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At least 919 records · Page 51Linked to original sources
PubMed1996

Immediate and long-term results of balloon mitral commissurotomy for rheumatic mitral stenosis: comparison between Inoue and double-balloon techniques.

We examined the immediate results and 2-year follow-up of percutaneous transvenous mitral commissurotomy (PTMC) using the Inoue balloon (IB) and double-balloon (DB) techniques. Short-term comparisons have been described, but long-term comparisons have not been available. PTMC was performed in 208 adult patients with symptomatic mitral stenosis (MS) and mitral valve area (MVA) of 0.94 +/- 0.2 cm2, by use of the IB in 157 (73.4%) and the DB technique in 56 (26.3%). Procedures were performed successfully and without complications in 198 (93%) cases. Adequate mitral dilatation (MVA = 1.6 cm2) without significant regurgitation was obtained in 179 (86%) of 192 patients. The final MVA was 2.0 +/- 0.43 cm2 after IB and 2.06 +/- 0.51 cm2 after DB (not significant). Technical difficulties and complications were more frequent with DB (16% vs 3.8%; p<0.001). Severe mitral regurgitation (grade III to IV) occurred in 4.6% of IB and 4.1% of DB (not significant), whereas grade 1 mitral regurgitation was greater with IB (21% vs 10.2%; p=0.01). A total of 172 patients were monitored an average of 23.8 +/- 10.6 months, with 83% in New York Heart Association functional class 1, echocardiographic MVA of 1.84 +/- 0.44 cm2, and restenosis rate of 22% at 36 months. PTMC is a safe, effective treatment for symptomatic MS. Results of both IB and DB techniques are similar, but the IB is simpler and safer, Long-term clinical improvement is maintained, although the restenosis rate seems to be progressive and related to inadequate immediate results.

Adolescent↗
PubMed1978

[Mitral stenosis on conventional radiographs. II. The relationship between pulmonary venous and arterial hypertension, their haemodynamic parameters and calcified mitral valves (author's transl)].

In the second paper, the relationship between pulmonary venous and arterial hypertension and calcification in the mitral valve is analysed statistically and its patho-physiological significance discussed. In one hundred cases of mitral stenosis the left atrium, as seen on the lateral projection, was always enlarged, but its size was independant of atrial pressure or the pressure gradient across the mitral valve. Apart from pulmonary fibrosis and haemosiderosis, the abnormal findings increased with increasing mean atrial pressure. Pulmonary-arterial mean pressure of more than 30 mmHg was found particularly in the presence of mitral valve calcification (94%). Calcification of the valve is the most important and reliable indicator for evaluating the severity of the stenosis.

Adult↗
PubMed1986

Attenuated pulmonary vascular obstructive disease in double-outlet right ventricle and mitral stenosis.

A young woman with double-outlet right ventricle, mitral stenosis, and high systemic pulmonary artery pressure is described. Pulmonary vascular morphometric analysis indicated considerably less pulmonary vascular obstructive disease than might otherwise have been expected. Total repair was performed and resulted in a marked fall in pulmonary artery pressure. Pulmonary vascular morphometry may be indicated in selected patients before palliative management is selected over complete repair.

Adult↗
PubMed1996

Inhaled nitric oxide in children with pulmonary hypertension and congenital mitral stenosis.

We demonstrated selective pulmonary vasodilation in patients with congenital mitral stenosis with inhaled NO, and used NO as prolonged therapy to stabilize the postintervention course of these children. The pulmonary vasoreactivity was greater than that previously reported in adults and may be due to particular sensitivity of pulmonary veins to inhaled NO when pulmonary venous hypertension has been present since birth.

Administration, Inhalation↗
PubMed2000

[Short-term course under beta blockers of clinical and echocardiographic parameters in mitral stenosis in sinus rhythm].

