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PubMed2001

Giant left atrium secondary to tight mitral stenosis leading to acquired Lutembacher syndrome: a case report with emphasis on role of echocardiography in assessment of Lutembacher syndrome.

Lutembacher syndrome is an unusual clinical entity of congenital secundum atrial septal defect in combination with rheumatic mitral stenosis. Although this classic form is seldom seen by the adult cardiologist, spontaneous Lutembacher syndrome as discussed later or the iatrogenic variant is not infrequently encountered. The pathophysiologic, clinical, and hemodynamic differences of mitral valve disease in the presence of atrial septal defect compared with isolated mitral stenosis are highlighted in this case review. Special emphasis has also been given to echocardiographic evaluation of this syndrome complex, particularly in the setting of percutaneous mitral valvuloplasty, which produces the iatrogenic form of Lutembacher syndrome.

Aged↗
PubMed1997

Actuarial outcome after catheter balloon commissurotomy in patients with mitral stenosis.

BACKGROUND: The goal of the present study was to determine the intermediate-term survival and the independent predictors of survival and event-free survival for patients who undergo catheter balloon commissurotomy (CBC). METHODS AND RESULTS: CBC for the treatment of mitral stenosis was performed in 132 patients from 1986 through 1994. The use of CBC increased the mitral valve area (MVA) from 1.0 +/- 0.3 to 1.9 +/- 0.6 cm2 (P < .001). There were six early deaths (4.5%) up to 1 month after CBC ("hospital" deaths). In the past 4.5 years, there have been no hospital deaths. Four late deaths occurred after elective mitral valve replacement (MVR). Actuarial 7-year survival was 95 +/- 1%; when mortality after MVR is included, 7-year survival was 83 +/- 6%. Actuarial 1-, 3-, 5-, and 7-year event-free survival (survival without MVR or repeat CBC) was 80 +/- 4%, 77 +/- 4%, 65 +/- 6%, and 65 +/- 6%. On multivariate analysis, the only two independent predictors (both after CBC) of 7-year event-free survival were MVA of > or = 1.5 versus < 1.5 cm2 (75 +/- 7% versus 32 +/- 12%) and mean pulmonary artery wedge pressure of < or = 18 versus > 18 mm Hg (84 +/- 6% versus 38 +/- 11%) (P < .001 for both). Patients with MVA of > or = 1.5 cm2 (n = 96) could be further subdivided into high- and low-risk subgroups for 7-year event-free survival by two post-CBC variables: mean pulmonary artery wedge pressure of < or = 18 versus > 18 mm Hg (90 +/- 6% versus 48 +/- 14%) (P = .0002) and cardiac index of > or = 2.5 versus < 2.5 L.min-1.m-2 (82 +/- 8% versus 61 +/- 13%) (P = .004). Patients with post-CBC MVA of < 1.5 cm2 (n = 24) had no additional predictors of event-free survival. Of patients who did not undergo MVR or repeat CBC, 8% were in New York Heart Association functional class III and 92% were in class I or early class II at the last follow-up. CONCLUSIONS: The rates for intermediate-term survival and event-free survival after CBC are very encouraging. Most patients without events were asymptomatic or minimally symptomatic. Thus, in selected patients with mitral stenosis who require an interventional procedure, CBC is the procedure of choice at centers with physicians who have experience and skill in performing this procedure.

Adult↗
PubMed1996

Successful treatment of Wolff-Parkinson-White syndrome with concomitant mitral stenosis by simultaneous surgery.

