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At least 631 records · Page 35Linked to original sources
PubMed1990

[Genesis and clinical significance of an apical diastolic rumble in patients with mitral Björk-Shiley valve: a Doppler echocardiographic study].

The genesis and clinical significance of an apical diastolic rumble after replacement with mitral Björk-Shiley prosthesis were studied in 20 patients by left ventricular (LV) inflow dynamics using Doppler echocardiography. 1. The rumble was audible in 17 of the 20 patients (85%). In all but one patient, its intensity was less than Levine 2/6. Duration of the rumble ranged from 248 to 544 (mean 377) msec. There was no case of prosthetic valve dysfunction. Duration of the slow filling wave (SF interval) of the apexcardiogram in 19 cases ranged from 150 to 541 (mean 317) msec, and it correlated significantly with the duration of the rumble (r = 0.95) in 15 cases. 2. In 20 patients, peak velocity of the LV inflow obtained from continuous wave Doppler echocardiograms ranged from 1.17 to 1.89 (mean 1.56) m/sec, and pressure half time (PHT) ranged from 82 to 233 (mean 134) msec. In 19 patients, the SF interval correlated significantly with PHT (r = 0.87), but not with peak inflow velocity. 3. Peak inflow velocity was significantly slower in cases without a rumble than in cases with a rumble. PHT and the SF interval tended to be shorter in the former than in the latter. 4. There was no significant difference in the SF interval, peak inflow velocity and PHT between eight patients with smaller valve sizes (less than or equal to 25 mm) and 12 with larger valve sizes (greater than or equal to 27 mm). 5. There was no obvious relation between the direction of the main LV inflow jet as assessed by Doppler color flow mapping and the presence of the rumble in 19 patients. 6. In 19 patients, the SF interval correlated significantly with left atrial dimension (r = 0.47), but it did not correlate with LV end-diastolic dimension, fractional shortening of the LV, and the peak lengthening rate of LV internal dimension. 7. Three patients with both the rumble and SF lasting 500 msec had prolonged PHT longer than 190 msec. One of these three had congestive heart failure and suspected prosthetic mitral valve stenosis. From these results, we concluded that an apical diastolic rumble after replacement with mitral Björk-Shiley valve is mainly due to the increase in resistance and velocity of the LV inflow, and that both durations of the rumble and the SF intervals as well as PHT of the Doppler echocardiogram are useful in detecting stenosis of prosthetic mitral valves.

Adult↗
PubMed1999

Balloon mitral valvuloplasty: comparison of haemodynamic and echocardiographic assessment of mitral stenosis at different heart rates in the catheterisation laboratory.

AIMS: To compare echo-Doppler, Gorlin equation and haemodynamic methods of measuring mitral valve stenosis during right ventricular pacing-induced tachycardia before and after Inoue balloon mitral valvuloplasty to determine which method gave the most consistent results. METHODS AND RESULTS: Measurements were made before and after valvuloplasty at: baseline heart rates, paced at 115 and then 145 beats/min. Mitral valve area by echo-Doppler was 1.1(+/-0.1) cm2 (mean +/- S.E.) before and 1.8(+/-0.2) cm2 after valvuloplasty; and by Gorlin equation: 0.9(+/-0.1) cm2 before and 1.5(+/-0.1) cm2 after. Echo-Doppler measurements were heart rate dependent but those by Gorlin measurements were not. At baseline, cardiac index was 2.08(+/-0.2) l min(-1), left atrial pressure 23.3(+/-7.9) mm Hg and mean mitral diastolic gradient 16.9(+/-9.9) mm Hg. After valvuloplasty, cardiac index was 2.31(+/-0.1) l min(-1), left atrial pressure fell to 19.2(+/-5.6) mm Hg and mean diastolic gradient was reduced to 8.5(+/-1.8) mm Hg. CONCLUSIONS: The Gorlin mitral valve area appeared to be the most heart rate independent indicator of success following valvuloplasty.

Aged↗
PubMed1999

Maze procedure and homograft replacement of a rheumatic mitral valve.

A 64-year-old woman presented with congestive heart failure due to severe mitral valve stenosis and chronic atrial fibrillation. A Maze III procedure was performed, and the mitral valve replaced with a mitral homograft. Postoperatively, the patient regained normal sinus rhythm, had trivial mitral regurgitation, regained her atrial transport function, and had improved myocardial function.

Atrial Fibrillation↗
PubMed1994

[Balloon dilatation of the mitral valve in a pregnant patient. A case report].

