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At least 1,099 records · Page 61Linked to original sources
PubMed1995

[Percutaneous valvuloplasty in the treatment of mitral stenosis: results in Geneva].

Percutaneous balloon valvotomy is a recognized form of treatment of mitral stenosis. In Geneva between 1986 and 1993, 62 procedures were attempted in 60 patients (87% females) aged 48 +/- 17 years (12 to 80 years). Patient selection was based on symptoms (NYHA class), echocardiography (valve area, Boston score), and hemodynamics. 11 patients (18%) had undergone surgical commissurotomy in the past, 28 patients (47%) were in atrial fibrillation, and 12 patients (30%) had a history of peripheral emboli. Mild or moderate mitral insufficiency was present angiographically in 17 patients (28%) and echographically in 42 patients (70%). Esophageal echocardiography was performed in 37 patients (62%) before the procedure. In 52 patients (84%) a single balloon (Inoue technique) was used. Technical success was obtained in 59 procedures (95%). Following the procedure, mitral valve area increased from 1.1 +/- 0.3 to 1.8 +/- 0.3 cm2 (p < 0.0001) at echocardiography and from 1.1 +/- 0.3 to 1.9 +/- 0.5 cm2 (p < 0.0001) based on invasive hemodynamic data. There were 5 complications directly related to the procedure. In two cases cardiac tamponade developed, one after pericardial perforation during the transseptal approach and one because of left ventricular perforation. The second patient required surgical treatment. In two other cases, a moderate pericardial effusion without clinical consequences was observed. In one case the venous sheath malfunctioned, rendering surgical repair of the right femoral vein necessary. A residual atrial septal defect was observed at echography in 13 patients (22%). Mitral insufficiency was increased in 6 patients (10%) angiographically and in 9 patients (15%) at echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[A case of SLE associated with antiphospholipid syndrome and mitral stenosis].

This case involves a 41-year-old woman with SLE. The patient began having symptoms of arthralgia in 1978 and developed fever, pleuritis and lupus psychosis in 1986. Laboratory exams showed positive antinuclear-antibody, LE-cell phenomenon, hypocomplementemia and lupus anticoagulant. Echo cardiography demonstrated mitral regurgitation and stenosis. She was treated with 50 mg of prednisolone and these manifestations subsided. In 1989, she developed dyspnea on exertion and echo cardiography revealed severe mitral stenosis. Pulmonary infarction was detected by MAA lung scintigraphy. At this time, she was diagnosed as SLE associated with antiphospholipid syndrome (APS). A mitral valvular replacement operation was performed in 1991. Pathological studies of mitral valve demonstrated Libman Sacks endocarditis. APS is known occasionally to complicate with left-sided valvular diseases, mitral stenosis is quite rare in both SLE and APS. This patient reveals a rare case of SLE associated with APS and mitral stenosis. It is suggested that this patient developed mitral stenosis with Libman Sacks endocarditis, associated with the presence of antibody against phospholipids.

Adult↗
PubMed2000

Mitral valve plasty using artificial chordae in a 1.5-year-old boy with congenital mitral stenosis and absent anterolateral chordae.

A 1.5-year-old boy with refractory heart failure due to congenital mitral stenosis exhibited fusion of the anterolateral leaflets associated with moderate mitral regurgitation due to absent anterolateral chordae. Fused leaflets were incised and the mitral valve opening improved. Mitral regurgitation increased due to the absence of chordae, so 2 pairs of artificial chordae of 5-0 expanded polytetrafluoroethylene suture were anchored to the hypoplastic anterolateral papillary muscle, then attached to the free margin of incised leaflets. Postoperative examination showed improved mitral opening without exacerbated mitral regurgitation.

Artificial Organs↗
PubMed1986

Long-term results of direct-current cardioversion after open commissurotomy for mitral stenosis.

