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At least 613 records · Page 34Linked to original sources
PubMed1990

Baseline and post-atrial pacing release of atrial natriuretic factor in mitral stenosis.

To investigate the release of atrial natriuretic factor (ANF) in mitral stenosis and the influence of the increase on the frequency of atrial contraction or atrial distention on ANF secretion, we studied 10 patients with symptoms of congestive heart failure (New York Heart Association classes II and III) in sinus rhythm, who were undergoing cardiac catheterization as part of an evaluation workup for mitral stenosis. Echocardiographic tracings, repeat determinations of mean pulmonary artery wedge pressure (MPAWP) and mean right atrial pressure, and blood sampling from the pulmonary artery for measurements of ANF were performed at baseline, during atrial pacing (pacing rate of 125 beats/min for 5 minutes), and 5 minutes after the pacing protocol was completed. Baseline ANF levels were closely related to right atrial pressure (r = 0.89; p less than 0.001) and increased markedly after atrial pacing from 205.6 +/- 39.8 (SEM) to 343.9 +/- 57.9 (SEM) pg/ml. A similar pacing-induced increase was shown for MPAWP and left atrial size. Our data indicate that pacing-induced increases in atrial distention and intracavitary pressure further stimulate release of ANF. However, an independent effect of frequency of atrial pacing on plasma ANF in humans could not be identified.

Adult↗
PubMed1979

Preoperative evaluation of subvalular fibrosis in mitral stenosis. A predictor factor in conservative vs replacement surgical therapy.

To assess the degree of mitral subvalvular fibrosis (SVF) in patients with mitral stenosis, left ventriculograms were reviewed, and a mitral subvalvular distance ratio (DR) was determined by dividing the distance from the papillary muscle tips to the closed mitral leaflets in systole by the distance from the aortic valve to the left ventricular apex in diastole. In 15 patients with normal ventricles, the mean DR was 0.244 +/- 0.017. In nine patients with minimal SVF, the mean DR was 0.181 +/- 0.025. In 10 patients with moderate SVF, the mean DR was 0.148 +/- 0.033. In 5 patients with severe SVF, the mean DR was 0.087 +/- 0.009. All mean DRs were mutually distinguishable at p less than 0.01. The clinical results and preoperative DR of 28 patients who had mitral commissurotomy were reviewed. A DR of less than 0.140 precluded a good longterm result from mitral commissurotomy alone. The DR reliably predicts the degree of SVF preoperatively and identifies patients with mitral stenosis who require valve replacement or a direct surgical attack on the subvalvular mechanism.

Angiocardiography↗
PubMed1995

Left atrial size--a risk factor for left atrial thrombi in mitral stenosis.

In a follow-up study, 77 patients with predominant mitral stenosis were examined to investigate the role of left atrial (LA) enlargement in LA thrombi. Fifteen (19.4%) patients had LA thrombi. Of these, 2 (13.3%) were in sinus rhythm and 13 (86.7%) in atrial fibrillation. Fourteen (93.3%) of the patients with LA thrombi had an LA size > or = 4.8 cm. Only one (6.7%) patient had an LA size of 4.4 cm and was in atrial fibrillation. The median LA size in patients with LA thrombi was 5.2 cm compared with 4.75 cm in patients without LA thrombi (p < 0.01). The relative risk for LA thrombi in patients with an LA size > or = 4.8 cm compared with patients with an LA size < 4.8 cm was 10.0 (95% confidence interval 1.4 to 71.4). It was thus confirmed that LA enlargement > or = 4.8 cm is an independent risk factor for LA thrombi in patients with mitral stenosis.

Adult↗
PubMedDate not supplied

[Ventricular rigidity in mitral stenosis measured by an echocardiographic and hemodynamic method].

