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At least 829 records · Page 46Linked to original sources
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↗
PubMedDate not supplied

Atrial myxoma--a case report and review of the literature.

Myxomas are the most common primary cardiac tumours. They are usually benign and have variable presentation. Although rare, atrial myxomas are the most important cardiac tumours to diagnose, as they have an excellent prognosis following surgical excision. We report a 56 year old man who presented with features of both right and left heart failure. Ausculation of the heart revealed an apical mid diastolic murmur. Two-dimensional colour flow Doppler echocardiography revealed a pedunculated left atrial myxoma that prolapsed into the mitral valve orifice in diastole producing functional mitral valve stenosis. The patient underwent a successful surgical excision of the tumour. The diagnosis and management of atrial myxomas is reviewed.

Cardiopulmonary Bypass↗
PubMed1996

[Open heart operation under videosurgery and minithoracotomy. First case (mitral valvuloplasty) operated with success].

The development of "less invasive surgery" using small incisions and videoscopic techniques may change, in the near future, our attitude towards "traditional" surgery. This is because of specific advantages such as skin limited incisions, reduced perioperative disability and lower cost. Up to now, only abdominal, thoracic and coronary artery surgery which do not imply the opening of the heart, or closure of simple atrial septal defects, have benefitted from this new approach. This article reports the first case of open heart surgery for complex lesions of the left heart through a minithoracotomy (5 x 4 cm) with the use of videotransmission and peripheral extracorporeal circulation. The patient, a 30-year-old female, was operated upon for a combined mitral valve stenosis and insufficiency of rheumatic origin unsuccessfully treated by a previous percutaneous valve dilatation. The 2.5 h open heart procedure comprised commissurotomy, repair of torn leaflets, chordal transposition and Carpentier-Edwards prosthetic ring implantation. The patient left the hospital 12 days after the operation. Transesophageal echocardiography at discharge showed normal valve function with no residual stenosis or residual leak.

Adult↗
PubMed2005

[Primary cardiac angiosarcoma in the left atrium with adrenal metastasis; report of a case].

We encountered a 61-year-old woman with primary cardiac angiosarcoma in the left atrium. On echocardiography, the tumor extended into the atrial septum and mitral valve, and mitral valve stenosis and regurgitation were significant. We resected the tumor protruding into left atrium, and affecting mitral valve. The surgical procedure was not radical, but on postoperative echocardiography, function of the mitral valve was improved. Three months later, elevation of her right diaphragma was observed on chest X-ray and a giant adrenal tumor was detected by magnetic resonance imaging. Tumor biopsy indicated that this tumor was adrenal metastasis from cardiac angiosarcoma. In addition, echocardiography showed the recurrence of angiosarcoma in the left atrium and the presence of mitral stenosis and regurgitation. She died of heart failure 185 days postoperatively.

Adrenal Gland Neoplasms↗
PubMed2004

[Clinical and haemodynamic results after repeat valvotomy of the mitral valve using the Inoue balloon. A comparison with the results after primary valvotomy].

BACKGROUND AND OBJECTIVE: Percutaneous mitral valvotomy (MVT) with the Inoue balloon is the most frequently performed therapeutic alternative to surgical commissurotomy in patients with symptomatic mitral valve stenosis. Few data are available on the results of repeat MVT. PATIENTS AND METHODS: We compared the immediate and 3-month results of all patients who had a repeat MVT (n = 39) with those who had a primary intervention (n = 1,117) in our institution between February 1989 and January 2001. Mean age of the 31 women and 8 men with repeat MVT was 53 +/- 14 years at the first and 57 +/- 14 years at the second intervention performed 3 - 10 years later. RESULTS: Following primary intervention the invasively assessed mitral valve are (MVA) had increased from an average of 1.0 +/- 0.2 cm(2) to 1.7 +/- 0.4 cm(2). Echocardiography three months after the intervention revealed a MVA of 1.7 +/- 0.3 cm(2). Repeat MVT resulted in an immediate increase of MVA from 1.0 +/- 0.2 cm(2) to 1.6 +/- 0.4 cm(2), after 3 months the average MVA was 1.6 +/- 0.3 cm(2). According to the NYHA classification clinical symptoms had improved on average from 2.6 to 1.6 three months after primay intervention and from 2.8 to 2.1 three months following the repeat procedure. The incidence of significant procedure-related complications was less than 3 % for both primary and repeat MVT. CONCLUSION: The clinical and hemodynamic results demonstrated in our patients suggests repeat MVT as the treatment option of choice in mitral restenosis after previous balloon intervention, if mitral valve morphology is still suitable.

