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PubMed1984

Measurement of the end-diastolic pressure gradient and mitral valve area in mitral stenosis by Doppler ultrasound.

The pressure gradient across the mitral valve in mitral stenosis was determined by measurement of the maximum recorded velocity of the mitral jet at end-diastole using non-invasive Doppler ultrasound. The accuracy of the Doppler ultrasound technique was evaluated in 25 adult patients with mitral stenosis. In 10 patients, simultaneous ultrasound recordings and manometric recordings were made during cardiac catheterization. In seventeen patients with pure mitral stenosis, the mitral valve area was calculated from the manometric data using the Gorlin formula and from the ultrasound data. Good correlation was found between the Doppler ultrasound and the manometric method for the determination of both the end-diastolic pressure gradient and the mitral valve area. Results confirm that the non-invasive Doppler ultrasound technique is of diagnostic value in the assessment of mitral stenosis.

Adult↗
PubMed2002

Five years of experience with mitral valve homografts.

INTRODUCTION: The main advantages of mitral homografts are preservation of the subvalvular apparatus and avoidance of life-long anticoagulation. In this communication, we will present our five-year experience using mitral homografts in mitral valve surgery. PATIENTS AND METHODS: Since 1996, 14 patients (mean age 46 +/- 8 years, range 27 - 65 years have had mitral homografts implanted. Thirteen patients had mitral valve replacement; the septal leaflet of the tricuspid valve was replaced in one case. The indications were mitral (n = 6) or tricuspid endocarditis (n = 1), mitral valve stenosis (n = 3), and combined mitral valve disease (n = 4). Complete mitral homografts were implanted in eight patients; partial homografts were used in six cases. Preoperatively, the dimensions of the left ventricle and the mitral valve were measured by transoesophageal echocardiography (TOE). The mean left ventricular ejection fraction was 56 +/- 9%, the mean end-diastolic diameter 58 +/- 6 mm. The technique described by Acar/Carpentier was adapted for implantation; a Carpentier ring was implanted in all cases for annular stabilization. The patients had anticoagulative therapy which was discontinued when stable sinus rhythm was present after three months postoperatively. Follow-up included clinical examination, ECG, and echocardiography, and was initiated six months postoperatively and continued on a yearly basis. The following parameters were determined by echocardiography--left atrial size, left ventricular end-diastolic and end-systolic diameter, pressure gradient across the mitral valve (c/w Doppler, Bernoulli's equation), and mitral regurgitation. RESULTS: All patients survived surgery; the mean operation-time was 281 +/- 37 minutes. Intraoperative TOE revealed a first degree insufficiency in 7 patients. Follow-up was completed in all patients, with a mean period of 30 months (6 - 60 months). Two patients had an acute endocarditis two years postoperatively, requiring repeat valve replacement with a mechanical prosthesis. An additional patient had to be reoperated due to chordal rupture three years postoperatively. All three patients had mitral valve stenosis as the initial indication for surgery and had received a complete homograft. In the remaining eleven patients, the morphological and functional state of the implanted grafts remained unchanged during follow-up. The freedom from valve-related events was 93% after one year, 86% after two years, and 79% after three years. At six-month follow-up, ECG and echocardiography revealed sinus rhythm and sufficient atrial contractions in 13 cases. At the last follow-up, the pressure gradients were 3.4 +/- 0.6 mmHg for complete homografts and 2.8 +/- 0.6 mmHg for partial homografts. In five cases, a mild insufficiency was documented, while six patients presented with competent grafts. CONCLUSIONS: Mitral homografts can be used with acceptable mid-term results in selected cases with good left ventricular function and only slightly dilated left ventricles. Partial mitral homografts represent an additional technique, especially for mitral valve repair in patients with acute endocarditis. The susceptibility to bacterial infections of a homograft makes strict prophylaxis against endocarditis mandatory.

Adult↗
PubMed1989

Subaortic stenosis in childhood: frequency of associated anomalies and surgical options.

