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PubMed1985

[Systolic honk in mitral stenosis: a case report].

This case report describes a mitral systolic honk originating from the mitral valve and adjacent structures in a 52 year-old woman with mitral stenosis. The patient was hospitalized because of dyspnea. Auscultation of the heart revealed a grade 3/6 apical early systolic honk accompanied by an increased first heart sound, an opening snap and a diastolic rumble. The phonocardiogram demonstrated an early systolic honk at a frequency of 115 Hz. Intensity of the honk varied on beat to beat basis, increasing in the short preceding R-R interval compared to that in the long one. The M-mode echocardiogram showed early systolic fluttering of the mitral valve and chordae tendineae at the same frequency as the honk. The two-dimensional echocardiogram showed bulging of the anterior mitral leaflet toward the left atrium in early systole. After treatment with digitalis and diuretics, the early systolic honk disappeared in beats with preceding long R-R intervals (greater than 1100 msec). In beats without the honk, systolic fluttering of the mitral valve was not observed. The genesis of the early systolic honk is analogous to that of the honk audible in mitral or tricuspid valve prolapse. The bulging of the anterior mitral leaflet into the left atrium may produce vibrations of the mitral valve leaflets and adjacent structures.

Chordae Tendineae↗
PubMed1981

Malignant mesenchymoma of the heart presenting as mitral stenosis.

Malignant mesenchymoma of the left atrium obstructing the mitral orifice was revealed at autopsy in a 39-year-old woman with a history indicating mitral stenosis. Minor tumour nodules were found in the walls of the right and left ventricle together with a few distant metastases. Clinical findings in primary cardiac tumours and the rarity of primary malignant mesenchymoma of the heart are discussed.

Adult↗
PubMed1990

Long-term hemodynamic results of percutaneous transvenous mitral commissurotomy in rheumatic mitral stenosis with pliable, non-calcified valves.

Percutaneous transvenous mitral commissurotomy (PTMC) for severe, symptomatic mitral stenosis was successfully performed in 47 of 50 patients with pliable, non-calcified valves. The procedure resulted in immediate hemodynamic and sustained clinical improvements in all patients. Repeat cardiac catheterization was performed in 22 patients at a mean follow-up period of 15 months (range 12 to 29). The patients were similar to the other 25 patients in regard to gender, age, clinical and hemodynamic characteristics. There were 4 males and 18 females with a mean age of 37 years (range 20 to 61). Immediately after PTMC, there were significant increases in the mitral valve area (1.0 +/- 0.2 to 2.4 +/- .9cm2, p less than 0.001) and cardiac index (3.1 +/- 0.7 to 3.3 +/- 0.7 l/min/m2, p less than 0.05) and significant (p less than 0.001) decreases in the left atrial pressure (25.7 +/- 6.4 to 13.2 +/- 3.9 mmHg), the mitral valve gradient (15.7 +/- 5.7 to 3.9 +/- 1.4 mmHg), mean pulmonary arterial pressure (41.5 +/- 10.7 to 29.2 +/- 10.9 mmHg) and the pulmonary vascular resistance (4.2 +/ 3.4 to 3.5 +/- 2.9 Wood unit). At follow-up study, the mitral valve area (2.2 +/- 0.7 cm2) and the left atrial pressure (12.6 +/- 3.7 mmHg) remained unchanged. There were further decreases in the mean pulmonary arterial pressure (22.4 +/- 5.9 mmHg, p less than 0.05) and the pulmonary vascular resistance (2.0 +/- 1.5 Wood unit, p less than 0.05). There were significant (p less than 0.05) increases in the mitral valve gradient (6.6 +/- 2.5 mmHg) and the cardiac output (3.6 +/- 0.7 l/min/m2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Association of mitral stenosis and membranous obstruction of the inferior vena cava.

