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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↗
PubMed1992

[Effects of prostaglandin E1 in the treatment of congestive heart failure after mitral valve replacement].

Prostaglandin E1 (PGE1) was intravenously administrated to 3 patients for treatment of postoperative congestive heart failure. Preoperative diagnoses of these patients were mitral valve stenosis (2 cases) and mitral valve regurgitation (1 case), associated with tricuspid valve regurgitation in every case. Mitral and tricuspid valve replacements was performed in one case, and mitral valve replacement and tricuspid annuloplasty in two cases. After infusion of PGE1, the central venous pressure was decreased rapidly and the patients recovered from congestive heart failure. As minimal doses of PGE1 (0.01-0.03 micrograms/kg/min) was infused, neither remarkable systemic hypotension nor fall of PaO2 were observed. It appears that application of small amount of PGE1 can be a useful mean for the treatment of congestive heart failure after valvular surgery.

Alprostadil↗
PubMed1997

[A case of Jehovah's Witness underwent double valves replacement in reoperation].

The patient was a sixty five-year-old woman and Jehovah's Witness who refused either homologous or autologous blood transfusion on the ground of her faith. At the age of 47, she had closed commissurotomy for mitral valve stenosis. This time, because mitral valve restenosis and tricuspid valve regurgitation were found, double valve replacement, mitral and tricuspid, was performed on her, with an excellent result. It is expected that, in the near future, the indication for open heart surgery without blood transfusion will be increased by means of the following considerations as to blood loss preservation; 1. to shorten the time necessitating for an operation and reduce preoperative blood loss, 2. to improve cardio-pulmonary bypass system (Heparin coating etc), and 3. to augment the erythropoiesis (administration of EPO at the patient's own expense, etc.) and so on.

Aged↗
PubMed1987

[Quantitative evaluation of complete endocardial cushion defect using two-dimensional echocardiography].

To avoid postoperative mitral valve dysfunction, the common atrioventricular valves of 21 preoperative patients with complete common atrioventricular canal were quantitatively evaluated using two-dimensional echocardiography. The criteria for diagnosing hypoplasia of the left lateral leaflet, which often made complete repair difficult, were also investigated. The patients were 10 boys and 11 girls, who ranged in age from one month to three years and three months. The subcostal short-axis view was used to evaluate the common atrioventricular valves. The sizes of the leaflets and diameters of the ventricles were measured by two-dimensional echocardiography and at surgery. The measurements by both methods were nearly identical, and the correlation coefficient was 0.95. Thus, two-dimensional echocardiography correctly evaluated common atrioventricular valve size. The length of the left lateral leaflet varied from 5 mm to 22 mm. In four patients, it was less than 10 mm, and was under the 99% confidence limit. In all four patients, two papillary muscles were noted in the left ventricle. Two of these patients underwent corrective surgery and died of postoperative mitral valve stenosis. This new technique can prevent postoperative mitral valve dysfunction by estimating preoperatively the appropriate suturing length of the anterior and posterior components of the anterior mitral valve. It is concluded that two-dimensional echocardiography can correctly evaluate the size of common atrioventricular valves, which is often difficult by angiocardiography. Hypoplasia of the left lateral leaflet could be diagnosed when its length was less than 10 mm measured by two-dimensional echocardiography. This technique is more accurate compared to the method which demonstrates the presence of a single papillary muscle in the left ventricle. Corrective surgery for the patients with a hypoplastic left lateral leaflet involves great risks, resulting in postoperative mitral valve stenosis. Preoperative evaluation of a common atrioventricular valve is useful to avoid postoperative mitral valve dysfunction.

Child, Preschool↗
PubMed1997

[A successful mitral valve replacement for a 13-year-old girl with mitral stenosis and pulmonary hypertension after renal transplantation].

Mitral valve replacement was successfully performed in a 13-year-old girl due to severely calcified mitral valve stenosis and pulmonary hypertension who had undergone renal transplantation from her father at the age of 8 years old. Although, percutaneous transluminal mitral commissurotomy had been performed for four times until January 1996, severe mitral stenosis could be relieved and she was transported to our hospital in emergency for respiratory failure caused by pulmonary edema. Then we decided to perform mitral valve replacement. The operation was done successfully using trans-septal superior approach with SJMHP 19 mmM. the blood cyclosporin levels were monitored and controlled within normal limits. This is the first successful case of pediatric open heart surgery after renal transplantation to our knowledge.

