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Journal of the American College of... May 1992The findings in rheumatic mitral stenosis appear to have undergone changes, probably in association with improved socioeconomic conditions, in developing countries. The... (Comparative Study)
Comparative Study
The findings in rheumatic mitral stenosis appear to have undergone changes, probably in association with improved socioeconomic conditions, in developing countries. The objective of this study was to assess such changes and to adapt strategies of management. The clinical and pathologic features, mortality rate, long-term functional class and restenosis rate in 168 children and 62 pregnant women who underwent closed transventricular mitral valvotomy in the first 14-year period (June 1964 to May 1978) were compared and correlated with those of 140 children and 106 pregnant women in the following 7-year period (June 1978 to May 1985). During the late period, there were attenuated severity of the disease, emergence of a mild pathologic type of valve involvement confined to the commissures (commissural band stenosis), decreased mortality (1.2%) and restenosis rates (p less than 0.001) and increased long-term improvement (p less than 0.001) during childhood. The best results of closed valvotomy were obtained in simple commissural and commissural band stenosis, the latter forming the predominant group in children and pregnant women in the late period (p less than 0.001). Poor results were observed in patients with the subtype of combined stenosis characterized by commissural rigidity, cuspal stenosis and chordal fusion, demonstrating the inapplicability of closed valvotomy. Closed valvotomy is safe in all stages of pregnancy, as evidenced by the zero mortality rate and rate (1.8%) of fetal death, and offers good long-term palliation. However, in pregnant women with pure mitral stenosis characterized by simple commissural or commissural band stenosis, balloon valvuloplasty is an acceptable alternative, especially in light of the risks associated with surgery. The choice of the procedure for the relief of stenosis is determined by the pathologic anatomy of the valve stenosis.
Topics: Adolescent; Adult; Catheterization; Chi-Square Distribution; Child; Echocardiography; Female; Follow-Up Studies; Humans; Mitral Valve; Mitral Valve Stenosis; Pregnancy; Pregnancy Complications, Cardiovascular; Rheumatic Heart Disease; Sri Lanka
PubMed: 1564228
DOI: 10.1016/0735-1097(92)90335-k -
Journal of the American College of... Jun 1993The aim of this study was to assess the effect of the atrial septal defect on mitral valve area calculations after balloon mitral valvuloplasty.
OBJECTIVES
The aim of this study was to assess the effect of the atrial septal defect on mitral valve area calculations after balloon mitral valvuloplasty.
BACKGROUND
There is poor correlation between the hemodynamic-derived and Doppler mitral valve area immediately after mitral valvuloplasty. The reasons for this are unclear.
METHODS
Twenty-five patients with severe mitral stenosis were studied. After balloon mitral valvuloplasty, serial mitral valve area calculations were performed with 1) the mitral dilating catheter across the atrial septum, 2) the 7F catheter across the atrial septum, and 3) with the atrial puncture site occluded with the balloon catheter.
RESULTS
The mitral valve area determined by the Gorlin formula with balloon occlusion of the atrial septum was smaller than the mitral valve area determined without balloon occlusion (mean +/- SD 1.8 +/- 0.43 vs. 2.24 +/- 0.67 cm2, p < 0.005 for the mitral dilating catheter across the atrial septum and 1.8 +/- 0.43 vs. 2.19 +/- 0.52, p < 0.05 for the 7F catheter across the atrial septum). The mean of the differences between the mitral valve area derived by the Gorlin formula and by the Doppler pressure half-time method was smaller with the atrial septum occluded than when the dilating catheter or the 7F catheter was across the atrial septum (0.12 +/- 0.26 vs. 0.56 +/- 0.48 cm2 [p < 0.005] and 0.12 +/- 0.26 vs. 0.48 +/- 0.55 cm2 [p < 0.05]). Left to right shunting was detected less frequently by oximetry (60%), than by shunt ratios calculated by using the cardiac output measurements with and without balloon occlusion of the atrial septum (84%).
CONCLUSIONS
The presence of left to right shunts after mitral valvuloplasty may account for some of the discrepancies between mitral valve area found at cardiac catheterization and that by the Doppler pressure half-time method; thus, the latter method may be reliably used to follow up patients in the long term.
Topics: Adult; Analysis of Variance; Cardiac Output; Catheterization; Female; Follow-Up Studies; Heart Septal Defects, Atrial; Hemodynamics; Humans; Male; Mitral Valve Stenosis
PubMed: 8496521
DOI: 10.1016/0735-1097(93)90370-g -
The Journal of Heart Valve Disease Jul 2013Although mitral stenosis has profound effects on the circulation and hemodynamics, few data exist regarding its impact on aortic elastic properties. The study aim was to...
BACKGROUND AND AIM OF THE STUDY
Although mitral stenosis has profound effects on the circulation and hemodynamics, few data exist regarding its impact on aortic elastic properties. The study aim was to determine the association between mitral stenosis and aortic elastic properties by using strain and distensibility as a surrogate.
