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Texas Heart Institute Journal Nov 2022There is a lack of data-driven consensus on the treatment of mitral stenosis at the time of left ventricular assist device implantation. The presence of severe mitral...
There is a lack of data-driven consensus on the treatment of mitral stenosis at the time of left ventricular assist device implantation. The presence of severe mitral annular calcification further complicates mitral valve intervention. This case report presents a 72-year-old woman with severe mitral stenosis and severe annular calcification with end-stage ischemic cardiomyopathy who underwent HeartMate 3 (Abbott Cardiovascular) implantation. The mitral valve pathology was successfully managed with concomitant open balloon valvuloplasty and surgical commissurotomy on a fibrillating heart without aortic cross-clamp. This approach avoided the need for mitral valve replacement and the potential risks associated with annular decalcification and reconstruction. Longer follow-up is needed to determine its effectiveness over time.
Topics: Aged; Female; Humans; Balloon Valvuloplasty; Calcinosis; Heart Valve Prosthesis Implantation; Mitral Valve Stenosis; Treatment Outcome
PubMed: 36515585
DOI: 10.14503/THIJ-21-7736 -
Clinical Cardiology Aug 1999Almost all mitral stenosis (MS) is rheumatic in etiology. The patient with MS who is symptomatic despite medical therapy should undergo percutaneous mitral balloon... (Review)
Review
Almost all mitral stenosis (MS) is rheumatic in etiology. The patient with MS who is symptomatic despite medical therapy should undergo percutaneous mitral balloon valvuloplasty or mitral valvular surgery (commissurotomy or replacement). The choice of procedure is determined by patient preference and the echocardiographic morphologic features of the valvular and subvalvular apparati. With balloon valvuloplasty, the rate of success is > 90%. At institutions where operators are experienced with balloon valvuloplasty and open surgical commissurotomy, their acute and long-term results are comparable. Balloon valvuloplasty occasionally is associated with complications, including death in 0 to 1%, moderate or severe valvular regurgitation in 3 to 5%, and systemic embolization in 1 to 3%.
Topics: Catheterization; Humans; Mitral Valve; Mitral Valve Stenosis; Rheumatic Heart Disease; Ultrasonography
PubMed: 10492838
DOI: 10.1002/clc.4960220803 -
European Journal of Cardio-thoracic... Aug 2022Large thoracic and thoraco-abdominal aneurysms may compress adjacent mediastinal structures. We present a case of a large thoraco-abdominal aneurysm compressing the left...
Large thoracic and thoraco-abdominal aneurysms may compress adjacent mediastinal structures. We present a case of a large thoraco-abdominal aneurysm compressing the left atrium and leading to functional mitral valve stenosis after total aortic arch repair, requiring urgent open thoraco-abdominal aneurysm repair.
Topics: Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Humans; Mitral Valve Stenosis; Treatment Outcome
PubMed: 35976126
DOI: 10.1093/ejcts/ezac418 -
Cardiovascular Intervention and... Jan 2018Optimal time to perform percutaneous mitral valvuloplasty (PMV) for patients with significant mitral stenosis (MS) and atrial fibrillation (AF) remains controversial. We...
Optimal time to perform percutaneous mitral valvuloplasty (PMV) for patients with significant mitral stenosis (MS) and atrial fibrillation (AF) remains controversial. We sought to identify prognostic factors and evaluate long-term clinical outcomes after PMV of 77 consecutive patients with MS with a mitral valve area (MVA) <1.5 cm. According to baseline heart rhythm, these patients were divided into sinus rhythm (SR; n = 24) and AF (n = 53) groups. The study endpoint was defined as a composite of all-cause mortality, admission for heart failure, mitral valve surgery, repeated PMV, and major cerebral vascular accident during follow-up. After successful PMV, there was no significant difference between the two groups in post-MVA and post-mitral mean pressure gradient. However, the New York Heart Association Functional Classification post-procedure was worse in the AF group (p < 0.01). In the AF group, event-free survival during follow-up was significantly lower compared with that of the SR group (p = 0.016). Independent predictors of clinical events were AF [hazard ratio (HR), 2.73; 95 % confidence interval (CI), 1.04-9.36; p = 0.03] and pulmonary artery systolic pressure (HR 2.57; 95 % CI 1.18-5.47; p = 0.017). Patients with AF at baseline were significantly associated with worse symptoms and higher event rates after successful PMV compared with those with SR. The clinical benefit of PMV may be considered for patients with MVA <1.5 cm before the onset of AF.
