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At least 739 records · Page 41Linked to original sources
PubMed1996

O2 supply dependence of respiration in patients with mitral stenosis undergoing valvuloplasty.

Although systemic oxygen consumption (V O2) is independent of O2 delivery (Q O2) in normal subjects, studies have suggested that supply dependence of V O2 may occur in patients with chronic diseases associated with reduced Q O2. In this regard, we previously found that Q O2 and V O2 increased when cardiac output was improved after balloon valvuloplasty in patients with aortic stenosis. However, their increases in Q O2 were relatively small, and it was not known whether the increase in V O2 was caused by the increase in delivery or was merely a response to the transient hypotension induced by valvuloplasty. Because patients with mitral stenosis frequently exhibit greater improvements in cardiac output after valvuloplasty than do patients with aortic stenosis, the present study sought to determine (1) whether V O2 is increased after valvuloplasty in patients with mitral stenosis, and (2) whether the magnitude of the increase in V O2 correlates with the magnitude of the improvement in cardiac output and Q O2. Oxygen delivery, V O2, and hemodynamics were measured in 57 patients with mitral stenosis before and 20 to 30 min after undergoing balloon valvuloplasty. After valvuloplasty, Fick-derived oxygen delivery increased by 13.0% (95% confidence interval: 10.8 to 15.2%), whereas V O2 (expired gas) increased by 8.3% (95% confidence interval: 9.5 to 12.3%). A correlation between Fick-derived Q O2 and V O2 was found (p<0.005) with a slope of 0.66 (95% confidence interval: 0.07 to 1.24), but the O2 extraction ratio did not change (-1.0%; 95% confidence interval: -2.7 to 0.5%). A significant correlation between the change in Q O2 and the change in V O2 was also seen (p<0.02). These findings suggest that the increase in V O2 may have been a consequence of the increase in Q O2 rather than a response to the procedure itself.

Adult↗
PubMed1991

[The atrial contribution to ventricular filling in mitral stenosis. An evaluation by Doppler echocardiography].

Using Doppler echocardiography, we have quantified the atrial contribution to ventricular filling in 22 patients with mitral stenosis in sinus rhythm without or with minimal mitral and/or aortic regurgitation. With continuous wave Doppler from apex we obtained the ventricular filling flow from which the valvular area was calculated. The product of the integrated ventricular filling waves multiplying by the valvular area was called total volume (TV). Assuming that the deceleration of the ventricular filling flow is linear and remain constant, we integrated the transmitral flow, this time without considering the atrial filling wave as if the patient was entering into atrial fibrillation. Multiplying this integration by the valvular area we obtained a second volume, atrial fibrillation volume (AFV). The atrial contribution was calculated by: 1) absolute value: TV-AFV and in 2) percent value or fraction: (TV-AFV/TV) x 100. When we correlate absolute and percent values with mitral valve area, the results were statistically significant in both cases (p less than 0.001), with an excellent regression factor both with absolute value r = 0.90 and the percent one r = 0.72. In mitral stenosis the atrial contribution to ventricular filling has an inverse relation with the grade of severity, being very low in the more severe lesions. This is why it would be doubtful that its lost (atrial contribution) is the only cause of hemodynamic deterioration that has been observed in patients who suddenly present atrial fibrillation.

Adolescent↗
PubMed2001

[A case of free-floating ball thrombus in left atrium with mitral stenosis].

We report a rare case of free-floating ball thrombus in the left atrium with mitral stenosis. The patient was 71-year-old woman who admitted to the local hospital for transient ischemic attack. Electrocardiography showed atrial fibrillation and an echocardiogram examination revealed free-floating ball thrombus in the left atrium with mitral stenosis. She was transferred to our hospital for emergency open heart operation. After removal of the ball thrombus, mitral valve replacement and modified MAZE procedure were successfully performed. The size of the ball thrombus was 40 x 30 x 33 mm and weighed 20 g. Postoperative course was uneventful.

Aged↗
PubMedDate not supplied

Determinants of left ventricular function in isolated rheumatic mitral stenosis.