The purpose of this study is to evaluate the short-term benefit of a beta-blocker (atenolol) on clinical and echocardiographic parameters of patients presenting isolated or predominant mitral stenosis in sinus rhythm. It is a prospective study performed on 26 patients who have had a clinical and echocardiographic assessment before and 15 days after treatment by atenolol. After 15 days of beta-blocker treatment, there is a significant improvement of dyspnea (57.6% in class III or IV before beta-blockade versus 15.3% with atenolol; P = 0.001) and a significant decrease of the heart rate (83.3 +/- 15.2 versus 68.9 +/- 13.9; P = 0.001) and the diastolic blood pressure (8 mmHg +/- 1.3 versus 7.2 mmHg +/- 0.9; P = 0.01). The Doppler echocardiography shows a significant increase of the stroke volume calculated by the Doppler method (28.7 +/- 6.2 versus 38.6 +/- 9.7 mL; P = 0.04). There is an insignificant trend to an improvement of the left ventricular systolic function, an increase of cardiac output and the decrease of the mean transmitral gradient. The factors associated with the failure of beta-blocker treatment are: the right heart failure (P = 0.04) and the low diastolic blood pressure (P = 0.01). The beta-blockers could be a logical and effective treatment of patients with mitral stenosis waiting for balloon commissurotomy or surgery.

Adolescent↗
PubMed2003

Cor triatriatum sinister presenting in the adult as mitral stenosis.

Cor triatriatum sinister is a rare congenital defect in which the left atrium is divided by a fibromuscular membrane into two distinct chambers. Classically, patients present in infancy although in some cases they remain asymptomatic until adulthood. The clinical features on presentation can mimic those of mitral stenosis due to the obstructive properties of the membrane. Cor triatriatum sinister presented in this case in an adult as mitral stenosis. Factors that may be relevant in determining late presentation are also discussed.

Cor Triatriatum↗
PubMedDate not supplied

Surgical treatment of mitral stenosis.

Analysis of 239 patients who underwent a commissurotomy for mitral stenosis (196 closed technique, 43 open technique). Total operative mortality was 2%. Long term follow-up is illustrated by an actuarial survival curve and long-term functional results are studied up to 15 years after operations. It allows the authors to consider commissurotomy alone as a good palliative procedure with good functional results in the majority of cases. However, in view of the collected data, they now elect to restudy all the patients 6 years after the primary correction and to perform a heart catheterization to consider appropriate reoperation in some cases.

Adult↗
PubMed1987

Transseptal pressure gradient and diastolic ventricular septal motion in patients with mitral stenosis.

Previous studies from our laboratory have shown that the position of the ventricular septum relative to the two ventricles at end-diastole is determined by the instantaneous transseptal pressure gradient (TSG) defined as left ventricular minus simultaneous right ventricular pressure. Since patients with mitral stenosis often have exaggerated leftward (paradoxic) motion of the ventricular septum during early diastole, we studied seven patients with mitral stenosis undergoing cardiac catheterization to determine if position (and therefore motion) of the ventricular septum was determined by TSG throughout diastole. M Mode echocardiograms derived from a two-dimensional parasternal short-axis view were recorded with simultaneous micromanometer measurements of left ventricular and right ventricular pressures. Six of seven patients demonstrated abnormal early diastolic leftward motion of the ventricular septum in at least one cardiac cycle. TSG measured at intervals throughout diastole ranged from -2.5 to +20 mm Hg, with abnormal TSG observed in most of the 40 cardiac cycles selected for analysis. The intracardiac position of the ventricular septum, defined as the distance from the right ventricular epicardium (RVEpi) to the left surface of the ventricular septum normalized for total cardiac dimension (RVEpi-VS), was plotted against left ventricular pressure, right ventricular pressure, and TSG. Linear regression of pooled data from all patients (164 observations) demonstrated a highly significant correlation between the instantaneous TSG and the relative intracardiac position of the ventricular septum (RVEpi-VS = 1.52 TSG + 42.7; r = .79, p less than .0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Left atrial mobile hydatid cyst mimicking left atrial myxoma and mitral stenosis and causing heart failure and arrhythmia.

