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At least 1,081 records · Page 60Linked to original sources
PubMed1998

Long-term results of percutaneous balloon mitral valvuloplasty for mitral stenosis: a follow-up study to 11 years in 202 patients.

We studied the first 202 patients with rheumatic mitral stenosis (MS) who underwent percutaneous balloon mitral valvuloplasty (PBMV) with the Inoue balloon catheter for a follow-up (FU) period of 5-11 years. Pre- and post-PBMV and at FU, the mean left atrial pressure was 21.3+/-7.4, 10.2+/-5.6, and 11.2+/-4.1 mm Hg; mean diastolic mitral gradient was 18.4+/-7.3, 2.9+/-3.2, and 5.1+/-4.3 mm Hg; and mitral valve area was 1.0+/-0.3, 2.1+/-0.6, and 1.7+/-0.5 cm2. Functional status improved from New York Heart Association (NYHA) class IV in 3, class III in 119, and class II in 80 pre-PBMV to class I in 163, class II in 37, and class III in 2 post-PBMV, and was class I in 146, class II in 39, and class III in 17 patients at FU. In the 17 patients with NYHA class III at FU, mitral restenosis was the culprit; 4 underwent repeat PBMV, 12 had mitral valve replacement for severe mitral calcification and subvalvular fusion, and 1 refused further intervention. Thus PBMV using the Inoue balloon catheter is an effective method of relieving MS with excellent long-term results in patients without severe mitral calcification and subvalvular fusion.

Adolescent↗
PubMedDate not supplied

[Tight mitral stenosis with normal unilateral pulmonary capillary pressure].

There are few reports of severe mitral stenosis with normal pulmonary artery wedge pressure. In order to illustrate this problem we present two adult patients with these abnormalities. Both patients had intact interatrial septum with partial anomalous pulmonary venous drainage, one to the inferior vena cava (The Scimitar Syndrome) and the other to the superior vena cava. In the first case the right pulmonary artery wedge pressure was 11 mm Hg. In the second case this pressure was only 8 mm Hg. Pulmonary arteriograms are of paramount importance in the diagnosis and surgical management. In both cases the surgical procedure with mitral commissurotomy and transplant of the anomalous pulmonary veins to the left atrium was successful.

Adult↗
PubMedDate not supplied

[Mitral valve and mitral ring movement in mitral stenosis. An ultrasonic study with different valve models (author's transl)].

We constructed three different mitral valve models in order to investigate the different mechanisms which account for the concordant opening and closing movement of the posterior compared to the anterior mitral valve in mitral stenosis. Three different types of movements are possible: a dorso-anterior movement of the mitral ring, opening and closure of the valve itself and a rotation of the entire valve apparatus. Our in-vitro studies showed that the best explanation for the concordant diastolic movement of the posterior valve is given by the assumption that during the early diastolic opening phase of the valves the whole stenotic valve apparatus is rotated upward, i.e. towards the transducer. This rotation, has a higher amplitude compared to the residual downward-oriented opening movement of the posterior valve.

Mitral Valve↗
PubMed1996

Insights from three-dimensional echocardiographic laser stereolithography. Effect of leaflet funnel geometry on the coefficient of orifice contraction, pressure loss, and the Gorlin formula in mitral stenosis.

BACKGROUND: Three-dimensional echocardiography can allow us to address uniquely three-dimensional scientific questions, for example, the hypothesis that the impact of a stenotic valve depends not only on its limiting orifice area but also on its three-dimensional geometry proximal to the orifice. This can affect the coefficient of orifice contraction (Cc = effective/anatomic area), which is important because for a given flow rate and anatomic area, a lower Cc gives a higher velocity and pressure gradient, and Cc, routinely assumed constant in the Gorlin equation, may vary with valve shape (60% for a flat plate, 100% for a tube). To date, it has not been possible to study this with actual valve shapes in patients. METHODS AND RESULTS: Three-dimensional echocardiography reconstructed valve geometries typical of the spectrum in patients with mitral stenosis: mobile doming, intermediate conical, and relatively flat immobile valves. Each geometry was constructed with orifice areas of 0.5, 1.0 and 1.5 cm2 by stereolithography (computerized laser polymerization) (total, nine valves) and studied at physiological flow rates. Cc varied prominently with shape and was larger for the longer, tapered dome (more gradual flow convergence proximal and distal to the limiting orifice): for an anatomic orifice of 1.5 cm2, Cc increased from 0.73 (flat) to 0.87 (dome), and for an area of 0.5 cm2, from 0.62 to 0.75. For each shape, Cc increased with increasing orifice size relative to the proximal funnel (more tubelike). These variations translated into important differences of up to 40% in pressure gradient for the same anatomic area and flow rate (greatest for the flattest valves), with a corresponding variation in calculated Gorlin area (an effective area) relative to anatomic values. CONCLUSIONS: The coefficient of contraction and the related net pressure loss are importantly affected by the variations in leaflet geometry seen in patients with mitral stenosis. Three-dimensional echocardiography and stereolithography, with the use of actual information from patients, can address such uniquely three-dimensional questions to provide insight into the relations between cardiac structure, pressure, and flows.

