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Journal of the American College of... Oct 1987The Doppler determination of the mitral pressure half-time has gained widespread acceptance as a reliable estimate for mitral valve area, despite little theoretical... (Review)
Review
The Doppler determination of the mitral pressure half-time has gained widespread acceptance as a reliable estimate for mitral valve area, despite little theoretical basis for its "independence" of other hemodynamic variables. A simple model of the left atrium and mitral valve has been developed and a governing equation derived from fluid dynamics fundamentals. Solution of this equation indicates that the pressure half-time should vary inversely with mitral valve area, but also proportionally to net left atrial and ventricular compliance and to the square root of the peak transmitral gradient. This complex relation is apparently masked in the typical clinical situation because pressure and compliance tend to change in opposite directions, thereby partly offsetting each other. In several clinical settings, such as balloon mitral valvotomy, left ventricular hypertrophy and aortic regurgitation, changes in initial pressure and compliance may be large enough to alter the relation between mitral area and pressure half-time. This study reviews the development of the pressure half-time concept, presents an overall method for studying mitral valve flow using mathematical modeling and describes the effects of factors other than mitral valve area on pressure half-time.
Topics: Blood Flow Velocity; Blood Pressure; Heart Atria; Humans; Mitral Valve; Mitral Valve Stenosis; Models, Cardiovascular
PubMed: 3309007
DOI: 10.1016/s0735-1097(87)80290-5 -
JACC. Cardiovascular Imaging Dec 2020
Topics: Balloon Valvuloplasty; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis; Predictive Value of Tests
PubMed: 33129730
DOI: 10.1016/j.jcmg.2020.07.044 -
Arquivos Brasileiros de Cardiologia Mar 2010The analysis of immediate and long-term results of mitral valvoplasty by balloon catheter (MVRBC) are still lacking in literature, mainly in the national context.
BACKGROUND
The analysis of immediate and long-term results of mitral valvoplasty by balloon catheter (MVRBC) are still lacking in literature, mainly in the national context.
OBJECTIVE
To assess the immediate and late results of patients submitted to mitral valve repair by balloon catheter.
METHOD
A total of 330 consecutive patients were followed-up by 47 +/- 36 months (up to 126 months). Univariate and multivariate analyses assessed the factors associated with the success of the procedure, restenosis and late events (death or necessity of new intervention on mitral valve). Kaplan-Meier method estimated survival without events.
RESULTS
The procedure was successful in 305 cases (92.4%). The mitral valve anatomy was the main predictor for immediate success for the procedure. During the procedure, restenosis occurred in 77 (23.3%) patients and was associated with smaller mitral valve area and with larger calcification before the process. In a mean period of 38 +/- 26-month follow-up, 67 events occurred. The probability of survival without events was of 95% in one year, 75% in five years and 61% in ten years. The predictors of survival without events were: age, echocardiography score and immediate result of the procedure.
CONCLUSION
Mitral valve repair by balloon catheter is an effective procedure, as 60% patients did not present events after the follow-up. The anatomical condition of the mitral valve and the patient's age were the best predictors of survival without events, and should be taken into account when selecting patients for the mentioned procedure.
Topics: Catheterization; Coronary Restenosis; Epidemiologic Methods; Female; Humans; Male; Mitral Valve Stenosis; Treatment Outcome; Ultrasonography
PubMed: 20730270
DOI: 10.1590/s0066-782x2010000300020 -
Heart and Vessels Sep 2013Percutaneous transcatheter mitral valvuloplasty is the indicated treatment of choice for symptomatic native mitral valve stenosis, but there have been limited reports of... (Review)
Review
Percutaneous transcatheter mitral valvuloplasty is the indicated treatment of choice for symptomatic native mitral valve stenosis, but there have been limited reports of successful procedures of balloon valvuloplasty for bioprosthetic mitral valve stenosis. We present the case of a 62-year-old woman suffering from progressive dyspnea due to bioprosthetic mitral valve stenosis. The measured mean pressure gradient across the mitral valve was 30 mmHg and the mitral valve area was 0.73 cm(2). Redoing mitral replacement was considered high risk and was refused by the patient. Percutaneous balloon valvuloplasty was performed with an Inoue balloon catheter inflated to 20 mm. The patient's symptoms immediately improved after the procedure, with no procedure-related complications. The mean pressure gradient across the valve decreased to 19 mmHg, and the mitral valve area increased to 1.21 cm(2) in postprocedural echocardiography. We conducted a literature search and identified 26 cases of balloon valvuloplasty for degenerated bioprosthetic valves. Of these, 14 cases were bioprosthetic mitral valves, and the results were favorable. However, more case reports are required to establish an evidence base for future expert recommendation of balloon valvuloplasty of prosthetic mitral valve. Meanwhile, balloon valvuloplasty will serve a niche role in highly selected patients with prosthetic mitral valve stenosis.
