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Results for “MITRAL VALVE STENOSIS”

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PubMed2000

Surgical management of heart failure.

Surgical therapy for congestive heart failure can offer gratifying results in selected elderly patients. Several trials have shown a survival advantage for surgical revascularization compared with medical therapy in the treatment of ischemic cardiomyopathy. Aortic valve replacement is highly effective in treating elderly patients with heart failure caused by severe aortic stenosis, and stentless aortic valves seem to provide a survival advantage in elderly patients with low-gradient aortic stenosis. Mitral valve repair with or without coronary revascularization has been used successfully in patients with severe mitral regurgitation. Transplantation is a viable but rarely used option for elderly patients with congestive heart failure. Totally implantable ventricular assist devices are an exciting new option for elderly patients with congestive heart failure who are not heart transplantation candidates.

Aged↗
PubMed1989

Evaluation of the left ventricular reserve by dynamic exercise echocardiography after surgery for valvular heart diseases.

Dynamic ergometer exercise in a supine position was applied to 64 patients more than 1 year after valvular heart surgery, and the left ventricular reserve was evaluated echocardiographically. The left ventricular reserve declined in the mitral stenosis-mitral valve replacement group, while it was better maintained in the mitral stenosis-mitral commissurotomy, aortic regurgitation and aortic stenosis groups. The patients were divided into 3 groups depending on whether the percentage increase during exercise of stroke index, an index of left ventricular pump function, increased, unchanged, or decreased. The percentage increase of mean velocity of circumferential fibre shortening (y) and that of left ventricular end-diastolic diameter (x) during exercise were plotted for each group. The increased group was isolated from the unchanged group by the line of y = -5.02x + 30.1; the unchanged group was isolated from the decreased group by that of y = -5.68x-10.0, and the increased and unchanged groups were clearly isolated from the decreased group by that of y = -6.86x-4.76. We conclude that dynamic ergometer exercise echocardiography is useful for evaluating the left ventricular reserve of postoperative patients with valvular heart disease. It was also thought that the subclinical state of cardiac failure can be effectively detected by the present method.

Adult↗
PubMed2000

Malfunction of a Hancock bioprosthesis in the mitral position 24 years after initial implantation.

BACKGROUND AND AIMS OF THE STUDY: Although many types of cardiac bioprosthetic valves are currently available, the major disadvantage of their use is limited durability due to progressive structural valve deterioration. Few such valves function beyond 20 years. METHODS: A 61-year-old man was admitted urgently to our institute with acute mitral insufficiency, 24 years after undergoing mitral valve replacement with a 25-mm standard Hancock porcine bioprosthesis for mitral stenosis. RESULTS: Mitral valve reoperation was performed successfully with a mechanical valve. The explanted bioprosthesis showed leaflet perforations and a commissural tear, moderate calcification on the commissures, and pannus overgrowth. CONCLUSION: The findings in this case suggest that individual patient variables, as well as the design and the construction of the valve are major determining factors in the rate of valve failure.

Bioprosthesis↗
PubMed1991

Intraoperative estimation of cardiac output by transesophageal pulsed Doppler echocardiography.

To determine whether transesophageal echocardiography could be used to estimate intraoperative cardiac output, the authors studied 35 consecutive patients undergoing cardiovascular surgery (coronary artery disease [n = 22], aortic valve disease [n = 5], mitral valve stenosis [n = 5], peripheral vascular disease [n = 3]). Two-dimensional echocardiographic and pulsed-wave Doppler signals of the pulmonary artery and mitral valve flow velocity were obtained simultaneously with thermodilution measurements of cardiac output. Cardiac output derived from pulsed Doppler imaging of pulmonary artery systolic flow velocity modestly correlated with the thermodilution-derived cardiac output (r = 0.65), but output determined from the mitral valve diastolic flow velocity did not (r = 0.24). Transesophageal echocardiography of pulmonary artery systolic flow satisfactorily detected intraoperative increases in cardiac output greater than 15% (sensitivity, 71%; specificity, 82%) but not decreases (sensitivity, 54%; specificity, 90%). Although this technique identifies increases in cardiac output greater than 15%, it does not detect decreases as accurately as those detected by thermodilution measurements. At this time, therefore, transesophageal Doppler echocardiography has significant limitations as an off-line monitor of cardiac output.

Adult↗
PubMed1955

Mitral stenosis.

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Humans↗