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At least 145 records · Page 8Linked to original sources
PubMed1998

Comparison of late results of balloon valvotomy in mitral stenosis with versus without mitral regurgitation.

Balloon mitral valvotomy (BMV) is safe and effective in patients with mitral stenosis (MS) and coexisting mild mitral regurgitation (MR). Influence of preexisting MR on late outcome of BMV is under evaluation. We included 77 patients without MR and 72 with MR in this study, and compared their immediate and late results in a mean follow-up of 33 +/- 24 months after BMV. Patients with coexisting MR were older and more frequently had significant valvular calcium and atrial fibrillation than patients without MR. After BMV, mitral valve gradient decreased, and cardiac output and mitral valve area by planimetry increased significantly (all p = 0.0001) in both groups. There was no difference in values of mitral valve gradient and cardiac output after BMV between the groups. Mitral valve area was significantly smaller in patients with preexisting MR. During follow-up, there were 11 patients (14%) in the group without MR and 24 (33%) in the group with MR developed cardiac events (p = 0.006). Cumulative event-free survival was 90% at the second year, 87% at the fourth year, and 69% at the sixth year, respectively, in the group without MR versus 78%, 62%, and 37%, respectively, in the group with MR (p = 0.0014). Cox regression showed that preexisting MR was a significant predictor for late cardiac events with a threefold increased hazard risk (p = 0.0025), but age, valvular calcium, echocardiographic score, and cardiac rhythm also played a culpable role. We conclude that preexisting MR is an important risk factor for poor, late outcome of BMV.

Adolescent↗
PubMed1994

Percutaneous transvenous mitral commissurotomy using Inoue catheter in juvenile rheumatic mitral stenosis.

Percutaneous transvenous mitral commissurotomy (PTMC) using Inoue balloon was performed in 270 patients with rheumatic mitral stenosis. Of these 81 (27%), 48 males and 33 females, had juvenile mitral stenosis (age < 20 years, range 9-20 years mean 14 +/- 5). All patients were symptomatic (New York Heart Association [NYHA] class III in 61 patients and class IV in 20 patients). Following PTMC, the mitral valve area (MVA) increased from 0.8 +/- 0.4 to 2.2 +/- 0.5 cm2 (P < 0.001) and the cardiac index increased from 2.4 +/- 0.8 to 3.0 +/- 0.8 L/min/m2 (P < 0.001). Mean transmitral gradients decreased from 24 +/- 8 to 4 +/- 3 mm Hg (P < 0.001). Three (4%) patients had an increase in mitral regurgitation by 1 grade (grade 2/4); however, none required surgery. Significant left to right atrial shunt (Qp/Qs > 1.3: 1) on oximetry was detected in 8 (10%) patients. Overall results were compared to those with adult subgroup of patients with rheumatic mitral stenosis (n = 189, 100 females and 89 males), who underwent PTMC simultaneously. Their age ranged from 21 to 44 years (mean 32 +/- 11 years). The percentage increase in MVA was higher in juvenile as compared to adult patients (172 +/- 61 vs. 154 +/- 69, respectively, P < 0.01). A larger final MVA was achieved in the juvenile group (2.2 +/- 0.5 vs. 1.9 +/- 0.3 cm2, P < 0.05). However, the incidence of increase in mitral regurgitation by 1 grade was similar in two groups (6% vs. 4%, P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

Value of exercise echocardiography in rheumatic mitral stenosis with and without significant mitral regurgitation.

Patients with rheumatic mitral valve disease (n = 48) underwent treadmill stress echocardiography and were classified as those with mitral stenosis (n = 24) or those with mitral regurgitation with mild mitral stenosis (n = 24). Despite marked differences in mitral valve area (1.1 +/- 0.3 vs 2.1 +/- 0.6 cm(2), respectively; p <0.0001), systolic tricuspid gradients were similar both at rest (37 +/- 11 vs 37 +/- 13 mm Hg) and at peak exercise (60 +/- 16 vs 55 +/- 13 mm Hg, respectively). Following stress echocardiography, an invasive procedure or modification of medical treatment was performed or recommended in 51% of the study patients.

Echocardiography, Doppler↗
PubMed1997

Transesophageal echocardiographic Doppler study of the pulmonary venous flow pattern in severe mitral stenosis with variable degrees of mitral regurgitation.

The transesophageal echocardiographic data of 62 patients with severe, rheumatic mitral stenosis, which was either isolated or associated with different degrees of mitral regurgitation were reviewed to study and compare their pulmonary venous flow patterns. Peak systolic and peak diastolic flow velocities and their respective time intervals were measured, and the presence or absence of systolic flow reversal (SFR) was noted. The venous flow velocities and time integrals were all below normal and the ratio between the systolic and diastolic velocities were all blunted. Systolic flow reversal was observed in some patients with severe mitral stenosis with or without mitral regurgitation, and was highly correlated with the presence of atrial fibrillation. Among patients with mitral regurgitation and in atrial fibrillation, flow reversal timing was shorter in patients with significant mitral regurgitation than in patients with mild or no mitral regurgitation.