Cardiac hydatid cysts are very rare in hydatid cyst disease. We report herein a case of hydatid cyst mimicking left atrial myxoma. A 78-year-old woman was admitted to our hospital with complaint of dyspnea and signs pulmonary edema and mitral stenosis. Echocardiography showed left atrial mobile, mostly solid mass with wall calcifications moving towards the orifice of the mitral valve. We also found loculated giant hepatic and right pulmonary cysts. We aimed to report this case because of mimicking mitral stenosis and left atrial myxoma and causing heart failure.

Aged↗
PubMed1980

Cross-sectional echocardiographic observations on the mechanism of preservation of the opening snap in calcific mitral stenosis.

Cross-sectional echocardiography (CSE) was performed on 19 patients with mitral stenosis (MS). Nine patients (group 1) had little or no mitral valve (MV) calcification; ten patients (group 2) had heavy MV calcification. An opening snap was present in each of the patients in group 1. Of the group 2 patients, five (group 2A) had an opening snap and five (group 2B) did not. CSE in the long axis revealed in group 1 patients a mobile MV with sharp anterior arching of the anterior leaflet in early diastole; in group 2A, dense echoes suggestive of calcification were noted near the tip of the MV, while the body of the leaflet was relatively thin and it arched anteriorly sharply in early diastole; and in group 2B, dense echoes were noted at the tip and body of the MV with reduction in mobility of the valve, and the sharp anterior arching of the anterior leaflet in early diastole was absent. Preservation of the OS in calcific MS depends on the distribution of calcification. Heavy calcification confined to the tip of the MV allows the anterior leaflet to arch anteriorly in early diastole, allowing preservation of the OS, whereas heavy calcification of the tip and body of the MV reduces the pliability of the valve with consequent disappearance of the OS.

Adult↗
PubMed1981

Intracardiac pressures in pregnant patients with mitral stenosis.

The influences of pregnancy on the pulmonary circulation in mitral stenosis (MS), were studied. 1) Twenty-two cardiac patients underwent serial right heart catheterization with the use of flow-directed catheter without X-ray fluoroscopy during the course of pregnancy. 2)In 23 cases of MS, in whom cardiac catheterization had been performed before pregnancy, clinical courses during the pregnancy were studied. In the 26-32 weeks' gestation: in MS (Group I), an elevation of peak systolic pulmonary arterial pressure (s-PAP) (mean + 14.9 mmHg, P less than 0.001) was seen; in contrast, in atrial septal defect (Group II), s-PAP remained constant. Right atrial pressure rose in the 26-32 weeks, gestation in both the groups. Infusion of 200 ml of dextran in 12-16 weeks, gestation induced an elevation of s-PAP in Group I, especially in those who fell into heart failure in the succeeding courses of pregnancy; but not in Group II. In MS, in 12 cases, whose s-PAP before the pregnancy was below 35 mmHg, no heart failure occurred during the pregnancy; in 6 of 8 cases with s-PAP between 35 and 50 mmHg, mild heart failure occurred; and in 2 cases with s-PAP over 50 mmHg, severe heart failure occurred during the pregnancy. In conclusion, in MS, PAP rises during pregnancy, and S-PAP before pregnancy and the reaction to dextran infusion can give suggestions for allowing pregnancy.

Adult↗
PubMed1993

[Laboratory diagnosis of left atrial thrombi in patients with mitral stenosis].

Left atrial (LA) thrombi sometimes occur in patients with mitral stenosis (MS) and may cause systemic embolization resulting in serious and fatal complications. Several clinical techniques are used to detect the presence of LA thrombi, but even echocardiography, the most widely used, has some drawbacks depending on the sizes and locations of the thrombi. This study evaluated D-dimer, fibrinopeptide A(FPA), and thrombin-antithrombin III complex (TAT) as molecular markers for diagnosing the presence of LA thrombi in 26 patients with MS who underwent cardiac surgery. Atrial fibrillation was detected in all patients. Patients with episodes of obvious thromboembolic diseases were excluded. Blood was obtained from the brachial vein before the surgery (3 +/- 1 days; mean +/- SD). The presence or absence of thrombi was confirmed at surgery in all patients. Levels of both D-dimer and TAT were significantly higher in patients with thrombi than in those without thrombi or in normal subjects. FPA levels did not differ significantly between the three groups. The levels of D-dimer and TAT correlated significantly with the weights of the LA thrombi. LA thrombi (ca > or = 2 g) were always confirmed at surgery in patients with levels of D-dimer higher than 200 ng/ml and/or levels of TAT higher than 4 ng/ml. These results indicate that D-dimer and TAT are simple and useful diagnostic markers for determining LA thrombi in patients with MS.

