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PubMedDate not supplied

[Study of left ventricular mass in pure mitral stenosis].

We studied 19 patients (13 women and 6 men), with pure mitral stenosis by cineangiocardiograms taken in the right anterior 30 degrees oblique projection. Seven patients were also studied by single element M mode echocardiography in monoplane projection. We observed a significative diminution in the wall thickness and mass of the left ventricle in those patients in which the mitral valvular area was less than 1 cm2/m2. These results were interpreted as due to a global diminution in the cardiac mass induced by a reduction in the wall thickness of the left ventricle in all segments. When the patients with diminished mass were grouped by age, no correlation between chronicity and diminished mass was observed. We concluded that the diminution of the left ventricular mass in pure, severe mitral stenosis has a multifactorial etiology; the prolonged immobility of some myocardial segments could play a role, but the fibrosis secondary to acute or chronic myocarditis could be more important.

Adolescent↗
PubMed2004

The transesophageal echocardiographic diagnosis of left atrial myxoma simulating a left atrial thrombus in the setting of mitral stenosis.

We report the case of a 56-year-old woman with a history of rheumatic heart disease. The clinical, electrocardiographic, and radiologic findings suggested mitral stenosis. Left atrial obstructive myxoma simulating a thrombus was found by transthoracic echocardiography (TTE). The diagnosis was established by use of transesophageal echocardiography (TEE), confirmed after surgery and by anatomical investigation. Cardiac myxoma associated with mitral stenosis may be difficult to diagnose accurately using TTE. The advantage of TEE in this case and in patients with mitral stenosis is emphasized.

Diagnosis, Differential↗
PubMed1951

The surgical treatment of mitral stenosis.

A surgical procedure known as commissurotomy, devised by Bailey for the relief of certain cases of mitral stenosis, gives promise of considerable benefit to a large number of patients who have the disease. The technique of the operation involves the introduction of the right index finger and an especially designed valvulotome through the left auricular appendage into the left auricle. The mitral valve commissures are then divided. Twentyfive cases of mitral stenosis in which this operation was performed are discussed.

Cardiac Surgical Procedures↗
PubMedDate not supplied

Time interval determination from left atrial appendage ejection flow in patients with mitral stenosis.

The feasibility of determining the time interval from left atrial appendage (LAA) flow was examined using transesophageal Doppler echocardiography. Time intervals were compared between LAA flow and mitral flow patterns during late diastole in 8 patients with mitral stenosis and in 12 controls. The start of ejection flow from the LAA was later than the initiation of mitral flow, but the termination was same in both flows, indicating the contribution of LAA ejection to the latter half of the left atrial booster pump function. The pre-ejection time and the time interval from P-wave to end-ejection correlated significantly with left atrial dimensions (r = 0.55, and r = 0.70, respectively). The pre-ejection time, duration of the ejection flow from the LAA, and duration of mitral flow in the atrial contraction phase were significantly longer in patients with mitral stenosis (126 +/- 14 msec, 131 +/- 36 msec, and 167 +/- 28 msec, respectively) than in the controls (109 +/- 13 msec, 108 +/- 15 msec, and 141 +/- 17 msec, respectively). These results indicate that electrical conduction time from the right atrium to LAA can be estimated from the LAA ejection flow, and the time is related to the left atrial size. In patients with mitral stenosis, LAA contraction may contribute to left ventricular filling in the latter half of the atrial contraction phase.

Blood Flow Velocity↗
PubMed1970

Regional pulmonary function in patients with mitral stenosis in relation to haemodynamic data.

Central haemodynamics in 23 patients with mitral stenosis and 7 control subjects were compared with the results of regional lung perfusion studied by (133)Xe, pulmonary scintigraphy with (99)mTc-labelled macro-aggregates of albumin, and regional ventilation by (133)Xe.A close correlation was found between both methods assessing regional pulmonary perfusion, i.e. pulmonary scintigraphy and (133)Xe. The results show that lower lung zones, when compared with upper zones, have both worse perfusion and worse ventilation. The changed distribution of perfusion and the changed distribution of ventilation correlated significantly with central haemodynamics in these patients. The ventilation gradient can be a valuable diagnostic tool for evaluating the severity of mitral stenosis, especially in long and repeated studies, due to its simplicity for the patient.

