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At least 1,153 records · Page 64Linked to original sources
PubMed1985

Echophonocardiographic estimates of pulmonary artery wedge pressure in mitral stenosis.

The efficacy of noninvasive indexes for predicting pulmonary artery wedge (PAW) pressure was reviewed in 77 patients with mitral stenosis. M-mode echocardiography and phonocardiography were used to measure the aortic valve closure-mitral valve E-point interval (A2-E) and the electrocardiographic Q wave-mitral valve closure interval (Q-C) close to the time of diagnostic cardiac catheterization. During catheterization, in 65 patients PAW pressure was measured and in 12 left atrial (LA) pressure was measured. The A2-E and Q-C intervals taken alone had only modest correlation with PAW pressure (r = -0.54 and r = 0.46, respectively). The correlation was weakest in patients with atrial fibrillation and best in sinus rhythm when heart rate variation between invasive and noninvasive studies was within +/- 5 beats. Substitution of V-wave pressure for mean PAW pressure and correction for variation in blood pressure improved the A2-E correlation (r = -0.64), as did combining the A2-E and Q-C intervals into a ratio [(Q-C)/(A2-E)] (r = 0.62). However, the best results were obtained in patients where LA pressure was measured directly (r = -0.91 for A2-E), suggesting the PAW pressure is not always an accurate reflection of LA pressure. In conclusion, many factors in addition to LA pressure affect the Q-C and A2-E intervals which, in many situations, decrease their predictive value. However, if used appropriately, these intervals may allow an estimation of PAW pressure.

Adult↗
PubMed1970

Haemodynamic factors influencing opening snap interval in mitral stenosis.

Various haemodynamic measurements were correlated with the A2-OS interval in 35 patients with pure or predominant mitral stenosis. There was good correlation of left atrial V wave pressure, left ventricular systolic pressure, and mitral mean diastolic gradient with A2-OS. There was no significant correlation of mitral valve area with A2-OS. When the left ventricular pressure was arbitrarily assigned to one particular pressure (100 mm. Hg) correlations with all other variables improved. There was still no correlation of A2-OS interval with mitral valve area. These and other haemodynamic factors influencing the A2-OS interval are briefly discussed.

Blood Pressure↗
PubMedDate not supplied

Successful preterm delivery in a patient with severe mitral stenosis.

We present the case of a 36-year-old woman who was diagnosed with severe mitral stenosis in the 30th week of a pregnancy that was complicated by complete placenta previa and placenta percreta. With medical management, she successfully carried the pregnancy to fetal viability and was delivered by cesarean section before undergoing percutaneous balloon mitral valvuloplasty.

Adult↗
PubMed1984

Atrial fibrillation in mitral stenosis: histologic, hemodynamic and metabolic factors.

We examined the histologic, hemodynamic and metabolic factors associated with rheumatic mitral stenosis. Eighteen patients comprised three groups: Group I - 7 patients in sinus rhythm; Group II - 5 patients in intermittent atrial fibrillation; Group III - 6 patients in chronic atrial fibrillation. The left atrial dimension was determined by echocardiography. Left atrial pressure, mitral valve gradient, mitral valve area and the presence or absence of calcium in the mitral valve were determined at catheterization. The left atrial appendage was removed during open heart surgery and the tissue was analyzed for cell size, percent fibrosis and content of cyclic AMP and GMP. There was no difference between the groups in pulmonary capillary wedge pressure, mitral valve gradient, mitral valve area or the presence of calcium. The Group I left atrial dimension (51 +/- 2 mm, means +/- SE) was significantly smaller than that of Group III (56 +/- 2 mm, P less than 0.05). Group II was not different from Groups I or III. Although the concentration of cyclic AMP did not differ among the groups, the cyclic GMP was significantly depressed in Group III (0.15 +/- 0.02 fmol/microgram protein) when compared to Group I (0.24 +/- 0.05 fmol/microgram protein, P less than 0.01). Group II had intermediate values which did not differ from Groups I or III. The percent fibrosis was greatest in Group III (34.8 +/- 1.8%) and least in Group I (27.2 +/- 2.8%, P less than 0.05). There was no difference in cell size among the groups. Although atrial fibrillation may lead to some of these irregularities, a depressed cyclic GMP, increased fibrosis and increased left atrial dimension may play a role in the pathogenesis of irreversible atrial fibrillation.

