Repeat operations for mitral stenosis.
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Humans↗
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Low dose synthetic human atrial natriuretic peptide infusion in a patient with mitral stenosis and severe pulmonary hypertension.
The present report concerns a case of very low plasma levels of atrial natriuretic peptide (ANP) accompanying severe pulmonary hypertension due to mitral stenosis. There was remarkable fibrosis in the atrium and ANP secretion may have been insufficient. Low-dose infusion (0.025 microg kg(-1) min(-1)) of synthetic human alpha-ANP infusion was very effective in improving the pulmonary hypertension.
Atrial Natriuretic Factor↗
[Use of exercise tests and echocardiography during long-term observation of patients with mitral stenosis and cardiac insufficiency].
Findings of echocardiography and bicycle exercise testing were considered objective hemodynamic criteria during long-term follow-up studies of patients with mitral stenosis and early stages of cardiac insufficiency. In patients with the first degree cardiac insufficiency the most sensitive parameters were: exercise tolerance, physical adaptation index and left atrial size. In patients with the second A degree cardiac insufficiency additional information has also been obtained upon studying the ejection fraction and the rate of left ventricular circular shortening.
Adult↗
Randomized comparison between Inoue balloon and metallic commissurotome in the treatment of rheumatic mitral stenosis: immediate results and 6-month and 3-year follow-up.
The metallic commissurotome (MC) technique is a cheaper alternative to the Inoue balloon (IB) technique for percutaneous mitral valvuloplasty (PMV). There are no randomized trials comparing these techniques with longer follow-up of the patients. The objective of this study was to compare the immediate results and short- and medium-term follow-up of PMV using either the IB or the MC technique. Fifty patients with rheumatic mitral stenosis were randomly assigned to PMV using the IB (n = 27) or the MC (n = 23) technique. There were no significant differences between the groups regarding baseline clinical, echocardiographic, and hemodynamic data. Clinical and echocardiographic follow-up were done 6 months and 3 years after the procedure. The success rate was 100% in the IB group and 91.3% in the MC group (P = 0.15); two patients in the latter group developed mitral regurgitation grade 3/4, requiring elective surgery. The mean final mitral valve area was bigger in the MC group (2.17 +/- 0.13 vs. 2.00 +/- 0.36 cm2; P = 0.04), but after 6-month and 3-year follow-up, this difference was no longer significant (2.06 +/- 0.27 vs. 1.98 +/- 0.38 cm2, P = 0.22, and 1.86 +/- 0.32 vs. 1.87 +/- 0.34 cm2, P = 0.89, respectively). This finding suggests valve stretching as an important mechanism of valve dilation with the MC. Three patients in the MC group and two patients in the IB group (P = 0.65) developed mitral valve restenosis; one of them underwent repeat PMV and the other four, all asymptomatic, were clinically followed. PMV performed either with the IB or the MC technique is effective and provides excellent short- and medium-term outcomes regardless of the technique employed.
Adolescent↗
[Changes in plasma TXB2 and 6-keto-PGF1 alpha and left atrial thrombosis in mitral stenosis].
This study was performed to determine the relationship between plasma concentration of thromboxane B2 (TXB2), 6-keto-prostaglandin F1a and atrial thrombosis in patients with mitral stenosis (MS). By radioimmunoassay and pathological examination, peripheral plasma TXB2 level was remarkably higher in patients with MS and persistent atrial fibrillation (AF) than in patients with MS but without AF (P less than 0.01). Plasma TXB2 level was significantly higher in patients with than in those without atrial thrombosis (P less than 0.05). There was no significant difference in plasma 6-keto-PGF1 alpha, plasma prostanoids level in peripheral venous blood correlated closely with that in left atrial blood. Patients with high plasma TXB2 level had a greater incidence of microthrombosis.
6-Ketoprostaglandin F1 alpha↗
Pulmonary capillary wedge pressure in mitral stenosis accurately reflects mean left atrial pressure but overestimates transmitral gradient.
Current opinion varies as to whether pulmonary capillary wedge pressure assessment of transmitral gradient in mitral stenosis is accurate; we therefore compared transmitral gradient in 36 patients awaiting balloon valvuloplasty using both pulmonary capillary wedge pressure and direct left atrial pressure. Mean pulmonary capillary wedge pressure correlated well with mean left atrial pressure (limits of agreement -1.5 to +3.7 mm Hg), but mean diastolic mitral gradient calculated using pulmonary capillary wedge pressure differed significantly from that calculated using left atrial pressure (limits of agreement -1.2 to +9.8 mm Hg): wedge pressure-assessed transmitral gradient is therefore misleading, routinely overestimating stenosis severity.