Adult↗
PubMed1976

Coronary atherosclerosis in subjects with mitral stenosis.

The coronary arteries were examined in 60 specimens from patients with mitral stenosis. In three, localized obstruction was nonatherosclerotic in nature (in one, arterial dysplasia; in two, embolic). In 18 of the remaining 57 cases (31.5%), significantly obstructive atherosclerosis in one or more segments of the coronary arterial system was found. This represented 46% of the males and 27% of the females. The incidence of involvement of three or more arteries by significantly obstructive atherosclerosis was 39%, while in a cited series of subjects with angina pectoris three or more vessels were involved in 79% of the cases. It may be concluded that, on the average, the distribution of lesions in patients with mitral stenosis and significant coronary atherosclerosis is less wide than in subjects with clinical coronary disease.

Age Factors↗
PubMed1996

Effects of increasing flow rate on aortic stenotic indices: evidence from percutaneous transvenous balloon dilatation of the mitral valve in patients with combined aortic and mitral stenosis.

OBJECTIVES: To investigate the effects of transvalvar flow rate on aortic valve resistance and valve area after percutaneous transvenous balloon dilatation of the mitral valve in a homogeneous group of patients with rheumatic heart disease. DESIGN: Retrospective analysis of 12 patients with combined aortic and mitral stenosis who had undergone balloon dilatation of the mitral valve over a period of 9 years. SETTING: Tertiary referral centre. PATIENTS: Twelve (8 women, 4 men; mean (SD) age 37 (9) of 227 consecutive patients with critical mitral stenosis undergoing transvenous balloon dilation of the mitral valve in the centre also had aortic stenosis, defined as a transaortic pressure gradient of more than 25 mm Hg measured at a catheterisation study before valvuloplasty. INTERVENTIONS: Echocardiographic variables (mitral valve area measured by the pressure half-time method and planimetry, and the aortic valve area derived from the continuity equation) and haemodynamic measurements (cardiac output, left ventricular mean systolic pressure, aortic mean pressure, transaortic valve pressure gradient, mitral valve and aortic valve areas derived from the Gorlin formula, and aortic valve resistance) were assessed before and after transvenous balloon dilatation of the mitral valve. Follow up catheterisation to measure haemodynamic variables was performed one week after mitral valvuloplasty. RESULTS: Mean transaortic flow rate increased 33% after mitral valvuloplasty (from 198 (68) to 254 (41) ml/s, P = 0.002). Aortic valve areas derived from the Gorlin formula were significantly increased from 0.57 (0.12) to 0.73 (0.14) cm2 (P = 0.006) after mitral valvuloplasty. However, aortic valve area and valve resistance derived from the continuity equation were independent of the increase in flow rate after mitral valvuloplasty (from 1.29 (0.35) to 1.30 (0.29) cm2 and from 317 (65) to 259 (75) dyn.s.cm-5, both P = NS). CONCLUSION: The Gorlin-derived aortic valve area tends to be flow-dependent, and continuity equation-derived aortic valve area and catheterisation-derived valve resistance seem to be less flow-dependent. In patients with combined mitral and aortic stenosis, these flow-independent indices are important for decision-making.

Adult↗
PubMedDate not supplied

[Catheter balloon valvuloplasty: new possibilities in the surgical treatment of mitral stenosis].