Ten patients with mitral stenosis underwent right and left heart catheterization. In order to assess the diastolic properties of these ventricles an hemodynamic-echocardiografic techniques was employed. Left ventricular pressure and an echocardiogram of the body of the left ventricle were simultaneously registered. Ventricular volume was determined using the minor axis (T) of the left ventricle measured form the echogram and assuming the long axis (L) from the L to T relationship observed in the left cineventriculography. Using a microcromputer, a smoothed volume-time curve was obtained, together with its first derivative and a pressure-volume loop. The exponential portion of the diastolic loop was used to obtain a felt ventricular stiffness index at zero volume. End diastolic volume and ejection fraction were normals. Left ventricular filling was impaired but ventricular stiffness was found in the normal range. It is concluded that the proposed method permits the simultaneous obtention of pressure volume data. The processing of complex data can be achieved with a pocket microcomputer. There is no evidence of a left ventricular compliance defect in mitral stenosis.

Adult↗
PubMed1995

Evaluation of mitral stenosis with velocity-encoded cine-magnetic resonance imaging.

Velocity-encoded cine-magnetic resonance imaging (VEC-MRI) is a new method for quantitation of blood flow with the potential to measure high-velocity jets across stenotic valves. The objective of this study was to evaluate the ability of VEC-MRI to measure transmitral velocity in patients with mitral stenosis. Sixteen patients with known mitral stenosis were studied. A 1.5 Tesla superconducting magnet was used to obtain velocity-encoded images in the left ventricular short-axis plane. Images were obtained throughout the cardiac cycle at 3 consecutive slices beginning proximal to the mitral coaptation point. To determine the optimal slice thickness for MRI imaging, both 10 mm and 5 mm thicknesses were used. Echocardiography including continuous-wave Doppler was performed on every patient within 2 hours of MRI imaging. Peak velocity was determined for both VEC-MRI and Doppler-echo images. Two observers independently measured the VEC-MRI mitral inflow velocities. Of the 16 patients, imaged data were incomplete in only 1 study, and all images were adequate for analysis. Strong correlations were found for measurements of mitral valve gradient for both 10 mm (peak r = 0.89, mean r = 0.84) and 5 mm (peak r = 0.82, mean r = 0.95) slice thicknesses. Measurements of peak velocity with VEC-MRI (10 mm) agreed well with Doppler: mean 1.46 m/s, mean of differences (Doppler MRI) 0.38 m/s, standard deviation of differences 0.2 m/s. These findings suggest that VEC-MRI can noninvasively determine the severity of mitral stenosis.

Adult↗
PubMed2004

Color Doppler tissue imaging to evaluate left atrial appendage function in patients with mitral stenosis in sinus rhythm.

Two-dimensional color Doppler tissue imaging (CDTI) has so far been used, in general, to evaluate ventricular function. In this study, the left atrial appendage (LAA) tissue velocity was measured by CDTI. LAA function in 38 patients with mitral stenosis in sinus rhythm (SR) and 19 healthy subjects undergoing transesophageal echocardiography were examined by CDTI. Systolic tissue appendage velocity (SaV, m/s) was measured at the tip of the LAA in the basal short-axis view. LAA emptying (LAAEV) and filling (LAAFV) velocities (m/s) were also recorded 1 cm below the orifice of the appendage. LAA ejection fraction was also measured. In addition, two-dimensional imaging was used to determine the presence of thrombus and/or spontaneous echo contrast (SEC). Patients with mitral stenosis in SR had significantly decreased LAAEV, LAAFV, SaV, and LAA ejection fraction compared to controls (0.34 +/- 0.15 vs 0.72 +/- 0.17, 0.37 +/- 0.13 vs 0.63 +/- 0.19, 0.050 +/- 0.015 vs 0.071 +/- 0.093, and 39 +/- 14% vs 69 +/- 13%, respectively, P < 0.001, P < 0.001, P < 0.001, and P < 0.001). Among the patients with mitral stenosis in SR, 10 patients had SEC and one had LAA thrombus. Compared with patients without SEC, patients with SEC had decreased LAAEV, LAAFV, SaV, and LAA ejection fraction (0.24 +/- 0.05 vs 0.37 +/- 0.16, 0.29 +/- 0.05 vs 0.39 +/- 0.14, 0.039 +/- 0.087 vs 0.055 +/- 0.015, and 28 +/- 14% vs 43 +/- 12%, respectively, P = 0.01, P = 0.02, P = 0.01, and P = 0.006). In conclusion, these results suggest that the LAA dysfunction may occur in patients with mitral stenosis in SR and CDTI can successfully be used for the quantification of contraction at the tip of the LAA.