Blood Pressure↗
A coconut left atrium 23 years after mitral valve replacement for chronic mitral stenosis.
We present the case of a 65 year-old female who was admitted to the hospital because of deterioration of chronic dyspnea. Twenty-three years prior to this admission, mitral valve replacement for chronic mitral stenosis was performed using a Starr-Edwards caged-ball prosthesis. There was severe pulmonary hypertension. On transthoracic echocardiography and on cineradiography, the function of the mitral valve prosthesis was unimpaired. However, cineradiography showed extensive mural calcification of the left atrium; we report this remarkable finding.
Aged↗
Comparison of left coronary and laevo-phase pulmonary angiograms in detecting left atrial thrombi in rheumatic mitral stenosis.
We have compared the diagnostic accuracy of left coronary and laevo-phase pulmonary angiograms in detecting left atrial thrombi in 27 consecutive patients with rheumatic mitral stenosis who underwent both these procedures prior to open-heart surgery. In 10 patients, both procedures were 'positive' for thrombus, confirmed at subsequent surgery in all instances (true positive). Both procedures were negative for thrombus in 11 patients, and none of these patients showed thrombi at subsequent surgery (true negative). Left coronary angiography only was positive for thrombus in one patient in whom no thrombus was found at surgery. Laevo-phase pulmonary angiography only was positive for thrombus in five patients, two of whom had thrombus at subsequent surgery. The sensitivity, specificity and predictive accuracy of left coronary angiogram were 83.3% and 93.3% and 90.9% and that of laevo-phase pulmonary angiogram 100%, 80% and 80% respectively. Laevo-phase pulmonary angiograms showed higher sensitivity and left coronary angiograms showed higher specificity for angiographic diagnosis. However, the differences were found to be statistically insignificant. Angiography is a reliable method for detecting left atrial thrombi if both left coronary and pulmonary angiograms are performed and both procedures are positive or negative for thrombus.
Adolescent↗
[Evaluation of commissurotomy in mitral stenosis; oximetrically controlled studies of performance before & after operative dilation of mitral orifice].
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Blood↗
Identification of electrocardiographic criteria for diagnosis of right ventricular hypertrophy due to mitral stenosis.
Current electrocardiographic (ECG) criteria for diagnosing right ventricular hypertrophy (RVH) have low sensitivity. In this study maximally specific and sensitive ECG criteria for RVH due to mitral stenosis (MS) were developed that incorporated the principles derived from spatial changes in the QRS complex observed on the vectorcardiogram and any existent ECG criteria that supplement the diagnostic capability of the criteria derived from the vectorcardiogram. The standard 12-lead electrocardiograms of a control group of 500 consecutively selected subjects with 50 women and 50 men in each decade between ages 20 and 69 years were compared with the electrocardiograms of a study population of 50 patients with RVH due to MS. Inclusion criteria were a diagnosis of MS by catheterization, normal coronary arteriographic and left ventriculographic findings and no other valvular abnormalities. It was hypothesized that patients with RVH resulting from MS would have QRS forces that are maximally anterior (A) and rightward (R) and minimally posterolateral (PL); thus, the A + R - PL value in the study group would be greater than that in the control group. The subsequently derived formula criterion (A + R - PL greater than or equal to 0.7 mV) and 2 additional criteria, R less than or equal to 0.2 mV in lead I and P less than 0.25 mV in leads II, III, aVF, V1 or V2, were tested in both groups. The specificity and sensitivity of each individual criterion was determined; when combined, the criteria yielded 94% specificity and 64% sensitivity. Moderate to severe RVH due to MS was detected in two-thirds of the patients using the proposed criteria.
Adult↗
[Pulmonary annuloplasty in functional pulmonary regurgitation associated with mitral stenosis: a case report].
In order to prevent disadvantage of pulmonary regurgitation (PR) on cardiac function, pulmonary annuloplasty (PAP) was performed in a 58-year-old female. She suffered from severe mitral stenosis with right heart failure, and was in a state of cardiac cachexia. She was associated with PR due to pulmonary annular dilatation secondary to severe pulmonary hypertension. She underwent mitral valve replacement, tricuspid annuloplasty and PAP around the pulmonary annulus using a Teflon tape. No PR was observed by postoperative angiograms, and the operative method was proved to be effective on the treatment for PR. The PAP is recommended for patients with functional PR secondary to severe pulmonary hypertension.
