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At least 379 records · Page 21Linked to original sources
PubMed1994

Mitral valve replacement with maintenance of mitral annulopapillary muscle continuity in patients with mitral stenosis.

Postoperative left ventricular performance was evaluated in patients with mitral stenosis who underwent mitral valve replacement with maintenance of the continuity of the mitral anulus and papillary muscles. Mitral valve replacement with preservation of autologous chordae tendineae (n = 7) or their replacement with expanded polytetrafluoroethylene sutures (n = 14) was performed in 21 patients with mitral stenosis. Hemodynamic parameters were compared with those of 28 patients who underwent conventional mitral valve replacement and 27 patients who underwent open mitral valve commissurotomy. No deaths occurred in the early or late follow-up period. All hemodynamic parameters were improved after the operation, and no significant differences were detected among the three groups with regard to postoperative cardiac index or mitral valve area. No significant differences were observed in left ventricular end-diastolic volume index, end-systolic volume index, or contractility index, but the postoperative left ventricular ejection fraction in the chordal preservation and open commissurotomy groups was greater than that in the group having conventional mitral valve replacement. Postoperative regional shortening was greatest at the diaphragmatic portion in the chordal preservation group and at the long axis in the open commissurotomy group. In the mid-term postoperative period, although no differences were noted among the three groups in echocardiographic data or global ejection fraction measured by multigated equilibrium radionuclide angiography, the regional shortening at the anterolateral portion of the left ventricle in the chordal preservation and commissurotomy groups was greater than that in the group having conventional mitral valve replacement. Postoperative radionuclide angiography during exercise failed to demonstrate any difference between the ejection fraction in the chordal preservation group and that in the group having conventional mitral valve replacement.

Adult↗
PubMed1996

Application of the flow convergence region method to the determination of stroke volume and cardiac output in patients with mitral stenosis.

OBJECTIVE: This study was undertaken to investigate the feasibility and accuracy of determination of stroke volume and cardiac output by calculating transmitral flow volume using the flow convergence region method in patients with mitral stenosis. PATIENTS AND INTERVENTIONS: Fifty-six patients with rheumatic mitral stenosis were studied using imaging and Doppler echocardiography. Aliasing velocities of 20 to 23 cm/s were used to record the flow vonvergence region proximal to the stenotic mitral orifice. The stroke volume (mL) was calculated by multiplying peak transmitral flow rate which was obtained using an angle-corrected hemispheric flow convergence equation, by transmitral velocity time integral (cm) divided by peak transmitral velocity (cm/s) recorded using continuous wave Doppler method. MAIN RESULTS: Stroke volume calculated using the flow convergence region method was not significantly different from that calculated using aortic Doppler two-dimensional echocardiographic method in 39 patients with pure mitral stenosis (75+/-19 [mean+/-1SD] versus 73+/-19 mL, P=0.12), and from that calculated using pulmonic Doppler two-dimensional echocardiographic method in nine patients with mitral stenosis with associated>2+ aortic regurgitation (77+/-12 versus 75+/-14 mL, P=0.49). No significant difference existed between the cardiac output obtained using the flow convergence region method and that obtained using Fick method in 12 patients with pure mitral stenosis. The stroke volume was overestimated by the flow convergence region method when compared with those obtained using aortic Doppler two-dimensional echocardiographic method in patients with mitral stenosis with associated >2+ mitral regurgitation (123+/-40 versus 67+/-15 mL, P=0.001). CONCLUSIONS: The present study provided an alternative way to calculate the stroke volume and cardiac output in patients with mitral stenosis.

Adult↗
PubMed1999

Effect of percutaneous balloon mitral valvotomy on pulmonary venous flow in severe mitral stenosis.

