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PubMed1976

[A rare case of endocardial fibroelastosis in the left atrium simulating mitral stenosis (author's transl)].

A rare case of primary endocardial fibroelastosis, involving only the left atrium, simulating mitral stenosis is reported; the clinical and hemodynamic features which led to the diagnosis of mitral stenosis are described. The authors discuss the data upon which a differential diagnosis between the two similar diseases can be established. The suggest that isolated fibroelastosis of the left atrium could have been developed slowly because of ipoxia of the left atrium for agenesia of the circumflex coronary artery. An operation of endotelial decortication of the left atrium is described.

Child, Preschool↗
PubMed2005

Moderate mitral stenosis in pregnancy: the haemodynamic impact of diuresis.

A case of asymptomatic, newly diagnosed, moderate mitral stenosis in a 27 year old pregnant woman is described. A conservative management strategy with regular cardiac assessment was adopted and the patient remained well. Routine transthoracic echocardiography at 36 weeks' gestation showed the development of severe pulmonary hypertension with right ventricular pressure overload, which was successfully treated with oral diuretics resulting in rapid normalisation of pulmonary pressure. Mitral stenosis in pregnancy and its management in pregnancy are briefly discussed.

Adult↗
PubMed2000

Echocardiographic evaluation of left ventricular function in pure mitral stenosis.

Echocardiographic evaluation of left ventricular function was performed in 22 cases of pure rheumatic mitral stenosis and 22 age matched normal persons. Cases with any evidence of rheumatic activity in the preceding six months, those with gross tricuspid regurgitation and paradoxical movement of the interventricular septum and cases with atrial fibrillation were excluded. None of the patients showed systolic left ventricular dysfunction. Left ventricular end diastolic dimension was also not affected. Echocardiographic parameters did not have any relation for mitral valve area. Our observations show that mitral stenosis per se does not affect left ventricular function.

Adolescent↗
PubMed1989

[Consumption coagulopathy found in mitral stenosis associated with atrial thrombus].

Two cases of consumption coagulopathy found in the patients having mitral stenosis with atrial thrombus were reported. In case 1, although anticoagulant (Warfarin) administration did not correct the hemostatic abnormality, combination of tranexamic acid with anticoagulant was effective. In case 2, atrial thrombus found in the echocardiography prior to the onset of thromboembolism in the lower limbs has been disappeared after embolism. Anticoagulant was effective for the improvement of hemostatic abnormality. We considered mitral stenosis with atrial thrombus as one of causes of the consumption coagulopathy.

Aged↗
PubMed1993

[A case of modified maze operation for atrial fibrillation accompanied by mitral stenosis].

A 45-year-old man suffering from mitral stenosis and atrial fibrillation underwent a mitral commissurotomy and received a modified maze operation. In order to preserve the sinus node artery, we used a new incision line differing from that of Cox and introduced a cryosurgery. After the operation, atrial fibrillation disappeared. The atrial kick was also clearly observed by the echocardiogram. We think that combined operations have advantage both to cure atrial fibrillation and to deal with the mitral valve easily.

Atrial Fibrillation↗
PubMed1993

Effect of mitral regurgitation and aortic regurgitation on Doppler-derived mitral orifice area in patients with mitral stenosis.

Traditional Doppler pressure half-time (T1/2) method (mitral valve area = 220/T1/2) is widely used for evaluating the mitral orifice area in patients with mitral stenosis (MS). However, the effect of mitral regurgitation (MR) and aortic regurgitation (AR) on the calculation of the mitral valve area by this method is still controversial. Therefore, we examined 493 consecutive patients with MS to evaluate the effect of MR and AR on Doppler-derived mitral orifice area. The mitral orifice area planimetered from two-dimensional echocardiogram was used as the standard reference. Excluding 16 patients with either unsatisfactory Doppler or echocardiographic tracings, 477 patients were enrolled in the study. There were 162 males and 315 females with a mean age of 49 years. They were divided into 4 groups: group A, 327 patients with MS but no MR and AR; group B, 68 patients with MS + MR but no AR; group C, 64 patients with MS + AR but no MR; group D, 18 patients with MS + MR + AR. The differences between echo and Doppler area were 0.02 +/- 0.02 cm2 (mean +/- SE), p = 0.220, in group A; 0.13 +/- 0.04 cm2, p = 0.004, in group B; 0.11 +/- 0.05 cm2, p = 0.026 in group C; and 0.31 +/- 0.08 cm2, p = 0.001, in group D. Thus, in patients with MS, the associated MR or AR may invalidate the pressure half-time method for the derivation of mitral valve area.

