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PubMed1992

Effect of heart rate on pressure half-time in patients with mitral stenosis.

The effect of heart rate on pressure-half time has been controversial. This study attempted to clarify this issue in patients with mitral stenosis. Twenty cases were enrolled, 10 with atrial fibrillation and 10 with sinus rhythm. Twenty beats were analyzed for each patient. The results showed that in patients with atrial fibrillation the pressure half-time was hardly measurable in the cardiac cycles with a ventricular rate more than 100/min; by excluding these fast beats, the pressure half-time showed no relationship with the heart rate. Similarly, there was no significant correlation between heart rate and pressure half-time in patients with sinus rhythm when the heart rate was less than 70/min. However, if the sinus rate was more than 70/min, the correlation became statistically significant. We conclude that when using pressure half-time to derive mitral valve area we should avoid to use the beats with ventricular rate greater than 100/min in patients with atrial fibrillation. In patients with sinus rhythm, we should try to use those beats with heart rate greater than 70/min if possible. Otherwise, significant error may occur.

Adult↗
PubMed1994

A comparative study of coumadin and aspirin for primary cardioembolic stroke and thromboembolic preventions of chronic rheumatic mitral stenosis with atrial fibrillation.

The comparative study of the efficacy of coumadin and aspirin in primary cardioembolic stroke prevention of chronic rheumatic heart disease (mitral stenosis) with atrial fibrillation was conducted at Siriraj Hospital, Mahidol University, Bangkok, Thailand. Seventy-nine patients were enrolled in the trial. Allocation of patients into coumadin or aspirin groups depended upon the patients' choice. Nineteen patients were given coumadin at the adjusted dosage to maintain the therapeutic range of International Normalised Ratio between 1.5-3. Sixty patients were given aspirin at the fixed dosage of 75 mg per day. Six patients were lost to follow-up over the 3 yr period; four in the aspirin group and 2 in the coumadin group. There were three patients with nonfatal cardioembolic stroke in the aspirin group but none in the coumadin group after three years of follow-up. Six patients had mitral valve replacement during the study (i.e. three patients in each group). There were complications in 12 patients, 10 in the aspirin (16.6 per cent) and 2 in the coumadin (10.5 per cent) group. The complications in coumadin group were minor bleeding over the thigh in one patient and generalised ecchymosis over the whole body in one other. In the aspirin group, the complication was gastrointestional symptoms, mainly epigastric pain, but no frank bleeding was observed. Primary prevention of cardioembolic stroke in chronic rheumatic heart disease was found to be more effective with coumadin than aspirin. Our study does not support the use of aspirin in primary prevention of cardiac embolism in chronic rheumatic heart disease.

Adolescent↗
PubMed1996

Colour doppler valvar and subvalvar flow diameter imaging versus echo score in mitral stenosis: comparison with type of surgery.

OBJECTIVE: To compare the value of echo score with that of Doppler subvalvar flow broadening in deciding the type of mitral stenosis surgery. PATIENTS: 30 patients, mean age 47 years, with severe stenosis undergoing surgery were divided into two groups according to type of surgery: open heart commissurotomy (group 1, n = 12), or prosthesis (group 2, n = 18). A control group of 10 patients with prosthesis served as reference, representing mild stenosis without subvalvar connection. METHODS: For echo, the score proposed by Wilkins for cross sectional imaging was used. For Doppler, the flow diameters were measured in cm by an independent examiner from the long axis view in early diastole at two levels: (1) at the level of the stenosis (origin flow diameter), and (2) 1.5 cm downstream from the stenosis in the left ventricle (subvalvar flow diameter) with calculation of a Doppler ratio relating these two measurements, expressed as a percentage of broadening. Diagnostic value was compared for both procedures. RESULTS: There was no significant difference in age, mitral valve areas, or haemodynamics for the two groups. Mean values (SD) were: echo score: group 1, 9.83 (1.26) v group 2, 10.8 (8.1), NS; Doppler ratio %: group 1, 44 (24) v group 2, 12 (21) (P < 0.001); control group: 69 (15). The per cent diagnostic value for an open heart commissurotomy of respective cut off points was: Doppler ratio > 25% (range 71% to 87%); echo score < 10 (range 50% to 75%). CONCLUSIONS: The new Doppler ratio diagnostic value agreed better with surgical management, repair or prosthesis, in this study. Thus, it appears to better reflect the subvalvar involvement and changes in kinetics than the echo score alone. This easy Doppler method might become a routine examination for follow up of patients with open heart commissurotomy, to avoid performing repeated transoesophageal echocardiography.

