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PubMed1976

Massive left atrial thrombus complicating mitral stenosis with atrial fibrillation: results of surgical treatment.

Thirty-five patients with massive atrial thrombus complicating mitral stenosis and atrial fibrillation were treated surgically. The mean age in this series is lower than that reported in the West. Furthermore, the incidence of preoperative embolic manifestations has been less frequent in our experience. We believe it is desirable to document the presence of a thrombus by selective left atrial cineangiography. Surgical treatment was accomplished with an acceptable mortality. The vital role played by the use of low-molecular-weight dextran and early anticoagulation in decreasing the incidence of postoperative cerebral embolism is emphasized. Follow-up data in the survivors has shown excellent functional status with no late embolic phenomena in any subject.

Adult↗
PubMed2005

Doppler tissue evaluation of intra-atrial and interatrial electromechanical delay and comparison with P-wave dispersion in patients with mitral stenosis.

OBJECTIVE: The aim of our study was to: (1) measure atrial electromechanical delay in patients with mitral stenosis (MS) and in a control group; (2) find the echocardiographic parameters that affect atrial electromechanical delay; and (3) examine the correlation between atrial electromechanical delay and P-wave dispersion (PWD). METHODS: A total of 25 patients with pure MS (age 43 +/- 10 years; 18 women, 7 men) and 16 control subjects (age 41 +/- 8 years; 9 women, 7 men) were studied. Interatrial and intra-atrial electromechanical delay was measured with Doppler tissue echocardiography. From the 12-lead electrocardiograms, PWD was calculated. RESULTS: Interatrial electromechanical delay was 71.2 +/- 33 in the MS group and 40.5 +/- 21.0 in the control group (P = .01). In the MS group, PWD was 50 +/- 7 and in the control group it was 29 +/- 5 (P = .03). A positive correlation was detected between interatrial electromechanical delay and PWD (r = 0.6, P = .03). CONCLUSION: This study shows that interatrial electromechanical delay gets longer in MS and is correlated with PWD. Atrial electromechanical delay is related with left atrial size but not with severity of MS.

Adult↗
PubMed1991

[Relationship between echocardiographic measurement of left atrial size and the incidence of systemic embolism in mitral stenosis].

In order to correlate left atrial diameter (LAD) with the prevalence of systemic embolism (SE) in mitral stenosis (MS), we assessed LAD by M mode tracings in 51 patients with SE and in 50 patients with MS without ES as control group (C). Mean age was similar in both groups (SE 47.3 +/- 12 vs C 46.8 +/- 14 years; p NS) (mean +/- SD). Functional class, cardiothoracic ratio and association of other valvular lesions were similar in both groups. Atrial fibrillation (AF) was more frequent in SE group (n = 39) than in C group (n = 20) (p less than 0.01). LAD in SE patients ranged from 2.9 to 9 cm (5.2 +/- 1) whereas in C patients range was from 2.8 to 7.5 (4.6 +/- 1) (p less than 0.01). Nevertheless, LAD in patients with AF was rather similar in both groups (SE 5.3 +/- 1.1 vs C 5.3 +/- 1; p NS). Our results suggest that LAD is not a good predictive parameter for SE in MS. The main risk factor for SE was the existence of AF. Echocardiographic LAD is not a useful parameter to prescribe chronic oral anticoagulation as prophylaxis for SE in patients with MS.

Adult↗
PubMed1989

[The influence of left ventricular function on surgical risk in mitral stenosis].