In a 4-year period from July 1984 to July 1988, 21 children required surgical treatment for subaortic stenosis. Age at operation ranged from 12 months to 17 years (mean, 7.3 +/- 4.8 years). Associated anomalies were common and occurred in 13 patients (62%), including aortic valve insufficiency (eight), and stenosis (two), mitral valve stenosis (two) and insufficiency (one), and pulmonary valve stenosis (two) and absent pulmonary valve syndrome (one). A ventricular septal defect was present in five patients, and coarctation and patent ductus arteriosus occurred in three patients each. One patient had a complete atrioventricular septal defect, and one had an aortopulmonary window. Six patients had 15 previous procedures. The left ventricular to aortic gradient ranged from 20 to 170 mm Hg (mean, 59 +/- 43 mm Hg). The operation consisted of a transaortic resection (17), transventricular septal defect resection (two), a modified Konno procedure or septoplasty with preservation of the aortic valve (one), and a combined aortoventriculoplasty with homograft reconstruction of the ascending aorta and coronary reimplantation (one). There were no early deaths. One patient required pacemaker insertion for heart block. Follow-up ranged from 1 to 48 months (mean, 26.4 +/- 11.6 months). There was one late death 2 years after operation in the child with the aortopulmonary window who had Heath Edwards Type IV changes on a lung biopsy specimen at the original operation. One patient required reoperation for a residual gradient of 34 mm Hg 1 year after resection. Three patients still have aortic insufficiency. No cases of iatrogenic aortic valve injury occurred. Patients with subaortic stenosis represent a heterogeneous group. Early resection and additional procedures can be performed with a low mortality rate and can eliminate aortic insufficiency in many cases.

Adolescent↗
PubMed1987

Double balloon technique for dilation of valvular or vessel stenosis in congenital and acquired heart disease.

Despite the generally excellent success with balloon dilation for the stenotic lesions of congenital and acquired heart disease, technical difficulties sometimes prevent satisfactory results. Such technical difficulties include: a large diameter of the anulus of the stenotic lesion relative to available balloon diameter, difficulty in the insertion or removal of the larger balloon catheters, and permanent damage to or obstruction of the femoral vessels by the redundant deflated balloon material of the large balloons. A double balloon technique was initiated to resolve these difficulties. With this method, percutaneous balloon angioplasty catheters were inserted in right and left femoral vessels, placed side by side across the stenotic lesion and inflated simultaneously. Dilation procedures using the two balloon technique were performed in 41 patients: 18 with pulmonary valve stenosis, 14 with aortic valve stenosis, 5 with mitral valve stenosis, 3 with vena caval obstruction following the Mustard or Senning procedure and 1 with tricuspid valve stenosis. Patient ages ranged from 1 to 75 years (mean 17.8) and patient weights ranged from 8.9 to 89 kg (mean 42.3). Balloon catheter sizes ranged from 10 to 20 mm in diameter. Average maximal pressure gradient in mm Hg before dilation was 61 in pulmonary stenosis, 68 in aortic stenosis, 21 in mitral stenosis, 12 in tricuspid stenosis and 25 in vena caval stenosis. Average maximal valvular pressure gradient after dilation was 13 in pulmonary stenosis, 24 in aortic stenosis, 4 in mitral stenosis, 0 in tricuspid stenosis, and 1 in vena caval stenosis. No major complications were encountered with the procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Tricuspid insufficiency and pulmonary hypertension in mitral disease: an echocardiographic study].

Tricuspid valve regurgitation and pulmonary hypertension have been evaluated with echo-color-Doppler technique in 100 patients (80 females and 20 males, mean age 54 years) affected by mitral valve stenosis. Pure mitral stenosis was present in 13 patients; 87 had an associated mitral regurgitation. The severity of mitral valve disease was based on the planimetric and functional (Doppler-derived) evaluation of valvular area. No relationship was found between extent of tricuspid regurgitation and severity of mitral valve disease, whereas pulmonary artery hypertension was significantly related to mitral valve involvement, above all Doppler mean gradient (r: 0.63, p < 0.005) and valvular area (r: -0.52, p < 0.01). The study suggests that in patients with mitral valve disease tricuspid regurgitation is independent of the degree of mitral valve involvement, whereas pulmonary hypertension is related to transvalvular gradient and to mitral valve area, but does not depend on the duration of the disease. This is evident only in patients who maintain the sinus rhythm.

Adult↗
PubMed1999

[Valve replacement for congenital mitral stenosis associated with double orifice mitral valve: a case report and a review of Japanese literatures].

