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PubMed1987

[Noninvasive assessment of the function of the lesser circulation and of the right heart in mitral stenosis].

Functional status of the pulmonary circulation network and the right compartments of the heart was assessed by two-dimensional Doppler echocardiography at rest and under isometric stress (handgrip with both hands) in 36 patients with varying degrees of mitral stenosis. An early stage of the condition is characterized by hyper-reactivity of the pulmonary circulation vessels as well as intact right-ventricular contractility. Hypertensive response of the pulmonary circulation vessels in combination with inadequately small increase in right-ventricular contractility are suggestive of an early stage of right-ventricular heart failure.

Adolescent↗
PubMed1975

Coronary artery to left atrial fistula in association with severe atherosclerosis and mitral stenosis: report of surgical repair.

Not uncommonly, atherosclerosis may be found associated with rheumatic heart disease. The combination of atherosclerosis, rheumatic heart disease and coronary fistula is an unusual combination of hemodynamic and disease states. We report a patient with advanced mitral stenosis and atherosclerosis who also had a fistula from the left coronary artery into the left atrium. Surgical approach: combined valve replacement, bypass grafting and closure of the fistula in an attempt to relieve the pathophysiologic abnormalities.

Aged↗
PubMed1992

The transesophageal echocardiographic diagnosis of left atrial myxoma simulating a left atrial thrombus in the setting of mitral stenosis.

We report a case of left atrial myxoma simulating a thrombus on transthoracic echocardiography, but correctly diagnosed using transesophageal echocardiography. As this tumor is usually fatal unless surgically resected, a correct diagnosis is essential. Myxomas which do not prolapse between the mitral valve leaflets and coexist with mitral stenosis may be difficult to diagnose accurately using transthoracic echocardiography. The advantages of transesophageal compared with transthoracic echocardiography in the diagnosis of nonclassical left atrial myxoma are discussed.

Aged↗
PubMed1997

Calculation of mitral valve area in mitral stenosis using the proximal isovelocity surface area method. Comparison with two-dimensional planimetry and Doppler pressure half time method.

Two-dimensional echocardiographic (2-D) planimetry and the Doppler pressure half-time (PHT) method have been used to estimate mitral valve area (MVA) in patients with mitral stenosis (MS). Recently, the proximal isovelocity surface area (PISA) method has been shown to be accurate for calculating MVA. The purpose of this study was to compare the PISA method with previous methods. Thirty patients with MS were studied; 17 had pure MS, 4 combined mild MR, 6 combined mild AR, and 3 combined MR and AR. Color Doppler flow mapping was performed at an aliasing (blue-red interface) velocity of 14 cm/sec using the zero-baseline shift. MVA was calculated as 2 x 3.14 x R2 x 14 x (theta/180) / PFV, where R is the distance from aliasing to orifice, 14 is the aliasing velocity, theta is the internal angle of the mitral valve, and PFV is the peak flow velocity at the mitral orifice. MVA was also calculated using the 2-D and PHT methods, and compared with the PISA method. MVA calculated using the PISA method correlated well with the 2-D (r=0.90, p < 0.01, SEE = 0.18 cm2) and PHT methods (r=0.82, p < 0.01, SEE = 0.24 cm2). Compared with the 2-D method, the standard error of the estimate of the PISA method was - 0.14+/-0.18 cm2 and the percent error was -10.4+/-18.9%. Compared with the PHT method, the standard error of the estimate of the PISA method was + 0.01+/-0.24 cm2 and the percent error was +3.4+/-34.6%. MVA calculated using the PISA method correlated well with the 2-D and PHT methods in patients with pure MS or with MS combined mild regurgitation. The PISA method may be useful for calculating MVA as an alternative method.

Adult↗
PubMedDate not supplied

Double outlet right ventricle with calcified rheumatic mitral stenosis.

A 21-year old female patient diagnosed to have double outlet right ventricle, ventricular septal defect, pulmonic stenosis and right-to-left shunt on cardiac catheterisation in childhood, presented with a recent onset right sided hemiparesis and congestive heart failure. Investigative data revealed atrial fibrillation, severe calcific mitral stenosis and multiple left atrial thrombi in addition to the previously reported findings. The diagnosis was confirmed by cross-sectional and colour Doppler echocardiography.

Adult↗
PubMed1989

[Free thrombus in the left atrium associated with mitral stenosis. Diagnostic and therapeutic aspects. Apropos of a case].

A patient with a history of transient cerebral ischemic episodes had two-dimensional echocardiographic findings consistent with mitral stenosis associated with a spherical free-floating left atrial thrombus. The patient was operated on in the next few days, performing a mitral commissurotomy, and the left atrial thrombus was removed, without intra- or postoperative complications. The patient was discharged from the hospital on an antiplatelet drug regimen. Free-floating left atrial thrombi are a very rare finding with an easy echocardiographic diagnosis. Prompt surgical treatment is mandatory because the risk of systemic embolization and sudden death are inherent in this entity.

