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At least 1,441 records · Page 80Linked to original sources
PubMed1988

[Comparison of continuous wave Doppler and heart catheterization in the determination of the mean transvalvular gradient in mitral stenosis. A simultaneous beat to beat analysis].

Continuous wave Doppler echocardiography (CWD) is widely used in the assessment of pressure gradients in patients with valvular heart disease, utilizing the simplified Bernoulli equation. However determination of non-simultaneous mean pressure gradient (MG) in mitral stenosis (MS) from CWD recordings has often been described as being unsatisfactory. Therefore, the purpose of this study was to compare the estimates of trans-mitral MG derived from CWD with gradients measured simultaneously at cardiac catheterization (beat to beat analysis). We studied 3 patients (pts) with MS (1 man and 2 women, aged 55, 55 and 62 years respectively); one patient (pt) was in sinus rhythm and 2 were in atrial fibrillation. In each pt the trans-mitral flow velocity curve was obtained simultaneously with trans-mitral gradient measured directly at cardiac catheterization (cath). In this way it was possible to obtain a beat to beat correlation between Doppler and cath in 181 beats taken from the 3 pts. These beats were selected from a total number of 321 beats because of their excellent quality for analysis (74 beats were obtained from the first pt, 38 from the second pt and 69 from the third pt). Mean diastolic velocity, defined as the mean of maximal velocities throughout diastole, was obtained for each beat by planimetring the envelope of the spectral velocity profile. MG was calculated from mean velocity by applying the simplified Bernoulli equation (delta P = 4V2).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Catheterization↗
PubMed1991

[Percutaneous balloon valvuloplasty in mitral stenosis].

Between June 1986 and June 1989, percutaneous balloon valvuloplasty (PBV), using the transseptal, single-balloon technique, was performed in 50 consecutive patients (38 women and 12 men; mean age 54 +/- 14 years) with mitral stenosis. The procedure was technically successful in 48 patients (in one patient the atrial septum could not be crossed, in the other cardiac tamponade occurred). The mean diastolic gradient was decreased from 12.5 +/- 6.6 to 6.1 +/- 3.1 mmHg, mean pulmonary artery pressure (PAP) reduced from 29 +/- 12 to 22 +/- 6 mmHg, and valve opening area increased from 1.0 +/- 0.25 to 1.6 +/- 0.4 cm2. Redilatation had to be undertaken in four patients because of restenosis. Commissurotomy had to be performed in one patient, valve replacement in nine (restenosis in 4, poor primary results in 3, increase in regurgitation in 2). One patient died of a noncardiac cause. Follow-up observations for an average of 14 (3-36) months indicated in 30 of the remaining 33 patients without additional intervention a stable clinical improvement of at least one class (NYHA classification), as well as stable haemodynamic findings (gradient: 6.0 +/- 2.7 mmHg, valve opening area 1.5 +/- 0.3 cm, PAP 23 +/- 7 mmHg. Thus PBV achieved, at least in the medium term, clinical improvement in about two thirds of patients, and an operation was avoided.

Adolescent↗
PubMed2006

Prediction of subclinical left ventricular dysfunction with strain rate imaging in patients with mild to moderate rheumatic mitral stenosis.

BACKGROUND: Left ventricular (LV) long-axis function evaluated by Doppler tissue echocardiography-derived strain rate (SR) imaging has been shown to be a useful index of LV systolic function; however, it has not been evaluated in patients with mitral stenosis (MS). We examined the LV long-axis function of patients with pure MS and normal global systolic function as assessed by LV ejection fraction. METHOD: In all, 30 patients (22 women; 45 +/- 9 years) with mild to moderate MS (mitral valve area = 1.5 +/- 0.3 cm2) and 28 healthy volunteers (20 women; 44 +/- 10 years) were evaluated by both conventional and Doppler tissue echocardiography. Two-dimensional Doppler tissue echocardiography was performed in the apical 4-chamber view in the septal and lateral wall on the mitral annular level. Peak systolic myocardial SR and end-systolic strain data were measured for both segments. RESULTS: Peak systolic SR (1.2 +/- 0.4% vs 1.8 +/- 0.39%, P < .001) and end-systolic strain (10 +/- 5 vs 25 +/- 6 s(-1), P < .001) were both significantly lower in patients with MS than in control subjects. CONCLUSIONS: Patients with MS had significantly impaired long-axis function evaluated by Doppler tissue echocardiography-derived SR imaging despite normal global systolic function.