A 3-year-old girl with congenital mitral stenosis (CMS) associated with double mitral orifice valve (DOMV) underwent successfully mitral valve replacement (MVR). DOMV is a rare form of congenital cardiovascular anomaly. To our knowledge, our patient is the first infant case of CMS due to DOMV in Japan. We present an infant case of CMS associated with DOMV who needed MVR, and discuss our patient with a review of Japanese literatures.

Cardiac Surgical Procedures↗
PubMed2000

Mitral stenosis in pregnancy: a four-year experience at King Edward VIII Hospital, Durban, South Africa.

OBJECTIVE: To evaluate prospectively mitral stenosis in pregnancy with emphasis on women with persistent symptoms. SETTING: King Edward VIII Hospital, a tertiary referral obstetric unit. PARTICIPANTS: One hundred and twenty-eight consecutive women with mitral stenosis. DEMOGRAPHICS: The mean age was 27 years and 38 women (30%) were primigravidae. Seventy-eight (61%) women had their first cardiac evaluation in the third trimester. Fifty-four women (42%) of these women had mitral stenosis diagnosed for the first time in the index pregnancy. Twenty-nine (23%) had a previous mitral valvulotomy. Nineteen women (15%) developed hypertension during pregnancy, 10 of whom had pre-eclampsia. Sixty-three women (49%) had a mitral valve area of < or = 1.2 cm2 with 11 having critical mitral stenosis (mitral valve area < or = 0.8 cm2). Atrial fibrillation was present in 12 women. Most women (87%) required medical therapy to control the heart rate. OUTCOME IN PERSISTENT SYMPTOMATIC WOMEN: Intervention was considered in 37 women (29%) who remained symptomatic, 11 (9%) of whom had a calcified mitral valve. The remaining 26 women were scheduled for balloon mitral valvulotomy during pregnancy, 20 of whom had balloon mitral valvulotomy with good effect (16 antepartum; 4 postpartum). In seven women, scheduled balloon mitral valvulotomy was not performed because of advanced preterm labour (n = 5), fetal distress (n = 1) and preterm labour with fetal distress (n = 1). These seven, together with the 11 with calcific mitral stenosis, were managed conservatively with good outcome. MATERNAL COMPLICATIONS: Fifty-one percent had maternal complications, the majority occurring at their initial admission to hospital. Pulmonary oedema was the most frequent. Multiple logistic regression analysis showed that the severity of stenosis assessed by measurement of the mitral valve area by echo-Doppler was the most powerful predictor of maternal pulmonary oedema. The other factors were late antenatal presentation, presence of symptoms prior to the index pregnancy and diagnosis of cardiac disease for the first time in the index pregnancy. CONCLUSION: Despite serious disease, women with persistent symptoms treated either by balloon mitral valvulotomy where feasible, or conservatively with close noninvasive monitoring, had a satisfactory fetal and maternal outcome.

Adolescent↗
PubMed2002

[Pulmonary diffusion of carbon monoxide in patients with mitral stenosis].

OBJECTIVE: The aim of our work has been the study of CO diffusion capacity in mitral valve stenosis patients. METHOD: We have studied 15 control subjects and 15 patients with mitral valve stenosis. We performed spirometry study and CO pulmonary diffusion tests (DLCO) by single breath method to determine two components: pulmonary capillary blood volume (Vc) and membrane diffusion factor (Dm). In addition, in mitral valve stenosis patients we performed a ecocardiography-doppler study. RESULTS: The mitral valve stenosis group had higher values of DLCO and Vc and a lower ratio of Dm/Vc than the control group. There is a negative correlation between Vc and the mitral valve area (r = -0.63; p = 0.037). We do not find any another correlation between the rest of ecocardiography doppler parameters and lung function test variables that we have measured. We have not found any differences between both groups in Dm. CONCLUSIONS: Mitral valve stenosis patients present a increase of CO pulmonary diffusion capacity and pulmonary capillary blood volume without changes in membrane diffusion factor.

Carbon Monoxide↗
PubMedDate not supplied

Safety and efficacy of enalapril in multivalvular heart disease with significant mitral stenosis--SCOPE-MS.