Female↗
Clinical and anatomic observations in patients having mitral valve replacement for mitral stenosis and simultaneous tricuspid valve replacement.
Certain clinical and morphologic findings are described in 67 patients (aged 23 to 76 years [mean 52]; 55 women [82%]) who had mitral valve replacement for mitral stenosis (with or without associated regurgitation), and simultaneous tricuspid valve replacement for pure tricuspid regurgitation (58 patients) or tricuspid stenosis (all with associated regurgitation; 9 patients). Of the 58 patients with pure tricuspid regurgitation, 21 had anatomically normal and 37 had anatomically abnormal (diffusely fibrotic leaflets) tricuspid valves. Among these 58 patients, no clinical or hemodynamic variable was useful before surgery in distinguishing the group without from that with anatomically abnormal tricuspid valves. All 9 patients with stenotic tricuspid valves had anatomically abnormal tricuspid valves. The latter group had a lower average right ventricular systolic pressure (tricuspid valve closing pressure) than those with pure tricuspid regurgitation, and none had severe pulmonary arterial hypertension (present in 20 [30%] of the 58 patients with pure tricuspid regurgitation).
Adult↗
Changes in P-wave after percutaneous mitral valvuloplasty in patients with mitral stenosis and left atrial enlargement.
OBJECTIVE: To investigate potential clinical, echocardiographic and/or hemodynamic predictors of the regression of electrocardiographic (ECG) signs of left atrial enlargement (LAE) after successful percutaneous mitral valvuloplasty (PMV). METHODS: We studied 24 patients (75% female, mean age =37.1 +/- 11.9 years) with moderate to severe mitral stenosis (MS), sinus rhythm (SR) and ECG signs of LAE who underwent successful PMV between 2002 and 2004. At least 6 months after the procedure (388.2 +/- 192.9 days), the patients returned for clinical, ECG and echocardiographic follow-up. They were then divided in 2 groups: patients of group 1 (n = 8; 33.3%) still had ECG signs of LAE, and patients of group 2 (n = 16; 66.6%), had normal P wave. A multivariate analysis of clinical, ECG, echocardiographic and hemodynamic variables was performed. RESULTS: The mitral valve area (MVA) increased from 1.12 +/- 0.15 cm2 to 1.9 +/- 0.35 cm2 immediately after the procedure (p < 0.0001) and decreased to 1.89 +/- 0.41 cm2 at follow-up (p = NS). Left atrium diameter decreased from 48 +/- 2.9 mm pre-procedure to 43 +/- 4.8 mm at follow-up (p = 0.0001). P-wave duration decreased from 0.12 +/- 0.01 sec pre-PMV to 0.09 +/- 0.02 sec at follow-up (p = 0.0001). An MVA > or = 1.7 cm2 at follow-up was the only independent predictor of a normal P-wave after PMV (p=0.02). CONCLUSION: ECG changes suggestive of LAE regress in the majority of patients with MS and sinus rhythm that undergo a successful PMV. An MVA > or = 1.7 cm2 at late follow-up was found to be an independent predictor of such normalization.
Adult↗
Rapid fall in elevated plasma atrial natriuretic peptide levels after successful catheter balloon valvuloplasty of mitral stenosis.
To determine whether an acute fall in atrial pressure decreases the secretion of atrial natriuretic peptide in man, changes in the plasma levels of this peptide were studied after catheter balloon valvuloplasty of the mitral valve. Ten patients with severe mitral stenosis were included in the study. The valvuloplasty resulted in an immediate reduction in left atrial pressure and an increase in the mitral valve area. Decreases in right atrial pressure were inconsistent and less significant. Plasma atrial natriuretic peptide levels, which were elevated before the valvuloplasty, decreased significantly in all 10 patients at 15 minutes after the valvuloplasty and reached lower plateaus at 30, 45, and 60 minutes after the procedure. In the seven patients studied for a longer period, both plasma atrial natriuretic peptide levels and the left atrial pressure remained reduced 24 hours after the valvuloplasty. Plasma atrial natriuretic peptide levels before and 30 to 60 minutes after the valvuloplasty were positively correlated to simultaneously determined left and right atrial pressures. These results indicate that atrial stretch caused by increased atrial pressure is an important stimulus for atrial natriuretic peptide release in man. "De-stretching" of the myocytes of the atria results in rapid inhibition of atrial natriuretic peptide secretion.
Adult↗
Impact of effective valvotomy in mitral stenosis on pulmonary venous flow pattern.
