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PubMed1980

[Electrocardiographic exercise test in assessment of hemodynamic patterns of mitral stenosis (author's transl)].

An ECG exercise test was performed in 36 patients with mitral stenosis, all in sinus rhythm and without digitalis therapy. In 21 subjects (group I = 58.6%) the test was negative, in the other 15 (group II = 41.7%) ischemic abnormalities of the ST segment were recorded during exercise; the mean value for the age is the same in both groups. All patients underwent cardiac catheterization; pulmonary pressure--and in 15 patients also cardiac output with thermodilution technique--were measured at rest and during the same exercise used for the ECG test. No relationship was found between ECG response and pulmonary capillary pressure (PCP), neither at rest nor during exercise, while exercise pressure values were well correlated with those at rest. The group I cardiac index (IC) and systolic index (IS) are significantly higher than in group II; the difference is remarkably more evident for the same indexes recorded during exercise, with splitting values, between the two groups, of 5000 ml/min/m2 for IC and 40 ml/beat/m2 for IS. Heart rate changes induced by exercise were similar in both groups, thus confirming the importance of the behaviour of output indexes. It is therefore possible to identify in mitral disease hemodynamic patterns due to different grouping of pathological features above (PCP) and below (IC) the valvular stenosis. Various hypothesis could be made in order to interpret the relationship between cardiac output and ischemic response to exercise. Anyway our results indicate that exercise ECG test is a non invasive technique useful to identify, among patients affected by mitral stenosis, those with a low IC and, mainly, those in whom this parameter fails to increase adequately with exercise.

Adult↗
PubMedDate not supplied

Ultrastructural and histological study of left ventricular myocardium in mitral stenosis. Correlations with angiocardiographic indices of left ventricular function (in 11 observations).

Left ventricular myocardial biopsies were performed during surgery in 11 patients with pure and isolated mitral stenosis. Patients had undergone a preoperative angiocardiographic study of left ventricular function. Biopsy specimens were examined with the light and electron microscope. Myocyte cell diameter was normal (20 +/- 1.6 mu). Lesions existed which were probably degenerative, including anarchy and irregularities of sarcomeres, Nemaline Myopathy-type Z line changes and alterations of intercalated discs. A moderate fibrosis was found in the interstitial spaces with very few histiocytes. The coincidence planimetry study of the interstitial spaces showed a 37 +/- 5.5% increase compared to a control group with no fibrosis (23 +/- 1.5%, p less than 0.01). The angiocardiographic indices of left ventricular function were all decreased. Only four subjects had normal left ventricular function (EF greater than or equal to 55%). Nevertheless, it was not possible to establish a significant correlation between the extent of fibrosis and the decrease of left ventricular function. Although left ventricular fibrosis could be one of the factors responsible for decreased myocardial function, it is not sufficient to explain the changes of left ventricular function which are rather frequently observed in mitral stenosis.

Adolescent↗
PubMed1998

Left atrial appendage function in mitral stenosis: is a group in sinus rhythm at risk of thromboembolism?

OBJECTIVE: To study the left atrial appendage (LAA) function and potential for embolization in severe mitral stenosis (MS). BACKGROUND: Patients with MS and atrial fibrillation or in sinus rhythm develop systemic emboli. LAA function has not been well studied in sinus rhythm. METHODS: Forty consecutive patients with MS (valve area < or =0.7 cm2/m2) were studied. LAA ejection fraction and peak emptying velocity were measured along with other data. RESULTS: Patients were subgrouped according to LAA Doppler flow pattern. Group I (n=13) in sinus rhythm had biphasic high velocity > or =25 cm/s. Group II (n=13) in sinus rhythm had biphasic low velocity <25 cm/s. Group III (n=14) in atrial fibrillation had multiphasic irregular flow <25 cm/s or no definite flow. The LAA ejection fraction and peak emptying velocity were strikingly different in all groups. They were lower in group II when compared to group I. Group II had intermediate risk for thromboembolism compared to Group I and III as judged by systemic embolization, spontaneous echo contrast, thrombus in left atrium and LAA. CONCLUSION: A subset of mitral stenosis in sinus rhythm at increased risk of embolization can be suspected by Doppler transesophageal echocardiographic LAA flow profile.