Adult↗
PubMed1986

Left ventricular function in isolated rheumatic mitral stenosis in children.

A total of 18 patients with pure rheumatic mitral stenosis between the ages of eight and 14 years (average 11.8 years) were studied. Left ventricular angiograms in the right anterior oblique view were obtained in each. Moderate to severe pulmonary arterial hypertension was present in all but one. The mean left ventricular end-systolic volume index was 25.4 +/- 8.5 ml/m2; it was increased in five patients. The mean left ventricular end-diastolic volume index was 64 +/- 13.5 ml/m2. It was normal in all except one patient, in whom it was increased to 91 ml/m2. The left ventricular stroke volume index, 39.6 +/- 8.8 ml/m2, was within the normal range. The left ventricular stroke volume index, 39.6 +/- 8.8 ml/m2, was within the normal range. The mean left ventricular ejection fraction was 0.61 +/- 0.09 ml, with a range of 0.44-0.72. The mean left ventricular ejection fraction was lower than normal (P less than 0.05). The ejection fraction was low in five of the 18 patients. Four of the five patients with an ejection fraction below 0.60 had severe pulmonary arterial hypertension. There was no correlation between the ejection fraction and left atrial pressure or the mitral valve area. Segmental contraction analysis in the five patients with a low ejection fraction showed global hypokinesia in four and segmental hypokinesia, involving predominantly the posterobasal segment, in one patient. Our study suggests that even children with pure mitral stenosis may have left ventricular dysfunction in the absence of active carditis.

Adolescent↗
PubMedDate not supplied

[Systolic stress in mitral stenosis].

Left ventricular systolic stress was studied in nineteen patients with mitral stenosis, twelve in sinus rhythm and seven in atrial fibrillation. Left ventricular dimensions and volumes and septal and posterior wall thickness were measured by means of M and two bidimensional echocardiography at rest and during isometric exercise. Expulsive indices: fractional shortening, ejection fraction and mean circumferential shortening rate were calculated. Ventricular mass, meridional stress and several end-systolic stress or pressure/volume relationships were estimated. Patients with atrial fibrillation were older and had systolic dysfunction: greater end-systolic volumes and depression of both expulsive fractions and some of the end-systolic indices. Preload and wall thickness were normal. Patients with atrial fibrillation showed higher ventricular stress as a consequence of greater ventricular dimensions. Ejection fraction correlates directly with mitral valve area and inversely with inotropic state and heart rate. It is concluded that systolic dysfunction in mitral stenosis is multifactorial. The most important determinants of the abnormality are heart rate and inotropic state. The study did not show any primary abnormality of afterload or hypotrophy of the left ventricle.

Adult↗
PubMed1990

Balloon angioplasty for congenital mitral stenosis.

We attempted balloon angioplasty in 9 children (ages 0.1 to 10 years) with congenital mitral stenosis. All were symptomatic with severe congestive heart failure and failure to thrive. Effective reduction in mitral gradient was initially achieved in 7 patients. For the entire group, mean valve gradient decreased from 14.8 +/- 5.0 to 8.1 +/- 6.7 mm (p = 0.0007) and mean valve area increased from 1.1 +/- 0.5 to 1.8 +/- 0.9 cm2/m2 (p = 0.003). More than mild mitral regurgitation developed in 2 patients but none required surgery for mitral regurgitation. Poor gradient relief followed dilation of valves with unbalanced chordal attachments, with restriction to the valve apparatus as in mitral arcade, and where the obstruction was not purely valvar as it is with a supramitral ring. No strokes, infection or deaths were due to the procedure. Based on these data, balloon angioplasty of congenital mitral stenosis should be considered before mitral valve replacement in younger patients and in those in whom mitral valve replacement would be problematic.

Angioplasty, Balloon↗
PubMed1996

[Correlation of selected hemodynamic parameters of pulmonary circulation and indices of pulmonary function in patients with mitral stenosis].