The influence of left ventricular (LV) function on surgical risk was assessed in 98 patients with mitral stenosis (MS) using echocardiographic studies including a dobutamine test in 42 cases. Intraoperative LV myocardial biopsy was also performed in 24 cases. Preoperatively, depressed LV function [% fractional shortening (%FS) less than or equal to 27%] was observed in 21 patients (21%). Seven patients had postoperative LV failure, five of whom had preoperative depression of LV function. Among these five patients, three had low cardiac output; and in the other two preoperative %FS was severely depressed. In cases of poor responses to preoperative dobutamine, postoperative improvement in %FS and the cardiac index were not as marked in the good-response group, and some of these patients had LV failure postoperatively. Percent fibrosis of the LV myocardium, which was demonstrated by intraoperative biopsy, correlated negatively with preoperative %FS, and %fibrosis was greater in the group responding poorly to dobutamine administration, especially in patients with postoperative LV failure. These results suggest that some patients with MS were developing LV failure postoperatively due to impaired myocardium. Myocardial fibrosis seemed to be an important causative factor in these patients. Preoperative evaluation utilizing dobutamine administration is useful in screening for high-risk patients.

Adult↗
PubMed2006

[Severe pulmonary hypertension caused by untreated mitral stenosis. It still happens in the XXI century].

We present a case of a 58 years old patient with extremely severe mitral stenosis. Several years ago she denied surgical treatment despite qualification by cardiologists. At present hospitalisation mitral valve area was calculated as 0.5 cm(2) with systolic right ventricular systolic pressure of 125 mmHg. Right ventricle was hypertrophied and extremely enlarged as well as both atria. Surprisingly she was still in sinus rhythm and had no thrombi in the left atrium. Patient died before scheduled surgery because of cardiac decompensation and renal insufficiency.

Echocardiography↗
PubMed1987

Doppler measurement of left atrial depressurization and mitral valve area in patients with suspected mitral stenosis: validation of a new method.

Atrial depressurization time measurement by Doppler ultrasound can be used to quantify stenotic mitral valve area. In this report, we present the results of a blinded trial comparing the standard Doppler method for "pressure half-time" (A) and another Doppler method we devised (B) for measurement of atrial depressurization time. Both methods were tested against valve area data from catheterization performed within 24 hours after Doppler echocardiography. Ten readers analyzed each of 10 Doppler profiles by methods A and B, in random order. After decoding, each of the 200 Doppler readings was compared to the catheterization result. Method B proved more accurate than method A by repeated measures analysis of variance (p less than 0.0001). Furthermore, method B took less than half as long to perform (p less than 0.0001). The methods presented herein provide a simple alternative means to follow the progression of mitral stenosis noninvasively and to determine optimal timing for surgery.

Heart Atria↗
PubMed2005

Mitral valve replacement for mitral stenosis secondary to Hunter's syndrome.

Hunter's syndrome is a rare, X-linked recessive, mucopolysaccharidosis. Survival into adulthood is uncommon. Mitral valve disease, predominantly regurgitation, has been reported in these patients. We have found no reports of mitral valve replacement for mitral stenosis secondary to Hunter's syndrome in the English literature. We report that mitral valve replacement for this pathology is a viable treatment option in an adult patient; however, specific precautions must be considered.

Adult↗
PubMed1991

Effect of severe pulmonary hypertension on the calculation of mitral valve area in patients with mitral stenosis.

We studied 50 consecutive patients with mitral valve stenosis (MS) by cardiac catheterization and Doppler echocardiography to assess whether the presence of severe pulmonary hypertension affected the calculation of valve area by Doppler pressure half-time method and by the Gorlin formula using pulmonary capillary wedge pressure as an index of left atrial pressure. Patients with severe mitral regurgitation were excluded. In patients with pulmonary artery systolic pressure (PAS) less than 70 mm Hg (n = 33), there was good correlation between the mitral valve area derived from Doppler echocardiography and from cardiac catheterization (r = 0.85). However, in patients with PAS greater than or equal to 70 mm Hg (n = 17), this correlation was not as good (r = 0.57). In these 17 patients, the Gorlin formula tended to underestimate the valve orifice area (mean valve area 0.85 +/- 0.49 and 1.06 +/- 0.46 cm2 by catheterization and by Doppler respectively, p = NS). Direct measurement of the valve area by two-dimensional echocardiography was possible in 12 of the 17 patients and correlated well with Doppler values (r = 0.91). Hence in the presence of severe pulmonary hypertension, Doppler pressure half-time estimation of mitral valve area is more accurate than is catheterization-derived valve area, using the wedge pressure and the Gorlin formula.