We report the case of a 61-year-old man with type B Wolff-Parkinson-White (WPW) syndrome associated with a right atrioventricular (AV) accessory pathway and concomitant mitral stenosis, who underwent successful operative treatment by simultaneous surgery. His preoperative course had been characterized by cardiac failure and repeated episodes of atrial tachyarrhythmia, in the form of fibrillation and flutter, which were difficult to control by conventional medication. Preoperative electrocardiograms (ECGs) had suggested that the accessory pathway was located in the right posterior to posteroseptal wall; however, at the time of surgery, epicardial electrophysiological mapping with sock electrodes revealed a preexcitation area in the AV groove at the lateral right margin of the heart. This discrepancy was thought to have been due to the presence of mitral stenosis or multiple accessory pathways. Thus, division and cryoablation of the accessory pathway by an endocardial approach, in addition to mitral valve replacement, were performed under cardiopulmonary bypass. His postoperative course was uneventful, and subsequent ECGs revealed that the delta waves had disappeared. The successful outcome of this patient demonstrates the effectiveness of simultaneous surgery for WPW syndrome associated with valvular disease.

Atrial Fibrillation↗
PubMed2001

Anxiety, depression and functional capacity in older women with mitral valve stenosis.

Mitral valve stenosis can lead to a range of symptoms that affect daily life. As many of the people with this problem are elderly, the difficulties resulting from age can be exacerbated by illness. A pilot descriptive study was designed to examine the differences in anxiety, depression and functional capacity in women with mitral valve stenosis who were aged over 60 years when compared to a similar group of volunteers who did not have any cardiac disease. Measurement was undertaken using the Hospital Anxiety and Depression scale, the SF-36 Health Status questionnaire and the Functional Limitations Profile. Forty women were recruited to the study: 20 women with mitral valve stenosis and 20 volunteers. Each person was asked to complete the three questionnaires on one occasion only. Non-parametric statistics were used for analysis. Patients fared worse than volunteers with significant differences between groups in respect of anxiety (P = 0.03), depression (P = 0.02) and overall function (P < 0.001), but not in physical (P = 0.52) or mental health (P = 0.32). Future research could focus on strategies that would help alleviate anxiety and depression and improve functional capacity in older women with mitral valve stenosis.

Aged↗
PubMed1997

Percutaneous balloon valvuloplasty for severe mitral stenosis in pregnancy. Four case reports.

Four pregnant women with mitral stenosis who did not respond to medical therapy underwent successful percutaneous balloon valvuloplasty with complete resolution of their symptoms. Their clinical features and echocardial and hemodynamic data are presented. The procedures and the remainder of their pregnancy were uncomplicated. Percutaneous balloon valvuloplasty of the mitral valve is a safe and effective alternative to surgical therapy if medical management is unsuccessful.

Adult↗
PubMed1975

[The contractile function of the left ventricle in pure mitral stenosis. Echocardiographic analysis].

The left ventricular performance in patients with mitral stenosis has been assessed by echocardiography, through the measurement of various parameters, such as the stroke volume, the ejection fraction (EF), the mean circumferential fiber shortening rate (VCF), the cardiac work and the left ventricular mass. Among these parameters only EF and VCF are statistically lowered in mitral disease, in comparison with their value for normal hearts: the mean value of EF is 0.62 in healthy people and 0.49 in mitralic patients; the mean value of the VCF rate is 1.05 circ/s and 0.78 circ/s respectively. The cardiac work and power in the considered patients are on the average lower than normal values by about 10%, but not significantly so. A good correlation has been obtained between the left ventricular work and mass, whereas no correlation has been found between the ventricular wall thickness and the diameter of the left cavity, both measured at end-diastole. The quotient of the ventricular thickness and intracavity radius, in diastole, is equal to 0.38 in healthy people and 0.30 in mitralic patients. Lastly, the echocardiographic results and those of angiocardiographic literature were in agreement.

Adult↗
PubMed1994

[Results of percutaneous mitral dilatation in 11 cases of poorly tolerated mitral stenosis during pregnancy].