Mitral stenosis associated with membranous obstruction of the inferior vena cava is a rare condition which has not been previously reported. We report a 60-year-old man who presented with pulmonary hypertension and obstruction of hepatic venous outflow due to the above combination. The interrelationship between these two disease entities is also discussed in detail.

Collateral Circulation↗
PubMed2003

[A case of delayed diagnosis of pulmonary thromboembolism in a patient with mitral stenosis undergoing cesarean section].

Cesarean section was performed under general anesthesia in a 38-year-old patient with congestive heart failure due to severe mitral stenosis. During surgery, pulmonary hypertension, right ventricular distension and the dissociation of PETCO2 and PaCO2 were observed. However, pulmonary thromboembolism (PTE) was proved after the operation when she developed severe hypotension in the intensive care unit. Although she recovered once from circulatory unstability with the use of percutaneous cardiopulmonary support (PCPS) and she could be weaned from PCPS at the 4th postoperative day, she died from tracheal bleeding and recurrent cardiopulmonary collapse 22nd day after the surgery. It should be noted that the increasing dissociation of PETCO2 and PaCO2 may be an early sign of PTE even in a patient with severe mitral stenosis and pulmonary hypertension.

Adult↗
PubMed1996

Prediction of hemodynamic conditions by noninvasive arterial tonometry in mitral stenosis.

To predict the hemodynamic conditions in patients with mitral stenosis (MS), continuous blood pressure responses were monitored noninvasively at the bedside by arterial tonometry during the Valsalva maneuver in 18 MS patients aged 54.2 +/- 9.1 (40 approximately 77) years (6 men, 12 women). Two indices during the Valsalva maneuver (blood pressure decline value at phase III (BPdec) and subsequent blood pressure overshoot value at phase IV (BPov)) were compared with hemodynamic data obtained by the cardiac catheterization method, and the correlations between the changes in these parameters were examined. In these 18 patients, BPdec showed a significant negative correlation with the mean diastolic pressure gradient between the left atrium and left ventricle and showed a significant negative correlation with pulmonary capillary wedge pressure (PCWP) (r = - 0.62, p < 0.01, r = - 0.53, p < 0.05, respectively). Mitral valve area (MVA) showed a significant positive correlation with BPdec (r = + 0.63, p < 0.01). Similarly, BPov showed a significant positive correlation with cardiac output (CO), cardiac index (CI) and MVA (r = + 0.60, p < 0.01, r = + 0.64, p < 0.01, r = + 0.65, p < 0.01, respectively). Thus, continuous monitoring of blood pressure by arterial tonometry during the Valsalva maneuver is useful for predicting the hemodynamic conditions in patients with MS.

Adult↗
PubMed1995

Changes of plasma dynorphin levels before and after percutaneous balloon mitral commissurotomy in patients with mitral stenosis.

Plasma dynorphin A1-13 levels were measured in 33 patients with mitral stenosis before and after percutaneous balloon mitral commissurotomy (PBMC). The results show that the basal levels of plasma dynorphin in blood from the antecubital vein in the patients were significantly higher than those in 31 healthy control subjects. The increase in circulating dynorphin closely correlated with the functional cardiac status and the presence of atrial fibrillation. Ten to fifteen minutes after PBMC, plasma dynorphin levels in blood from the femoral vein increased significantly. Seventy-two hours after the procedure, the levels of plasma dynorphin in blood from the antecubital vein had decreased significantly, but they did not decrease to the normal range. Plasma dynorphin levels in blood from the femoral vein were positively correlated with the mean left atrial pressure and the mean right atrial pressure before the first balloon inflation. Plasma dynorphin levels in blood from the antecubital vein were positively correlated with the heart rate and the mean transmitral pressure gradient, and negatively with the mitral valve area before and 72 hours after PBMC.

Adolescent↗
PubMedDate not supplied

[QRS in mitral stenosis: Electrohemodynamic correlation].

