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PubMed1996

Doppler echocardiographic assessment of long-term progression of mitral stenosis in 103 patients: valve area and right heart disease.

OBJECTIVES: The purpose of this study was to determine, in a large referral population, the rate of echocardiographic change in mitral valve area (MVA) without interim intervention, to determine which factors influence progression of narrowing and to examine associated changes in the right side of the heart. BACKGROUND: Little information is currently available on the echocardiographic progression of mitral stenosis, particularly on progressive changes in the right side of the heart and the ability of a previously proposed algorithm to predict progression. METHODS: We studied 103 patients (mean age 61 years; 74% female) with serial two-dimensional and Doppler echocardiography. The average interval between entry and most recent follow-up study was 3.3 +/- 2 years (range 1 to 11). RESULTS: During the follow-up period, MVA decreased at a mean rate of 0.09 cm2/year. In 28 patients there was no decrease, in 40 there was only relatively little change (< 0.1 cm2/year) and in 35 the rate of progression of mitral valve narrowing was more rapid (> or = 0.1 cm2/year). The rate of progression was significantly greater among patients with a larger initial MVA and milder mitral stenosis (0.12 vs. 0.06 vs. 0.03 cm2/year for mild, moderate and severe stenosis, p < 0.01). Although the rate of mitral valve narrowing was a weak function of initial MVA and echocardiographic score by multivariate analysis, no set of individual values or cutoff points of these variables or pressure gradients could predict this rate in individual patients. There was a significant increase in right ventricular diastolic area (17 to 18.7 cm2) and tricuspid regurgitation grade (2 + to 3 +; p < 0.0001 between entry and follow-up studies). Progression in right heart disease occurred even in patients with minimal or no change in MVA. Patients with associated aortic regurgitation had a higher rate of decrease in MVA than did those with trace or no aortic regurgitation (0.19 vs. 0.086 cm2/year, p < 0.05). CONCLUSIONS: The rate of mitral valve narrowing in individual patients is variable and cannot be predicted by initial MVA, mitral valve score or transmitral gradient, alone or in combination. Right heart disease can progress independent of mitral valve narrowing.

Algorithms↗
PubMed2000

Lung water, hemodynamics and dyspnea before and after valvuloplasty in mitral stenosis.

UNLABELLED: The investigation was to elucidate the role of the reduction of extravascular pulmonary fluid in the immediate symptomatic improvement and its impact on hemodynamics in patients with mitral stenosis treated by percutaneous transluminal valvuloplasty. METHODS: In a prospective study of 12 patients with severe mitral stenosis extravascular pulmonary fluid volume was determined by a combined dye and thermodilution technique (COLD Z-021(TM) Version 5.x, Pulsion((R))) before and after valvuloplasty. Cardiac output, left atrial pressures, atrial V-waves, diastolic transmitral gradients and their respiratory changes were measured. Dyspnea was assessed by validated questionnaires. RESULTS: Symptomatic improvement correlated (r=0. 808) with a decrease of extravascular lung water, but not with either an increase or a decrease of cardiac output or left atrial filling pressures. The decrease of the lung water index may be predicted from the lung water index before valvuloplasty, the final left atrial mean pressure and the cardiac index prior to intervention. The change of the mean difference between inspiratory and expiratory mitral gradient demonstrated a significant inverse correlation with the change of mean left atrial filling pressures (r=-0.778) and with extravascular lung water after valvuloplasty (r=-0.871). CONCLUSION: There is a complex relationship between left atrial filling pressures, extravascular lung water, respiratory changes of gradients, and dyspnea that need further investigation.

Aged↗
PubMed2003

Balloon mitral commissurotomy in juvenile rheumatic mitral stenosis: a ten-year clinical and echocardiographic actuarial results.