For a 7-year period, cardiac rhythm before and after surgery was determined in 106 patients with mitral stenosis presenting with atrial fibrillation (AF) who had undergone open mitral commissurotomy. Forty-three of the patients reverted to sinus rhythm (SR) after primary or secondary direct-current (DC) cardioversion after surgery and maintained it until discharge from hospital. Thirty patients maintained SR for 3 months to 7.2 years (mean 2.5 years) after surgery. The actuarial maintenance rate of SR was 50% 7 years after surgery in these 43 patients. The duration of AF, preoperative left atrial dimension by M-mode echocardiogram and pathologic classification of the mitral valve were factors supposedly influencing the maintenance of SR for a long period after DC cardioversion. In 30 patients who reverted back to SR and maintained SR late postoperatively, the preoperative duration of AF was up to 5 years, and 35% of the patients had had AF for more than 1 year. Also, in 40% of these 30 patients, the preoperative cardiothoracic ratio was more than 60%. It is concluded that if sinus rhythm is restored by DC cardioversion before discharge from hospital after open mitral commissurotomy, it has a 50% chance of being maintained for 7 years after surgery. Long duration of AF and large cardiothoracic ratio should probably not dissuade one from attempting secondary DC cardioversion in these patients.

Adult↗
PubMed1976

Supravalvular mitral stenosis associated with tetralogy of Fallot.

The association of tetralogy of Fallot with supravalvular mitral stenosis is a rare anomaly that has been reported only once previously. The difficulty of preoperative diagnosis is emphasized. Although left-sided obstructive lesions in association with tetralogy of Fallot are rare, their recognition is imperative since these are surgically correctable anomalies and potentially lethal, as proved in this case and the one previously reported.

Adult↗
PubMed1977

Congenital mitral stenosis. A review of 20 years' experience.

The clinical course of 38 patients with congenital mitral stenosis (MS) is reviewed. Associated cardiac defects were present in 28 patients, including tetralogy of Fallot in five. In all but one of the eight patients with supravalvar mitral ring (SVR), there were concomitant abnormalities of the mitral valve. Delay in the diagnosis of MS was common. Serial cardiac catheterizations and pulmonary pathologic examination indicated that pulmonary vascular obstructive disease develops during childhood. Mitral valve surgery was performed in 19 of 38 patients: valvotomy alone in eight, excision of SVR in five (two ofwhom also had valvotomy) and mitral valve replacemtnt in seven. Additional non-mitral cardiac surgery was performed in 18 patients. Overall surgical mortality was 49%; mortality for surgery on the mitral valve was 26%. Only patients having mitral valve replacement or with isolated SVR which was then resected became asymptomatic and had normal hemodynamics on postoperative catheterization.

Adolescent↗
PubMed2001

[Functional assessment of mitral stenosis].

The following parameters must be taken into account when assessing the severity of mitral stenosis: symptoms, objective examination, electrocardiogram, chest X-ray, a simple exercise test with or without cardiopulmonary test, echocardiography and lastly a hemodynamic test. Differences are often observed between the clinical and instrumental findings. In these cases a major contribution is made by the use of physical effort in response to both ECG and heart catheterization in order to quantify the patient's functional deficiency and valve response. The latter aspect must be validated using a simultaneous comparison between echocardiography and the hemodynamic test and longitudinal clinical studies.

Exercise Test↗
PubMed2004

Long-term outcome after mitral valve replacement with preservation of continuity between the mitral annulus and the papillary muscle in patients with mitral stenosis.

