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PubMed1992

Mitral stenosis in pseudoxanthoma elasticum.

A 54-year-old woman with pseudoxanthoma elasticum presented with tight mitral stenosis with thickened and restricted mitral valve leaflets. She initially revealed systemic hypertension and moderate mitral regurgitation due to mitral valve prolapse. One year after the start of treatment for hypertension, thickening of the mitral valve gradually progressed and she showed tight mitral stenosis without regurgitation. It was considered that another differential diagnosis must be added to the uncommon causes of mitral stenosis.

Biopsy↗
PubMedDate not supplied

[Segmental analysis of the movement of the posterior mitral valve in mitral stenosis].

We have analyzed independently, both, early diastolic and end diastolic (A wave) movements of the posterior mitral leaflet in 302 cases of mitral stenosis with sinus rhythm, as well as in a control group of 100 subjects without mitral stenosis. Studied patients were separated into two groups: 275 that were not treated surgically, and 27 studied after mitral commisurotomy. We described 4 patterns of posterior mitral leaflet early diastolic movement, and 3 patterns of A wave motion. Only those patterns that showed anterior drift of the studied segment of the posterior mitral leaflet, were considered diagnostic of mitral stenosis. The sensitivity found was 49% for the anterior early diastolic movement; 89,5% for the anterior A wave, and 95,3% for both signs considered together. The specificity was 99% for anterior A wave, with a predictive value of 99,6%. When surgical and non surgical groups were compared, the absence of anterior drift in early diastole in the former group, showed to have statistical significance when the Chi square test was employed, while A wave pattern (anterior drift) did not show any difference between both groups. It is concluded that the most sensitive and specific sign for M-mode echocardiagraphic diagnosis of mitral stenosis in patients with sinus rhythm is the anterior drift of posterior mitral leaflet's A wave.

Diastole↗
PubMed1991

[Contribution of the continuity equation for the assessment of mitral valve area in mitral stenosis].

The aim of this study was to evaluate the continuity equation in the quantification of mitral valve area in mitral stenosis, the area being considered as the product of the area of the left ventricular outflow tract multiplied by the ratio of the velocity time integrals of the aortic or pulmonary flow to that mitral flow. The continuity equation was compared to two other echocardiographic methods, planimetry and Hatle's method, and to the results obtained at catheterization using the Gorlin formula in a population of 44 patients with mitral stenosis. All were in sinus rhythm; twelve had Grade I mitral regurgitation and 9 patients had Grade I aortic regurgitation. Excellent correlation were observed between the values obtained by the continuity equation and planimetry (r = 0.91; SEE = 0.19 cm2; p less than 0.001) and Hatle's method (r = 0.87; SEE = 0.20 cm2, p less than 0.001). The correlation with the catheter values were also excellent (r = 0.83; SD = 0.22 cm2, p less than 0.001), better than those observed with Hatle's method (r = 0.73; SEE = 0.27 cm2, p less than 0.001) and very similar to those obtained with planimetry (r = 0.87; SEE = 0.23 cm2, p less than 0.001). The sensibility and specificity of the continuity equation for the diagnosis of severe mitral stenosis (surface less than 1.5 cm2) were 90% and 100% respectively, when those of Hatle's method were 88% and 91% respectively. The continuity equation in the evaluation of mitral valve area in mitral stenosis seems to be reliable and accurate compared with catheter data, and superior to Hatle's method.

Echocardiography, Doppler↗
PubMed2004

Left ventricular long-axis function is reduced in patients with rheumatic mitral stenosis.

