[Involvement of the tricuspid valve in mitral stenosis].
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Constriction, Pathologic↗
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Percutaneous transvenous balloon mitral valvuloplasty: mid-term results in adolescents.
Six patients with mitral valve stenosis underwent percutaneous balloon mitral valvuloplasty (PBMV) in our department between November 1992 and December 1997. Five patients had rheumatic mitral valve stenosis and one had congenital mitral valve stenosis and Eisenmenger's syndrome with patent ductus arteriosus (PDA). Functional status before PBMV was class IV in two patients, class III in two patients, and class II-III in two patients, as classified by the New York Heart Association (NYHA). The mean diastolic pressure gradient across the mitral valve measured during heart catheterization before and immediately after PBMV was 18.8 +/- 10.42 and 9.4 +/- 7.7 mmHg, respectively (p < 0.01). The patients were followed for a mean period of 36.6 +/- 8.5 months (range 12 to 72 months) after the procedure. During follow-up, post PBMV mean diastolic transmitral gradient measured by color Doppler echocardiography decreased from 19.3 +/- 11.16 to 7.43 +/- 7.3 mmHg (p < 0.01) and the mitral valve area increased from 1.09 +/- 0.7 to 3.1 +/- 0.9 cm2 (p < 0.002). Functional capacity showed improvement to NYHA class I in four patients, to class II-III in the patient with congenital mitral valve stenosis and Eisenmenger's syndrome with PDA and to class II in one patient with severe mitral valve calcification in whom restenosis occurred three years after PBMV. Percutaneous balloon mitral valvuloplasty PBMV can achieve very good short- and mid-term results in relieving symptomatic rheumatic mitral valve stenosis.
Adolescent↗
[Doppler sonographic determination of the degree of severity of mitral valve stenoses].
Using combined two-dimensional echocardiography and Doppler technique in 30 patients with pure mitral valve stenosis or combined valve disease with prevailing mitral stenosis, the mitral valve area and diastolic pressure gradient were determined, and compared to the invasively recorded values obtained during heart catheterization. Four patients were examined by Doppler ultrasound before and after mitral valve replacement. The determination of the mitral valve area was performed 1) invasively by means of the formula derived by Gorlin (and measured between 0.5 and 2.9 cm2), 2) by means of planimetry by integration of the two-dimensional echo in the short-axis view (between 0.7 and 2.8 cm2), and 3) by Doppler ultrasound based on the formula 220/t1/2, whereby the pressure half-time was obtained by dividing maximum flow velocity by square root 2. Here, the mitral valve area was between 0.5 and 2.8 cm2. The correlation between values obtained invasively and by means of Doppler ultrasound was good (r = 0.86), and compared well to the correlation between two-dimensional echocardiography and heart catheterization (r = 0.88). The best correlation of r = 0.89 was found between the mitral valve areas obtained by Doppler ultrasound and two-dimensional echocardiography. The diastolic pressure gradient was calculated by means of the formula derived from the Bernoulli equation, which is: delta P = 4Vmax2, whereby Vmax equals the maximum transmitral flow velocity. The invasively measured pressure gradients were between 2 and 30 mm Hg, the values obtained by Doppler ultrasound were between 6 and 29 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
MRI planimetry for diagnosis and follow-up of valve area in mitral stenosis treated with valvuloplasty.
PURPOSE: We sought to determine whether noninvasive planimetry by magnetic resonance imaging (MRI) is suitably sensitive and reliable for visualizing the mitral valve area (MVA) and for detecting increases in the MVA after percutaneous balloon mitral valvuloplasty (PBMV). MATERIALS AND METHODS: In 8 patients with mitral valve stenosis, planimetry of the MVA was performed before and after PBMV with a 1.5 T MR scanner using a breath-hold balanced gradient echo sequence (True FISP). The data was compared to the echocardiographically determined MVA (ECHO-MVA) as well as to the invasively calculated MVA by the Gorlin formula at catheterization (CATH-MVA). RESULTS: PBMV was associated with an increase of 0.79 +/- 0.30 cm (2) in the MVA (Delta MRI-MVA). The correlation between Delta MRI-MVA and Delta CATH-MVA was 0.92 (p < 0.03) and that between Delta MRI-MVA and Delta ECHO-MVA was 0.90 (p < 0.04). The overall correlation between MRI-MVA and CATH-MVA was 0.95 (p < 0.0001) and that between MRI-MVA and ECHO-MVA was 0.98 (p < 0.0001). MRI-MVA slightly overestimated CATH-MVA by 8.0 % (1.64 +/- 0.45 vs. 1.51 +/- 0.49 cm (2), p < 0.01) and ECHO-MVA by 1.8 % (1.64 +/- 0.45 vs. 1.61 +/- 0.43 cm (2), n. s.). CONCLUSION: Magnetic resonance planimetry of the mitral valve orifice is a sensitive and reliable method for the noninvasive quantification of mitral stenosis and visualization of small relative changes in the MVA. This new method is therefore capable of diagnosing as well as following the course of mitral stenosis. It must be taken into consideration that planimetry by MRI slightly overestimates the MVA as compared to cardiac catheterization.
