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British Heart Journal Mar 1975In 33 patients with confirmed mitral valve disease, the mitral valve flow velocity traces were recorded by means of a directional Doppler ultrasonic velocimeter using...
In 33 patients with confirmed mitral valve disease, the mitral valve flow velocity traces were recorded by means of a directional Doppler ultrasonic velocimeter using the transseptal route, and correlated with the clinical and haemodynamic data. In all cases, characteristic anomalies of the mitral flow velocity patterns were noted and could be related to the type of lesion, stenosis, regurgitation, or a combination of these. Furthermore, specific patterns of the flow velocity traces were shown to correlate satisfactorily with the degree of severity of the disease. The authors propose a pathophysiological interpretation of the anomalies of the velocity patterns, based on turbulence for stenosis and backward flow wave for regurgitation. They conclude that the transseptal directional Doppler catheterization provides a new reliable method for establishing the diagnosis and grading the severity of mitral valve disease using pattern recognition, and, moreover, offers a new approach to the understanding of mitral haemodynamic disturbances on a beat-to-beat basis.
Topics: Adult; Aged; Blood Flow Velocity; Cardiac Catheterization; Female; Heart Septum; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Stenosis; Ultrasonography
PubMed: 1138730
DOI: 10.1136/hrt.37.3.257 -
British Heart Journal Dec 1994To compare Doppler, echocardiographic, and clinical variables in female and male patients with mitral stenosis. (Comparative Study)
Comparative Study
OBJECTIVE
To compare Doppler, echocardiographic, and clinical variables in female and male patients with mitral stenosis.
DESIGN
Observational study in consecutive patients with mitral stenosis of cross sectional and Doppler echocardiographic and clinical variables and a retrospective search for a history of systemic embolism.
SETTING
A medical centre with 3000 beds, serving both urban and rural populations.
PATIENTS
500 consecutive patients with an echocardiographic mitral valve area of 2 cm2 or less. 331 (66.2%) were female and 169 (33.8%) male (mean (SD) ages of 49 (13) and 48 (14) respectively).
MAIN OUTCOME MEASURES
Mitral valve areas by echocardiographic planimetry and Doppler pressure half-time method, peak early diastolic mitral velocity and pressure gradient, echocardiographic score of mitral valve, left atrial end systolic diameter, frequency of left atrial thrombus and smoky echoes as well as various valve lesions detected with Doppler and echocardiography, cardiac rhythm, symptomatic functional class of heart failure, and history of systemic embolism.
RESULTS
The prevalence of significant tricuspid (22% v 9%, P < 0.001) and pulmonary regurgitation (5% v 1%, P = 0.018) was higher in the female patients than in the male patients. Female patients also had a higher peak regurgitant velocity (3.2 (0.7) v 2.9 (0.7) m/s, P = 0.007) and pressure gradient (41 (21) v 36 (19) mm Hg, P = 0.010) across the tricuspid valve. However, the male patients had a higher echocardiographic score (9.7 (2.4) v 7.0 (2.3), P < 0.001) and a smaller Doppler-derived mitral valve area (0.9 (0.4) v 1.0 (0.4) cm2, P = 0.027). There were no differences between the female and the male patients in mitral valve area measured by planimetry, peak early diastolic mitral velocity and pressure gradient, and left atrial end systolic diameter or in the prevalence of atrial fibrillation, left atrial thrombus, left atrial smoky echoes, significant aortic stenosis, aortic regurgitation, or heart failure of New York Heart Association class III or IV.
CONCLUSIONS
Female patients not only had a higher prevalence of mitral stenosis but also had a higher prevalence of associated tricuspid and pulmonary regurgitation along with a higher velocity and gradient of tricuspid regurgitation. The echocardiographic score was higher in male patients, however. These findings suggest that the pathophysiology of mitral stenosis is different in the two sexes and that gender should be taken into account when therapeutic strategies are formulated.
Topics: Echocardiography; Echocardiography, Doppler; Female; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Pulmonary Valve Insufficiency; Sex Factors; Tricuspid Valve Insufficiency
PubMed: 7857741
DOI: 10.1136/hrt.72.6.567 -
The Journal of Thoracic and... May 1994Mitral valve repair in children has the advantage of avoiding mitral valve replacement with its attendant need for anticoagulation and reoperation. Seventy-nine children...
