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At least 793 records · Page 44Linked to original sources
PubMed1990

Percutaneous double balloon valvotomy for severe rheumatic mitral stenosis.

Percutaneous double balloon valvotomy for severe rheumatic mitral stenosis was successfully performed in 281 of 285 consecutive patients. The changes evoked were a decrease of the mean transvalvular gradient from 16 +/- 7 to 5 +/- 3 mm Hg, an increase in cardiac output from 3.8 +/- 1.0 liters/min to 5.4 +/- 1.5 liters/min and an increase in mitral valve area from 0.86 +/- 0.24 cm2 to 2.41 +/- 0.54 cm2. The mean pulmonary artery pressure decreased from 37 +/- 13 mm Hg to 27 +/- 12 mm Hg and the pulmonary vascular resistance decreased from 307 +/- 181 to 238 +/- 122 dynes/s/cm-5. Symptomatic improvement occurred in 272 of the 285 (95%) patients. There were 3 procedure-related deaths (1%). Postdilatation mitral regurgitation was not significant in most patients. Therefore, this procedure can be performed at a low risk with effective results and a fast recovery.

Adult↗
PubMed1993

Comparison of balloon valvuloplasty with operative treatment for mitral stenosis.

To determine the optimal role for percutaneous balloon mitral valvuloplasty or open mitral commissurotomy, the outcome of 164 consecutive patients undergoing either percutaneous balloon mitral valvuloplasty, open mitral commissurotomy, or mitral valve replacement for mitral stenosis was reviewed. No preoperative differences existed between percutaneous balloon mitral valvuloplasty and open mitral commissurotomy in age, symptoms, or mitral valve characteristics. Symptoms improved similarly in all groups, and median hospital stays after procedures were 2, 9, and 10 days for percutaneous balloon mitral valvuloplasty, open mitral commissurotomy, and mitral valve replacement (p < 0.005). Actuarial survivals at 36 months did not differ significantly (83% +/- 6%, 94% +/- 4%, and 90% +/- 4%). Actuarial freedoms from subsequent mitral valve procedures at 36 months were 66% +/- 7%, 87% +/- 6%, and 100% +/- 13% (p < 0.005), with the linearized rate of subsequent mitral valve procedures being 12% +/- 3%, 4% +/- 2%, and 1.2% +/- 0.8%/patient-year for percutaneous balloon mitral valvuloplasty, open mitral commissurotomy, and mitral valve replacement (p < 0.01). Prior mitral commissurotomy increased the likelihood of subsequent mitral procedures after percutaneous balloon mitral valvuloplasty from 10% +/- 3% to 20% +/- 7%/patient-year.

Adult↗
PubMed1997

Percutaneous transvenous mitral commissurotomy versus surgical commissurotomy in the treatment of mitral stenosis.

There is no doubt that percutaneous transvenous mitral commissurotomy (PTMC) in experienced centers is associated with a low risk of major complications and yields excellent immediate and long-term outcome. Although previous observational studies on both PTMC and surgical commissurotomy have indicated similar outcome between the two treatment strategies in terms of valve area improvement and risk of major complication (death, thromboembolism and significant resultant mitral regurgitation), it was not until recently that several prospective randomized trials comparing the two procedures and involving > 470 patients with favorable valve characteristics (pliable, noncalcified valve with mild subvalvular disease and no or mild mitral regurgitation), have confirmed that PTMC is indeed just as, if not more, effective as surgical commissurotomy. The late restenosis rate at up to 3-year follow-up appears comparable. Furthermore, PTMC has other additional benefits. It is nontraumatic, may be repeated without additional risk, and has been shown to be an extremely useful and efficacious palliative tool in those with end-stage mitral stenosis or with unfavorable valve anatomy who refuse surgery, and in certain subset of patients at high surgical risk because of medical comorbidities.

Angioplasty, Balloon, Coronary↗
PubMed1992

Mitral valve resistance as a hemodynamic indicator in mitral stenosis.