A total of 170 catheter balloon valvuloplastic (CBV) operations for rheumatic mitral stenosis were carried out in patients aged 19 to 68, 30 of these in pregnant women, at A. V. Vishnevsky Institute of Surgery, Russian Academi of Medical Scients, from 1988 to 1994. Characteristic features of such operations are a minor surgical trauma and no necessity in deep narcosis and artificial circulation. Analysis of the immediate results and of the data of five-year follow-up brings the authors to a conclusion about the efficacy of the new method of treatment of this heart disease and about the physiological nature of forming an adequate route of blood flow into the right ventricle with a balloon. Comparing various balloon catheters for valvuloplasty and methods to carry out this procedure, the authors emphasize the advantages of the instruments and method developed by professor V. A. Silin et al. (St. Petersburg). The possibility of correction of mitral stenosis by CBV in pregnant women appears to be particularly important. Retrospective analysis of the immediate results and follow-up data helped the authors not only formulate the indications for this intervention, but permitted them to develop an original system of comprehensive clinical and instrumental assessment of the degree of involvement of the mitral valve and subvalvular structures, and of hemodynamic disorders.

Adult↗
PubMed2006

Which method should be the reference method to evaluate the severity of rheumatic mitral stenosis? Gorlin's method versus 3D-echo.

INTRODUCTION: Several studies have shown a wide variability among different methods to determine the valve area in patients with rheumatic mitral stenosis. Our aim was to evaluate if 3D-echo planimetry is more accurate than the Gorlin method to measure the valve area. METHODS: Twenty-six patients with mitral stenosis underwent 2D and 3D-echo echocardiographic examinations and catheterization. Valve area was estimated by different methods. A median value of the mitral valve area, obtained from the measurements of three classical non-invasive methods (2D planimetry, pressure half-time and PISA method), was used as the reference method and it was compared with 3D-echo planimetry and Gorlin's method. RESULTS: Our results showed that the accuracy of 3D-echo planimetry is superior to the accuracy of the Gorlin method for the assessment of mitral valve area. CONCLUSIONS: We should keep in mind the fact that 3D-echo planimetry may be a better reference method than the Gorlin method to assess the severity of rheumatic mitral stenosis.

Adult↗
PubMed1994

Factors affecting the postoperative exercise capacity of patients with mitral stenosis and aortic regurgitation.

Factors affecting the exercise capacity of patients with mitral stenosis (MS) and aortic regurgitation (AR) are incompletely understood. Accordingly, exercise capacity was assessed in 13 patients with MS and in 13 with AR by means of cardiopulmonary exercise testing before as well as 3, 6 and 12 months after valve replacement. Left- and right-ventricular function were evaluated echocardiographically. Both in MS and in AR exercise capacity expressed by maximal oxygen consumption (VO2max) increased significantly after valve replacement and was directly related to right ventricular (RV) function assessed by the ratio of RV acceleration time to RV ejection time (r = 0.87, p < 0.001 and r = 0.74, p < 0.001, respectively) and inversely related to left atrial diameter (r = -0.72, p < 0.001 and r = -0.76, p < 0.001, respectively). No relation between VO2max and resting left-ventricular function was found. Thus, the postoperative improvement in the exercise capacity both in mitral stenosis and in aortic regurgitation is associated with an improvement in right-ventricular function and a decrease in left-atrial size.

Aortic Valve Insufficiency↗
PubMed1991

Dextrocardia, situs inversus and severe mitral stenosis in a pregnant woman: successful closed commissurotomy.

A 16-weeks' pregnant woman with situs inversus and dextrocardia underwent successful closed commissurotomy for severe mitral stenosis. The electrocardiogram revealed sinus rhythm with right axis deviation and progressive diminishing of QRS amplitude towards the left precordial leads. The chest X-ray showed dextrocardia with situs inversus. Doppler echocardiography depicted severe mitral stenosis; the mitral valve area increased from 0.9 cm2 pre-operatively to 1.8 cm2 post-operatively with mild increase of mitral regurgitation from grade I to II post-valvotomy. She also had associated mild functional tricuspid insufficiency and moderate pulmonary hypertension. No thrombo-embolic complications occurred intra- or post-operatively. There was no evidence of either clinical or Doppler restenosis. The course of pregnancy was uneventful. At 39 weeks a healthy baby was vaginally delivered. The patient is still free of cardiac symptoms.

