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At least 991 records · Page 55Linked to original sources
PubMed1990

[Transfemoral, transatrial double-balloon valvuloplasty of rheumatic mitral stenosis].

A percutaneous transfemoral, transatrial double-balloon valvuloplasty was performed on 21 patients (53 +/- 14 years) with rheumatic mitral stenosis. An open commissurotomy was performed in six patients, 20 +/- 9 years previously; in three patients an arterial embolism had occurred previously. Balloon valvuloplasty resulted in a reduction of the mean diastolic gradient from 16 +/- 7 to 8 +/- 3 mm Hg (p less than 0.001), and the mitral valve orifice area increased from 1.1 +/- 0.3 to 2.2 +/- 0.8 cm2 (p less than 0.001). Mitral insufficiency increased in three patients and was first observed after valvuloplasty in four patients. Complications were seen in three patients: a left ventricular perforation resulting in pericardial tamponade occurred in two patients, which required cardiothoracic intervention. In one patient a pulmonary embolism occurred five days after the invasive procedure. The study shows that percutaneous transfemoral balloon valvuloplasty can successfully be performed in patients with severe or even calcified mitral valve stenosis. The risk of severe complications is, however, not negligible.

Adult↗
PubMed1993

A reconsideration of surgery for mitral stenosis based on the extent of valvular distortion shown by two-dimensional echocardiography preoperatively.

A twelve-year follow-up study was carried out with 98 consecutive patients operated on for pure mitral stenosis with open mitral commissurotomy (OMC) or valve replacement with porcine valves (MVR). Each patient had the extent of valve distortion diagnosed preoperatively by two-dimensional echocardiography as either grade I of the dome-formation type, grade II of the intermediate type, or grade III of the mass-formation type. Thirty grade I patients and 24 grade II patients underwent OMC and 44 grade III patients received MVR. The long-term survival and reoperation rates were significantly poorer with grade II than grade I patients and there was no statistical significance between grades II and III. However, the clinical conditions set by NYHA are significantly worse in grade II than in grade III. This can be clearly explained by the fact that the left atrial volume decreasing ratio (LAVDR) in the latest period, which was measured in patients with more than 7 years survival, remained nearly at the early postoperative value in grade III, while the LAVDR of grade II at the latest period grew worse and became insignificantly different from the preoperative values. This study clearly shows that when OMC is applied to grade II patients, frequent reoperations might be necessary because of poor hemodynamic conditions. Thus, it might be better to adopt MVR rather than OMC with grade II patients with moderately distorted mitral valves.

Actuarial Analysis↗
PubMed1978

Noninvasive study of early diastole in mitral stenosis.

Cardiac events of early diastole were studied in 50 normal subjects and 46 patients with mitral stenosis (MS) by simultaneous recordings of the mitral valve echogram (MVE), phonocardiogram, and apexcardiogram (ACG). Left ventricular isovolumic relaxation time (IRT), measured between A2 and onset of the MVE opening motion, had almost the same values in normals 54 +/- 7 msec, and MS 51 +/- 16 msec. The interval between A2 and the ACG "O" point was approximately double that of IRT: 99 +/- 11 msec in normal subjects, 109 +/- 20 msec in MS. The normal MVE opening motion had a velocity 293 +/- 76 mm/sec and duration 45 +/- 6 msec, values significantly different (P less than 0.001) from 536 +/- 271 mm/sec, 23 +/- 7.5 msec found in MS patients. In atrial fibrillation the length of the cardiac cycle did not affect A2-O interval or mitral valve opening movement duration; however cycle length was clearly related to isovolumic relaxation time. This resulted in a variation in the interval between completion of the mitral valve opening (opening snap) and O point. This interval was longer after a short diastole and vice versa.

Adolescent↗
PubMed1993

Mitral stenosis. Evaluation and guidance of valvuloplasty by transesophageal echocardiography.