Adult↗
PubMed1998

[Effect of dauricine on redistribution of glycoprotein IV in platelet membrane of patients with mitral stenosis].

OBJECTIVE: To investigate the effect of dauricine on the irreversible platelet aggregability of patients with mitral stenosis (MS). METHODS: Glycoprotein IV (GP IV) and thrombospondin (TSP) levels on the membrane surface of the stationary platelet or platelet activated by thrombin (0.05 U/ml, 0.1 U/ml, 0.5 U/ml, 1.0 U/ml) in 16 patients with MS were measured with flow cytometric method and compared with those of the healthy (14 cases). RESULTS: The GP IV level of stationary platelet, the GP IV and TSP levels of activated platelet in MS patients were higher than those in the healthy significantly (P < 0.01), while the TSP level of stationary platelet was not different between the patients and the healthy (P > 0.05). The GP IV redistribution on the activated platelet surface was apparently inhibited by dauricine (50 mumol/L, P < 0.05, P < 0.01) and the release of TSP from intracellular alpha-granules was inhibited by dauricine only in the activated platelets induced by thrombin of low concentration (0.05 U/ml and 0.1 U/ml, P < 0.05, P < 0.01), inhibiting effect was not found in those activated with high concentration of thrombin. CONCLUSION: The activity and reactivity to thrombin of platelets increased in MS patients, and dauricine was able to reduce the occurrence of the irreversible platelet aggregation in MS patients.

Adult↗
PubMed1994

[Bronchial hyperresponsiveness and relaxability in patients with mitral stenosis].

To study the differences in bronchial responsiveness to inhaled methacholine and salbutamol between patients with mitral valve disease those with bronchial asthma a bronchial provocation test (Astograph) and pulmonary function tests were done in 25 patients with mitral stenosis (MS) and 18 patients with bronchial asthma (BA). We derived an index of airway reloxability from the effect of salbutamol after precontraction with inhaled methacholine. This index was the change in respiratory conductance (Grs) over time during inhalation of salbutamol (SGrs-d). It was computed as SGrd = delta Grs/delta t. Eighteen patients with MS (72%) showed bronchial hyperresponsiveness (BHR) to methacholine. The MS patients with BHR (MS(+)) had lower values of the ratio of the forced expiratory volume in one second to the forced vital capacity (FEV/FVC) and maximal expiratory flow at 25% of vital capacity (V25) than MS patients without BHR (MS(-)). There was a significant correlation between V25 and the log cumulative dose producing a 35% decrease in respiratory conductance (PD35Grs) in MS(+). The mean log Dmin of MS(+) was significantly higher than that of the patients with BA (0.14 +/- 0.64 log units and -0.30 +/- 0.65 log units, p < 0.05, respectively). The mean log PD35Grs of MS(+) was also significantly higher than that of the patients with BA (1.09 +/- 0.53 log units and 0.45 +/- 0.66 log units, p < 0.01, respectively). Indices of relaxability (SGrs-d and SCrs-d/Grs-d) in MS(+) were significantly lower than in BA patients. Indices of hyperresponsiveness and relaxability were both significantly lower in patients with MS than in patients with BA.(ABSTRACT TRUNCATED AT 250 WORDS)

Albuterol↗
PubMedDate not supplied

Left ventricular function and geometry in juvenile mitral stenosis.