Variability of the valve area calculated by the Gorlin formula has been noted in bioprosthetic and aortic valves, but few data are available for native stenotic mitral valves. Valve resistance has been proposed as an alternative hemodynamic indicator; however, its value in mitral stenosis has not been assessed. Thirty-four patients had simultaneous recordings of left atrial and ventricular pressures, 26 after percutaneous balloon mitral dilatation (PBMD). Patients with shunt or mitral regurgitation were excluded. Mitral valve resistance correlated exponentially with Gorlin mitral area (y = 133*[area]-1.5; p less than 0.0001). Both Gorlin mitral area and mitral resistance improved after PBMD (0.89 +/- 0.07 cm2 to 2.22 +/- 0.15 cm2; p less than 0.001; and 166 +/- 20 to 40 +/- 8 dynes.s.cm-5; p less than 0.001). Gorlin area and mitral resistance correlated with New York Heart Association functional class. After infusion of isoproterenol in 17 patients, there was an increase in Gorlin area (baseline 1.77 +/- 0.22 cm2, change 0.23 +/- 0.10; p less than 0.03), whereas mitral resistance did not change (baseline 96 +/- 16 dynes.s.cm-5, change 2 +/- 5; p = not significant). Mitral resistance is valuable in the assessment of mitral stenosis. It varies less than Gorlin mitral area under changing hemodynamic conditions.

Adolescent↗
PubMed1983

Left atrial-left ventricular bypass for congenital mitral stenosis.

The case of a patient with congenital mitral stenosis successfully treated by insertion of a left atrial-left ventricular valved conduit is presented. After insertion of the conduit, pulmonary artery pressure was normal, persistent pulmonary edema and ascites disappeared, and the child's rate of growth and level of activities returned to normal.

Child↗
PubMed1987

Invasive monitoring and anaesthetic management of a parturient with mitral stenosis.

The anaesthetic management of a parturient with mitral stenosis is presented and discussed. In particular, the beneficial effects of epidural anaesthesia for vaginal delivery are described with respect to the significant improvement noted in haemodynamic parameters. The information derived from the pulmonary artery catheter greatly assisted the management of the patient throughout labour and in the puerperium.

Adult↗
PubMed2004

Regional left atrial coagulation and fibrinolytic activities in patients with mitral stenosis.

Systemic thromboembolism is a major complication of mitral stenosis (MS), especially in those patients having atrial fibrillation (AF). Recent evidence has suggested that regional left atrial coagulation activity may be increased in MS and may contribute to the pathophysiology of left atrial thrombus. However, the relation of left atrial coagulation activity to factors that predispose to left atrial thrombus formation is unknown. Also, the relations between left atrial and systemic coagulation activity, fibrinolysis, and platelet activation remain unresolved. Left atrial and peripheral venous levels of fibrinogen, antithrombin III, factor VII and factor VIII for coagulation, D-dimer, tPA and PAI-I, plasmin and antiplasmin for fibrinolysis, and platelet factor 4 and vWF for platelet activation, and endothelial dysfunction were measured in 46 patients with MS and normal clotting times who were undergoing percutaneous mitral valvuloplasty. Left atrial tPA, plasmin, PAI-I, antiplasmin, PF4, and vWF levels exceeded the corresponding peripheral venous levels (P < 0.05) in patients with MS, being more significant in the AF subgroup. There were no significant differences between left atrial and peripheral venous levels of fibrinogen, D-dimer, factor VII, and factor VIII within the patient group (P > 0.05). The results suggest that there are significant variations in the indices of coagulation, fibrinolytic system and platelet activation, and endothelial dysfunction between left atrial and peripheral venous blood samples of patients with MS that may be due to limited spillover from the left atrium to the systemic circulation.

Adult↗
PubMed1985

[Pre- and postoperative results of spirography and blood gas analysis in patients with atrial septal defect or mitral stenosis].