Percutaneous transvenous balloon mitral valvuloplasty is a well-established alternative to surgical commissurotomy for selected symptomatic patients with rheumatic mitral stenosis. This procedure normally is performed with fluoroscopic guidance; however, even the experienced operator can be misled by radiographic landmarks. The addition of on-line TEE during PBMV facilitates the success and safety of this procedure by guiding the transseptal puncture and the positioning of the dilating balloon catheters across the stenotic mitral valve. In addition to guiding the manipulation of catheters, on-line TEE is also useful for confirming the efficacy of valvuloplasty and for detecting complications. TEE during PBMV is feasible, safe, and well-tolerated by awake patients.

Catheterization↗
PubMed2001

Role of closed mitral commissurotomy in mitral stenosis with severe pulmonary hypertension.

BACKGROUND AND AIMS OF THE STUDY: Closed mitral commissurotomy (CMC) is a well-established method for treatment of rheumatic mitral stenosis, but outcome in patients with severe pulmonary arterial hypertension (PAH) has not been clearly documented. METHODS: Between April 1996 and October 1999, among 61 patients who underwent CMC, 27 had severe PAH (systolic pressure > 100 mmHg). Of these patients, 11 were in NYHA class III, and 16 were in class IV. Preoperatively, the mean pulmonary artery (PA) pressure was 107.85 +/- 5.74 mmHg (range: 100-118 mmHg), mitral valve area (MVA) 0.704 +/- 0.106 cm2 (range: 0.5-0.91 cm2), and transmitral gradient 11.93 +/- 1.54 mmHg (range: 10-15 mmHg). The echocardiographic mitral valve score was 6.37 +/- 1.11 (range: 6-10). RESULTS: There was no operative mortality or incidence of significant (> or = 2+) post-CMC mitral regurgitation or cerebrovascular accident. The MVA increased to 2.385 +/- 0.248 cm2 (range: 1.9-2.8 cm2), the transmitral gradient fell to 2.44 +/- 0.51 mmHg (range: 2-3 mmHg), and postoperative PA systolic pressure fell to 33.33 +/- 8.20 mmHg (range: 30-60 mmHg). During a mean follow up of 26.9 months (range: 11-51 months), 23 patients were in NYHA class I and four were in class II. There were no significant differences in parameters between sexes, but mean male age was five years less than mean female age. CONCLUSION: In the subset of patients with severe PAH, surgical CMC is a safe and effective procedure that results in greater MVA and a more significant and sustained fall in PA pressure compared with reported series of percutaneous balloon mitral valvuloplasty.

Adolescent↗
PubMed1975

Analysis of left ventricular function in response to afterload changes in patients with mitral stenosis.

In order to assess left ventricular function in patients with rheumatic mitral stenosis, left ventricular function curves (plotting stroke work index vs left ventricular end-diastolic pressure) were constructed using angiotensin to augment, and nitroprusside to reduce, afterload. Hemodynamic responses to these alterations in afterload were measured. Resting ejection fractions and qualitative assessment of left ventricular angiographic contraction abnormalities were also determined. Changes in left ventricular end-diastolic pressure following afterload interventions could be linearly related to changes in mean aortic pressure, but mitral valve gradients were unaffected. Afterload reduction with nitroprusside did not augment cardiac output. Afterload elevation with angiotensin significantly depressed both cardiac output and calculated mitral valve areas. Patients with normal resting ejection fractions evidenced normal ventricular function curves and those with depressed ejection fractions showed flat or declining function curves. Contraction abnormalities, generally in the posterobasal area, correlated well with abnormal left ventricular function curves.

Adult↗
PubMed1977

Valvotomy in young patients with rheumatic mitral stenosis.

Twenty-nine patients younger than 18 years of age with mitral stenosis were operated upon in the Osaka University Hospital. Five patients who underwent operation in the early period of this study died postoperatively. Follow-up study was made in 20 of the surviving patients for a period of 6 to 20 years. Three died during the follow-up period. Twelve of the survivors were in NYHA Functional Class I, 4 were in Class II, and 1 was in Class III. Reactivation of rheumatic disease did not occur after mitral valvotomy.

Adolescent↗
PubMed2003

Echocardiographic predictors of hemodynamic response and significance of dyspnea development in patients with mitral stenosis during dobutamine stress echocardiography.