Echocardiography↗
PubMed1992

[Validity of the proximal isovelocity surface area color Doppler method for calculating the valve area in patients with mitral stenosis; comparison with the two-dimensional echocardiographic method].

BACKGROUND: The proximal isovelocity surface area (PISA) method, assessed by color Doppler echocardiography, has gained acceptance as a means of calculating flow rate through regurgitant orifice. The method can also be used to derive mitral valve area (MVA), by continuity equation, in patients with mitral stenosis (MS). The aim of this study was to compare the PISA method with the two-dimensional echocardiographic planimetry (2D) method and pressure half-time method (PHT) in MVA calculations in a group of 37 patients with MS. METHODS AND RESULTS: All of these patients had satisfactory MVA by 2D method. There were 22 female and 15 male; age 56 +/- 11 years (range 32-71); 19 were in sinus rhythm (SR) and 18 in atrial fibrillation (AF); 17 patients had pure MS, while the remaining 20 had associated mitral regurgitation (MR); in 23 patients the orifice morphology was circular or elliptic, and was defined as regular; while in 14 patients the morphology was irregular for the presence of two or more nodular calcifications on the commissures or leaflet's edges. MVA by PISA method was calculated assuming a uniform radial flow convergence region along a hemispherical surface, according to the formula: MVA = 2 pi r2 Vn(1-cos theta)/Vmax; where r was the PISA radius measured in 2D from the first alias to the mitral leaflet's edge; Vn was the flow velocity at radial distance from the mitral orifice; Vmax was the peak transmitral velocity by CW Doppler; 1-cos theta was a factor that accounted for the inflow angle formed by the mitral leaflets. The Nyquist limit was lowered to 29 cm/sec. Alpha angle formed by the mitral leaflets ranged between 86 degrees and 134 degrees; average 110 degrees +/- 10 degrees. 2D MVA was 1.33 +/- 0.37 cm2; range 0.69-2.2 cm2; PHT MVA was 1.29 +/- 0.34 cm2; range 0.70-2.1 cm2; PISA MVA was 1.18 +/- 0.36 cm2; range 0.47-1.95 cm2. The PISA method underestimates MVA by 0.15 +/- 0.21 cm2, in comparison with the 2D method; and by 0.11 +/- 0.18 cm2 in comparison with PHT method (p ns). The correlation between 2D and PISA MVA was: r = 0.84; p < 0.001; y = 0.83x + 0.06; 95% confidence intervals +/- 0.40 cm2; and between PHT and PISA MVA was: r = 0.79; y = 0.84x + 0.09; p < 0.001; 95% confidence intervals +/- 0.46 cm2. The correlation coefficient was similarly good in patients with SR or AF, and did not significantly change in patients with pure MS or MS+MR; neither did it vary with respect to the orifice morphology (p < 0.001 for all the variables considered), except for the correlation PHT-PISA in the group of patients with irregular orifice morphology (r = 0.70; p = 0.005). The interobserver and intraobserver variability were, respectively: 2.2% and 4.4% for 2D MVA; 3.4% and 3.8% for PHT MVA; 5.2% and 3.5% for the PISA radius; 6.1% and 4.4% for the alpha angle; 10.2% and 7.2% for PISA MVA (F ratio of variances ns). CONCLUSIONS: In conclusion, the PISA method allows accurate assessment of MVA in patients with MS, regardless of cardiac rhythm or additional MR. Moreover, our study suggests that orifice morphology does not affect the accuracy of this method.

Adult↗
PubMed2003

Left atrial platelet activity with rheumatic mitral stenosis: correlation study of severity and platelet P-selectin expression by flow cytometry.

