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At least 811 records · Page 45Linked to original sources
PubMed1988

Balloon valvuloplasty for treating pulmonic, mitral and aortic valve stenosis.

Percutaneous balloon valvuloplasty is a technique that has been developed in the cardiac catheterization laboratory over the last 5 years for the treatment of pulmonic, mitral and aortic valve stenosis in children and adults. This review will attempt to summarize recent advances in this new field of invasive cardiology over the last several years.

Aortic Valve Stenosis↗
PubMed1998

Percutaneous balloon versus surgical closed and open mitral commissurotomy: seven-year follow-up results of a randomized trial.

BACKGROUND: Percutaneous balloon mitral commissurotomy (BMC) has been proposed as an alternative to surgical closed mitral commissurotomy (CMC) and open mitral commissurotomy (OMC) for the management of rheumatic mitral valve stenosis (MS). METHODS AND RESULTS: We conducted a prospective, randomized trial comparing the results of the 3 procedures in 90 patients (30 patients in each group) with severe pliable MS. Cardiac catheterization was performed in all patients before and at 6 months after each procedure. All patients had clinical and echocardiographic evaluation initially and throughout the 7-year follow-up period. Gorlin mitral valve area (MVA) increased much more after BMC (from 0.9+/-0.16 to 2.2+/-0.4 cm2) and OMC (from 0.9+/-0.2 to 2.2+/-0.4 cm2) than after CMC (from 0.9+/-0.2 to 1.6+/-0.4 cm2). Residual MS (MVA <1.5 cm2) was 0% after BMC or OMC and 27% after CMC. There was no early or late mortality or thromboembolism among the three groups. At 7-year follow-up, echocardiographic MVA was similar and greater after BMC and OMC (1.8+/-0.4 cm2) than after CMC (1.3+/-0.3 cm2; P<.00l). Restenosis (MVA <1.5 cm2) rate was 6.6% after BMC or OMC versus 37% after CMC. Residual atrial septal defect was present in 2 patients and severe grade 3 mitral regurgitation was present in 1 patient in the BMC group. Eighty-seven percent of patients after BMC and 90% of patients after OMC were in New York Heart Association functional class I versus 33% (P<.0001) after CMC. Freedom from reintervention was 90% after BMC, 93% after OMC, and 50% after CMC. CONCLUSIONS: In contrast to surgical CMC, BMC and OMC produce excellent and comparable early hemodynamic improvement and are associated with a lower rate of residual stenosis and restenosis and need for reintervention. However, the good results, lower cost, and elimination of drawbacks of thoracotomy and cardiopulmonary bypass indicate that BMC should be the treatment of choice for patients with tight pliable rheumatic MS.

Adolescent↗
PubMedDate not supplied

[Percutaneous mitral valvulotomy using the Inoue balloon technique].

We have reviewed our initial experience with percutaneous mitral valvulotomy (PMV) in 29 consecutive patients with mitral stenosis using the Inoue mono-balloon technique. In all cases, the venous transeptal anterograde approach was used. Age was 49.5 +/- 12.5 years (range 21-78) and only 5 (17%) patients were male. Clinical status was as follows: 15 patients were in NYHA class II, 13 NYHA class III and one in NYHA class IV. Atrial fibrillation was present in 15 (52%) patients and 16 (55%) were on coumarin. An echocardiographic score was employed to assess mitral valve anatomy, parameters including degree of thickening, mobility, calcification and subvalvular involvement were scored independently from 1 to 4. The echocardiographic score so determined was 7.72 +/- 2.1 for the entire group. Ten patients presented mild (+) mitral regurgitation prior to PMV. The mean duration of PMV was 76.2 +/- 29.6 minutes. In only one patient an inadequate positioning of the balloon prevented dilatation of the valve whereas the remaining 28 patients had their valves successfully dilated. Mitral valve area, by means of both Gorlin and Doppler (pressure half time) methods, increased in all cases: from 0.95 +/- 0.17 cm2 to 1.92 +/- 0.31 cm2 (p less than 0.001) and from 0.97 +/- 0.22 to 1.84 +/- 0.33 cm2 (p less than 0.001), respectively. Mitral regurgitation increased angiographically in more than 1 degree only in 1 patient, but no other cardiac or vascular complication occurred. Thus, in our experience PMV with the Inoue mono-balloon catheter is a safe and effective method for dilating mitral valve stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

Nongenetically transmitted disproportionate ventricular septal thickening associated with left ventricular outflow obstruction.

Clinical, haemodynamic, and morphological features are described in 2 patients with disproportionate ventricular septal thickening, left ventricular outflow obstruction with systolic anterior motion of the anterior mitral leaflet, and either acquired or congenital heart disease. The disproportionate septal thickening in these patients appeared to be secondary to their underlying cardiac disease rather than a manifestation of genetically transmitted hypertrophic cardiomyopathy. One patient with combined aortic and mitral stenosis had severe systolic anterior motion of the anterior mitral leaflet and a residual large systolic pressure gradient between left ventricle and systemic artery after aortic valve replacement. In this patient the systolic anterior motion was evident in the presence of mitral valve stenosis. The other patient with mild aortic stenosis and a previously repaired coarctation of the aorta also had mild systolic anterior motion and a small subaortic systolic pressure gradient. Hence, these 2 patients demonstrate that disproportionate septal thickening secondary to acquired or congenital heart disease may be associated with left ventricular outflow obstruction and systolic anterior motion of the anterior mitral leaflet.

Adolescent↗
PubMed1991

[Cardiovascular causes of abnormal fatigability].