Topics: Aged; Atrial Fibrillation; Balloon Valvuloplasty; Humans; Male; Middle Aged; Mitral Valve Stenosis; Preoperative Period; Prognosis; Retrospective Studies; Treatment Outcome
PubMed: 27709537
DOI: 10.1007/s12928-016-0434-9 -
Journal of the American College of... Nov 1996This study sought to compare the mitral valve areas of patients with rheumatic mitral valve stenoses as determined by means of four echocardiographic and Doppler methods... (Comparative Study)
Comparative Study
OBJECTIVES
This study sought to compare the mitral valve areas of patients with rheumatic mitral valve stenoses as determined by means of four echocardiographic and Doppler methods with those obtained by direct anatomic measurements.
BACKGROUND
There has been no systemic comparison between Doppler-determined valve areas and the true anatomic orifice in a single cohort.
METHODS
In 30 patients with mitral stenosis, the mitral valve areas determined by two-dimensional echocardiographic planimetry, pressure half-time, flow convergence region and flow area were compared with the values directly measured on the corresponding excised specimen by means of a custom-built sizer.
RESULTS
The correlation coefficient was r = 0.95 (SE 0.06, p < 0.0001) for two-dimensional planimetry; r = 0.80 (SE 0.09, p < 0.0001) for pressure half-time; r = 0.87 (SE 0.09, p < 0.0001) for flow convergence region; and r = 0.54 (SD 0.1, p < 0.002) for flow area. Two-dimensional echocardiographic planimetry, pressure half-time, flow convergence region and flow area overestimated the actual anatomic orifice by > 0.3 cm2 in 2, 1, 6 and 0 patients, respectively, and underestimated it by > 0.3 cm2 in 0, 4, 1 and 8 patients, respectively.
CONCLUSIONS
Mitral valve areas determined by two-dimensional planimetry, pressure half-time and proximal flow convergence region reliably correlated with size of the anatomic orifice. The flow area method provided a less reliable correlation.
Topics: Adult; Aged; Echocardiography; Female; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Rheumatic Heart Disease
PubMed: 8890815
DOI: 10.1016/S0735-1097(96)00326-9 -
The American Journal of Cardiology Apr 1988Thirty-seven patients with symptomatic mitral stenosis underwent balloon dilatation of the mitral valve. Significant increases (p less than 0.001) were noted in both...