BACKGROUND AND AIM OF THE STUDY: The effect on left ventricular performance of mitral valve replacement (MVR) with preservation of continuity between the mitral annulus and papillary muscle was studied in patients with mitral stenosis (MS). METHODS: Forty patients with MS who underwent MVR between 1986 and 1995 and had long-term echocardiographic follow up were studied retrospectively. Eighteen patients had conventional MVR (CMVR group), and 22 (PMVR group) had either preservation of autologous chordae tendineae (n = 6) or replacement of the chordae with expanded polytetrafluoroethylene sutures (n = 16). RESULTS: Preoperatively, there were no significant differences between the two groups in age, body surface area, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), fractional shortening (FS) or ejection fraction (EF). At 3.1-6.5 years after surgery, periodic echocardiography showed significant differences (p <0.05) in LVESD (35.8 versus 31.6 mm, respectively, in the CMVR and PMVR groups) and FS (31.8% versus 38.1%). At 6.6-9.7 years postoperatively, no significant differences were observed between the two groups in FS, but LVESD was significantly greater in the CMVR group than in the PMVR group (37.3 versus 31.5 mm). CONCLUSION: In the long term, MVR with preservation of continuity between the mitral annulus and papillary muscle improves systolic left ventricular performance in patients with MS.

Aged↗
PubMedDate not supplied

[Calculation of the mitral valve area with the proximal convergent flow method with Doppler-color in patients with mitral stenosis].

In this study we evaluate prospectively a new color Doppler method for calculating the mitral valve area based on identifying a blue-red aliasing interfase proximal to the orifice, corresponding to the flow convergence region (FCR). This method can be used to calculate areas using the continuity equation. We studied 61 patients with stenosis. The mitral valve area was calculated using pressure half-time (PHT) Doppler method which were compared with values that obtained by the FCR method, according to the following formula. AVM (cm2) = 2 pi r2 x VN/Vmax; where "r" is the FCR radius measured from the orifice to the first color aliasing (blue-red interface); VN is Nyquist velocity and Vmax is the peak flow velocity by continuous wave Doppler. Twenty three patients had pure mitral stenosis and 38 double mitral lesion. Twenty patients were on sinus rhythm while 41 in atrial fibrillation. Calculated mitral valve area using the FCR method correlated well with mitral valve area determined by PHT method at a correlation coefficient of r = 0.96 (y = 0.097 x + 54.9, SEE = 0.10 cm2, p < 0.001). MVA by FCR ranged from 0.4 to 2.5 cm2 (mean = 1.19 cm2). MVA by PHT ranged from 0.42 to 2.48 cm2 (mean = 1.15 cm2). Color Doppler FCR method provides an accurate estimate of effective mitral valve area and may be useful as an alternative to the pressure half-time method. The calculated mitral valve area by the FCR method is not influenced by the presence of mitral regurgitation nor atrial fibrillation.

Adult↗
PubMed2006

Relation between sympathetic overactivity and left atrial spontaneous echo contrast in patients with mitral stenosis and sinus rhythm.

BACKGROUND: Spontaneous echo contrast (SEC) is common in patients with mitral stenosis (MS) and presence of SEC in left atrium (LA) is associated with a higher risk of thromboembolism. Recently, an increase in activation of platelets was demonstrated in patients with SEC raising the hypothesis that platelets are involved in the pathogenesis of SEC. In this study, we evaluated effects of autonomic nervous system activity on SEC formation in patients with rheumatic MS and sinus rhythm by heart rate variability analysis. METHODS AND RESULTS: Twenty-six patients with LASEC were compared with 28 patients without LASEC. Mean heart rate, low frequency (LF) and low frequency/high frequency (LF/HF) ratio were significantly higher, standard deviation of all NN (SDNN), root mean square of successive differences (RMSSD), number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50) and high frequency (HF) values were lower in the patients with LASEC. A standard deviation of all NN intervals <90ms separated the patients with LASEC from control subjects with a sensitivity of 77% and specificity of 90%; a low frequency >79.5 with a sensitivity of 92% and specificity of 90; a low frequency/high frequency ratio >3.7 with a sensitivity of 96% and specificity of 90%. A left atrial diameter >4.3 cm increased the LASEC formation by 3.0 folds, HR >78 beats/min by 6.4 folds, standard deviation of all NN intervals <90 ms by 9.2 folds, a low frequency/high frequency ratio >3.7 by 6.4 folds, sP-selectin>142 by 5.8 folds. Variables affecting sP-selectin levels were LA diameter, mitral valve area, transmitral mean gradient, left ventricular ejection fraction, the presence of mitral regurgitation, HR, standard deviation of all NN intervals, low frequency, high frequency and low frequency/high frequency ratio. CONCLUSION: Sympathetic overactivity and reduced heart rate variability are important determinants for LASEC formation and increased s-P selectin levels. Therefore, platelet activation via increased sympathetic activity may play an important role in pathogenesis of LASEC.