BACKGROUND AND AIM OF THE STUDY: In mitral stenosis (MS) patients, resting hemodynamic data do not always correlate with symptom severity. Stress tests may be carried out in these patients, but the mechanisms of different hemodynamic and clinical responses to stress are not clearly established. The study aim was to evaluate hemodynamic changes that correlate with dyspnea development during dobutamine infusion (DI) in patients with MS, and to assess determinants of transmitral gradient response. METHODS: Forty-five consecutive mild or moderately symptomatic patients (36 women, nine men; mean age 44 +/- 10 years; range: 26-66 years), in NYHA class II and with MS (mean mitral valve area (MVA) 1.6 +/- 0.1 cm2; range: 1.5-1.9 cm2) were evaluated with dobutamine stress echocardiography. RESULTS: During DI, dyspnea developed in 12 patients, and 33 patients remained asymptomatic. During infusion, both mean transmitral gradient (6 +/- 3 versus 11 +/- 6 mmHg, p = 0.01) and pulmonary artery systolic pressure (PASP) (13 +/- 4 versus 21 +/- 3 mmHg, p < 0.001) were significantly increased in patients who developed dyspnea compared to others. Hence, a subgroup of patients with more serious MS was identified using the hemodynamic response to dobutamine. Based on these clinical and hemodynamic results, management was changed in 12 patients (27%); five underwent percutaneous mitral balloon commissurotomy and seven received intensive medical treatment. In all patients, PASP at rest (p = 0.001), MVA (p < 0.0001) and subvalvular mitral score (p = 0.004), which is indicative of mitral valve damage, were significantly correlated with mean mitral valve gradient response. CONCLUSION: These results suggest that patients in whom dyspnea is provoked during DI show a greater increase in hemodynamic parameters than patients in whom provocation does not occur. The mean mitral valve gradient-response correlates with baseline pulmonary artery pressure, MVA and subvalvular echo score, and may be predicted by these parameters. Association between dyspnea and presence of severe mitral valve hemodynamics showed a high sensitivity and negative and positive predictive value. It is possible that dyspnea may be of value in identifying those patients with significant mitral valve obstruction.

Adrenergic beta-Agonists↗
PubMed1985

[Microcirculatory disorders in mitral stenosis surgery].

The clinical investigation of microcirculation in 100 patients with rheumatic mitral stenosis performed by clinico-morphological and laboratory methods has revealed changes of microcirculation in 100% of cases. Three degrees of disturbances of microcirculation are shown. The authors believe microcirculation disturbances to be responsible for severity of the patient's state and effectiveness of surgical treatment.

Adult↗
PubMed1988

Abnormal breathing patterns in patients with mitral stenosis: a possible compensatory role.

The breathing patterns of 37 patients with mitral stenosis were investigated in standing position by Konno-Mead analysis. Hemodynamic parameters were measured by cardiac catheterization, pulmonary function variables by pulmonary function testings and distribution of pulmonary perfusion by Tc-99m-MAA scintigraphy. Seventeen patients displayed rib cage dominant breathing patterns, and 6 patients displayed paradoxical breathing patterns, whereas 14 patients displayed normal breathing patterns. None of these patients exhibited an abdomen dominant breathing pattern. The patients with abnormal breathing patterns (rib cage dominant or paradoxical) displayed significantly higher values of pulmonary arterial pressure (p less than 0.01), capillary wedge pressure (p less than 0.01), total pulmonary vascular resistance (p less than 0.01) and mitral valve gradient (p less than 0.05) as well as smaller mitral valve area (p less than 0.05) and lower values of both in PaO2 (p less than 0.05) and diffusing capacity (p less than 0.05) than patients with normal breathing patterns. Abnormal distribution of pulmonary perfusion with hyperperfusion in the upper zone of the lung were found to be associated with the abnormal breathing patterns. Since rib cage dominant and paradoxical breathing patterns are known to increase ventilation in the upper zone of the lung, these abnormal breathing patterns may represent a compensatory mechanism serving to match ventilation and perfusion.

Adult↗
PubMed1992

Effect of heart rate on transmitral flow velocity profile and Doppler measurements of mitral valve area in patients with mitral stenosis.