Adolescent↗
PubMed1979

[Echocardiographic determination of the severity of mitral stenosis by the mitral valve closure index (author's transl)].

In 34 patients with mitral stenosis or combined mitral valve disease class II, III or IV (NYHA), the mitral valve closure index (MVCI, Shiu et al. 1977), based on the rate of diastolic apposition of the anterior and posterior mitral leaflet echos, and the diastolic closure rate (EF-slope) were determined and compared with hemodynamic data such as mean left atrial pressure (PLA), mean diastolic pressure gradient across the stenotic valve (DP) and mitral valve orifice area (Q), calculated by the Gorlin formula. MVCI and EF-slope correlated more favorably with DP (MVCIr = -0.71, EF-sloper = -0.53) than with Q and PLA. The results were not different in patients with sinus rhythm or atrial fibrillation. Using MVCI or EF-slope thie discrimination between severe and moderate or between moderate and light mitral stenosis was uncertain. Nevertheless, MVCI below 30 was associated with light, above 50 with severe mitral stenosis. In spite of the relationship between MVCI or EF-slope and the severity of mitral stenosis, in the individual case an exact quantification of mitral stenosis is not possible due to the great variability of echocardiographic data. For the assessment of the severity of mitral stenosis the mitral valve closure index is not superior to the EF-slope.

Adult↗
PubMed2000

[The effect of the duration of the cardiac cycles on determining mitral valve area by means of pressure half-time].

INTRODUCTION AND AIMS: To analyze the influence of variations in the length of cardiac cycle length of calculating mitral valve area by means of the pressure half time in patients with mitral valve stenosis and atrial fibrillation. METHODS: Fifty-nine patients with pure mitral valve stenosis and atrial fibrillation were subjected to transmitral flow measurements by continuous Doppler monitoring from the apical window. In each patient the pressure half time was quantified, corresponding to a minimum of 30 consecutive cycles. RESULTS: Considering all the measurements made in each patient, the correlation between pressure half time and cardiac cycle was significant in 20 cases (34%). The pressure half time variation coefficients were significantly greater when including the values corresponding to the shortest cycles. Thus, for cycle duration of > or = 800, 700, 600, 500 and 400 ms, the mean values were 0.096 +/- 0.041, 0.106 +/- 0.042 (NS), 0.128 +/- 0.032 (p < 0.05), 0.167 +/- 0.048 (p < 0.001) and 0.231 +/- 0.057 (p < 0.0001), respectively. Upon analyzing the relation between pressure half time and cardiac cycle with progressive exclusion of the longer cycles > or = 800, 700 and 600 ms the number of patients with significant correlation coefficients increased to 19/37 (51%), 12/23 (52%) and 4/6 (67%) on respectively excluding. CONCLUSIONS: Patients with mitral valve stenosis and atrial fibrillation show a variation in pressure half time that may complicate calculation of the mitral valve area. Variability is inherent to the measurement method, and is furthermore dependent upon cardiac cycle duration. This may be resolved by limiting determinations to cycles longer than 800 ms.

Adult↗
PubMedDate not supplied

Inhaled prostacyclin, nitric oxide, and nitroprusside in pulmonary hypertension after mitral valve replacement.

OBJECTIVE: Pulmonary hypertension increases morbidity and mortality in patients undergoing heart surgery. Mitral valve stenosis is frequently associated with an increase in pulmonary vascular resistance (PVR). Cardiopulmonary bypass exacerbates pulmonary hypertension in patients undergoing cardiac surgery. The aim of this study was to compare the hemodynamic effects of inhaled prostacyclin and nitric oxide and the administration of i.v. nitroprusside during cardiac surgery with a clinical, pharmacodynamic dose-response, prospective, randomized, and double-blind study (Group A: inhaled prostacyclin; Group B: inhaled nitric oxide; Group C: nitroprusside). MATERIALS AND METHODS: Fifty-eight patients with mitral valve stenosis and elevated PVR (>200 dynes sec/cm5) after mitral valve surgery were studied. Inhaled prostacyclin and nitric oxide were administered at concentrations of 10 g/min and 20 ppm, respectively. Nitroprusside i.v. was administered at the dose of 5-15 g/min. RESULTS: Prostacyclin and nitric oxide produced a significant dose-related decrease of mean pulmonary arterial pressure, pulmonary vascular resistance, and transpulmonary gradient. A significant increase in cardiac output was observed in both groups. In Group C, nitroprusside administration was interrupted in 62% patients due to occurrence of systemic hypotension. CONCLUSIONS: Inhaled prostacyclin and nitric oxide are effective in the treatment of postoperative pulmonary hypertension in patients with mitral valve stenosis undergoing mitral valve surgery. Both drugs improve cardiac output and reduce mean pulmonary arterial pressure, pulmonary vascular resistance, and trans-pulmonary gradient. They may be useful in patients with acute right ventricular failure following cardiac surgery. In comparison to nitric oxide, inhaled prostacyclin is free from toxic side effects and is easier to administer.