Left ventricular end-diastolic volume (preload), peak systolic wall stress (afterload), instant Emax (contractility index = peak systolic left ventricular pressure/end-systolic volume), left ventricular mass, left ventricular ejection fraction (LVEF) alone and normalised for mass index, were studied in 30 patients with isolated rheumatic mitral stenosis (group 1) and compared with 24 normal individuals (group II) who served as control. Preload was not different in the two groups (p = NS), afterload was increased in group I (p = 0.01), while LVEF, Emax, left ventricular mass and mass normalised LVEF were reduced in mitral stenosis as compared to normal control (p less than 0.01- less than 0.001). Comparison of patients with reduced ejection performance (LVEF less than 50%, n = 9, group IA) with those having normal LVEF (n = 21 group IB) revealed increased left ventricular end-diastolic volume and reduced left ventricular mass, mass normalised ejection fraction and Emax (in IA p less than 0.05). Peak systolic wall stress was comparable in these two subgroups. This study shows that the major determinant of left ventricular dysfunction in isolated rheumatic mitral stenosis is impaired contractility and not the loading factors.

Adolescent↗
PubMed2005

Rheumatic mitral stenosis presenting as acute abdominal aortic occlusion and foot drop.

Systemic thromboembolism in not an infrequent complication of rheumatic mitral stenosis. We report a case of acute abdominal aortic occlusion due to rheumatic mitral stenosis, in the absence of atrial fibrillation, mimicking spinal cord compression. Systemic streptokinase given 48 hours after symptom's onset lead to rapid and dramatic recovery with limb salvage.

Aorta, Abdominal↗
PubMed2005

Usefulness of measuring net atrioventricular compliance by Doppler echocardiography in patients with mitral stenosis.

Twenty-six patients with severe pure mitral stenosis underwent Doppler echocardiographic examination and cardiac catheterization within the same day before the realization of mitral valve balloon valvuloplasty. Net atrioventricular compliance estimated by Doppler echocardiography from the ratio of mitral valve effective orifice area and E-wave downslope was a major independent determinant of left atrial and pulmonary arterial pressures measured by catheterization.

Atrioventricular Node↗
PubMed1992

[Two operated cases of mitral stenosis (MS) associated with left atrial ball thrombus].

Mitral stenosis associated with left atrial ball thrombus is rare. Removal of left atrial ball thrombus and mitral valve replacement was performed in two patients successfully. The rate of thromboembolism was high in patient who has left atrial ball thrombus. Also, sudden death was reported in these cases due to incarceration of ball thrombus in the mitral orifice (hole-in-one thrombus). We concluded that we should operate the MS associated with left atrial ball thrombus as soon as possible.

Female↗
PubMed1996

Severely symptomatic mitral stenosis with a low gradient: a case for low-technology medicine.

We have observed a group of patients with mitral valve disease and severe symptoms but also with low transmitral gradients and normal cardiac outputs who defy the traditional hemodynamic explanation of mitral stenosis. We performed a 10-year retrospective chart review of all mitral valve replacements at our institution to further characterize this population. The study group consisted of 16 of 132 patients (12%) with symptomatically severe (New York Heart Association [NYHA] class 3.3 +/- 0.5) mitral stenosis but a low (< 10 mm Hg) transmitral gradient, a normal cardiac output (4.8 +/- 1.2 L/min), and a preserved valve area (1.6 +/- 0.4 cm2). Sixteen patients were randomly chosen from the remaining group to serve as a comparison population. Study patients were noted to have less atrial fibrillation, lower wedge and mean pulmonary artery pressures, and a higher incidence of subvalvular disease identified at the time of surgery than did the comparison population. Left ventricular end-diastolic pressure and cardiac output did not differ. Study patients did well with surgery and reported an excellent functional benefit. We believe that this subgroup of patients with mitral valve disease is important, may be missed by using conventional criteria of valve area to determine timing of surgical intervention, and may have their symptoms primarily because of subvalvular disease. Further and perhaps most important, this group illustrates the ongoing need for careful clinical assessment skills and judgement in the face of ever-increasing technology.

Adult↗
PubMed1993

Left atrial spontaneous echo contrast is highly associated with previous stroke in patients with atrial fibrillation or mitral stenosis.