The aim of this study was to test if the lung compliance and other indices of pulmonary function correlated with hemodynamic parameters in patients with secondary pulmonary hypertension due to mitral stenosis. 36 patients (mean age 50 years) with mitral stenosis (mean mitral valve area-1.2 cm2), without history of lung diseases were analyzed in the study. 16 patients (group A) were in the II-nd and 20 patients (group B) were in the III-rd and IV-th NYHA class. All patients underwent Swan-Ganz catheterization with evaluation of pulmonary pressures, resistances and pulmonary veins compliance. Pulmonary function tests (spirometry, plethysomography, lung compliance) were also performed. In both analyzed groups the pulmonary artery pressure and pulmonary vein compliance correlated significantly with pulmonary compliance.

Adult↗
PubMed2006

Giant left atrium with rheumatic mitral stenosis.

A chest radiograph of a 38-year-old woman, who was diagnosed with rheumatic mitral stenosis, revealed cardiac enlargement due to a giant left atrium that was distorting the cardiac structures. The patient's cardiothoracic ratio was approximately 0.90. A giant left atrium can readily be delineated by echocardiography. Optimal timing of surgery is important in cases of mitral stenosis, because delaying mitral valve replacement can lead to fatal outcomes. To our knowledge, the left atrial diameter of 18.7 cm that we found in our patient is the largest reported to date.

Adult↗
PubMed1996

Immediate and long-term effect of mitral balloon valvotomy on left ventricular volume and systolic function in severe mitral stenosis.

To determine the immediate and long-term effect of mitral balloon valvotomy (MBV) on left ventricular (LV) volume and function, we studied 17 patients (mean age 27 +/- 9 years) with severe mitral stenosis undergoing MBV by cardiac catheterization and angiography before and immediately after MBV and at mean 12 months later. At baseline, LV end-diastolic volume index (EDVI) was reduced. Ten patients had EDVI < or = 55 ml/m2, and four patients (23.5%) had LV ejection fraction < 50%. EDVI increased from 60 +/- 17 ml/m2 to 66 +/- 17 ml/m2 (p < 0.05) immediately after MBV and increased further to 72 +/- 16 ml/m2 (p < 0.05) later. Stroke volume index increased from 34 +/- 10 ml/m2 to 41 +/- 12 ml/m2 (p < 0.05) immediately after MBV and increased further to 50 +/- 11 ml/m2 (p < 0.001) later. LV end diastolic pressure increased from 12 +/- 5 mm HG to 16 +/- 4 mm HG (p < 0.05) immediately after MBV and fell to 13 +/- Hg at follow-up. LV ejection fraction increased from 57 +/- 7% to 62 +/- 6% (p < 0.05) immediately after MBV and 71 +/- 8% later (p < 0.001). Mean systolic ejection rate increased from 82 +/- 35 ml/sec to 101 +/- 48 ml/sec (p < 0.05) immediately after and 165 +/- 81 ml/sec later (p < 0.05). Systemic vascular resistance fell from 1887 +/- 525 dyne/sec/cm-5 to 1280 +/- 231 dyne/sec/cm-5 (p < 0.001) at follow-up. We conclude that the LV end-diastolic volume and systolic function are reduced in patients with mitral stenosis, and the LV end-diastolic volume is increased immediately after MBV and continues to increase at follow-up 12 months later; the LV ejection performance improves after successful MBV because of an increase in end-diastolic LV volume (preload) and reduction of SVR.

Adolescent↗
PubMed2005

Left atrial function, cytokines and soluble apoptotic markers in mitral stenosis: effects of valvular replacement.