Topics: Balloon Valvuloplasty; Bioprosthesis; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Prosthesis Design; Treatment Outcome
PubMed: 23180241
DOI: 10.1007/s00380-012-0309-7 -
Anatolian Journal of Cardiology Jul 2022Rheumatic mitral stenosis is the common valvular heart disease seen during pregnancy. Percutaneous transvenous mitral commissurotomy is an effective, safe, and...
Maternal and Fetal Outcomes Following Percutaneous Transluminal Mitral Commissurotomy in Pregnant Women with Critical Mitral Stenosis: An Experience of a Tertiary Care Center from Northern India.
BACKGROUND
Rheumatic mitral stenosis is the common valvular heart disease seen during pregnancy. Percutaneous transvenous mitral commissurotomy is an effective, safe, and recommended treatment for critical mitral stenosis during pregnancy. We hereby report the maternal and fetal outcomes of pregnant women subjected to percutaneous trans- venous mitral commissurotomy at our institute.
METHODS
Seventy consecutive pregnant women with critical mitral stenosis, who under- went PTMC during the last 10 years, were retrospectively analyzed. All patients had a detailed clinical and obstetric evaluation and were optimally managed with drugs, before the intervention. A comprehensive pre- and post-percutaneous transvenous mitral commissurotomy transthoracic echocardiographic evaluation was performed. Detailed obstetric and fetal outcomes were noted at the time of delivery. Six weeks of post-partum follow-up was noted in all patients.
RESULTS
The mean gestational age at the time of percutaneous transvenous mitral com- missurotomy was 29.5 ± 6.68 weeks. Percutaneous transvenous mitral commissurotomy was successful in 97% of patients. Post-percutaneous transvenous mitral commissurot- omy New York Heart Association functional class, mitral valve area, trans-mitral pres-sure gradient, and left atrial pressure had a significant improvement (P < .001). The mean gestational age at the time of delivery was 36.92 ± 3.02 weeks. The mean birth weight of live newborn was 2.29 ± 0.55 kg. The fetal complications include growth restriction in 62.85%, preterm delivery in 34.37%, and low birth weight in 67.21%. A delayed percutane- ous transvenous mitral commissurotomy at about 30 weeks of gestation did not affect the maternal and fetal outcomes.
CONCLUSION
Percutaneous transvenous mitral commissurotomy is safe and efficacious in managing pregnant women with critical mitral stenosis. There was a significant improve- ment in clinical symptoms and echocardiographic parameters following percutaneous transvenous mitral commissurotomy.
Topics: Female; Humans; Infant, Newborn; Mitral Valve; Mitral Valve Stenosis; Pregnancy; Pregnant Women; Retrospective Studies; Tertiary Care Centers
PubMed: 35791711
DOI: 10.5152/AnatolJCardiol.2022.1644 -
Journal of the American Heart... May 2022Background The aim of this study was to establish prognostic hemodynamic parameters in patients with mitral stenosis secondary to mitral annular calcification. Methods...
Background The aim of this study was to establish prognostic hemodynamic parameters in patients with mitral stenosis secondary to mitral annular calcification. Methods and Results A retrospective cohort of 105 patients undergoing transseptal catheterization for hemodynamic evaluation of mitral annular calcification-related mitral stenosis between 2004 and 2020 was studied. Mitral valve gradient (MVG) and mitral valve area (MVA; calculated by the Gorlin formula) were measured using direct left atrial and left ventricular pressures. The median age of the patients was 70.3 years (58.4-76.7 years), and 53.3% were women. The median MVA was 1.7 cm (1.3-2.3 cm) and MVG was 7.3 mm Hg (5.3-10.3 mm Hg); left ventricular end-diastolic pressure was 17.6±28.3 mm Hg. During a median of 2.1 years (0.7-4.5 years), there were 63 deaths; 1- and 5-year survival were 76% and 40%, respectively. There was no association between left ventricular end-diastolic pressure and survival. After adjusting for age and comorbidities, both MVA (hazard ratio [HR], 0.50 per cm; 95% CI, 0.34-0.73) and MVG (HR, 1.1 per mm Hg; 95% CI, 1.05-1.20) were independent predictors of death. Atrial fibrillation was also independently associated with mortality. When added to a combined model, MVA remained associated with death (HR, 0.51 per cm; 95% CI, 0.33-0.79) while MVG was not. Conclusions In patients with mitral annular calcification-related mitral stenosis, survival was poor. MVA and MVG were independently associated with death, but MVA was a better predictor of outcomes.
Topics: Aged; Calcinosis; Female; Hemodynamics; Humans; Male; Mitral Valve; Mitral Valve Stenosis; Retrospective Studies
PubMed: 35574960
DOI: 10.1161/JAHA.121.023107 -
Brazilian Journal of Cardiovascular... Aug 2021Left ventricular dysfunction after surgical treatment of mitral stenosis is uncommon. We intend to determine the pattern of left ventricular remodeling, shortly after...
