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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 -
The Journal of Invasive Cardiology Nov 2021The reuse of sterilized Inoue catheters is practiced widely in developing countries to bring down the procedure cost. However, blood can enter the space between the...
The reuse of sterilized Inoue catheters is practiced widely in developing countries to bring down the procedure cost. However, blood can enter the space between the latex layers and become embedded in the mesh layer, which is difficult to clean when sterilizing the catheters. This is a common cause of rupture. Proper meticulous inspection of reused Inoue balloons for deformity or leakage through the small holes is necessary to prevent such complications.
Topics: Cardiac Surgical Procedures; Catheterization; Catheters; Humans; Mitral Valve; Mitral Valve Stenosis
PubMed: 34735355
DOI: No ID Found -
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 -
Archives of Cardiovascular Diseases Oct 2008
Topics: Humans; Mitral Valve Stenosis; Prevalence; Rheumatic Heart Disease; Streptococcal Infections; Treatment Outcome
PubMed: 19056064
DOI: 10.1016/j.acvd.2008.09.003 -
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 -
The Journal of Invasive Cardiology Mar 2023To enlighten preprocedural risk factors of mitral valve restenosis in a large, single-center cohort of patients submitted to percutaneous mitral balloon commissurotomy...
OBJECTIVE
To enlighten preprocedural risk factors of mitral valve restenosis in a large, single-center cohort of patients submitted to percutaneous mitral balloon commissurotomy (PMBC) for the treatment of mitral stenosis (MS) secondary to rheumatic heart disease.
METHODS
This is a database analysis of a single-center, high-volume tertiary institution involving all consecutive PMBC procedures performed in the mitral valve (MV). Restenosis was diagnosed when MV area was <1.5 cm² and/or loss of 50% or more of the immediate procedural result aligned with the return/worsened symptoms of heart failure. The primary endpoint was to determine the preprocedural independent predictors of restenosis after PMBC.
RESULTS
Among a total of 1921 PMBC procedures, 1794 consecutive patients without previous intervention were treated between 1987 and 2010. Throughout 24 years of follow-up, MV restenosis was observed in 483 cases (26%). Mean age was 36 years and most (87%) were female. Median follow-up duration was 9.03 years (interquartile range, 0.33-23.38). Restenosis population, however, presented a significantly lower age at the procedure time as well as a higher Wilkins-Block score. At multivariate analysis, independent preprocedure predictors of restenosis were left atrium diameter (hazard risk [HR], 1.03; 95% confidence interval [CI], 1.02-1.05; P<.04), preprocedure maximum gradient (HR, 1.02; 95% CI, 1.00-1.03; P=.04), and higher Wilkins-Block score (>8) (HR, 1.38; 95% CI, 1.14-1.67; P<.01).
CONCLUSIONS
At long-term follow-up, MV restenosis was observed in a quarter of the population undergoing PMBC. Preprocedure echocardiographic findings, including left atrial diameter, maximum MV gradient, and Wilkins-Block score were found to be the only independent predictors.
Topics: Humans; Female; Adult; Male; Catheterization; Follow-Up Studies; Echocardiography; Mitral Valve Stenosis; Mitral Valve; Constriction, Pathologic; Recurrence; Treatment Outcome
PubMed: 36884359
DOI: No ID Found -
The Journal of Thoracic and... Aug 2016To provide initial evidence on the management of mitral stenosis and pulmonary hypertension (PH) based on short-term and long-term outcomes following mitral valve...
OBJECTIVES
To provide initial evidence on the management of mitral stenosis and pulmonary hypertension (PH) based on short-term and long-term outcomes following mitral valve surgery.
METHODS
Consecutive patients with mitral stenosis (n = 317) who had undergone mitral valve surgery between 1992 and 2014 with recorded pulmonary artery pressure (PAP) data were reviewed. PH severity, based on systolic PAP, was categorized as mild (35 to 44 mm Hg), moderate (45 to 59 mm Hg), or severe (>60 mm Hg). Primary outcomes were 30-day mortality and long-term survival.
RESULTS
There were no significant between-group differences in age or preoperative comorbidities. Mitral valve surgery included mitral valve replacement (78%) and repair (22%). The severe PH group had more mitral valve replacement (81%; P = .04), severe tricuspid valve regurgitation (31%; P = .003), right heart failure (17%; P = .02), and concomitant tricuspid valve procedures (46%; P < .001). For severe PH, 30-day mortality was 9%, with no significant group differences. Ten- and 12-year survival were significantly worse in the moderate-severe PH group (58% and 51%, respectively) compared with the normal PAP-mild PH group (83% and 79%, respectively) with a hazard ratio of 2.98 (95% confidence interval, 1.55-5.75; P = .001). Ten-year survival after mitral valve surgery for mitral stenosis was inversely associated with preoperative PAP.