Antithrombin III↗
PubMed1991

[Laboratory diagnosis of left atrial thrombi in patients with mitral stenosis].

Left atrial (LA) thrombi sometimes occur in patients with mitral stenosis (MS) and the systemic embolization due to thrombi causes a serious, occasionally fatal complication. Several clinical techniques have been used to estimate the presence of LA thrombi. However, the hitherto available methods, even an echocardiography which has been most widely used, still have some drawbacks, depending on the size and location of thrombi. The author measured D-dimer, fibrinopeptide A (FPA) and thrombin-antithrombin III complex (TAT) in the patients with MS and evaluated the diagnostic value of these molecular markers to estimate the presence of LA thrombi. Twenty six patients with MS who had undergone cardiac operation were studied. Atrial fibrillation was found in all the patients. Episode of obvious thromboembolic diseases is a criteria of exclusion. Blood was drawn from the brachial vein several days (3 +/- 1 days: mean +/- SD) before the operation. The presence or absence of thrombus was confirmed at the surgery in all the cases. 1) Both levels of D-dimer and TAT were significantly higher in the patients with thrombi than those in the patients without thrombus or those in normal controls (mean: 378, 93 and 64 ng/ml, respectively; p less than 0.01 for both and 9.1, 2.0 and 1.7 ng/ml, respectively; p less than 0.01 for both). However, levels of FPA were not significantly different among the three groups (mean: 7.9, 4.9 and 3.7 ng/ml, respectively; NS for both). 2) both levels of D-dimer and TAT were significantly correlated with the weights of LA thrombus (r = 0.87, p less than 0.01: r = 0.79, p less than 0.01, respectively). 3) LA thrombi (ca. greater than or equal to 2 g) were always confirmed at the surgery in the patients who had levels of D-dimer higher than 200 ng/ml and/or TAT higher than 4 ng/ml. The plasma levels of D-dimer and TAT were further followed after the surgery in the same 18 patients (8 patients who had thrombus, the rest who didn't). 1) In the patients who had thrombi, levels of D-dimer were significantly decreased after the surgery (mean: from 267 ng/ml to 73 ng/ml, p less than 0.05). Levels of TAT were slightly but not significantly decreased (mean: from 82 ng/ml to 76 ng/ml, NS).(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMedDate not supplied

The effects of exercise on ventilation-perfusion relationship in patients with mitral stenosis.

Exercise limitation is common in patients with chronic pulmonary venous hypertension. One postulated mechanism is ventilation-perfusion inequality secondary to vascular congestion and edema formation. To investigate this possibility, five patients with symptomatic, chronic mitral stenosis were studied at rest, during 10 min of steady-state exercise and during recovery from exercise. Both conventional indices of gas exchange and the multiple inert gas elimination method were used. Hypoxemia was not present in patients at any stage in the study and negligible shunt or low VA/Q lung units were demonstrated by the inert gas method. Instead, regions with high VA/Q ratio appeared toward the end of exercise and immediately after exercise. We postulate that this was the result of a marked redistribution of pulmonary blood flow, possibly due to an accumulation of interstitial edema fluid. It is concluded that the excessive ventilatory response to exercise observed in patients with mitral stenosis may, in part, be explained by an unequal distribution of ventilation and perfusion.

Adult↗
PubMed1997

Accurate assessment of mitral valve area in patients with mitral stenosis by three-dimensional echocardiography.