The authors report the results of percutaneous mitral dilatation (PMD) during pregnancy in 11 cases of tight and poorly tolerated mitral stenosis (MS). This dilatation was performed on average at 22 +/- 5 weeks of pregnancy, protecting the fetus against radiation and using the double balloon technique. Fluoroscopy time, with a mean of 10.5 +/- 2.2 minutes, was greatly reduced in the last five patients by the elimination of cineangiography. Mitral insufficiency was then sought and estimated by colour Doppler. This also avoided iodine overload and its possible effects on the fetal thyroid. Mitral surface area and hemodynamic parameters were very significantly improved by PMD: mean capillary pressure fell from 25.1 +/- 6.2 to 10.7 +/- 4.4 mmHg, mean transmitral gradient from 18.8 +/- 6.2 to 5.9 +/- 2.9 mmHg and mitral surface area increased from 0.9 +/- 0.2 to 2.1 +/- 0.4 cm2 (p < 0.0001). Pregnancy continued under good hemodynamic conditions until delivery which occurred after 8 and a half months, vaginally, in 10 cases. Cesarean section was performed at 8 months in only one patient because of fetal distress not related to the dilatation and with a satisfactory outcome. The 11 children, now with a mean age of 18 months, are all well and free of any functional or organic abnormality. Measurement of thyroid hormone levels in the first 6 also proved normal. In the light of these results, PMD during pregnancy can be considered as an excellent alternative to surgery when it is possible in terms of the anatomical status of the mitral valve.

Adult↗
PubMed1975

[Correlation between the diffusion capacity of the lungs and certain ventilation indices in mitral stenosis].

A study is performed on the correlation relationship between diffusion lung capacity (DLCO) and its components (DM and VC) and the ventilatory indices, VC, FEV1 and FEV 1% VC in 100 patients with mitral stenosis. The determined correlation coefficients and the constructed regression lines show that DLCO and DM have a considerable direct reciprocal relationship with VC and FEVI. The correlation dependence of blood component (VC) with VC, FEV1 and FEV1%VC is low. The close reciprocal relationship of DL CO and DM with VC and FEVI reveals that in patients with mitral stenosis one can judge, to a certain extent, about the severness of the disturbance in the alveolo-capillary diffusion.

Female↗
PubMed1981

A 25-year experience with the closed method of treatment in 139 patients with mitral stenosis.

A 25-year experience with 139 patients undergoing closed mitral commissurotomy is reviewed. The primary indication for closed mitral commissurotomy was mitral stenosis, but 24 patients also had other less important valvular defects. Preoperatively, all patients were in New York Heart Association (NYHA) Functional Class III or IV. Average age was 46 years (range, 18 to 77 years). There were 24 men and 115 women. No further operation after initial closed mitral commissurotomy was required in 68% of the patients (95 patients), and NYHA Functional Classification was improved in 93%. Postoperative complications occurred in 3%, and operative mortality was 2.0%. Follow-up revealed restenosis in 6% of the patients, mitral regurgitation in 14%, complications in 7%, and late deaths in 3%. Reoperation, required in 32% (44 of 139 patients), included a second closed mitral commissurotomy (21 patients), open mitral commissurotomy (3), mitral valve replacement (MVR) (18), and MVR after a second closed mitral commissurotomy (2). Improvement in NYHA classification was found in 82% of these patients. Operative mortality was 9.5% for patients having a second closed mitral commissurotomy and 20% for those having MVR.

Adolescent↗
PubMed1980

[The atrial vectorcardiogram at rest and during exercise. Comparison, by computerized analysis, of normal subjects and patients with mitral stenosis].

This study on rest and exercise atrial vectorcardiogram (Frank method) was carried out on a group of 27 healthy volunteers (Group A) and on a group of 24 patients with mitral stenosis (Group B). All 51 subjects were women. Our original program was performed using a Hewlett Packard 2100 computer. The pattern recognition of every wave was carried out by analysing a particular function obtained by translating the X, Y, Z leads on the line joining the T-P, P-Q, ST segments. In the group B on rest a significant correlation between atrial vectorcardiogram parameters and pulmonary capillary wedge pressure was not present. Between both group A and B the vectorcardiographic data were greatly superposables. It is difficult, because of the great interindividual variability of results obtained, to have very discriminant vectorcardiographic parameters between group A and group B on rest and during exercise, performed in the supine position with a bicycle ergometer. In the both groups A and B the exercise induces a significant increase of spatial magnitude of maximal P xyz vector (max P xyz) and maximal P amplitude on frontal and sagittal planes, with P loop shifting towards a vertical position. The following significant results were observed only in group B of mitral patients: 1) an increase of P wave duration; 2) an increase of the interval between the two peaks of P wave (measurable only in group B); 3) an increase in the amplitude and backward rotation of max P xyz azimuth and of the maximal vector backward directed on horizontal (H) plane; 4) an increase of P loop linear, tangential and areolar velocities. The P loop anterior and posterior area on H plane and of the spatial P xyz vectors changes during exercise were directionally similar in the normal group and in the patients with mitral stenosis. These results suggest a little diagnostic power of the P wave area changes during exercise. In both groups maximal atrial T vector increases with exertion, but only in group B migrates backward on H plane, suggesting an atrial gradient directed towards the left atrium.

