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PubMed2003

[Feasibility of transesophageal echocardiography during balloon mitral valvulotomy].

The purpose of this study was to demonstrate the utility and feasibility of transesophageal echocardiography during percutaneous balloon mitral valvuloplasty (PBMV). 40 patients were included with symptomatic rheumatic mitral valve stenosis with mean age of 31 years. Transoesophageal echocardiographic monitoring allowed an immediate detection of mitral insufficiency in 10 patients. This latter was moderate in eight cases and severe in two cases indicating to stop the procedure. The addition of on-line TEE during PBMV facilitate and confirm the success of the procedure and detect complications.

Adolescent↗
PubMed1993

Long-term results of mitral commissurotomy.

Between January 1968 and December 1989, 280 patients underwent conservative surgical treatment for pure mitral stenosis. Closed commissurotomy was utilized in 134 patients, with a mean age of 38 +/- 11 years and a mean valve area of 1.0 +/- 0.29 cm2. Open commissurotomy was performed in 146 older patients (mean age 44 +/- 11 years) with a mean valve area of 0.9 +/- 0.3 cm2. The perioperative mortality was 3% in closed procedures and 3.4% in open procedures. Surviving patients were evaluated by questionnaires or phone interviews, and 129 patients were examined by two-dimensional echocardiography with the purpose of analyzing long-term results. Follow-up was 95% complete (Grunkemeier-Starr method), with a median of 18 years in patients with closed commissurotomy and 6.6 years in patients with open commissurotomy. The actuarial survival at 21 years was 60.8% (70% confidence limits 55% to 66%) in patients having closed commissurotomies and 60.6% (70% confidence limits 49% to 71%) at 22 years in patients having open commissurotomies. The "effective palliation" rate, defined by clinical and echocardiographic criteria, was 47% at 15 years and 15% at 20 years. We conclude that mitral commissurotomy is the procedure of choice in pure mitral valve stenosis and should be applied early. When performed in patients aged less than 40 years, a 78% (70% confidence limits 72% to 84%) survival at 18 years and 67% "effective palliation" at 15 years were observed. The closed valvotomy results of our study support the present trend toward use of percutaneous balloon valvotomy.

Adolescent↗
PubMed1986

Transesophageal two-dimensional echocardiography for the detection of left atrial appendage thrombus.

Thrombi located in the left atrial appendage are frequently not detected with conventional two-dimensional echocardiography. The transesophageal echocardiographic approach readily visualizes left atrial morphology and may be used as an alternative. In 6 of 21 patients with mitral valve stenosis, a left atrial appendage thrombus was diagnosed by transesophageal two-dimensional echocardiography when transthoracic echocardiography had failed. The transesophageal echocardiographic findings were confirmed at surgery for mitral valve replacement in all cases.

Adult↗
PubMed1992

Estimation of mitral valve area from regression analysis of the pressure gradient in mitral stenosis.

Estimation of mitral valve area (MVA) in the cardiac catheterization laboratory is prone to pitfalls because of the time required for calculations and inaccuracies in the measurement of cardiac output. Because the rate of decrease in the mitral gradient directly correlates with the severity of mitral stenosis, an on-line estimate of MVA at the time of catheterization may be possible with regression analysis of digitized pressure recordings. A total of 61 comparisons of mitral gradient measurements and MVA were obtained in 37 patients at diagnostic catheterization and in 24 patients after balloon mitral valvotomy. Linear and nonlinear regression parameters yielded pressure half-time values and empiric constants similar to those used in Doppler echocardiography for estimation of MVA. The correlations derived from linear analysis were as good as those obtained from nonlinear analysis: from linear analysis, MVAregression = 0.79.MVAGorlin -0.03; r2 = 0.64, p = 0.0001; and from double exponential analysis, MVAregression = 0.86.MVAGorlin -0.07; r2 = 0.74; p = 0.0001. The correlations were not significantly affected by the presence of mild to moderate mitral regurgitation or whether they were obtained after balloon valvotomy. In summary, linear regression analysis yields accurate estimates of MVA despite the theoretical superiority of nonlinear methods. On-line digital analysis of mitral gradient tracings may thus be useful at the time of diagnostic cardiac catheterization or balloon mitral valvotomy to assess the severity of mitral stenosis and the response to interventions.

Aged↗
PubMed2003

Floating ball thrombus in the left atrium with mitral stenosis.