During the 17th week of gestation a 26-year-old female suffered pulmonary edema following appendectomy. Subsequently, the diagnosis of mitral stenosis was established. Balloon mitral valvotomy was performed in order to reduce the perinatal risk. During the procedure radiation exposure was minimized by means of total abdominal and pelvic shielding and transthoracic echocardiography was used for monitoring. Mitral valve area was increased from 1.4 to 2.1 cm2 without complications and the further course of pregnancy and delivery were uneventful. Balloon mitral valvotomy should be considered as a therapeutic alternative in pregnant women with symptomatic pliable mitral valve stenosis.

Adult↗
PubMed1995

Results of percutaneous double-balloon mitral commissurotomy in one medical center in Tunisia.

Percutaneous balloon mitral commissurotomy was attempted in Tunisia, where rheumatic fever is still endemic, in 463 consecutive patients with severe rheumatic mitral valve stenosis. Their mean age +/- SD was 33 +/- 12 years (range 8 to 68), 324 patients (70%) were women, and 327 (71%) were in sinus rhythm. Valvotomy was technically successful in 454 patients (98%). The mean mitral valve gradient decreased from 20 +/- 7 to 6 +/- 4 mm Hg, mean left atrial pressure decreased from 27 +/- 8 to 15 +/- 6 mm Hg, cardiac index increased from 3.0 +/- 0.7 to 3.6 +/- 0.8 L/min/m2, and Gorlin mitral valve area, from 0.97 +/- 0.19 to 2.2 +/- 0.4 cm2 (all p < 0.001). Two-dimensional echocardiographic mitral valve area increased from 1.03 +/- 0.18 to 2.15 +/- 0.36 cm2 (p < 0.00001). A final valve area of > or = 1.5 cm2 was achieved in 98% of patients. Multivariate analysis identified a pre-mitral valve area < 0.8 cm2 and an echocardiographic score (echo score) > or = 12 as the strongest predictors of residual stenosis (final mitral valve area < 1.5 cm2). Major procedural complications included mortality (0.4%), tamponade (0.7%), thromboembolism (2.0%), severe mitral regurgitation (4.6%), significant (pulmonary to systemic flow ratio > or = 1.5) interatrial shunt (4.8%). Four hundred thirty patients were followed up between 6 and 82 months (mean 37 +/- 22): 95% were in functional class I to II without reintervention, and 7 patients died (1.6%); restenosis (echocardiographic mitral valve area < 1.5 cm2) occurred in 10.4% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Reconstructive procedures in heart valve disease.

The percentage of patients who undergo valve repair has increased considerably during the past decade. Valve repair is particularly important in patients with atrioventricular valve disease since it provides better results than replacement. Aortic valve repair is presently performed only in selected patients with aortic stenosis and insufficiency. There is a renewed interest in aortic valve debridement in patients with calcific aortic stenosis. Mitral valve repair can be performed in most patients with mitral insufficiency and in many with mitral stenosis. The surgical techniques for mitral valve repair are well established and are reproducible. The tricuspid valve is almost always reparable in patients with tricuspid disease associated with mitral valve disease.

Aortic Valve↗
PubMed1992

Evaluation of mitral stenosis by cine magnetic resonance imaging.

To evaluate the ability of cine magnetic resonance imaging (cine MRI) in the assessment of mitral stenosis (MS), we studied 20 patients (14 women and 6 men, mean age 60.6 +/- 8.5 years) with rheumatic mitral valve stenosis by using an 0.5 T magnet. Cine MRI showed several signs of MS. Mitral leaflet thickening, reduced diastolic opening, and abnormal valve motion toward the left ventricular outflow tract were all common features. MS was also characterized by an abnormal diastolic transmitral signal from blood. Both left atrial and left ventricular dimensions were similar to those obtained at two-dimensional echocardiography (2-DE) (r = 0.89 and r = 0.86, respectively; p less than 0.001). A significant relationship was also found between the maximum mitral leaflet separation measured by cine MRI in diastole and the mitral valve area as calculated using the pressure half-time method and continuous wave Doppler (r = 0.81; p less than 0.001). These data indicate the improved ability of MRI to detect and assess MS and also suggest that this technique may contribute to the noninvasive assessment of MS.

Aged↗
PubMed1999

Papillary fibroelastoma of the mitral valve 12 years after mitral valve commissurotomy.

A 63 year-old woman who had had mitral valve commissurotomy 12 years earlier was seen because of rheumatic mitral stenosis and left brachial paresis due to cerebral embolism. On clinical evaluation, a diastolic rumble was heard over the mitral area, and the echocardiogram revealed a mass attached to the mitral subvalvular apparatus. The patient was operated on, and both the surgical and histologic findings depicted papillary fibroelastoma. This tumor may occur as an isolated lesion or be associated with mitral valve stenosis or other cardiac abnormalities, and it is an important source of emboli. Early echocardiographic diagnosis, followed by surgical excision, may avoid serious complications such as stroke, myocardial infarction, and sudden death.