Adult↗
PubMed1993

Midazolam as an induction agent in mitral stenosis patients for closed mitral commissurotomy.

In 30 patients of rheumatic heart disease with mitral stenosis (MS) belonging to NYHA class II and III scheduled for closed mitral commissurotomy anaesthesia was induced with morphine 0.15 mg/kg followed by either thiopentone (group A, n = 15) or midazolam (group B, n = 15) titrated to produce sleep. Patients were intubated with pancuronium bromide in a dose of 0.12 mg/kg. Minimum mean arterial blood pressure following induction was significantly lower in thiopentone group (77 +/- 7 mm Hg) than midazolam group (85 +/- 6 mm Hg; P < 0.05). After intubation blood pressure was significantly higher in thiopentone group (99 +/- 8 mm Hg) than midazolam group patients (89 +/- 7 mm Hg). Heart rate was significantly higher in thiopentone treated patients both before and after endotracheal intubation. During surgery, three patients in group A had hypotensive episodes (mean arterial blood pressure 20% below basal at two successive readings 5 min apart) while one in group B had a hypotensive episode. Average duration of surgery was comparable between the two groups (102 +/- 15 and 95 +/- 18 min) and postoperatively there was no significant difference in sedation score and incidence of nausea and vomiting between the two groups.

Adult↗
PubMed1986

The usefulness of dobutamine in the assessment of the severity of mitral stenosis.

Patients with mitral stenosis often require supine exercise in order to increase their heart rate and cardiac output to assess the severity of their valvular obstruction during cardiac catheterization. We substituted dobutamine for exercise in 14 patients with suspected mitral stenosis. The dobutamine infusion was started at 5 micrograms/kg/min and was increased to 10, 15, and 20 micrograms/kg/min every 3 minutes as tolerated. The heart rate increased from 84 +/- 4 to 123 +/- 7 bpm (p less than 0.001), the cardiac index increased from 2.4 +/- 0.2 to 3.4 +/- 0.2 L/min/m2 (p less than 0.001), and the mean pulmonary artery pressure increased from 27 +/- 3 to 30 +/- 2 mm Hg (p less than 0.02). The pulmonary wedge pressure of 19 +/- 2 mm Hg and the mitral valve index of 0.8 +/- 0.1 cm2/m2 remained unchanged, but the left ventricular end-diastolic pressure decreased from 11 +/- 2 to 6 +/- 2 mm Hg (p less than 0.02). The hemodynamic response during the infusion of dobutamine identified a subgroup of patients with more severe mitral stenosis. Thus, the administration of dobutamine is useful in the evaluation of the severity of mitral valve obstruction during catheterization.

Adult↗
PubMed1994

Doppler echocardiographic study of pulmonary venous flow in mitral stenosis and early after mitral valve replacement.

The aim of the study was Doppler echocardiographic assessment of the effect of mitral stenosis (MS) on pulmonary venous flow (PVF), and of any changes occurring after mitral valve replacement. Fifty patients with MS (22 in atrial fibrillation (AF)) and 28 healthy subjects (control group) underwent transthoracic echocardiographic evaluation of PVF. Fourteen of the 22 patients in AF were submitted in addition to transesophageal echo study before and after mitral valve replacement. Pulmonary wedge pressure was measured in 18 patients. Patients in sinus rhythm (SR) and more than mild MS showed significantly decreased peak velocity and flow velocity time integral of the systolic forward PVF. This finding was more exaggerated in MS with AF. Concerning diastolic forward PVF, patients in SR showed significantly decreased peak velocity and velocity time integral, irrelevant of the degree of MS, while patients with AF exhibited adequate signs of flow. In all patients duration, deceleration time (D-DT) and pressure half-time (D-PHT) of the diastolic forward PVF were significantly increased. The last two parameters correlated with the corresponding variables of mitral flow and with echocardiographically determined mitral valve area and the D-DT of the pulmonary wedge pressure. Concerning reversed PVF, patients with more than mild MS exhibited significantly increased peak velocity and velocity time integral. After mitral valve replacement, a significant increase of diastolic forward peak velocity and velocity time of the PVF were detected. The duration of diastolic forward peak velocity of PVF, D-DT and D-PHT decreased. The systolic forward phase did not change significntly after the valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Percutaneous balloon mitral valvotomy in pregnant patients with tight pliable mitral stenosis.