BACKGROUND: Patients with mitral stenosis (MS) and heart failure (HF) are characterized by changes in the left atrial (LA) function and activation of the apoptotic process. The purpose of the present study was the evaluation of the effect of mitral valve replacement on the LA function, on inflammatory process and apoptotic markers in patients with MS and HF. METHODS: We studied 30 patients with MS and HF (15 in NYHA III-IV and 15 in NYHA IV) in sinus rhythm (mean age 56.2 +/- 4.6 years), and 20 age and gender matched healthy volunteers. Blood samples were obtained before and 6 months after surgical mitral valve replacement, and plasma levels of soluble Fas/APO-1 receptor (sFas), tumor necrosis factor-alpha (TNF-a) and interleukin-6 (IL-6) were measured. Echocardiographically, LA volumes were measured at mitral valve opening (Vmax), at the onset of left atrial systole (P wave of the electrocardiogram, Vp) and at the mitral valve closure (Vmin). LA contractile function was assessed by the LA active emptying fraction (ACTEF). RESULTS: After mitral valve replacement, TNF-a, IL-6 and sFas levels, as well as the Vmax LA volume, were significantly reduced (p < 0.05). ACTEF showed a significant postoperative decrease (0.29 +/- 0.09 vs. 0.23 +/- 0.06, p < 0.01) and it was significantly correlated with sFas (r = -0.88, p = 0.001), TNF-a (r = -0.81, p = 0.001) and IL-6 (r = -0.74, p = 0.001) levels. CONCLUSION: The present findings indicate that mitral valve replacement in patients with mitral valve stenosis, reduces the size of the left atrium, improves left atrial contractile function and depresses inflammatory and apoptotic process.

Adult↗
PubMed1999

Immediate and delayed effects of successful percutaneous transvenous mitral commissurotomy on global right ventricular function in patients with isolated mitral stenosis.

Global right ventricular function of the pressure-overloaded right ventricle in patients with mitral stenosis and pulmonary hypertension after successful percutaneous transvenous mitral commissurotomy (PTMC) has not been well-defined. With the use of a recently developed Doppler method for estimating right ventricular function in human beings, we studied 25 consecutive patients with isolated rheumatic mitral stenosis before, immediately after (mean, 40+/-12 h) and at a mean follow-up of 11.5 months after PTMC. Immediately after percutaneous mitral commissurotomy, there was a significant increase in mitral valve area (P = 0.000017) along with a decrease in mean pulmonary pressure (P = 0.001). The index was not affected immediately after successful PTMC (0.70+/-0.25 vs., 0.58+/-0.18; P = 0.06); however, at follow-up of about one year, the index showed a significant decrease (0.697+/-0.28 vs. 0.380+/-0.13; P = 0.0008, n = 24). The change in the index was characterised by a significant prolongation of the right ventricular ejection time, with a decrease in the isovolumic intervals. The Doppler index of combined right ventricular function was significantly correlated to the mean pulmonary artery pressure (r = 0.695, P<0.001) and systolic pulmonary artery pressure (r = 0.60, P = 0.007) before PTMC and also immediately after the procedure; however, at follow-up, the index had no correlation with the Doppler estimated pulmonary artery systolic pressure (r = 0.07). Despite a larger mitral valve area following PTMC, right ventricular isovolumic indices remain abnormal on mid-term follow-up, although global function tends to normalise in two-thirds of the patients.

Adult↗
PubMed1992

Two-dimensional and Doppler echocardiographic determinants of the natural history of mitral valve narrowing in patients with rheumatic mitral stenosis: implications for follow-up.

Fifty patients with rheumatic mitral stenosis were studied with serial two-dimensional and Doppler echocardiography to determine the natural history of changes in mitral valve area and its relation to transmitral gradients and mitral valve morphology. Over the 39-month observation period (range 7 to 74 months) the decline in valve area was 0.09 +/- 0.21 cm2/year. In addition, there were significant increases in total echocardiographic score (p = 0.0001), severity of mitral anulus calcification (p = 0.05) and severity of mitral regurgitation (p = 0.0007). Patients with an echocardiographic score greater than or equal to 8 had a more progressive course. In addition, patients with a more progressive course (decline in valve area greater than or equal to 0.1 cm2/year) had a significantly greater initial mean gradient (p = 0.01), peak gradient (p = 0.007) and total echocardiographic score (p = 0.0008). Initial valve area did not correlate with the rate of stenosis progression. Of 22 patients with an echocardiographic score less than 8 and a peak mitral gradient less than 10 mm Hg, only 1 patient (5%) had a more progressive course, compared with 80% of those with a total echocardiographic score greater than or equal to 8 and a gradient greater than or equal to 10 mm Hg. The rate of mitral valve narrowing in individual patients with rheumatic mitral stenosis is variable. Patients whose valve disease progresses rapidly are those with a greater mitral valve echocardiographic score and higher peak and mean transmitral gradients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Emergent percutaneous mitral valve repair with Inoue balloon-catheter in severe mitral stenosis and cardiogenic shock].

