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At least 487 records · Page 27Linked to original sources
PubMed1997

Functional mitral stenosis resulting from a large mitral valve prosthesis vegetation.

Obstruction of a prosthetic valve by an infective vegetation is a rare and life-threatening complication of endocarditis that demands emergent surgical intervention. In our patient's case, transthoracic echocardiography showed the large vegetation, transthoracic Doppler imaging showed severe obstruction of diastolic flow through the bioprosthetic valve, and transesophageal echocardiography showed that no perivalvular abscess was present. Rapid diagnosis of prosthetic valve infection and obstruction demanded application of all three major echocardiographic modalities and proved critical to the patient's recovery.

Adult↗
PubMed1993

Determinants of stroke volume response to exercise in patients with mitral stenosis: a Doppler echocardiographic study.

OBJECTIVES: The aim of this study was to assess exercise-induced changes in stroke volume and their main determinants in mitral stenosis. BACKGROUND: The mechanisms of the stroke volume response to exercise in mitral stenosis are not clearly established. METHODS: Twenty-seven patients with mitral stenosis, aged 47 +/- 13 years, and 10 healthy control subjects, aged 46 +/- 11 years, were examined by Doppler echocardiography to obtain stroke volume, mitral velocity-time integral and calculated mitral valve area (by continuity equation) at rest and during submaximal supine bicycle exercise. Measured mitral valve area at rest and total mitral score were also obtained. RESULTS: During exercise, stroke volume increased significantly (p < 0.001) in the control subjects (+25 +/- 6%) but remained unchanged in the patients. In 10 patients (Group I), stroke volume increased by > or = 14% (+23 +/- 10%, p < 0.001); in the other 17 (Group II), it decreased or increased by < 14% (-5 +/- 14%, p = NS). Mitral velocity-time integral did not change in the three groups, whereas calculated mitral valve area increased significantly (p < 0.001) and similarly in Group I and the control group but remained unchanged in Group II. The exercise change in calculated mitral valve area correlated significantly with both measured mitral valve area at rest (r = 0.46, p < 0.05) and total mitral score (r - 0.53, p < 0.005). However, at constant mitral score, exercise change in calculated mitral valve area no longer correlated significantly with measured mitral valve area at rest. CONCLUSIONS: In mitral stenosis, the change in stroke volume during exercise depends on the change in mitral valve area, which itself depends on the degree of mitral valve damage.

Blood Flow Velocity↗
PubMed1980

Rheumatic mitral stenosis:cross-sectional echocardiographic analysis.

Twenty-one patients with rheumatic mitral stenosis diagnosed by both M-mode echocardiography and hemodynamic findings were subjected to detailed cross-sectional echocardiographic studies. The age of the patients ranged from 27 to 79 years with 76% females. Left ventricular longitudinal, short axis, and apical four-chamber cross-sectional echocardiographic views were obtained in each patient. Three predominant patterns of anterior mitral leaflet motion on left ventricular longitudinal view were observed and correlated with the severity of mitral stenosis: Pattern A (eight patients) with diastolic leaflet doming and restricted leaflet tip motion. Pattern B (eight patients) tip and body leaflet motion, and Pattern C (five patients) with the entire leaflet motion restricted. Mitral valve prolapse as a rebound phenomenon was observed in three patients who had marked leaflet doming in Pattern A and two had severe obstruction. The longitudinal cross-sectional echocardiography was superior to the apical view in assessing the diastolic doming motion of the anterior mitral leaflet. Thus, longitudinal cross-sectional echocardiographic analysis of the pliability and degree of doming of the anterior of the pliability and degree of doming of the anterior mitral leaflet is valuable in estimating the severity of mitral stenosis.

Adult↗
PubMed1990

A new method of haemodynamic assessment of mitral stenosis in atrial fibrillation: construction of a nomogram.

Accurate haemodynamic assessment of mitral stenosis by hydraulic formulas requires measurement of the mean valve gradient and the cardiac output. The calculation is laborious, particularly in the presence of atrial fibrillation when averaged values obtained from multiple beat-to-beat determinations must be used. The relations between valve area, end diastolic gradient, and heart rate in 20 patients with mitral stenosis and atrial fibrillation were examined. In each patient the end diastolic pressure gradient for each cardiac cycle was related linearly to the RR interval of that cycle, and this relation was unchanged on exercise. The slope (S) and intercept (I) of this relation correlated with the degree of mitral stenosis as measured by the Gorlin valve area. The regression equations describing these relations were then used to construct a nomogram relating end diastolic pressure gradient to mitral valve area at different heart rates. When the nomogram was applied to catheterisation data from a further 30 patients the results correlated well with direct calculation of valve area by the Gorlin formula. The nomogram is simple to use, does not require measurement of cardiac output, and is independent of heart rate so that it is unnecessary for the patient to exercise during catheterisation.

Atrial Fibrillation↗
PubMed1978

[State of the hemodynamics in pregnant women suffering from mitral stenosis].

