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At least 1,243 records · Page 69Linked to original sources
PubMed1998

[A rare case of 2 free thrombi in left atrium with mitral stenosis].

A 64-year-old female was admitted with general fatigue and orthopnea. Preoperative echocardiography showed a free ball thrombus in the left atrium, mitral stenosis and severe tricuspid regurgitation. To avoid a herniation of thrombus to the mitral orifice, an emergency operation was performed. Two free and small mural thrombi were found in the left atrium. Thrombectomy, mitral valve replacement and tricuspid annuloplasty were performed successfully. Postoperative course was uneventful, and she was discharged in good condition on the 21st postoperative day.

Female↗
PubMed1992

Response of left ventricular ejection performance following balloon valvuloplasty in patients with mitral stenosis.

In order to see if any change of left ventricular ejection performance (LEVP) would occur after successful balloon mitral valvuloplasty (BMV), a prospective study on echocardiography and calibrated carotid pulse tractings was performed two days before, two days and then six months after BMV in 24 patients with pure rheumatic mitral stenosis (MS). Echocardiographic parameters representing preload i.e. end-diastolic volume index (EDVI); afterload i.e. end-systolic wall stress (ESS), and the indices of LVEP i.e. ejection fraction (EF), fractional shortening, rate-corrected velocity of circumferential shortening (VCFc) and a ratio of ESS over end-systolic volume index (ESS/ESVI) were measured. A group of 66 normal subjects was used to establish the 95% confidence interval of the echo parameters. The incidence of depressed LVEP in MS patients was about 21% when measured by load-independent index i.e. ESS/ESVI. In the MS group, 7 out 24 (29%) patients achieved an increased cardiac index after BMV. Six (25%) MS patients showed an EF below 95% confidence interval of control (less than 55%) before BMV and, of these 6, only 3 patients increased their EDVI after the BMV. Those who showed an EF greater than or equal to 55% before BMV gave no change in their preload (EDVI) after the BMV. Only one MS patient showed high afterload (ESS) both before and after BMV. However, the ESS/ESVI showed insignificant improvement (p = 0.055) after BMV. It was therefore concluded that (1) a depressed LVEP is frequently seen in patients with MS; (2) LVEP can be improved by BMV in some (21%) patients with MS, and the improvement is not related to the change of preload or afterload but more likely secondary to an increased myocardial contractility.

Adult↗
PubMed2006

Evaluation of mitral valve area by the proximal isovelocity surface area method in mitral stenosis: could it be simplified?

AIM: One limitation for a wider use of the proximal isovelocity surface area method (PISA) for the evaluation of the mitral valve area (MVA) in patients with mitral stenosis (MS) is the requirement of an angle correction factor (angle alpha between the mitral leaflets) which cannot be obtained using the machine's built-in software and requires a manual measurement. The aim of the present study was to evaluate if the use of a fixed angle could provide an acceptable MVA estimation. METHODS AND RESULTS: In 48 patients (53 +/- 14 years, 75% female and 32% atrial fibrillation), MVA was prospectively measured by planimetry (MVA(2D)) and PISA (PISA(mes)). The angle alpha was manually measured on paper prints using a protractor. MVA(2D) was 1.38 +/- 0.56 cm(2) [0.5-2.40]. PISA(mes) (alpha = 104 +/- 13 degrees inter-quartiles 90-115) was 1.34 +/- 0.64 cm(2) [0.31-2.95] and did not differ from and correlated well with MVA(2D) (P = 0.25; r = 0.93, P < 0.0001). MVA estimated using the PISA method and a fixed angle value from 90 to 110 (MVA(alpha)(=90) to MVA(alpha)(=110)) progressively increased from 1.20 +/- 0.66 to 1.48 +/- 0.81 cm(2). Only MVA(alpha)(=100) (1.34 +/- 0.74 cm(2)) did not differ from and correlated well with both MVA(2D) and PISA(mes) (both P > 0.35 and r > 0.90, P < 0.0001). CONCLUSION: The angle formed by the mitral leaflet only slightly changes in between patients and use of a fixed angle value of 100 degrees provides an accurate estimation of the MVA by the PISA method in patients with MS. This simplification would facilitate and extend the use of the PISA as an additional method for the assessment of MS severity in routine practice.

Adult↗
PubMed1983

The apex impulse in mitral stenosis: graphic explanation of the palpable movements at the cardiac apex.