The electrocardiograms of 50 patients with mitral stenosis in sinus rhythm were reviewed (axis of QRS and T in the frontal and horizontal planes, with each one of their modules, Lewis index and right Sokolow-Lyon, quotient R/R + S in V1, time of beginning of the intrinsecoide deflection of QRS), they were related with the hemodynamic data; and the existence of clear relations between both methods of exploration were confirmed. 1. The QRS axis in the frontal plane kept a good relation with the hemodynamic data (mainly thzontal axis there proved to be a closer relation than in this one. 2. The quotient R/R + S in V1 was the parameter that best correlated with the mean pressure of the pulmonary artery and with the pulmonar capillary pressure. 3. Although the right Sokolow-Lyon index is not a definite criterion for recognizing a right ventricular hypertrophy; it is very useful in correlating the total pulmonary resistances with the mean pulmonary arterial pressure, even if it did not reach pathologic values. The same can be said the Lewis index, although the dependence is less important. 4. The horizontalization of the frontal axis of T becomes more important with the increase in the hemodynamic repercution. 5. As an expression of the systemic hemodynamic alteration, the decrease in time of inscription of the intrinsecoid deflection, of the left ventricle in V6 became evident when the mitral area diminished or by increase of mean pressure of the pulmonary artery. 6. The electrocardiographic characteristics that allow to recognize the existence of a mitral area smaller than 0.8 cm2, with a possibility of error of less than 5% (false positives), are: -- a horizontal axis of QRS less or equal to + 9 degrees -- a right Sokolow-Lyon index of more than 21.56. 7. The existence of a mean pressure of more than 25 mm. Hg in the pulmonary artery can be acknowledged, with a possibility of false positives of less than 5%, by the apparition of one or more of the following data: -- a frontal axis of QRS more or equal to + 87 degrees -- a Lewis index of less than -7.44. 8. The diagnosis of mean pressures of the pulmonary artery of more than 35 mm. Hg can be established, with the same degree of possibility, by: -- a T frontal axis of less or equal to + 10 degrees -- a horizontal axis of QRS of less or equal to + 13 degrees -- a right Sokolow-Lyon index of more than 19.71 -- a quotient R/R + S in V1 more or equal to 0.88. 9. The only finding that permits to establish of a pulmonary capillary pressure higher of 25 mm. Hg, with false positives possibility of less of 5% is: -- quotient R/R + S in higher or equal to 0.07 in V1.

Electrocardiography↗
PubMed1985

[Ventilation and gas exchange in the lungs during physical exertion in patients following the correction of mitral stenosis].

During rehabilitation of 40 patients after correction of mitral stenosis, a study was made of ventilation and gas exchange in the lungs under spirometric bicycle ergometry according to the "standard protocol" until the maximal oxygen consumption (MOC) was attained. The patients were examined 20-30 days, 3 and 6 months after operation. In accordance with the magnitude of the MOC expressed in metabolic equivalents (MET), all the patients were divided into 3 functional classes which corresponded roughly to the NYHA classification. It was revealed that with the same magnitude of the MOC the patients of the worst functional class had a lower production of CO2, a greater volume of the dead space and a higher level of minute ventilation. It is supposed that the described respiratory abnormalities are connected with enhanced ventilation of the poorly perfused alveoli, apparently because of venous congestion in the pulmonary capillaries. The characteristics of gas exchange and ventilation in the lungs investigated under the conditions of the "standard protocol" of spirometric bicycle ergometry objectively mark pump function of the heart and respiratory potentialities of the cardiorespiratory system, which might be the basis for the functional classification of the patients after cardiosurgical interventions.

Adolescent↗
PubMed1994

Plasma atrial and brain natriuretic peptides in mitral stenosis treated by valvulotomy.