METHODS
Sixty-six patients with echocardiographic documentation of rheumatic mitral stenosis, and 25 age- and gender-matched healthy control subjects were enrolled in the study. Aortic elasticity parameters including strain and distensibility were measured by means of echocardiography.
RESULTS
The mean age of the patient and control groups were 41.8 +/- 12.0 and 38.9 +/- 5.0 years, respectively (p = 0.12). There was a significant impairment in distensibility and strain in the patient group compared to controls (0.276 +/- 0.167 versus 0.491 +/- 0.260 cm2 x dyn(-1), p = 0.001; 6.54 +/- 3.18% versus 9.19 +/- 4.78%, p = 0.015). There was a strong correlation between distensibility and left atrial diameter (p < 0.001; r = -0.39), left atrial volume index (p < 0.001; r = -0.56), mitral valve area (p < 0.001; r = 0.40), and mean transmitral gradient (p = 0.022; r = -0.18). Strain was also associated with left atrial diameter (p = 0.002; r = -0.32), left atrial volume index (p < 0.001; r = -0.41), mitral valve area (p = 0.002; r = 0.31), and mean transmitral gradient (p = 0.035; r = -0.18).
CONCLUSION
Mitral stenosis was shown to be associated with impaired aortic elasticity, but further studies are required to clarify the clinical significance of this finding.
Topics: Adult; Aorta; Echocardiography, Doppler, Pulsed; Elastic Modulus; Female; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Stenosis; Rheumatic Heart Disease; Statistics as Topic
PubMed: 24224419
DOI: No ID Found -
Turk Kardiyoloji Dernegi Arsivi : Turk... Sep 2014The aim of the study was to evaluate left atrial (LA) mechanical functions in MS before and after percutaneous mitral balloon valvuloplasty (PMBV) and to follow it up in...
OBJECTIVES
The aim of the study was to evaluate left atrial (LA) mechanical functions in MS before and after percutaneous mitral balloon valvuloplasty (PMBV) and to follow it up in short- and mid-term.
STUDY DESIGN
We carried out a prospective study of 49 patients with critical mitral stenosis (MS) who had normal sinus rhythm. LA mechanical functions were evaluated before and 24-48 h, 3 months, and 1 year after PMBV, which included LA passive emptying volume (LAPEV), LA active emptying volume (LAAEV), LA total emptying volume (LATEV), LA passive emptying fraction (LAPEF), LA active emptying fraction (LAAEF), LA total emptying fraction (LATEF), and conduit volume.
RESULTS
The transthoracic echocardiography parameters of the MS patients before and 24-48 h, 3 months, and 1 year after PMBV were as follows: (a) mitral valve area 1.1 cm² (0.9-1.6); 2.2 cm² (1.8-2.8) (p<0.001); 2.2 cm² (1.7-2.9) (NS); 2.1 cm² (1.8-2.7) (p<0.001); (b) LAPEV 13 ml/m² (9-27); 11 ml/m² (8-19) (p<0.001); 10 ml/m² (7-19) (p<0.001); 10 ml/m² (6-18) (p<0.001); (c) LATEV 26 ml/m² (19-50); 21 ml/m² (16-40) (p<0.001); 20 ml/m² (15-36) (p<0.001); 19 ml/m² (15-34) (p<0.001); (d) Conduit volume 30 ml/m² (22-44); 33 ml/m² (26-46) (p<0.001); 34 ml/m² (30-42) (p<0.001); 36 ml/m² (31-42) (p<0.001), respectively. However, LAAEV, LAPEF, LAAEF, and LATEF were not altered after PMBV.
CONCLUSION
The findings of this study demonstrated an improvement of LA mechanical functions, which continued to improve for 1 year, after successful treatment of MS by PMBV.
Topics: Adult; Atrial Function, Left; Balloon Valvuloplasty; Echocardiography, Transesophageal; Female; Humans; Male; Mitral Valve Stenosis; Postoperative Complications; Prospective Studies; Stroke Volume
PubMed: 25362941
DOI: 10.5543/tkda.2014.09147 -
JACC. Cardiovascular Interventions Dec 2019
Topics: Aged; Aortic Valve Stenosis; Balloon Valvuloplasty; Bioprosthesis; Cardiac Catheterization; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve; Mitral Valve Stenosis; Prosthesis Design; Prosthesis Failure; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 31563686
DOI: 10.1016/j.jcin.2019.07.053 -
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 -
BMJ Case Reports Jul 2013
Topics: Echocardiography; Female; Humans; Jugular Veins; Middle Aged; Mitral Valve Annuloplasty; Mitral Valve Stenosis; Pulse
PubMed: 23884990
DOI: 10.1136/bcr-2013-200023 -
Journal of Medical Case Reports Feb 2017Infective endocarditis rarely causes mitral valve stenosis. When present, it has the potential to cause severe hemodynamic decompensation and death. There are only 15...