Simultaneously recorded phonocardiograms and apexcardiograms of 39 patients with mitral stenosis (MS) were retrospectively analyzed. A notch on the upstroke of the apexcardiogram coincidental with the first heart sound (S1) occurred in 18 (47%) of the patients. The notch ratio or vertical distance from the onset of the apical impulse to the notch ratio or vertical distance from the onset of the apical impulse to the notch as a percentage of the total upstroke was measured and compared with the mean mitral diastolic gradient obtained at cardiac catheterization. Statistical analysis showed a significant relation (r = 0.61; p less than 0.01) between notch ratio and the mean mitral diastolic gradient. This study reaffirms that the complex palpable movements at the cardiac apex, consisting of a "tap" representing S1 occurring perceptibly after the onset of the apex impulse itself, are a useful diagnostic sign of MS. Furthermore, a graphic measurement of the extent of delay of S1 with respect to the onset of the apical thrust can provide a rough measure of the severity of the valvular obstruction.

Adult↗
PubMed1999

Balloon dilatation of congenital mitral stenosis in a critically ill infant.

We report a case of a 14-month-old-infant with severe congenital mitral stenosis who presented with pulmonary oedema, acute renal failure and haemodynamic instability. Balloon dilatation was successfully performed under fluoroscopic and transesophageal echocardiographic guidance. Cathet. Cardiovasc. Intervent. 48:191-193, 1999.

Cardiac Catheterization↗
PubMed1984

[Comparison of quantitative data from two-dimensional echocardiography and anatomical examination in mitral stenosis].

This prospective study was undertaken to assess the results of 2D echocardiography in the assessment of valvular and subvalvular lesions in mitral stenosis. The echocardiographic findings (E) were compared with peroperative and laboratory anatomical examination of the excised valve (A). The following criteria were compared: 1) planimetry of mitral valve surface area, 2) mobility of the anterior leaflet, assessed anatomically by the flexibility of the tissue, and echocardiographically by the amplitude of early diastolic excursion, 3) length of anterior and posterior leaflets, 4) presence of calcification, 5) length of the longest tendinae chordae, measured from the papillary muscle to the insertion of the valve, 6) thickness of the thickest tendinae chordae attached to each leaflet. Echocardiography was carried out preoperatively by two different operators without knowledge of the haemodynamic and later anatomical findings. The anatomical results were taken as reference. Mitral valve surface area measured by both methods was comparable (A = 0,96 +/- 0,28 cm2; E = 1,04 +/- 0,33 cm2, N = 17, t = NS) and a good correlation was found between the two measurements (r = 0,79; p less than 0,01). 2D echo assessed the loss of valvular mobility by limitation of early diastolic opening of the AML with a sensitivity of 71 p. 100 and a specificity of 70 p. 100. Measurement of valve length of the anterior (N = 14) and posterior leaflets (N = 15) may be difficult in the presence of severe calcification. The results of both measurements were comparable. AML, 25,2 +/- 1,9 mm (A) and 24,6 +/- 2,1 mm (E); PML, 13,9 +/- 1,9 mm (A) and 14,2 +/- 2,2 (E) correlated well, r = 0,71 and r = 0,71 respectively (p less than 0,01).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1994

Percutaneous mitral balloon valvotomy in patients with calcific mitral stenosis: immediate and long-term outcome.

OBJECTIVES: This study analyzed the immediate and long-term outcome of percutaneous balloon mitral valvotomy in patients with and without fluoroscopically visible mitral valve calcification. BACKGROUND: Mitral valve calcification has been shown to be an important factor in determining immediate and long-term outcome of patients undergoing surgical mitral commissurotomy. Patient selection has an important impact on the outcome of percutaneous balloon mitral valvotomy. METHODS: The immediate and long-term results of percutaneous balloon mitral valvotomy were compared in 155 patients with and 173 patients without mitral valve calcification. The patients with calcified valves were assigned to four groups according to severity of calcification. RESULTS: Patients with calcified mitral stenosis more frequently were in New York Heart Association functional class III or IV and more frequently had atrial fibrillation, previous surgical commissurotomy, echocardiographic score > 8, higher pulmonary artery and left atrial pressures, higher pulmonary vascular resistance and mean mitral valve gradient and lower cardiac output and smaller mitral valve area. Mitral valve area after valvotomy was significantly smaller in patients with calcified valves (1.8 +/- 0.06 vs. 2.1 +/- 0.06 cm2) and was > or = 1.5 cm2 in 65% of patients with and 83% of patients without calcified valves (p = 0.004). A successful outcome, defined as mitral valve area > 1.5 cm2 without significant mitral regurgitation and left to right shunting, was achieved in 52% of patients with and 69% of patients without uncalcified valves (p = 0.001). The success rate was 59%, 48%, 35% and 33% in subgroups with 1+, 2+, 3+ and 4+ calcification, respectively. The rates of significant left to right shunting and mitral regurgitation after valvuloplasty were similar in the two groups. Estimated survival rate (80% vs. 99%, respectively, p = 0.0001), survival rate without mitral valve replacement (67% vs. 93%, respectively, p < 0.00005) and event-free survival rate (63% vs. 88%, respectively, p < 0.00005) at 2 years were significantly better in the patients with uncalcified valves. Survival rate curves became progressively worse as the severity of calcification increased. CONCLUSIONS: These findings indicate that immediate and long-term results of mitral valvuloplasty are not as successful in patients with fluoroscopically visible mitral valve calcification as in those without calcification.