1. In order to appreciate the effect of changes in left atrial pressure on plasma brain natriuretic peptide, 20 patients with mitral stenosis treated by percutaneous valvulotomy were studied 10 min before and 15 min after the first balloon inflation. They were also studied 24 h before and 48 h after the valvulotomy. At these times the effect of postural changes on brain natriuretic peptide secretion was examined. A group of 10 control subjects was also studied under basal conditions. In each case, plasma atrial natriuretic peptide was measured in parallel with plasma brain natriuretic peptide. 2. Similarly to plasma atrial natriuretic peptide, plasma brain natriuretic peptide was elevated in patients with mitral stenosis (32 +/- 2.9 and 32 +/- 2.8 pg/ml in the upright and supine position respectively versus 13.5 +/- 0.5 and 13.8 +/- 1.8 pg/ml in controls; P < 0.01). Changing from standing to lying did not modify plasma brain natriuretic peptide, whereas it produced an increase in plasma atrial natriuretic peptide in controls (13.3 +/- 1.6 versus 24.8 +/- 5.2 pg/ml; P < 0.01) and in patients 48 h after valvulotomy (52.5 +/- 4.6 versus 66.9 +/- 6.6 pg/ml; P < 0.01). Plasma brain natriuretic peptide also fell at this time (18.8 +/- 1.1 and 19.1 +/- 1.1 pg/ml in the upright and supine position respectively; P < 0.01) similarly to plasma atrial natriuretic peptide and cyclic GMP (P < 0.01). The acute left atrial mean pressure variation was significantly correlated with the parallel change in plasma atrial natriuretic peptide (P < 0.001) but not in plasma brain natriuretic peptide.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

[Preliminary echocardiographic evaluation on prosthetic valve replacement of preserving the subvalvular apparatus with artificial chorade for mitral stenosis].

The purpose of this study was to evaluate the preliminary results after prosthetic valve replacement of preserving the subvalvular apparatus with artificial chorade for mitral stenosis. 20 patients had received operation with expanded polytetrafluoroethylene(e-PTFE) as artificial chordade. The patients were followed up by means of echocardiography. The time of follow-up study varied from 4 to 18 months with a mean of 6 months. The left atrial, ventricular dimension as well as ventricular function were assessed. In addition, the length of artificial chorade and obstruction of left ventricular outflow track were observed. The results showed that left atrial diameter (LAD, from 57.59 +/- 13.51 mm to 47.05 +/- 9.55 mm), left ventricular end-diastolic dimension (LVEDD, from 46.23 +/- 12.56 mm to 42.41 +/- 10.86 mm), left ventricular end-systolic dimension (LVESD, from 33.50 +/- 10.20 mm to 29.68 +/- 8.40 mm) decreased (P < 0.01), and ejection fraction (EF, from 52.59 +/- 11.89% to 58.36 +/- 8.03%) increased (P < 0.05) after operation. There were no significant changes of fractional shortening (FS, from 29.23 +/- 8.99% to 31.05 +/- 6.08%). The length of artificial chorade ranged from 2.6 cm to 4.3 cm (the mean, 3.2 cm). There was no case of obstruction of left ventricular outflow track. It is believed that the result of preliminary echocardiographic observation on prosthetic valve replacement of preserving the subvalvular apparatus with artificial chorade for mitral stenosis is satisfactory.

Adult↗
PubMed1980

[Histological and ultrastructural study of the left ventricular myocardium in mitral stenosis. Correlations with angiocardiographic indices of left ventricular function. Eleven cases].

Left ventricular myocardial biopsy was carried out at operation in 11 patients with pure, isolated mitral stenosis after preoperative angiocardiographical assessment of left ventricular function. The biopsy specimens were examined by light and electron microscopy. The diameter of the myocytes was normal (20 +/- 1.6 mu). The changes observed were probably of a degenerative type with anarchy and irregularities in the sarcomeres, modification of the Z bands, as seen in Nemaline myopathies, and changes in the intercalatory discs. Moderate interstitial fibrosis with scanty histiocytes was also observed. A quantitative assessment by two dimensional planimetry showed a significant increase in the interstitial space (37 +/- 5.5%) compared to a control group without fibrosis (22 +/- 1.1%). The angiocardiographical indices of left ventricular function were all decreased. The amplitude of circumferential fibre shortening was reduced: 25 +/- 6% the ejection fraction by 52 +/- 9% and the average speed of circumferential fibre shortening by 1.0 +/- 0.3 circ/s. Only four patients had normal left ventricular function (ejection fraction > 55%). However, it was not possible to establish a significant correlation between the degree of fibrosis and the reduction in left ventricular function. Left ventricular fibrosis may be one of the factors responsible for the reduction of myocardial function, but it does not in itself explain all the changes in left ventricular function observed in mitral stenosis.

