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At least 505 records · Page 28Linked to original sources
PubMed1993

Cross-sectional echocardiographic left ventricular geometry in rheumatic mitral stenosis.

The ultrastructural myopathic changes and deranged left ventricular contractile function have been reported in patients with rheumatic mitral stenosis. It is not clear if as a result of these myopathic changes, global left ventricular myocardial remodelling occurs to alter its normal elliptical shape in the absence of qualitative segmental asynchrony. To study the left ventricular cavity shape independent of chamber size, cross-sectional echocardiographically measured longest long axis (L) of the left ventricular cavity in the apical four-chamber view and short axis diameters at the level of tips of the mitral leaflets in the parasternal long axis view (D-1), of the basal cavity (D-2) and the apical segment (D-3) in the apical four-chamber view at end-diastole and their ratio, were studied in 20 patients with isolated rheumatic mitral stenosis. Twenty healthy volunteers matched for age, sex, heart rate, height and body surface area provided the normal control data. The patients with mitral stenosis had shorter long axis diameter (7.2 +/- 0.7 vs 7.9 +/- 0.5 cm, p < 0.001) and greater short axis/long axis diameter ratios at every level with the most pronounced change in the apical segment of the cavity (D-3/L 0.49 +/- 0.09 vs 0.40 +/- 0.05, p < 0.001). Left ventricular end-diastolic sphericity index was also markedly increased in the patients with mitral stenosis (0.57 +/- 0.09 vs 0.40 +/- 0.05, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1977

Clinical, electrocardiographic, and radiological evaluation of pulmonary hypertension in patients with mitral stenosis.

Fifty-one patients with dominant rheumatic mitral stenosis were studied by clinical, electrocardiographic, and radiological criteria for evaluation of pulmonary hypertension. Predicted pulmonary artery pressure from these criteria were then compared with the pulmonary artery pressure measured during cardiac catheterization. In the first 31 patients, the assessment of pulmonary hypertension using combined clinical, electrocardiographic, and radiological methods gave better results than any one single method alone. On the basis of these observations, a composite criterion was arrived at. This new criterion was then prospectively applied to the next 20 consecutive patients with dominant mitral stenosis. In 14 of the 20 patients, the predicted pulmonary artery mean pressures were in the same range as the measured mean pulmonary artery pressures when the new composite criterion was used.

Adolescent↗
PubMedDate not supplied

[Percutaneous mitral commissurotomy with an Inoue catheter in congenital mitral stenosis].

We describe a 3-years-old boy, with congenital mitral stenosis, who underwent percutaneous transvenous mitral commissurotomy (PTMC) with Inoue balloon. The mitral gradient decreased from 24 to 4 mmHg, the mitral valvular area (MVA) increased from 1.2 to 1.6 cm2 without modification in mitral regurgitation. One year later the recatheterization showed decreased pulmonary pressures, and a 7.5 mmHg mitral valvular gradient without mitral insufficiency. MVA by echo is 1.8 cm2 with mild regurgitation. As far as we know there is no experience with Inoue balloon in children. We conclude that PTMC with Inoue balloon could be an attractive alternative in some patients with congenital mitral stenosis.

Cardiac Catheterization↗
PubMed1978

Influence of pulmonary hypertension on pulmonary diffusing capacity in patients with mitral stenosis.

The pulmonary diffusing capacity (DLCO--steady state method according to Bates and coworkers) was measured at the time of heart catheterization in 12 patients with mitral stenosis without mitral incompetence. DLCO correlates with the tidal volume at rest and during exercise and with pulmonary vascular resistance during exercise only. DLCO and left atrial pressure exhibit a positive correlation up to 22.5 mm Hg only. In patients with mitral stenosis DLCO depends on the alveolar surface area and DLCO is influenced by regional changes in the pulmonary vascular resistance.

Adult↗
PubMed1989

[2-dimensional echocardiography of mitral stenosis in patients 60 years of age and older].

The authors examined 28 patients with mitral stenosis aged 60 years or older, incl. 20 (71%) with atrial fibrillation and 14 (50%) who had moreover signs of heart failure. None of them suffered from severe mitral stenosis with an area of the mitral orifice smaller than 1 sq. cm. Statistical comparison of groups of patients with sinus rhythm and atrial fibrillation and groups with symptoms of heart failure or without it revealed a significant difference only between the areas of the mitral orifice (P less than 0.005). In the other echocardiographic indicators (dimensions of the left atrium and volume ratio of its evacuation, left ventricular ejection fraction) there was no significant difference. According to criteria published by Okamura et al. in 1986 for patients above 60 years with mitral stenosis and incipient cardiac failure cardiosurgery should be an opportunity to prolong life.