Adult↗
PubMed1996

The relief of mitral stenosis. An historic step in cardiac surgery.

Significant progress has been achieved in cardiac surgery in the last 50 years. Mitral valve surgery (especially for the relief of mitral stenosis) has paralleled the innovations and trends of cardiac surgery and often has served as the benchmark of the latest procedures and techniques. A chronological survey of mitral valve surgery is presented, with emphasis on parallels to cardiac surgery in general and with highlights of key figures and events that have conclusively altered the surgeon's approach to and success with cardiac dysfunction. A few surgeons promulgated the idea of cardiac surgery in the late 19th century, but mitral valve surgeries were not performed in earnest until Souttar's and Cutler's initial attempts in the 1920s and were not successful on large groups of patients until Bailey and Harken made independent breakthroughs in the 1940s, finally laying to rest the idea of the "inviolable heart." Cardiopulmonary bypass provided cardiac surgeons with the time to implant mechanical and bioprosthetic valves for palliative benefit to patients. The "perfect" valve has yet to be found, but the Starr-Edwards mechanical valve since its inception in 1961 has been one of the most successful and widely used prosthetic valves. Gradual improvement in surgical technique and growing knowledge of valve function enabled the re-emergence of mitral valve repair in the 1980s as the preferred surgical method of treating mitral stenosis. In the last 10 years, mitral valve balloon dilation has provided a nonsurgical technique for relief of stenosis and represents the broader trend towards interventional techniques.

Cardiac Surgical Procedures↗
PubMed1990

A comparison of repair and replacement for mitral stenosis with partially calcified valve.

From January 1978 to December 1987 we operated on 135 patients with calcified mitral stenosis. In 60 patients a conservative operation was performed (group I). Nine patients required mitral annuloplasty associated with the commissurotomy. The other 75 patients underwent mitral valve replacement (group II). In 37 patients a mechanical prosthesis was used and in 38 a biologic one. The patients given mitral valve replacement had a more heavily calcified valve than those undergoing a conservative procedure. Twenty-one patients (12 from group I and 13 from group II) required associated tricuspid annuloplasty. The mean follow-up time was 69.1 months (1 months to 10 years). There were no significant differences between the two groups in terms of operative death (0% and 4%, respectively), postoperative functional class, actuarial survival rate at 10 years (84% and 96%, respectively), and probability of freedom from thromboemboli at 10 years (98% and 96%, respectively). However, the probability of freedom from reoperation at 10 years significantly favored the conservative surgery group (84% and 69%, respectively, p less than 0.01). Finally, the probability of freedom from complications at 10 years was also significantly higher in the conservative surgery group (82% and 64%, respectively, p less than 0.005). Because of these results we believe that conservative surgery is, at present, a better alternative than mitral valve replacement for patients with partially calcified mitral stenosis.

Actuarial Analysis↗
PubMed1990

Should patients with mitral stenosis who are acceptable surgical commissurotomy candidates now have balloon valvuloplasty treatment?

This review of the surgical and valvuloplasty literature demonstrates that mitral valve morphology rather than the type of intervention determines the therapeutic results after surgical commissurotomy or balloon valvuloplasty treatment of mitral stenosis. The mechanism of dilatation and hemodynamic results of transventricular mitral commissurotomy and of mitral balloon valvuloplasty are similar. Both techniques should be considered palliative. Because the balloon catheter technique can achieve hemodynamic results similar to surgery and may delay the trauma and expense of surgery, it can be offered to patients as a primary treatment for relief of symptomatic mitral stenosis.