Adult↗
PubMed2005

Balloon mitral commissurotomy for patients with mitral stenosis in atrial fibrillation: ten-year clinical and echocardiographic actuarial results.

BACKGROUND AND AIM OF THE STUDY: Controversy persists as to whether atrial fibrillation (AF) has a direct negative effect on the outcome of percutaneous balloon mitral commissurotomy (PBMC). The study aim was to assess the effect of AF on immediate and 10-year clinical and echocardiographic actuarial results of patients with rheumatic mitral stenosis undergoing PBMC. METHODS: A total of 195 consecutive patients with AF (group 1) was analyzed and compared with 195 patients in sinus rhythm (group 2), matched for the severity of mitral valve morphological changes. RESULTS: Group 1 patients were older (43.8 + 12 versus 30.5 +/- 12.7 years; p <0.001), and a greater proportion had grade 1 mitral regurgitation (25.1 versus 9.7%; p <0.0001). The procedural success was 89.8% in group 1 and 92.3% in group 2 (p = NS), but group 1 patients had a smaller mitral valve area (2.1 +/- 0.4 versus 2.3 +/- 0.4 cm2; p <0.0001). Patients in AF had a lower 10-year survival (91.4 versus 99.4%; p = 0.018), a lower 10-year event-free-survival (60.3 versus 70%; p = 0.02), and a lower 10-year freedom from restenosis (40 versus 66%; p = 0.048). AF was an independent predictor of overall mortality (OR = 10.79; p <0.033) and of combined events (death, redo PBMC or mitral valve surgery; OR = 1.95; p <0.012), and was a univariate predictor of restenosis (p = 0.048). CONCLUSION: Patients with AF have good immediate results, but poorer long-term outcome after PBMC. AF a marker of worse prognosis in patients with mitral stenosis as it is in the general population.

Adult↗
PubMed1977

Supravalvular mitral stenosis associated with ventricular septal defect.

We describe three patients with supravalvular mitral stenosis caused by a diaphragm located just above the mitral valve and associated with a ventricular septal defect. Two of our three patients also had an associated coarctation of the aorta. The physical signs, ECGs, chest roentgenograms, and cardiac catheterization data are described. Points helpful in the differential diagnosis of this malformation are emphasized. All three patients were treated successfully by surgery.

Adolescent↗
PubMed1990

Factors influencing progression of mitral regurgitation after transarterial balloon valvuloplasty for mitral stenosis.

This study analyzes the clinical, echocardiographic and hemodynamic factors affecting progression of mitral regurgitation (MR) after transarterial balloon valvuloplasty in 200 consecutive patients with rheumatic mitral stenosis. After valvuloplasty, the mitral valve area increased in all patients, from 1.03 +/- 0.36 to 2.06 +/- 0.71 cm2 (p less than 0.0001). With regard to the basal stage, the mitral valve was competent in 139 patients and there was mild MR in 61 (grade I in 53, and grade II in 8). Three patients had progression of MR induced by a technical deficiency and they were excluded from analysis. Patients were classified into 2 groups on the basis of the degree of MR before and after valvuloplasty: group A--no progression of MR (n = 167; 85%) when the degree of MR did not change, disappeared after valvuloplasty, or increased from grade 0 to I; group B--progression of MR (n = 30; 15%) when the degree of MR increased to greater than or equal to grade II. Progression of MR was observed more frequently in older patients with presence of chronic atrial fibrillation, larger left atrial size and left ventricular volumes, baseline MR, more severe stenosis and a lower ejection fraction. Multivariate analysis selected age, left ventricular volumes and ejection fraction as independent predictors of progression of MR. All these factors suggest that progression of MR after balloon valvuloplasty could be related to a more advanced degree of disease.