Adolescent↗
PubMed2002

Impaired fibrinolytic capacity in rheumatic mitral stenosis with or without atrial fibrillation and nonrheumatic atrial fibrillation.

Chronic atrial fibrillation (AF) has often been associated with systemic embolization, and patients with mitral stenosis (MS) have the highest thromboembolic risk. Increased risk of thromboembolism could be in part due to impaired fibrinolytic function. Global fibrinolytic capacity (GFC) is an innovative technique for evaluating the entire fibrinolytic system. The aim of our study was to evaluate fibrinolytic activity in patients with rheumatic and nonrheumatic chronic AE To investigate fibrinolytic activity, we assessed GFC in peripheral blood samples of 32 patients with nonrheumatic AF (14 women; mean age, 56 +/- 1 years), 30 patients with rheumatic MS and AF (23 women; mean age, 35 +/- 9 years), and 32 patients with rheumatic MS and sinus rhythm (24 women; mean age, 36 +/- 8 years). The control group comprised 30 healthy adult subjects in normal sinus rhythm. Patients with chronic AF (rheumatic and nonrheumatic) had lower GFC than did the controls (P = .0001). The rheumatic AF group also showed decreased levels of GFC compared with the nonrheumatic AF group, with the rheumatic MS and sinus rhythm group, and with controls (P = .03, P = .02, P = .0001, respectively). GFC was lower in patients with rheumatic MS and sinus rhythm than in controls (P = .003). Although there were correlations between GFC and mitral valve area, transmitral mean gradient, left atrial diameter, and mitral calcification in patients with rheumatic MS, multivariate analysis showed only transmitral gradient as an independent factor affecting GFC. Patients with AF have decreased GFC, a finding that suggests the presence of a hypofibrinolytic state. Fibrinolytic dysfunction was more pronounced in rheumatic MS patients with AF than in those with nonrheumatic AF. Moreover, patients with rheumatic MS and sinus rhythm had decreased global fibrinolytic activity. Hypofibrinolysis documented by decreased GFC can be one of the important causes of increased risk of embolism in patients with AF and rheumatic MS.

Adult↗
PubMed2002

Is the mitral valve area flow-dependent in mitral stenosis? A dobutamine stress echocardiographic study.

OBJECTIVES: The purpose of this study was to compare the effect of changes in flow rate on the mitral valve area (MVA) derived from two-dimensional echocardiographic planimetry and Doppler pressure half-time (PHT) methods in patients with mitral stenosis (MS). BACKGROUND: Dobutamine stress echocardiography has been proposed as a means of assessing the severity of MS. However, data regarding the effect of an increase in flow rate on MVA are limited. If MVA is indeed flow-dependent, this has important implications for the assessment of the severity of MS, particularly in the setting of reduced cardiac output (CO). METHODS: Dobutamine echocardiography was performed in 57 patients with isolated MS who were in sinus rhythm. The MVA was determined by planimetry and Doppler PHT methods. RESULTS: Cardiac output increased by > or =50% in 27 patients (group I) and by <50% in 30 patients (group II). In group I, the MVA by planimetry increased by only 10.6 +/- 2% and the MVA by PHT increased by 21.9 +/- 4.8%. These changes were similar to those observed in group II (10.7 +/- 3% and 14.8 +/- 4%, respectively; p = NS), despite a much smaller increase in CO. A clinically important change (from the severe to mild category) occurred in only one patient when using the PHT method and in none by planimetry. CONCLUSIONS: Changes in flow rate result in small but clinically insignificant changes in echocardiographic MVA measurement. These methods provide an accurate assessment of MS severity in a majority of patients, independent of changes in flow rate.