BACKGROUND AND PURPOSE: Spontaneous echo contrast is a dynamic smokelike signal that is detected by transesophageal echocardiography in patients with stasis of blood in the left atrium. We designed this study to determine if spontaneous echo contrast is associated with an increased risk of previous stroke or peripheral embolism. METHODS: Forty-two patients with spontaneous echo contrast were identified (34 had atrial fibrillation or mitral stenosis; 8 had neither). Control subjects comprised 40 patients randomly selected from patients with atrial fibrillation or mitral stenosis who did not have spontaneous echo contrast at transesophageal echocardiography. The frequency of vascular risk factors, echocardiographic features, and stroke or peripheral embolism within 1 year of echocardiography were compared in the two groups. RESULTS: The frequency of traditional risk factors for stroke were the same in both groups, yet 9 of 42 patients with spontaneous contrast had stroke or peripheral embolism compared with only 1 of 40 control subjects (P < .02; relative risk, 10.6; 95% confidence interval, 1.3 to 88.4). In patients with nonvalvular atrial fibrillation, 6 of 12 patients with spontaneous contrast had a stroke or peripheral embolism compared with 1 of 28 patients without spontaneous contrast (P < .001; relative risk, 27.0; 95% confidence interval, 2.7 to 267.8). CONCLUSIONS: Spontaneous echo contrast is highly associated with previous stroke or peripheral embolism in patients with atrial fibrillation or mitral stenosis. Transesophageal echocardiography may enable stratification of cardioembolic risk in patients with nonvalvular atrial fibrillation.

Aged↗
PubMed1997

[A successful mitral valve replacement for a 13-year-old girl with mitral stenosis and pulmonary hypertension after renal transplantation].

Mitral valve replacement was successfully performed in a 13-year-old girl due to severely calcified mitral valve stenosis and pulmonary hypertension who had undergone renal transplantation from her father at the age of 8 years old. Although, percutaneous transluminal mitral commissurotomy had been performed for four times until January 1996, severe mitral stenosis could be relieved and she was transported to our hospital in emergency for respiratory failure caused by pulmonary edema. Then we decided to perform mitral valve replacement. The operation was done successfully using trans-septal superior approach with SJMHP 19 mmM. the blood cyclosporin levels were monitored and controlled within normal limits. This is the first successful case of pediatric open heart surgery after renal transplantation to our knowledge.

Adolescent↗
PubMed1989

Exercise Doppler echocardiography in patients with pure mitral stenosis.

Exercise increases heart rate and cardiac output and is helpful in the determination of dynamic mitral gradient in patients with mitral stenosis. However exercise is difficult to perform during cardiac catheterization in a premedicated recumbent patient and is only feasible when the brachial approach is used. Therefore, in the haemodynamic laboratory, exercise has important practical limitations. In order to obtain similar information using a reproducible and non-invasive technique, we tested the feasibility of combined two-dimensional and continuous wave Doppler echocardiography during exercise in a selected number of patients with pure mitral stenosis and in sinus rhythm. Seven patients, ranging from 14 to 48 years (average: 35 +/- 13), underwent baseline two-dimensional and continuous wave Doppler examinations, repeated after 2 minutes of supine bicycle exercise at a workload of 25, 50, 75 watts. The following parameters were derived and averaged: mean velocity of flow across the mitral valve, mean mitral valve gradient, diastolic filling period and heart rate. The increase in mitral valve flow was from 1.5 +/- 0.3 to 2.2 +/- 0.5 m/s (p less than 0.001); the corresponding increase in mean pressure gradient was from 11 +/- 3 to 21 +/- 8 mmHg (p less than 0.001). The decrease in the diastolic filling period was from 424 +/- 170 to 272 +/- 73 msec (p less than 0.005). The increase in heart rate was from 60 +/- 10 to 100 +/- 18 beats/minute (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[The treatment of severe mitral stenosis by percutaneous transvenous commissurotomy].