Adult↗
PubMed2001

The active molecular form of plasma adrenomedullin is extracted in the pulmonary circulation in patients with mitral stenosis: possible role of adrenomedullin in pulmonary hypertension.

Adrenomedullin (AM), a novel hypotensive peptide, preferentially dilates pulmonary vessels rather than systemic vessels. This suggests the possibility that AM is a circulating hormone which participates in regulation of the pulmonary circulation. A recent study revealed that two molecular forms of AM, i.e. a mature, active form of AM (AM-m) and an intermediate, inactive, glycine-extended form of AM (AM-Gly), circulate in human plasma. In the present study we investigated the production and clearance sites and pathophysiological significance of the two molecular forms of AM in the pulmonary circulation in patients with mitral stenosis. We measured the plasma levels of AM-m and total AM (AM-T; AM-m+AM-Gly) using a recently developed specific immunoradiometric assay, and thus calculated plasma AM-Gly levels, in blood samples obtained from the femoral vein, pulmonary artery, left atrium and aorta of 28 consecutive patients with mitral stenosis (20 females and eight males; age 53+/-10 years). Patients with mitral stenosis had significantly higher venous concentrations of AM-T, AM-Gly and AM-m than age-matched normal controls (AM-T, 15.9+/-2.5 and 10.6+/-2.1 pmol/l respectively; AM-Gly, 14.0+/-2.1 and 9.8+/-1.9 pmol/l respectively; AM-m, 1.9+/-0.6 and 1.1+/-0.3 pmol/l respectively; each P<0.001). There was a significant decrease in the concentrations of AM-m and AM-T between the pulmonary artery and the left atrium (AM-T, 16.1+/-2.7 and 14.0+/-2.4 pmol/l respectively; AM-m, 2.0+/-0.6 and 0.7+/-0.2 pmol/l respectively; each P<0.001); however, there were no differences in plasma AM-Gly levels between the pulmonary artery and the left atrium (14.1+/-2.3 and 13.5+/-2.3 pmol/l respectively). The venous concentrations of AM-m, AM-Gly and AM-T showed similar correlations with mean pulmonary artery pressure (AM-T, r=0.67; AM-Gly, r=0.63; AM-m, r=0.59; each P<0.001) and total pulmonary vascular resistance (AM-T, r=0.77; AM-Gly, r=0.70; AM-m, r=0.75; each P<0.001). These results suggest that the plasma concentration of AM-m is increased in parallel with those of AM-Gly and AM-T, and that the main site for clearance of AM-m from the plasma is the lung; the extracted AM-m in the lungs may help to attenuate the increased pulmonary arterial resistance in secondary pulmonary hypertension due to mitral stenosis.

Adrenomedullin↗
PubMed1999

Reversal of increased diastolic stiffness in mitral stenosis after successful balloon valvuloplasty.

BACKGROUND AND AIM OF THE STUDY: Abnormal passive elastic properties have been reported in patients with severe mitral stenosis and have been attributed to either: (i) chamber atrophy due to unloading; (ii) myocardial fibrosis; (iii) right and left ventricular (LV) interaction; or (iv) internal restrictions due to the rigid mitral valve apparatus. The study aim was to evaluate the effect of percutaneous mitral balloon valvuloplasty (PMV) on passive elastic properties in 19 patients with severe mitral stenosis. Ten patients with normal coronary arteries and LV function served as controls. METHODS: LV high-fidelity pressure measurements and simultaneous biplane LV angiograms were obtained before and after PMV (n = 11). The constant of chamber stiffness (b; ml(-1)) was calculated from the diastolic pressure-volume relationship and the constant of myocardial stiffness (beta) from the diastolic stress-strain relationship. The time constant of relaxation (T; ms) was calculated from the LV pressure decay during isovolumic relaxation. Regional ejection fraction (radial axis system) was determined in six regions of the right anterior oblique (RAO) and left anterior oblique (LAO) angiographic projections. RESULTS: Mitral valve area was increased from 1.0 to 2.2 cm2 after PMV, whereas diastolic pressure gradient was reduced from 14 to 4 mmHg. Global LV ejection fraction (EF) was slightly reduced (57% versus 63%; p<0.05) before valvuloplasty and normalized thereafter. Regional EF increased significantly (p<0.05) in the posterolateral region of the LAO projection after intervention. Myocardial stiffness was increased before, and decreased significantly after balloon valvuloplasty (from 16 to 11; p<0.05). The rate of relaxation and chamber stiffness remained unchanged. CONCLUSIONS: Myocardial stiffness is increased in patients with mitral stenosis, but normalized after successful PMV. The improvement in passive elastic properties after valvuloplasty can be explained by the mobilization of the subvalvular apparatus with an improvement in regional LV function.