Aged↗
PubMed1984

[2-dimensional echography in the preoperative evaluation of mitral stenosis].

2D echocardiography has become one of the most important investigations in the preoperative assessment of mitral stenosis. This study was undertaken to determine the reliability of the information so obtained, by comparison with the surgical appearances. The study population consisted of 104 patients (average age 45 years, 76% women) undergoing open heart surgery for pure mitral stenosis (72%) or mixed mitral valve disease (28%) between 1980 and 1981. All underwent 2D echo using a phased array Aloka SSD 800 80 degrees sector scanner. Cardiac catheterisation was performed in 102 cases and left ventricular angiography in 89 cases. The echocardiogramme was interpreted by an observer who had no knowledge of the surgical results. The mitral surface area, the condition of the valves and subvalvular apparatus and the predictive value of the possible surgical technique were analysed. The 2D echo mitral surface area was estimated by planimetry and quantitatively by using the Gorlin formula during catheterisation and by the surgical description preoperatively. 2D echo was more sensitive than M mode in the detection of severe mitral stenosis (90% vs 73%, p less than 0,01). The 2D echo-Gorlin correlation was quite good (R = 0,70, p less than 0,01) but was worse when the valves were very thickened. When compared with the surgical observations, 87% of the 2D echo data was correct. The thickness of the valves, their amplitude, the diastolic bowing of the anterior leaflet and the presence of calcification were assessed by 2D echo. The echo-surgical results matched perfectly in 76% of cases. The usual cause of error was underestimation of the degree of valvular damage. The valvular bowing and thickness were the most useful signs. Dense, brilliant echos of valvular calcification were found in only 58% of surgically proven cases of valvular calcification, but the error was often related to fine calcification, not visible on fluoroscopy, or to its localisation on the posterior leaflet. The subvalvular apparatus was evaluated in over 93% of patients, a complete study being possible in 73% of them. The 2D echo-surgical correlations were excellent in 90% of the cases in which it had been completely visualised. The chordal thickening was correctly predicted in 79% of cases. The surgical assessment was more pessimistic in 1/3 of cases in which the chordae appeared to be of normal thickness. The length of the chordae was correctly predicted in 68% of cases. The surgical assessment was more pessimistic in 1/2 of cases in which the chordae appeared to be of normal length.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1998

Effects of percutaneous balloon mitral valvuloplasty and exercise training on the kinetics of recovery oxygen consumption after exercise in patients with mitral stenosis.

AIMS: Kinetics of recovery oxygen consumption after exercise plays an important role in determining exercise capacity. This study was performed to assess the kinetics of recovery oxygen consumption in mitral stenosis and evaluate the effects of percutaneous balloon mitral valvuloplasty and exercise training on the kinetics. METHODS AND RESULTS: Thirty patients with mitral stenosis (valve area < or =1.0 cm2) and same sized age- and size-matched healthy volunteers were included for this study. All subjects performed maximal upright graded bicycle exercise. Thirty consecutive patients who underwent successful percutaneous balloon mitral valvuloplasty (valve area > or =1.5 cm2 and mitral regurgitation grade < or =2), were randomized to an exercise training group or non-training group. The exercise group performed daily exercise training for 3 months. Half-recovery time of peak oxygen consumption was significantly delayed in mitral stenosis as compared to normal subjects (120+/-42 s vs 59+/-5, P<0.01). Peak oxygen consumption (ml x min(-1) x kg(-1)) was significantly increased in both the training (16.8+/-4.9 to 25.3+/-6.9) and non-training groups (16.3+/-5.1 to 19.6+/-6.0) 3 months after percutaneous balloon mitral valvuloplasty. Half-recovery time of peak oxygen consumption was significantly shortened in the training group (124+/-39 to 76+/-13, P<0.01), but not in the non-training group (114+/-46 to 109+/-44 s, P=0.12) at 3 months follow-up. The degrees of symptomatic improvement after percutaneous balloon mitral valvuloplasty were more closely correlated with the changes of the half-recovery time of peak oxygen consumption than those of peak oxygen consumption. CONCLUSION: Kinetics of recovery oxygen consumption was markedly delayed in mitral stenosis, which was improved after exercise training but not after percutaneous balloon mitral valvuloplasty alone. These results suggest that adjunctive exercise training may be useful for improvement of recovery kinetics and subjective symptoms after percutaneous balloon mitral valvuloplasty.