Angiotensin-converting enzyme inhibitors (ACEI) are often used in preventing and treating heart failure due to regurgitant valve disease. The majority of patients with symptomatic rheumatic heart disease (RHD) have significant mitral stenosis (MS) and are denied ACEI therapy, because of the fear of hypotension in the presence of fixed obstruction. The authors assessed the safety and efficacy of ACEI in 109 consecutive patients with RHD and with significant mitral stenosis (mitral valve orifice, MVO < 1.5 cm2)and with NYHA class III or IV heart failure symptoms. Mean age was 33.1+/-12 years, systolic blood pressure (BP) was 111+/-10, and diastolic BP was 73+/-8 mm Hg. MS was significant in 100 patients with mitral regurgitation in 46, aortic regurgitation in 19, and pulmonary hypertension in 60 patients. After initial stabilization, enalapril 2.5 mg bid was started in hospital and titrated up to 10 mg bid over 2 weeks. NYHA status, Borg score, and 6-minute walk test were assessed at baseline, and at 1, 2, and 4 weeks. Seventy-nine of the 100 patients who completed the study had severe MS (MVO < 1.0 cm2). Enalapril was well tolerated by all study patients without hypotension or worsening of symptoms. NYHA class (3.2+/-0.5 baseline vs 2.3+/-0.5 at 4 weeks, p < 0.01) Borg Dyspnea Index (7.6+/-1.3 vs 5.6+/-1.3, p < 0.01), and 6-minute walk distance (226+/-106 vs 299+/-127 m, p < 0.01) improved significantly with enalapril. Patients with associated regurgitant lesions showed more improvement in exercise capacity (120+/-93 vs 39+/-56 m, p < 0.001). Enalapril was well tolerated in patients with RHD with moderate and severe MS. Irrespective of the valve pathology, enalapril improved functional status and exercise capacity with maximum benefit in patients with concomitant regurgitant valvular heart disease.

Adult↗
PubMed1986

[Ventricular arrhythmias in mitral valve disease: incidence, severity and relations to hemodynamic parameters].

The incidence and severity of ventricular arrhythmias was analyzed in 42 patients with pure or predominant mitral valve stenosis (age: 51 +/- 9 years; NYHA class: 2.7 +/- 0.5) and 23 patients with pure or predominant mitral valve regurgitation (age: 55 +/- 11 years; NYHA class: 2.7 +/- 0.6) employing 24 h ambulatory monitoring. Coronary artery disease was excluded by angiography in all patients. Ten patients (14%) had no ventricular premature beats (VPB), 5 patients (7%) greater than 1,000 VPB/24 h, 31 patients (44%) multiform VPB, 19 patients (27%) repetitive VPB and 7 patients (10%) ventricular tachycardia. There was no difference in VPB between patients with mitral valve stenosis and mitral valve regurgitation. The incidence and severity of ventricular arrhythmias was significantly higher (p less than 0.001) in patients with mitral valve disease compared to the VPB of 50 normals without identifiable heart disease. This was still valid, if only patients with normal left ventricular ejection fraction greater than 55% (n = 60) were compared (p less than 0.01). The occurrence of frequent and complex ventricular arrhythmias was not determined by age, NYHA class, pulmonary artery pressure, pulmonary artery resistance, size of the left atrium, mitral valve area, degree of mitral regurgitation or cardiac index. However, a significant inverse correlation was found between incidence and severity of VPB and left ventricular ejection fraction. A reduced right ventricular ejection fraction, on the other hand, barely affected the occurrence of complex ventricular arrhythmias. Thus frequent and complex ventricular arrhythmias may be a sign of reduced left ventricular function in patients with mitral valve disease.

Adult↗
PubMed1985

Measurement of mitral valve area in mitral stenosis by Doppler ultrasound.

The mitral valve area in mitral stenosis was determined from Doppler velocity recordings and by cross-sectional echocardiography. There was good agreement (r = 0.93) between the two methods in 18 adult patients with mitral stenosis. The results confirm that the non-invasive continuous wave Doppler ultrasound technique is of diagnostic value in the assessment of mitral stenosis.

Adult↗
PubMed2001

[Mitral stenosis evaluated with three-dimensional echocardiography].