AIMS: To evaluate the safety, efficacy and long-term actuarial results of balloon mitral commissurotomy in young patients with severe rheumatic mitral stenosis. METHODS AND RESULTS: Event-free survival and freedom from restenosis were analyzed in 110 patients 20 years old or younger (group 1) and compared with those of 554 adults (group 2). Young patients were less frequently in atrial fibrillation (6% vs 35%, P<0.001) and had less mitral valve deformities (echo score 5.9+/-2.1 vs 7.5+/-3.0, P<0.0001). Mitral valve area index by 2D-echo was of 0.66+/-0.1cm(2)/m(2)in group 1 and 0.67+/-0.1cm(2)/m(2)in group 2 (P=ns) and was larger in group 1 (1.5 vs 1.3 cm(2)/m(2)) after the procedure (P<0.0001). There were more complications in group 2 (8.4% vs 0%, P=0.01). Procedural success was obtained in 110 (100%) patients of group 1 vs 501 (92%) patients of group 2 (P<0.0001). At follow-up mitral valve area index was 1.34 cm(2)/m(2)in group 1 and 1.16 cm(2)/m(2)in group 2 (P<0.0001). At 10 years, freedom from restenosis was 61% in group 1 vs 71% in group 2 (P=0.35) and event-free survival was 74% and 69% respectively (P=0.15 CONCLUSION: Balloon mitral commissurotomy is safe and effective in young with rheumatic mitral stenosis and provides better immediate results than in adults. However long-term outcome was similar between the 2 groups: 2/3 of patients were alive and free from clinical events at 10 years.

Adolescent↗
PubMed1992

Respiratory dead space under anaesthesia in patients with mitral stenosis.

Physiological deadspace (VDphys) and arterial to end-tidal carbon dioxide tension difference [P(a-E)CO2] were calculated under anaesthesia in 27 patients with mitral stenosis planned for close mitral commissurotomy and in 15 healthy individuals for elective non-thoracic surgical procedures. A square wave inspiratory flow pattern and an end-inspiratory pause (25% and 10% of cycle time respectively) were given with a SERVO 900B ventilator used at respiratory rate of approximately 16 per min. An infra-red CO2 analyser was used to measure CO2 production and end-tidal CO2 concentration. Measurements were made prior to the start of the surgery after a minimum of 10 min of stable ventilation to avoid the effect of surgery. Patients with multiple stenosis had significantly higher VDphys (4.28 +/- 1.02 ml kg-1 as compared to 2.10 +/- 0.52 ml kg-1 in controls, P less than 0.001), higher P(a-E)CO2 [0.43 +/- 0.51 kPa as compared to -0.02 +/- 0.23 kPa, P less than 0.01] and lower respiratory system compliance (Crs). Péco2 was positively correlated with PaCO2 in both groups (P less than 0.01). PaO2 was lower in mitral stenosis patients and P(A-a)O2 negatively correlated to Crs (P less than 0.01).

Adult↗
PubMed2001

Surgery of rheumatic mitral stenosis: comparison of different techniques.

OBJECTIVE: The breakthrough of percutaneous transvenous mitral commissurotomy (PTMC) has dramatically changed the indications for the surgical treatment of rheumatic mitral stenosis over the last decade. No recent studies comparing long-term results of PTMC, open mitral commissurotomy (OMC) and mitral valve replacement (MVR) with bileaflet prostheses are available in medical literature. METHODS AND RESULTS: Between January 1991 and December 1997, 313 patients with pure and isolated rheumatic stenosis were treated in our department. One hundred and eleven patients underwent PTMC, 82 OMC and 120 MVR. There was no statistical difference (p>0.05) between the mortality rates of the three groups of patients. No cases of hospital mortality were observed in the patients who underwent PTMC and OMC, whereas two patients (1.6%) died within 30 days after MVR. Seven year actuarial survival results are: 95.41+/-2(SE)% (PTMC), 98.05+/-1% (OMC) and 92.82+/-33% (MVR) (p=NS). Freedom from embolism was 98.78+/-1% in PTMC, 98.78+/-1% in OMC and 92.52+/-2% in MVR (p>0.05); freedom from reoperation was 88.43+/-8% in PTMC, 96.35%+/-2% in OMC and 97.72+/-1% in MVR (p>0.05). The mean NYHA class at the end of follow-up was lower in OMC (1.14+/-0.3) versus PTMC (1.39+/-0.6) and MVR (1.41+/-0.71) (p=0.001). CONCLUSIONS: Even though conservative techniques are the first option to consider in treating mitral valve stenosis, valve replacement with bileaflet prostheses no longer represents a limiting factor to survival and quality of life.

