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At least 685 records · Page 38Linked to original sources
PubMed1990

Mitral stenosis: evaluation with MR imaging after percutaneous balloon valvuloplasty.

To evaluate the pathoanatomic findings of mitral valve stenosis and changes after percutaneous balloon valvuloplasty (PBV), magnetic resonance (MR) imaging was performed in 23 patients. The patients were imaged with a 2.0-T system within 1 week before and 3-10 days after PBV. The angle of the interatrial septum was measured on the transverse image to facilitate a successful transseptal puncture. On MR images, the mean transverse and anteroposterior diameters of the left atrium at the level of the aortic root in the ventricular diastolic phase decreased significantly after PBV. Areas of flow-related intraluminal signal intensity detected in the left atrial cavity of 17 patients (74%) before the procedure disappeared in 15 patients after the procedure. Other MR imaging findings after PBV were the disappearance of intraluminal signal intensity in the pulmonary artery, normal curvature of the interatrial and interventricular septa, and pericardial effusion as a complication. MR imaging was thought to provide useful information before and after PBV in patients with mitral stenosis.

Adolescent↗
PubMed2002

Prevalence and clinical significance of left atrial spontaneous echo contrast detected by transesophageal echocardiography.

The prevalence and clinical significance of left atrial spontaneous echo contrast (SEC) were studied in patients undergoing transesophageal echocardiography (TEE). The study group included 290 consecutive patients (186 male and 104 female, aged 17-86 years, mean age 56.1 +/- 12.8 years). Left atrial SEC was found in 50 (17.2%) patients, and was significantly associated with atrial fibrillation, mitral stenosis, absence of mitral regurgitation, and left atrial dimension. Atrial fibrillation was recorded in 44 (88%) patients, mitral stenosis or mitral valve replacement in 21 (42%) patients, and left atrial thrombus or previous embolism in 23 (46%) patients with SEC. Univariate analysis showed a significant association between the presence of SEC and atrial fibrillation, mitral stenosis or mitral valve replacement, and left atrial size. Multivariate analysis showed the presence of left atrial SEC and atrial fibrillation to be independent factors for thrombus formation and/or thromboembolism. Since left atrial SEC associated with atrial fibrillation, left atrial enlargement, mitral stenosis, or mitral valve prosthesis was found in 17.2% of patients undergoing TEE, it might be considered a marker of left atrial thrombus or previous thromboembolism.

Adolescent↗
PubMed1977

Mitral valve closure index. Echocardiographic index of severity of mitral stenosis.

A new echocardiographic index of mitral valve diastolic closure, based on the rate of diastolic apposition of the anterior and posterior mitral leaflet echoes, was measured in 40 patients with mitral stenosis. This mitral valve closure index correlated highly significantly with the mitral valve orifice area (calculated from the Gorlin formula) (r = 0-87). Correlation between the diastolic closure rate (based) on the EF slope) and the calculated valve area was poor (r = 0-37). It is proposed that the mitral valve closure index excludes movement extraneous to the mitral apparatus and expresses the actual rate of valve closure, thus avoiding some of the factors known to contribute to the poor specificity of the diastolic closure rate. The better correlation of the mitral valve closure index with the calculated valve orifice area makes it possible to assess the severity of mitral stenosis by echocardiogram with greater accuracy and confidence.

Adult↗
PubMed1987

[Determination of the transvalvular gradient using continuous wave Doppler in patients with mitral stenosis. Correlation with the hemodynamic method].

In order to assess the reliability of Doppler echocardiography in the determination of mean mitral gradient 38 consecutive patients (pts) affected by rheumatic mitral valve stenosis (MS) were analyzed by continuous wave Doppler echocardiography (CWD). Cardiac catheterization (CATH) was performed within 24 hours from echocardiographic examination. The mean diastolic mitral gradient (MG) at CATH was calculated by planimetry from simultaneously recorded left ventricular and pulmonary artery wedge pressure. The maximal velocity profile through the mitral valve was used to calculate pressure gradient by CWD. A mean mitral gradient was calculated for each patient by the planimetered velocity profile throughout diastole. MG determined by CATH ranged from 6 to 31 mmHg (mean 15.2 +/- 6.0); MG determined by CWD ranged from 4 to 18 mmHg (mean 10 +/- 3.7). The correlation between CWD and CATH by linear regression analysis was: y = 0.53 X + 1.8; r = 0.85; p less than 0.001. Mean % error of CWD in the assessment of MG was 34.7%. In conclusion this study indicates that CWD seems systematically underestimate MG with respect to CATH. The identification of CWD flow tracings "optimal" for analysis could not represent the maximal velocity of transmitral jet, which is a complex three dimensional entity. In addition non-simultaneous determinations of gradient and day-to-day variations in cardiac output may account for discrepancies between CWD and CATH measurements.