Catheterization↗
PubMed2001

Low prevalence of coronary arterial disease in Chinese adults with mitral stenosis.

BACKGROUND: We attempted to evaluate the prevalence of coronary artery disease in Chinese adults with severe rheumatic mitral stenosis. METHODS: We prospectively performed coronary angiography in 119 consecutive Chinese patients older than 40 years old (mitral valve area less than 1.5 cm2) who were about to undergo balloon mitral commissurotomy for significant rheumatic mitral stenosis. The exclusion criteria were the presence of left atrial cavitary thrombi or mitral regurgitation greater than grade 3. RESULTS: There were 32 men (26%) and 87 women (74%) with a mean age of 55 +/- 9.7 years (ranging from 40 to 78). Ninety-two patients (77%) were in atrial fibrillation. The prevalence of risk factors for atherosclerotic cardiovascular disease were hypertension (22%), diabetes mellitus (4%), hypercholesterolemia > or = 240 mg/dL (5%), hypertriglyceridemia > or = 150 mg/dL (13%), and cigarette use (7%). Coronary artery disease on angiography was defined as stenosis of more than 50% of the luminal diameter. We found that only 2 patients (1.7%) had coronary artery disease. CONCLUSION: The prevalence of coronary artery disease was much lower than in previous reports, some of which, however, had already pointed out the relatively low prevalence of coronary artery disease in rheumatic mitral disease. The definite mechanisms require further study.

Adult↗
PubMed1983

Radiocardiographic assessment of dobutamine and isosorbide dinitrate therapy in patients with mitral stenosis and pulmonary congestion.

Simultaneous hemodynamic and radiocardiographic measurements were performed on 10 patients with mitral stenosis and pulmonary congestion for evaluating the acute effects of dobutamine (DB, 5 micrograms/kg/min), isosorbide dinitrate (ISD, 10 mg sublingually) or a combination of the two. DB alone produced a significant increase of the cardiac index (CI) from 2.9 +/- 0.1 to 3.7 +/- 0.2 L/in/m2 (p less than 0.01), but a modest increase in pulmonary artery diastolic pressure (PADP) and in pulmonary blood volume by approximately 15%, respectively. ISD alone caused a decline in PADP from 26 +/- 2 to 18 +/- 1 mmHg (p less than 0.001), in right heart volume from 300 +/- 36 to 215 +/- 18 ml/m2 (p less than 0.05) and in left heart volume from 321 +/- 28 to 248 +/- 20 ml/m2 (p less than 0.05), but no change in the CI. Combined administration of the two agents resulted in favorable alterations in both hemodynamic variables: PADP decreased from 26 +/- 2 to 20 +/- 1 mmHg (p less than 0.01) and the CI increased from 2.9 +/- 0.1 to 3.3 +/- 0.1 L/min/m2 (p less than 0.05). Thus, DB alone had a tendency to aggravate pulmonary venous congestion in our patients, while ISD is effective in reducing the congestive manifestations of heart failure due to its venodilating effects but less beneficial in increasing the CI. The combined therapy of DB and ISD appears to be extremely effective in restoring an adequate cardiac output and in relieving the symptoms of pulmonary vascular congestion in the presence of mitral stenosis.

Adult↗
PubMed1989

[A case of mitral stenosis with left atrial thrombus arose and reduced in a short-term].

A case of mitral stenosis with left atrial thrombus which rapidly arose and reduced within a month was reported. A 61-year-old female was admitted to our hospital on November 14, 1986 because of a syncopal attack due to ventricular tachycardia. On admission she had typical auscultatory signs of mitral stenosis, mild hepatomegaly and no neurological abnormality. Laboratory findings included coagulation studies were normal, and atrial fibrillation was noted on ECG. Heart catheterization revealed low cardiac output, the mitral orifice area to be 2.4 cm2 and left ventriculography showed mild mitral regurgitation. Ventricular tachycardia was controlled following improvement of heart failure. On two-dimensional echocardiography performed on December 24, left atrial thrombus was revealed which was not detected on December 3. Through the continuous administration of warfarin and aspirin to prevent the thrombus' growth, it markedly reduced in size, from 3 x 2 x 4.5 cm on December 24, 1986 to 1.5 x 1 x 2.5 cm on January 30, 1987 without systemic embolism. Then a mitral valve replacement and a left atrial thrombectomy were performed on February 3, with the removal of a red thrombus, partially organized, measuring 1 x 0.7 x 2.5 cm. This case is unique in its clinical outcome and further investigation is necessary for the management of patients as our case.