The purpose of this study was to investigate possible differences between juvenile and adult variety of mitral stenosis (MS) with regard to left ventricular preload, afterload, contractile function and geometry by two-dimensional echocardiography. Thirty six consecutive children and adolescents with MS (Group 1, mean age +/- 1 standard deviation 16 +/- 3 yrs) were compared with an equal number of adults with MS of comparable mitral valve area (Group II, mean age 30 +/- 8 yrs). Patients with juvenile versus adult MS had similar left ventricular ejection fraction (0.57 +/- 0.09 vs 0.57 +/- 0.11, p = not significant (NS)), end-systolic wall stress (64.8 +/- 21 vs 64.3 +/- 25 Kdynes/cm2, p = NS), wall stress to end-systolic volume ratio (2.6 +/- 1.2 vs 2.71 +/- 0.9, p = NS) and mass (77 +/- 19 vs 83 +/- 26 gm/m2 p = NS) but the former had greater end diastolic volume (68 +/- 16 vs 57 +/- 18 ml/m2, p = 0.008) and sphericity index (0.62 +/- 0.19 vs 0.50 +/- 0.19, p = 0.01) and lower mass to volume ratio (1.01 +/- 0.32 vs 1.36 +/- 0.42, p (0.01). Compared to normal controls, adult patients with MS had similar end-diastolic volume (58 +/- 13 vs 57 +/- 18 ml/m2), mass (84 +/- 20 vs 83 +/- 26 gm/m2), mass to volume ratio (1.45 +/- 0.4 vs 1.36 +/- 0.42) but greater wall stress (45.6 +/- 11.7 vs 64.3 +/- 25 Kdynes/cm2, p < 0.001) and lower ejection fraction (0.66 +/- 0.07 vs 0.57 +/- 0.11, p < 0.001). Thus patients with juvenile MS have significantly altered left ventricular geometry and increased preload in response to comparably elevated afterload due to compensatory adaptive process.

Adolescent↗
PubMed1975

Congenital mitral stenosis.

This report presents a 15 year review of the surgical treatment of 9 patients with congenital mitral stenosis seen at the Columbus Children's Hospital. The over-all mortality rate was 45 per cent. Seven patients had associated lesions, mostly coarctation of the aorta and patent ductus arteriosus. In the planning of the operative procedure, distal obstructive lesions of the left heart should generally be relieved first. The mitral valve should be explored with the use of cardiopulmonary bypass and the anatomic type of the valve determined. Type I valves will often respond to open valvulotomy, whereas Type II and III valves must be replaced.

Adolescent↗
PubMed1986

[Mitral stenosis of the postoperative state evaluated by echocardiography].

Echocardiography was performed to compare pre- and postoperative findings and to evaluate the postoperative state in 109 patients with mitral stenosis (MS) including 22 who underwent closed mitral commissurotomy (CMC) (34.3 +/- 6.9 y.o.); 71, open mitral commissurotomy (OMC) (42.9 +/- 8.7 y.o.); and 16, mitral valve replacement (MVR) (44.5 +/- 8.9 y.o.). Echocardiographic examinations were performed using a Toshiba SSL-51H with a mechanical sector scanner or an SSH-11A with a phased-array electronic sector scanner, one or two weeks before and about one month after surgery, and were reviewed yearly. The results were as follows: The E-F slope of the anterior mitral leaflet (AML) and mitral valve orifice area (MVA) were significantly increased after cardiac surgery in both the CMC and OMC groups. The amplitude of the mitral valve was slightly increased in the CMC group, but was unchanged in the OMC group. Before surgery, the left atrial dimension (LAD) was larger in the MVR group than in the other two groups, and it was significantly decreased after surgical intervention in all three groups. The aortic dimension (AOD) was slightly increased in the majority of patients, and the ratio of the aortic dimension to the sum of the aortic and left atrial dimensions [AOD/(AOD + LAD)] was significantly increased after cardiac surgery due to the improvement of cardiac function and the resolution of the left atrial enlargement. Repeated echocardiography facilitated follow-up of the state of the mitral valve and of cardiac performance, and is considered useful in determining indication for reoperation.

