport function plays an important role in the left ventricular filling in mitral stenosis.

Adult↗
PubMed1990

Acquired Lutembacher syndrome or mitral stenosis and acquired atrial septal defect after transseptal mitral valvuloplasty.

Critical mitral stenosis in selected patients may be treated successfully with percutaneous mitral valvuloplasty. Complications of this procedure, particularly an atrial septal defect following transseptal approach, are generally of minor clinical significance. We describe a woman who initially underwent a successful percutaneous double-balloon mitral valvuloplasty via the transseptal approach. Three months later she presented with right-sided heart failure. Color Doppler echocardiography and cardiac catheterization demonstrated an atrial septal defect (ASD) as well as restenosis of the mitral valve. We conclude that significant ASDs may occur following transseptal mitral valvuloplasty with appearance of right ventricular failure and that color Doppler imaging aids in the diagnosis of this new variant of the classical Lutembacher syndrome.

Aged↗
PubMed1997

[A patient with mitral stenosis due to infective endocarditis].

A 51-year-old woman presented with mild stenosis of the mitral valve which had become thickened and rigid due to infective endocarditis, manifesting as persistent fever of up to 40 degrees C and general fatigue of a few days' duration. A harsh systolic murmur was heard. Multiple blood cultures revealed alpha-streptococcus. Echocardiography disclosed asymmetric septal hypertrophy (interventricular septal thickness/posterior wall thickness, 19/14 mm) and systolic anterior wall motion of the mitral valve. Continuous wave Doppler ultrasonography showed a peak left ventricular outflow tract pressure gradient of 170 mmHg. Transesophageal echocardiography revealed vegetations on the anterior mitral leaflet, aortic valve and interventricular septum along the left ventricular outflow tract. In particular, the anterior mitral leaflet was thickened and moved poorly. The calculated mitral valve areas was 1.5 cm2 and peak diastolic left atrium-left ventricle pressure gradient was 7 mmHg. A specimen of the mitral valve did not reveal commissural adhesion, but the anterior mitral leaflet showed marked fibrous thickening caused by scarred vegetation. Based on these findings, the diagnosis was hypertrophic obstructive cardiomyopathy complicated by infective endocarditis and "mitral stenosis". Valvular regurgitation is a common complication of active and healed infective endocarditis. In contrast, infective endocarditis rarely causes valvular stenosis except for stenosis caused by large fungus vegetation.

Cardiomyopathy, Hypertrophic↗
PubMed1991

Value of a modified continuity equation method to quantify mitral valve area in patients with mitral stenosis and sinus rhythm.

To quantify valve area in mitral stenosis, a modified continuity equation method using continuous wave Doppler and thermodilution measurements was applied. In 14 patients with mitral stenosis and sinus rhythm (age: 49 +/- 11 years), transmitral flow velocity was recorded by continuous wave Doppler during right and left heart catheterization. Mitral valve area was calculated by three different methods: 1. According to the continuity equation, stroke volume (thermodilution technique) was divided by the registered time velocity integral of the mitral stenotic jet (continuous wave Doppler). 2. Mitral valve area was calculated by the pressure half-time method. 3. Simultaneous pulmonary capillary wedge and left ventricular pressure measurements were used for determination of mitral valve area according to the Gorlin formula. The mitral valve area determined by application of the continuity equation (y) showed a close correlation to the valve area calculated by the Gorlin equation (x): y = 0.73x + 0.12, SEE = 0.11 cm2, r = 0.88, P less than 0.001. In contrast, the correlation between mitral valve area determined by pressure half-time (y) and the Gorlin formula (x) was not as good: y = 0.77x + 0.11, SEE = 0.26 cm2, r = 0.65, P less than 0.05. Thus, the continuity equation method using combined continuous wave Doppler and thermodilution technique allows a valid determination of mitral valve area. In patients with mitral stenosis and sinus rhythm, this technique is superior to the noninvasive determination of mitral valve area by the conventional pressure half-time method.

Adult↗
PubMed1988

[Systolo-diastolic events in mitral stenosis].

Left ventricular contractility and relaxation in mitral stenosis are still controversial. 20 patients with pure mitral stenosis in sinus rhythm have been studied during diagnostic cardiac catheterization with high fidelity pressure and output recording at rest (R), during dynamic exercise (E), handgrip (HG), methoxamine infusion (M) and amyl nitrite inhalation (AN). - The results were as follows: Mitral valve area was 1.2 +/- 0.4 cm2 and did not change during interventions. LV end-diastolic volume were 106.3 +/- 19.6 ml and ejection fraction 66.5 +/- 3.2%. The mitral valve opening occurred irrespective of interventions 37 +/- 2 msec after left ventricular and left atrial pressure crossover. The mitral valve opening was followed by left ventricular negative pressure of -4.6 +/- 1 mm Hg, suggesting active left ventricular suction. This negative protodiastolic pressure was accentuated by the premature ventricular beat (-7.2 +/- 2.0 mm Hg), AN (-7.4 +/- 1.8 mm Hg) and M infusion (-7.4 +/- 1.2 mm Hg). Closure of the mitral valve occurred 10-15 msec after left ventricular and left atrial pressure crossover, and thus the first part of left ventricular contraction is "non-isovolumic". The LV-LA diastolic pressure gradient at R (15 +/- 7 mm Hg) rose during AN (20 +/- 7.8 mm Hg) and E (28 +/- 8 mm Hg) and remained unchanged during M (15 +/- 6 mm Hg). LV end-diastolic pressure was normal (6.5 +/- 2.4 mm Hg), unchanged during E (6.6 +/- 2.7 mm Hg), diminished during AN (3.6 +/- 1.3 mm Hg) and rose during M (16 +/- 5.8 mm Hg). The peak rate of rise of LV pressure (max dP/dt) was a little low at R (1163 +/- 236 mm Hg/sec) but rose normally on E (1860 +/- 503 mm Hg/sec) and did not change on M (1177 +/- 180 mm Hg/sec), suggesting normal systolic function.

Adult↗