Aspirin↗
PubMed1989

[Anaerobic threshold and oxygen uptake in patients with mitral stenosis].

The exercise stress test with a bicycle ergometer was performed for 31 patients with mitral stenosis and for 10 normal subjects. The patients were categorized in two groups. Group 1 consisted of 16 patients having indication for surgical intervention and Group 2 consisted of 15 patients without such surgical indications. Oxygen uptakes at the anaerobic threshold and at peak exercise (MAX) were assessed by percent attainment of the predicted normal value from Posner's equation. Heart rates during exercise did not differ between the two groups. However, Group 1 had significantly smaller values of percent attainment of oxygen uptake both at the anerobic threshold and peak exercise than the controls and Group 2. Oxygen pulses in Group 1 were also significantly less than in the controls or Group 2. Seven cases were reassessed six months or more after surgery including open mitral commissurotomy in two and mitral valve replacements in five. The improvement of oxygen pulse showed a statistical significance. Percent oxygen uptake attainment was also significantly improved both at the anaerobic threshold and at peak exercise. Percent attainment of oxygen uptake in mitral stenosis differed significantly according to the NYHA class both at the anaerobic threshold and peak exercise. These values are considered useful for making decisions for surgical treatment in borderline cases.

Adult↗
PubMed1984

[Non-invasive estimation of transmitral pressure gradient and mitral valve area in mitral stenosis by an ultrasonic pulsed Doppler technique].

We attempted to estimate transmitral pressure gradient and mitral valve area (MVA) noninvasively in mitral stenosis (MS) by a bi-directional pulsed Doppler flowmeter combined with an electronic two-dimensional echocardiograph. Eleven patients with MS in sinus rhythm were studied by cardiac catheterization. Fifteen healthy subjects (H) served as normal control. The pulsed Doppler flowmeter operated with a carrier frequency of 2.5 MHz, a pulse repetition rate of either 5 KHz or 10 KHz and a sample volume of 1 X 3 X 3 mm. The velocity of transmitral central flow was measured by this system, monitoring audible Doppler sounds and cardiac images which depict the anatomic location of the sampling site. The Doppler signal was analyzed by a sound spectrograph. In estimating the transmitral pressure gradient and MVA, we employed a Doppler parameter (half time) defined as the time for instantaneous maximal blood flow velocity to reduce to one-half from its rapid inflow peak, which is independent of the angle between the ultrasonic beam and blood flow. Transmitral pressure gradient (delta P100) was measured as the pressure gradient between either left atrial or pulmonary capillary pressure and left ventricular pressure at the point after 100 msec from the nadir of left ventricular early diastolic pressure [( LA or PC--LVDP]100). MVA was obtained using a Gorlin's formula. The transmitral blood flow velocity in both MS and healthy groups revealed a narrow frequency band pattern with two peaks, R and A, in diastole. The former peak occurred during rapid inflow phase and the latter following atrial contraction. In the healthy group, the descent rate of R wave was increased than that in the MS group. The square root of the pressure gradient also reduced linearly with transmitral flow velocity in the MS group. Thus in the MS group, the transmitral velocity was directly proportional to the square root of the pressure gradient as described by a Bernoulli theorem, and the half time was proportional to the transmitral velocity. The square of the half time (delta t2) was highly correlated with delta P100 (r = 0.97), and the inverse of the half time (delta t-1) was correlated with MVA (r = 0.76). There was no significant correlation between delta P100 and diastolic descent rate of anterior mitral leaflet (DDR). The present study indicates that the half time is useful in estimating transmitral pressure gradient and MVA in mitral stenosis.

Adult↗