Blood Pressure↗
PubMed1996

Balloon mitral valve dilatation as an aid to weaning from ventilatory support in patients with intractable pulmonary oedema caused by severe mitral stenosis.

Intractable pulmonary oedema in patients undergoing mechanical ventilation must be investigated as older patients with severe mitral stenosis can be rescued by balloon dilatation of the mitral valve, thus enabling elective cardiac surgery at reduced risk. We describe two such cases and discuss the role of transoesophageal echocardiography in the intensive care unit in the diagnosis and management of these patients.

Catheterization↗
PubMed1995

[Pulsed Doppler findings of the pulmonary vein flow in mitral stenosis].

Left atrial function was assessed by transesophageal echocardiography in 8 patients with mitral stenosis and sinus rhythm (MS group), and 16 age-matched normal controls (C group). Pulsed Doppler findings of left upper pulmonary vein flow were classified into first and second forward waves during systole (S1, S2), forward wave during diastole (D), and backward flow during left atrial contraction (PVA). Peak velocity (P) and time-velocity integral (TVI) of each wave and acceleration and deceleration slope of S2 wave (S2-Ac, S2-Dc) were obtained. TVI-S2 and P-D in the MS group were significantly lower than those in the C group (TVI-S2: 4 +/- 2 vs 12 +/- 3 cm, P-D: 27 +/- 13 vs 41 +/- 12 cm/sec). S2-Ac and S2-Dc in the MS group were significantly higher than those in the C group (S2-Ac: 456 +/- 116 vs 323 +/- 118 cm/sec2, S2-Dc: 380 +/- 102 vs 165 +/- 48- cm/sec2). There were no differences in S1 and PVA. Lower TVI-S2 in the MS group suggests decreased reservoir function of the left atrium. Lower TVI-S2 in the MS group was caused by increased S2-Ac and S2-Dc which suggests increased left atrial preload and deterioration of left atrial compliance. Decreased P-D in the MS group reflects dysfunction of mitral valve opening.

Adult↗
PubMed1989

[Volume, flow and respiratory muscle strength in mitral stenosis].

Pulmonary function and respiratory muscle strength was assessed in 20 patients with mitral stenosis uncomplicated by other illness. Pulmonary function was evaluated by spirometry, flow-volume curves, functional residual capacity (FRC) and total lung capacity (TLC). Respiratory muscle strength was evaluated by measurement of maximal static inspiratory and expiratory mouth pressure (PIM, PEM cmH2O) at FRC and TLC respectively. Spirometric, FRC and TLC average values were normal. The maximal expiratory flow rate at 50 and 25% of vital capacity were decreased to 49.5 and 38.3% from predicted values. The values of PIM and PEM in patients (-93 +/- 17; 128 +/- 32 cmH2O, respectively) were similar to those of 12 normal subjects studied at comparable lung volume. Our results were similar to previous reports. There was no evidence of decreased respiratory muscle force, probably because the patients nutritional status and cardiac output were normal.

Adolescent↗
PubMed1995

Comparison of proximal isovelocity surface area method with pressure half-time and planimetry in evaluation of mitral stenosis.