A 30-year-old woman with severe mitral stenosis was admitted to hospital in cardiogenic shock (tachycardia, hypotension, low cardiac output) requiring artificial ventilation. As the cardiovascular state failed to respond to drug treatment, percutaneous mitral valvoplasty (MVP) was performed as an emergency with the Inoue balloon catheter. This brought about immediate improvement in the clinical and haemodynamic condition. As later seen at open-heart surgery, the MVP had produced a tear in the anterior mitral leaflet with considerable regurgitation. Mitral valve replacement was performed as an elective procedure 4 weeks after the MVP, at a time when the patient was mobile. MVP with the Inoue catheter system can achieve a stable clinical and haemodynamic state when there is cardiogenic shock due to severe mitral stenosis and conservative measures have failed.

Adult↗
PubMed1999

[Predictive factors of atrial fibrillation in mitral stenosis. Clinical and echocardiographic study].

The objective of this study was to define the predictive factors of atrial fibrillation in pure or very predominant mitral stenosis in a series of 472 consecutive patients divided into 2 groups according to the presence (group I: n = 113) or absence (group II: n = 359) of permanent atrial fibrillation. Univariate analysis showed that predictive factors for atrial fibrillation in mitral stenosis are age (40.3 +/- 9 years vs 31.4 +/- 9.5, p < 0.0001), history of commissurotomy or mitral angioplasty (13 cases vs 10, p < 0.01), functional class III or IV (36 cases vs 43, p < 0.01), history of valvular heart disease (8.4 +/- 7.3 years vs 6.4 +/- 9.2, p < 0.05), left atrial diameter (53.3 +/- 10.3 mm vs 46.5 +/- 8.5, p < 0.0001) and mitral surface area (1.1 +/- 0.4 cm2 vs 1.3 +/- 0.4, p < 0.0001). On multivariate analysis, age and left atrial dilatation were independent predictive factors of atrial fibrillation in mitral stenosis.

Adult↗
PubMed1993

Rapid increase in plasma endothelin concentrations during percutaneous balloon dilatation of the mitral valve in patients with mitral stenosis.

OBJECTIVE: To investigate the relation between plasma concentrations of immunoreactive endothelin and haemodynamic variables before and after percutaneous transvenous balloon dilatation of the mitral valve. DESIGN: Prospective study. SETTING: National cardiovascular centre. PATIENTS: 25 patients with mitral stenosis and 26 healthy volunteers. MAIN OUTCOME MEASURES: Plasma concentrations of immunoreactive endothelin were measured in the pulmonary artery, left atrium, ascending aorta, and femoral vein before and after balloon dilatation of the mitral valve. RESULTS: Peripheral venous concentrations (mean (SD)) of endothelin were higher in the patients with mitral stenosis than in the healthy volunteers (1.76 (0.51) v 1.37 (0.45) pg/ml, p < 0.05) and they correlated with the mean left atrial pressure (r = 0.74, p < 0.01). Balloon dilatation of the mitral valve reduced the mean left atrial pressure without changing the mean right atrial pressure, systemic arterial pressure, heart rate, or cardiac index. Concentrations of plasma endothelin in the femoral vein increased from 1.76 (0.51) to 3.39 (2.46) (p < 0.01), 4.82 (2.34) (p < 0.001), and 2.43 (0.52) pg/ml (p < 0.05) at 15 and 30 minutes and 24 hours after the procedure. The concentration of endothelin in the pulmonary artery also increased from 1.85 (0.85) to 4.32 (1.58) pg/ml (p < 0.01) 30 minutes after the dilatation, whereas there were no appreciable changes in endothelin concentration in the left atrium or ascending aorta. CONCLUSIONS: Plasma endothelin concentrations were higher in patients with mitral stenosis than in healthy volunteers and the increase was proportional to left atrial pressure. After balloon dilatation of the mitral valve there was an abrupt rise in endothelin in the femoral vein and pulmonary artery but no change in left atrial or aortic blood samples. These findings suggest that endothelin may be another vasoactive substance involved in congestive heart failure.

Adult↗