Adolescent↗
PubMed2001

Percutaneous transluminal mitral valvuloplasty improves cardiopulmonary baroreflex sensitivity in patients with mitral stenosis.

Patients with heart failure frequently have increased sympathetic tone, which could result in part from impairment of the inhibitory influence of cardiopulmonary baroreflexes. Percutaneous transluminal mitral valvuloplasty (PTMV) provides a unique model for evaluating functional changes in cardiopulmonary baroreflexes without open-heart surgical manipulation. We examined the effects of PTMV on cardiopulmonary baroreflexes and sympathetic nerve activity in 10 patients with mitral stenosis. We measured muscle sympathetic nerve activity using microneurography. Cardiopulmonary baroreflex provocation was performed by applying a lower body negative pressure of -10 mm Hg, and its sensitivity was determined by dividing the percent change in muscle sympathetic nerve activity by the change in central venous pressure. Response to isometric exercise was assessed by handgrip at 30% of maximal voluntary contraction for 3 min. PTMV significantly increased mitral valve area and cardiac index and decreased mean left atrial pressure. PTMV significantly decreased burst rate from 25.1+/-2.5 to 15.6+/-2.6 bursts/min (p < 0.01) and burst incidence from 37.1+/-3.7 to 23.6+/-3.3 bursts/100 heart beats (p < 0.01). After PTMV, cardiopulmonary baroreflex sensitivities measured using burst rate and burst incidence were -39.9+/-4.9%/mm Hg and -38.7+/-6.2%/mm Hg, respectively, which were significantly steeper than those before PTMV (-9.2+/-1.1%/mm Hg and -8.4+/-1.1%/mm Hg; p < 0.01). There were significant correlations between muscle sympathetic nerve activity at rest and cardiopulmonary baroreflex sensitivity. PTMV did not affect muscle sympathetic responses to handgrip exercise. These results suggest that patients with mitral stenosis have baseline sympathetic nerve activation, which could result in part from impaired cardiopulmonary baroreflexes.

Adult↗
PubMed1988

[Doppler echocardiographic findings before and after balloon catheter valvuloplasty in mitral stenosis].

This study was undertaken to analyze the diagnostic value of Doppler echocardiographic determination of pressure gradient and valve orifice area for the evaluation of balloon valvuloplasty in mitral stenosis as well as the echocardiographic assessment of calcification, leaflet motion and the subvalvular apparatus for characterization of the most favorable morphologic prerequisites for this procedure. Doppler echocardiographic studies were performed in 24 patients with mitral stenosis, 21 women and three men, age range from 29 to 79 years, mean age 55 years, one day before and after balloon valvuloplasty and the results were compared with invasively-determined hemodynamic measurements. The Doppler echocardiographic determination of the mean pressure gradient before and after balloon valvuloplasty was carried out with the modified Bernoulli equation from the velocity profile of the stenotic jet and calculation of the mitral valve orifice area using the pressure half-time method. Echocardiographic assessment of valve morphology and motion was based on two-dimensional echocardiographic cross-sectional images. Calcification, as observed in the parasternal cross-sectional image, was classified as absent (grade 0), slight to moderate (grade 1) or severe (grade 2). Motion of the valve leaflets, as judged from the apical four- and two-chamber views, was assigned one of five grades taking into consideration the motion of the bodies of both leaflets from the systolic baseline position as less than 10 degrees, between 10 and 45 degrees and more than 45 degrees. The subvalvular apparatus, that is the chordae and the papillary muscles, were graded as unremarkable (grade 0), slightly altered (grade 1) and markedly altered (grade 2). Using a score derived by adding the grade of these three criteria, a formal value between 0 and 8 was calculated. Hemodynamic measurements were carried out with standard techniques employing simultaneous registrations of left atrial and left ventricular pressure for evaluation of the mean diastolic pressure gradient. Determination of the stroke volume was based on biplane left ventriculograms using Simpson's rule. The valve orifice area was calculated according to the Gorlin formula. Dilatation was carried out with a Bifoil (12F, balloon diameter 2 X 19 mm) or Trefoil (10F, 3 X 12 mm) valvuloplasty catheter. After PTVP, on comparison of the Doppler-echocardiographically determined pressure gradient (5.7 +/- 1.9 mm Hg) with that determined invasively (6.4 +/- 3.2 mm Hg) there was a moderate correlation (n = 19, r = 0.74, SEE = 1.3 mm Hg) where the noninvasively-determined values, in general, were smaller.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