Acute Disease↗
PubMed1987

Conservative operation for mitral stenosis with densely fibrosed or partially calcified valves. An eight-year evaluation.

Of 284 patients undergoing open mitral commissurotomy for mitral stenosis from January 1978 to December 1985, 81 patients had a densely scarred or partly calcified valve. In this study, we evaluated the postoperative results in these 81 patients. There were no operative or late deaths. Seventy-seven patients (95%) are in Functional Class I or II. Three patients required reoperation 3, 30, and 50 months after the initial procedure because of moderate or severe residual mitral regurgitation. After valvotomy there were four episodes of embolism. The actuarial rate of freedom from any complication (mortality, reoperation, congestive heart failure, and thromboembolic events) was 89.3% +/- 3.9% (mean +/- standard error of the mean) 8 years after operation. We conclude that for a follow-up period of 8 years, the stenotic mitral valve with anatomical deformities can be salvaged with satisfactory results. Therefore, we believe that this approach, at present, is a better alternative than prosthetic replacement with any type of valve presently available.

Adult↗
PubMed1985

Open mitral commissurotomy for recurrent mitral stenosis after closed commissurotomy.

We evaluated the long-term results in 43 patients who had undergone open mitral commissurotomy for recurrent mitral stenosis after closed commissurotomy. There was one operative death (2.3 percent) and one case of reoperation (2.3 percent). Twenty patients (42 percent) were in NYHA Class I and 22 patients (51 percent) in Class II. In 12 randomly selected patients subjected to postoperative cardiac catheterization, the pulmonary arterial mean pressure remained high at rest and increased to 48 mmHg (mean) during exercise with significant differences in patients who underwent open mitral commissurotomy in the first operation (control group). The left atrial mean pressure was significantly high at rest and rose to 27 mmHg (mean) during exercise. The pulmonary vascular resistance also increased during exercise, with significant differences for the control group. We conclude from these studies that the less satisfactory clinical improvement in patients undergoing reoperation apparently was related to advanced pathology of the mitral valve and development of pulmonary vascular disease.

Adolescent↗
PubMed1986

[Mitral stenosis with notable or important subvalvular changes. Complete open commissurotomies supported by chorda transfer].

Since 1983, 40 consecutive patients with mitral stenosis (MS) and significant disease of the subvalvular apparatus underwent open heart mitral commissurotomy (OHMC). The aim of the study was to evaluate the effects of an unrestricted dilatation of the two commissures followed by repair of the subsequent mitral regurgitation. The mitral regurgitation created by this procedure in 24 cases was corrected by transferring 2 to 6 chordae tendinae to the free border of the anterior and/or posterior leaflet in the commissural region. A central regurgitant lesion due to lack of coaptation of the valvular surfaces was treated by annuloplasty with a Carpentier prosthesis in 12 cases. The subvalvular abnormalities were treated by the conventional techniques of fenestration, resection and division of the papillary muscles. Thirty of the 38 survivors had no residual murmur, and 6 had a short low intensity systolic murmur. The 2D echocardiographic study showed no residual stenosis. The residual systolic murmurs were evaluated by pulsed Doppler and corresponded to very localised regurgitation. This extensive operative technique gives very good immediate valvular results which, associated with an adequate subvalvular procedure, are considered to be an important prognostic factor.

Adolescent↗
PubMed2004

Dobutamine stress echocardiography for noninvasive assessment and risk stratification of patients with rheumatic mitral stenosis.