Adult↗
PubMed2006

Mitral annular systolic velocity reflects the left atrial appendage function in mitral stenosis.

BACKGROUND: Left atrial appendage (LAA) dysfunction is an independent predictor of thromboembolism in mitral stenosis (MS). OBJECTIVES: To investigate whether there is a relation between annular velocities obtained by tissue Doppler imaging and LAA function and to determine if the annular velocities can predict the presence of the inactive LAA in MS. METHODS: Eighty-five MS patients and 80 healthy controls were evaluated by transthoracic echocardiography and all patients underwent transesophageal echocardiography. The annular systolic (S-wave) and diastolic (E- and A-waves) velocities were recorded. Inactive LAA was defined as LAA emptying velocity <25 cm/sec. Patients were divided into three groups; group I (n = 43): sinus rhythm (SR) and LAA emptying velocity > or =25 cm/sec, group II (n = 15): SR and LAA emptying velocity <25 cm/sec and group III (n = 27): atrial fibrillation. RESULTS: Thrombus was detected in 12 patients and spontaneous echo contrast (SEC) was detected in 48 patients. Both S-wave and peak LAA emptying velocities were decreasing, while SEC frequency and density were increasing from group I to group III. There was a positive correlation between LAA emptying and S-wave velocities (P < 0.001, r = 0.682). Multivariate regression analysis showed that only S-wave is the independent predictor of inactive LAA (P = 0.001, odds ratio = 0.143, 95% CI = 0.047-0.434). In patients with SR, the cutoff value of S-wave was 13.5 cm/sec for the prediction of the presence of inactive LAA (sensitivity: 95.3%, specificity: 93.3%). CONCLUSIONS: S-wave is an independent predictor of inactive LAA and a useful parameter in estimating inactive LAA in MS with SR.

Adult↗
PubMed1983

Value of isometric exercise testing during cardiac catheterization in mitral stenosis.

To examine the value of preoperative isometric exercise testing during cardiac catheterization in patients with mitral stenosis, the isometric handgrip exercise test was performed on 28 patients during preoperative diagnostic catheterization. Eighteen patients who subsequently underwent mitral valve surgery were recatheterized and reevaluated clinically 12 months after operation. Preoperatively, the patients were divided into 2 groups: 16 whose mean mitral valve pressure gradient increased greater than 4 mm Hg during isometric exercise (group A) and 12 whose pressure gradient decreased or increased less than 4 mm Hg (group B). The ejection fraction remained unchanged and the peak systolic pressure/end-systolic volume ratio increased during isometric exercise in group A (p less than 0.001). In group B, the ejection fraction decreased (p less than 0.001) and the peak systolic pressure/end-systolic volume ratio remained unchanged. In the total group, a positive correlation existed between the change in mean mitral valve pressure gradient during isometric exercise and the changes in measures of left ventricular function during exercise. The patients in group A had a significant improvement in both symptoms and in exercise tolerance as determined by symptom-limited bicycle ergometry after surgery. The patients in group B showed minimal or no symptomatic improvement and their exercise tolerance did not improve. The change in mitral valve pressure gradient during isometric exercise appears to reflect the left ventricular response to exercise.

Adult↗
PubMedDate not supplied

[Treatment of rheumatic mitral stenosis in children and adolescents by a balloon catheter].