OBJECTIVES: This study sought to 1) compare the accuracy of the proximal isovelocity surface area (PISA) and Doppler pressure half-time methods and planimetry for echocardiographic estimation of mitral valve area; 2) evaluate the effect of atrial fibrillation on the accuracy of the PISA method; and 3) assess factors used to correct PISA area estimates for leaflet angulation. BACKGROUND: Despite recognized limitations of traditional echocardiographic methods for estimating mitral valve area, there has been no systematic comparison with the PISA method in a single cohort. METHODS: Area estimates were obtained in patients with mitral stenosis by the Gorlin hydraulic formula, PISA and pressure half-time method in 48 patients and by planimetry in 36. Two different factors were used to correct PISA estimates for leaflet angle (theta): 1) plane-angle factor (theta/180 [theta in degrees]); and 2) solid-angle factor [1-cos(theta/2)]. RESULTS: After exclusion of patients with significant mitral regurgitation, the correlation between Gorlin and PISA areas (0.88) was significantly greater (p < 0.04) than that between Gorlin and pressure half-time (0.78) or Gorlin and planimetry (0.72). The correlation between Gorlin and PISA area estimates was lower in atrial fibrillation than sinus rhythm (0.69 vs. 0.93), but the standard error of the estimate was only slightly greater (0.24 vs. 0.19 cm2). The average ratio of the solid- to the plane-angle correction factors was approximately equal to previously reported values of the orifice contraction coefficient for tapering stenosis. CONCLUSIONS: 1) The accuracy of PISA area estimates in mitral stenosis is at least comparable to those of planimetry and pressure half-time. 2) Reasonable accuracy of the PISA method is possible in irregular rhythms. 3) A simple leaflet angle correction factor, theta/180 (theta in degrees), yields the physical orifice area because it overestimates the vena contracta area by a factor approximately equal to the contraction coefficient for a tapering stenosis.

Adult↗
PubMed1982

[Evaluation of mitral valve, subvalvular structures and valvular flexibility in mitral stenosis by two-dimensional echocardiography].

UNLABELLED: In order to identify the determinants for surgical procedures in mitral stenosis, we evaluated two-dimensional echocardiographic findings of the mitral valve and subvalvular structures in 35 patients undergoing open mitral commissurotomy (OMC) or valve replacement (MVR). As indices of a degree of subvalvular shortening and valvular flexibility, the distance between the mitral ring and the tip of the anterior mitral leaflet was measured by the LV long-axis view by in both midsystole (S) and early diastole (D). As a possible major determinant for MVR, a degree of valvular calcification (C) was semi-quantatively scored according to the extent of abnormally strong echo density. In nine of 11 patients undergoing MVR, a main reason for selecting MVR was a marked thickening or shortening of subvalvular structures. In patients in whom OMC was feasible, the degree of improvement of the mitral valve area (delta MVA) was assessed by the pre- and post-operative mitral valve areas (MVA) measured on the LV short-axis view, which were averaged 0.15 and 1.38 cm2, respectively. RESULTS: The index C was significantly higher in cases with MVR than those with OMC (9.2 +/- 2.6 vs 4.7 +/- 2.3 points, p less than 0.001), although there was a significant overlap between these two groups and index C did not correlate with delta MVA in the OMC patients. Similarly, the value S was significantly smaller in patients undergoing MVR than those undergoing OMC (1.2 +/- 0.4 vs 0.7 +/- 0.2 cm, p less than 0.001), though S did not correlate with delta MVA. On the other hand, the index of valve flexibility D--S was smaller in patients undergoing MVR (0.5 +/- 0.3 vs 0.8 +/- 0.3 cm, p less than 0.05) and correlated well with delta MVA (delta MVA = 0.699 x (D--S)+0.007, R = 0.678, p less than 0.02) in patients undergoing OMC. Furthermore, in all patients undergoing OMC with D--S greater than or equal to 0.8 cm, delta MVA was above 0.5 cm2, contrasting with delta MVA of 0.5 cm2 or less in 6 of 7 patients with D--S less than 0.7 cm. Using these indices, surgical procedures were successfully predicted in another 7 prospectively studied patients and predicted delta MVA in 4 patients was quite comparable with actual delta MVA. It was concluded that measurements of S and D by two-dimensional echocardiography are useful, 1) to predict patients requiring MVR and 2) to predict patients with inadequate delta MVA in whom OMC is surgically feasible.

Adult↗
PubMed1988

Improvement in exercise capacity and exercise hemodynamics 3 months after double-balloon, catheter balloon valvuloplasty treatment of patients with symptomatic mitral stenosis.