OBJECTIVE: To study the effect of percutaneous balloon mitral valvotomy (PBMV) on the deranged systolic and diastolic pulmonary venous flows in mitral stenosis. DESIGN: Open, non-randomised, case-control study. SETTING: Mater Misericordiae Cardiac Catheterisation Laboratory and Kenyatta National Hospital Cardiac Catheterisation Laboratory. PATIENTS: Twelve consecutive patients with severe symptomatic mitral stenosis with valve characteristics suitable for PBMV on echocardiographic evaluation. INTERVENTION: Percutaneous baloon mitral valvotomy. MAIN OUTCOME MEASURES: Peak systolic and diastolic pulmonary flow velocities and velocity time integrals (VTI). RESULTS: Peak sytolic pulmonary flow velocity increased from 29.8 +/- 9.6 to 46.1 +/- 8.5 cm/s p < 0.01) and systolic VTI from 2.6 +/- 1.0 to 5.5 +/- 0.9 cm (p < 0.01). Peak diastolic flow velocity increased from 39.3 +/- 5.7 to 43.0 +/- 6.9 cm/s (p < 0.05) and diastolic VTI from 3.9 +/- 1.5 to 4.8 +/- 1.6 cm (p < 0.05). Mean mitral valve area increased from 0.65 +/- 0.15 to 1.98 +/- 0.34 cm2 (p < 0.001) and mean left atrial pressures from 30.5 +/- 9.1 to 11.9 +/- 5.1 mmHg (p < 0.001). CONCLUSIONS: In patients with severe mitral stenosis and sinus rythm, left atrial filling is biphasic with diastolic preponderance. Successful PBMV causes predominant increase in atrial systolic filling.

Adolescent↗
PubMed1998

Plasma levels of adrenomedullin in patients with mitral stenosis.

Although plasma levels of adrenomedullin are elevated in patients with heart failure, levels in patients with mitral stenosis are unknown. We determined plasma levels of adrenomedullin in specimens of blood obtained from the peripheral veins of 15 consecutively treated patients with mitral stenosis 1 week before and 1 week after percutaneous mitral valvuloplasty. We also measured adrenomedullin in blood obtained from the right and left atria of 13 of 15 patients immediately before valvuloplasty. Plasma adrenomedullin level in the peripheral vein was 27.3 +/- 3.2 pg/ml among healthy subjects (n = 15) and 59.8 +/- 2.7 pg/ml among patients with mitral stenosis (n = 15, p < 0.0001). Plasma adrenomedullin level in the peripheral veins of patients with mitral stenosis before valvuloplasty correlated significantly with mean pulmonary artery pressure, mean pulmonary arterial wedge pressure, and mean left atrial pressure. Plasma levels of adrenomedullin in the peripheral vein and the right atrium were significantly higher than those in the left atrium (59.5 +/- 3.0 and 55.8 +/- 2.4 versus 45.9 +/- 2.9 pg/ml, n = 13, p < 0.005). Percutaneous mitral valvuloplasty caused a significant decrease in plasma adrenomedullin levels in peripheral veins from 59.8 +/- 2.7 to 49.9 +/- 3.1 pg/ml (p < 0.02). Percentage decrease in plasma adrenomedullin levels in the peripheral vein correlated significantly with percentage decreases in mean pulmonary artery pressure and mean pulmonary arterial wedge pressure. This study demonstrated that plasma adrenomedullin levels of patients with mitral stenosis correlated positively with mean pulmonary artery pressure and pulmonary arterial wedge pressure. These findings suggested that adrenomedullin may play an important role in the pulmonary circulation of these patients.

Adrenomedullin↗
PubMed1991

Balloon valvuloplasty versus closed commissurotomy for pliable mitral stenosis: a prospective hemodynamic study.

Closed surgical mitral valvotomy is the procedure of choice in most patients with symptomatic pliable mitral stenosis in developing countries. The procedure is efficacious and safe. Mitral valvotomy performed with a balloon has shown similar good results, with infrequent complications in selected subjects. Because there is a paucity of studies comparing the two techniques, this study was undertaken to compare the results of percutaneous balloon mitral valvuloplasty with those of closed commissurotomy as determined by catheterization studies. Forty-five patients with tight pliable mitral stenosis were randomly assigned to one of two groups: 23 patients had balloon valvuloplasty by the single catheter technique (group I) and 22 underwent closed surgical valvotomy (group II). The two groups were similar with regard to clinical and hemodynamic findings before intervention. Mitral valve area increased from 0.8 +/- 0.3 to 2.1 +/- 0.7 cm2 in group I (p less than 0.001) and from 0.7 +/- 0.2 to 1.3 +/- 0.3 cm2 in group II (p less than 0.001). Pulmonary artery pressure and pulmonary vascular resistance decreased in both groups, but these changes did not reach statistical significance in group II. Treadmill exercise time increased from 3.8 +/- 2.3 to 7.3 +/- 2.6 min in group I (p less than 0.001) and from 4 +/- 2.6 to 5.6 +/- 2.6 min in group II (p less than 0.001). There were no deaths. One patient in each group developed moderate (3+) mitral regurgitation. A small interatrial shunt (less than 1.5:1) was detected in three patients in group I immediately after the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1977

Rheumatic aortic stenosis in young patients presenting with combined aortic and mitral stenosis.

