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At least 775 records · Page 43Linked to original sources
PubMed1976

Regional lung function in chronic pulmonary congestion with and without mitral stenosis.

Relative regional ventilation and perfusion were measured with xenon-133 in 16 seated patients with pure or predominant mitral stenosis (group 1) and in 12 patients with chronic pulmonary congestion due to left-sided heart disease without mitral stenosis (group 2). The apex-base perfusion gradient was abnormally reduced and often reversed in group 1 patients. There was a significant negative correlation between perfusion gradient and mean pulmonary capillary pressure in both groups, but for a given elevation of pulmonary capillary pressure the perfusion gradient tended to be greater (i.e., less abnormal) in group 2. The regression line of perfusion gradient on pulmonary capillary pressure indicated that perfusion gradient had a value of zero (indicating reversal of the perfusion gradient) at a mean pulmonary capillary pressure of 26 mm Hg in group 2 but at only 18 mm Hg in group 1. Relative lower zone ventilation was abnormally reduced in group 1 and there was a significant negative correlation between ventilation gradient and pulmonary capillary pressure in group 1 but not group 2 patients. Comparison of the distribution of slowly inhaled small volume boluses, large volume boluses, and inspiratory capacity breaths of 133Xe suggested that the lower zone hypoventilation was due mainly to closure of peripheral airways but that selectively increased resistance and reduced compliance in the lower zones may contribute in some patients. Both ventilation and perfusion were reduced at the lung bases in group 1 patients, and between regions nonuniformity of relative ventilation/perfusion was significantly less than normal. Although ventilation distribution was relatively normal in group 2 patients, they also had significantly less regional ventilation/perfusion nonuniformity than normal subjects.

Adult↗
PubMed2004

Factors affecting ST depression during cardiopulmonary exercise testing in patients with mitral stenosis without significant coronary lesions.

Symptom-limited cardiopulmonary exercise testing was performed in 37 patients with mitral stenosis (MS) without significant coronary artery stenosis to evaluate factors affecting ST depression in exercise electrocardiograms. The degree of ST depression was not associated with gender or exercise tolerance. The incidence of significant ST depression was higher in the patients receiving than in those not receiving digitalis (P < 0.05). In addition, the patients with atrial fibrillation and a higher heart rate response were more likely to have a high prevalence of significant ST depression than those with sinus rhythm and a lower response (P < 0.05). We concluded that atrial fibrillation, a higher maximum heart rate, and oral digitalis administration were involved in ST depression during exercise testing in patients with mitral stenosis without coronary heart disease.

Anti-Arrhythmia Agents↗
PubMed1988

Takayasu's arteritis and mitral stenosis.

A 44-year-old housewife was found to have coarctation of the abdominal aorta secondary to Takayasu's arteritis. Since she also had mitral stenosis, possible etiological relation between Takayasu's arteritis and mitral stenosis is suspected.

Adult↗
PubMed1971

Pressure-flow studies in man: effect of atrial systole on ventricular function in mitral stenosis.

The effect of atrial contraction on left ventricular function in six patients with varying degrees of mitral stenosis was determined by utilizing the pressure gradient technique to measure instantaneous aortic blood flow and pressure. Aortic flow was measured as ventricular rate was controlled by right ventricular pacing to create A-V (atrioventricular) dissociation at varying rates (90-150 beats/min). At each heart rate, beats with preceding P waves, effective atrial systole, were grouped according to the duration of the P-R interval. Beats without P waves served as controls. There was always a significant increase in stroke volume, created by effective atrial systole, but the P-R interval at which it took place was different for each patient. There was no difference in the stroke volume for beats preceded by P waves having a P-R interval within the range of 0.05-0.20 sec. These beats were grouped for each patient, subjected to regression analysis, and compared to control beats. The absolute and percent change created by effective atrial systole was inversely proportional to the severity of the disease as determined by mitral valve orifice size. Effective atrial systole plays less of a role in augmenting left ventricular function in patients with mitral stenosis than in patients with normal valves.

Adult↗
PubMed1999

[Percutaneous transvenous mitral valvuloplasty in a pregnant patient. Successful treatment of severe mitral stenosis].