Hemodynamics was studied in different trimesters of pregnancy in 94 women with mitral stenosis and in 32 healthy women with pregnancy following a normal course. Each trimester in women with mitral stenosis was marked by different changes in hemodynamics. Study of the state of hemodynamics allows preclinical signs of cardiac insufficiency to be already detected in the early periods. This makes it possible to assess the risk of pregnancy and delivery in women with mitral stenosis at the right time and more correctly. The disclosure of unfavourable signs of changes in hemodynamics in conjunction with the clinical signs of cardiac insufficiency aids in the choice of the therapeutic and obstetrical tactics.

Adolescent↗
PubMed1978

[Hemodynamic effects of aldosterone antagonists in patients with mitral stenosis (author's transl)].

In 12 patients with mitral stenosis of a severity that surgery was required, some hemodynamic parameters after intravenous injection of 400 mg Kaliumcanrenoat were studied. The hemodynamic changes were noted after 15 min and reached maximal values after 60 min. The increased values of pulmonary wedge, pulmonary artery and right atrial pressures were significantly reduced and the cardiac index and stroke volume index augmented, with unchanged systemic arterial pressure. Thus, a remarkable relief from pulmonary congestion followed, accompanied by an increase of the left-ventricular working index.--These results encourage the use of aldosterone antagonists in certain cases suffering from severe mitral stenosis.

Adult↗
PubMed2001

Percutaneous balloon mitral valvuloplasty in comparison with open mitral valve commissurotomy for mitral stenosis during pregnancy.

OBJECTIVES: We sought to compare the maternal and fetal outcomes of patients with severe mitral stenosis submitted to percutaneous balloon dilation versus open mitral valve commissurotomy (MVC) during pregnancy. BACKGROUND: Heart failure in patients with mitral stenosis complicating pregnancy is a common problem in developing countries. Since 1984, percutaneous dilation of the mitral valve using a balloon catheter has become a therapeutic alternative to open heart surgery. Although the efficacy of percutaneous mitral valve balloon dilation is well established, its results have never before been compared with the results of commissurotomy during pregnancy. METHODS: We compared the clinical and obstetric complications in 45 women who were treated with percutaneous mitral valve balloon dilation (group I, n = 21; from 1990 to 1995) or open MVC (group II, n = 24; from 1985 to 1990) for severe heart failure due to mitral stenosis during pregnancy. RESULTS: In our study, percutaneous balloon dilation of the mitral valve had a success rate of 95% (Gorlin formula) and 90.5% (echocardiographic "pressure half-time" method), as demonstrated by the final mitral valve area achieved. This improvement was followed by a marked decrease in the mitral valve gradient, left atrial pressure and mean pulmonary artery pressure. Patients in both groups had similar improvements in symptoms. Patients who underwent percutaneous balloon dilation had significantly fewer fetal complications, with a reduction in fetal and neonatal mortality (1 death in group I vs. 8 in group II, p = 0.025). CONCLUSIONS: Percutaneous balloon mitral valvuloplasty is safe and effective and appears to be preferable for the fetus, compared with open MVC during pregnancy.

Adult↗
PubMed1999

A left atrial thrombus is not an absolute limitation to balloon mitral commissurotomy for patients with mitral stenosis. a serial transesophageal echocardiographic study.

Previous reports did not encourage balloon mitral commissurotomy (BMC) when left atrial (LA) thrombi were located beyond LA appendage. We hypothesize that LA thrombi may be resolved in some patients after anticoagulant therapy, and BMC can be performed subsequently. In the present study, we used transesophageal echocardiography (TEE) to evaluate the effects of anticoagulant on LA thrombi in patients with mitral stenosis, to compare the clinical differences between patients with (group A) and without (group B) resolution of LA thrombi, and to evaluate the safety of subsequent BMC in these patients. TEE was performed on 190 consecutive patients with mitral stenosis; 14 (7.4%) of them were found with LA thrombi. Serial TEE was performed and optimal anticoagulant therapy was achieved in all 14 patients. The thrombi were located within the LA appendage in 6 cases, attached to the LA posterior wall in 5, posterior wall and interatrial septum in 1, and LA appendage and posterior wall in 2. Based on the 6-month TEE follow-up, we found that the LA thrombi disappeared in 8 (57.2%) patients (group A) and persisted in 6 patients (group B). LA thrombi resolved within 3 months in 7 group A patients (87.5%). Furthermore, the resolution of LA thrombi was more frequently observed in patients either with a smaller LA dimension (51.9 +/- 3.4 vs. 57.8 +/- 4.8 mm, p = 0.02) or with their thrombi located inside their LA appendage (p = 0.03). No differences in other clinical and echocardiographic variables were noted between these two groups. Subsequently, group A patients underwent BMC without complications of systemic embolization. In conclusion, LA thrombi can be resolved after optimal anticoagulant therapy in a considerable proportion of patients with mitral stenosis. Serial TEE studies are helpful to observe LA thrombus resolution; they may also be useful in planning the treatment strategy.