We report a case of a floating ball thrombus in the left atrium with mitral stenosis in a 76-year-old woman. The patient had been followed-up at our hospital due to mitral valve stenosis for several years, and was recognized to have atrial fibrillation and a left atrial mural thrombus by echocardiography. She was admitted to our hospital for right cerebral infarction. Echocardiography showed a floating ball thrombus in the left atrium. After the treatment of cerebral infarction, she was referred to cardiac surgery, and a semi-urgent operation was performed. Removal of the ball thrombus and mitral valve replacement were performed simultaneously. The thrombus was single, round, soft, relatively smooth surfaced, and about 30 x 30 x 30 mm in diameter. The postoperative course was uneventful. Left atrial ball thrombus appears to be uncommon. This is a rare case, in which it was documented that a pre-existing left atrial mural thrombus was thought to drop off spontaneously, to be a cerebral embolic source, and to develop into a ball thrombus in the left atrium.

Aged↗
PubMedDate not supplied

[Relationship of mitral valve area to hemostatic condition in rheumatic mitral stenosis].

The influence of mitral valve area (MVA) on hemostatic conditions was assessed in patients with rheumatic mitral stenosis (MS) without atrial thrombus who underwent percutaneous mitral valvuloplasty (PMV). The Doppler-derived MVA and hemostatic variables were obtained before and 2-3 months after PMV. Hemostatic tests included measurements of beta-thromboglobulin and platelet factor 4 levels as indexes of platelet activation, fibrinopeptide A and thrombin-antithrombin complex as markers of fibrin generation, and D-dimer and plasmin-alpha 2-plasmin inhibitor complex as indexes of active fibrinolysis. Thirty-three measurements in 17 MS patients were subdivided into three groups: group A, 16 samples when MVA was < 1.5 cm2, group B, 12 samples obtained when MVA was 1.5 - < 2.0 cm2, and group C, 5 samples obtained when MVA was > or = 2.0 cm2. The mean level of beta-thromboglobulin was significantly lower in group C (43.6 +/- 32.4 ng/ml) than in group A (142.5 +/- 132.5 ng/ml) or B (163.8 +/- 179.8 ng/ml) (p < 0.05). The incidence of abnormal beta-thromboglobulin was also significantly lower in group C (20%) than in group A (67%) or B (73%) (p < 0.05). Other mean values or incidence of abnormal values of other hemostatic parameters did not differ between the groups. The hemostatic change induced by PMV was examined in 15 MS patients with no change in cardiac rhythm after PMV therapy. The patients were divided into suboptimal (MVA widening < 0.5 cm2, n = 7) and optimal (> or = 0.5 cm2, n = 8) groups. No favorable hemostatic changes were achieved by PMV in the suboptimal group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

[Simultaneous coronary angioplasty and percutaneous mitral valvuloplasty: a case report].

A patient with symptomatic pliable mitral stenosis and a significant lesion of the left coronary artery underwent combined interventional procedures during a single session. From the femoral approach a percutaneous transluminal coronary angioplasty was performed, with unsatisfactory results and necessitating stent implantation. Thereafter, mitral valve stenosis was relieved by percutaneous balloon valvotomy.

Aged↗
PubMed2003

Mitral stenosis due to fibrous tissue overgrowth after mitral valve repair.

We report an extremely rare case of fibrous tissue overgrowth 3 years after mitral valve repair using a mitral annuloplasty ring in a 53-year-old woman who underwent mitral valve replacement for mitral stenosis. Whitish fibrous tissue had overgrown from the ring on the atrial side of the annulus, and had severely reduced the valvular area. However, the motion of the mitral leaflets was not restricted. Considering the presence of concomitant aortitis syndrome, it is strongly suggested that the overgrowth of fibrous tissue was promoted as a reaction to chronic inflammation.

Cardiac Catheterization↗
PubMed1979

Echocardiographic and exercise evaluation of results of mitral valvotomy operations.

M-mode echocardiography was performed in 54 patients 1 month to 3 years after mitral valvotomy for dominant mitral stenosis. The mitral valve closure index (MVCI), an index previously shown to correlate well with the calculated mitral valve area, was used to diagnose residual mitral stenosis. Using the equation MVCI = 33 MVC--12, 12 patients (22%) were deemed to have mild, 4 (7%) moderate, and 2 (4%) severe residual stenosis. Repeat cardiac catheterisation confirmed the diagnosis in 7 patients. The postoperative mitral valve closure index correlated significantly with patients' subjective symptoms and objective exercise indices. It was higher in patients in whom the posterior mitral leaflet movement became normal after valvotomy, and was lower in patients in whom the anterior mitral leaflet excursions below 14 mm before operation. The mitral valve closure index is a sensitive index for diagnosing residual mitral stenosis after valvotomy.

Adolescent↗
PubMed1990

Ultrasonic debridement during mitral valve reconstruction for calcified mitral stenosis.