Clinical status, exercise treadmill performance, and hemodynamics were determined in 24 patients with symptomatic mitral stenosis before catheter balloon valvuloplasty (CBV) and at 3 months follow-up. Hemodynamic determinations at rest showed that mitral CBV performed by the double-balloon technique resulted in significant immediate decreases in mean pulmonary arterial wedge pressure (28 +/- 7 to 16 +/- 5 mm Hg, p less than .01), mean pulmonary arterial pressure (41 +/- 11 to 33 +/- 10 mm Hg, p less than .05), and mitral valve gradient (16 +/- 7 to 6 +/- 3 mm Hg, p less than .01), and significant increases in cardiac output (4.3 +/- 1.1 to 5.0 +/- 1.4 liters/min, p less than .01). Mitral valve area increased from 1.0 +/- 0.3 to 2.2 +/- 0.7 cm2 (p less than .01). The mitral valve area was unchanged (2.0 +/- 0.7 cm2, p = NS) at 3 months. The lower pulmonary arterial wedge pressure, pulmonary arterial pressure, and mitral valve gradient persisted at 3 month follow-up catheterization. Clinical examinations showed that before CBV, 21 of 24 patients were in New York Heart Association functional class III or IV; 3 months after CBV, 22 patients were in class I or II. Before CBV, the mean exercise treadmill time was 5.9 +/- 3.2 min and it had increased to 9.8 +/- 2.9 min (p less than .01) by the 3 month follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1978

Chylothorax as a manifestation of rheumatic mitral stenosis: its postoperative management with a diet of medium-chain triglycerides.

Chylothorax occurred as a manifestation of severe congestive heart failure resulting from rheumatic mitral stenosis. Following replacement of the mitral valve, chylothorax recurred and was treated by thoracocentesis initially and then resolved during six months of therapy with a diet of medium-chain triglycerides. Ultimately, the patient resumed a regular diet with no further accumulation of pleural fluid.

Chylothorax↗
PubMed1994

[A left atrial appendage thrombus without mitral stenosis--a successful case of removal].

Successful thrombectomy for left atrial ball thrombus without mitral stenosis is presented. A 62-year-old man was admitted to our department because of intermittent claudication. Arteriography demonstrated complete occlusion in bilateral superficial femoral arteries, however, the arterial wall was much smooth, suggesting thrombo-embolism rather than arteriosclerosis obliterans. The transthoracic echocardiography revealed no abnormal lesion in mitral apparatus and in left atrial cavity. The bypass operation was carried out for arterial occlusion, when the intraoperative transesophageal echocardiography showed the ball thrombus in left atrial appendage. The urgent operation was successfully carried out on 14th postoperative day after bypass operation. The thrombus occupied almost all the left atrial appendage, and its size was 24 x 19 x 13 mm. The transesophageal echocardiography was useful in diagnosis for left atrial appendage thrombus. Once the diagnosis was made for large and movable left atrial thrombus, immediate surgical therapy should be recommended to avoid serious complications and sudden death.

Echocardiography, Transesophageal↗
PubMed2005

Current management of severe congenital mitral stenosis: outcomes of transcatheter and surgical therapy in 108 infants and children.

BACKGROUND: Severe congenital mitral stenosis (MS) is a rare anomaly that is frequently associated with additional left heart obstructions. Anatomic treatments for congenital MS include balloon mitral valvuloplasty (BMVP), surgical mitral valvuloplasty (SMVP), and mitral valve replacement (MVR), although the optimal therapeutic strategy is unclear. METHODS AND RESULTS: Between 1985 and 2003, 108 patients with severe congenital MS underwent BMVP or surgical intervention at a median age of 18 months (range 1 month to 17.9 years). Anatomic subtypes of MS were "typical" congenital MS in 78 patients, supravalvar mitral ring in 46, parachute mitral valve in 28, and double-orifice mitral valve in 11, with multiple types in approximately 50% of patients. Additional left heart anomalies were present in 82 patients (76%). The first MS intervention was BMVP in 64 patients, SMVP in 33, and MVR in 11. BMVP decreased peak and mean MS gradients by a median of 33% and 38%, respectively (P<0.001), but was complicated by significant mitral regurgitation in 28%. Cross-sectional follow-up was obtained at 4.8+/-4.2 years. Overall, Kaplan-Meier survival was 92% at 1 month, 84% at 1 year, and 77% at 5 years, with 69% 5-year survival during the first decade of our experience and 87% since (P=0.09). Initial MVR and younger age were associated with worse survival. Survival free from failure of biventricular repair or mitral valve reintervention was 55% at 1 year among patients who underwent BMVP and 69% among patients who underwent supravalvar mitral ring resection initially. Among patients who underwent BMVP, survival free from failure of biventricular repair or MVR was 79% at 1 month and 55% at 5 years, with worse outcome in younger patients and those who developed significant postdilation mitral regurgitation. CONCLUSIONS: BMVP effectively relieves left ventricular inflow obstruction in most infants and children with severe congenital MS who require intervention. However, surgical resection is preferable in patients with MS due to a supravalvar mitral ring. Five-year survival is relatively poor in patients with severe congenital MS, with worse outcomes in infants and patients undergoing MVR, but has improved in our more recent experience. Many patients have undergone second procedures for either recurrent/residual MS or mitral regurgitation resulting from dilation-related disruption of the mitral valve apparatus.