BACKGROUND: Previous studies have demonstrated that platelet activation, evaluated by measuring the secretory substances of platelets (ie, platelet factor 4 and beta-thromboglobulin), occurs in the peripheral blood of patients with rheumatic mitral stenosis (MS). However, the differences in platelet activation between peripheral and atrial blood, and the relationship between regional left atrial platelet P-selectin expression and the severity of MS have never been investigated. METHODS AND RESULTS: A total of 16 patients with symptomatic MS undergoing percutaneous transluminal mitral valvuloplasty were studied (group 1). The fractions of platelets expressing P selectin in the prevalvuloplasty left atrial, right atrial, peripheral venous, and arterial blood were determined by flow cytometry. The mitral valve area was calculated by means of the Doppler pressure half-time method. Peripheral venous platelet activity also was evaluated in 23 control patients (including 15 healthy volunteers who were in sinus rhythm [group 2] and 8 patients who had chronic lone atrial fibrillation [group 3]). The fraction of peripheral venous platelets expressing P selectin among group 1 patients was significantly higher than that of group 2 or 3 patients (p = 0.008). In group 1 patients, the fraction of platelets expressing P selectin in the left atrium was significantly higher than that in the right atrium, the femoral vein, or the femoral artery (p < 0.01). Correlation analysis demonstrated that there was a significantly direct relationship between the severity of MS and the fraction of left atrial platelets expressing P selectin (p = 0.01; r = -0.620). The fraction of peripheral venous platelets expressing P selectin among group 2 patients did not differ from that of group 3 patients CONCLUSIONS: In patients with rheumatic MS, increased regional left atrial platelet P-selectin expression had a significantly direct relationship with the severity of MS. The increased regional left atrial platelet P-selectin expression was not reflected in peripheral venous blood samples.

Adult↗
PubMed1980

Hypercoagulability in patients with mitral stenosis -- from the viewpoint of the behavior of plasma antithrombin III and alpha2-plasmin inhibitor.

The concentration of plasma antithrombin III (AT III) and the biological activity of plasma alpha2-plasmin inhibitor (alpha 2-PI) were measured in cases of mitral stenosis (MS) and rheumatic heart disease (RHD) without MS. Cases of MS showed the findings of the low levels of plasma AT III and normal or a little higher levels of plasma alpha 2-PI, that was not recognized in RHD without MS. This finding was interpreted to be hypercoagulable because of the acceleration of coagulation and of little or slight retardation of fibrinolysis. Besides, the influence of atrial fibrillation and chronic congestive heart failure on hypercoagulability in cases of MS was detected clearly, but the influence of them in cases of non-RHD was obscure. As the results, the severer the degree of MS, the clearer the hypercoagulable state. Therefore, the prethrombotic state existed in cases of MS, combined with blood flow disturbance due to atrial fibrillation or chronic congestive heart failure, endocardial damage resulted from rheumatic fever in an early stage and hypercoagulable state mentioned above in the present study. There was no significant difference between cases with and without thrombi in the degree of hypercoagulability in subjects with MS shown in the present work. It was concluded that the consumption of AT III caused the low levels of it in cases of MS, and that the low production of AT III in the liver rather than consumption caused the low levels of it in cases of non-RHD.

Adult↗
PubMed1970

Q-I-IIA-OS formula for predicting left atrial pressure in mitral stenosis.

The relation of the phonocardiographic time intervals (Q-I) and (IIA-OS) and the use of two formulas (Q-I, IIA-OS difference versus their ratio) for estimation of left atrial pressure were investigated in 70 cases of pure mitral stenosis. It was noted that, in cases with normal blood pressure and pluse rate, there was a fair correlation of the two intervals to left atrial pressure. In our studies the best correlation was obtained by using the ratio of these two intervals (Q-I)/(IIA-OS). These results indicate that it is possible to use a new formula and equation that are dependable for phonocardiographic evaluation of left atrial pressure.

Adolescent↗
PubMed1980

New vectorcardiographic criteria for diagnosing right ventricular hypertrophy in mitral stenosis: comparison with electrocardiographic criteria.

Frank-lead vectorcardiograms (VCGs) and standard 12-lead electrocardiograms (ECGs) were analyzed to develop simple, linear, quantitative criteria for the diagnosis of right ventricular hypertrophy (RVH). The study subjects included a population with a definite RVH (84 patients with mitral stenosis proved by cardiac catheterization and pulmonary arterial systolic pressure > 40 mm Hg) and a population with minimal likelihood of RVH (173 young, healthy volunteers and 151 normal subjects proved by cardiac catheterization). VCGs were evaluated to identify criteria that provided maximum sensitivity and at least a 95% specificity: the maximum QRS magnitude had to be < 1.8 mV and either (1) the amplitude at -45 degrees (transverse plane) had to be < 0.3 mV or (2) the maximum anterior amplitude plus the maximum rightward amplitude minus the amplitude at -45 degrees must be greater than or equal to 0.5 mV. Application of these criteria achieved 60% (50 of 84) sensitivity in patients with RVH, similar to that for previous VCG criteria but significantly better (p < 0.01) than the best sensitivity with any ECG criteria (27%, 23 of 84). The specificity of the proposed criteria was 96% (310 of 324), significantly better (p < 0.001) than the 78% specificity (252 of 324) of existing VCG criteria. Thus, linear measurements of the QRS complex displayed on the VCG identify 60% of patients with moderate-to-severe RVH and falsely indicate RVH in only 4% of normal subjects.

Adult↗