In patients with atrial septum defect and mitral stenosis, respectively, the ventilation and blood gas parameters were compared before and after cardiac operation. In general postoperatively no reversibility of preoperatively proved pulmonary functional disturbances could be established. Only in individual cases a discrete improvement of some of the functional indicators could be observed. Therefore, the operative intervention on the heart should be performed possibly before the onset of irreversible pulmonary structural changes.

Adolescent↗
PubMed1998

[A successful surgical repair of mitral stenosis and regurgitation with pulmonary arteriovenous fistula].

The patient was a 74-year-old man who was complained cyanosis and shortness of breath on exertion. He had undergone open mitral commissurotomy for mitral stenosis 19 years previously. He was diagnosed with mitral stenosis and regurgitation combined with pulmonary arteriovenous fistula (PAVF). Moderate pulmonary hypertension was also observed. It appeared that the PAVF was located where one-step operation with open heart surgery was anatomically feasible, and that his condition would be improved by resection of the fistula and decreasing overload of left atrium by mitral valve replacement. One-step operation including mitral valve replacement and tricuspid annuloplasty with enuculation of the PAVF was therefore performed. The patient has done well postoperatively, and postoperative cardiac catheterization revealed no increase in pulmonary arterial pressure.

Aged↗
PubMed1989

Beneficial effects of ACE inhibitors in severe mitral stenosis.

There are several reports of beneficial effects of ACE inhibitors in both primary and secondary pulmonary hypertension. However the effect of ACE inhibitors in mitral stenosis is not documented. The authors report three patients with severe mitral stenosis in whom surgery was delayed. They had initial symptomatic improvement with diuretics and sodium restriction, but had recurrence of their symptoms while on treatment. Enalapril not only relieved their symptoms in particular exertional dyspnoea and haemoptysis but prevented recurrence and improved their effort tolerance without causing excessive fall of blood pressure or impairment of renal function.

Adult↗
PubMedDate not supplied

Beta blockade for patients of mitral stenosis in sinus rhythm.

Twenty patients of isolated mitral stenosis in normal sinus rhythm (age 22 +/- 4 yrs) in whom symptoms of systemic and pulmonary congestion were controlled on diuretics were the subjects of the present study. The effects of addition of Metoprolol 50 mg po bid for 4 weeks on subjective and objective indices of exercise tolerance were evaluated. Metoprolol produced greater than 50% subjective improvement in 80% of these patients. The increase in time to dyspnoea and total work done on treadmill after 90-120 mins, and after 12 hrs of a dose of metoprolol, were both significant (p less than 0.01). In none of the patients, resting heart rate less than 50/mt, resting and exercise systolic BP less than 90 and less than 105 mmHg, respectively, or any important untoward effects were observed. Metoprolol's beneficial effects and safety can be judged in these patients at two hours after first dose in out patients clinic.

Heart Rate↗
PubMed1999

Combined spinal-epidural analgesia in the management of labouring parturients with mitral stenosis.

We report the use of combined spinal-epidural analgesia during labour in three parturients with moderately severe mitral stenosis. In each case, rapid analgesia was achieved using intrathecal fentanyl 25 micrograms without major haemodynamic changes. Maintenance analgesia was then established gradually using a dilute epidural infusion of bupivacaine 0.1% and fentanyl 0.0002%, with the avoidance of large or rapid boluses of local anaesthetic. Supplementary analgesia in the latter stages of labour was provided using slow epidural boluses of fentanyl, with or without a low concentration of bupivacaine, which was sufficient to allow controlled instrumental deliveries. We conclude that combined spinal-epidural analgesia is a useful technique for providing analgesia and maintaining haemodynamic stability in parturients with mitral stenosis.

Adult↗
PubMed1995

Long-term outcome of cardiac surgery in patients with mitral stenosis and severe pulmonary hypertension.