Left ventricular long-axis function evaluated by M-mode or tissue Doppler echocardiography has been shown to be useful indexes of left ventricular systolic function; however it has not been evaluated in patients with mitral stenosis. We examined the left ventricular long-axis function of the patients with pure mitral stenosis and normal global systolic function as assessed by fractional shortening of the left ventricle (LV). Fifty-two patients with pure mitral stenosis and twenty-two healthy controls were evaluated by echocardiography. Although there was no statistically significant difference in global systolic function, M-mode derived systolic motion of the septal side and (12 +/- 3 vs 14.4 +/- 1.5 mm, P = 0.016) the lateral side of mitral annulus (13.2 +/- 3 vs 16.8 +/- 2 mm, P = 0.001) were both significantly lower in the patients with mitral stenosis than control subjects. Similarly tissue Doppler systolic velocity of the septal annulus (7.6 +/- 1.1 vs 10.4 +/- 3.2 cm/s, P = 0.03) and lateral mitral annulus (7.6 +/- 1.1 vs 10.4 +/- 3.2 cm/s, P = 0.003) were also significantly lower in patients with mitral stenosis than in controls. There was a statistically significant correlation between septal annular motion and annular velocity (r = 0.643, P = 0.002). Septal annular motion and annular velocity were also correlated with left atrial ejection fraction (r = 0.338, P = 0.005 and r = 0.676, P = 0.001, respectively). Thus, patients with mitral stenosis had significantly impaired long-axis function evaluated by M-mode or tissue Doppler echocardiography despite normal global systolic function.

Adult↗
PubMed1993

Atrial natriuretic peptide and bronchial hyperresponsiveness in patients with mitral stenosis.

Atrial natriuretic peptide (ANP) has been reported to have protective effects against methacholine-induced bronchoconstriction in asthmatics. The aim of the study was to evaluate the relationship between plasma ANP levels and bronchial responsiveness to methacholine in patients with mitral stenosis. In 12 patients with moderate mitral stenosis, age 35-58 years, 9 female, 8 in NYHA class 2, 4 in NYHA class 3 for symptoms, plasma ANP and bronchial threshold to methacholine (PD20FEV1) were determined. The same measurements were performed in 10 asthmatic patients, hyperresponsive to methacholine, and in 10 normal subjects, nonresponsive to methacholine. Mean +/- SE plasma ANP levels were significantly higher in patients with mitral stenosis in comparison with asthmatics and normals (159 +/- 41.8, 7.3 +/- 0.98, 7.6 +/- 1.3, respectively, p < 0.01). In patients with mitral stenosis there was a significant relationship between plasma ANP and PD20FEV1 (r = 0.81, p < 0.01). No relationship was found between ANP and PD20FEV1 in asthmatics. In conclusion, in patients with mitral stenosis ANP seems to play a protective role against bronchial hyperresponsiveness to methacholine.

Adult↗
PubMed1988

[Mitral stenosis and the problem of critical constriction in blood circulation].

The results of a combined echocardiographic study of 127 patients with mitral stenosis are reviewed. Echocardiographic and hemodynamic parameters are divided into 3 groups with respect to the severity of mitral stenosis. A relationship is demonstrated between mitral opening area and diastolic pressure gradient, as evidenced by dopplerography. The definition of critical mitral stenosis is given. A classification of the severity of mitral stenosis on the basis of two-dimensional echocardiography is offered, that provides indications for surgery.

Adult↗
PubMed2001

Pulmonary function alterations after correction of mitral stenosis.

The aims of the study is to demonstrate the degree of pulmonary function reversibility after successful correction of mitral stenosis, transvenous as well as surgical. Before and in the short- and long-term follow-up after mitral stenosis correction (mitral valve replacement and percutaneous balloon mitral valvuloplasty) echocardiographic and pulmonary function studies were performed in 125 patients with pure or dominant mitral stenosis in order to investigate the influence of hemodynamic changes on pulmonary function. Immediately after procedure moderation of bronchial obstruction could be detected although only in balloon valvuloplasty group. In pts after surgery dramatic decline of pulmonary function due to thoracotomy was found. In the long-term follow-up substantial improvement of all ventilatory parameters in both groups was revealed, diffusing capacity remained unchanged. The favourable evolution was comparable in both groups. The explanation are time consuming beneficial peripheral metabolic, circulatory and organic pulmonary changes, what implies also irrelevant changes of PF in the early phase and unalterable diffusing capacity. (Tab. 1, Fig. 4, Ref. 15.)