Adult↗
PubMed1982

Vasomotor dynamics associated with cardiac operations. I. Venous tone and the effects of vasodilators.

Vasomotor dynamics were studied in 52 patients undergoing direct coronary revascularization or mitral valve replacement utilizing cardiopulmonary bypass. Emphasis was placed on the study of venous tone. Operation resulted in a general vasoconstrictive response with increased arterial resistance and reduced venous capacitance. These changes were magnified in patients who underwent mitral valve replacement for mitral valve stenosis related or partially related to reduced cardiac performance before and after operation. Nine patients became hypertensive following coronary artery bypass and were treated with nitroprusside; eight patients were given nitroglycerin to reduce venous tone and prevent hypertension. A comparison of these two vasodilators, with their somewhat different actions on the vascular bed, reveals that afterload reduction and increase of cardiac output were equivalent with both. However, nitroglycerin had the effect of increasing venous capacitance, while nitroprusside had little effect on the venous circulation. In addition, nitroglycerin was especially effective in reducing venous tone and left ventricular preload following mitral valve replacement. Relative merits of pharmacologic reduction of venous tone as a part of overall relief of increased vascular resistance following cardiac operation should be considered when attempting to obtain an optimal hemodynamic state.

Adult↗
PubMed1986

Importance of the "atrial kick" in determining the effective mitral valve orifice area in mitral stenosis.

Atrial fibrillation with a rapid ventricular response in patients with mitral stenosis (MS) is often accompanied by pulmonary congestion and reduced cardiac output owing to a diminished diastolic filling period and the loss of the end-diastolic left ventricular (LV) pressure increment. To test the hypothesis that loss of atrial contraction (atrial kick) also results in a decrease in effective mitral valve orifice area, 6 patients with pure, isolated MS were studied in sinus rhythm during atrial pacing and simultaneous atrioventricular pacing. Atrial pacing at 140 beats/min caused no significant change from baseline in cardiac output or mitral valve area, but there was a decrease in LV end-diastolic volume and ejection fraction as well as an increase in left atrial pressure and mean diastolic gradient. Simultaneous atrioventricular pacing (to eliminate atrial kick) induced a decrease in cardiac output (4.4 +/- 0.9 vs 5.2 +/- 0.8 liters/min at 110 beats/min, 4.2 +/- 0.9 vs 5.1 +/- 0.9 liters/min at 140 beats/min; p less than 0.05) and LV end-diastolic volume (77 +/- 27 vs 93 +/- 29 ml at 110 beats/min, 54 +/- 17 vs 65 +/- 19 ml at 140 beats/min; p less than 0.05), an increase in left atrial pressure (28 +/- 3 vs 20 +/- 5 mm Hg at 110 beats/min, 30 +/- 4 vs 25 +/- 5 mm Hg at 140 beats/min; p less than 0.05), and a decrease in mitral valve area (1.2 +/- 0.4 vs 1.4 +/- 0.5 cm2 at 110 beats/min, 1.2 +/- 0.4 vs 1.4 +/- 0.4 cm2 at 140 beats/min; p less than 0.05). Thus, loss of atrial kick may cause pulmonary congestion and reduced cardiac output in patients with MS, partly because of a decrease in effective mitral valve area.

Adult↗
PubMed1999

Minimally invasive closed mitral commissurotomy.

Today, technical advances have decreased the risk of cardiopulmonary bypass to the point that closed mitral commissurotomy is performed infrequently in most cardiac centers and is considered hazardous. We describe a modified technique for closed mitral commissurotomy, improved in terms of safety and efficacy, and adapted for situations in which resources are limited. This operation was performed in 12 symptomatic patients with severe mitral stenosis whose valves were judged suitable for closed mitral commissurotomy or balloon valvuloplasty. After modified closed commissurotomy, the mitral valve areas of these patients were increased substantially, from 1.8 to 3.1 cm2. There was no new incidence of mitral regurgitation. We conclude that closed mitral commissurotomy is a safe alternative to open mitral commissurotomy, provided that patient selection criteria are strictly followed.

Adolescent↗
PubMed2004

Beating mitral valve replacement for a patient with porcelain aorta.

Beating mitral valve replacement was performed for mitral valve stenosis in a patient with a porcelain aorta after aortic valve replacement. The 77-year-old patient had developed heart failure several times. A chest computed tomographic scan revealed severe calcification on the ascending aorta and aortic arch. A cardiopulmonary bypass was established by bicaval drainage and aortic return after epiaortic echographic evaluation of the ascending aorta. The mitral valve was successfully replaced under a beating heart.

Aged↗