An ultrasonic device in conjunction with open mitral commissurotomy was applied in 8 patients with heavily calcified, stenosed mitral valves. In 6 patients, reconstruction of the mitral valve by debridement of the leaflet calcification with the device was successful. Two patients required valve replacement because of an increase in preexistent mitral regurgitation caused by excessive decalcification. The ultrasonic device proved to be a useful and effective adjunct for salvaging the heavily calcified mitral valve, which would otherwise have to be replaced.

Adult↗
PubMed1998

Balloon mitral valvotomy in pregnancy: maternal and fetal outcomes.

BACKGROUND: Rheumatic mitral valve stenosis contributes to significant morbidity in pregnancy. Surgical commissurotomy has been performed during pregnancy in patients with severe mitral stenosis for several decades, but the efficacy and safety of percutaneous balloon mitral valvotomy (BMV) in this subset has not been clearly defined. STUDY DESIGN: In 1996 and 1997, 40 pregnant women aged 24+/-5 years underwent BMV at 21+/-11 weeks of pregnancy. Special shielding was used during BMV to limit radiation to the fetus, except in those who were to undergo medical termination of pregnancy subsequently. A detailed echocardiographic evaluation was performed before and after BMV. After the BMV, the 29 patients in whom pregnancy was continued were assessed every 2 weeks for symptoms and fetal growth. RESULTS: The BMV procedure was successful in 39 patients with an increase in mitral valve area from 0.8+/-0.2 cm2 to 1.7+/-0.2 cm2 (p < 0.001) and marked symptomatic relief. Fluoroscopy time was 7.8+/-1.9 minutes. Eleven patients whose BMV was performed before 20 weeks of pregnancy, subsequently underwent medical termination of pregnancy uneventfully. Eighteen patients had a normal delivery, three underwent cesarean section for fetal distress, one had a preterm delivery, and there was one stillbirth. Four patients are continuing pregnancy and two are lost to followup. Fullterm delivery data were available in 23 babies, whose birth weights were 2.32+/-0.5 kg. None of these babies needed any special care and were healthy at discharge. CONCLUSIONS: During pregnancy, BMV by the Inoue technique is feasible, safe, and effective. There is marked symptomatic relief, along with excellent maternal and fetal outcomes.

Adult↗
PubMed1984

Cardiac valve orifice equation independent of valvular flow intervals: application to mitral valve area computation in mitral stenosis and comparison with the Gorlin formula and direct anatomical measurements.

An orifice equation is developed which relates the effective mitral valve area (A), the average mitral valve pressure gradient (dP), the cardiac output (Q) and the heart frequency (f) through considerations of momentum conservation across the mitral valve. The form of the new equation is A = (4.75 X 10(-5)Qf/dP, where A, Q, and dP are expressed in cm2, ml X min-1 and mmHg respectively. Mitral valve areas computed with the new orifice formula are found to correlate with those computed by the Gorlin formula in conditions of equilibrium associated with the resting state at a level of r = 0.95, SE = 0.15 cm2, with autopsy measurements at a level of r = 0.85, SE = 0.18 cm2 and with direct anatomical measurements of excised valves at a level of r = 0.78, SE = 0.41 cm2. The results suggest that the new formula may be considered as an independent orifice equation enjoying a similar domain of validity as the Gorlin formula. The new equation offers the possibility of deriving additional useful haemodynamic relationships when used in combination with established cardiological formulas.

Hemodynamics↗
PubMed1992

[Spontaneous left atrial echo contrast in trans-esophageal echocardiography].

Left atrial spontaneous contrasts (LASC) are found almost exclusively with transesophageal echocardiography (TEE), usually in patients with mitral stenosis or mitral prosthetic valves. The prevalence of LASC was examined in 143 consecutive patients undergoing TEE and transthoracic echocardiography (TEE). LASC of variable intensity were observed in 31 patients (22%) with TEE, in contrast to none with TTE. There was a significant correlation between the presence of LASC and atrial fibrillation (p less than 0.001), left atrial dilatation (p less than 0.005) and presence of mitral valve prosthesis or mitral stenosis (p less than 0.02). In 48% of patients with LASC the mitral valve was entirely normal. Multivariance analysis showed atrial fibrillation and left atrial dilatation to be independent predictors for the presence of LASC. There were significantly more ischemic strokes in patients with LASC (35% vs 12% in patients without LASC). LASC are a frequent observation with TEE. As sensitivity of the echocardiography instruments steadily improves, LASC are also found in increasing numbers of patients with minimal structural change of the heart. LASC may indicate the presence of microthrombi and thus be involved in the pathogenesis of thromboembolic complications; their clinical relevance and prognostic significance needs to be further investigated.

Adult↗