Anatomy, Cross-Sectional↗
[Cesarean section in a patient with severe mitral stenosis after mitral valve replacement].
A 30-year-old woman with mitral stenosis after mitral valve replacement was scheduled for cesarean section at 28 weeks and 6 days of pregnancy. Cesarian section was decided at a conference of obstetrics, cardiac surgery, neonatology and anesthesiology. Anesthesia was successfully managed with epidural block and pulmonary arterial pressure monitoring. During operation, blood pressure was controlled by dopamine, milrinone and phenylephrine. Patient did not develop cardiac insufficiency perioperatively. Cardiac function deteriorated gradually and reoperation of mitral valve replacement was performed 2 months later.
Adult↗
MR phase-shift velocity mapping of mitral and pulmonary venous flow.
Mitral and pulmonary venous flows are important indexes in the evaluation of left ventricular diastolic function and in the assessment of mitral valve disease. We used MR phase-shift velocity mapping to measure mitral and pulmonary venous flow velocity in 10 healthy volunteers and mitral flow velocity in 5 patients with mitral valve stenosis. Normal mitral flow shows two positive peaks: one during early ventricular diastole and the other during atrial contraction. Peak mitral flow velocity (mean +/- SD) in early diastole was 68 +/- 12 cm/s and during atrial contraction 39 +/- 10 cm/s. The ratio of peak mitral flow velocity in early diastole to that during atrial contraction was 1.9 +/- 0.6. In patients with mitral valve stenosis, the initial high flow velocity persisted through diastole. Peak mitral flow velocity of patients with mitral valve stenosis correlated well with values obtained from Doppler echocardiography. Pulmonary venous flow showed two positive peaks: one during ventricular systole and the other in ventricular diastole. A small backflow during atrial contraction was noticed. Peak systolic velocity in the right lower pulmonary vein was 47 +/- 11 cm/s, peak diastolic velocity was 40 +/- 9 cm/s, and peak backflow velocity was 14 +/- 3 cm/s. Magnetic resonance velocity mapping is a noninvasive technique for the evaluation of time-related flow velocity patterns and for quantitative measurement of mitral and pulmonary venous blood flow velocity.
Adult↗
Pasteurella multocida endocarditis: report of a case.
The present case involves a 48-year-old male patient who presented with Pasteurella multocida endocarditis associated with preexisting mitral valve stenosis. A mitral valve replacement was successfully performed after 3 weeks of intravenous infusion with antibiotics. Pasteurella multocida is a normal inhabitant of the oral cavity of dogs and cats. Therefore, people who have frequent contact with these animals should be examined periodically for signs of infection.
Endocarditis, Bacterial↗
Contractile behaviour of skinned papillary muscle in mitral valve disease.
The contractile behaviour of Triton-X 100 skinned left ventricular papillary muscle from 19 patients undergoing cardiac surgery for mitral valve stenosis: n = 6, mitral valve incompetence: n = 7, or combined mitral valve disease: n = 6 was analyzed. At supramaximal activation the "vibration induced force clamping technique" was used for isometric analysis of time course and extent of isometric postvibration force recovery. Afterloaded contractions were applied for extrapolation of the maximum shortening velocity at zero load (Vmax). The Calcium sensitivity was analysed by variation of the free EGTA-buffered Calcium concentration at a passive resting force of 2 mN at 26 degrees C. In different types of mitral valve disease the characteristics of isometric force development were unaltered in terms of maximum force development, force per square mm, Calcium sensitivity and the time course of isometric contraction after force clamping. However the capability to shorten as expressed by Vmax was reduced in mitral valve incompetence (3.87 +/- 0.37 ML/s) as compared with mitral valve stenosis (5.29 +/- 0.35 ML/s) or combined mitral valve disease (4.83 +/- 0.51 ML/s). The ratio between the inverse value of Vmax and the time constant of isometric force development after force clamping was significantly different in mitral valve incompetence as compared with other types of mitral valve disease (p < 0.0001). These data argue for the presence of different resistances against shortening in various types of mitral valve disease, due to altered cross-bridge cycling characteristics or to morphological factors.
Adult↗
Congenital left ventricular inflow obstruction evaluated by two-dimensional echocardiography.
Several forms of congenital heart disease that cause left ventricular inflow obstruction have similar M-mode findings, and frequently the exact anatomic diagnosis cannot be made by M-mode echocardiography alone. We examined five children with various forms of left ventricular inflow obstruction using two-dimensional echocardiography. The diagnosis was confirmed by cardiac catheterization and surgery in all five patients. In one patient with congenital mitral valve stenosis, a thick mitral valve with two papillary muscles was imaged. This patient was easily distinguished from a second child with parachute deformity of the mitral valve in whom a single papillary muscle arising from the left ventricular apex was seen. These two patients with mitral valve stenosis were easily differentiated from the three patients in whom the left ventricular inflow obstruction was caused by a membrane within the left atrium. The membrane could be seen in several spatial planes; however, we could not distinguish by two-dimensional echocardiography one child who had cor triatriatum from the other two patients who had a supravalvar mitral ring. Because of its spatial anatomic display, the two-dimensional echocardiogram provides information for a more detailed anatomic diagnosis in children with congenital left ventricular inflow obstruction.
