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PubMed1991

[A case of mitral stenosis developing infective endocarditis 18 months after PTMC].

We presented here a case of mitral stenosis developing infective endocarditis 18 months after PTMC. A 33-year-old male was admitted to our hospital for the evaluation of mitral stenosis with signs of congestive heart failure. The use of PTMC was adequately indicated based on the data of previous cardiac catheterization and was successfully performed. The post-operative clinical course was good leaving only slight mitral regurgitation demonstrated by post-valvuloplasty LVG. About 18 months after PTMC, the patient developed a high fever and erythema with tenderness on his leg, so he was admitted again. Blood culture was positive for streptococcus viridans. Moreover, echocardiogram revealed valvular vegetation on the anterior mitral leaflet, which is the characteristic finding of infective endocarditis. Antibiotics were so effective that his clinical course was relatively good with minor cerebral infarction during chemotherapy. Little is known about the prognosis and late complication of PTMC. However, our reported case may suggest that prophylactic chemotherapy might be recommended at least in some cases showing mitral regurgitation after PTMC.

Adult↗
PubMed1995

Color flow Doppler determination of transmitral flow and orifice area in mitral stenosis: experimental evaluation of the proximal flow-convergence method.

To evaluate the in vivo accuracy of color Doppler flow-convergence methods for determining transmitral flow volumes and effective orifice areas in mitral stenosis, we studied two models for flow-convergence surface geometry, a hemispheric (HS) model and an oblate hemispheroid (OH) model in a chronic animal model with quantifiable mitral flows. Color Doppler flow mapping of the proximal flow-convergence region has been reported to be useful for evaluation of intracardiac flows. Flow-convergence methods in patients with mitral stenosis that use HS assumption for the isovelocity surface have resulted in underestimation of actual flows. Chronic mitral stenosis was created surgically in six sheep with annuloplasty rings (group 1) and 11 sheep with bioprosthetic porcine valves (group 2). Hemodynamic and echocardiographic/Doppler studies (n = 18 in group 1; n = 21 in group 2) were performed 20 to 34 weeks later. Left ventricular inflow obstruction was of varied severity, with mean transmitral valve gradients in group 1 ranging from 1.3 to 18 mm Hg and in group 2 ranging from 6.3 to 25.6 mm Hg. Although transmitral flows derived by both geometric flow convergence models showed significant correlations with reference cardiac outputs, the correlations for the OH model were better than those for the HS model (group 1, r = 0.86 for the OH model vs r = 0.72 for the HS model; group 2; r = 0.84 for the OH model vs r = 0.62 for the HS model). The OH model was also superior to the HS model in determining effective orifice areas compared to reference orifice areas determined by postmortem planimetry of anatomic orifices (group 1 only, r = 0.64 for OH vs 0.58 for HS), by the Gorlin and Gorlin formula (group 1, r = 0.63 for OH vs 0.72 for HS; group 2, r = 0.82 for OH vs 0.76 for HS), and by the Doppler pressure half-time method (group 1, r = 0.76 for OH vs 0.69 for HS; group 2, r = 0.84 for OH vs 0.62 for HS).(ABSTRACT TRUNCATED AT 400 WORDS)

Analysis of Variance↗
PubMed2004

Usefulness of percutaneous balloon mitral commissurotomy in preventing the development of atrial fibrillation in patients with mitral stenosis.

A prospective cohort of patients with mitral stenosis and no history of atrial arrhythmias showed no decrease in the incidence of atrial fibrillation (AF) after successful versus unsuccessful Inoue balloon percutaneous balloon mitral valve commissurotomy. Advanced age and left atrial dimension best predicted which patients developed AF during follow-up, whereas percutaneous balloon mitral valve commissurotomy procedural success and left atrial pressure reduction did not have an impact on incidence of AF.

Adult↗
PubMed1980

[Echocardiographic evaluation of mitral stenosis: significance of Pc-To/Ac-Mo ratio (author's transl)].