Adolescent↗
PubMedDate not supplied

Reliability and efficacy of metoprolol and diltiazem in patients having mild to moderate mitral stenosis with sinus rhythm.

The authors evaluated the effects of beta blockers (metoprolol) and calcium channel blockers (diltiazem) in patients having mild to moderate mitral stenosis (MS) with sinus rhythm. Eighty patients with a complaint of dyspnea with diagnosed MS were included in this study. Patients were randomized into metoprolol and diltiazem groups. The first group received oral diltiazem treatment for 3 months following an i.v. dose of 25 mg diltiazem. The second group received oral metoprolol for 3 months following an i.v. dose of 5 mg metoprolol. All patients performed a treadmill exercise test at the beginning of and after 3 months of treatment. Transthoracic echocardiographic studies were also performed following the i.v. drug administration and after 3 months of treatment. In addition, oxygen uptakes of patients were measured before and after the stress and after 3 months of treatment. Decreases in peak gradient (PG) and mean transmitral gradient (MG) were observed in the metoprolol group after i.v. and oral metoprolol treatment. A prolongation of exercise time in treadmill exercise test (TET) and a decrease in the maximum heart rate after oral metoprolol treatment were noted. Eighteen patients in the metoprolol group had benefited symptomatically from this treatment and complaints of dyspnea were alleviated, whereas no symptomatic relief was seen in the diltiazem group. No significant prolongation was observed in effort times (p>0.05) of the diltiazem group. Transmitral gradients measured via echocardiographic examination did not change (p>0.05). With respect to oxygen uptake rates, a statistically significant decrease was determined in the metoprolol group, whereas no difference was found in diltiazem group. The authors conclude that metoprolol may be useful in patients with MS and can provide symptomatic relief. They did not observe any beneficial effect of diltiazem in these patients.

Administration, Oral↗
PubMed1993

Mitral annulus size in isolated mitral stenosis.

M-mode and two-dimensional echocardiographic images were obtained using the planimeter method in the short axis view and calculated by Doppler-derived pressure half-time in 24 patients with mitral stenosis before and after surgical commissurotomy and posterior annuloplasty. The diameter of the mitral valve annulus was measured in the standard long axis view and in the apical four-chamber view using two-dimensional echocardiography. Preoperatively, the mitral annulus was dilated in all patients as a consequence of left atrial dilation. This could be one of the factors causing residual regurgitation after surgical mitral commissurotomy. However, more data are needed to demonstrate that annuloplasty can prevent the development of mitral regurgitation after surgery.

Adult↗
PubMed2002

Relationship between resting parameters of the mitral valve and exercise capacity in patients with mitral stenosis: can the diastolic filling period predict exercise capacity?

BACKGROUND AND AIMS OF THE STUDY: In order to provide patients with better exercise capacity, interventional therapy to the mitral valve is often carried out in mitral stenosis (MS). Hence, it is crucial to determine exercise capacity before deciding on the time of intervention. The study aim was to demonstrate whether resting parameters of the mitral valve, notably left ventricular diastolic filling period (LVDFP) and mitral valve resistance (MVR), relate to restricted exercise capacity. METHODS: Forty-six patients (30 females, 16 males; mean age 44+/-11 years; range: 33-55 years) with rheumatic MS were enrolled. Exercise capacities of patients were grouped according to NYHA classification and maximal exercise tolerance values obtained using exercise testing. Exercise capacity in male patients was quantified. Relationships between patient variables and exercise capacity were evaluated using simple linear regression analysis. In order to identify determinants of exercise capacity, a discriminate multivariate analysis was performed with variables, which were found to correlate significantly in the univariate analysis. RESULTS: There were no correlations between echo score, MVR, planimetric mitral valve area (MVA), MVA obtained by the pressure half-time method or calculated by the continuity equation, and transmitral mean gradient and exercise capacity classes as defined by both NYHA and exercise testing. The only predictor of exercise capacity class determined by discriminate multivariate analysis using the significant parameters in the linear regression analysis was LVDFP. The quantified exercise capacity in male patients correlated only with LVDFP (r = 0.64, p = 0.008). CONCLUSION: Exercise capacity cannot be predicted using routine resting parameters of the mitral valve (including MVR) in patients with MS. In this respect, the LVDFP may be of value.