HISTORY AND CLINICAL FINDINGS: A 31-year-old woman presented in the 25th week of pregnancy with ankle and pretibial oedema and increasing dyspnoea, ultimately in class IV (New York Heart Association classification). There were fine rales on auscultation and dullness on palpation over both lung bases. The heart rate was regular at 110/min. The first heart sound was very loud, and there was a mitral opening snap and a loud diastolic murmur maximal, over the cardiac apex. INVESTIGATIONS: The ECG showed sinus rhythm at a rate of 110/min, left axis deviation, incomplete right bundle branch block and P biatriale, but no other abnormalities. Echocardiography revealed biatrial enlargement and an enlarged right ventricle as well as pulmonary systolic hypertension of 100 mm Hg. Doppler sonography demonstrated severe mitral stenosis with a calculated mitral opening area of 0.9 cm2. DIAGNOSIS, TREATMENT AND COURSE: The symptoms improved only slightly under conservative drug treatment. The mitral valve changes, as noted sonographically, met the criteria for percutaneous transluminal balloon mitral valvoplasty (PTBMV), which was successfully performed. Afterwards the mitral opening area was 2.6 cm2 and pulmonary artery pressure gradually became normal. She was delivered without complication of a healthy child in the 39th week of pregnancy. CONCLUSION: PTBLMV is a relatively low-risk treatment in pregnant women with symptomatic mitral stenosis.

Adult↗
PubMed2001

Closed commissurotomy versus balloon valvuloplasty for rheumatic mitral stenosis.

BACKGROUND AND AIM OF THE STUDY: Closed mitral commissurotomy (CMC) and percutaneous mitral balloon valvuloplasty (PMBV) were compared by their initial results and Doppler echocardiographic data obtained at one week and one year after the procedure. METHODS: Of 580 patients with severe rheumatic mitral stenosis, 280 underwent CMC and 300 PMBV. The mean pre-procedural transmitral gradient (TMG) was 21 +/- 6 mmHg in the CMC group and 20 +/- 5 mmHg in the PMBV group (p = 0.6); the mean mitral valve area (MVA) was 1.1 +/- 0.2 cm2 in both groups. RESULTS: Mortality was 0.7% after CMC and 0.3% after PMBV; the primary success rates were 98.3% and 89% respectively (p <0.0001). Two CMC patients and three PMBV patients underwent emergency mitral valve replacement. At the first week, the mean TMG was decreased to 4 +/- 3 mmHg in the CMC group, and to 5.8 +/- 2 mmHg in the PMBV group (p <0.0001). The mean MVA was increased to 2.5 +/- 0.5 cm2 after CMC, and to 2.1 +/- 0.4 cm2 after PMBV (p <0.0001). After one year, TMG was 5.4 +/- 4 mmHg in the CMC group (p <0.0001) and 7.1 +/- 3 mmHg in the PMBV group (p <0.0001); MVA was 2.3 +/- 0.5 cm2 (p <0.0001) and 1.9 +/- 0.4 cm2 (p <0.0001), respectively. The results of CMC were significantly better (p <0.0001) with regard to TMG and MVA at these times. A significant decrease was also seen in mean left atrial diameter and pulmonary artery pressure in both groups (p <0.0001). CONCLUSION: Although satisfactory results can be achieved using either approach, CMC provides a higher primary success rate, greater MVA augmentation, and better technical control during the procedure, while reducing the cost. PMBV shortens in-hospital stay and eliminates the risk imposed by thoracotomy and anesthesia. Therefore, in our practice, when surgical intervention is contraindicated due to associated problems, PMBV may be the preferred approach, but exposure to radiation may be of concern in pregnant patients.

Adult↗
PubMed1981

[Two-dimensional echocardiography in preoperative evaluation of mitral stenosis (author's transl)].