This report describes 30 patients under the age of 30 years with rheumatic aortic stenosis, presenting with combined aortic and mitral stenosis. Three patients had additional tricuspid stenosis. Twenty-eight patients gave a history of rheumatic polyarthritis. The diagnosis was confirmed by right and left heart catheterisation in all. The murmur of aortic stenosis was not initially present in 8 out of 10 patients in congestive heart failure. Aortic valve calcification was not seen. Cineangiography showed a tricuspid aortic valve in all, unlike congenital aortic stenosis. A unique feature of this group was the raised pulmonary vascular resistance in 87 per cent of the patients. The present study shows that patients in India developing aortic stenosis after rheumatic fever do so early in the natural history of the disease.

Adolescent↗
PubMed2003

Percutaneous transvenous mitral commissurotomy in juvenile mitral stenosis.

OBJECTIVE: To determine the efficacy and safety of percutaneous transvenous mitral commissurotomy (PTMC), using multi-track double balloon technique in juvenile mitral stenosis. DESIGN: Open non-randomised intervention. SETTING: Cardiac catheterisation laboratories of The Mater Hospital, The Nairobi Hospital and Kenyatta National Hospital from 1996 to 2001. PATIENTS: Forty five consecutive patients aged less than 21 years with severe pure mitral stenosis and suitable mitral valve apparatus (leaflets, chordae and papillary muscles) for successful commissurotomy. INTERVENTION: Percutaneous transvenous mitral commissurotomy under local anaesthesia. Standard left and right heart catheterisation for mitral valve disease. Trans-septal left atrial entry using standard septal puncture technique and left ventricular position secured by super-stiff guide-wire. Double-balloon mitral valvotomy on single guide-wire using multi-track balloon catheters. MAIN OUTCOME MEASURES: Mitral valve area, left atrial pressures, mitral regurgitation grade, NYHA functional class. RESULTS: Mitral valve area increased from 0.6 +/- 0.19 cm2 to 1.9 +/- 0.19 cm2 (p<0.001), left atrial pressures from 30.5 +/- 3.9 mmHg to 11.5 +/- 3.8 mmHg (p<0.001). Most patients NYHA functional class immediately improved from class III-IV to class I-II. There was no significant changes in grades of mitral regurgitation or significant complications related to the procedure. CONCLUSIONS: PTMC in juvenile mitral stenosis using the multi-track technique is safe and effective yielding satisfactory immediate results.

Adolescent↗
PubMed1980

Negative intraventricular diastolic pressure in patients with mitral stenosis: evidence of left ventricular diastolic suction.

Left ventricular diastolic pressure was evaluated in 15 patients with mitral stenosis and 16 patients with no significant heart disease to determine if a stenotic mitral valve can cause the left ventricle to produce a negative diastolic pressure, indicative of ventricular diastolic suction. The minimal level of diastolic pressure in patients with mitral stenosis ranged between 6 and -7 mm Hg; in normal subjects it did not fall below 0. The average value of minimal diastolic pressure in patients with mitral stenosis (-2 +/- 1 mm Hg [mean +/- standard error of the mean]) was significantly lower than in patients without significant heart disease (5 +/- 1 mm Hg) (p less than 0.001). These observations indicate that the human left ventricle, in the presence of mitral stenosis, can generate a negative diastolic pressure. The presence of a negative diastolic pressure in patients with mitral stenosis suggests that the dynamics of the ventricle during diastole may contribute to the filling process.

Blood Pressure↗
PubMed1993

Replacement of chordae tendineae using expanded polytetrafluoroethylene (ePTFE) sutures during mitral valve replacement in patients with severe mitral stenosis.