Adult↗
PubMed1993

Pulmonary venous flow pattern studied by transoesophageal pulsed Doppler echocardiography in mitral stenosis in sinus rhythm: effect of atrial systole.

In 13 patients with isolated mitral stenosis in sinus rhythm the pulmonary venous flow was evaluated by transoesophageal pulsed Doppler echocardiography. The patients were divided into two groups according to their mitral valve area (MVA); Group I (MVA < 1.5 cm2, n = 7 patients); and Group II (MVA > 1.5 cm2, n = 6). The patients in group I with haemodynamically significant mitral stenosis had lower velocities of systolic (S), diastolic (D) and atrial retrograde (A) waves of pulmonary venous flow (PVF) compared to milder stenosis (P < 0.05). The peak velocity of pulmonary retrograde venous flow at atrial contraction (A) primarily depends on the relative amplitude of the atrial transmitral wave (RA), which is measured from the onset of atrial systole to its peak velocity. We found a highly positive correlation between RA of mitral valve flow (MVF) and A wave of PVF (r = 0.87, P < 0.0001). There was also a highly negative correlation (r = 0.80, P < 0.001) between A of PVF and ratio of early (PE) to late (PA) velocities of MVF. Therefore, the retrograde A wave of PVF is related to the pressure generated in the left atrium during atrial systole. Use of pulmonary vein velocities in conjunction with mitral flow velocities can increase our understanding of the haemodynamics of mitral stenosis and provide a new insight into left atrial performance.

Adult↗
PubMed1978

Noninvasive assessment of pressure drop in mitral stenosis by Doppler ultrasound.

A noninvasive method is described for measuring the pressure drop across the mitral valve in mitral stensois by Doppler ultrasound. A maximum frequency estimator was used to record maximum velocity in the Doppler signal from the mitral jet. Provided the angle between the ultrasound beam and the maximum velocity is close to zero the pressure drop can be calculated directly. Good correlation was found between Doppler measurements and simultaneous pressure recordings during heart catheterisation in 10 patients. No false negative or false positive diagnoses of mitral stenosis were made among 55 patients (35 patients with mitral stenosis and 20 patients with other valve lesions). The measurements were easy to perform in most patients and the method seems well suited both to diagnose and to follow patients with mitral stenosis.

Aged↗
PubMed1977

[Echocardiographic diagnosis of mitral stenosis].

One hundred forty nine subjects have their echocardiography recorded by Echoview apparatus, Picker firm. The echocardiographic parameters found in 72 patients in pure or almost pure mitral stenosis were confronted to those of 77 healthy subjects. The high sensitivity of the echocardiographic method is stressed upon in the differentiation of mitral stenosis. The most important echocardiographic criterion of mitral stenosis is the slowed down speed of the early diastolic movement, EF of the anterior mitral cusp and the shifting of the posterior mitral cusp forward from the line, passing through the point of the mitral closing. Confirmed diagnosis of mitral stenosis could only be obtained by the combination of those two echocardiographic changes. Echocardiographic significance is stressed in the establishment of the thickness of the two mitral cusps, increased number of component echolines and amplitude decrease in anterior mitral cusp opening in the assessment of the presence of mitral fibrosclerosis and calcinosis.

Adolescent↗
PubMed1985

Poor R wave progression in pure mitral stenosis. Correlation with hemodynamic data.

Poor R wave progression in the right precordial leads has frequently been reported in patients with pure mitral stenosis, but has never been investigated from clinical and hemodynamic points of view. In this work the clinical, electrocardiographic and hemodynamic data of 19 patients (mean age: 49 +/- 8.6 years), with pure mitral stenosis and poor R wave progression (study group) were compared with those of 19 subjects with pure mitral stenosis and normal R wave progression (control group). The age, sex distribution and duration of mitral valve disease were similar in the two groups; also clinical status, i.e. the distribution in the functional classes (NYHA), was similar in the two groups. Mitral valve area was similar in the two groups (1.3 +/- 0.5 vs 1.1 +/- 0.3 cm2), whereas wedge pressure, mean pulmonary artery pressure, systolic and diastolic right ventricle pressures and total pulmonary resistances showed significant lower values in patients with poor R wave progression compared to those with normal R wave progression (P less than 0.05). The hemodynamic variables of left ventricle and the cardiac index were similar in the two groups. In study group patients there was higher prevalence of vertical axis (P less than 0.05). These data indicate that in pure mitral stenosis, clinical status is similar in patients with poor R wave progression and in those with normal R wave progression, whereas in the former there is slighter hemodynamic involvement of the right ventricle.