Two-dimensional echocardiograms were correlated with the operative findings and surgical procedures in 46 patients with mitral stenosis. In addition, a new projection evaluating subvalvular lesion more precisely was reported. Two-dimensional echocardiographic findings studied were 1) pathology of the two leaflets of the mitral valve, 2) valve area, and 3) subvalvular lesion. The findings of leaflets and valve area were well correlated with the operative findings. But there were six cases with discrepancies in the initial 22 cases about the findings of subvalvular lesion; there were 5 false negative and one false positive case. It was considered that insufficient information about the appositional zone of the mitral valve and chordae tendineae made it difficult to evaluate them correctly. We have designed a new projection for delineating the subvalvular apparatus and employed in the next 24 cases, and the transducer was placed near the apical heart to visualize 4 chambers. This eliminated greatly the false positive cases (only 2 out of 24 cases). There were three cases of mitral valve replacement (MVR) in the initial 22 cases, but we could expect the necessity of MVR in only one case, and we had to perform chordotomy, papillotomy, or debridement as well as commissurotomy in two false positive cases. In the next 24 cases, however, we could predict it in all three cases of MVR before the operation. It was valuable for surgery of mitral stenosis to get enough information about the subvalvular lesion as well as mitral leaflets by two-dimensional echocardiography.

Adult↗
PubMed1995

[Correlation between transthoracic and transesophageal echocardiography and surgery in mitral stenosis].

This prospective study was designed to analyse transthoracic and transesophageal echocardiographic findings in the morphological study of the mitral valve and to compare them with surgical findings. This study was based on a series of 60 consecutive patients (38 men and 22 women with a mean age of 36.3 +/- 4.2 years) undergoing open heart surgery for pure or very predominant symptomatic mitral stenosis between November 1993 and December 1994. All patients were investigated by transthoracic and transesophageal echocardiography an average of 3 days before the surgical operation. Qualitative analysis of the mitral valve was rigorously performed according to a 4-point severity score taking into account mobility, thickness and degree of valve calcification as well as the condition of the subvalvular apparatus. The global echocardiographic score corresponded to the sum of the scores for these 4 elements. Transesophageal echocardiographic data and surgical findings were identical: global score: 9.3 vs 9.5, mobility: 2.8 vs 2.9, thickness: 2.6 vs 2.5, calcifications: 1.7 vs 1.8, condition of the subvalvular apparatus: 2.2 vs 2.3. The degree of valve damage was overestimated by transthoracic echocardiography compared to surgical data: global score: 10.4 vs 9.5 (p < 0.05), mobility: 3.1 vs 2.9 (p < 0.05), thickness: 2.8 vs 2.5 (p < 0.01), calcifications: 2.1 vs 1.8 (p < 0.01), but the difference was not significant for the condition of the subvalvular apparatus: 2.4 vs 2.3. In conclusion, surgical findings in pure or very predominant mitral stenosis are more closely correlated with transesophageal echocardiographic data than with transthoracic echocardiography, which tends to overestimate the severity of anatomical lesions, particularly valvular calcification.

Adult↗
PubMed1999

[A case report of successful mitral valve replacement for congenital mitral stenosis associated with coarctation of the aorta and ventricular septal defect].

A 5-month-old infant with coarctation of the aorta, ventricular septal defect and mitral stenosis known as "Shone's anomaly" is presented. He underwent the repair of coarctation of the aorta by means of the extended aortic arch anastomosis and banding of the pulmonary trunk at 1 month of age and the patch closure of ventricular septal defect and debanding of the pulmonary trunk at 3 months of age in our institution. About 2 months after second surgery, he had been admitted to our institution due to developing tachypnea and he needed the support of mechanical ventilation. The chest X-ray showed pulmonary congestion and the echocardiography revealed only one papillary muscle of mitral valve and pressure gradient about 30 mmHg through mitral valve. Mitral stenosis due to parachute mitral valve was suspected and he was subjected to an emergent surgery. Initially we performed mitral valve repair for parachute mitral valve but echocardiography during the surgery revealed moderate grade of mitral regurgitation and a hemodynamics was not satisfactory. Eventually mitral valve replacement was successfully done with Carbo-Medics mechanical valve (19 mm in diameter) in the position of left atrial wall because his mitral annulus was so small as 10 mm in diameter. The postoperative course was uneventful and the patient has been doing well.

Aortic Coarctation↗