Catheterization↗
PubMed2004

Does chronic mitral regurgitation influence Doppler pressure half-time-derived calculation of the mitral valve area in patients with mitral stenosis?

BACKGROUND: In patients with mitral stenosis (MS), Doppler pressure half-time (PHT) may be influenced by hemodynamic variables other than the anatomic mitral valve orifice narrowing. This study was undertaken to assess whether the presence of concomitant mitral regurgitation (MR) affects mitral valve area (MVA) estimation by PHT. METHODS: Consecutive patients (n = 166) with noncalcific MS, in sinus rhythm, were studied. Group 1 (n = 106) had no or mild MR, and group 2 (n = 60) had moderate or severe MR. MVA was assessed by using the PHT method and planimetry. RESULTS: There was a strong correlation between planimetry and PHT MVA in both groups (group 1: r = 0.86, P <.001; group 2: r = 0.73, P <.001). However, compared with planimetry MVA, PHT underestimated MVA by > or =20% in 18 patients (17%) in group 1 and 21 patients (35%) in group 2 (P <.01). Overestimation by > or =20% occurred in 12 patients (11%) in group 1 and in 7 (12%) in group 2. Group 2 subanalysis (group 2A: moderate MR, n = 16; group 2B: severe MR, n = 44) revealed that linear regression weakened with increasing severity of MR (group 2A: r = 0.824, P <.001, group 2B: r = 0.70, P <.001). PHT underestimation of MVA occurred in 31% and 36% of patients in Groups IIA and IIB, respectively (P = NS). CONCLUSIONS: PHT appears to be reliable for estimating MVA in most patients with MS, even in the presence of MR. However, the presence of significant MR reduces the reliability of PHT-derived MVA, with underestimation of MVA in a significant number of subjects. The severity of MR has a direct impact on PHT-derived MVA.

Adolescent↗
PubMedDate not supplied

The effect of handgrip upon Doppler data in mitral stenosis.

UNLABELLED: The usefulness of physical rehabilitation in patients with valvular heart disease is now well established. But, mainly in mitral stenosis, the isometric exercises are under question, because of the risk of sudden rise in capillary pulmonary pressure. In order to clarify this aspect we have studied the effect of isometric exercise upon Doppler data in mitral stenosis. METHODS: in 25 patients with mitral stenosis the Doppler indices of severity-mitral valve area (MVA), pressure half time (PHT), maximal velocity (MxV), mean pressure gradient (MPG)-were determined before and after 3-4 minutes of handgrip performed with a dynamometer at 30% of the maximal voluntary contraction (MVC). There are no significant differences of Doppler parameters before and during handgrip: MVA (1.56 +/- 0.30/1.49 +/- 0.53 cm2), PHT (171 +/- 72/150 +/- 58 ms) MPG (7.07 +/- 2.61/7.21 +/- 1.8 mmHg), MxV (2.186 +/- 0.79/2.276 +/- 0.73 m/s). The results suggest that mild isometric exercise does not alter hemodynamic parameters in mitral stenosis. Consequently isometric exercise can be included in physical programmes of rehabilitation for this category of patients.

Adult↗
PubMed1994

Hemodynamics of mitral stenosis: a review.

This review discusses the latest developments in the hemodynamics of mitral stenosis. English-language journal articles, reviews, and textbooks from the clinical, physiology, and engineering literature related to mitral valve stenosis were identified and reviewed. The main conclusions are: (1) the hemodynamics of mitral stenosis are determined by the complex anatomical and pathophysiologic features of the valve apparatus, (2) the properties of the left ventricle, atrium, and pulmonary vasculature also have a major impact on the hemodynamic significance and the clinical syndrome of mitral stenosis, (3) the valve and the cardiac chambers have a functional reserve that become exhausted as the stenosis worsens and/or the compensatory mechanisms of the chambers fail, and (4) a careful approach to data acquisition and analysis will lead to an accurate assessment of the hemodynamics of mitral stenosis before and after therapeutic interventions.