Adolescent↗
PubMed1998

[Study of flow field uniformity downstream of mitral stenosis using Doppler echocardiography].

To research into the relationship between mitral lesion, stenosed degree and flow field uniformity downstream of mitral valve, we adopted the advanced color Doppler echocardiographic technique to conduct a quantitative study of flow field uniformity downstream of mitral valve in sixty patients with varying-degree of mitral stenosis in vivo. Twenty normal persons acted for comparison. The results showed that there was a linear correlation between the extent of valvular lesion, the stenosed degree and flow field uniformity downstream of mitral valve. We conclude that the more severe the mitral lesion is, the more grave the stenosis is and the worse the flow field uniformity is. This suggests that there might be a reciprocity between valvular lesion and flow field uniformity as well as turbulent shear stress, which should be further studied.

Adult↗
PubMed1984

Extravascular lung water in patients with mitral stenosis: relationship to pulmonary capillary wedge pressure and Kerley B lines.

To evaluate the relationship between extravascular lung water, pulmonary capillary wedge pressure, and chest radiographic findings, extravascular lung water (EVLW) was assessed using double indicator-dilution techniques in 34 adult patients with mitral stenosis. Seven patients were studied 6 to 12 months after successful mitral valve replacement. In the 27 preoperative patients, septal lines were found to be indicative of elevated EVLW only in the presence of intravascular congestion. An excellent correlation between EVLW and pulmonary capillary wedge pressure was observed in these patients (r = .81, p less than .001), whereas only a rough correlation between scored radiographic findings and EVLW was observed. Postoperatively, septal lines were invariably associated with normal filling pressures and EVLW. Thus in both preoperative and postoperative mitral stenosis patients, interstitial Kerley B lines are insensitive markers of elevated extravascular lung water in the absence of pulmonary vascular engorgement. This emphasizes the importance of interpreting radiographic findings of extravascular fluid in conjunction with evaluation of the vascular bed in patients with chronic postcapillary hypertension.

Adult↗
PubMed1997

Aortic arch interruption with rheumatic mitral stenosis and Ebstein's anomaly. Report of a case with successful surgical outcome.

We present a rare case of a patient with interrupted aortic arch with Ebstein's anomaly of the tricuspid valve and rheumatic mitral stenosis. This patient presented in early adulthood, which makes his case even more unusual. We successfully treated the mitral stenosis and the interrupted aortic arch through a left lateral thoracotomy, but we decided against correcting the Ebstein's anomaly, which was mild. The hemodynamic effects of each lesion, independently and in the presence of each other, are discussed.

Adult↗
PubMed1975

Nonobstructive hypertrophic cardiomyopathy mimicking mitral stenosis. Documentation by echocardiography, phonocardiography and intracardiac pressure and sound recordings.

The physical findings in hypertrophic cardiomyopathy with left ventricular outflow tract obstruction are well described. In the absence of outflow tract obstruction the findings are less distinctive. There have been several reported cases in which the cardiac findings have suggested the diagnosis of mitral stenosis, In this report we describe a patient whose auscultatory and roentgenographic findings more closely mimicked mitral stenosis. The patient had a loud first heart sound, mitral opening snap and an apical presystolic murmur; left atrial enlargement was present. Noninvasive studies, including phonocardiography, echocardiography and apex cardiography, strongly suggested the correct diagnosis of nonobstructive hypertrophic cardiomyopathy. The diagnosis and unusual auscultatory findings were confirmed by results of cardiac catheterization and intracardiac phonocardiography. The importance of recognizing this syndrome and the use of noninvasive methods to establish the diagnosis are stressed.

Angiocardiography↗
PubMed1996

Left circumflex coronary artery to left atrial fistula in a patient with mitral stenosis: invasive and noninvasive findings with pathophysiologic correlation.