Adult↗
PubMed1993

Pulmonary arteriovenous malformation. Progressive enlargement with replacement of the entire right middle lobe in a patient with concomitant mitral stenosis.

OBJECTIVE: To present a case of pulmonary arteriovenous malformation (AVM) that showed progressive enlargement in a patient with concomitant rheumatic mitral stenosis. CLINICAL FEATURES: A 73-year-old woman first presented eight years ago because of an uncomplicated acute myocardial infarction. She was noted to have rheumatic mitral stenosis. Six years later, she developed symptomatic sick sinus syndrome for which a permanent pacemaker was implanted. Chest x-ray revealed new development of an opacity in the middle zone of the right lung. Two years later, she was admitted to hospital because of progressive dyspnoea. Chest x-ray showed further increase in size of the right middle zone opacity. OUTCOME: She died of cardiopulmonary failure on the 18th day in hospital. Autopsy revealed a pulmonary AVM, replacing the entire right middle lobe. CONCLUSION: The elevated pulmonary vascular resistance caused by mitral stenosis may have increased the preferential flow of blood through the AVM, leading to its rapid enlargement. Patients with concomitant pulmonary AVM and mitral stenosis need to be recognised, as close follow-up and early treatment may be desirable.

Aged↗
PubMedDate not supplied

[Left ventricle function in isolated mitral stenosis. Regional angiographic study during the ejection phase].

Twenty two patients with rheumatic mitral stenosis and 12 healthy individuals were studied, using the following parameters: 1) Basal (B), Medial (M) and apical (A) mean velocity of circunferential shortening (VMAC); 2) Ejection fraction (EF); 3) Mid-systolic ejection fraction (FE 50); 4) Relative ejection fraction (REF = FE 50/FE). The student T comparing the patients with mitral stenosis to the control group showed statistical difference in all the parameters studied, but in the M and A, VMAC. In 13 patients (59%) the EF and the REF were found diminished, on the other hand, the EF 50 was definitively abnormal in 19 patients (86%). Twenty one patients (96%) showed abnormalities at least in two of the mentioned parameters and finally, only one had normal ventricular function. We conclude that the ejection ventricular function studied with "regional" indexes is almost always abnormal in patients with mitral stenosis.

Cardiac Output↗
PubMed1980

[Mimicking of mitral stenosis by asymmetrical hypertrophic cardiomyopathy].

Pressure gradients between atrium and left ventricle were measured in 5 of 17 patients with the diagnosis of hypertrophic cardiomyopathy. The diagnosis was confirmed by echocardiography and angiography. In 2 patients the hypertrophic cardiomyopathy was obstructive for the left ventricular outflow tract. Mitral stenosis was suspected in 3 out of the 5 patients who presented atrial fibrillation or frequent premature atrial beats and atrial overload phenomena of a third heart sound (which was misinterpreted as mitral opening snap) together with radiological enlargement of left atrium. Cardiac catheterization revealed middle pressure gradients between 7 and 14 mm Hg over mitral valve in 3 patients. In 2 patients significant early and middiastolic pressure gradients were recorded only after left ventricular angiography (volume load) was performed. Based on the data from cardiac catheterization, mitral stenosis was diagnosed in one patient, surgery revealed normal mitral leaflets. Echocardiography showed normally mobile mitral leaflets as well as signs of interventricular septal hypertrophy in all 5 patients. (In the patient who underwent surgery echocardiography was performed after the operation.) There were no echocardiographic signs of left ventricular inflow obstruction. The pathophysiologic mechanism of myocardial hypertrophy mimicking mitral stenosis is unknown. It may be suspected that third heart sound, diastolic murmur and the left ventricular inflow obstruction apparent from the pressure gradient are due to diminished myocardial compliance, direct mechanical effects of septal hypertrophy and decreased mobility of anterior mitral leaflet. Mimicking of mitral stenosis exists. Hypertrophic cardiomyopathy should therefore be considered in the differential diagnosis of mitral stenosis. Echocardiography may be helpful in evaluation.