The authors evaluated the possibilities of three-dimensional echocardiography in the assessment of the severity of mitral valve stenosis. In 45 patients, the Doppler pressure half-time method was compared with two three-dimensional echocardiographic methods in the measurement of mitral valve orifice: anyplane echocardiography and surface rendering. There was significant relation between them: r = 0.74 and r = 0.70, both p < 0.0001. In addition, mitral valve stenosis was also quantified by two new indices, such as the doming volume of the mitral apparatus and mitral valve volume. Subgroup analysis revealed relation between atrial fibrillation and decreasing doming volume as well as significantly higher mitral valve volume in patients with critical stenosis. Associated valve abnormalities did not influence the mitral orifice measurement neither by Doppler method nor three-dimensional echocardiography. In conclusion, three-dimensional echocardiography allows reliable assessment of mitral stenosis and moreover provides new quantitative indices, which can be clinically important in the assessment of three-dimensional geometry of the mitral apparatus.

Adolescent↗
PubMed2003

Open mitral commissurotomy in the current era: indications, technique, and results.

BACKGROUND: The present retrospective study is focused on indications, techniques, and results of open mitral commisurotomy in the current era. METHODS: Of the 1,280 patients undergoing open-heart surgical procedures for rheumatic mitral stenosis between January 1990 and July 2000, 276 (21.6%) patients underwent open mitral commissurotomy. Major indications included presence of left atrial thrombus/clot (n = 82, 29.7%), severe subvalvular disease (n = 110, 39.8%), mitral valve calcification (n = 42, 15.2%), mild mitral regurgitation (n = 28, 10.0%), associated aortic valve disease (n = 55, 19.9%), organic tricuspid valve disease (n = 20, 7.2%), and failure or restenosis after closed or balloon mitral valvuloplasty (n = 55, 19.9%). Age of patients ranged from 7 to 67 years (mean, 30.2 +/- 12 years). The majority (76%) were in New York Heart Association class III or IV, and 6.9% were in congestive heart failure. Atrial fibrillation was present in 134 (48.6%) patients. Mitral valve area ranged from 0.3 to 0.7 cm2 (mean, 0.52 +/- 0.12 cm2). Mid-diastolic gradients across the mitral valve ranged from 8 to 34 mm Hg (mean, 14.5 +/- 6.2 mm Hg), and end-diastolic gradients ranged from 8 to 42 mm Hg (mean, 15.2 +/- 5.7 mm Hg). Open mitral commissurotomy was performed using standard cardiopulmonary bypass. Associated aortic valve procedure was performed in 55 patients, and either tricuspid valvotomy or repair was performed in 28 patients. RESULTS: There were four early deaths. All these patients had associated aortic valve procedure (Ross procedure in 2 and homograft aortic valve replacement in 2). Three patients developed severe mitral regurgitation in early postoperative period (< or = 30 days) and required reoperation. Predischarge echocardiography showed mitral valve area from 1.4 to 3.5 cm2 (mean, 2.6 +/- 0.6cm2) and moderate mitral regurgitation in 4 patients. Follow-up ranged from 1 to 130 months (mean, 64.5 +/- 28.6 months). There was no late death. There were three reoperations for mitral valve failure, and an additional 2 patients developed severe mitral stenosis (mitral valve area < 1.0 cm2). In operative survivors, freedom from mitral valve failure at 10 years was 87.0% +/- 3.5%. In patients with isolated open mitral commissurotomy, the incidence of thromboembolism was 0.5%/patient-year. CONCLUSIONS: Open mitral commissurotomy provides excellent early and long-term results in a selected group of patients.

Adolescent↗
PubMed1988

[The potentials of pulse Doppler echocardiography for the diagnosis and determination of the degree of mitral stenosis].

84 persons were examined: 61 patients with rheumatic mitral valve stenosis (21 men and 40 women), mean age 39.38 +/- 11.2 years and 23 healthy controls (14 men and 9 women), mean age 25.62 +/- 3.8 years. The morphologic and quantitative characteristics of the diastolic part of the pulse Doppler echocardiographic signal of mitral circulation analyzed by histogram of the time intervals show highly significant statistical differences between the patients with mitral valve stenosis and the healthy controls (100% specificity and sensitivity). The differentiation of mild and moderate from severe mitral stenosis by pulse Doppler echocardiography of mitral valve circulation, analyzed by histogram of the time intervals, is achieved with satisfactory precision by determination of the speed of the circulation fall in the early 1/3 of the diastole. The pulse Doppler echocardiograph performed by a transducer with 2.5 mHz frequency and the simultaneous M-echocardiography, the Doppler effect being analyzed by histogram of the time intervals, do not allow the precise determination of the degree of mitral valve stenosis.

Adult↗