In 110 adult selected patients, 87.1% female (average age 38.2 years, range 16-72) with symptomatic, severe mitral stenosis eligible for surgery, we performed balloon catheter transvenous mitral commissurotomy (BCTMC) as alternative treatment. Inoue's catheter was utilized in 80 cases (72.7%), and the double-balloon technique in 30 (27.3%). The procedure was successful in 102 patients (92.7%, 2nd attempt in 5 cases), with optimal results in 96 (87.3%); and it was unsuccessful in one patient for a technical difficulty. Complications occurred in 3 cases due to perforation of a cardiac chamber (2.7%); and 4/106 patients developed severe mitral insufficiency (3.8%). The mitral valve area increased from 1.09 +/- 0.27 to 2.6 +/- 0.87 cm2 (p < 0.0001); the diastolic mitral gradient decreased from 18.9 +/- 5.9 to 3.6 +/- 2.8 mmHg (p < 0.0001); similar reduction was obtained in mean left atrial pressure from 26.2 +/- 6.5 to 12.5 +/- 4.2 mmHg (p < 0.0001), and mean pulmonary artery pressure from 38 +/- 17 to 26.2 +/- 10.4 mmHg (p < 0.005). New mitral insufficiency appeared or increased in more of one grade in 12/106 patients (11.3%), and it was not detectable in 86/106 patients. During long-term follow-up (average 10.4 months, range 5 to 24), all patients (100 cases) improved their functional class (83.1% asymptomatic), and maintained their 2D echocardiographic mitral valve area. In conclusion BCMTC is the treatment of choice for selected cases of acquired symptomatic mitral stenosis, with immediate and long term results comparable to surgical commissurotomy.

Adolescent↗
PubMed1988

Coronary arterial embolism due to valvular debris after percutaneous valvuloplasty of calcific mitral stenosis.

A 74-year-old woman with refractory congestive heart failure due to long-standing calcific mitral stenosis who refused surgical intervention was treated with percutaneous balloon valvuloplasty. After an uneventful procedure, hemodynamic results were satisfactory with an increase in the mitral valve area from 0.4 to 1.1 cm2. Five hours after the procedure, the patient had a bout of vomiting followed by pulmonary aspiration. Electrocardiography, and in the further course, creatine kinase MB elevation, showed anterior myocardial infarction. Necropsy disclosed embolic material in the mid left anterior descending artery which unequivocally consisted of valvular material. This case demonstrates embolism of valvular debris as a life-threatening, procedure-related complication of percutaneous valvuloplasty of calcific mitral stenosis.

Aged↗
PubMed1993

[Percutaneous valvuloplasty in mitral stenosis].

Since May 1991 to July 1992, 83 patients (mean age 49 +/- 13 years, 17 males and 66 females) underwent percutaneous mitral valvuloplasty according to Inoue's technique. Following Wilkins' criteria echo-score was < or = 8 in 46 patients and mono-commissural calcifications were present in 8 cases. Sixteen (19%) patients had previous surgical mitral commissurotomy and 15 (18%) had previous embolic events. The indications for the procedure were given on the basis of the echo-score (ideal cases with score < or = 8). All patients but 2 were successfully treated. Two patients who developed mitral regurgitation grade 3+/4+ were referred to elective surgery. Mitral valve area increased from 1.1 +/- 0.2 to 2 +/- 0.3 cm2 (p < 0.001) and transvalvular pressure gradient fell from 16 +/- 5 to 6 +/- 3 mmHg (p < 0.001). Patients with previous surgical commissurotomy had a lower increase in mitral valve area than patients without previous surgery (p < 0.02). Patients with echo-score > 8 presented a more evident increase in mitral regurgitation than patients with good valvular anatomy, even if this difference was not significant. At 6 and 12 month follow-up respectively 2 and 1 restenosis occurred, but in 1 of these cases the residual valvular area was > 1.5 cm2. The authors conclude that in selected patients with mitral stenosis percutaneous mitral valvuloplasty seems to be an effective and safe treatment. Furthermore, immediate and middle-term results show that this technique can be performed without adjunctive risks and with satisfactory results also in cases of no ideal clinical and/or valvular conditions (echo-score > 8, previous surgical commissurotomy, history of embolism, mono-commissural calcifications).

Adult↗
PubMed1992

Immediate effects of percutaneous transvenous mitral commissurotomy on pulmonary hemodynamics at rest and during exercise in mitral stenosis.