Adult↗
PubMedDate not supplied

Increased systemic and regional coagulation activity in patients with mitral stenosis and sinus rhythm.

A hypercoagulable state has been reported in patients with mitral stenosis (MS) and sinus rhythm (SR). However it has been suggested that the coagulation activity may be increased only within the left atrium in MS, with normal peripheral blood levels. The aim of the present study was to assess regional left atrial and systemic coagulation activities by measuring PF1+2 in patients with severe mitral stenosis and sinus rhythm, normal blood clotting times, and no left atrial thrombus. The study was conducted in 25 consecutive patients with moderate-to-severe MS and sinus rhythm who underwent percutaneous balloon mitral valvuloplasty. Transesophageal echocardiography was performed before the valvuloplasty procedure in all patients to exclude the presence of left atrial thrombus and left atrial spontaneous echo contrast (LASEC). There were no statistically significant differences between LASEC-positive and LASEC-negative patients with respect to age, gender, fibrinogen levels, prothrombin time, mitral valve area, mean mitral gradient, pulmonary artery pressure (in all p > 0.05). Regional (left atrial) PF1+2 levels of both LASEC-positive and LASEC-negative patients were significantly elevated when compared to control subjects (p < 0.01). Statistically significant elevated systemic level of PF1+2 was observed only in LASEC-positive patients when compared to control subjects (p < 0.01, p > 0.05, respectively). In conclusion patients with severe mitral stenosis and SR have increased regional coagulation activity in both LASEC-negative and LASEC-positive groups. Although this increased regional coagulation activity has been reflected in peripheral blood of LASEC-positive patients, it has not been reflected in peripheral blood of LASEC-negative patients.

Adult↗
PubMedDate not supplied

Quantitative angiocardiography--evaluation of left ventricular function in mitral stenosis.

Investigations of left ventricular function were carried out in 59 patients with mitral stenosis and 8 healthy subjects by means of one-plane quantitative angiocardiography. A statistically significant increase of the left-ventricular systolic volume was observed in patients (x=74.9 +/- 29,8 ml) as compared with the control group (x=35.2 +/- 12,7 ml), the systolic ejection fraction decreased (patients: x=49% +/- 12, controls: x=74% +/-3), similarly as the stroke volume (patients x=74.8 +/- 29.6 ml, controls: x=104 +/- 42 ml). The diastolic volume of the left ventricle was similar in both groups (patients: x=143 +/- 43 ml, controls: x=134 +/- 47.9 ml). A significant decrease of the systolic ejection fraction and an increase of the systolic volume of the ventricle were observed with higher grades of mitral stenosis evaluated according to the classification of the New York Heart Association. A negative correlation was demonstrated between the systolic volume of the left ventricle and the systolic ejection fraction (r=-0.707) and the work of the left ventricle (r=-0.237). On the other hand, a positive correlation was found between the left-ventricular work and the systolic ejection fraction (r=+0.227). The results indicate unequivocally impairment of left ventricular function in mitral stenosis and a considerable role played in it by the myocardial factor.

Adolescent↗
PubMed1980

Diagnosis of intracardiac thrombi in mitral stenosis and left ventricular dysfunction. Use of selective coronary arteriography.

Neovascularization of the left atrial appendage on selective coronary arteriography implying left atrial thrombus occurred in five of 20 patients with mitral stenosis, and is consistent with the incidence of left atrial thrombi in mitral stenosis determined both surgically and post mortem. The presence of a thrombus was confirmed at surgery in the two patients operated on. Selective coronary arteriography with attention to the presence or absence of left atrial neovascularization is suggested for the full evaluation of mitral stenosis. The absence of left atrial neovascularization in mitral stenosis strongly suggests, but does not confirm, the absence of left atrial thrombi. Left ventricular neovascularization was not found to be a sign of left ventricular thrombi, and left ventriculography remains the diagnostic procedure of choice in assessing the presence or absence of left ventricular thrombi.

Adult↗
PubMed1981

[Work capacity of mitral stenosis patients before and after mitral commissurotomy].

Analysis of the working capacity of 1,000 patients who underwent mitral commissurotomy showed that 67.0% of individuals who were operated on for grade III stenosis and 27.99% of those operated on for grade IV stenosis resumed work. Frequent exacerbations of rheumatism and changes in the myocardium and valvular apparatus are among the causes of the decrease in the number of persons who resume work after the operation. Another reason is overestimation of the group of invalidity or its unjustified qualification

Disability Evaluation↗