Atrial Function↗
PubMed1995

Acute alterations of oxygen uptake and symptom-limited exercise time in patients with mitral stenosis after balloon valvuloplasty.

STUDY OBJECTIVES: To determine the acute influence of improvement in orifice area in mitral stenosis by percutaneous transluminal valvuloplasty (PTVP) on cardiopulmonary exercise capacity, treadmill walking time (TWT), oxygen uptake parameters at maximum exercise as well as at highest comparable workloads and parameters of breathing work were assessed pre- and post-PTVP. PATIENTS AND INTERVENTIONS: PTVP was carried out in 16 patients who had moderately severe mitral stenosis, bringing about an average increase in mitral valve orifice area from 1.0 +/- 0.1 cm2 to 2.2 +/- 0.5 cm2 (p < 0.0005). Based on standardized conditions, the patients (six in functional class A, five in class B, and five in class C according to Weber's classification) underwent symptom-limited treadmill cardiopulmonary exercise testing before as well as 2 days after PTVP. In addition, subgroup analysis (eight patients in sinus rhythm, eight patients in atrial fibrillation) was performed to determine a potential influence of the underlying cardiac rhythm on cardiopulmonary exercise parameters. To rule out a PTVP-independent training effect, a control group of ten patients with mitral stenosis underwent the same kind of cardiopulmonary exercise testing on 2 consecutive days. MEASUREMENTS AND RESULTS: After-PTVP, TWT augmented by 19% (p < 0.0005) in all patients. Maximum oxygen uptake in percent of predicted maximal values at peak exercise and at anaerobic threshold was enhanced by 10% (p < 0.005). Ventilation at highest comparable workload was diminished by 10% (p < 0.025), whereas oxygen uptake and oxygen pulse at highest comparable workload did not differ, reflecting both unaltered cardiac output at comparable workloads and a more economic ventilation, respectively. Furthermore, PTVP-mediated alterations of TWT, but not of oxygen uptake at peak exercise were more pronounced in patients in sinus rhythm than in those in atrial fibrillation, reflecting more effective economization of cardiac work and ventilation in the former subgroup. Except for a statistically significant increase of TWT of 5%, no clinically relevant differences between both exercise tests were found with respect to oxygen uptake in the control group. CONCLUSIONS: Impaired cardiopulmonary fitness in patients with moderately severe mitral stenosis is improved substantially by PTVP immediately after the intervention, mainly the result of acute reduction of pulmonary congestion and subsequent decrease in dead space to tidal volume ratio. Adherence to standardized conditions is considered crucial for comparability of cardiopulmonary data.

Adult↗
PubMed2005

The protective effect of mitral stenosis on the embolization of a free-floating left atrial myxoma.

Mitral stenosis associated with free left atrial myxoma is very rare. A free myxoma is life-threatening when incarcerated in the mitral orifice or if embolization of the whole tumor occurs. We report a case of a female patient with moderate mitral stenosis and a detached left atrial myxoma. The myxoma was spherical, solid and smooth-surfaced. Mitral stenosis prevented the exit of the tumor from the left atrium and a possible fatal outcome. The tumor was surgically removed and mitral commissurotomy was successfully performed. Histological analysis confirmed the diagnosis of myxoma.

Aged↗
PubMed1999

[Significance of atrial fibrillation, left atrial thrombus and severity of stenosis for risk of systemic embolism in patients with mitral stenosis].