The echocardiographic tracings of 40 subjects with pure or prevalent mitral stenosis are obtained. The modification of the isovolumetric relaxation time of the right (Pc-To) and the left (Ac-Mo) ventricle, measured from echocardiographic tracings, versus the values of systolic (PSP cat.) and wedge (PVCP cat.) pulmonary pressure are studied in 15 sinusal rhythm patients who underwent cardiac catheterization. The variations of Pc-To versus Ac-Mo and of Pc-To/Ac-Mo ratio versus the most important indices of mitral stenosis and right ventricular performance evaluation are studied in all the patients. Good correlation has been found between Pc-To and Ac-Mo ratio and PSP, PVCP, E-F, Wells index, Yigitbasi index, RICT/RVET, RPEP/RVET, mitral surface; poor correlation has been found between Pc-To/Ac-Mo ratio and left atrial dimension and stroke volume, while no-significant correlation has been found between this ratio and the ejection fraction, V cf, delta S%. For values of Pc-To/Ac-Mo ratio less than 1.20, 1.20 greater than and less than 1,50, greater than 1.50 the stenosis has been considered, respectively, mild, moderate and severe. The Pc-To/Ac-Mo ratio, obtained from echocardiographic tracings, is considered a useful index in the evaluation of the severity of the stenosis and of the pulmonary pressure variations in the presence of mitral stenosis.

Adult↗
PubMed1997

Effect of mitral valvuloplasty in mitral stenosis on coagulation activity.

We investigated the plasma levels of molecular markers for the status of thrombin generation and fibrinolysis in patients with mitral stenosis before and after percutaneous mitral valvuloplasty. Our results show that percutaneous mitral valvuloplasty results in decreased coagulation activity, suggesting that percutaneous mitral valvuloplasty is also useful for prevention of systemic embolism in patients with mitral stenosis.

Blood Coagulation↗
PubMed1986

[Rheumatic mitral stenosis. The medical solution].

The first case of balloon catheter valvular dilatation for rheumatic mitral stenosis is reported in a 13 year-old child. The technique, under local anesthesia, required a transseptal access, then the introduction of one, then simultaneously 2 balloon catheters through the mitral valve. A perfect opening of the valve, without mitral insufficiency was obtained. This technique, even if difficult, seems to be adaptable to most children with rheumatic mitral stenosis.

Adolescent↗
PubMed1997

[Role of beta-blockers in the treatment of mitral stenosis, apropos of 4 cases].

The use of beta blockers during treatment of mitral stenosis is discussed on four cases involving females patients who are symptomatic. All had sinusal tachycardia, one was pregnant, one with cardiothyreosis, two with anemia. In all cases, it's the use of beta-blockers with diuretic, veinous vasodilator and digitalic drugs that allowed the successful treatment of the pulmonary oedema. These observations, added with the literature study, showed that beta-blockers treatment is wise when the subject is carefully studied. The best result is obtained on pure mitral stenosis without left ventricular systolic dysfunction, with sinusal tachycardia and high cardiac output state.

Adrenergic beta-Antagonists↗
PubMed1980

[M-mode and two-dimensional echocardiography in evaluating mitral stenosis before and after commissurotomy].

A first group of 51 patients with pure or predominant mitral stenosis underwent M-mode (M) and two-dimensional (2D) echocardiography and cardiac catheterization (cath). After elimination of 3 incomplete cases, the series consists of 48 patients. 20 later underwent surgery. Quantitative correlations between M and cath are poor (r = 0.34, p less than 0.05); however, correlations between 2D and cath were excellent (r = 0.89, p less than 0.001). There were 4 major discrepancies between 2D and cath: 3 of these patients were operated upon and surgery confirmed 2D mitral valve area in all of them. 2D had served to diagnose all 6 cases of mitral calcifications seen at surgery; however, M provided 1 false negative and 5 false positive results with regard to diagnosis of calcifications. A second group consisted of 18 patients who had undergone mitral commissurotomy, 8 of these had a pre- and postoperative echocardiography. 10 also underwent postoperative cath. M appeared to be unable to predict correctly the presence or absence of a recurrence of mitral stenosis. Quantitative correlations between diastolic slope and mitral valve area at cath were poor. However, excellent correlations were found between 2D and cath, showing that 2D also serves to measure mitral valve area after commissurotomy.

Calcinosis↗
PubMed1994

Endothelin production in pulmonary circulation of patients with mitral stenosis.