The accuracy of measurements of mitral valve orifice area (MVA) from three-dimensional echocardiographic (3DE) image data sets obtained by a transthoracic or transesophageal rotational imaging probe was studied in 15 patients with native mitral stenosis. The smallest MVA was identified from a set of eight parallel short-axis cut planes of the mitral valve between the anulus and the tips of leaflets (paraplane echocardiography) and measured by planimetry. In addition, MVA was measured from the two-dimensional short-axis view (2DE). Values of MVA measured by 3DE and 2DE were compared with those calculated from Doppler pressure half-time (PHT) as a gold standard. Observer variabilities were studied for 3DE. MVA measured from PHT ranged between 0.55 and 3.19 cm2 (mean +/- SD 1.57 +/- 0.73 cm2), from 3DE between 0.83 and 3.23 cm2 (mean +/- SD 1.55 +/- 0.67 cm2), and from 2DE between 1.27 and 4.08 cm2 (mean +/- SD 1.9 +/- 0.7 cm2). The variability of intraobserver and interobserver measurements for 3DE measurements was not significantly different (p = 0.79 and p = 0.68, respectively); for interobserver variability, standard error of the estimate = 0.25. There was excellent correlation, close limits of agreement (mean difference +/- 2 SD), and nonsignificant differences between 3DE and PHT for MVA measurements (r = 0.98 [0.02 +/- 0.3] and p = 0.6), respectively. There was moderate correlation, wider limits of agreement, and significant difference between 2DE and PHT for MVA measurements (r = 0.89 [0.32 +/- 0.66] and p = 0.002), respectively. This may be related to the difficulties in visualization of the smallest orifice in precordial short-axis views. This study suggests that three-dimensional image data sets, by providing the possibility of "computer slicing" to generate equidistant parallel cross sections of the mitral valve independently from physically dictated ultrasonic windows, allow accurate and reproducible measurement of the MVA.

Adult↗
PubMed1983

Hemodynamic correlates of vectorcardiographic QRS loops in pure mitral stenosis.

The hemodynamic correlates of the vectorcardiographic types of right ventricular hypertrophy (RVH) according to Chou and Helm and those with normal QRS loop in the horizontal plane of Frank system were analyzed in 100 patients with pure mitral stenosis. All underwent right and left heart catheterization. Additionally, coronary arteriography was done on 16 whose ages were above 40. Type A RVH was associated with the most severe hemodynamic alterations with markedly elevated total pulmonary vascular resistance (TPVR), mean pulmonary artery pressure (MPAP), peak right ventricular pressure (RRVP) and the smallest mitral valve area (MVA). The severity of these parameters were to a lesser degree obtainable in type C but with no significant difference from type A (p greater than 0.05). However, types A and C were clearly separated from type B and normal QRS loop (p less than 0.05). Type B RVH and normal QRS loop showed milder hemodynamic changes and were not significantly different (p greater than 0.05). Our results indicate that in pure mitral stenosis the development of RVH is from a normal loop into type B, C and A reflecting an increasing severity of hemodynamic changes which affect the right ventricle. This order of development is different from the traditional view.

Adolescent↗
PubMed1984

[Adrenaline-induced autorhythmic activity in the isolated atrial myocardium of mitral stenosis patients and its suppression by etmozin and ethacizin (the diethylamino analog of etmozin)].

The authors studied the effect of the new Soviet antiarrhythmic phenothiazine drugs etmozine and etacizine (a diethylamine analog of etmozine) on the adrenaline-induced (10(-4)M) autorhythmic activity of the myocardium of the atria of patients with mitral stenosis. Different types of autorhythmic activity occurring in the myocytes of the atria of patients with mitral stenosis are described. It was established that neither etmozine nor etacizine produce any significant changes in the action potential (AP) amplitude and in the maximal diastolic potential of spontaneous AP. However, the action of etacizine on the rate of diastolic depolarization and the frequency of AP discharges was more remarkable. Moreover, etacizine (10(-5) g/ml) completely suppressed autorhythmic activity of the myocytes in 60% of the preparations whereas etmozine administered at the same concentration only in 33%. It is assumed that substantially higher efficacy of etacizine in the reduction of the adrenaline-induced autorhythmic activity in human atrial fibers as compared with etmozine is explained by the action of etacizine not only on the fast sodium current but also on the slow calcium current.

Action Potentials↗