We report a case of an angiographically documented fistula between the circumflex coronary artery and a left strial appendage thrombus in a patient with mitral stenosis, flow from which can be demonstrated solely by a color doppler transesophageal echocardiogram. Evaluation of catheter derived hemodynamics and angiographic flow patterns reveals a heretofore undescribed physiologic property of coronary to atrial shunts in patients with mitral stenosis.

Blood Flow Velocity↗
PubMedDate not supplied

Contrast transesophageal echocardiographic demonstration of coronary artery fistula within left atrial appendage thrombus in mitral stenosis.

Coronary neovascularization and fistula formation arising from the left circumflex artery demonstrated by coronary angiography is a specific sign for the presence of left atrial appendage thrombus in patients with mitral stenosis. However, the fistula drainage site in the left atrium in relation to the thrombus cannot be ascertained by the angiographic method. We performed transesophageal echocardiography simultaneously with coronary angiography in five patients with severe mitral stenosis and left atrial appendage thrombus. The angiography showed coronary neovascularization and fistula arising from the left circumflex artery in three patients. In these three patients, the transesophageal echocardiography confirmed the presence of a coronary fistula by identifying contrast exuding from the surface of the thrombus. Thus we have shown for the first time the usefulness of contrast transesophageal echocardiography in imaging the exact drainage site of coronary artery fistula from left atrial appendage thrombus.

Aged↗
PubMed2003

Floating ball thrombus in the left atrium with mitral stenosis.

We report a case of a floating ball thrombus in the left atrium with mitral stenosis in a 76-year-old woman. The patient had been followed-up at our hospital due to mitral valve stenosis for several years, and was recognized to have atrial fibrillation and a left atrial mural thrombus by echocardiography. She was admitted to our hospital for right cerebral infarction. Echocardiography showed a floating ball thrombus in the left atrium. After the treatment of cerebral infarction, she was referred to cardiac surgery, and a semi-urgent operation was performed. Removal of the ball thrombus and mitral valve replacement were performed simultaneously. The thrombus was single, round, soft, relatively smooth surfaced, and about 30 x 30 x 30 mm in diameter. The postoperative course was uneventful. Left atrial ball thrombus appears to be uncommon. This is a rare case, in which it was documented that a pre-existing left atrial mural thrombus was thought to drop off spontaneously, to be a cerebral embolic source, and to develop into a ball thrombus in the left atrium.

Aged↗
PubMed1999

Inverse relation of haematocrit to cardiac index in mitral stenosis and atrial fibrillation.

We investigated the relationship between atrial fibrillation and the red cell parameters haematocrit, red cell concentration and mean corpuscular volume in 95 female patients with mitral stenosis (mean age 51+/-11 years, 38 patients in atrial fibrillation, 57 patients in sinus rhythm) who had undergone full blood examination and right and left heart catheterisation. Haematocrit was a positive correlate of atrial fibrillation (r=0.29, p<0.009) and a negative correlate of cardiac index (r=-0.37, p<0.003), but cardiac index was the only independent correlate of haematocrit on multivariate analysis (r2=0.14). The mean corpuscular volume was a positive correlate of age (r=0.42, p<0.0001) and atrial fibrillation (r=0.29, p<0.005) and a negative correlate of cardiac index (r=-0.22, p<0.04) and red cell concentration (r=-0.56, p<0.0001). On multivariate analysis, however, only age and red cell concentration were independent correlates of mean corpuscular volume (r2=0.43). Cardiac index was inversely correlated with both haematocrit and red cell concentration in the subgroup of patients with atrial fibrillation but not those with sinus rhythm. This study demonstrates that the major determinant of the higher haematocrit in mitral stenosis patients with atrial fibrillation is an associated reduction in cardiac index.

Adult↗
PubMed1978

Echocardiographic left ventricular function in mitral stenosis.