Excess fatigue is a common symptom of many chronic cardiovascular disorders with low cardiac output. Impairment of skeletal muscle function due to metabolic alterations seems to play a major role. In heart failure fatigue is a predominant symptom. It may be an early symptom on diseases with slow but progressive inhibition of blood flow, i.e. in constrictive pericarditis, pulmonary hypertension or mitral valve stenosis. Excess fatigue as a precursor of myocardial infarction is being discussed. Finally fatigue may be a limiting side effect of diuretic and beta-blocking agents.

Arrhythmias, Cardiac↗
PubMed1960

Aortic stenosis: surgical treatment under direct vision, using the heartlung machine.

Cardiac operation with the operative field under direct vision and the patient's oxygenation maintained by a heart-lung machine affords an excellent means of treating aortic stenosis, for it allows unlimited time in which to repair aortic stenosis no matter how involved the cusps are with calcium. The valves can be sculptured and the commissures cut at their place of fusion. Concomitant aortic insufficiency can also be taken care of at the same time, as can associated mitral valve stenosis and insufficiency. This method was used in ten patients. Two died. Eight were considerably improved.

Aortic Valve Insufficiency↗
PubMed1991

Percutaneous mitral balloon valvotomy in pregnancy using the Inoue balloon technique.

We describe a 40-year-old female who was 27 weeks pregnant and had severe rheumatic mitral valve stenosis. The patient presented with severe biventricular heart failure and fast atrial fibrillation. Soon after admission the patient sustained a cardiac arrest and was successfully resuscitated. Despite maximal medical therapy the patient was still in pulmonary edema. Beta blockers were contraindicated as the patient had bronchial asthma. Balloon mitral valvotomy using an Inoue 26 mm balloon catheter was done. The procedure was done with pelvic and abdominal shielding. To minimize radiation exposure no angiography was done and the procedure was done with echo-Doppler guided stepwise mitral valve dilatation. The mitral valve area after balloon valvotomy increased from 0.9 to 2 cm2. The total fluoroscopy time was 14 minutes. At 6-week follow-up the patient was virtually asymptomatic. Vaginal delivery was uneventful. Balloon mitral valvotomy using the Inoue technique in pregnancy with echo guided stepwise dilatation is accomplished with minimal radiation exposure, provided abdominal shielding is implemented throughout the procedure.

Adult↗
PubMed1985

Fate of tricuspid regurgitation after closed valvotomy for mitral stenosis.

Rheumatic mitral valve disease is not infrequently associated with tricuspid regurgitation (TR). To determine the fate of TR following closed mitral valvotomy (CMV), we examined the records of 23 patients with variable degrees of TR and significant mitral stenosis (MS). Based on angiocardiographic assessment of TR, patients were divided into two groups: group 1 (15 patients) had mild-to-moderate TR, while group 2 (eight patients) had severe TR. After valvotomy, dyspnea lessened in all patients. Right ventricular (RV) failure signs (jugular venous distension and hepatomegaly) and the amounts of diuretics used diminished in 12 of 15 patients in group 1. Group 2 patients showed insignificant improvement at one-year follow-up period. Cardiac recatheterization was performed in four of group 2 patients three to five years later primarily for persistence of RV failure signs. The mitral valve areas varied from 1.4 to 2.7 cm2. There was mild mitral regurgitation in two patients. There was no deterioration of the left ventricular ejection fraction, but TR was at least moderate in all cases.

Adolescent↗
PubMed1999

Definitive percutaneous treatment of Lutembacher's syndrome.

Definitive percutaneous treatment of a patient with Lutembacher's syndrome was successfully accomplished using the Amplatzer septal occluder to close a secundum atrial septal defect and the Joseph mitral balloon catheter to dilate rheumatic mitral valve stenosis. Transcatheter therapy is an effective alternative to surgery in selected patients with Lutembacher's syndrome. Cathet. Cardiovasc. Intervent. 48:199-204, 1999.

Adult↗
PubMed1951

The surgical treatment of mitral stenosis.

A surgical procedure known as commissurotomy, devised by Bailey for the relief of certain cases of mitral stenosis, gives promise of considerable benefit to a large number of patients who have the disease. The technique of the operation involves the introduction of the right index finger and an especially designed valvulotome through the left auricular appendage into the left auricle. The mitral valve commissures are then divided. Twentyfive cases of mitral stenosis in which this operation was performed are discussed.

Cardiac Surgical Procedures↗
PubMed1996

Valvular disease in pregnancy.

Previously asymptomatic mitral stenosis can lead to remarkably sudden development of life-threatening pulmonary edema in pregnancy and the patients, often immigrants from the developing world, may be unaware that they have heart disease. Diagnosis and treatment need to be rapid and effective. Left ventricular outflow tract obstruction may also lead to trouble in pregnancy with the development of angina and left ventricular failure. Regurgitant valve disease is much better tolerated in pregnancy than valvular stenosis, but mitral valve repair, usually feasible for nonrheumatic prolapsing mitral valves, should be carried out before pregnancy if regurgitation is severe. The treatment of women with Marfan's syndrome who already have aortic root widening but desire children remains very difficult, both with regard to the mother's safety and in relation to the dominant inheritance of the condition. Advice to women with artificial valves desiring pregnancy remains controversial, with continuation of warfarin increasingly favored over transfer to heparin in Europe. The use of bioprostheses in young women anticipating future pregnancy is also fading due to mounting evidence of accelerated deterioration of such bioprostheses during pregnancy.

Aortic Valve Stenosis↗