CONCLUSIONS
Mitral valve surgery can be performed with acceptable 30-day mortality for patients with mitral stenosis and moderate to severe PH, but long-term survival is impaired by moderate to severe PH. Patients with mitral stenosis and mild PH (systolic PAP 35-44 mm Hg) should be considered for mitral valve surgery.
Topics: Adult; Aged; Arterial Pressure; Female; Heart Valve Prosthesis Implantation; Humans; Hypertension, Pulmonary; Kaplan-Meier Estimate; Male; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Proportional Hazards Models; Pulmonary Artery; Recovery of Function; Retrospective Studies; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome
PubMed: 27045044
DOI: 10.1016/j.jtcvs.2016.02.038 -
Journal of the American College of... Apr 2003In 2003, pulmonary venous flow (PVF) evaluation by Doppler echocardiography is being used daily in clinical practice. Twelve years ago, we reviewed the potential uses of... (Review)
Review
In 2003, pulmonary venous flow (PVF) evaluation by Doppler echocardiography is being used daily in clinical practice. Twelve years ago, we reviewed the potential uses of PVF in various conditions. Some of its important uses in cardiology have materialized, while others have not and have been supplanted by newer approaches. Current applications of measuring PVF have included: differentiating constrictive pericarditis from restriction, estimation of left ventricular (LV) filling pressures, evaluation of LV diastolic dysfunction and left atrial (LA) function, and grading the severity of mitral regurgitation (MR). However, there have been a number of controversies raised in the use of PVF profiles. Using transthoracic echocardiography, there may be technical issues in measuring the atrial reversal flow velocity. The use of PVF in the evaluation of the severity of MR is not always specific and can be affected by atrial fibrillation (AF) and elevated mean LA pressure. Mitral valvuloplasty and radiofrequency ablation for AF, which are the newer applications of PVF in monitoring invasive procedures, are mentioned. This article reviews the important clinical role of Doppler evaluation of PVF, discusses its limitations and pitfalls, and highlights its newer applications.
Topics: Catheter Ablation; Echocardiography, Doppler; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis; Pericarditis, Constrictive; Pulmonary Circulation; Pulmonary Veins
PubMed: 12706916
DOI: 10.1016/s0735-1097(03)00126-8 -
British Heart Journal Apr 1956
Topics: Electrocardiography; Humans; Mitral Valve Stenosis; Postpericardiotomy Syndrome
PubMed: 13315845
DOI: 10.1136/hrt.18.2.153 -
The Tohoku Journal of Experimental... Apr 2010Reliable non-invasive new indices reflecting severity of rheumatic valve disease would be highly beneficial. Recently, presence of fragmented QRS (fQRS) in ECG was...
Reliable non-invasive new indices reflecting severity of rheumatic valve disease would be highly beneficial. Recently, presence of fragmented QRS (fQRS) in ECG was accepted as a marker of myocardial fibrosis. fQRS is defined as the presence of RSR' patterns such as additional R wave (R'), notching in the R wave or the S wave in 2 contiguous leads. Purpose of our study was to establish frequency of fQRS in isolated rheumatic mitral stenosis compared with control group. We studied 193 patients with mitral stenosis and age/gender matched 97 healthy subjects. Patients were categorized according to the New York Heart Association (NYHA) functional class. Severity of mitral stenosis, left ventricular ejection fraction, and pulmonary artery pressure were obtained by means of echocardiography. fQRS was defined on routine 12-lead ECG. fQRS was more frequent in subjects with mitral stenosis than in control group (p < 0.001). fQRS was associated with low ejection fraction, pulmonary hypertension, poor functional NYHA class, increased mean mitral valve gradient and decreased mitral valve area (R = 0.1, p = 0.02; R = 0.1, p = 0.001; R = 0.1, p = 0.01; R = 0.1, p = 0.04; and R = -0.1, p = 0.009, respectively). Mitral valve area was the only independent predictor of fQRS in multiple logistic regression analysis. In conclusion, fQRS is predictive of severe mitral stenosis, lower ejection fraction, increased pulmonary artery pressure, and poor functional class. fQRS might be considered as a novel indicator of mitral stenosis severity and associated complications.
Topics: Echocardiography; Female; Heart; Humans; Hypertension, Pulmonary; Mitral Valve Stenosis; Myocardium; Rheumatic Heart Disease
PubMed: 20383039
DOI: 10.1620/tjem.220.279