Adult↗
PubMed1990

Left coronary angiography in the pre-operative diagnosis of thrombosis of the left atrium or its appendage in rheumatic mitral stenosis.

We studied the utility of pre-operative selective left coronary angiograms for detecting thrombosis in the left atrium or its appendage in 81 patients with rheumatic mitral stenosis, who subsequently underwent open-heart surgery. Thrombus was predicted by the angiographic demonstration of neovascularity seen as a bunch of small vessels arising from the circumflex branch of the left coronary artery coursing superiorly to the region of the left atrial appendage and terminating in a network of smaller vascular channels with a blush of contrast medium coalescing into small 'lakes'. This pooling of contrast medium was considered essential for positive angiographic diagnosis. Based on these criteria, the angiographic diagnosis of thrombus was made in 27 patients. Thrombus was found in 33 patients at surgery. Selective left coronary angiography had a sensitivity of 72.7%, specificity of 92.7% and predictive value of 88.8% for detecting thrombi in the left atrium or its appendage. Coronary angiography should be performed in all the patients with mitral stenosis who are undergoing cardiac catheterization especially if balloon mitral valvoplasty or closed mitral valvotomy are planned.

Adolescent↗
PubMed2006

Measurement of vena contracta width for the assessment of severity of mitral stenosis.

This study was designed to test whether vena contracta width (VCW) measured by color Doppler flow could be used to assess the severity of mitral stenosis (MS). A secondary objective was to determine the cut-off value of VCW for the prediction of severe MS. We studied 47 consecutive patients with MS (mean age, 50+/-11 years; 34 females) who did not have more than mild mitral regurgitation. We compared VCW with conventional methods for determining mitral valve area (MVA). Mitral valve area was assessed by one observer using continuity equation (CE), pressure half-time (PHT), and planimetry in the parasternal short axis view. Vena contracta width was measured in the same patients by two observers (blinded to the MVA data) using the apical four-chamber view by color Doppler flow. Vena contracta width measurements were compared with MVA by CE, PHT, and planimetry. The MVA determined by CE, PHT, and planimetry was 1.19+/-0.42, 1.31+/-0.53, and 1.27+/-0.43 cm2, respectively. The VCW in patients with MVA<1 cm2, 1-1.5 cm2, and >1.5 cm2 (calculated by the CE method) was 0.77+/-0.19, 1.13+/-0.16, and 1.36+/-0.24 cm, respectively. Vena contracta width was significantly correlated to MVA by planimetry (r=0.756, P<0.001), PHT (r=0.673, P<0.001), and CE (r=0.813, P<0.001). The VCW of patients with MVA 1 cm2 determined by the CE method (0.77+/-0.19 vs 1.26+/-0.26, P<0.001). Vena contracta width measurement of 1 cm or less had a sensitivity of 88% and a specificity of 77% for the prediction of severe MS. These results demonstrate that the correlations between VCW and MVA measured by conventional methods were highly significant. In addition, these results suggest that VCW<or=1 cm may indicate the presence of severe mitral stenosis.

Adult↗
PubMed1976

[Reutilization of the right-side approach in commissurotomy in recurrent mitral stenosis].

Based on histotopographic studies of heart specimens taken from patients died after commissurotomy with a right-side approach, and the experience with eleven mitral commissurotomies using an access via the interatrial septum repeatedly, it is concluded that a close mitral commissurotomy for reccurrent mitral stenosis with the repeat use of a right-side approach seems to be anatomically grounded and easy to be performed from the point of view of the operative technic. This intervention should be accomplished in patients with recurrent mitral stenosis, previously operated upon with a right-side access. The opportunities of reused right-side approach offer prerequisites for its wider application in primary commissurotomy.

Adult↗
PubMed2000

Lung function in mitral stenosis.