BACKGROUND: Although plasma endothelin concentrations are elevated in patients with pulmonary hypertension, the precise sites of endothelin production have not been defined. We investigated the endothelin production in the pulmonary circulation of patients with mitral stenosis and its effects on pulmonary vascular tone. METHODS AND RESULTS: We measured plasma concentrations of endothelin-1, angiotensin II, and thrombomodulin in blood samples obtained from the right and left atria of 10 consecutive patients with rheumatic mitral stenosis (mean age, 55 years; range, 39 to 68) who were undergoing percutaneous mitral valvuloplasty. Plasma levels of endothelin-1 were significantly higher in the left atrium than in the right atrium (3.25 +/- 0.45 versus 2.53 +/- 0.36 pg/mL, mean +/- SE, P < .001). The increased plasma endothelin-1 level in the left atrium, which reflected endothelin-1 production in the pulmonary circulation, was correlated with mean pulmonary artery pressure (r = .65, P = .04), mean pulmonary arterial wedge pressure (r = .67, P = .03), total pulmonary resistance (r = .68, P = .03), and 1/mitral valve area (r = .85, P = .002) but not with pulmonary vascular resistance (r = .04, P = .91). There were no significant differences in plasma levels of angiotensin II and thrombomodulin between the right and left atria (angiotensin II, 16.40 +/- 3.08 versus 15.50 +/- 4.85 pg/mL; thrombomodulin, 2.96 +/- 0.34 versus 2.85 +/- 0.37 ng/mL). CONCLUSIONS: Endothelin-1 production is increased in the pulmonary circulation of patients with mitral stenosis in response to increased pulmonary artery pressure but is not directly related to increased pulmonary vascular tone in this disorder.

Angiotensin II↗
PubMed1993

[The results of the surgical treatment of recurrent mitral stenosis under artificial circulation].

A total of 533 operations for recurrent mitral stenosis have been performed since 1987. Two hundred and twenty-six patients were operated on under extracorporeal circulation. Indications for open correction of the abnormality as an alternative to transventricular commissurotomy were defined by echocardiographic studies. In 86 patients, mitral restenosis was accompanied by involvement of other valves: aortic, tricuspid. Mitral prosthesis was required in 216 cases. Valve-preserving operations were made in 10 cases. The hospital mortality was 12.8%, it decreased from 17.5 for the first 126 operations to 7% for the last 100 operations. In isolated restenosis, the hospital mortality rate was 7.8%, it has reduced by 1.8% in the past 2 years. The hospital mortality was 2.4% for 327 transventricular recommissurotomies. There were 20.9% fatal outcomes in restenosis concurrent with other valvular diseases. In mitral-tricuspid stenosis, deaths reduced from 23.8% to 9.5%. The mortality rates decreased from 35.7 to 15.4% in mitral-aortic stenosis and from 33.3% to 18.2% in tricuspid stenosis. High mortality rates in restenosis concurrent with involvement of other valves are mainly related to the baseline status of the patients operated on.

Adult↗
PubMed2004

Left atrial diameter is a simple indicator of a deficiency in atrial natriuretic peptide secretion in patients with mitral stenosis: efficacy of postoperative supplementation with synthetic human alpha-atrial natriuretic peptide.

OBJECTIVE: With regard to a deficiency in atrial natriuretic peptide (ANP) secretion, the relationship between plasma ANP and left atrial diameter measured by echocardiography was examined and the efficacy of postoperative supplementation was evaluated. METHODS: (1) Ninety-six patients with mitral valve disease from 1997 to 2002 (M:F = 65:31, mean-age 65.3 +/- 8.9 years) were studied for relationship analyses. (2) Twenty-six patients with mitral stenosis and left atrial diameter > or = 60 mm undergoing mitral valve replacement (M:F = 17:9, mean-age 67.4 +/- 7.5 years) were randomly allocated to one of two groups; ANP-treated group (n = 13, 0.05 microg/kg/min of synthetic human alpha-ANP was postoperatively administered) and Control group (n = 13). RESULTS: (1) There were significant positive correlations between left atrial diameter and plasma renin-activity (r = 0.690, P < 0.01) and between left atrial diameter and plasma aldosterone (r = 0.757, P < 0.01). The maximum value of plasma ANP was 249.5 pg/mL accompanied with 56.2 mm of left atrial diameter in 29 patients suffering from mitral stenosis. There was a significant negative correlation between left atrial diameter and ANP in patients with left atrial diameter > 56.2 mm (r = - 0.725, P < 0.0001), whereas there was a significant positive correlation in patients with left atrial diameter < or = 56.2 mm (r = 0.529, P = 0.0066). (2) At 24 hours after operation, the ANP-treated group showed significantly lower plasma renin-activity (9.2 +/- 3.3 versus 36.2 +/- 7.4 ng/mL/h) and aldosterone (113.6 +/- 36.9 versus 473.8 +/- 95.8 pg/mL) than the Control group. CONCLUSIONS: Left atrial diameter can be a simple and useful indicator of a deficiency in endogenous ANP secretion in patients with mitral stenosis, and postoperative ANP supplementation contributes to suppressing further activation of renin-angiotensin system during the immediate postoperative period.

