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Current Cardiology Reports Aug 2017This review aims to provide a comprehensive assessment of mitral valve disease, both mitral stenosis and mitral regurgitation, starting with an overview of the valve... (Review)
Review
PURPOSE OF REVIEW
This review aims to provide a comprehensive assessment of mitral valve disease, both mitral stenosis and mitral regurgitation, starting with an overview of the valve anatomy.
RECENT FINDINGS
The advent of three-dimensional imaging has allowed a better representation of the valve anatomy. Rheumatic disease is still the number one cause of mitral stenosis worldwide and percutaneous balloon mitral valvuloplasty remains the therapy of choice when indicated and in anatomically eligible patients. Mitral regurgitation (MR) is classified as primary (i.e., lesion in the mitral apparatus) or secondary (caused by left ventricular geometrical alterations). While surgery, preferably repair, is still the recommended therapy for severe primary MR, percutaneous approaches to repair and/or replace the mitral valve are being extensively investigated. Mitral valve disease is common. A careful understanding of mitral valve anatomy and the disease processes that affect the valve are crucial for providing optimal patient care.
Topics: Cardiac Surgical Procedures; Humans; Imaging, Three-Dimensional; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Stenosis; Rheumatic Heart Disease
PubMed: 28688022
DOI: 10.1007/s11886-017-0883-5 -
Primary Care Mar 2018This article outlines the diagnosis and management of commonly occurring valvular heart diseases for the primary care provider. Basic understanding of pathologic murmurs... (Review)
Review
This article outlines the diagnosis and management of commonly occurring valvular heart diseases for the primary care provider. Basic understanding of pathologic murmurs is important for appropriate referral. Echocardiography is the gold standard for diagnosis and severity grading. Patients with progressive valvular heart disease should be followed annually by cardiology and imaging should be performed based on the severity of valvular dysfunction. Surgery or intervention is recommended only when symptoms dictate or when changes in left ventricular function occur. Surgery or intervention should be performed after discussion by a heart team, including cardiologists and cardiac surgeons.
Topics: Aortic Valve Insufficiency; Aortic Valve Stenosis; Heart Valve Diseases; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis; Tricuspid Valve Insufficiency
PubMed: 29406946
DOI: 10.1016/j.pop.2017.10.002 -
Current Cardiology Reports Feb 2019This review provides an update on rheumatic mitral stenosis. Acute rheumatic fever (RF), the sequela of group A β-hemolytic streptococcal infection, is the major... (Review)
Review
PURPOSE OF REVIEW
This review provides an update on rheumatic mitral stenosis. Acute rheumatic fever (RF), the sequela of group A β-hemolytic streptococcal infection, is the major etiology for mitral stenosis (MS).
RECENT FINDINGS
While the incidence of acute RF in the Western world had substantially declined over the past five decades, this trend is reversing due to immigration from non-industrialized countries where rheumatic heart disease (RHD) is higher. Pre-procedural evaluation for treatment of MS using a multimodality approach with 2D and 3D transthoracic and transesophageal echo, stress echo, cardiac CT scanning, and cardiac MRI as well as hemodynamic assessment by cardiac catheterization is discussed. The current methods of percutaneous mitral balloon commissurotomy (PMBC) and surgery are also discussed. New data on long-term follow-up after PMBC is also presented. For severe rheumatic MS, medical therapy is ineffective and definitive therapy entails PMBC in patients with suitable morphological mitral valve (MV) characteristics, or surgery. As procedural outcomes depend heavily on appropriate case selection, definitive imaging and interpretation are crucial. It is also important to understand the indications as well as morphological MV characteristics to identify the appropriate treatment with PMBC or surgery.
Topics: Balloon Valvuloplasty; Cardiac Catheterization; Catheterization; Echocardiography; Hemodynamics; Humans; Mitral Valve; Mitral Valve Stenosis; Rheumatic Heart Disease
PubMed: 30815750
DOI: 10.1007/s11886-019-1099-7 -
Heart (British Cardiac Society) Nov 2022There is a paucity of studies looking at the natural history of valvular heart disease (VHD) in exercising individuals, and exercise recommendations are largely based on... (Review)
Review
There is a paucity of studies looking at the natural history of valvular heart disease (VHD) in exercising individuals, and exercise recommendations are largely based on expert consensus. All individuals with VHD should be encouraged to avoid sedentary behaviour by engaging in at least 150 min of physical activity every week, including strength training. There are generally no exercise restrictions to individuals with mild VHD. Regurgitant lesions are better tolerated compared with stenotic lesions and as such the recommendations are more permissive for moderate-to-severe regurgitant VHD. Individuals with severe aortic regurgitation can still partake in moderate-intensity exercise provided the left ventricle (LV) and aorta are not significantly dilated and the ejection fraction (EF) remains >50%. Similarly, individuals with severe mitral regurgitation can partake in moderate-intensity exercise if the LV end-diastolic diameter <60 mm, the EF ≥60%, resting pulmonary artery pressure <50 mm Hg and there is an absence of arrhythmias on exercise testing. Conversely, individuals with severe aortic or mitral stenosis are advised to partake in low-intensity exercise. For individuals with bicuspid aortic valve, in the absence of aortopathy, the guidance for tricuspid aortic valve dysfunction applies. Mitral valve prolapse has several clinical, ECG and cardiac imaging markers of increased arrhythmic risk; and if any are present, individuals should refrain from high-intensity exercise.