Administration, Inhalation↗
PubMed1989

[A case of mitral valve replacement with autologous pulmonic valve in congenital mitral stenosis].

A one-year-old infant with congenital mitral stenosis and pulmonary hypertension underwent by mitral valve replacement with his pulmonic valve autograft and pulmonary tract reconstruction with heterogeneous pericardial conduit. His postoperative hemodynamics data showed that left atrial pressure decreased and pulmonary hypertension continued. Echocardiography showed that the implanted autograft functioned properly. On the seventh postoperative day, he died of pulmonary hypertension. In case with congenital mitral stenosis with the small mitral annulus and the small left ventricular cavity, it is difficult to perform mitral valve replacement by commercially available mechanical or tissue valves. Because these valves are not suitable for the small mitral annulus. The mitral valve replacement with pulmonic valve autograft is recommended in such a case with the congenital mitral stenosis.

Female↗
PubMed2002

[Intractable infective endocarditis associated with supraaortic stenosis in Williams syndrome: a case report].

A 17-year-old man with supravalvular aortic stenosis associated with Williams syndrome was admitted to our hospital for intensive treatment for intractable infective endocarditis. The patient had a history of percutaneous balloon valvuloplasty for aortic stenosis in 1992. He was well until late in 1999, when he had a high temperature after dental work-up. The diagnosis was infective endocarditis but antibiotic therapy was not effective. He was transferred to our clinic. Transthoracic echocardiography demonstrated bicuspid aortic valve, supraaortic stenosis, mitral valve prolapse with severe regurgitation and scattered vegetations on the anterior mitral and aortic valves. In addition, transesophageal echocardiography showed innumerable mobile vegetations located from Valsalva's sinus to the descending aorta. Aortic root and arch replacement with a homograft and mitral valve replacement with an artificial valve were successfully performed to eliminate the infective endocarditis. In the present patient, the flow jet across the supraaortic stenosis seemed to cause a predisposition to severe endocarditis.

Adolescent↗
PubMed1983

Relationship between left ventricular morphology and postoperative cardiac function following valve replacement for mitral stenosis.

The left ventricular myocardium excised from 14 patients who had mitral stenosis and who underwent mitral valve replacement was examined, and myocardial fibrosis was quantitated in relation to cardiac function. Conventional mitral valve replacement was performed with cold potassium-induced cardioplegia associated with systemic hypothermia (28 degrees C rectal temperature) and topical cooling. All 14 patients had perivascular fibrosis; the amounts ranged from 16% to 54% of the whole tissue excised. The mean left ventricular end-diastolic volume index (LVEDVI) determined by M-mode echocardiography increased significantly (p less than 0.001) from 66.9 +/- 4.6 ml/m2 preoperatively to 79.0 +/- 2.9 ml/m2 postoperatively. The difference between preoperative and postoperative LVEDVIs was significantly correlated (p less than 0.01) to the percentage of myocardial fibrosis (r = 0.72), in that the index increased postoperatively when myocardial fibrosis was more than 35% and decreased when fibrosis was less than 35%. After mitral valve replacement, the mean ejection fraction increased when fibrosis was less than 35% of whole tissue (+0.12 +/- 0.04) and decreased when fibrosis was greater than 35% (-0.02 +/- 0.02, p less than 0.01). No measured preoperative hemodynamic parameters were predictive of prognosis. These data suggest that the degree of myocardial fibrosis is related to left ventricular performance after mitral valve replacement.

Adult↗
PubMed1999

Role of closed mitral commissurotomy for mitral restenosis.