Adult↗
PubMed1984

[Mechanism of an early diastolic posterior motion of the interventricular septum in patients with mitral stenosis: with special reference to left ventricular inflow velocity pattern].

The mechanism of an early diastolic posterior motion of the interventricular septum (IVS) was investigated by means of M-mode, two-dimensional and pulsed Doppler echocardiographies in 53 patients with pure mitral stenosis (MS). Velocity patterns of the blood flow at the inflow tract of the left ventricle (LVIT) were classified into three types as previously reported (cf. Fig.3). The results obtained were as follows: The mitral valve orifice area (MVA) was significantly smaller in patients with type III of the LVIT flow velocity pattern than in patients with type I (p less than 0.001). An amplitude ("a") of the posterior IVS motion in systole (P1) was significantly diminished in type III (4.2 +/- 1.1 mm) than in type I (6.6 +/- 1.5 mm) (p less than 0.001). An amplitude ("b") of the posterior IVS motion in early diastole (P3) showed a significant increase in type III (7.5 +/- 1.2 mm) than in type I (5.2 +/- 1.5 mm) (p less than 0.001). Difference of the amplitude between P1 and P3 ("a-b") was significantly greater in type III (-3.4 +/- 1.1 mm) than in type I (1.4 +/- 0.9 mm) (p less than 0.0001). MVA was correlated statistically with "a" (r = 0.58, p less than 0.001), "b" (r = -0.38, p less than 0.01) and "a-b" (r = 0.80, p less than 0.0001). Deformity of the left ventricular cavity due to the flattened IVS in early diastole was observed in severe MS with an augmented septal P3 dip. A case of severe MS with type III velocity pattern and an augmented P3 dip showed type II velocity pattern and a decreased P3 dip after the attack of acute myocardial infarction. These findings suggested a close relationship between type III of the LVIT flow velocity pattern and the prominent septal P3 dip. The importance of diastolic suction of the left ventricle in producing an early diastolic posterior motion of IVS (P3) was discussed.

Biomechanical Phenomena↗
PubMed2006

Angiographic detection of the left anterior descending and the right coronary artery after fistulas into the pulmonary artery in a patient with rheumatic mitral stenosis.

Coronary artery fistula is a rare heart defect found in approximately 0.2% of the adult population undergoing coronary angiography. The diagnosis is usually made by aortography and selective coronary angiography. We report here an adult patient with rheumatic mitral stenosis and left anterior descending coronary artery and pulmonary conus branch of right coronary artery-pulmonary artery fistulas detected by coronary angiography.

Arterio-Arterial Fistula↗
PubMed1985

Hemodynamic effects of digoxin on congestive heart failure in old myocardial infarction, dilated cardiomyopathy, acute myocardial infarction and mitral stenosis.

The hemodynamic effects of digoxin (0.01 mg/Kg) on congestive heart failure were compared in 32 patients with old myocardial infarction (OMI) (n = 9), dilated cardiomyopathy (DCM) (n = 10), acute myocardial infarction (AMI) (n = 5) and mitral stenosis (MS) (n = 8). The responses of heart rate (HR) and pulmonary capillary pressure (PCP) to digoxin in OMI, DCM and MS were marked but different in each of these groups and no significant changes were found in patients with AMI. The responses of cardiac index (CI) to digoxin in patients with OMI and DCM in whom left ventricular myocardial contractile force was impaired were divided into 2 groups (Group 1: CI increased more than 15% and Group 2: less than 15%). In Group 1, both CI and percent fractional shortening (%FS) before digoxin administration were lower than in Group 2, i.e., 1.97 +/- 0.27 vs 2.80 +/- 0.48 L/min/m2 (p less than 0.001) and 10.9 +/- 8.0 vs 19.5 +/- 11.9% (p less than 0.05), respectively. In MS, CI increased after digoxin administration only in the 2 patients with low CI and rapid HR in the control state. These results indicate that the mode of hemodynamic response to digoxin is considerably different in various diseases. They further suggest that digoxin should not be used in the early phase of AMI, although digoxin was of great clinical benefit in patients with OMI and DCM through such mechanisms as its positive inotropic and negative chronotropic effects and lowering of PCP.