Age Factors↗
PubMed1978

Ventilatory responses to exercise and to carbon dioxide in mitral stenosis before and after valvulotomy: causes of tachypnoea.

1. The ventilation and cardiac frequency during progressive exercise and the respiratory responses to breathing carbon dioxide have been measured in 33 female patients with mitral stenosis and in 31 control subjects. Compared with the control subjects, the patients' exercise ventilation and cardiac frequency were increased; the exercise tidal volume at standard minute volume, the vital capacity and the ventilatory response to carbon dioxide were reduced. The extent to which the standardized tidal volume was lower during exercise than during breathing carbon dioxide was correlated with the severity of the stenosis, as gauged by the increase in exercise cardiac frequency above the level predicted from anthropometric measurements. 2. Twenty patients were studied postoperatively. In the 12 who showed clinical improvement the exercise ventilation and cardiac frequency were reduced and the exercise tidal volume at a given minute ventilation was increased. The latter change occurred despite a reduction in vital capacity, which was probably a residual effect of thoractomy. There was no significant change in the response to breathing carbon dioxide. No material change in function was observed in the patients whose condition was not improved by the operation. 3. It is suggested that in mitral stenosis the tachypnoea which occurs during exercise, whilst mainly a mechanical consequence of the reduced vital capacity, is also partly due to pulmonary congestion stimulating intrapulmonary receptors.

Adult↗
PubMed1986

Comparative accuracy of two-dimensional echocardiography and Doppler pressure half-time methods in assessing severity of mitral stenosis in patients with and without prior commissurotomy.

This study was undertaken to compare the accuracies of the two-dimensional echocardiographic (2DE) and Doppler pressure half-time methods for the noninvasive estimation of cardiac catheterization measurements of mitral valve area in patients with pure mitral stenosis both with and without a previous commissurotomy. Data were retrospectively obtained from 74 consecutive patients who underwent cardiac catheterization within a 30 month period for evaluation of mitral stenosis, and who had two-dimensional echocardiograms performed before catheterization. Six patients (8.1%) had technically inadequate 2DE images and their data were excluded from analysis. Two of these patients had undergone commissurotomy, while the remaining four had not. Continuous-wave Doppler echocardiographic examinations were attempted in 45 patients and adequate measurements of pressure half-times were obtained in all patients studied. Mitral valve area by two-dimensional echocardiography was measured as the planimetered area along the inner border of the smallest mitral orifice visualized during short-axis scanning, while pressure half-time was calculated as the interval between the peak transmitral velocity and velocity/square root 2 as measured from the envelope of the Doppler spectral signal. Calculations from catheterization represented the minimal valve area at rest as derived from the Gorlin formula with the use of pressure gradients and thermodilution measurements of cardiac output. Thirty-seven of the patients had had a previous mitral commissurotomy a mean of 11.2 +/- 5.4 years before, while the remaining 37 patients were previously unoperated. Mean valve area as determined at catheterization for the total group of patients ranged from 0.37 to 2.30 cm2 (mean = 1.08 +/- 0.42 cm2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Mitral stenosis: implications for critical care obstetric nursing.

Pregnancy complicated by mitral stenosis poses a significant risk for maternal morbidity and mortality. The perinatal nurse is challenged to use obstetric and cardiac physiologic principles in planning and guiding care during the intrapartum period. Nursing assessments and interventions based on these principles promote positive outcomes.

Adult↗
PubMed1984

Echocardiographic assessment of congenital mitral stenosis.