Left ventricular function was measured by echocardiography in 22 patients with pure mitral stenosis. Thirteen patients underwent closed transventricular mitral valvulotomy and nine underwent open mitral valvulotomy using cardiopulmonary bypass. Preoperative left ventricular function was normal in most patients but was depressed in older subjects (P less than 0.05) and in those undergoing a second operation on the mitral valve (P less than 0.001). The decrease in left ventricular function was probably related to the duration of mitral valve disease, with fibrosis and rigidity of the subvalvar apparatus and posterobasal left ventricular wall. There was no change in ventricular dimensions or in left ventricular function as measured by percentage shortening of the left ventricular diameter and ejection fraction 7 to 12 days after open or closed mitral valvulotomy.

Adult↗
PubMed1976

[Calculation of the mean pressure of the pulmonary artery and of the valve surface by ECG in mitral stenosis].

From a group of 50 patients affected by pure mitral stenosis with sinus rhythm, we have tried to obtain multiple correlation equations which enable in to calculate, in each particular case, the mean pressure of the pulmonary artery and mitral valvular area from purely electrocardiographic facts. In an additional group of 16 patients we have been able to verify the mentioned equations, placing all the calculated points within the presumed limits of tolerance. So it appears that the electrocardiographic calculation of these hemodynamic parameters is possible, with sufficient approximation for clinical requirements.

Blood Pressure Determination↗
PubMed1986

[Pressure gradient across the mitral valve in mitral stenosis estimated by high pulse repetition frequency Doppler method].

High pulse repetition frequency (HPRF) Doppler and continuous wave (CW) Doppler methods were used to estimate the pressure gradient across the mitral valve. Twenty-two cases of mitral stenosis and five cases of ischemic heart disease were studied. Both the HPRF and CW Doppler studies were conducted during catheterization in all cases. In the Doppler study, pressure gradient was calculated using the simplified Bernoulli's formula. The HPRF device used was a type SSD-730 produced by Aloka Co. It had a reference frequency of 2 MHz. Its minimum pulse repetition frequency was 4.2 KHz; its maximum, 19.2 KHz. Among the 27 cases, the maximum flow velocity measured by the HPRF method at the level of the mitral valve orifice was compared with that by the CW method. As the velocity increased, the discrepancy of measured values between the two methods increased, but it was within 0.1 m/sec. Therefore, there was a good correlation between the HPRF and CW methods (r = 0.98). The pressure gradient between time delay-corrected pulmonary artery wedge pressure and left ventricular pressure was compared with that obtained by the HPRF method. Contrary to our expectations, the correlation coefficient between the two was not so high, and the pressure gradients calculated by the HPRF method tended to be underestimated. For eight patients in whom the left atrial pressure could be recorded, the pressure gradient between the left atrium and left ventricle was compared with that obtained by the HPRF method. There was underestimation, and a good correlation coefficient was obtained. When using pulmonary artery wedge pressure as a substitute for left atrial pressure, one must realize that the time delay varies in every case and that the pressure pulse itself is not the same. When the pressure gradient between the left atrium and left ventricle is used, a good correlation coefficient can be obtained. Therefore, the flow velocity obtained by the HPRF method will reflect the true pressure gradient across the mitral valve. The HPRF method proved to have a potential equal to that of the CW method for estimating mitral valve flow velocity in mitral stenosis, and it may be used as a helpful diagnostic tool.

Adult↗
PubMed1977

[Parallel and opposite mitral leaflet motion in mitral stenosis. An echocardiographic study (author's transl)].

In 45 patients (pts.) with mitral stenosis (MS) multiple echocardiographic recordings of the posterior mitral leaflet (PML) were obtained and its motion pattern was carefully analyzed. 25 pts. showed only parallel motion (PM), one patient only opposite motion (OM) of the leaflets during diastole. In 19 pts. PM as well as OM (defined as backward movement of the PML immediately after the D-point and as forward motion during mitral closure, respectively) could be recorded at least two times. In most of these cases PM was impressive while OM could be demonstrated only by careful analysis of numerous recordings. In 4 of the 19 cases with PM and OM, however, the reverse was true. We conclude that OM should only be taken as evidence against MS when multiple recordings of the mitral leaflets have failed to reveal PM and when other echocardiographic signs of MS are missing. Possible explanations of the PM-OM combination are discussed.

Echocardiography↗