Thirty-seven patients with symptomatic mitral stenosis underwent balloon dilatation of the mitral valve. Significant increases (p less than 0.001) were noted in both catheterization- and Doppler-determined valve area (0.9 +/- 0.3 to 1.8 +/- 0.8 and 0.9 +/- 0.2 to 1.7 +/- 0.5 cm2). However, catheterization and Doppler areas before and after valvuloplasty correlated less well (r = 0.51, p less than 0.002 and r = 0.47, p less than 0.005, respectively) than the catheterization-Doppler area correlation in a previous study of 59 consecutive patients with varying degrees of mitral stenosis (r = 0.84, p less than 0.001). Mitral valve area increases were independent of valve thickness estimated using 2-dimensional echocardiography. Flail mitral leaflet movement was not observed and the degree of mitral regurgitation qualitatively assessed using pulsed Doppler mapping techniques increased by greater than 1 of 4 grades in only 1 patient. The lateral mitral valve orifice diameter increased more than the anteroposterior diameter, suggesting commissural splitting as the mechanism of successful valvuloplasty. Increases (all p less than 0.0001) were noted in mitral valve EF slope (7 +/- 5 to 18 +/- 10 mm/s), excursion (11 +/- 5 to 13 +/- 4 mm), S20S interval (0.07 +/- 0.02 to 0.08 +/- 0.02 s) and cardiac output (4.2 +/- 1.3 to 5.3 +/- 2.0 liters/min). There were significant decreases (all p less than 0.001) in left atrial diameter (5.4 +/- 1.0 to 5.1 +/- 1.0 cm), mean catheterization gradient (15 +/- 5 to 8 +/- 4 mm Hg) and mean Doppler gradient (10 +/- 4 to 6 +/- 3 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Catheterization; Echocardiography; Female; Humans; Male; Middle Aged; Mitral Valve Stenosis; Phonocardiography
PubMed: 3354446
DOI: 10.1016/0002-9149(88)91073-9 -
Romanian Journal of Internal Medicine =... Jun 2017The change in the level of NT-pro-BNP (N-terminal-pro-Brain Natriuretic Peptide) is now considered as a reflection of the hemodynamic alterations and its circulatory...
BACKGROUND
The change in the level of NT-pro-BNP (N-terminal-pro-Brain Natriuretic Peptide) is now considered as a reflection of the hemodynamic alterations and its circulatory reductions reported early after successful PTMC (percutaneous transvenous mitral commissurotomy). The present study aims to assess the change in the level of NT-pro BNP following PTMC in patients with mitral stenosis and also to determine the association between circulatory NT-pro-BNP reduction and post-PTMC echocardiography parameters.
METHODS
Twenty five symptomatic consecutive patients with severe MS undergoing elective PTMC were prospectively enrolled. All patients underwent echocardiography before and also 24 to 48 hours after PTMC. Peripheral blood samples were taken for measurement of NT-pro-BNP before as well as 24 to 48 hours after PTMC. The patients were also classified in group with normal sinus rhythm or having atrial fibrillation (AF) based on their 12-lead electrocardiogram.
RESULTS
It was shown a significant decrease in the parameters of PPG (Peak Pressure Gradient), MPG (Mean Pressure Gradient), PHT (Pressure Half Time), PAP (Pulmonary Arterial Pressure), LAV (Left Atrial Volume), and also a significant increase in MVA (Mitral Valve Area) RVS (Right Ventricular S velocity), and strains of lateral, septal, inferior and anterior walls of LA following PTMC. The mean LVEF remained unchanged after PTMC. The mean NT-pro-BNP before PTMC was 309.20 ± 17.97 pg/lit that significantly diminished after PTMC to 235.72 ± 22.46 pg/lit (p = 0.009). Among all echocardiography parameters, only MPG was positively associated with the change in NT-pro-BNP after PTMC. Comparing the change in echocardiography indices between the patients with normal rhythm and those with AF, lower change in PAP was shown in the group with AF. However, more change in the level of NT-pro-BNP after PTMC was shown in the patients with AF compared to those without this arrhythmia.
CONCLUSION
PTMC procedure leads to reduce the level of NT-pro-BNP. The change in NT-pro-BNP is an indicator for change in MS severity indicated by decreasing MPG parameter. Lower change in PAP as well as higher change in NT-pro-BNP is predicted following PTMC in the group with AF compared to those with normal sinus rhythm.
Topics: Adult; Aged; Biomarkers; Cardiac Surgical Procedures; Echocardiography; Electrocardiography; Female; Humans; Male; Middle Aged; Mitral Valve Stenosis; Natriuretic Peptide, Brain; Peptide Fragments; Pilot Projects; Prospective Studies
PubMed: 28103203
DOI: 10.1515/rjim-2017-0005 -
Journal of the American College of... Jun 1991Doppler echocardiography was used to determine changes in transmitral gradient and pulmonary artery pressure after exercise in 12 patients with mitral stenosis and 11... (Comparative Study)
Comparative Study
Effects of exercise on transmitral gradient and pulmonary artery pressure in patients with mitral stenosis or a prosthetic mitral valve: a Doppler echocardiographic study.