Since September 1991, 20 patients with mitral stenosis underwent mitral valve replacement and chordal replacement with expanded polytetrafluoroethylene (ePTFE) sutures. The continuity between the papillary muscles and the mitral annulus was maintained by four mattress sutures of ePTFE, which connected the stumps of the papillary muscle heads to the mitral annulus at the 2, 4, 8, and 10 o'clock positions. Low profile bileaflet prosthetic valves were inserted. There was no mortality either in-hospital or during follow-up. There was no valve related morbidity, such as valve structural failure, thromboembolism, anticoagulant related hemorrhage, prosthetic valve endocarditis, or posterior left ventricular rupture. The technique of replacing chordae tendineae is described in detail.

Chordae Tendineae↗
PubMed2002

Percutaneous mitral balloon valvuloplasty in pregnant women with mitral stenosis.

Forty-four consecutive pregnant patients with mitral stenosis were submitted to percutaneous mitral valvuloplasty (PMV) over a period of 12 years. The mean age was 28 +/- 6 years and the mean gestational age was 23 +/- 6 weeks. The mean mitral valve area had a significant increase from 1.17 +/- 0.26 to 2.06 +/- 0.41 cm(2) (P = 0.0000). The mean mitral valve gradient decreased from 16.22 +/- 5.55 to 7.94 +/- 3.75 mm Hg (P = 0.0001). The procedure was performed successfully in 95% of the patients and there were no major complications. Concerning labor and delivery, we evaluated 37 patients. Thirty patients (81%) reached term and delivered normal infants. Seven patients (18.9%) delivered prematurely, resulting in two fetal death; one patient delivered a stillborn. We concluded that PMV is a safe procedure for the treatment of mitral stenosis in pregnant patients, providing significant symptomatic relief and better clinical conditions for labor and delivery.

Adult↗
PubMed1984

[Doppler-echocardiographic determination of the degree of severity of mitral stenosis].

The assessment of severity of mitral stenosis is generally based on the mitral valve orifice area as calculated by the Gorlin formula from the invasively-measured pressure gradient and flow across the valve. As an additional reference for evaluating severity, the hemodynamically-determined pressure half-time has been suggested; that is, the time required for the peak gradient across the stenotic valve to drop to one-half of its original value. Since the pressure gradient and the velocity of flow in the region of the stenosis are related to each other as described in the Bernoulli equation and, since the velocity of flow can be analyzed with Doppler echocardiography, the possibility is afforded for noninvasive determination of both the pressure gradient and the pressure half-time. From the Doppler echocardiographically determined pressure half-time, the mitral valve orifice area can be calculated. This study, in a relatively large population of patients with mitral stenosis, was undertaken to compare the pressure half-times obtained from Doppler echocardiography with the valve orifice areas derived from hemodynamic measurement, to analyze the relationship between the two latter parameters and to evaluate the relevance of the newly-developed method. In Doppler echocardiography, the frequency shift of emitted sound reflected from moving blood cells is measured. The velocity of blood flow is proportional to the frequency shift delta f.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

The value of standardized exercise testing in the noninvasive evaluation of mitral stenosis.

The determination of functional impairment is an important portion of the evaluation of patients with mitral stenosis and frequently is instrumental in the determination to proceed with invasive testing. To test the hypothesis that patients with slowly evolving disability from mitral stenosis frequently do not recognize the degree of their limitations and to determine the utility of formal exercise testing, 24 consecutive patients with pure or predominant mitral stenosis were evaluated for NYHA functional category (NYHA class) by historical determination of functional impairment, echocardiographic mitral valve area (echo MVA), exercise duration, estimated maximum oxygen consumption, and functional aerobic impairment during a symptom-limited Bruce protocol exercise test and multiple catheterization-derived parameters. The data revealed no difference in exercise duration or mitral valve area between NYHA classes, but demonstrated an excellent correlation between exercise duration and severity of mitral valve stenosis determined at cardiac catheterization (cath MVA). This relationship was similar to that of echo MVA to cath MVA and exceeded that of exercise time to any other parameter measured during catheterization. Estimation of maximum oxygen consumption or functional aerobic impairment did not improve the exercise duration to valve area relationship. The data presented thus demonstrate that Bruce protocol exercise testing is a valuable adjunct to other noninvasive tests in the initial evaluation of selected patients with mitral stenosis. By virtue of being easily repeated at low risk, exercise testing may also be useful in long term follow-up of medically treated mitral stenosis patients.

Adult↗