Topics: Humans; Heart Valve Diseases; Mitral Valve Stenosis; Mitral Valve Prolapse; Aortic Valve Insufficiency; Exercise; Mitral Valve Insufficiency
PubMed: 35236765
DOI: 10.1136/heartjnl-2021-319824 -
Journal of Cardiothoracic and Vascular... Aug 2020
Topics: Heart Defects, Congenital; Humans; Mitral Valve; Mitral Valve Stenosis; Stroke; Young Adult
PubMed: 32146100
DOI: 10.1053/j.jvca.2020.01.041 -
Heart (British Cardiac Society) May 2020
Topics: Atrial Fibrillation; Humans; Incidence; Mitral Valve Stenosis; Republic of Korea; Treatment Outcome
PubMed: 32029526
DOI: 10.1136/heartjnl-2019-316282 -
BMJ Case Reports May 2017
Topics: Adult; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Hypertension, Pulmonary; Mitral Valve; Mitral Valve Stenosis; Phonocardiography
PubMed: 28512104
DOI: 10.1136/bcr-2017-220120 -
Echocardiography (Mount Kisco, N.Y.) Oct 2019Mitral stenosis (MS) is a common valvular disease characterized by narrowing of the mitral valve orifice and a reduction in mitral valve area (MVA). While rheumatic MS... (Review)
Review
Mitral stenosis (MS) is a common valvular disease characterized by narrowing of the mitral valve orifice and a reduction in mitral valve area (MVA). While rheumatic MS (RMS) is frequently encountered in young individuals in developing countries, degenerative MS (DMS) is seen in the elderly in developed countries and its prevalence is increasing. DMS is usually a late presentation of mitral annular calcification (MAC). Accurate assessment of MVA in patients with MAC is challenging due to the alterations in the atrial and valvular structures as well as the presence of other comorbidities in this aging population. We will review the epidemiology, etiology, pathophysiology, diagnostic assessment, and management of DMS and compare the findings with RMS. The latest therapeutic approaches, including medical, surgical, and transcatheter valvular interventions, will be discussed.
Topics: Echocardiography; Echocardiography, Three-Dimensional; Humans; Mitral Valve; Mitral Valve Stenosis; Tomography, X-Ray Computed
PubMed: 31587368
DOI: 10.1111/echo.14495 -
Seminars in Thoracic and Cardiovascular... Mar 2018We report the techniques and long-term outcome of mitral valve (MV) repair to correct congenital mitral stenosis in children. Between 1986 and 2014, 137 children (mean... (Review)
Review
We report the techniques and long-term outcome of mitral valve (MV) repair to correct congenital mitral stenosis in children. Between 1986 and 2014, 137 children (mean age 4.1 ± 5.0, range 1 month-16.8 years) underwent repair of congenital mitral stenosis (CMS). In 48 patients, CMS is involved in Shone's anomaly. The typical congenital MS (type I) was seen in 56 patients. Hypoplastic MV (type II, n = 15) was associated with severe left ventricular outflow tract abnormalities and hypoplastic left ventricular cavity and muscle mass. Supravalvar ring (type III, n = 48) ranged from a thin membrane to a thick discrete fibrous ridge. Parachute MV (type IV, n = 10) have 2 leaflets and barely distinguishable commissures, but all chordae merged either into 1 major papillary muscle or asymmetric papillary muscles-1 dominant and the other minuscule. Hammock valve (type IV, n = 8) appeared dysplastic with shortened chordae directly inserted into the posterior left ventricular muscle mass. MV repair was performed using commissurotomy, chordal division, papillary muscle splitting and fenestration, and mitral ring resection, each applied according to the presenting morphology. During the 28-year follow-up period, 23 patients underwent repeat MV repair and 3 underwent MV replacement after failed attempts at repeat repair. At 1 and 15 years postoperatively, freedom from reoperation was 89.3 ± 5.1% and 52.8 ± 11.8%, and cumulative survival rates were 92.3 ± 4.3% and 70.3 ± 8.9, respectively. Mortality unrelated to repair accounted for 9 (20%) deaths. Long-term functional outcome of MV repair in children with CMS is satisfactory. Repeat repair or replacement may be deemed necessary during the course of follow-up.
Topics: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Male; Mitral Valve Stenosis; Papillary Muscles; Plastic Surgery Procedures; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 29425525
DOI: 10.1053/j.pcsu.2017.11.008 -
Journal of the American College of... Jun 2020
Topics: Aging; Calcinosis; Constriction, Pathologic; Humans; Mitral Valve; Mitral Valve Stenosis
PubMed: 32553259
DOI: 10.1016/j.jacc.2020.04.056