Atrial Fibrillation↗
PubMed2000

Mitral valve plasty in systemic lupus erythematosus in the setting of antiphospholipid syndrome.

The first case was of a 27-year-old female, who was diagnosed as having mitral valve stenosis with regurgitation, systemic lupus erythematosus and antiphospholipid syndrome at her previous pregnancy. We performed mitral valve plasty, which included open mitral commissurotomy and Kay's annulo plasty. The second case was of a 53-year-old female, who was diagnosed as old myocardial infarction, mitral regurgitation, systemic lupus erythematosus and antiphospholipid syndrome. She underwent mitral valve plasty and coronary artery bypass grafting. Both cases were treated by administration of methylpredonisolone and heparin perioperatively to avoid thrombosis and aggravation of systemic lupus erythematosus. Both patients showed good postoperative outcome without complications. We consider that it is important to perform the plasty as far as possible, and to administer effective anticoagulation treatment to prevent complications for patients in the setting of systemic lupus erythematosus and antiphospholipid syndrome.

Adult↗
PubMed1995

Study on three dimensional reconstruction of transesophageal echocardiographic images.

Using biplane transesophageal echocardiography and the concept of three dimensional transthoracic echocardiography, we performed three dimensional reconstruction of transesophageal images of various clinicopathologic cases, including atrial septal defect, mitral stenosis, mitral valve prolapse and pulmonary stenosis. The hardware equipment and image processing flow chart of three dimensional reconstruction of transesophageal echocardiographic images are described. Our present study indicates that three dimensional reconstruction of transesophageal echocardiographic images could display multi-regional three dimensional structures of heart and great vessels, including superior vena cava, ascending aorta, right ventricular outflow tract, pulmonary artery and left heart, with clear, visual and stereoscopic imaging. The regional structures could be displayed at different levels of stereo-anatomic-sections and in different orientations of rotating stereo-images, which could provide accurate three dimensional anatomical information for cardiac stereo-morphological study and definition of spatial location and size of cardiac abnormalities.

Adolescent↗
PubMed1990

Practical value of echo Doppler evaluation of aortic and mitral stenosis: a comparative study with cardiac catheterization.

This retrospective analysis compares data derived by echocardiography and cardiac catheterization in the evaluation of aortic and mitral valve stenosis. Sixty-seven patients, aged 69 +/- 12 years, underwent 76 catheterization procedures. In all studies the Doppler recording was technically adequate. In 64 studies of patients with aortic stenosis, correlation was good between the gradient obtained at catheterization (peak 51 +/- 28 mm Hg, mean 48 +/- 24 mm Hg) and the Doppler gradient (peak 73 +/- 29 mm Hg, mean 41 +/- 17 mm Hg) (R = 0.78 peak, 0.77 mean). In 15 studies the aortic valve area, 0.8 +/- 0.2 cm2, calculated by the simplified continuity equation, correlated well with the catheterization valve area, 0.7 +/- 0.3 cm2, calculated by the Gorlin equation (R = 0.80). In 14 studies in mitral stenosis patients, the mean gradient at catheterization was 11 +/- 5 mm Hg compared to the Doppler gradient of 8 +/- 4 mm Hg (R = 0.58). The mitral valve area was 1.1 +/- 0.3 cm2 by the Gorlin equation and 1.2 +/- 0.3 cm2 by echo Doppler, using pressure half-time. When cardiac rhythm, the presence and severity of regurgitation, and the cardiac index were analyzed, none was shown to have demonstrable influence on the accuracy of the Doppler study. Doppler echocardiography can be used reliably to assess valvular stenosis in a clinical, noninvasive laboratory where routine tests are performed and interpreted by more than one individual.

Aged↗
PubMedDate not supplied

Encircling isolation of pulmonary vein orifice for elimination of persistent atrial fibrillation associated with mitral valve disease.

The authors treated a 70-year-old woman with persistent atrial fibrillation associated with mitral valve stenosis. Restoration of sinus rhythm was achieved with encircling isolation of pulmonary vein orifices concomitant with mitral valve replacement. A vertical incision in the right side of left atrium was extended to the margin of the upper and lower left pulmonary vein orifices. Supplemental cryo-coagulation was applied to the remnant of the circular incision, avoiding the entire encircling incision. Consequently, all pulmonary veins were electrically isolated. Encircling pulmonary vein orifice isolation is less invasive than the MAZE procedure because of reductions in surgical time and cardiopulmonary bypass time, minimization of atrial incisions, and prevention of injury to the coronary artery. It is thus an effective option for selected patients with atrial fibrillation.

Aged↗