Aged↗
PubMed1991

Severity of rheumatic mitral stenosis in children.

Clinical, hemodynamic and operative findings of 125 children, up to the age of 12 years, were analysed to determine if the severity of pulmonary venous and arterial hypertension correlated with the severity of rheumatic mitral stenosis. Moderately severe to severe pulmonary venous and arterial hypertension was found in almost three-quarters of the patients. Operative findings indicated critical mitral stenosis in 69% of the cases. In India, following rheumatic fever, some patients follow an unusually rapid course in developing mitral stenosis severe enough to require operative treatment, even at the age of six years.

Child↗
PubMed1984

Determination of left ventricular residual function by analysis of post-extrasystolic beat in mitral stenosis.

Residual function of the left ventricle was assessed in 25 patients with mitral stenosis and a normal left ventriculogram. The post-extrasystolic beat (R2) in sinus rhythm (nine patients) and the first beat after an early beat (R2) in atrial fibrillation (16 patients) were analysed angiocardiographically. Five subjects with a normal heart (controls) were also studied. The results are expressed as percentage changes in left ventricular contractility from the beat preceding the extra beat (R1) to the beat R2. In the control group the mean changes from R1 to R2 were: end diastolic volume +68.3% (increase), end systolic volume -21.7% (decrease), ejection fraction +36.2%, mean systolic ejection rate +22.1%, and mean velocity of circumferential fibre shortening +31%. A significant increase in proportional systolic shortening of all left ventricular axes was found in R2 compared with R1. In five patients with sinus rhythm and nine with atrial fibrillation the results fell within the normal range. In the remaining patients the beat R2 indicated signs of poor left ventricular function. The mean changes from R1 to R2 in the patients with sinus rhythm and those with atrial fibrillation were respectively: end diastolic volume +47.8% and +36.6%, end systolic volume +20% and +27%, ejection fraction +12.5% and +6.2%, mean systolic ejection rate -23.3% and -30.2%, and mean velocity of circumferential fibre shortening -25.5% and -39.2%. The increase in the left ventricular axial systolic shortening was not significant. Thus analysing a post-extrasystolic beat in sinus rhythm of the beat following an early beat with a long diastole in atrial fibrillation is a valuable method of determining the residual function in patients with mitral stenosis who have a normal left ventriculogram in basic rhythm.

Adolescent↗
PubMed1986

Preoperative clinical predictors of long term survival in mitral stenosis: analysis of 200 cases followed for up to 27 years after closed mitral valvotomy.

Two hundred patients aged 17-40 years undergoing closed mitral valvotomy during 1955-60 were studied by actuarial survival analysis. The period of follow up was 22-27 years. The following preoperative features were found to be independent predictors of long term survival: sinus rhythm (p less than 0.05); pulmonary arterial pressure below systemic pressure (p less than 0.01); absence of congestive cardiac failure (p less than 0.01) and pure mitral stenosis (p less than 0.01). A better long term survival was found for mitral valvotomy with a Tubb's dilator than finger splitting or Brock's method. The presence of calcification at the time of valvotomy adversely affected survival (p less than 0.01). Anticoagulation improved survival (p less than 0.01). It is concluded that closed mitral valvotomy gives good results if performed before the onset of established atrial fibrillation and congestive cardiac failure and that all patients should have anticoagulation. These results have important implications for selection of patients in countries with limited facilities for open heart surgery.