To study the effect of heart rate changes on Doppler measurements of mitral valve area atrial pacing was performed in 14 patients with mitral stenosis and sinus rhythm. Continuous wave Doppler and haemodynamic measurements were performed simultaneously at rest and during pacing-induced tachycardia. (1) Mitral valve area was determined using the conventional pressure half time method. (2) Additionally, mitral valve area was calculated with a combined Doppler and thermodilution technique according to the continuity equation. (3) Simultaneous invasive measurements were used for calculation of the mitral valve area according to the Gorlin formula. With increasing heart rate (69 +/- 13-97 +/- 15-114 +/- 13 beats min-1) mitral valve area either determined by the continuity equation (1.0 +/- 0.2-1.0 +/- 0.3-1.1 +/- 0.4 cm2) or the Gorlin formula (1.2 +/- 0.3-1.2 +/- 0.4-1.3 +/- 0.4 cm2) remained constant. Both methods correlated closely not only at rest (r = 0.88, SEE = 0.11 cm2, P less than 0.001), but also during atrial pacing (first level: r = 0.95, SEE = 0.10 cm2, P less than 0.001, second level: r = 0.95, SEE = 0.13 cm2, P less than 0.001). In contrast, mitral valve area calculated according to the pressure half time method increased significantly during atrial pacing (1.0 +/- 0.3-1.8 +/- 0.5-2.0 +/- 0.5 cm2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Single coronary artery with "high take-off" origin in a patient with rheumatic mitral stenosis--a case report.

In this case report, a patient with rheumatic mitral stenosis and R-1 subtype single coronary artery arising from the ascending aorta ("high take-off" origin) and coursing between the aorta and pulmonary artery is presented. The clinical significance and differential diagnosis are discussed. To the authors' knowledge, this is the first case reported in the literature with a single R-1 subtype coronary artery that shows "high take-off" origin.

Aorta↗
PubMed2003

Does the myocardial performance index affect pulmonary artery pressure in patients with mitral stenosis? A tissue Doppler imaging study.

BACKGROUND: The relation between systolic pulmonary artery pressure (PAP) and mitral stenosis (MS) has been poorly understood. Although the mitral valve area (MVA) is an important factor affecting the PAP, there is a wide spectrum of the PAP in patients with MS despite a similar MVA. So, we analyzed whether the left and right ventricular myocardial performance index (MPI) correlated with the PAP. METHODS: Two-dimensional Doppler echocardiography was performed in 46 patients with MS. The left atrial diameter, mean mitral gradient, and MVA were measured. The PAP was derived from the tricuspid regurgitant jet velocity. The ejection time (ET), isovolumetric relaxation time (IRT), and contraction time (ICT) were measured on annulus of interventricular septum, lateral, inferior and anterior wall of left ventricle, and right ventricle free wall from apical two- and four-chamber views in patients with MS and 40 age-matched healthy patients by tissue Doppler imaging (TDI). Then the MPI was calculated as (IRT + ICT)/ET for both left and right ventricle. The correlation of PAP with MVA, mean mitral gradient, left atrial diameter, and left and right ventricular MPI was evaluated. RESULTS: MVA and PAP were measured as 1.57 +/- 0.39 cm2 (0.8-2.5 cm2)and 42 +/- 16 mmHg, respectively. It was determined that the MPI increased in patients with MS(0.59 +/- 0.1 vs 0.48 +/- 0.07, P < 0.001). It was also demonstrated that the MVA, left atrial diameter, mean diastolic gradient, and left ventricular MPI were correlated with PAP(r =-0.39 [P = 0.007], r = 0.43 [P = 0.003], r = 0.58 [P < 0.001], and r = 0.65 [P < 0.001], respectively). In multivariate analysis, although the PAP correlated with mean diastolic gradient and MPI (r = 0.39 [P = 0.013], and r = 0.48 [P < 0.001]), it did not correlate with left atrial diameter and MVA. The PAP also correlated with right ventricular MPI(r = 0.63 [P < 0.001]). CONCLUSION: This study demonstrates that the left ventricular MPI obtained by TDI is an important marker of PAP, and right ventricular MPI correlates with the PAP in patients with MS.

Adult↗