Between April 1986 and August 1987, eight children, 9 to 18 years old, with rheumatic mitral valve stenosis underwent a percutaneous balloon valvotomy. Immediate results were good. By echocardiographic measurements, mean transmitral gradients went from 23.7 +/- 7.1 mmHg to 5.8 +/- 4.7 mmHg (p less than 0.001), diastolic pressure half-times went from 299.0 +/- 15.6 msec to 123.3 +/- 42.3 msec (p less than 0.001) and mitral valve areas measured by planimetry went from 1.00 +/- 0.15 cm2/1.73 m2 to 2.68 +/- 0.71 cm2/1.73 m2 (p less than 0.001). Hemodynamic measurements showed a decrease in mean pulmonary artery pressure from 48.3 +/- 13.2 mmHg to 32.5 +/- 5.7 mmHg (p less than 0.01), a decrease in the mean left atrial pressure from 26.1 +/- 6.3 mmHg to 14.6 +/- 4.7 mmHg (p less than 0.02) and an increase in calculated mitral valve area (Gorlin formula) from 1.07 +/- 0.31 cm2/1.73 m2 to 2.73 +/- 1.17 cm2/1.73 m2 (p less than 0.02). The only complication observed was a grade III mitral insufficiency in a child with marked subvalvular fibrosis. Six patients had a very good result and one kept a moderate mitral stenosis. Percutaneous balloon valvotomy gives probably better results in children than in adults and obtains at least as good results as surgical closed mitral commissurotomy. Presently, this technique is the treatment of choice for rheumatic mitral stenosis in children. Contra-indications are intra-atrial thrombus and shortened, thickened subvalvular apparatus.

Adolescent↗
PubMed1990

Beta-adrenergic receptor blockade in the management of pregnant women with mitral stenosis.

Twenty-five pregnant women with symptomatic mitral valve stenosis (mean valve area, 1.1 +/- 0.25 cm2) were managed by initiation or modification of beta-adrenergic receptor blockade with the use of either propranolol or atenolol. Significant improvement of symptoms occurred in 23 patients (92%) (p less than 0.01); the mean maternal heart rate was reduced significantly from 86 +/- 4 to 78 +/- 5 beats/min (p less than 0.0001). The overall fetal heart rate ranged between 130 to 150 beats/min during treatment. Only two patients required urgent closed mitral valvotomy, after pulmonary edema developed as a result of poor compliance to beta-blockade. All patients were safely delivered of infants at term. Fetal heart rates ranged between 120 to 140 beats/min at delivery. There was no maternal or fetal death. Pregnant woman with symptomatic mitral valve stenosis can be safely managed with beta-blockade, giving significant reduction in the incidence of pulmonary edema with no unwanted neonatal side effect.

Adrenergic beta-Antagonists↗
PubMed1994

Value of exercise Doppler-echocardiography in patients with mitral stenosis.

The value of exercise Doppler-echocardiography was studied in 60 patients with mitral valve stenosis. Patients were divided in three groups. In patients with a mitral valve area of more than 1.4 cm2, maximal and mean diastolic gradient over the mitral valve increased from 13.2 +/- 3.6 to 18.4 +/- 5.4 and from 5.2 +/- 1.9 to 8.8 +/- 3.0 mmHg, respectively. In patients with a mitral valve area in between 1.0 and 1.4 cm2, maximal and mean gradient increased from 19.0 +/- 8.0 to 28.1 +/- 8.9 and from 8.8 +/- 4.9 to 14.8 +/- 6.4 mmHg, respectively. In patients with a mitral valve area of less than 1 cm2, the maximal gradient increased from 21.5 +/- 5.8 to 34.2 +/- 8.7 and mean gradient increased from 11.8 +/- 4.1 to 20.3 +/- 5.8 mmHg. Mean tricuspid regurgitation velocity increased from 2.9 +/- 0.5 m/s to 3.6 +/- 0.5 m/s, indicating increase in right ventricular to right atrial pressure difference from 34 mmHg to 52 mmHg. We conclude that exercise during the Doppler-echocardiographic evaluation provides additional information about the hemodynamic significance of mitral stenosis and can therefore be of value in decision making.

Adult↗