Adolescent↗
PubMed1975

Hemodynamic and clinical significances of atrial fibrillation, pulmonary vascular resistance and left ventricular function in rheumatic mitral stenosis.

Seventy-four patients with rheumatic mitral stenosis were catheterized and hemodynamic and clinical significances of atrial fibrillation, pulmonary vascular resistance and left ventricular function were studied. These data were also compared to those in the 6 control cases. In addition to the correlation of mitral valve area to the functional classification of patients, significance of atrial fibrillation was also demonstrated. Patients with this arrhythmia had lower cardiac index than those with regular sinus rhythm by approximately 20%, throughout the range of mitral valve area observed. The lower average cardiac index was associated with a higher average left ventricular end-diastolic pressure in cases with atrial fibrillation than in cases without the arrhythmia, in the face of similar average heart rate and average mitral valve area; Average pulmonary vascular resistance correlated to the functional classification, but its systematic influence on the relation between mitral valve area and cardiac index was not observed. Abnormalities of left ventricular function were suggested frequently by various combinations of abnormal values in end-diastolic pressure, end-diastolic volume, ejection fraction, angiographically-measured circumferential fiber shortening velocity (Vcf), and pressure-derived maximal contractile element velocity (Vmax). Patients with enlarged left ventricle had significantly lower average cardiac index than those with normal ventricular size.

Adult↗
PubMed1989

Improvement in left ventricular ejection fraction after surgery for mitral stenosis.

It is recognised that patients with mitral stenosis may have impaired left ventricular function. The reasons for this are speculative and the effects of surgical relief of stenosis on left ventricular function unknown. Five patients showed dramatic improvement in left ventricular ejection fraction after surgery. Possible reasons include altered loading conditions, changes in ventricular interaction and partial restoration of the normal anatomical structure of the mitral valve complex.

Adult↗
PubMed1985

[Continuous wave Doppler measurement of transmitral pressure gradients in mitral stenosis: comparisons with simultaneous catheterization measurements].

To determine the accuracy and reliability of measurements of mitral flow velocity and pressure gradients obtained from continuous wave Doppler (CWD) echocardiography, the left ventricular pressure, pulmonary capillary wedge pressure and CWD echo were simultaneously recorded simultaneously for 22 patients with mitral stenosis. An ultrasonic transducer was placed over the left ventricular apex to direct the ultrasonic beam parallel with the mitral flow. High-pitched audio signals were used to determine whether the ultrasonic beam direction was appropriate. The angle formed by the beam direction and the blood flow was assumed to be zero when a good Doppler echo was recorded. The maximum flow velocity and pressure gradients calculated from CWD echo were compared with pressure gradients obtained by catheterization. These were analyzed during the same heart beats. The results were as follows: Good recordings of pressures and CWD echograms were obtained for 17 patients, and their data were used for the analysis. The maximum flow velocity through the mitral valve obtained by CWD echography was very similar to the pressure gradients obtained by catheterization in terms of phases and patterns. The pressure gradients (x) calculated from CWD using a simplified Bernoulli's equation correlated well with those (y) measured at the same time on pressure tracings (y = 1.2x + 1.5, r = 0.92, p less than 0.001). Mean diastolic pressure gradients (X) obtained by CWD echography also correlated well with those (Y) recorded at catheterization (Y = 1.2X + 0.15, r = 0.95). Based on these results, we conclude that CWD echography is a reliable, noninvasive method to measure the pressure gradient across the mitral valve in patients with mitral stenosis.

Adult↗
PubMed1989

[Potential of noninvasive determination of the left atrioventricular aperture in mitral stenosis (according to data of ultrasound studies)].

The results of the measurement of the mitral opening in mitral stenosis patients by planimetry and by the computation method via the half-cycle of the atrioventricular pressure were found to be in satisfactory agreement except those in a group of patients with concomitant failure of the semilunar aortic valve. Moderate or appreciable mitral regurgitation and stenosis of the aortic ostium associated with mitral stenosis exerted no substantial effect on the accuracy of the design parameter of the mitral opening.

Atrial Fibrillation↗