BACKGROUND
Infective endocarditis rarely causes mitral valve stenosis. When present, it has the potential to cause severe hemodynamic decompensation and death. There are only 15 reported cases in the literature of mitral prosthetic valve bacterial endocarditis causing stenosis by obstruction. This case is even more unusual due to the mechanism by which functional mitral stenosis occurred.
CASE PRESENTATION
We report a case of a 23-year-old white woman with a history of intravenous drug abuse who presented with acute heart failure. Transthoracic echocardiography failed to show valvular vegetation, but high clinical suspicion led to transesophageal imaging that demonstrated infiltrative prosthetic valve endocarditis causing severe mitral stenosis. Despite extensive efforts from a multidisciplinary team, she died as a result of her critical illness.
CONCLUSIONS
The discussion of this case highlights endocarditis physiology, the notable absence of stenosis in modified Duke criteria, and the utility of transesophageal echocardiography in clinching a diagnosis. It advances our knowledge of how endocarditis manifests, and serves as a valuable lesson for clinicians treating similar patients who present with stenosis but no regurgitation on transthoracic imaging, as a decision to forego a transesophageal echocardiography could cause this serious complication of endocarditis to be missed.
Topics: Acute Disease; Echocardiography, Transesophageal; Endocarditis; Fatal Outcome; Female; Heart Failure; Humans; Mitral Valve; Mitral Valve Stenosis; Young Adult
PubMed: 28209176
DOI: 10.1186/s13256-017-1197-3 -
Texas Heart Institute Journal Nov 2022Mitral valve stenosis (MS) is the primary pathologic feature of rheumatic mitral valve disease, and the complex repair affects its clinical outcome. This study aimed to...
BACKGROUND
Mitral valve stenosis (MS) is the primary pathologic feature of rheumatic mitral valve disease, and the complex repair affects its clinical outcome. This study aimed to examine the efficacy of the 4-step commisuroplasty "SCORe" procedure by assessing changes in the mobility of mitral valve leaflets and its clinical effects.
METHODS
From September 1, 2018, to January 13, 2019, patients with MS who underwent mitral valve repair with the SCORe procedure in the study center were analyzed in this prospective study. Mitral valve structure was assessed by transthoracic echocardiography pre- and postoperatively as well as during follow-up.
RESULTS
In total, 60 consecutive patients were examined. In 56 patients (93.3%), mitral valve orifice area (MVOA) was less than 1.5 cm2, and mean (SD) MVOA for the whole cohort was 1.20 (0.34) cm2. The mobility of the anterior leaflet was improved (P < .001) during the cardiac cycle postsurgery, but that of the posterior leaflet was not (P = .591). The mean (SD) coaptation length was increased significantly from 6.69 (1.32) mm to 7.92 (1.24) mm (P < .001) postoperatively. Mean (SD) MVOAs increased to 2.24 (0.38) cm2 postoperatively (P < .001). During the 1-year follow-up, there were no deaths or reoperations. Follow-up echocardiography revealed minor or mild regurgitation in 98.3% of patients.
CONCLUSION
These findings demonstrated that the SCORe procedure can effectively improve the mobility of mitral leaflets and enlarge the valve orifice area in patients with rheumatic MS in China, with minimal complications and promising results.
Topics: Humans; Mitral Valve; Prospective Studies; Cardiac Surgical Procedures; Mitral Valve Stenosis; Heart Valve Diseases
PubMed: 36450146
DOI: 10.14503/THIJ-21-7801 -
Multimedia Manual of Cardiothoracic... 2014Rheumatic mitral valve disease often manifests with leaflet fibrosis, commissural fusion and early calcific degeneration. The thickening and fibrosis of the valvular and...
Rheumatic mitral valve disease often manifests with leaflet fibrosis, commissural fusion and early calcific degeneration. The thickening and fibrosis of the valvular and subvalvular apparatus has made prosthetic mitral replacement the traditional surgical solution. However, favourable valve morphology in some patients may permit a durable mitral repair rather than replacement. There is growing interest in reparative techniques that durably improve the mitral orifice while preserving the subvalvular apparatus. Many of these techniques are technically challenging and require complex resections with intricate chordal adjustments, which may have limited their global acceptance. In this report, we outline a three-step technique that does not require significant resection or involve the use of neochords. This offers a potentially simplified approach to the repair of rheumatic mitral stenosis.
Topics: Cardiopulmonary Bypass; Echocardiography; Female; Heart Arrest, Induced; Heart Valve Prosthesis Implantation; Humans; Intraoperative Care; Male; Middle Aged; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Stenosis; Postoperative Period; Retrospective Studies; Rheumatic Heart Disease; Treatment Outcome
PubMed: 24435097
DOI: 10.1093/mmcts/mmt020