OBJECTIVES: The aim of this study was to look to for a relationship between pulmonary artery pressure (PAP), left atrial pressure (LAP), mitral valve area (MVA) and transmitral gradient (Gr) on the one hand and the spirometric data on the other, in cases of mitral stenosis. METHODS: The spirometry values measured were forced vital capacity (FVC), forced expiratory volume in one second and as percent of FVC (FEV1, FEV1/FVC%), forced expiratory flow between 25% to 75% of FVC (FEF 25-75%), at 50% of FVC (FEF 50%) 75% of FVC (FEF 75%) and peak expiratory flow rate (PEFR). The PAP, LAP, MVA and Gr were measured at echocardiography and cardiac catheterisation. RESULTS: Analysis of results was done of 60 patients in four groups divided on basis of mean PAP: Group 1 with least and group 4 with highest mean PAP. FVC values were reduced in direct proportion to PAP, LAP, MVA and Gr in three out of four groups. FEV1% as a percent of predicted value showed uniform reduction in all the groups, PEFR was moderately affected in group 1 and most severely in group 4. Values of FEV1/FVC% were within normal range in all the groups. FEF 25-75%, and FEF 50% showed serial reduction in values in keeping with the elevation of the PAP. FEF 75% was also moderately affected in group 1 and most severely in group 4. CONCLUSION: We found that a moderate restrictive defect and a small airway defect which is found in cases of mitral stenosis, directly correlates to the PAP, LAP, MVA and Gr. There was no significant involvement of the larger airways.

Adolescent↗
PubMed1975

[Coronary emboli in mitral stenosis].

Study of four personal cases and of twelve cases reported in the literature makes it possible to describe the characteristics of coronary embolism in mitral stenosis, a rare complication but indicating the presence of a left intra-atrial thrombosis: -- variable clinical picture, dominated by a syndrome combining simultaneously a picture of myocardial infarction and of peripheral arterial emboli of other localizations; -- diagnosis to be discussed within the framework of coronary syndromes in mitral heart disease: embolism requiring to be distinguished from coronary atherosclerosis combined with mitral stenosis, more rarely a functional coronary insufficiency; -- severe course and prognosis: besides the possibility of rapidly lethal cases, coronary embolism seems liable to result in weakening and diminishing of the adaptation possibilities of the left ventricle, responsible for attacks of heart failure after mitral valvulotomy.

Adult↗
PubMed2005

Role of closed mitral commissurotomy for mitral stenosis: mid- and long-term surgical outcome of 36 patients.

PURPOSE: To evaluate long-term survival and valve-related complications as well as prognostic factors for mid- and long-term outcome after closed mitral commissurotomy, covering a follow-up period of 14 years. MATERIAL AND METHODS: Between 1989 and 2003, 36 patients (28 women and 8 men, mean age 28.8 +/- 6.1 years) underwent closed mitral commissurotomy at our institution. The majority of patients were in New York Heart Association (NYHA) functional class IIB, III, or IV. Indication for closed mitral commissurotomy was mitral stenosis. Closed mitral commissurotomy was undertaken with a Tubbs dilator in all cases. Median operating time was 2.5 hours +/- 30 minutes. RESULTS: After closed mitral commissurotomy, the mitral valve areas of these patients were increased substantially, from 0.9 to 2.11 cm(2). No further operation after initial closed mitral commissurotomy was required in 86% of the patients (n = 31), and NYHA functional classification was improved in 94% (n = 34). Postoperative complications and operative mortality were not seen. Follow-up revealed restenosis in 8.5% (n = 3) of the patients, minimal mitral regurgitation in 22.2% (n = 8), and grade >or=3 mitral regurgitation in 5.5% (n = 2) patients. No early mortality occurred in closed mitral commissurotomy patients. Reoperation was essential for 5 patients following closed mitral commissurotomy; 2 procedures were open mitral commissurotomies and 3 were mitral valve replacements. No mortality occurred in these patients. CONCLUSIONS: The mitral valve area was significantly increased and the mean mitral valve gradient was reduced in patients after closed mitral commissurotomy. Closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients.

Adolescent↗
PubMed1990

Aortic regurgitation shortens Doppler pressure half-time in mitral stenosis: clinical evidence, in vitro simulation and theoretic analysis.