Percutaneous balloon mitral valvotomy was attempted in severely symptomatic (New York Heart Association class III or IV) pregnant patients (mean age 30 years) with tight mitral stenosis. Nineteen patients were pregnant (mean gestation 30 weeks, range 26 to 34) and one patient was in the immediate postpartum period. All patients had undergone a trial of diuretic therapy and 16 were also taking atenolol. Percutaneous valvotomy was performed with the Inoue catheter (18 patients) or the Schneider-Medintag bifoil (2 x 19 mm) balloon catheter (2 patients). The fluoroscopy time was 9.2 +/- 3.4 minutes. After percutaneous valvotomy the mean mitral gradient decreased from 17.9 +/- 6.2 to 5.9 +/- 2.4 mm Hg (p < 0.001). The mitral valve area (pressure half time) increased from 0.8 +/- 0.2 to 1.7 +/- 0.2 cm2 (p < 0.001). These hemodynamic changes were accompanied by immediate symptomatic improvement by at least one New York Heart Association functional grade in all patients. Moderate (3+) mitral regurgitation developed in one patient. Eighteen patients had normal infants delivered vaginally at term without assistance, and one patient had a normal infant delivered by cesarean section at 35 weeks' gestation. We conclude that percutaneous balloon mitral valvotomy for pliable mitral stenosis in pregnancy is safe for both the mother and fetus. We recommend that it be performed in symptomatic patients with tight mitral stenosis so as to avoid hemodynamic complications in the latter stages of pregnancy.

Adult↗
PubMed2005

Left atrial appendage function analyzed by tissue Doppler imaging in mitral stenosis: effect of afterload reduction after mitral valve commissurotomy.

BACKGROUND: This study sought to investigate the relative load dependence of left atrial appendage (LAA) tissue Doppler velocities in patients with mitral stenosis after percutaneous mechanical mitral commissurotomy (PMMC). METHODS: LAA tissue Doppler velocities were obtained in 34 patients with mitral stenosis (20 with sinus rhythm and 14 with atrial fibrillation) before and after PMMC by transesophageal echocardiography. Standard ultrasound studies were also performed for mitral valve orifice area, transmitral pressure gradient, and LAA blood flow velocity measurements. RESULTS: PMMC resulted in a significant increase in mitral valve area (P < .001) and decrease in mean transmitral pressure gradient (P < .001). LAA tissue Doppler velocities consisted of a triphasic velocity profile: SLAA and ELAA occurring during left ventricular contraction and relaxation, respectively, and ALAA occurring after the atrial contraction. After PMMC, ELAA and ALAA velocities consistently increased (4.8 +/- 1.2 to 7.9 +/- 2.6 cm/sec [P < .001] and 6.6 +/- 2.9 to 8.1 +/- 4.2 cm/sec [P < .05], respectively). The mean transmitral pressure gradient was significantly correlated with ALAA before and after PMMC (r = .65). CONCLUSIONS: In mitral stenosis, tissue Doppler velocities illustrated improvement of regional LA function after PMMC, in relation to decreased transmitral pressure gradient.

Atrial Function, Left↗
PubMed1997

[Usefulness of exercise Doppler in the diagnosis of severe mitral stenosis].

BACKGROUND: Exercise in mitral stenosis produces an increase in cardiac output and heart rate which determines the increment in the transmitral gradient. However, it has not yet been established what level is reached by the gradients on exercise in severe mitral stenosis nor whether the rise in the gradient during such exercise is different to that occurring in non-severe stenosis. OBJECTIVE: To evaluate the effect of exercise in patients with severe mitral stenosis on the mitral valve gradients in absolute values and on the increment with respect to base values. METHODS: Forty-eight mitral stenosis patients (mean age: 48.8 +/- 11 years) underwent 50 exercise Doppler echocardiographic studies using supine bicycle ergometry in two stages with increases of 25 W every 3 minutes; from each of these we obtained the peak and mean mitral gradient using a non-imaging continuous-wave Doppler probe. We also conducted this procedure on 14 patients with a mean age of 50 +/- 6 who had Bjork mitral prostheses which were functioning normally. RESULTS: We defined a hemodynamic profile of severity based on the data from 18 patients whose basal mitral valve areas was < 1.2 cm2 (group I), and compared them with the data from the 32 studies of mitral stenosis patients with an area > 1.1 cm2 (group II) and with the patients with mitral prostheses (group III). The mean mitral gradient (mmHg) in group I was greater than in group II at rest (9.3 +/- 3.2 and 6.6 +/- 2.7; p < 0.001), at 25 W (20.6 +/- 4.8 and 14.1 +/- 5; p < 0.001) and at 50 W (25.9 +/- 5.4 and 17.3 +/- 5.8; p < 0.001). The increase in mean mitral gradient from the baseline to 50 watts was 16.7 +/- 4.5 mmHg in group I, which was greater than in group II and III (11.1 +/- 4.1 and 6.8 +/- 2.6 mmHg; p < 0.001). CONCLUSIONS: Exercise Doppler echocardiography enabled us to define a differential hemodynamic profile in patients with severe mitral stenosis which can be used in isolation as an indicator of severity in this condition.

Adult↗