Mitral valve repair in children has the advantage of avoiding mitral valve replacement with its attendant need for anticoagulation and reoperation. Seventy-nine children between the ages of 2 months and 17 years (mean 4.9 years) underwent mitral valve repair between May 1982 and April 1993. There were five patients with mitral stenosis and 74 patients with mitral regurgitation, and 19 children were less than 2 years of age. Patients were divided into anatomic subgroups on the basis of the primary cardiac pathologic condition. Forty-three had severe mitral regurgitation, 21 had moderate mitral regurgitation, and 12 patients with primum atrial-septal defect and 2 patients with univentricular hearts had minimal to moderate mitral regurgitation. Associated cardiac anomalies were present in 68 patients and 85% of the patients required concomitant intracardiac procedures. The methods of mitral valve repair included annuloplasty in 68 (86%), repair of cleft leaflet in 41 (52%), chordal shortening in 9 (11%), triangular leaflet resection in 8 (10%), splitting of papillary muscles with resection of subvalvular apparatus in 7 (9%), and chordal substitution in 1 (1%). The technique of annuloplasty was modified to allow for annular growth. Follow-up was available from 1 to 10 years (mean 4 +/- 2.5 years). There were three early deaths (4%), all occurring as a result of low output cardiac failure in patients with minimal postoperative mitral regurgitation. Three late deaths (4%) occurred in patients with persistent moderate to severe mitral regurgitation and progressive cardiac failure and eight patients (10%) required either rerepair or replacement of the mitral valve. Actuarial survival was 94% at 1 year, 84% at 2 years, and 82% at 5 years, and actuarial freedom from reoperation was 89% at 8 years. All patients received postoperative echocardiography with 82% having minimal to no mitral regurgitation and 98% of long-term surviving patients being free of symptoms. We conclude that mitral valve repair can be done with low early and late mortality. The need for reoperation is relatively low and valve growth has occurred with the use of a modified annuloplasty.
Topics: Actuarial Analysis; Child, Preschool; Female; Follow-Up Studies; Heart Defects, Congenital; Humans; Male; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Stenosis; Reoperation; Survival Rate; Time Factors
PubMed: 8176970
DOI: No ID Found -
Circulation Journal : Official Journal... Mar 2018
Topics: Adult; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve; Mitral Valve Stenosis; Papillary Muscles; Thrombosis
PubMed: 28804106
DOI: 10.1253/circj.CJ-17-0209 -
The Journal of Thoracic and... Jul 1994Postoperative left ventricular performance was evaluated in patients with mitral stenosis who underwent mitral valve replacement with maintenance of the continuity of...
Postoperative left ventricular performance was evaluated in patients with mitral stenosis who underwent mitral valve replacement with maintenance of the continuity of the mitral anulus and papillary muscles. Mitral valve replacement with preservation of autologous chordae tendineae (n = 7) or their replacement with expanded polytetrafluoroethylene sutures (n = 14) was performed in 21 patients with mitral stenosis. Hemodynamic parameters were compared with those of 28 patients who underwent conventional mitral valve replacement and 27 patients who underwent open mitral valve commissurotomy. No deaths occurred in the early or late follow-up period. All hemodynamic parameters were improved after the operation, and no significant differences were detected among the three groups with regard to postoperative cardiac index or mitral valve area. No significant differences were observed in left ventricular end-diastolic volume index, end-systolic volume index, or contractility index, but the postoperative left ventricular ejection fraction in the chordal preservation and open commissurotomy groups was greater than that in the group having conventional mitral valve replacement. Postoperative regional shortening was greatest at the diaphragmatic portion in the chordal preservation group and at the long axis in the open commissurotomy group. In the mid-term postoperative period, although no differences were noted among the three groups in echocardiographic data or global ejection fraction measured by multigated equilibrium radionuclide angiography, the regional shortening at the anterolateral portion of the left ventricle in the chordal preservation and commissurotomy groups was greater than that in the group having conventional mitral valve replacement. Postoperative radionuclide angiography during exercise failed to demonstrate any difference between the ejection fraction in the chordal preservation group and that in the group having conventional mitral valve replacement.
Topics: Adult; Aged; Chordae Tendineae; Female; Heart Valve Prosthesis; Humans; Male; Methods; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Polytetrafluoroethylene; Survival Rate; Sutures
PubMed: 8028378
DOI: No ID Found -
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 -
British Medical Journal Sep 1955
Topics: Heart Valve Diseases; Heart Valves; Humans; Mitral Valve; Mitral Valve Stenosis
PubMed: 13240183
DOI: 10.1136/bmj.2.4939.573 -
The Journal of Thoracic and... Aug 2009We performed mitral valve replacement with a pulmonary autograft using the technique described by us earlier and present the results.
OBJECTIVE
We performed mitral valve replacement with a pulmonary autograft using the technique described by us earlier and present the results.
METHODS
Between August 2000 and July 2007, 19 patients (16 male patients; age, 30-58 years) with isolated calcific mitral stenosis (n = 16) or mixed mitral stenosis and regurgitation (n = 3) underwent mitral valve replacement with a pulmonary autograft. Sixteen patients were in New York Heart Association class III and 3 were in New York Heart Association class IV preoperatively. Eight patients were in atrial fibrillation. The autograft implantation was achieved by using a scalloped stent of polytetrafluoroethylene felt for external support of the autograft. No anticoagulants were prescribed.