Adolescent↗
PubMed1994

Severe congenital mitral stenosis in infants.

BACKGROUND: Despite current medical and surgical therapy, infants with symptomatic congenital mitral stenosis (CMS) continue to have high rates of morbidity and mortality. Catheter balloon dilation has been successful in relieving symptoms in a few older children with CMS but has not been evaluated in infants. METHODS AND RESULTS: We reviewed the records of 85 infants with CMS to assess severity of CMS, associated cardiac lesions, echocardiographic morphological appearance of the mitral valve, treatment, and outcome. There were five valve morphologies identified: "typical" hypoplastic mitral valve with symmetric papillary muscles (SYMM, 52%), supravalvar mitral ring (SVMR, 20%), double-orifice mitral valve (DOMV, 11%), hypoplastic mitral valve with asymmetric papillary muscles (ASYMM, 8%), and parachute mitral valve (PARA, 8%). Of the 85 infants, 31 (36%) were severely symptomatic, requiring intervention within the first 2 years. Balloon dilation was performed in 18 infants (age, 8.7 +/- 5.7 months; weight, 5.9 +/- 1.9 kg) and valve surgery in 13 (age, 10.9 +/- 5.9 months; weight, 6.7 +/- 2.1 kg). Balloon dilation decreased the peak transmitral gradient (LAa-LVED) > 30% in 15 of 18 initial attempts, from 20.3 +/- 8.2 to 10.9 +/- 4.9 mm Hg (P < .001), and the mitral valve area increased from 0.7 +/- 0.3 to 1.0 +/- 0.5 cm2/M2 (n = 10, P = .01). No infants died during the initial balloon dilation, although 2 of 3 died during a repeat procedure for restenosis. Other complications included significant mitral regurgitation in 7 of 18 patients (39%), 4 of whom had SVMR. Of the 18 infants, 8 (44%) had persistent symptomatic improvement at a mean follow-up of 14 months (range, 2 to 32 months). The 2-year survival after balloon dilation was 70%; 40% remained free of repeat intervention. Mitral valve surgery in 13 infants consisted of SVMR resections in 7, mitral valve replacements in 4, and LA-to-LV aortic valved homografts in 2. The operative mortality was 30%. Sustained improvement occurred in 8 (6 with SVMR) at 11 to 62 months of follow-up (mean, 30 months), with a 2-year survival of 60%. CONCLUSIONS: Infants with severe CMS have 2-year mortality rates approaching 40% regardless of treatment modality. Balloon dilation significantly reduces the transmitral gradient in the majority, but symptomatic improvement persists in only 40%. Procedure-related mortality was associated with repeat balloon dilation in patients with left ventricular hypoplasia. Balloon dilation of "typical" CMS can provide symptomatic relief in many infants, allowing postponement of valve replacement, although infants with SVMR do better with surgical management.

Cardiac Catheterization↗
PubMed2004

[Percutaneous mitral commissurotomy and left ventricular function in severe mitral stenosis].

The purpose of this study was to determine the immediate effect of percutaneous mitral commissurotomy (PMC) on left ventricular (LV) performance. We studied 30 patients with severe mitral stenosis undergoing successful PMC by cardiac catheterization and angiography before and 5 minutes after PMC. All patients were in sinus rhythm and no patient had hypertension or clinical coronary artery disease. We conclude that the left ventricular end-diastolic volume and the stroke volume increased significantly immediately after PMC because of and increase in LV filling after relieving the mitral mechanical obstruction.

Adult↗
PubMed1982

Mitral stenosis with severe pulmonary hypertension.

Consecutive catheterizations in 512 patients with mitral valve disease revealed 85 cases of mitral stenosis with systolic pulmonary artery pressures equal to or in excess of 100 mm Hg. Forty-four patients (51.8%) were in New York Heart Association functional Class IV; 30 (35.3%) were in Class III; and 11 (12.9%) were in Class II. Symptoms related to pulmonary capillary hypertension were prominent in 48 patients (56.5%) while the remaining patients showed signs of low cardiac output syndrome. Forty patients underwent surgery: mitral commissurotomy was performed in 26 patients; mitral valve replacement in 10 patients, and double valve replacement in four patients. Nitroprusside was infused into the pulmonary artery in six patients with severe perioperative low cardiac output; four of these patients survived. The overall operative mortality was 15% (six patients). Good long-term results were achieved in 30 cases.

Journal Article↗