INTRODUCTION
Left ventricular dysfunction after surgical treatment of mitral stenosis is uncommon. We intend to determine the pattern of left ventricular remodeling, shortly after open mitral valve replacement for rheumatic mitral stenosis, with in-hospital postoperative outcomes and the determinants of postoperative worsening of left ventricular ejection fraction.
METHODS
From January 2008 to January 2015, 107 adult patients with rheumatic mitral stenosis were submitted to open mitral valve replacement. Their mean age was 45±11 years and 93 (86.9%) were women. Left ventricular morphology and function were studied longitudinally with echocardiography. The end point was postoperative worsening of left ventricular ejection fraction, defined by a decrease of 10% compared to preoperative basal assessment. Determinants of worsening left ventricular ejection fraction were determined by multivariable logistic regression analysis.
RESULTS
The end point occurred in 18 patients (16.8%). We tested clinical and echocardiographic parameters to verify independent variables related to the decrease in postoperative ejection fraction. Lower body weight (P=0.005; odds ratio [OR]=0.89) and smaller preoperative mitral valve area (P=0.02; OR=0.02) were independent predictors of left ventricular dysfunction. These patients presented higher mortality and morbidity rates.
CONCLUSION
Left ventricular remodeling patterns differed among patients with predominant rheumatic mitral stenosis undergoing open mitral valve replacement. Lower preoperative body weight and mitral valve area were independent determinants of deteriorating ejection fraction with increased end-systolic volumes, indicating that this specific problem may occur in anthropometric smaller patients with more extensive rheumatic disease.
Topics: Adult; Female; Humans; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Stroke Volume; Ventricular Function, Left; Ventricular Remodeling
PubMed: 34617428
DOI: 10.21470/1678-9741-2020-0641 -
JPMA. the Journal of the Pakistan... Jan 2022We present an unusual case of massive mitral annular calcification (MAC) leading to severe mixed mitral valve disease, viz severe mitral regurgitation and severe mitral... (Review)
Review
We present an unusual case of massive mitral annular calcification (MAC) leading to severe mixed mitral valve disease, viz severe mitral regurgitation and severe mitral stenosis. To our knowledge, severe mixed mitral valve disease secondary to MAC is extremely rare. The patient (a 65-year-old lady) presented with worsening shortness of breath and signs of congestive heart failure. Echocardiographic examination revealed massive mitral annular calcification. Despite the massive annular calcification, she had experienced neither embolism nor endocarditis in the past. Because of severe symptomatic mitral regurgitation and mitral stenosis, surgery was advised; however, the patient declined it.
Topics: Aged; Calcinosis; Female; Heart Defects, Congenital; Heart Valve Diseases; Humans; Mitral Valve; Mitral Valve Stenosis
PubMed: 35099457
DOI: 10.47391/JPMA.11-1172 -
Journal of Ultrasound Mar 2023The present case report describes a rare case of a cardiac abnormality diagnosed as Supravalvular Mitral Stenosis in an asymptomatic cat. An 11-years old cat was...
The present case report describes a rare case of a cardiac abnormality diagnosed as Supravalvular Mitral Stenosis in an asymptomatic cat. An 11-years old cat was presented for orthopedic evaluation, and during general clinical examination a heart rate of 180 bpm and left diastolic cardiac murmur grade III-IV/VI, between the mitral and aortic foci, were found. Radiographic, echocardiographic, angiocardiographic and post-mortem (the patient died during anesthesia performed to diagnose the orthopedic condition) magnetic resonance and pathologic findings are reported herein.
Topics: Animals; Cats; Mitral Valve Stenosis; Echocardiography; Anesthesiology
PubMed: 35809203
DOI: 10.1007/s40477-022-00702-2 -
The Journal of Thoracic and... Jun 2014A severely calcified mitral annulus represents a unique challenge during mitral valve replacement. To ensure proper healing of the sewing ring of the prosthesis and to...
A severely calcified mitral annulus represents a unique challenge during mitral valve replacement. To ensure proper healing of the sewing ring of the prosthesis and to avoid periprosthetic regurgitation, the mitral annulus often must be debrided for secure attachment. However, the extensive debridement that can be required in some cases could increase the risk of atrioventricular groove disruption, with a subsequent increase in morbidity and mortality. Bypass of the mitral valve with a left atrial to left ventricular-valved conduit has been described for difficult cases with congenital mitral valve stenosis. In our report, we describe its use as a safe alternative to standard mitral valve replacement in a patient with a densely calcified annulus and severe mitral stenosis.
Topics: Adult; Calcinosis; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Mitral Valve Stenosis; Prosthesis Design; Severity of Illness Index; Treatment Outcome
PubMed: 24656669
DOI: 10.1016/j.jtcvs.2014.02.039