OBJECTIVES: We sought to evaluate the impact of dobutamine stress echocardiography (DSE) in patients with known rheumatic mitral stenosis (MS) in order to assess its safety, feasibility, and prognostic correlation to well-known clinical outcomes. BACKGROUND: Noninvasive prognostic assessment of MS still represents an unresolved task in patients with clinically challenging disease. METHODS: Dobutamine stress echocardiography was performed in 53 patients with MS (8 males; age 37.4 +/- 11.3 years) with no major complications. RESULTS: During follow-up (60.5 +/- 11.0 months), 29 patients presented with clinical events: 16 hospitalizations, seven cases of acute pulmonary edema, and six symptomatic supraventricular arrhythmias. On multivariate analysis, the diastolic mitral valve mean gradient at peak DSE (DSE-MG) was the best predictor of clinical events (p < 0.008), especially in patients with moderate disease (p < 0.001). The best performance of DSE for the detection of clinical events was obtained at a cut-off value of 18 mm Hg DSE-MG (sensitivity 90%, specificity 87%, and accuracy 90%). The addition of DSE to the conventional cardiology work-up would allow a 17% increment for the detection of high-risk patients in the entire population and a 40% increment in patients with presumed moderate disease. CONCLUSIONS: In patients with MS, DSE is a safe and highly feasible stress test. A DSE-MG > or =18 mm Hg identifies a subgroup of high-risk patients in whom a more aggressive approach may be warranted; on the other hand, patients with a DSE-MG <18 mm Hg predicts an uneventful clinical course and may justify a more conservative strategy.

Adolescent↗
PubMed1991

The role of echocardiography/Doppler in catheter balloon treatment of adults with aortic and mitral stenosis.

Doppler and two-dimensional echocardiography (2DE) have played a major role in the evaluation of patients undergoing catheter balloon treatment of aortic and mitral stenosis. Doppler/2DE has made possible an understanding of the mechanism of increase in valve area. Before the procedure, Doppler/2DE provides a reasonable estimate of the severity of the valvular stenosis and associated cardiac abnormalities. The evaluation of mitral valve morphology by 2DE before catheter balloon treatment has shown that patients with excellent leaflet motion and minimal increase in valve thickness have the greatest increase in mitral valve area. During the procedure, Doppler/2DE can aid in the transseptal puncture, in positioning the balloons across the stenotic orifice, and in the immediate assessment of changes in valve function and complications. The estimate of the aortic and mitral valve gradients and areas by Doppler/2DE before catheter balloon treatment shows a reasonable correlation with hemodynamic measurements. Immediately after the procedure, the Doppler/2DE estimates of aortic valve gradient and area show a fair correlation with data from cardiac catheterization, provided care is taken to avoid technical problems. Doppler/2DE assessment of mitral valve area immediately after catheter balloon commissurotomy (CBC) shows a poor correlation with catheterization data, which has been attributed to rapid changes in left atrial compliance and gradient. However, the correlation of Doppler estimates of mitral valve area with catheterization data improves at 3 months after CBC. Serial evaluations of patients after aortic or mitral catheter balloon dilatation should permit detection of restenosis and valve regurgitation and assessment of ventricular function and may provide valuable insights into the mechanisms of restenosis and changing clinical status.

Adult↗
PubMed1977

[Isolated mitral stenosis: systolic and diastolic dynamic geometry of the left ventricle. Integration with several hemodynamic parametres (author's transl)].

75 patients with isolated mitral stenosis were studied. Particular attention was paid to the integration of the parametres VTD, FE, mitral area, pulmonary artery pressure and dynamic systolic and diastolic geometry of the left ventricle. The existence of isolated MS with alteration of the left ventricular function not depending on the alterations of the preload and the forms with raised FE, was demonstrated. A classification into 6 groups was made, each characterized by special geometric modalities of contraction and relaxation. A significant compensation of several of the parametres of systolic mecanism (hyperkinesia) and diastolic (SERP) dynamic geometry was observed. It was therefore concluded that a more precise definition of the interaction of ventricular function with left atrial function is necessary.

Cardiomegaly↗
PubMed1968

Mitral stenosis together with a giant cell myocarditis limited to the left atrium.

A case is described in which mitral stenosis was associated with a giant cell myocarditis; the latter lesion was, however, localized to the left atrium. A quite high proportion of reported cases of giant cell myocarditis have occurred in association with rheumatic heart disease. The nature of this relationship is discussed and it is concluded that, in such cases, the giant cell reaction may represent an unusual myocardial response to rheumatic fever.

Female↗