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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 -
Journal of the American Society of... Jan 2023Acute rheumatic fever and its chronic sequela, rheumatic heart disease (RHD), pose major health problems globally, and remain the most common cardiovascular disease in...
Acute rheumatic fever and its chronic sequela, rheumatic heart disease (RHD), pose major health problems globally, and remain the most common cardiovascular disease in children and young people worldwide. Echocardiography is the most important diagnostic tool in recognizing this preventable and treatable disease and plays an invaluable role in detecting the presence of subclinical disease needing prompt therapy or follow-up assessment. This document provides recommendations for the comprehensive use of echocardiography in the diagnosis and therapeutic intervention of RHD. Echocardiographic diagnosis of RHD is made when typical findings of valvular and subvalvular abnormalities are seen, including commissural fusion, leaflet thickening, and restricted leaflet mobility, with varying degrees of calcification. The mitral valve is predominantly affected, most often leading to mitral stenosis. Mixed valve disease and associated cardiopulmonary pathology are common. The severity of valvular lesions and hemodynamic effects on the cardiac chambers and pulmonary artery pressures should be rigorously examined. It is essential to take advantage of all available modalities of echocardiography to obtain accurate anatomic and hemodynamic details of the affected valve lesion(s) for diagnostic and strategic pre-treatment planning. Intraprocedural echocardiographic guidance is critical during catheter-based or surgical treatment of RHD, as is echocardiographic surveillance for post-intervention complications or disease progression. The role of echocardiography is indispensable in the entire spectrum of RHD management.
Topics: Child; Humans; Adolescent; Rheumatic Heart Disease; Echocardiography; Rheumatic Fever; Mitral Valve Stenosis; Mitral Valve; Disease Progression
PubMed: 36428195
DOI: 10.1016/j.echo.2022.10.009 -
Progress in Cardiovascular Diseases 2021Valvular heart disease is common and increasingly prevalent among the elderly. The end result of valvular pathologies is cardiac failure and can lead to sudden death;... (Review)
Review
Valvular heart disease is common and increasingly prevalent among the elderly. The end result of valvular pathologies is cardiac failure and can lead to sudden death; thus, diagnosis and interventions are very important in the early stages of these diseases. The usual treatment methods of mitral regurgitation include percutaneous mitral valve repair, mitral valve replacement and minimally invasive surgery, whereas the treatment methods of mitral stenosis include percutaneous transluminal mitral commissurotomy and mitral commissurotomy as well as open surgical repair. Nonetheless, ongoing clinical trials are a clear indicator that the management of valve diseases is ever evolving. The focus of this paper is on the various pathologies of the mitral valve, their etiology and clinical management, offering a comprehensive view of mitral valve diseases.
Topics: Cardiac Catheterization; Clinical Decision-Making; Endocarditis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Mitral Valve Stenosis; Patient Selection; Risk Assessment; Risk Factors; Sternotomy; Treatment Outcome
PubMed: 33812859
DOI: 10.1016/j.pcad.2021.03.008 -
Current Opinion in Cardiology Sep 2020Mitral stenosis remains clinically relevant in developing countries where rheumatic heart disease is the predominant culprit. In the western world, mitral annular and... (Review)
Review
PURPOSE OF REVIEW
Mitral stenosis remains clinically relevant in developing countries where rheumatic heart disease is the predominant culprit. In the western world, mitral annular and valvular calcification is an increasingly recognized cause, particularly in an aging population. Echocardiography plays a primary role in imaging mitral stenosis with a growing role for cardiac computed tomography and magnetic resonance imaging. In this review, we aim to revisit mitral stenosis assessment and quantification using multimodality imaging.
RECENT FINDINGS
There is an increasing role for advanced cardiac imaging especially in the era of transcatheter mitral valve intervention. Also, when echocardiography is suboptimal or discordant with symptoms, computed tomography can provide anatomical data, whereas magnetic resonance imaging can provide anatomical along with hemodynamic data.
SUMMARY
Diagnosis of mitral stenosis is crucial as it carries an increased morbidity and mortality risk. Echocardiography is the cornerstone imaging modality with alternative, complementary advanced imaging considered when images are suboptimal.
Topics: Aged; Echocardiography; Hemodynamics; Humans; Mitral Valve; Mitral Valve Stenosis; Rheumatic Heart Disease
PubMed: 32649347
DOI: 10.1097/HCO.0000000000000760 -
Heart (British Cardiac Society) Oct 2022
Topics: Aortic Valve Insufficiency; Heart Valve Diseases; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis
PubMed: 35676069
DOI: 10.1136/heartjnl-2022-321214 -
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 Cardiothoracic and Vascular... Dec 2023Shone complex is defined by 4 anomalies: parachute mitral valve, supravalvar mitral ring, subaortic stenosis, and coarctation of the aorta. Establishing a clear... (Review)
Review
Shone complex is defined by 4 anomalies: parachute mitral valve, supravalvar mitral ring, subaortic stenosis, and coarctation of the aorta. Establishing a clear definition is one of the principal challenges in the study of Shone complex as not all patients have all lesions. The essential feature of Shone complex is multilevel left-sided obstruction involving both the left ventricular inflow and outflow. This anatomic variability is reflected in the clinical presentation as signs of left ventricular inflow obstruction are often masked by outflow obstruction and the multilevel nature of the condition is thus underappreciated. Surgical treatment is often stepwise addressing the outflow obstruction first. In this review, geared to the pediatric cardiac anesthesiologist, we review the pathophysiology, diagnosis, treatment, and outcomes of Shone complex.
Topics: Humans; Child; Aortic Coarctation; Mitral Valve Stenosis; Heart Defects, Congenital; Mitral Valve; Aorta
PubMed: 37750051
DOI: 10.1177/10892532231203372 -
Heart (British Cardiac Society) May 2021
Topics: Atrial Fibrillation; Global Health; Humans; Incidence; Mitral Valve Stenosis; Rheumatic Heart Disease; Risk Assessment; Stroke
PubMed: 33462122
DOI: 10.1136/heartjnl-2020-318756