Mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis.

A women who developed mitral stenosis from Libman-Sacks endocarditis is described. The mitral valve was replaced by a Starr-Edwards prosthesis. One year later, despite her being maintained on steroids and azathioprine, the verrucous endocarditis progressed to cause sudden, severe dysfunction of the prosthetic valve.     

Mitral valve resistance as a hemodynamic indicator in mitral stenosis.

Variability of the valve area calculated by the Gorlin formula has been noted in bioprosthetic and aortic valves, but few data are available for native stenotic mitral valves. Valve resistance has been proposed as an alternative hemodynamic indicator; however, its value in mitral stenosis has not been assessed. Thirty-four patients had simultaneous recordings of left atrial and ventricular pressures, 26 after percutaneous balloon mitral dilatation (PBMD). Patients with shunt or mitral regurgitation were excluded. Mitral valve resistance correlated exponentially with Gorlin mitral area (y = 133*[area]-1.5; p less than 0.0001). Both Gorlin mitral area and mitral resistance improved after PBMD (0.89 +/- 0.07 cm2 to 2.22 +/- 0.15 cm2; p less than 0.001; and 166 +/- 20 to 40 +/- 8 dynes.s.cm-5; p less than 0.001). Gorlin area and mitral resistance correlated with New York Heart Association functional class. After infusion of isoproterenol in 17 patients, there was an increase in Gorlin area (baseline 1.77 +/- 0.22 cm2, change 0.23 +/- 0.10; p less than 0.03), whereas mitral resistance did not change (baseline 96 +/- 16 dynes.s.cm-5, change 2 +/- 5; p = not significant). Mitral resistance is valuable in the assessment of mitral stenosis. It varies less than Gorlin mitral area under changing hemodynamic conditions.     

Mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis.

A women who developed mitral stenosis from Libman-Sacks endocarditis is described. The mitral valve was replaced by a Starr-Edwards prosthesis. One year later, despite her being maintained on steroids and azathioprine, the verrucous endocarditis progressed to cause sudden, severe dysfunction of the prosthetic valve.     

Echocardiographic assessment of mitral valve calcification.

The mitral valve was assessed by echocardiography in 20 patients, aged 27 to 67 years, who subsequently underwent mitral valve replacement. After removal, the mitral valve cusps were examined by direct measurement, radiography, and quantitative calcium extraction. Increased thickness of the E-F echo was found where calcification or fibrosis was present, differentiation by echocardiography alone being unreliable. However, multiple dense parallel E-F echoes were found in all 10 patients with more than 80 milligrammes of calcium in the valve, while a single thin E-F echo indicated the absence of significant calcification or fibrosis.     

Echocardiographic assessment of mitral valve calcification.

The mitral valve was assessed by echocardiography in 20 patients, aged 27 to 67 years, who subsequently underwent mitral valve replacement. After removal, the mitral valve cusps were examined by direct measurement, radiography, and quantitative calcium extraction. Increased thickness of the E-F echo was found where calcification or fibrosis was present, differentiation by echocardiography alone being unreliable. However, multiple dense parallel E-F echoes were found in all 10 patients with more than 80 milligrammes of calcium in the valve, while a single thin E-F echo indicated the absence of significant calcification or fibrosis.     

应用Carpentier-Edwards生理环治疗退行性二尖瓣反流的二尖瓣成形术后的二尖瓣狭窄

Repair durability for degenerative mitral regurgitation is excellent. Although the main reason for reoperation is residual or recurrent regurgitation, Postoperative mitral stenosis is extremely rare.     

Echocardiographic screening to assess the severity of congenital aortic valve stenosis in children.

Recent reports suggest that peak left ventricular systolic pressure can be estimated from the echocardiogram. This study compares the accuracy of echocardiographic measurements with clinical estimates of severity of aortic stenosis derived from information of the Joint Natural History Study. Twenty-seven children with isolated aortic valve stensosis were evaluated clinically and with echocardiography and cardiac catheterization. From the echocardiograms, the ratio of systolic left ventricular wall thickness to internal dimension (Ws/Ds) showed a better correlation (r = 0.82) with peak left ventricular systolic pressure than did the diastolic ratio. However, there was significant variation so that a precise estimate of peak left ventricular systolic pressure could not be made from the echocardiogram. Eight of the 27 patients had a normal Ws/Ds ratio (0.55 or less), and their cardiac catheterization data revealed mild aortic stenosis not requiring operation. In contrast, clinical criteria based on the Natural History Study identified only three of the patients with mild aortic stenosis. Prospective studies are needed to confirm the usefulness of echocardiography in noninvasive evaluation of children with aortic valve stenosis.     

Echocardiographic pattern of posterior mitral valve leaflet movement after mitral valve repair.

The pattern of movement of the posterior leaflet at the time of opening of the stenosed mitral valve has been described as either anterior or posterior in direction. In 32 patients who underwent mitral annuloplasty, the anatomical features of the mitral apparatus were correlated with the postoperative echocardiographic pattern of movements of the posterior leaflet. Anterior movement of the posterior leaflet was associated with extensive disease of this leaflet, and posterior movement with minimal disease. No relation was found between valve orifice or anterior leaflet mobility and the pattern of movement of the posterior leaflet.     

Echocardiographic variables associated with mitral regurgitation after aortic valve replacement for aortic valve stenosis

BackgroundMitral regurgitation (MR) is frequently associated with aortic stenosis. Previous reports have shown that coexisting mitral insufficiency can regress after aortic valve replacement (AVR) while others recommend dealing with examination.AimThe study aimed to assess the severity of MR before and after aortic valve replacement for aortic stenosis and to define the determinants of its postoperative evolution.MethodsFor this purpose, 30 adult patients referred for aortic valve surgery underwent pre- and 1 month postoperative transthoracic echocardiography including 2D, MM, PW, CW and color Doppler examination.ResultsPostoperative MR improved in 68.4% of the 19 patients (63.3%) who had preoperative moderate MR (p = 0.002). The effect of the valve size on the postoperative MR was statistically insignificant (0.059) but was significant on regression of the mass (p = 0.001) and drop in mean PG (p = 0.04) across AV. Patients with persistent moderate MR after surgery were all in AF and had significantly larger left atrial size (45 ± 26 mm), compared to none and a smaller left atrial (37 ± 19 mm) in patients in whom MR regressed or disappeared after surgery; respectively, p < 0.05. The postoperative variables associated with moderate MR were peak PG across AV (29.4 ± 5.1 vs 38.0 ± 5.7 p = 0.004), mean PG (15.04 ± 4.4 vs 22.8 ± 5.8 p = 0.009) and LVMI (124.7 ± 19.3 vs 147.2 ± 31.6 p = 0.065).ConclusionPreoperative predictors of residual postoperative MR were large LA and AF while the postoperative variables were high peak and mean pressure gradient across the aortic valve and high LVMI.     

Echocardiographic pattern of posterior mitral valve leaflet movement after mitral valve repair.

The pattern of movement of the posterior leaflet at the time of opening of the stenosed mitral valve has been described as either anterior or posterior in direction. In 32 patients who underwent mitral annuloplasty, the anatomical features of the mitral apparatus were correlated with the postoperative echocardiographic pattern of movements of the posterior leaflet. Anterior movement of the posterior leaflet was associated with extensive disease of this leaflet, and posterior movement with minimal disease. No relation was found between valve orifice or anterior leaflet mobility and the pattern of movement of the posterior leaflet.