The prognostic significance of atrial fibrillation, left atrial thrombus and the severity of mitral stenosis (MS) for systemic embolism was evaluated in 142 consecutive patients with MS (male 61, female 81; mean age 51 +/- 10 years) who were referred for cardiac catheterization. The relationships between systemic embolization, atrial fibrillation, left atrial thrombus and the size of mitral valve area obtained by the echocardiographic or Doppler method, or cardiac catheterization (Gorlin's formula) were studied. The effects of mitral regurgitation (MR) (Sellers II < or =) on systemic embolism or left atrial thrombus were also evaluated. Atrial fibrillation was observed in 117 patients (87%), 30 (28%) of whom had a history of systemic embolism. Four of 18 patients (22%) with sinus rhythm had a history of systemic embolism. Left atrial thrombus was observed in 63 patients (45%), including 17 (27%) with a history of systemic embolism. Seventeen (22%) of 76 patients without left atrial thrombus had a history of systemic embolism. Left atrial thrombus was detected in 17 of 41 (41%) patients with severe MS [mitral valve area (MVA) < or = 1.0 cm2], 8 of 25 (32%) patients with moderate MS (1.1 < MVA < or = 1.5 cm2), 2 of 14 (14%) patients with mild MS (MVA > or = 1.6 cm2), and embolization was complicated in 11% of cases of severe MS, 32% of cases of moderate MS and 21% of cases of mild MS. There was no significant difference between the 3 groups. Left atrial thrombus was more frequently observed in patients without MR than with MR (44% vs 13%, p < 0.05), but there was no significant difference in the incidence of embolism between the groups (28% vs 22%). Positive therapy intervention should be considered to prevent systemic embolism regardless of the presence or absence of sinus rhythm, MR, left atrial thrombus or severity of stenosis.

Atrial Fibrillation↗
PubMed1996

[Predictive factors of thromboembolic complications in mitral stenosis in sinus rythm].

The authors analyse the predisposing factors to the development of thromboembolic complications in mitral stenosis in sinus rhythm and propose preventive therapeutic measures. Eighty five consecutive patients with pure or very predominant mitral stenosis in sinus rhythm were included in this study and divided into two groups according to the presence (Group I: n = 27, age: 34.2 +/- 8.31 years) or absence (Group II: n = 58, age: 32.6 +/- 9.7 years) of thromboembolic complications. No significant difference was observed between the two groups for age, sex and functional class. Patients of group I had a more dilated left auricle (57.3 +/- 4.5 vs 48.4 +/- 4.7 mm; p < 0.001) and a smaller mitral surface area (0.8 +/- 0.15 vs 1.1 +/- 0.21 cm2, p < 0.05). The spontaneous left intra-atrial contrast phenomenon was more frequently observed in patients with thromboembolic complications (23 out of 27) than in those not presenting this complication (17 out of 58), (p < 0.001). This phenomenon was the only independent predictive factor on multivariate analysis. In conclusion, left atrial dilatation, the severity of mitral stenosis and especially the presence of spontaneous contrast are the main predictive factors of the development of thromboembolic complications in mitral stenosis in sinus rhythm. Patients presenting one or several of these factors may benefit from prophylactic anticoagulant treatment.

Adult↗
PubMed1970

Valvotomy in calcific mitral stenosis.

The results of transventricular mitral valvotomy in 50 cases of heavily calcified mitral stenosis are presented. The mortality and quality of results in patients undergoing a first valvotomy were more satisfactory than in patients undergoing a second operation. Associated mitral incompetence has an adverse effect on the results, particularly after a second operation. As a result, it is suggested that closed valvotomy, in these circumstances, is only acceptable for patients who are undergoing a first operation and who have minimal or no regurgitation. Valve replacement is advised for all other cases.

Adult↗
PubMed1982

Mechanism of abnormal motion of the posterior leaflet in mitral stenosis.