Doppler echocardiography was used to determine changes in transmitral gradient and pulmonary artery pressure after exercise in 12 patients with mitral stenosis and 11 patients with a prosthetic mitral valve. The mean transmitral gradient in the mitral stenosis group was 9 +/- 7 mm Hg at rest and increased to 17 +/- 8 mm Hg after exercise. In patients with a prosthetic mitral valve, exercise resulted in an increase in mean transmitral gradient from 5 +/- 2 to 8 +/- 3 mm Hg. Calculated pulmonary artery systolic pressure increased with exercise from 41 +/- 19 to 70 +/- 32 mm Hg in the mitral stenosis group and from 28 +/- 8 to 39 +/- 15 mm Hg in patients with a prosthetic valve. Exercise Doppler echocardiographic evaluation of changes in transmitral gradient and pulmonary artery systolic pressure was found to be technically simple and an important addition to the noninvasive evaluation of patients with mitral valve disease.
Topics: Adult; Echocardiography, Doppler; Evaluation Studies as Topic; Exercise; Exercise Test; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Pulmonary Wedge Pressure
PubMed: 2033184
DOI: 10.1016/0735-1097(91)90641-l -
Indian Heart Journal 2022We studied left atrial (LA) function in severe rheumatic mitral stenosis (MS) patients using two-dimensional speckle tracking echocardiography (STE). Eighty patients...
We studied left atrial (LA) function in severe rheumatic mitral stenosis (MS) patients using two-dimensional speckle tracking echocardiography (STE). Eighty patients with isolated severe MS in sinus rhythm and 40 controls underwent comprehensive echocardiography including STE derived LA strain [reservoir strain (LAS), conduit strain (LAS) and contractile strain (LAS)]. The mean MVA was 0.93 ± 0.21 cm. The mean values of LAS (14.73 ± 8.59%), LAS (-7.61 ± 4.47%) and LAS (-7.16 ± 5.15%) in patients were significantly lower (p < 0.001) vs. controls 44.11 ± 10.44%, -32.45 ± 7.63%, -11.85 ± 6.77% respectively and showed decreasing trend with increasing MS severity and higher NYHA class. In conclusion, LA dysfunction is prevalent in severe MS irrespective of NYHA functional class.
Topics: Atrial Function, Left; Echocardiography; Heart Atria; Humans; Hypertension, Pulmonary; Mitral Valve Stenosis
PubMed: 34958795
DOI: 10.1016/j.ihj.2021.12.011 -
Multimedia Manual of Cardiothoracic... Oct 2019This video tutorial is a guide to transfemoral, transcatheter mitral valve-in-valve implantation using advanced preoperative planning and intraprocedural fusion imaging....
This video tutorial is a guide to transfemoral, transcatheter mitral valve-in-valve implantation using advanced preoperative planning and intraprocedural fusion imaging. We demonstrate mitral valve-in-valve implantation in a patient after surgical bioprosthetic replacement of the mitral valve, with severe restenosis and elevated surgical risk, and we discuss preoperative planning and work-up using advanced imaging software.. The procedure itself is documented in a step-by-step fashion for every important phase of the intervention. Finally, we present the postoperative result after successful implantation and provide a brief discussion of the key points of the case and procedure.
Topics: Aged, 80 and over; Bioprosthesis; Cardiac Catheterization; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Intraoperative Care; Male; Mitral Valve; Mitral Valve Stenosis; Prosthesis Failure; Reoperation; Surgery, Computer-Assisted; Treatment Outcome
PubMed: 31751004
DOI: 10.1510/mmcts.2019.028