BACKGROUND: Pulmonary hypertension increases perioperative risk in patients having mitral valve replacement, but most studies have included patients with mixed mitral valve disease and have not examined long-term outcome. METHODS AND RESULTS: We retrospectively examined the results and predictors of outcome of cardiac surgery in 43 patients (age, 62 +/- 13 years [mean +/- SD]; 81% women) with a primary diagnosis of mitral stenosis and severe pulmonary hypertension (pulmonary artery systolic pressure > or = 60 mm Hg or mean pressure > or = 50 mm Hg). Patients with more than mild mitral regurgitation were excluded. Thirty-eight patients (88%) were in NYHA functional class III or IV, and 11 patients (26%) had an acute presentation requiring urgent surgery. Preoperative hemodynamics demonstrated a mean mitral valve area of 0.7 +/- 0.3 cm2, mean pulmonary artery pressure of 50 +/- 9 mm Hg, and pulmonary artery systolic pressure of 81 +/- 18 mm Hg. Other characteristics included right ventricular failure (18 patients), coronary artery disease (16 patients), and critical aortic stenosis (11 patients). Forty patients underwent mitral valve replacement with St Jude prostheses; 3 had open commissurotomy. Additional surgical procedures included aortic valve replacement (42%), coronary artery bypass graft surgery (26%), and tricuspid valvuloplasty (16%). There were 5 perioperative deaths (11.6%), and 7 other patients (16%) had major complications, including reoperation for hemorrhage, stroke, respiratory failure, myocardial infarction, or a > 30-day hospitalization. Univariate analysis of demographic, hemodynamic, and operative characteristics identified the following predictors of perioperative death (P < .05): acute presentation, clinical evidence of right ventricular failure, impaired left ventricular ejection fraction, and increased left ventricular diastolic pressure. Predictors of complications (P < .05) were acute presentation, ECG evidence of right ventricular hypertrophy, and elevated right ventricular systolic pressure. Multivariate analysis showed only acute presentation and right ventricular hypertrophy as predictors of perioperative death or major complications, respectively. Five- and 10-year actuarial survivals were 80% and 64%, respectively. The only predictor of long-term mortality was advanced age. Functional NYHA status was improved by one grade or more in 76% of survivors. CONCLUSIONS: Patients referred to a tertiary care hospital in the United States with mitral stenosis and severe pulmonary hypertension often have other associated cardiac diseases and comorbid conditions. Cardiac surgery can be successfully performed with an acceptable mortality, and risk factors for poor perioperative outcome can be identified by preoperative clinical characteristics. Younger patients have the best long-term survival, and most survivors experienced long-term improvement in functional status.

Adult↗
PubMed1997

Echocardiographic assessment of mitral stenosis and its associated valvular lesions in 205 patients and lack of association with mitral valve prolapse.

To date, the relation between mitral stenosis (MS) and other associated cardiac valvular lesions has been reported by angiography and surgical pathologic study in patients with more advanced disease but has not been studied systematically by two-dimensional echocardiography and Doppler color flow mapping in a large referral population with a broader spectrum of severity. In addition, prior reports have suggested that up to 40% of patients with MS have mitral valve prolapse (MVP); however, because of recent developments in two-dimensional echocardiographic imaging and the definition of MVP, this association must now be reconsidered. The purpose of this study was to explore the association of other valvular lesions with MS and their relation to its severity and in particular to test whether MS is in fact associated with MVP with the frequency reported previously. We reviewed the studies of 205 consecutive patients (aged 61 +/- 14 years; range 26 to 87 years) with MS who were studied from 1992 to 1994 by two-dimensional echocardiography and Doppler color flow mapping to assess valvular stenosis, regurgitation, and MVP in patients with a range of severity of MS (28% mild, 34% moderate, and 38% severe MS based on mitral valve area). MS was associated with at least mild mitral regurgitation in 78% of patients (160/205), and pure MS was correspondingly uncommon (22%). There was an inverse relationship between the severity of MS and the degree of mitral regurgitation (p < 0.001). MS was frequently associated (54% of patients) with significant lesions of other valves, including aortic stenosis (17%), at least moderate aortic regurgitation (8%) and tricuspid regurgitation (38%), and tricuspid stenosis (4%). Tricuspid stenosis was associated with more severe MS (p < 0.01), and tricuspid regurgitation was more common in patients with mixed MS and regurgitation than in those with pure stenosis (60% versus 26% for at least moderate tricuspid regurgitation; p < 0.001). Mitral valve prolapse was present in only one patient (0.5%). Superior systolic bulging of the midportion of the anterior mitral leaflet toward the left atrium (but not superior to the annular hinge points) was seen in 22 patients (11%). Patients with such superior bulging had significantly lower mitral valve scores but a similar degree of mitral regurgitation compared with those without bulging. The majority of patients with MS (78%) have associated mitral regurgitation and significant lesions of the other cardiac valves (54%). The frequency of true MVP associated with chronic MS is much lower than reported previously. This may provide insight into the underlying pathophysiologic process, tending to shorten the chordae tendineae and leaflets to produce stenosis rather than elongate them to produce prolapse.