Adult↗
PubMed1990

Risk for systemic embolization of atrial fibrillation without mitral stenosis.

The risk for systemic embolization was studied in 272 patients without mitral stenosis or prosthetic valves who were referred to the echocardiography laboratory with atrial fibrillation (AF). During a mean follow-up period of 33 months (range less than 1 to 83), 27 (10%) patients had a systemic embolic event, which was cerebral in 23 patients (85%) and peripheral in 4 (15%). In the analysis of individual variables, the risk of embolization was increased by female sex, underlying heart disease and left atrial size greater than or equal to 4.0 cm, but not by age, hypertension or type of AF (paroxysmal vs chronic). In multivariable analysis, left atrial size greater than or equal to 4.0 cm was the single strongest predictor of increased risk for embolization (p less than 0.001), but female sex (p = 0.014) and underlying heart disease (p = 0.027) also contributed. When each of these 3 factors was assigned 1 point in a risk score, embolic events were found to occur in none (0%) of 24 patients with a risk score of 0, in 2 (3%) of 83 patients with a risk score of 1, in 13 (11%) of 118 patients with a risk score of 2 and in 12 (26%) of 47 patients with a risk score of 3. The score allows patients with AF and without mitral stenosis to be stratified into high-, medium- and low-risk groups for systemic embolization. Such information could be useful in decision making for anticoagulation in patients with AF.

Aged↗
PubMed1999

[Anesthetic management for mitral valve replacement in a patient with mitral stenosis and dilated cardiomyopathy].

A 42-year-old man with dilated cardiomyopathy and rheumatic mitral stenosis underwent mitral valve replacement. Prior intravascular fluid administration and infusion of dopamine and dobutamine stabilized hemodynamics during the induction of anesthesia. High-dose fentanyl at pre-cardiopulmonary bypass period and circulatory assist with milrinone and intraaortic balloon pumping after the bypass enabled us to obtain stable hemodynamics. Preoperative dobutamine stress test provided us the effective information for circulatory management in this patient.

Adult↗
PubMed1984

Elementary echographic estimation of cardiac output independent of the symmetry and kinetic state of the left ventricle in mitral stenosis. Potential application to the determination of the circulation of pregnancy.

An orifice equation is demonstrated which is independent of the symmetry and kinetic state of the left ventricle. The expression allows calculation of the cardiac output in conditions of mitral stenosis when the mitral valve area is known. This equation is Q = (1/21) R A T2, where Q = cardiac output in ml/min, R = heart rate, A = mitral valve area and T = diastolic filling period in sec/min. Ten patients whose gynecologic or obstetric exam suggested a diagnosis of mitral stenosis were evaluated by conventional cardiac catheterization and M-mode echocardiography. Cardiac output computed using the new equation and the Fick principle corresponded at r = 0.95, SE = 340 ml, N = 10. These results suggest that cardiac output may be conveniently estimated for serial studies by the readily measurable echographic variables of heart rate and diastolic filling period once the mitral valve area has been measured by conventional catheterization or bi-dimensional echographic methods.

Adolescent↗