Mitral valve areas determined by Doppler pressure half-time were compared with areas obtained by planimetry in two groups of patients with mitral stenosis: 24 patients without aortic regurgitation and 32 patients with more than grade 1 aortic regurgitation. The severity of aortic regurgitation was assessed by color flow mapping; 17 patients had grade 2, 10 had grade 3 and 5 had grade 4 aortic regurgitation. Regression equations for pressure half-time area versus planimetry mitral valve area were calculated separately for the aortic regurgitation (r = 0.88) and the nonaortic regurgitation group (r = 0.86); analysis of covariance revealed a significant (p less than 0.001) difference between the two groups leading to overestimation of planimetry area by the pressure half-time method in the aortic regurgitation group. The mitral valve areas in the group without regurgitation were best calculated with the expression 239/T1/2 (r = 0.77) as compared with a best fit of 195/T1/2 (r = 0.85) for the aortic regurgitation group. To elucidate the mechanisms affecting pressure half-time in aortic regurgitation, an in vitro model of mitral inflow in the presence of varying regurgitant volumes and different ventricular chamber compliances was used. Aortic regurgitation shortened directly measured pressure half-time proportional to the regurgitant fraction but an increase in left ventricular compliance could offset this effect. Finally, in a mathematic model of mitral inflow the competing effects of aortic regurgitation and chamber compliance could be confirmed. In conclusion, aortic regurgitation results clinically in a significant net shortening of pressure half-time leading to mitral valve area overestimation. However, the effect is moderate and individually unpredictable because of changes in chamber compliance.

Adult↗
PubMed1988

Conservative operation for mitral stenosis. Independent determinants of late results.

A retrospective study was designed to define the independent determinants of late results in 282 consecutive patients operated on for mitral stenosis between 1978 and 1985. A total of 25 variables were investigated by multivariate discriminant analysis for their possible influence on symptomatic outcome, subsequent reoperation, postoperative thromboembolism, and death. All the patients underwent a conservative mitral valve operation. In addition, 25 patients required concomitant tricuspid annuloplasty. The surgical mortality rate was 1.4% and the late mortality, reoperation, and thromboembolism rates were, respectively, 0.14%, 0.80%, and 0.95%/pt-yr. Actuarial probability of complication-free survival at 8 years was 83% +/- 3.7%. Left atrial size on the M-mode echocardiograms, tricuspid annuloplasty, mitral annuloplasty, presence of left atrial thrombus, male gender, and separation of subvalvular apparatus portended a significantly higher likelihood of poor postoperative symptomatic status (p less than 0.0005). Preoperative mild mitral regurgitation, E to F slope on the M-mode echocardiogram, and tricuspid annuloplasty had significant influence on the need for late reoperation (p less than 0.05). Postoperative atrial fibrillation, mitral valve amplitude on the M-mode echocardiogram, preoperative embolism, and residual mitral incompetence had an independent predictive power for postoperative thromboembolism (p less than 0.05). Finally, preoperative atrial fibrillation, preoperative cardiothoracic ratio, postoperative left atrial size, and postoperative atrial fibrillation all influenced the probability of long-term complications. These results suggest that earlier operation should be considered in patients with mitral stenosis, to increase the complication-free survival rate.

Actuarial Analysis↗
PubMed2005

Effects of percutaneous balloon mitral valvuloplasty on plasma B-type natriuretic peptide in rheumatic mitral stenosis with and without atrial fibrillation.