Adolescent↗
PubMed1978

Severe and early stenosis of porcine heterograft mitral valve.

A patient who had aortic and mitral valves replaced by Carpentier porcine heterografts for bacterial endocarditis developed severe heart failure 18 days after operation. A second emergency operation revealed that the mitral prosthesis had become severely stenosed and calcified. A loud Graham Steell murmur had developed during the 12 hours before reoperation but no distinct murmurs of mitral stenosis had been detected.

Adult↗
PubMed2003

Intraoperative assessment of mitral valve and peri-operative results of surgical treatment of mitral valve disease in patients who previously underwent closed surgical and percutaneous transluminal mitral commissurotomy.

BACKGROUND: Surgical open or closed mitral commisurotomy and percutaneous transluminal mitral commissurotomy (PTMC) are the well-established therapies in patients with mitral valve stenosis. However, due to various factors the long-term effects may not be optimal in some patients, so they should undergo surgical mitral valve replacement. AIM: The intra-operative assessment of the morphology of mitral valve and the evaluation of the peri-operative results of surgical treatment in patients with mitral valve disease who previously underwent closed surgical commissurotomy followed by PTMC. METHODS: Twenty one patients (20 males, mean age 49 years) who underwent surgery due to mitral valve disease after closed mitral commissurotomy and PTMC, are presented. The time from closed mitral commissurotomy to PTMC was 3-42 years, and the time from PTMC to mitral valve replacement - 9 days to almost 9 years. RESULTS: One patient died on the second day after the operation because of left ventricular failure. The outcome of the remaining patients was good. Advanced changes of the mitral valve and subvalvular apparatus were present in the majority of patients. CONCLUSIONS: The results of the implantation of mitral valve prosthesis in patients who previously underwent closed surgical mitral commissurotomy and PTMC are good. In some patients with a history of closed surgical mitral commissurotomy, PTMC delays surgical replacement of the mitral valve. Advanced changes in the mitral valve leaflets and subvalvular apparatus are the causes of PTMC failure.

Adult↗
PubMed1976

Opening snap and isovolumic relaxation period in relation to mitral valve flow in patients with mitral stenosis. Significance of A2--OS interval.

In 15 patients with pure or predominant mitral stenosis and in a control group of 11 patients without mitral stenosis the blood flow velocity through the mitral valve orifice was recorded by means of a directional Doppler ultrasound velocity catheter introduced transeptally and positioned in the orifice of the mitral valve. A simultaneous surface phonocardiogram was obtained. The timing of the mitral opening snap in relation to the blood velocity record of the flow through the valve supported the hypothesis that the opening snap is due to a sudden tensing of the valve leaflets by the chordae tendineae. Determination of the exact time of mitral valve opening, made possible by the blood velocity record, led to the division of the classical A2-0S interval (aortic valve closure to opening snap) into two components representing respectively the diastolic isovolumic relaxation period and the time of excursion of the mitral valve cusps. The durations of the isovolumic relaxation period were compared with those in the control patients and were found to correlate with the severity of the mitral stenosis, whereas those of the excursion time of the mitral cusps were influenced by the presence or absence of mitral valve calcification.

Adult↗
PubMed1999

Predictors of clinical events or restenosis during follow-up after percutaneous mitral balloon valvotomy.