Adult↗
PubMed2003

Cardiac angiosarcoma: an unusual presentation simulating mitral stenosis and constrictive-effusive pericarditis.

This case report details a patient with a cardiac angiosarcoma who had an unusual presentation with hemodynamics consistent with mitral stenosis and constrictive-effusive pericarditis. It illustrates how transesophageal echocardiography adds to the information obtained from transthoracic imaging and hemodynamics in this unusual presentation of a cardiac tumor.

Echocardiography, Transesophageal↗
PubMed1996

Constrictive pericarditis causing extrinsic mitral stenosis and a left heart mass.

Constrictive pericarditis is a fibrotic process involving both layers of the pericardium and is known to give rise to obstruction to blood flow in the right heart. We report a patient with constrictive pericarditis who had echocardiographic features of mitral stenosis caused by a fibrocalcific mass lesion involving the mitral annulus with infiltration into the base of the posterior mitral leaflet. To our knowledge, this has not been reported in the literature.

Biopsy, Needle↗
PubMed2005

N-terminal proBNP plasma levels correlate with severity of mitral stenosis.

BACKGROUND AND AIM OF THE STUDY: Brain natriuretic peptide (BNP), a neurohormone, is secreted predominantly from the ventricular myocardium. Studies investigating BNP secretion in diseases affecting the right side of the heart are scarce. The relationship between N-terminal proBNP (NT-proBNP) and echocardiographic and clinical findings was studied in cases with isolated moderate to severe rheumatic mitral stenosis (MS), and in patients with previous mitral valve replacement (MVR). METHODS: Thirty-two patients with MS (mean age 41.2 +/- 5.7 years), 20 with MVR (mean age 46.0 +/- 4.6 years) and 30 healthy individuals (mean age 40.3 +/- 4.9 years) were included in the study. In addition to NT-proBNP measurements, detailed transthoracic echocardiography was performed in all patients and healthy subjects. RESULTS: Plasma levels of NT-proBNP were significantly higher in patients with MS than in those with MVR or in controls (99.8 +/- 12.7 versus 74.7 +/- 6.9 and 48.5 +/- 10.5 pg/ml, respectively; p <0.0001 all groups). NT-proBNP levels showed a significantly greater increase in severe MS than in moderate MS (109.8 +/- 5.6 versus 88.3 +/- 7.6 pg/ml, p <0.0001). NT-proBNP levels also were higher in MVR patients than in controls (74.7 +/- 6.9 versus 48.5 +/- 10.5 pg/ml; p <0.0001). Although NT-proBNP levels did not correlate with left ventricular ejection fraction (LVEF) in patients with MS (r = -0.33; p >0.05), there was a positive correlation with pulmonary artery pressure (r = 0.87; p <0.001) and a negative correlation with mitral valve area (MVA) (r = -0.89; p <0.0001). However, multivariate analysis identified only MVA as an independent correlate of NT-proBNP (beta = -0.47; p = 0.02). CONCLUSION: In patients with rheumatic MS, NT-proBNP levels correlated positively with MS severity. Moreover, NT-proBNP levels increased significantly in patients with MS, but were significantly lower in those who underwent MVR.

Adult↗
PubMed1991

Value and limitations of Doppler pressure half-time in quantifying mitral stenosis: a comparison with micromanometer catheter recordings.

The purpose of this study was to compare the Doppler and catheterization pressure half-time methods of estimating mitral valve area with valve areas obtained by the Gorlin equation in a group of patients with clinically significant mitral stenosis. Data were analyzed from 67 consecutive patients who were undergoing continuous-wave Doppler examination and catheterization with micromanometer catheters. Doppler pressure half-time was calculated as the interval between peak transmitral velocity and velocity divided by the square root of 2, as measured from the outer border of the spectral envelope. Doppler mitral valve area (MVA) was obtained with the equation: MVA = 220 divided by pressure half-time. For catheterization data, the pressure half-time was measured directly from simultaneously recorded left ventricular and left atrial pressure (18 patients) or pulmonary capillary wedge pressure (49 patients). The catheterization half-time was taken as the time required for the peak pressure gradient to fall to one half of the initial value. Calculations of the mitral valve area at catheterization were obtained by the Gorlin equation with pressure gradient and cardiac output determinations. Mitral valve area as determined by the Gorlin equation for all cases ranged from 0.4 to 2.0 (mean = 1.03 +/- 0.37) cm2. Linear regression analysis that compared cardiac catheterization and Doppler half-times yielded r = 0.68. For the subgroup of patients with sinus rhythm, the correlation improved to r = 0.76.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Fibrillation↗
PubMed2001