Calcinosis↗
PubMed2003

Percutaneous mitral balloon valvuloplasty in rheumatic mitral stenosis without heparin.

BACKGROUND AND AIM OF THE STUDY: Customarily, heparin is used to prevent embolic complications arising during percutaneous mitral balloon valvuloplasty (PMBV), but this may prolong hospital stay and increases the risk of bleeding, hemopericardium and cardiac tamponade. The study aim was to assess in-hospital complications of PMBV performed without heparin. METHODS: Rheumatic mitral stenosis patients undergoing PMBV between February 1997 and March 2000, either with (18 males, 91 females; mean age 37.5 +/- 8.8 years) or without (15 males, 119 females; mean age 37.5 +/- 15.1 years) heparin at conventional doses, were included in the study. Neurologic and cardiac examinations were conducted after PMBV and repeated before discharge from hospital. RESULTS: There was no statistically significant difference between groups in terms of age, gender, NYHA class, presence of atrial fibrillation, spontaneous echo contrast, left atrial appendix thrombus, left atrial diameter and mitral valve echo score. There was no difference between groups with regard to procedural success, mitral valve area and gradient attained, or rates of mitral insufficiency. Ten patients in the heparin group required transesophageal echocardiography (TEE) guidance during PMBV (p <0.001). The mean duration of PMBV was greater in the heparin group due to increased use of TEE guidance during septal puncture. During follow up, no patients in the non-heparin group had hemopericardium, cardiac tamponade, embolic event or death; by comparison, in the heparin group one patient had hemopericardium and one had a cardiac tamponade. No major bleeding episode requiring transfusion occurred in either group, but six and 10 cases of minor bleeding at access sites occurred in the non-heparin and heparin groups, respectively (p = NS). Duration of hospitalization was statistically longer in the heparin group than in the non-heparin group. CONCLUSION: Avoidance of heparin did not lead to an increase in embolic complications. The vascular access sites were withdrawn early, thereby reducing the duration of hospital stay and time to ambulation. This method did not cause any increase in numbers of vascular complications and blood transfusions.

Adult↗
PubMed1982

Improvement of the cardiac function after electrical cardioversion of atrial fibrillation. Echocardiographic study in patients with and without mitral stenosis.

The improvement of the cardiac function after electrical cardioversion of atrial fibrillation has been studied by echocardiography by few authors and only in patients without mitral stenosis. Moreover, discordant results have been obtained. We have studied nine patients with mitral valve disease as well as nine other patients with ischemic heart disease. Both groups were cardioverted within five days of onset of atrial fibrillation, and appropriate echocardiographic measurements were made one hour before and two hours after cardioversion. We found a significant decrease of left atrial diameter in both groups, as well as a significant increase of the end-diastolic diameter and volume of left ventricle and an improvement of the cardiac index. These changes were significantly more pronounced in patients with mitral valve disease and they appear in accordance with the improvement of the cardiac function demonstrated with invasive hemodynamic studies after cardioversion to sinus rhythm. In the group of patients with mitral valve disease and a very dilated left atrium (more than 6 cm. of diameter) atrial fibrillation recurred within the next twelve months. In spite of the limitations of M-mode approach for calculating left ventricular volumes, echocardiography appears to be sensitive and useful for evaluating in the single patient the changes in left ventricular performance after cardioversion of atrial fibrillation to sinus rhythm.

Arteriosclerosis↗