Adult↗
PubMedDate not supplied

Case report: factors involved in the production of the presystolic murmur in a patient with mitral stenosis and atrial trigeminy. Correlation of echocardiographic, phonocardiographic, and hemodynamic data.

The study of a patient with mitral stenosis and periods of atrial trigeminal rhythm afforded an opportunity to test some factors important in the production of the presystolic murmur. The echocardiogram and phonocardiogram were correlated with hemodynamic data obtained both with the patient at rest and with right atrial and ventricular pacing. The results showed that atrial contraction was a major determinant in the production of the presystolic murmur and seemed to exert an even greater influence than did either the end-diastolic pressure gradient across the mitral valve or the duration of the preceding RR interval. Corollaries from this study may have practical application for the clinician in his bedside physical examination. The data suggested that the production of the presystolic murmur in our patient might have been related to geometrical shifts of intracardiac anatomical structures resulting from changes in the left ventricular end-diastolic distending pressure.

Arrhythmias, Cardiac↗
PubMed2006

Hemodynamic significance of mitral stenosis: use of a simple, novel index by 2-dimensional echocardiography.

OBJECTIVE: We sought to assess the hemodynamic significance of mitral stenosis (MS) using a new index. METHODS: We studied 88 patients with MS. Maximum separation of mitral leaflet tips in diastole in parasternal long-axis and apical 4-chamber views was measured. These two parameters were averaged to yield the mitral leaflet separation index. The index was compared with mitral valve area by planimetry and pressure half-time. RESULTS: The mitral leaflet separation index was measurable in 76 (86.4%) patients. There was excellent correlation with mitral valve area by planimetry (r = 0.91, P < .001) and pressure half-time (r = 0.86, P < .001) across a wide range of mitral valve areas. Good correlation was found even in atrial fibrillation (r = 0.86 and r = 0.79, respectively). The index could discriminate between hemodynamically significant and insignificant MS (P < .001). An index of 0.81 cm or less predicted severe MS with 92.3% sensitivity and 100% specificity whereas a value of 1.11 cm or more identified mild MS with 85.7% sensitivity and 100% specificity. CONCLUSION: The mitral leaflet separation index is an independent and reliable measure of MS severity that is easy to measure.

Echocardiography, Doppler↗
PubMed1998

Epidural analgesia for term vaginal delivery after balloon valvotomy for mitral stenosis at 24 weeks gestation.

A woman presented at 24 weeks gestation with previously undiagnosed mitral stenosis. She did not respond to conservative management and underwent successful percutaneous balloon mitral valvotomy for refractory congestive cardiac failure, with complete resolution of her symptoms. The remainder of her pregnancy was uncomplicated and she delivered a healthy infant at 39 weeks gestation. An epidural block provided analgesia/anesthesia for vaginal delivery and repair of the perineal tear.

Journal Article↗
PubMed2004

Comparison of open commissurotomy and balloon valvuloplasty in mitral stenosis. A five-year follow-up.