Anomalous coronary artery origin associated with bicuspid aortic valve in a patient with rheumatic mitral stenosis: a case report.

A rare case of an anomalous left coronary artery arising from the right sinus of Valsalva associated with bicuspid aortic valve is presented. This case is unique because these congenital anomalies were associated with rheumatic mitral stenosis. This anomalous coronary origin was found at catheterization before balloon mitral valvuloplasty. The clinical significance of this finding is discussed.

Aortic Valve↗
PubMed2001

Successful inoue balloon valvotomy in a difficult case of mitral stenosis using multiple modifications of technique: alternative method for loop formation of the Inoue balloon catheter.

Transseptal puncture was accomplished with difficulty at an unfavorable site in a case of severe mitral stenosis with distorted atrial and septal anatomy. Septal balloon entrapment could not be avoided during attempts to cross the mitral valve using the standard technique. This problem was circumvented by resorting to the loop method and the left ventricle was entered first with a guidewire, which then supported the balloon catheter. Successful mitral valve dilatation could thus be performed. A simple alternative method that was used to form the Inoue balloon catheter into a loop is also described.

Adult↗
PubMed1987

Mitral stenosis with free-floating left atrial thrombus and recurrent systemic embolisation. A case report.

A 64-year-old white woman with moderately severe rheumatic mitral stenosis complicated by atrial fibrillation and recurrent systemic embolisation to the brain was found at operation to have a large 'free-floating' left atrial thrombus, as well as multiple left atrial appendage thrombi. These had not been detected by echocardiography. She also had significantly reduced left ventricular contractility on cine angiography, and right coronary artery atherosclerosis. She underwent successful mitral valve replacement and excision of the left atrial appendage.

Atrial Fibrillation↗
PubMed1998

[Cerebral embolism due to left atrial ball thrombus without mitral stenosis--usefulness of the transesophageal echocardiography for the diagnosis].

We reported two cases of cerebral embolism associated with atrial fibrillation. Left atrial ball thrombus without mitral stenosis was diagnosed by the transesophageal echocardiography, followed by successful removal. Left atrial ball thrombus has a risk for lethal complications, and a high incidence of systemic embolism even during anticoagulation therapy. An immediate surgical treatment is needed. The transthoracic echocardiography is not useful in diagnosis for left atrial ball thrombus. It is important to examine left atrial ball thrombus by the transesophageal echocardiography in patients with cerebral embolism associated with atrial fibrillation.

Atrial Fibrillation↗
PubMed1976

[Lowering of pulmonary-arterial pressure with nitroprusside in mitral stenosis and cor pulmonale (author's transl)].

Nitroprusside was infused intravenously (20, 40, 80 and 200 mug/min) in nine patients with pulmonary hypertension due to mitral stenosis (group I), nine with precapillary pulmonary hypertension associated with primary lung disease (group II) and nine with normal pulmonary-arterial pressures (group III). The mean pulmonary-arterial pressure was markedly reduced at a rate of 20 mug/min in group I and II, while higher doses were necessary in group III to produce a similar effect. Mean arterial pressure was decreased in all three groups and was dose-related. Heart rate rose, stroke volume fell during nitroprusside administration, while cardiac output remained unchanged. Pulmonary vascular resistance was reduced on 20 mug/min in group I, but only on 200 mug/min or more in group II, and unchanged at all dosages in group III. Peripheral vascular resistance declined in all three groups on nitroprusside infusion, which is apparently of value in the short-term lowering of pulmonary hypertension.

Blood Pressure↗