[Interest of percutaneous transvenous mitral commissurotomy in the management of rheumatic mitral stenosis].

During from April 1987 to October 1988, 13 cases of mitral stenosis (MS) were treated with percutaneous transvenous mitral commissurotomy (PTMC) among 24 cases of MS. The indications of PTMC were determined by surgeons in 4 cases with several reasons described as follows: 1. Patient, having been treated with closed mitral commissurotomy, who refused to be operated with open heart technique. 2. Patient associated with early gastric cancer. 3. Patient associated with severe hyperthyroidism and cardiac cachexia. 4. Patients suffering from acute renal failure following left heart failure due to association of aortic stenosis. Other 9 cases were determined by cardiologist because of the inherent benefit of PTMC being less invasive. After PTMC, the symptomatic improvement, assessed by means of NYHA classification, were observed in 11 cases out of 13. Hemodynamic data such as mitral valvular area, mitral valve gradient and cardiac index showed marked improvement without any inducing of significant mitral regurgitation. The authors thought with these results as follows: 1. The effect of PTMC may be appreciable for mild or moderate stenotic lesion of mitral orifice, however, severely affected valves should be treated by open heart techniques in order to perform radical procedures. Otherwise, significant MR may occur by overloading of balloon size beyond some extent. 2. On account of the appearance of PTMC, the indicational determination for the treatment of MS will be more controvertial than now.

Adult↗
PubMed2003

Life-saving PTMC for critical calcific mitral stenosis in cardiogenic shock with balloon impasse.

A 32-year-old male patient, a case of critical calcific mitral stenosis (following closed mitral valvotomy in 1989) was admitted for mitral valve replacement in September 2001. In hospital, he developed cardiogenic shock, pulmonary oedema and oliguria precluding surgery. An emergency percutaneous transatrial balloon mitral commissurotomy as a life-saving procedure in a valve with unfavourable morphology and 'balloon impasse' is discussed.

Adult↗
PubMedDate not supplied

[Silent mitral stenosis (report of 8 cases)].

We studied eight cases of mitral "mute" stenosis we had discovered through echocardiogram, and analysed its clinical behaviour, the various findings in exploration, and electrocardiographic, radiologic, phonomecanocardiographic and echocardiographic changes. We mention the most notable signs for the suspected diagnosis of this kind of stenosis and the importance they have in the alleviation of this illness--frequently a very severe one, through surgical treatment. When mitral stenosis is not recognized in time through a precise diagnosis, turns to be a potentially lethal illness a short time after being diagnosed as a pulmonary arterial hypertension. We highly recommend the use of echocardiography for the diagnosis of mitral "mute" stenosis, because it has proved to be a inocuous, easy to obtain and very sensible way of diagnosing.

Adult↗