OBJECTIVE: To compare clinical and laboratory data in patients with mitral stenosis undergoing open commissurotomy or balloon valvuloplasty, who were followed up for 5 years. METHODS: Eighty-one patients were prospectively assessed prior to the procedure (PRE) and immediately after the procedure, in the immediate postoperative period (IPO), and followed up yearly for 5 years (PO12M, PO24M, PO36M, PO48M, and PO60M). They were randomized into the following 2 groups: GC (group undergoing open commissurotomy): 37 patients (32.4 +/- 7.2 years; 89.2% females); and GV (group undergoing balloon valvuloplasty): 44 patients (32.9 +/- 9.5 years; 90.9% females). The patients' assessment comprised the following items: functional class, occurrence of events, electrocardiography, and Doppler echocardiography. RESULTS: A significant improvement in functional class occurred in most patients. Three patients in GC and in GV were in functional class III in PO60M. No difference in the mitral gradient was observed between the groups. A difference in the mean mitral valve areas was observed between the groups during the entire evaluation. No patients died. In regard to the IPO of GC, 3 patients had moderate mitral insufficiency (MI), and 3 had bleeding (1 was reoperated upon). In the IPO of GV, 4 patients had moderate MI, 1 had severe MI, 2 had cardiac tamponade, and 1 patient required surgery due to severe MI. Over 60 months, 9 GV patients evolved to moderate or severe MI, while 6 GC patients evolved to moderate or severe MI, and 2 other GC patients required surgery due to double mitral dysfunction. CONCLUSION: The rate of success in open mitral commissurotomy and balloon mitral valvuloplasty was 100%, and the rate of complications was low. During follow-up, a mild elevation in mitral gradient and a drop in mitral valve area were observed in both groups.

Adult↗
PubMed1986

The importance of quantitative Doppler in assessment of mitral stenosis.

Duplex Doppler echocardiography with high pulse repetition frequency was used to study: group A - 7 patients with mitral stenosis (MS) during cardiac catheterization, and group B - 26 patients with MS in whom the Doppler examination was performed 24 h-3 months prior to catheterization. Using the peak flow velocity within the stenotic flow jet, the pressure drop and mitral valve area (MVA) were calculated and compared with data obtained invasively. The inter-observer variability of the two parameters was 12% and 5%, respectively. The correlation between Doppler pressure drop and invasive measurement was excellent in group A (r = 0.83), while less close in group B (r = 0.71). However, using only MVA estimates (group B), it was possible to recognize most of MS with catheterization MVA less than or equal to 1.0 cm2/m2 (sensitivity and predictive value both of 90%). Therefore, even nonsimultaneous quantitation of MS seems valuable in pre-operative patient evaluation, adding a new information to hitherto existing echocardiographic criteria.

Cardiac Catheterization↗
PubMed1987

[Correlations between the features of first heart sound and opening snap and the shape and motion of the anterior mitral leaflet in patients with mitral stenosis].

To evaluate the relationship between the motion pattern and degree of organic change of the anterior mitral leaflet (AML) and the features of the mitral component of the first heart sound (M1) or the opening snap (OS), 37 patients with mitral stenosis (MS) were studied by auscultation, phonocardiography and echocardiography. Based on the features of M1 and OS according to auscultation and phonocardiography, the patients were categorized as group I, 18 patients with loud and snappy M1 and OS; group II, 12 patients with snappy M1 but small and dull OS; and group III, seven patients with small and dull M1 and OS. Intensities of M1 and OS were calculated by the ratios of their amplitudes to the aortic component of the second heart sound on the high frequency phonocardiograms recorded at points of the maximum intensities, respectively. Echocardiographic parameters related to productions of M1 and OS were obtained from M-mode and two-dimensional echograms of the AML; they were amplitudes and velocities on closing and opening, M1 area defined as that between end-diastolic and systolic echoes, OS area between systolic and early diastolic echoes, the doming area between the trailing edge of an early diastolic echo and a line projected from the anterior annulus to the tip of the leaflet, and the degree of systolic ballooning. Results were as follows: 1. Significant differences in the area of the mitral valve orifice were found among three groups. The area was maximum in group II, minimum in group III and intermediate in group I. 2. In group I, the body of the AML was pliable, resulting in a ballooning into the left atrium in systole and a marked doming toward the left ventricle in early diastole. Various parameters related to the production of M1 and OS in group I were significantly increased as compared with those of the other two groups. 3. In group II, the body of the AML was not pliable in spite of mild organic changes in the valve. The degree of early diastolic doming was mild. Compared to group III, the intensity of M1 in group II was significantly larger, but no significant difference was observed in the parameters related to the production of M1 between the two groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