Adult↗
PubMed1990

Epidural anesthesia with the Trendelenburg position for cesarean section with or without a cardiac surgical procedure in patients with severe mitral stenosis: a hemodynamic study.

The hemodynamic effects of epidural anesthesia (EA) with the Trendelenburg position were studied in seven patients with severe mitral stenosis undergoing emergency cesarean section (CS) because of hemodynamic deterioration. In six patients, the CS was immediately followed by an open mitral commissurotomy under general anesthesia, whereas in one patient, the CS was performed alone. A significant reduction in heart rate (120 +/- 5 to 83 +/- 7 beats/min; P less than 0.001) was observed after induction of EA. Mean arterial pressure (MAP) decreased (78 +/- 9 to 55 +/- 5 mm Hg; P less than 0.01) simultaneously with reduction of the pulmonary capillary wedge pressure (PCWP) (37 +/- 4 to 15 +/- 4 mm Hg, P less than 0.001) and cardiac index (CI) (2.4 +/- 0.3 to 1.8 +/- 0.32 L/min/m2; P less than 0.001). However, PCWP could be adjusted by selecting the appropriate angle of the Trendelenburg position. When the PCWP was approximately 25 mm Hg, MAP and Cl increased to 72 +/- 7 mm Hg and 3.1 +/- 0.4 L/min/m2, respectively, and a satisfactory hemodynamic state was achieved. Systemic vascular resistance decreased after induction of EA (2,250 +/- 250 to 1,750 +/- 450 dyne.s.cm-5; P less than 0.001), and remained unchanged during the perioperative period. It is concluded that the combination of epidural anesthesia with tilting of the table is a safe method for urgent CS in pregnant women with critical mitral stenosis in whom termination of pregnancy is indicated because of hemodynamic deterioration.

Adult↗
PubMed1988

[The potentials of pulse Doppler echocardiography for the diagnosis and determination of the degree of mitral stenosis].

84 persons were examined: 61 patients with rheumatic mitral valve stenosis (21 men and 40 women), mean age 39.38 +/- 11.2 years and 23 healthy controls (14 men and 9 women), mean age 25.62 +/- 3.8 years. The morphologic and quantitative characteristics of the diastolic part of the pulse Doppler echocardiographic signal of mitral circulation analyzed by histogram of the time intervals show highly significant statistical differences between the patients with mitral valve stenosis and the healthy controls (100% specificity and sensitivity). The differentiation of mild and moderate from severe mitral stenosis by pulse Doppler echocardiography of mitral valve circulation, analyzed by histogram of the time intervals, is achieved with satisfactory precision by determination of the speed of the circulation fall in the early 1/3 of the diastole. The pulse Doppler echocardiograph performed by a transducer with 2.5 mHz frequency and the simultaneous M-echocardiography, the Doppler effect being analyzed by histogram of the time intervals, do not allow the precise determination of the degree of mitral valve stenosis.

Adult↗