Adult↗
PubMed1983

[Diagnostic importance of radionuclide scintigraphy of the lungs in mitral stenosis].

The author shows close correlation between the degree of regional redistribution of the pulmonary blood flow using the radionuclide scintigraphy data and a mean pressure value in the left auricle and pulmonary artery in patients with mitral stenosis. In the course of disease development the index of upward-downward blood flow redistribution and the value of mean pressure in the pulmonary artery showed an increasing degree of correlation that indicated the development of the angiospastic component. A tendency to irregular growth of vascular resistance of the right and left lung was demonstrated. Blood flow deficiency in the right lung observed in these patients that depended on the degree of blood pressure elevation in the pulmonary artery, pointed to the predominant growth of right lung resistance.

Adolescent↗
PubMed1987

Application of Doppler flow mapping in assessing the severity of mitral stenosis.

The purpose of the flow mapping procedure is to pick up flow signals related to jets at the site of lesions, in order to delineate the cross-section of the jets. The pulsed Doppler procedure was applied to a group of 33 consecutive patients with mitral stenosis confirmed invasively in all cases and by surgery in 15 cases. The examination involved the recording of flow signals at the distal edge of the mitral oriface investigated in the short-axis view. Doppler criteria for required flow signals were the presence of a high-pitched tone and of a laminar spectrum, occurring at a definite timing in early to mid-diastole, i.e. at the period of the maximal atrioventricular pressure gradient. Planimetry of the flow area was performed and correlated with haemodynamic data using the Gorlin formula. The procedure was applicable in 32/33 patients. The correlation coefficient was 0.94, standard error of estimate 0.13 cm2, P less than 0.001. The mean difference between invasive and non-invasive measurements was -0.04 +/- 0.14 cm2 and the standard error of the mean 0.03 cm2. This new application of flow mapping provided reliable information for the later surgical procedure. It should benefit in future from improvements in spatial resolution and in signal to noise ratio.

Humans↗
PubMed1990

Practical value of echo Doppler evaluation of aortic and mitral stenosis: a comparative study with cardiac catheterization.

This retrospective analysis compares data derived by echocardiography and cardiac catheterization in the evaluation of aortic and mitral valve stenosis. Sixty-seven patients, aged 69 +/- 12 years, underwent 76 catheterization procedures. In all studies the Doppler recording was technically adequate. In 64 studies of patients with aortic stenosis, correlation was good between the gradient obtained at catheterization (peak 51 +/- 28 mm Hg, mean 48 +/- 24 mm Hg) and the Doppler gradient (peak 73 +/- 29 mm Hg, mean 41 +/- 17 mm Hg) (R = 0.78 peak, 0.77 mean). In 15 studies the aortic valve area, 0.8 +/- 0.2 cm2, calculated by the simplified continuity equation, correlated well with the catheterization valve area, 0.7 +/- 0.3 cm2, calculated by the Gorlin equation (R = 0.80). In 14 studies in mitral stenosis patients, the mean gradient at catheterization was 11 +/- 5 mm Hg compared to the Doppler gradient of 8 +/- 4 mm Hg (R = 0.58). The mitral valve area was 1.1 +/- 0.3 cm2 by the Gorlin equation and 1.2 +/- 0.3 cm2 by echo Doppler, using pressure half-time. When cardiac rhythm, the presence and severity of regurgitation, and the cardiac index were analyzed, none was shown to have demonstrable influence on the accuracy of the Doppler study. Doppler echocardiography can be used reliably to assess valvular stenosis in a clinical, noninvasive laboratory where routine tests are performed and interpreted by more than one individual.

Aged↗
PubMedDate not supplied

Pulmonary venous velocity patterns in mitral stenosis.