Echocardiographic visualization of diastolic anterior motion of the posterior leaflet has proven to be diagnostic of mitral stenosis. In order to elucidate the mechanisms which underlie this finding and to explain why it is absent in some proven instances of mitral stenosis, we analyzed leaflet motion as a function of torque and derived a theoretic expression which permitted us to predict the direction of leaflet motion in mitral stenosis in terms of degree of commissural fusion and leaflet dimensions. The analysis was tested in an experimental model consisting of an isolated, perfused pig heart. Dimensions and degree of fusion of mitral valve leaflets were varied surgically in 5 specimens. Corresponding values proportional to torque were computed for each leaflet and the associated modifications of valve motion recorded cinematographically through a fiberscope inserted into the left ventricular cavity. The theoretical considerations indicated that, when leaflet commissures are fused, diastolic movement of the posterior leaflet is determined by the torques on both leaflets and that the relative length (base to free edge) of the leaflets is the major determinant of the direction of the resultant displacing force. The posterior leaflet may move posteriorly early in diastole until this motion is restricted by the fusion, but anterior motion of both leaflets results when the anteriorly directing force becomes dominant. Anterior motion of the posterior leaflet therefore occurs when leaflet fusion is extensive and the anterior leaflet remains longer than the posterior. Posterior motion of the posterior leaflet tends to occur with leaflet fusion, even in severe or moderate mitral stenosis, when the ratio of anterior to posterior leaflet length approximates unity. Direct observations of leaflet motion in the perfused porcine hearts confirmed these relationships.

Animals↗
PubMed1980

Left atrial--left ventricular conduit for relief of congenital mitral stenosis in infancy.

Severe congenital mitral stenosis in the infant poses a difficult problem. We present the case history of an infant in whom a left atrial--left ventricular apical conduit was used to bypass a severely hypoplastic mitral valve. Associated coarctation of the aorta, patent ductus arteriosus, and ventricular septal defect were corrected at the same time. This method of circumventing the mitral valve offers a new approach to the relief of congenital mitral hypoplasia in small infants.

Aortic Coarctation↗
PubMed1994

Comparisons between female and male patients with mitral stenosis.

OBJECTIVE: To compare Doppler, echocardiographic, and clinical variables in female and male patients with mitral stenosis. DESIGN: Observational study in consecutive patients with mitral stenosis of cross sectional and Doppler echocardiographic and clinical variables and a retrospective search for a history of systemic embolism. SETTING: A medical centre with 3000 beds, serving both urban and rural populations. PATIENTS: 500 consecutive patients with an echocardiographic mitral valve area of 2 cm2 or less. 331 (66.2%) were female and 169 (33.8%) male (mean (SD) ages of 49 (13) and 48 (14) respectively). MAIN OUTCOME MEASURES: Mitral valve areas by echocardiographic planimetry and Doppler pressure half-time method, peak early diastolic mitral velocity and pressure gradient, echocardiographic score of mitral valve, left atrial end systolic diameter, frequency of left atrial thrombus and smoky echoes as well as various valve lesions detected with Doppler and echocardiography, cardiac rhythm, symptomatic functional class of heart failure, and history of systemic embolism. RESULTS: The prevalence of significant tricuspid (22% v 9%, P < 0.001) and pulmonary regurgitation (5% v 1%, P = 0.018) was higher in the female patients than in the male patients. Female patients also had a higher peak regurgitant velocity (3.2 (0.7) v 2.9 (0.7) m/s, P = 0.007) and pressure gradient (41 (21) v 36 (19) mm Hg, P = 0.010) across the tricuspid valve. However, the male patients had a higher echocardiographic score (9.7 (2.4) v 7.0 (2.3), P < 0.001) and a smaller Doppler-derived mitral valve area (0.9 (0.4) v 1.0 (0.4) cm2, P = 0.027). There were no differences between the female and the male patients in mitral valve area measured by planimetry, peak early diastolic mitral velocity and pressure gradient, and left atrial end systolic diameter or in the prevalence of atrial fibrillation, left atrial thrombus, left atrial smoky echoes, significant aortic stenosis, aortic regurgitation, or heart failure of New York Heart Association class III or IV. CONCLUSIONS: Female patients not only had a higher prevalence of mitral stenosis but also had a higher prevalence of associated tricuspid and pulmonary regurgitation along with a higher velocity and gradient of tricuspid regurgitation. The echocardiographic score was higher in male patients, however. These findings suggest that the pathophysiology of mitral stenosis is different in the two sexes and that gender should be taken into account when therapeutic strategies are formulated.

Echocardiography↗