AIMS: The purpose of this study is to define predictors of events or restenosis during follow-up after percutaneous mitral balloon valvotomy. METHODS AND RESULTS: Percutaneous mitral balloon valvotomy was attempted in 137 patients with severe mitral valve stenosis. In 127 patients follow-up was complete with a mean of 4.2 +/- 2.6 years. Events during follow-up were defined as death, mitral valve surgery or repeat percutaneous mitral balloon valvotomy. Restenosis was defined as a decrease in mitral valve area from > or = 1.5 cm2 following percutaneous mitral balloon valvotomy to < 1.5 cm2. There was 80 +/- 4% event-free survival 4 years after percutaneous mitral balloon valvotomy. Multivariate analysis showed chronic atrial fibrillation at baseline (P = 0.039, relative risk (RR) = 2.5) and a high residual maximal gradient after percutaneous mitral balloon valvotomy (P = 0.004, RR = 2.0 per 5 mmHg) to be independent predictors of an event during follow-up. The restenosis rate was 28.3% after 4 years. Chronic atrial fibrillation at baseline (P = 0.0338, RR = 2.2), a small mitral valve area after percutaneous mitral balloon valvotomy (P = 0.0003, RR = 0.8/0.1 cm2) and a high residual maximal transmitral gradient (P = 0.0252, RR = 1.6/5 mmHg) were all independent predictors of restenosis. CONCLUSION: Patients with chronic atrial fibrillation and a high maximal transmitral gradient after percutaneous mitral balloon valvotomy have a higher risk for events during follow-up. Restenosis is related to the presence of chronic atrial fibrillation at baseline and a suboptimal percutaneous mitral balloon valvotomy result.

Adult↗
PubMed1994

[Bronchial hyperresponsiveness before and after percutaneous transluminal mitral commissurotomy in patients with mitral stenosis].

To study the effects of percutaneous transluminal mitral commissurotomy (PTMC) on bronchial responsiveness to inhaled methacholine in patients with mitral valve stenosis (MS), methacholine inhalation tests and pulmonary function tests were done in 10 patients with MS before and one week after PTMC. The mean log cumulative dose producing a 35% decrease in respiratory conductance (PD35Grs) was significantly higher after PTMC in nine patients in whom PTMC was successful (p < 0.05). There were no significant changes in the results of pulmonary function tests after PTMC. One patient had severe mitral regurgitation after PTMC, and a decrease in PD35Grs. Six of the other nine patients in whom PTMC was successful continued to be hyperresponsive to inhaled methacholine. These data show that bronchial hyperresponsiveness in patients with MS is less severe after PTMC, concomitant with the relief of pulmonary congestion, and they suggest that the remaining bronchial hyperresponsiveness is responsible for peripheral airway narrowing with organic remodeling.

Bronchial Hyperreactivity↗
PubMed1999

Perinatal mitral valve interventions: a report of 10 cases.

BACKGROUND: Rheumatic mitral valve stenosis is still an endemic disease in some parts of the world and may complicate pregnancy and perinatal period. During the 10-year period between January 1988 and December 1997, 10 pregnant women with mitral stenosis were operated on. METHODS: Combined cesarean delivery and closed mitral valvulotomy (CMV) were performed on 6 patients, combined cesarean delivery and Mitral Valve Replacement (MVR) were performed on 1 patient, and 3 patients had CMV during their third trimester. RESULTS: There was 1 stillbirth. All other patients and delivered babies were healthy. MVR was necessary for mitral restenosis in one patient 5 years after her CMV. Three of the remaining patients had some degree of restenosis but did not require reoperation. CONCLUSION: CMV when indicated during pregnancy can be performed with low risk. For symptomatic patients responding to medical therapy, a combined approach of cesarean section and CMV will prevent possible complications that may arise on perinatal period due to hemodynamic fluctuation.

Adult↗
PubMedDate not supplied

[Immediate results in percutaneous mitral valvuloplasty with the Nucleus balloon].

UNLABELLED: We present the immediate results of mitral valvuloplasty in 10 patients using Nucleus balloon. Several publications show highly successful results obtained with the Inoue balloon and double balloon technique. There are no publications of Nucleus balloon. We consider that this device could offer several advantages according to its physical and technical characteristics. We performed the procedure in 10 female patients, with severe mitral valve stenosis, with an average age of 44.8 years (23-70) and an average Wilkins score of 7.5 (6-9), using a combined technique. The increase in mitral valve area with Gorlin equation was 1.03 +/- .13 to 2.6 +/- .67 cm2, the decrease in transmitral gradient from 15 +/- 4.1 to 3.42 +/- 2.6 mm Hg, and decrease in systolic pulmonary pressure from 54.1 +/- 18.8 to 24.9 +/- 5.1 mm Hg. One patient developed grade I mitral insufficiency after the procedure, and another non significant interatrial shunt. CONCLUSIONS: Good results are obtained with this balloon, the valvuloplasty technique is more simple than with double balloon, it is much cheaper than Inoue balloon and we consider it could be useful in moderately calcified valves.

Adult↗