Adolescent↗
Hutchinson-Gilford progeria syndrome with severe calcific aortic valve stenosis and calcific mitral valve.
The case of a 12-year-old girl with clinical features of progeria with severe calcific valvar aortic stenosis is presented. The mitral valve showed the presence of calcium, and peripheral vascular disease was also present, though there was no family history of this. Aortic valve replacement was deferred because of insufficient data relating to this condition. The genetics and phenotypic mechanisms of the disease are reviewed. In view of the association of progeria with valve disease, all patients should undergo electrocardiography and echocardiography as part of their routine work-up.
Aortic Valve Stenosis↗
[Communication between left atrium and venous coronary sinus associated with stenosis of the venous ostium and with stenosis the mitral valve. A case report].
Woman, 76 years old with mitral stenosis died due to peripheral arterial embolism. The necropsy identified left atrial to coronary sinus fenestration associated with stenosis of the coronary sinus ostium and rheumatic mitral stenosis.
Aged↗
Proximal flow convergence method in the assessment of mitral stenosis.
Mitral valve area (MVA) was calculated using the proximal flow convergence method in 60 patients with severe mitral stenosis. Using the apical 4 chamber view, colour Doppler was used to measure the peak forward flow rate. From this, the mitral valve area was calculated according to the formula: mitral valve area = peak forward flow rate/peak mitral velocity. This method compared well with the established 2D planimetry derived valve area (r = 0.89) and Doppler pressure half time method (r = 0.88). Hence, this can be used as an alternative method to estimate the valve area in patients with mitral stenosis.
Echocardiography, Doppler, Color↗
Surgical treatment of mitral stenosis of mitral valve commissurotomy; a history of its development and its adaptability to the sequelae of rheumatic heart disease.
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Cardiac Surgical Procedures↗
CLINICAL pathological conference: rheumatic heart disease with stenosis of mitral valve.
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Constriction, Pathologic↗
Left-sided anomalies in Ebstein's malformation of the tricuspid valve.
A review of 34 autopsied cases with classical Ebstein's malformation of the tricuspid valves revealed 8 cases with left-sided anomalies. Among these, appearing in 1 case each, were aortic atresia and persistent common atrioventricular canal. The latter 2 conditions were dominant clinically. In the remaining 6 cases the left-sided anomalies were not apparent clinically and probably of no functional significance. These conditions were parachute mitral valve, bicuspid aortic valve, cor triatriatum and pulmonary stenosis, cleft mitral valve, stenosis of individual pulmonary veins, and prolapse of mitral valve.
Adolescent↗
[Pressure gradient across the mitral valve in mitral stenosis estimated by high pulse repetition frequency Doppler method].
High pulse repetition frequency (HPRF) Doppler and continuous wave (CW) Doppler methods were used to estimate the pressure gradient across the mitral valve. Twenty-two cases of mitral stenosis and five cases of ischemic heart disease were studied. Both the HPRF and CW Doppler studies were conducted during catheterization in all cases. In the Doppler study, pressure gradient was calculated using the simplified Bernoulli's formula. The HPRF device used was a type SSD-730 produced by Aloka Co. It had a reference frequency of 2 MHz. Its minimum pulse repetition frequency was 4.2 KHz; its maximum, 19.2 KHz. Among the 27 cases, the maximum flow velocity measured by the HPRF method at the level of the mitral valve orifice was compared with that by the CW method. As the velocity increased, the discrepancy of measured values between the two methods increased, but it was within 0.1 m/sec. Therefore, there was a good correlation between the HPRF and CW methods (r = 0.98). The pressure gradient between time delay-corrected pulmonary artery wedge pressure and left ventricular pressure was compared with that obtained by the HPRF method. Contrary to our expectations, the correlation coefficient between the two was not so high, and the pressure gradients calculated by the HPRF method tended to be underestimated. For eight patients in whom the left atrial pressure could be recorded, the pressure gradient between the left atrium and left ventricle was compared with that obtained by the HPRF method. There was underestimation, and a good correlation coefficient was obtained. When using pulmonary artery wedge pressure as a substitute for left atrial pressure, one must realize that the time delay varies in every case and that the pressure pulse itself is not the same. When the pressure gradient between the left atrium and left ventricle is used, a good correlation coefficient can be obtained. Therefore, the flow velocity obtained by the HPRF method will reflect the true pressure gradient across the mitral valve. The HPRF method proved to have a potential equal to that of the CW method for estimating mitral valve flow velocity in mitral stenosis, and it may be used as a helpful diagnostic tool.
Adult↗
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↗
[THE VENTILATION PERFUSION RATIO IN MITRAL VALVE DISEASES].
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Aortic Valve Stenosis↗