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the effect of percutaneous balloon mitral valvuloplasty (PBMV) on plasma B-type natriuretic peptide (BNP) levels in patients in sinus rhythm (SR) and with atrial fibrillation (AF). METHODS: Thirty patients with rheumatic mitral stenosis who underwent successful PBMV were included in the study. Of these patents, 21 were in SR (SR group) and nine had AF (AF group). Plasma BNP levels were measured using the Triage BNP Test in all patients before, and at 20 min and 24 h after, PBMV. Control levels were measured in eight healthy volunteers. RESULTS: Basal plasma BNP levels in patients were significantly higher than those in controls (123.5 +/- 69.5 versus 16.4 +/- 7.6 pg/ml, p < 0.01), and correlated with mean left atrial pressure (mLAP; r = 0.441, p < 0.05) and pulmonary artery pressure (PAP; r = 0.488, p < 0.01). No significant difference was observed in BNP levels between the SR and AF groups. In the SR group, BNP levels decreased after PBMV (pre-PBMV 128.7 +/- 75.9 pg/ml; at 20 min, 88.6 +/- 62.0 pg/ml; at 24 h, 43.4 +/- 26.7 pg/ml; respectively, p < 0.05). Changes in plasma BNP (deltaBNP) correlated positively with those in mLAP (deltamLAP) (r = 0.696, p < 0.01) and PAP (deltaPAP) (r = 0.456, p < 0.05). Left ventricular end-diastolic volume (LVEDV) (96.1 +/- 21.6 versus 111.5 +/- 25.2 ml, p < 0.01) and stroke volume (SV) (59.2 +/- 15.8 versus 69.0 +/- 17.9 ml, p < 0.05) augmented accordingly without any changes in left ventricular end-diastolic pressure (LVEDP) (p = NS). In contrast, in group AF, BNP levels remained unchanged (pre-PBMV 111.6 +/- 53.4 pg/ml; at 20 min, 122.0 +/- 68.7 pg/ml; at 24 h, 106.1 +/- 56.2 pg/ml; respectively, p = NS), while LVEDP increased (6.4 +/- 3.6 versus 8.6 +/- 3.2 mmHg, p < 0.01), without any changes in LVEDV and SV (p = NS). CONCLUSION: The study results indicate that, in mitral stenosis patients, a high BNP level is associated with high mLAP and PAP. Cardiac rhythm may play an important role in changes of BNP level after PBMV. BNP may be a valid marker to reflect changes in mLAP and PAP after PBMV in patients with SR, but not in those with AF.

Atrial Fibrillation↗
PubMed2006

Favorable effect of balloon mitral valvuloplasty on the incidence of atrial fibrillation in patients with severe mitral stenosis.

BACKGROUND: The long-term effect of balloon mitral valvuloplasty (BMV) on the incidence of atrial fibrillation (AF) in patients with severe mitral stenosis (MS) remains undetermined. AIMS: To assess the effect of successful BMV on the incidence of chronic AF in patients with severe MS, compare the results with historical controls, and identify factors associated with AF in such patients. METHODS: Retrospective analysis of 382 consecutive patients with severe MS and in sinus rhythm (SR) who underwent successful BMV (post procedure mitral valve area (MVA) > or =1.5 cm(2), mitral regurgitation (MR) < or =2/4) at our hospital and followed-up for 1-15.6 (mean 5.6 +/- 3.9) years with clinical and echocardiographic examination. RESULTS: Thirty-four (8.9%) patients developed AF at follow-up (group A) and 348 patients (group B) remained in SR. At baseline, and in comparison with group B, patients who developed AF (group A) were older, had higher mitral echo score but equal MVA and left atrial (LA) size. The postprocedure MVA was smaller in group A (1.7 +/- 0.3 cm(2)) than in group B (2.0 +/- 0.2 cm(2;) P = 0.002). At follow-up, and in comparison to group B, group A had smaller MVA (1.5 +/- 0.4 cm(2) vs 1.8 +/- 0.4 cm(2) P <0.0001), larger LA dimension (49.4 +/- 6.5 vs 42 +/- 6.5 mm; P <0.0001) and higher restenosis rate (35% vs 14%; P = 0.001). Multivariate logistic regression analysis identified age at follow-up (P < 0.0001), LA size at follow-up (P = 0.004), and MVA at follow-up (P = 0.006) as predictors of AF. CONCLUSIONS: This study demonstrated favorable effect of BMV on the incidence of AF (8.9%) in patients with severe MS in comparison with reported series (29%) of patients with severe MS with similar baseline characteristics who were not submitted to any intervention. The predictors of AF were age, larger LA, and smaller MVA, at follow-up.

Adolescent↗
PubMed1992

Excessive vasoconstriction in rheumatic mitral stenosis with modestly reduced ejection fraction.