Pulmonary venous (PV) velocities obtained by transthoracic echocardiography are used to assess diastolic function. The systolic/diastolic (S/D) PV velocity ratio is increased with impaired early diastolic filling and decreased with elevated mean left atrial pressure (LAP). Mitral stenosis (MS) is characterized by impaired filling and elevated LAP. We hypothesized that the S/D ratio would be increased in MS except in severe MS with high LAP, in which the S/D ratio would be decreased. Patients with isolated MS who underwent transthoracic echocardiography were studied. The PV S/D ratio was compared in mild (n = 18), moderate (n = 16), and severe (n = 7) MS. There was no characteristic PV pattern, with each category showing a wide range of S/D ratios (mild, S/D ratio = 1.42 +/- 0.56; moderate, S/D ratio = 1.19 +/- 0.59, and severe, S/D ratio = 1.33 +/- 0.53) (mean +/- SD). Furthermore, there was no relationship between the S/D ratio and any index of severity of MS. There is no characteristic PV velocity pattern in MS.

Atrial Function, Left↗
PubMedDate not supplied

Supravalvular mitral stenosis in a cat.

A 3-year-old, 4-kg, castrated male domestic shorthair cat presented with signs of progressive respiratory distress. Thoracic radiographs showed pulmonary edema and pleural effusion. Echocardiography revealed a perforate membrane immediately above the mitral valve that divided the left atrium into proximal and distal chambers. The left auricle was proximal to the dividing membrane and connected to the markedly enlarged proximal left atrial chamber, consistent with the diagnosis of supravalvular mitral stenosis (SMS). Position of the obstructing membrane relative to the left auricle distinguishes SMS from cor triatriatum sinister (CTS). In CTS, the left auricle is distal to the dividing membrane and connects to the distal left atrial chamber.

Animals↗
PubMed1988

New electrocardiographic criteria for diagnosing right ventricular hypertrophy in mitral stenosis--comparison with the Bonner's and Mortara's criteria.

New criteria for the diagnosis of right ventricular hypertrophy (RVH) using a point scoring system were developed after analyzing standard 12-lead ECGs in 155 patients with mitral stenosis verified by cardiac catheterization and 155 age and sex-matched apparently normal healthy subjects. ECGs were evaluated to identify criteria that provided maximum sensitivity and at least a 95% specificity: (1) the R wave magnitude in V1 had to be greater than 0.7 mV; (2) the S wave magnitude in V6 had to be greater than 0.3 mV; (3) the S wave magnitude in V1 less than 0.5 mV; (4) the R wave magnitude in V1 plus the S wave magnitude in V6 minus the S wave magnitude in V1 must be greater than 0 mV; and (5) the degree of frontal QRS axis had to be greater than 90 degrees. Application of these criteria achieved 25% (39 of 155) sensitivity in patients with RVH, significantly better (p less than 0.01) than the 17% sensitivity (17 of 155) of Bonner's criteria for the automated ECG. The specificity of the proposed criteria was 98% (152 of 155), significantly better (p less than 0.01) than the 90% specificity (139 of 155) of Mortara's criteria. Thus, it was evident that the accuracy of the proposed criteria was the highest among those criteria used in a point scoring system including the currently used automated ECG criteria for the diagnosis of RVH.

Cardiomegaly↗
PubMed1988

[Utility of digital perfusion images of the lung in mitral stenosis: the pathophysiological significance of the distribution of pulmonary perfusion].

The relationship between pulmonary hemodynamics (cardiac index; CI and the mean pulmonary artery wedge pressure; mPw) and the redistribution of pulmonary perfusion were studied in 300 patients with mitral stenosis using computerized Tc99m-MAA perfusion images (digital perfusion images: DPI), which consisted of isocount areas. Various types of DPI were obtained and were classified in six grades according to patterns of 100-70% of the isocount area in the right anterior DPI, i.e. grade-0 (normal), grade-1 (increased perfusion in the upper zone), grade-2 (uniform distribution), grade-3 (disappearance of the basal hyperperfusion area), grade-4 (apical hyperperfusion area) and grade-5 (decrease of perfusion at the lower zone). The mPw was thought to be one of the factors determining distribution. Thus, it was not adequate to estimate the mPw from DPI. In patients with the mPw less than 20 mmHg, an increase in perfusion at the upper zone and disappearance of the basal hyperperfusion might be noted, however, the mPw more than 20 mmHg was necessary to cause an apical hyperperfusion area. The predictive values of grades 0 and 1 for the mPw less than 20 mmHg were 70% (54/77) and those of grades 4 and 5 for the mPw less than 20 mmHg and the mPw less than 25 mmHg were 86% (110/128) and 56% (71/128), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