Out of 1184 consecutive cases of rheumatic mitral stenosis treated surgically by closed mitral commissurotomy (CMC) at NRS Medical College and Hospital, Calcutta, 20 (1.68%) were mitral valve restenosis. Twelve cases (60%) were females, The median age was 32 years. Duration between the first operation and reappearance of symptoms varied with a mean of 8 years. The previous operations were digital dilatation and instrumental dilatation in 6 and 14 cases respectively. History of thromboembolism was present in 4 cases. On echocardiography, calcification of the mitral valve was present in 2 cases, left atrial clot in 4 cases, associated mild to moderate mitral regurgitation in 6 cases and mild aortic regurgitation in 4 cases. All cases presented with New York Heart Association (NYHA) III and IV symptoms. Critical stenosis (mitral valve orifice less than 0.5 cm2) was present in 12 cases. Re-do CMC was undertaken in all cases with Tubb's dilator. Median operating time was 2.5 hours. Satisfactory split was achieved in 13 cases. One patient died during surgery. Four cases having less than satisfactory split were asymptomatic on follow-up. In one case no split was possible and in another, gross mitral regurgitation was noted postoperatively. These 2 cases had to undergo open heart surgery. It is concluded that re-do CMC is a feasible and suitable alternative in mitral restenosis even in the presence of complications.

Adult↗
PubMed1990

Effects of standard mitral valve replacement on left ventricular function.

Recent studies have suggested that excision of the mitral valve apparatus during mitral valve replacement impairs left ventricular performance. However, functional measurements in humans have been difficult to obtain in a load-independent fashion. To investigate this concept, 12 patients (mean age, 65 +/- 8 years; mean New York Heart Association functional class, 3.3 +/- 0.7) with 4+ mitral regurgitation (n = 8) or mitral stenosis (valve area, 1.2 +/- 0.2 cm2) (n = 4) underwent prosthetic valve replacement using crystalloid cardioplegia. No patient required therapeutic inotropic support, every patient had at least the anterior mitral leaflet excised, and paced heart rate was maintained constant throughout. Left ventricular volume was measured with radionuclide angiocardiography, left ventricular pressure with a 3F micromanometer, and left ventricular wall volume with two-dimensional transesophageal echocardiography. Left ventricular preload was varied over a mean end-diastolic pressure range of 9 to 20 mm Hg and an end-diastolic volume range of 134 to 170 mL to generate four to five steady-state pressure-volume loops before and ten minutes after cardiopulmonary bypass. Left ventricular performance was estimated with the stroke work/end-diastolic volume relationship, which is insensitive to load. After bypass, no significant change (p greater than 0.1) was noted in wall volume for patients with mitral regurgitation or mitral stenosis (175 +/- 68 to 189 +/- 63 mL/m2 and 130 +/- 22 to 127 +/- 19 mL/m2, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2004

Prevalence of angiographically significant coronary artery disease in patients with rheumatic mitral stenosis.

OBJECTIVE: In order to evaluate the prevalence of angiographically significant coronary artery disease (CAD) in patients with predominant mitral stenosis (mitral valve area < or = 1.5 cm2), coronary angiograms of the 837 consecutive patients with mitral stenosis (482 women and 355 men; median age = 50 years [ranging from 35 to 77]) were retrospectively analysed. METHODS AND RESULTS: Significant CAD was defined as at least 50% diameter narrowing of a major coronary artery. Significant CAD was detected in 63 patients (7.5%, 30 men and 33 women). Patients with CAD were significantly older than those without CAD (median: 59 vs. 49 years; p < 0.0001, respectively). With respect to coronary risk factors, diabetes mellitus (28.6% vs. 9.4%; p < 0.0001), hypertension (46% vs. 16.7%; p < 0.0001) and family history of CAD (34.9% vs. 17.3%; p = 0.001) were significantly more frequent in the CAD+ group as compared to the CAD- group. Serum levels of cholesterol were significantly higher in CAD+ group as compared to the CAD-patients (median: 199 vs. 176 mg/dl; p = 0.003). No significant differences were noted between the two groups in both serum levels of HDL-cholesterol (p = 0.12) and triglycerides (p = 0.08). Of the 63 patients with CAD, 21 (33.3%) had angina pectoris (AP) and, in patients free of CAD, AP was present in 106 (13.7%). The sensitivity and specificity of AP for the presence of significant CAD were 33.3% and 86.3%, respectively. The positive predictive value of AP for the presence of CAD was 16.5% and the negative predictive value of its absence was 94.1%. CONCLUSION: It is concluded that routine coronary angiography is not necessarily indicated in predominant mitral stenosis particularly in patients who are younger than 40 years and have no coronary risk factors and typical chest pain.

Adult↗