Adult↗
PubMed2000

Influence of valve replacement on plasma endothelin-1 level in mitral stenosis.

BACKGROUND AND AIM OF THE STUDY: The rise of pressure in the pulmonary circulation during the course of mitral stenosis leads to pathomorphological changes and a reduction in vascular compliance. Endothelial dysfunction is also promoted, with increased expression of endothelin. This aim of this study was to evaluate whether the increase in endothelin-1 levels in pulmonary hypertension due to advanced mitral stenosis is reversible after valve replacement. METHODS: Thirty-nine patients with isolated, longlasting post-rheumatic mitral stenosis were enrolled. During preoperative Swan-Ganz catheterization blood samples were withdrawn from the pulmonary artery and capillaries for measurement of endothelin-1 (ET-1). Similar examinations were performed six months after mitral valve replacement. Hemodynamic parameters were measured also during 25-W exercise effort. RESULTS: The mean preoperative hemodynamic parameters of the pulmonary circulation were moderately increased. Mean plasma levels of ET-1 were about three-fold higher than normal. Capillary levels of ET-1 were significantly higher than those in the pulmonary artery (1.78+/-1.22 versus 1.03+/-1.16 pg/ml, p <0.05). There was no significant correlation between ET-1 level and any hemodynamic or clinical parameters, except NYHA functional class. After surgery, pulmonary capillary levels of ET-1 fell significantly, but were still high (1.78+/-1.22 versus 1.41+/-1.00 pg/ml); ET-1 levels in the pulmonary artery were unchanged. Patients with persistently high ET-1 levels had significantly worse exercise hemodynamic parameters, especially of pulmonary arterial compliance. CONCLUSION: In patients with long-lasting, severe mitral stenosis, ET-1 levels remained increased and the ET-1 concentration gradient across the pulmonary circulation persisted for six months after valve replacement. High ET-1 capillary levels are correlated with poor exercise tolerance and poor exercise compliance of the pulmonary vessels.

Endothelin-1↗
PubMedDate not supplied

Prevalence of left atrial thrombus in rheumatic mitral stenosis with atrial fibrillation and its response to anticoagulation: a transesophageal echocardiographic study.

BACKGROUND: The frequency of occurrence of left atrial thrombi, and the effect of anticoagulation in patients with rheumatic mitral stenosis and atrial fibrillation is not well established. This study was conducted to evaluate the occurrence of left atrial body and left atrial appendage clots in patients with rheumatic mitral stenosis and atrial fibrillation, and to document the effect of long-term anticoagulation on clot dissolution. METHODS AND RESULTS: Consecutive patients with severe rheumatic mitral stenosis and atrial fibrillation were assessed by transesophageal echocardiography. Those with left atrial body or left atrial appendage clots were anticoagulated with oral nicoumalone. Transesophageal echocardiography was then repeated in patients on anticoagulation who were on regular follow-up, and in whom percutaneous transvenous mitral commissurotomy could be considered. Of the 490 patients studied, 163 had left atrial body or left atrial appendage clots. A repeat transesophageal echocardiographic examination was done in 50 patients who had optimal anticoagulation for a period of 6 months. Only 2 of the 17 patients who had left atrial body clots had successful clot dissolution after long-term anticoagulation, while the left atrial appendage clots disappeared in 31 of 33 patients (p<0.001). CONCLUSIONS: Left atrial clots are present in a third of patients with severe rheumatic mitral stenosis and atrial fibrillation. Isolated left atrial appendage clots in patients with rheumatic mitral stenosis and atrial fibrillation can disappear with long-term anticoagulation, while thrombi that extend into the left atrial body may persist despite optimal anticoagulation.

Adult↗
PubMed1991

[A case of mitral stenosis associated with cardiac sarcoidosis and left ventricular aneurysm].

We report a rare case of mitral stenosis associated with cardiac sarcoidosis and left ventricular aneurysm. A 60-year-old female was admitted with complaint of palpitation and dyspnea on exertion. Chest X-ray revealed cardiomegaly and pericardial calcification, but no bilateral hilar lymphadenopathy. Electrocardiogram showed various arrhythmia. Coronary angiography showed no stenosis in any coronary arteries. Cardioangiogram showed left ventricular aneurysm at the apex and mitral stenosis. Laboratory findings showed no evidence of sarcoidosis. Open mitral commissurotomy and left ventricular aneurysmectomy was performed. Pathological findings of the myocardium showed a remarkable degenerative change and a granulomatous inflammation. Postoperative biopsied specimens of right scalene lymph nodes revealed sarcoid reaction. The postoperative course was satisfactory, but arrhythmia remained. The patient was treated with steroids and pacemaker implantation. She has been doing well for 2 year postoperatively. An operative case of mitral stenosis associated with cardiac sarcoidosis and ventricular aneurysm due to sarcoidosis is very rare and the prognosis in patient is very poor usually.

Cardiomyopathies↗