To assess the severity and precise anatomy of congenital mitral stenosis (MS), 17 patients with congenital left ventricular inflow obstruction were studied by M-mode and two-dimensional echocardiography (2DE) and by cardiac catheterization. In six patients MS was an isolated lesion and in 11 it was combined with other cardiovascular malformations. The diagnosis was confirmed at operation or autopsy in 15 patients. Twenty normal subjects of the same age and sex were selected as controls. M-mode amplitude and speed of diastolic closure (E-F slope) of the anterior mitral valve leaflet were determined in all patients. Mitral valve areas were traced after careful short-axis 2DE scans in 15 patients. Supravalvar, valvar, or subvalvar obstruction was evaluated in patients with surgical or autopsy documentation. Analysis of M-mode echocardiograms showed a reduction of E-F slope in all patients compared to normal control subjects but a poor correlation between E-F slope and hemodynamic data (mitral valve areas or pressure gradients). Diastolic fluttering of either or both mitral valve leaflets was found in 12 patients. It is concluded that M-mode echocardiography may be useful for qualitative assessment of congenital MS, even in the presence of associated heart defects, but less useful in evaluating its severity. Analysis of 2DE revealed good correlation between mitral valve areas as calculated with 2DE and with the Gorlin formula at cardiac catheterization, despite the complexity of the congenital mitral lesion. Anatomic varieties of congenital left ventricular inflow obstruction, such as stenosing supravalvar mitral ring or parachute deformity of the mitral valve, were recognized at 2DE.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

Percutaneous transvenous mitral commissurotomy: hemodynamic and initial outcome differences between atrial fibrillation and sinus rhythm in rheumatic mitral stenosis patients.

BACKGROUND: Atrial fibrillation (AF) occurs frequently in severe rheumatic mitral stenosis (MS) and has been reported to be a predictor of poor outcome after percutaneous transvenous mitral commissurotomy (PTMC). Nevertheless, according to observations in our catheterization laboratory, patients with sinus rhythm (SR) seem to have a higher pulmonary artery pressure than AF. PURPOSE: To determine 1) the hemodynamic differences between MS patients with AF and SR before and after PTMC and 2) the success rate and difference in outcome between both groups. METHOD: A total of 145 patients who had undergone PTMC with the Inoue balloon technique in King Chulalongkorn Memorial Hospital between 1993 and 1997 were enrolled. The data were presented as mean +/- SD. Student t-test was used to compare the difference in hemodynamic and outcome between the AF and SR groups. RESULTS: Fifty-six patients (38.6%) were in the AF group. The AF patients were older (42.0 +/- 11.3 vs 32.4 +/- 8.7 yr., p < 0.0001), had a larger left atrium (49.2 +/- 6.1 vs 45.3 +/- 4.9 mm, p < 0.001) and a higher valvular calcification score (1.8 +/- 0.6 vs 1.5 +/- 0.6, p = 0.02) than the SR group. There was no significant difference between baseline heart rate and overall MV score index. The hemodynamic data showed that the SR group had higher systolic (59.9 +/- 26.0 vs 47.4 +/- 16.8 mmHg, p < 0.05), diastolic (28.1 +/- 12.8 vs 22.7 +/- 9.2 mmHg, p < 0.05) and mean (40.1 +/- 17.1 vs 32.7 +/- 11.8 mmHg, p < 0.05) pulmonary artery (PA) pressure than the AF group. After successful PTMC, the SR group exhibited a more favorable change in all PA pressures and the transmitral valvular gradient (10.0 +/- 6.5 vs 6.7 +/- 6.5 mmHg, p < 0.01) than the AF group. Procedural success rates were 98 per cent in the AF and 96 per cent in the SR group (p = ns). Transthoracic colour-flow echocardiographic imaging detected atrial septal defects in 18.2 per cent and 7.5 per cent (p = 0.08) of the AF and SR groups, respectively. There was no systemic embolization, peri-procedural death or emergency surgery in both groups. CONCLUSION: Patients with MS and AF were older, had a larger LA and lower pre-PTMC PA pressure than the patients who had MS and SR. In addition, patients with SR had a more favourable PA and LA pressure reduction than patients with AF.

Adult↗