AIMS: Transesophageal Doppler echocardiography (TEE) is a useful tool to investigate pulmonary venous flow (PVF) velocity, which is altered in patients with mitral stenosis (MS). This study used TEE to analyze the variations in the PVF pattern after successful valvar dilatation in MS patients. METHODS/RESULTS: A total of 15 MS patients, mean age 27.2 years, underwent effective percutaneous balloon valvotomy (PBV). All were submitted to TEE before and after PBV. TEE assessed systolic (SPFV) and diastolic (DPFV) peak flow velocities and their ratio (SPFV/DPFV), time-velocity integrals (STVI and DTVI) and their ratio, and diastolic flow deceleration (DFD). Valvotomy yielded statistically significant increases (P < or = 0.05) in the SPFV: increase on average by 67% and STVI by 120%, as well as in the diastolic component: increased on average by 35%, DTVI by 33%, and DFD by 75%. CONCLUSION: TEE demonstrated that PBV induced a global increase in velocities of PVF, probably related to improvement of left atrial emptying.
Adolescent↗
[Change of right ventricle performance caused by intravenous nitroglycerin infusion in patients with isolated mitral stenosis].
The impact of intravenous infusion of nitroglycerin (NTG) on the conditions of the right ventricle (RV) load was assessed in a group of 27 patients with isolated mitral stenosis (SM). Swan-Ganz catheter was used to assess the parameters influencing preload and afterload of the RV at rest and during effort of its performance under NTG. NTG infusion caused lowering of RV filling pressure at rest (from 5.1 +/- 2.8 to 3.2 +/- 1.9 mm Hg, p < 0.001), and during effort (from 7.6 +/- 3.6 to 4.9 +/- 2.2 mg Hg, p < 0.001), lowering of mean pulmonary artery pressure at rest (from 27 +/- 10.7 to 19.8 +/- 9.2 mm Hg, p < 0.001) and during effort (from 48.6 +/- 15.5 to 39.4 +/- 16.1 mm Hg, p < 0.001), and lowering of capillary wedge pressure at rest (from 17.1 +/- 6.9 to 12.7 +/- 6.2 mm Hg, p < 0.001) and during effort (from 32.9 +/- 10.1 to 25.9 +/- 8.4 mm Hg, p < 0.001). NTG infusion lowers pulmonary vascular resistance at rest (from 2.5 +/- 1.6 to 1.9 +/- 1.5 W.u., p < 0.001) and during effort (from 2.9 +/- 2.0 to 2.4 +/- 1.9 W.u., p < 0.001). NTG causes beneficial lowering of the stroke work index of the RV at rest (from the average of 9.9 +/- 5.3 to the average of 6.4 +/- 3.9 pm/m2, p < 0.001) and during effort (from the average of 19.1 +/- 9.1 to the average of 15.7 +/- 9.0 pm/m2, p < 0.001). Beneficial hemodynamic effect of NTG on preload and afterload of the RV in patients with isolated SM was demonstrated.
Adult↗
Transesophageal echocardiographic recognition of infiltrative cardiac sarcoma mimicking mitral stenosis.
Primary cardiac sarcomas are very rare. Infiltrative cardiac tumors may be difficult to diagnose by transthoracic echocardiography (TTE) only. Herein, we report a case of primary unclassified cardiac sarcoma with clinical and echocardiographic manifestations of mitral stenosis (MS). The tumor was not identified by TTE preoperatively because of its diffuse infiltration of the left atrial wall and both mitral leaflets without protruding mass, and was only discovered by intraoperative transesophageal echocardiography (TEE). This report alerts clinicians that TEE is a necessary adjunctive tool to facilitate the correct diagnosis in patients with obscure etiologies of mitral valve diseases especially when they will receive surgical intervention.
Aged↗
Doppler color flow imaging: a new technique for visualization and characterization of the blood flow jet in mitral stenosis.
We used Doppler color flow imaging, a new noninvasive technique for mapping of intracardiac blood flow, to visualize and characterize the blood flow jet in 42 patients with mitral stenosis. Color flow imaging provides information about the direction of blood flow, its velocity, and the presence of turbulence. Although we found various jet configurations, most frequently the jet was centrally and apically directed and had a "candle flame" appearance (a central blue zone surrounded by hues of yellow and orange). The blood flow jet can be used to guide the positioning of the continuous-wave Doppler beam parallel to the blood flow; thus, the accuracy of the Doppler data can be enhanced. This new technology has promising potential for other clinical applications in cardiology.
Adult↗