RESULTS
There were 3 early deaths, one each caused by ventricular dysfunction, ventricular arrhythmias, and autograft dehiscence requiring early reoperation. Follow-up of survivors ranged from 34 to 99 months (mean, 71.9 +/- 18.2 months; median, 75 months). The mean valve area was 2.96 +/- 0.9 cm(2) (range, 2.2-4.3 cm(2)). Fourteen survivors are in New York Heart Association class I, and 2 are in NYHA class II; 4 continue to be in atrial fibrillation. Follow-up echocardiograms (n = 16), magnetic resonance imaging (n = 6), and cardiac catheterization (n = 4) have demonstrated no significant autograft and pulmonary homograft dysfunction. There were no late deaths or reoperations or thromboembolic complications.
CONCLUSIONS
Mitral valve replacement with a pulmonary autograft, a complex operation, can be performed in selected patients with acceptable results. The use of our technique of autograft implantation offers several advantages and avoids exposure of the scaffold to the bloodstream.
Topics: Adult; Calcinosis; Cardiac Surgical Procedures; Disease-Free Survival; Female; Hospital Mortality; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Pulmonary Valve; Reoperation; Rheumatic Heart Disease; Transplantation, Autologous; Ultrasonography
PubMed: 19619779
DOI: 10.1016/j.jtcvs.2008.11.063 -
British Heart Journal Oct 1988Twenty two patients (four men, 18 women, mean age 56 years, range 21 to 88 years) with a history of rheumatic mitral stenosis were studied by cross sectional...
Twenty two patients (four men, 18 women, mean age 56 years, range 21 to 88 years) with a history of rheumatic mitral stenosis were studied by cross sectional echocardiography before and after balloon dilatation of the mitral valve. The appearance of the mitral valve on the pre-dilatation echocardiogram was scored for leaflet mobility, leaflet thickening, subvalvar thickening, and calcification. Mitral valve area, left atrial volume, transmitral pressure difference, pulmonary artery pressure, cardiac output, cardiac rhythm, New York Heart Association functional class, age, and sex were also studied. Because there was some increase in valve area in almost all patients the results were classified as optimal or suboptimal (final valve area less than 1.0 cm2, final left atrial pressure greater than 10 mm Hg, or final valve area less than 25% greater than the initial area). The best multiple logistic regression fit was found with the total echocardiographic score alone. A high score (advanced leaflet deformity) was associated with a suboptimal outcome while a low score (a mobile valve with limited thickening) was associated with an optimal outcome. No other haemodynamic or clinical variables emerged as predictors of outcome in this analysis. Examination of pre-dilatation and post-dilatation echocardiograms showed that balloon dilatation reliably resulted in cleavage of the commissural plane and thus an increase in valve area.
Topics: Adult; Aged; Aged, 80 and over; Catheterization; Echocardiography; Female; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Probability; Prognosis
PubMed: 3190958
DOI: 10.1136/hrt.60.4.299 -
International Heart Journal 2015The aim of this study was to provide a histopathological validation of cardiac late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) for the assessment of...
Accuracy of Late Gadolinium Enhancement - Magnetic Resonance Imaging in the Measurement of Left Atrial Substrate Remodeling in Patients With Rheumatic Mitral Valve Disease and Persistent Atrial Fibrillation.
The aim of this study was to provide a histopathological validation of cardiac late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) for the assessment of left atrial (LA) substrate remodeling (SRM) in patients with rheumatic mitral valve disease and persistent atrial fibrillation (AF).Adult patients with rheumatic mitral valve disease and persistent AF undergoing open-heart surgery for mitral valve replacement were enrolled. Both two-dimensional (2D) sections and 3-dimensional (3D) full-volume LGE-MRI with different signal intensities were performed preoperatively to determine the extent of LA-SRM. Tissue samples were obtained intraoperatively from the LA roof and posterior lateral wall for pathological validation with Masson trichrome staining and immunostaining for collagen type I/III deposition. A linear regression model was used to determine the relationship between MRI-derived LA-SRM parameters and pathological results.Between February 2013 and March 2014, we successfully acquired LA tissue samples from 22 patients (13 men), with a mean age of 47 ± 8 years. All patients had rheumatic mitral valve stenosis, with a mean effective orifice area of 0.9 ± 0.2 cm(2) on echocardiography and a mean LA volume of 235 ± 85 mL on 3D-MRI. Multiple moderate linear associations were noted between the pathological results and LGE-MRI-derived LA-SRM parameters, with correlation indices (r(2)) of 0.194-0.385.LA-SRM measured by LGE-MRI showed moderate agreement with LA pathology in patients with rheumatic valve disease and persistent AF.
Topics: Adult; Atrial Fibrillation; Atrial Remodeling; Echocardiography; Female; Fibrosis; Gadolinium; Heart Atria; Heart Valve Prosthesis Implantation; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Middle Aged; Mitral Valve Annuloplasty; Mitral Valve Stenosis; Preoperative Care; Radiopharmaceuticals; Reproducibility of Results; Rheumatic Heart Disease
PubMed: 26370371
DOI: 10.1536/ihj.15-098