OBJECTIVES: The primary hypothesis examined was that underfilling due to inflow obstruction accounts for modestly depressed ejection performance in mitral stenosis. Having found little evidence to support this hypothesis, we sought to determine other factors that might differentiate patients with different levels of ejection performance. METHODS: Ventricular load and performance were compared in two groups of patients before and immediately after successful balloon valvuloplasty that was not complicated by mitral regurgitation: those in whom prevalvuloplasty ejection fraction was > or = 0.55 (group I, n = 10) and those in whom it was < 0.55 (group II, n = 11). RESULTS: Before valvuloplasty, mitral valve area was less in group II (0.65 cm2) than in group I (0.84 cm2, p = 0.02), but end-diastolic pressure (12 vs. 12 mm Hg in group I), end-diastolic wall stress (46 vs. 44 kdynes/cm2 in group I) and end-diastolic volume (152 vs. 150 ml in group I) were not less in group II, nor were these variables significantly reduced compared with those of a normal control group. In group II, end-systolic volume was larger (77 vs. 55 ml in group I, p = 0.001) and cardiac output was less (3.1 vs. 3.6 liters/min in group I, p = 0.03), possibly owing to higher systemic vascular resistance (2,438 vs. 1,921 dynes.s.cm-5 in group I, p = 0.05) and end-systolic wall stress (273 vs. 226 kdynes/cm2 in group I, p = 0.06), although mean arterial pressure in the two groups was similar (91 vs. 84 mm Hg in group I, p = 0.22). Group II patients also had higher values for pulmonary vascular resistance (712 vs. 269 dynes.s.cm-5 in group I, p = 0.03) and mean pulmonary artery pressure (47 vs. 29 mm Hg in group I, p = 0.02) despite similar values for mean left atrial pressure (20 vs. 18 mm Hg in group I, p = 0.35). After valvuloplasty, mitral valve area increased by 2.5- and 3-fold, respectively, in group I (to 2.1 cm2) and group II (to 2.0 cm2). Modest increases in left ventricular end-diastolic pressure, end-diastolic stress and end-diastolic volume (+9%) after valvuloplasty were statistically significant only for group II. End-systolic wall stress did not decline in either group II (281 kdynes/cm2) or group I (230 kdynes/cm2), and ejection fraction failed to increase significantly (0.49 to 0.51 for group II and 0.62 to 0.61 for group I) after valvuloplasty. Contractile performance estimated with a preload-corrected ejection fraction-afterload relation was within or near normal limits in all 19 patients in whom it was assessed. CONCLUSIONS: Excessive vasoconstriction may account for the higher afterload, lower ejection performance and lower cardiac output observed in a subset of patients with mitral stenosis because contractile dysfunction could not be detected and left ventricular filling--which was not subnormal despite severe inflow obstruction--improved only modestly after valvuloplasty.

Adolescent↗
PubMedDate not supplied

Use of continuous wave Doppler echocardiography to evaluate the hemodynamic importance of atrial systole in patients with mitral stenosis.

Continuous wave Doppler echocardiography was used to assess the hemodynamic role of left atrial systole and its effect on left ventricular performance in 31 patients with isolated mitral stenosis. Fourteen of the patients had mild stenosis, whereas the remaining 17 had severe stenosis. The contribution of atrial systole to the cardiac output was 24% in the patients with mild stenosis and 15% in those with severe stenosis (p less than 0.01). This study reveals the importance of continuous wave Doppler echocardiography in assessing the atrial influence on left ventricular performance in patients with mitral stenosis.

Adult↗
PubMed1977

Significance of echocardiographic evaluation on surgery to mitral stenosis.

1) Diastolic descent rate (DDR) of the anterior mitral leaflet improved after the surgery. However, this improvement was not modified with a) atrial fibrillation b) damages of the subvalvular supporting tissue c) valvular calcification d) the method of the operation, namely the open or closed commissurotomy. 2) DDR was fairly well correlated with the mitral orifice area, the cardiac output and the pressure gradient across the mitral valve. Therefore, the echocardiographic diagnosis and the follow up evaluation of the mitral stenosis after the surgery were thought to be very reliable, considering the accuracy of this diagnosis as disclosed in this study. The contributory effect to DDR was discussed.

Adult↗