Hemodynamics were evaluated during exercise in 33 patients with mitral stenosis who underwent percutaneous transvenous mitral commissurotomy (PTMC). PTMC was performed using an Inoue balloon. Each patient underwent a supine ergometer exercise test before and on the day after PTMC. Ergometer work load was started at 20 W and increased in increments of 20 W at 3-minute intervals until terminated by the patient's fatigue or shortness of breath. Mitral valve area increased by 0.8 +/- 0.4 cm2 (1.1 +/- 0.3 to 1.9 +/- 0.4 cm2, p less than 0.001). Mean mitral pressure gradient decreased (12 +/- 5 to 6 +/- 2 mm Hg, p less than 0.001). Pulmonary arterial pressure significantly decreased and the cardiac index significantly increased both at rest and during exercise after PTMC. Before PTMC, the increases in pulmonary arterial pressure, total pulmonary resistance and pulmonary arteriolar resistance during exercise were greater in patients with a mitral valve area less than 1.0 cm2 than in patients with an area greater than or equal to 1.0 cm2. After PTMC, total pulmonary resistance still increased during exercise. However, pulmonary arteriolar resistance did not change during exercise in patients with a mitral valve area greater than or equal to 1.5 cm2, whereas it increased in patients with an area less than 1.5 cm2. An enlarged mitral valve area greater than or equal to 1.5 cm2, which may prevent pulmonary vasoconstriction and permits a greater increase in pulmonary blood flow during exercise, is considered a good result immediately after PTMC.

Cardiac Catheterization↗
PubMed1983

Detection and estimation of rheumatic mitral regurgitation in the presence of mitral stenosis by pulsed Doppler echocardiography.

The sensitivity and specificity of pulsed Doppler echocardiography (PDE) in diagnosis and estimation of the severity of mitral regurgitation in the presence of rheumatic mitral stenosis was studied in 34 patients (18 women and 16 men) ranging in age from 33 to 70 years (mean 55). Definitive diagnosis of mitral regurgitation was confirmed in all patients by angiography and in 20 patients also by indicator dilution technique. Mitral regurgitation was detected by PDE in all patients with angiographically proven severe mitral regurgitation and in 7 of 8 patients with moderate mitral regurgitation. In patients with trace to mild mitral regurgitation, PDE was positive in only 7 of 13 patients. When subdivided for mild, moderate and severe mitral regurgitation, PDE sensitivity for diagnosis was 54, 88, and 100%, respectively; overall accuracy was 79% and specificity was 100%. Average systolic dispersion on time-interval histogram was 59% for mild, 89% for moderate, and 100% for severe mitral regurgitation. Groups of patients with mild mitral regurgitation could be differentiated from those with moderate (p less than 0.05) and severe (p less than 0.01) mitral regurgitation. A significant overlap of individual values, however, occurred. In 7 of 11 patients with moderate to severe mitral regurgitation, systolic turbulence also was detected in the left atrium. PDE was sensitive and specific in diagnosing moderate to severe mitral regurgitation in the presence of mitral stenosis. Assessment of precise severity of mitral regurgitation is still a problem in individual patients.

Adult↗
PubMed1983

Relationship between left ventricular morphology and postoperative cardiac function following valve replacement for mitral stenosis.

The left ventricular myocardium excised from 14 patients who had mitral stenosis and who underwent mitral valve replacement was examined, and myocardial fibrosis was quantitated in relation to cardiac function. Conventional mitral valve replacement was performed with cold potassium-induced cardioplegia associated with systemic hypothermia (28 degrees C rectal temperature) and topical cooling. All 14 patients had perivascular fibrosis; the amounts ranged from 16% to 54% of the whole tissue excised. The mean left ventricular end-diastolic volume index (LVEDVI) determined by M-mode echocardiography increased significantly (p less than 0.001) from 66.9 +/- 4.6 ml/m2 preoperatively to 79.0 +/- 2.9 ml/m2 postoperatively. The difference between preoperative and postoperative LVEDVIs was significantly correlated (p less than 0.01) to the percentage of myocardial fibrosis (r = 0.72), in that the index increased postoperatively when myocardial fibrosis was more than 35% and decreased when fibrosis was less than 35%. After mitral valve replacement, the mean ejection fraction increased when fibrosis was less than 35% of whole tissue (+0.12 +/- 0.04) and decreased when fibrosis was greater than 35% (-0.02 +/- 0.02, p less than 0.01). No measured preoperative hemodynamic parameters were predictive of prognosis. These data suggest that the degree of myocardial fibrosis is related to left ventricular performance after mitral valve replacement.

Adult↗