Cases Of Mitral Valve Disease Research Articles

Rapid progression of mitral valve disease in a child with Noonan syndrome.

Noonan syndrome is the second most common genetic syndrome associated with congenital heart disease after Trisomy 21. The two most common cardiac lesions associated with Noonan syndrome are pulmonary stenosis and hypertrophic cardiomyopathy. Although the incidence of mitral valve disease in Noonan syndrome ranges between 2 and 6%, rapid progression of mitral valve dysplasia causing severe mitral valve regurgitation and left atrial dilatation is seldom seen. Most cases of mitral valve disease have been diagnosed either on routine echocardiographic surveillance or when presented with heart failure symptoms. We describe an 18-month-old boy with Noonan syndrome presenting in atrial flutter due to a massively enlarged left atrium caused by severe mitral valve regurgitation which developed and progressed in less than 17 months.

Lutembacher's syndrome: Is the mitral pathology always rheumatic?

The mitral valve disease (MVD) in Lutembacher's syndrome has been infrequently analyzed from a pathological standpoint. In this study, we have attempted to elucidate the pathology of MVD in this interesting syndrome in 44 autopsied cases of combined non-primum atrial septal defect (ASD) and MVD collected over 16 years. The patients were divided into 3 groups: Group 1: non-primum ASD with clinically diagnosed mitral stenosis (MS)±regurgitation, Group 2: non-primum ASD with clinically diagnosed mitral regurgitation (MR) and, Group 3: non-primum ASD with no clinically evident MVD, but with mitral valve pathology diagnosed at autopsy. All 44 patients were symptomatic. There were 26 males (59%). The ages ranged from 13 to 73 years. A history of rheumatic fever was available in 2 patients while 16 patients had undergone surgery or intervention for the disease. Of the 18 patients in Group 1, six patients did not show histological features of rheumatic heart disease, although they shared similar gross morphological features. Furthermore, the mitral regurgitation in 12 of 19 patients in Group 2 was non-rheumatic. Also, only one patient had histological evidence of rheumatic activity among seven cases in Group 3. In spite of a high rheumatic load at our center, more than half (54.5%) of patients had “non-rheumatic” mitral valve pathology. Thus, the mitral valvular lesions commonly labeled ‘rheumatic’ in Lutembacher's syndrome are not always so. The distinction into rheumatic and non-rheumatic MVD in non-primum ASD has to be made on the basis of microscopic criteria.

EComment. Mini-partial heart autotransplantation for atrial fibrillation and mitral valve surgery

It is very exciting to discuss this beautiful article by Pan et al. [1]. There is considerable documentation in the literature about the use of partial heart autotransplantation for a variety of purposes. My teacher, Arrigo Lessana in Aubervilliers, France, had begun to use partial cardiac autotransplantation in the spring of 1998 [2] for adequate visualization to reduce the size of the left atrium (LA). Later, when I came back to Mexico, I operated on three cases of mitral valve disease and chronic atrial fibrillation (AF) with giant LA from 2000 to 2001 [3]. All three cases had a spectacular outcome. After this very nice experience, I promptly realized that by sectioning only the superior vena cava (SVC) one can get an effective access to the whole LA. So I performed about 100 cases of surgical isolation of the pulmonary veins to treat AF in mitral valve disease [4]. But it is clear that this was not a left-sided maze, and the sinus rhythm conversion rate was lower than those reported by Cox et al. [5]. With all this experience, I made contact with Professor Jim Cox in 2012. After he emphasized the key aspects for successful completion of the Cox maze III 'cut-and-sew' procedure, I started to perform it by adding the transection of the SVC. This modification from the original technique can be termed as mini-partial heart autotransplantation. And this is just the point that I want to emphasize in this comment. Once the entire LA has been circumferentially divided and the SVC sectioned, the heart is lifted up and twisted towards the left side of the patient. I have found that this technique allows an extraordinary visualization of the mitral valve. Since the heart is twisted, the surgeon works from 'ground level'. I have performed 14 cases of the Cox maze III procedure and mitral valve surgery by means of mini-partial heart autotransplantation with an excellent outcome. Re-anastomosis of the SVC is performed in 5 to 10 minutes in a beating heart. No additional risks are added with this technique. I encourage cardiac surgeons to use this technique to make both mitral valve surgery and the Cox-maze III procedure more amenable. Conflict of interest: none declared

Closed Mitral Commissurotomy Utilizing Right Thoracotomy Approach

Right thoracotomy provides an alternative approach for commissurotomy in selected cases of mitral valve disease. From 1970 through 1985, over 300 patients underwent closed mitral commissurotomy by this approach, with satisfactory early results.

Limitations and Potentialities of Doppler Echocardiography in the Evaluation of Mitral Flow

Doppler ultrasound has improved the evaluation of mitral valve diseases. There are, however, some limitations to its use. We describe a case of mitral valve disease in which an unusual concomitant rhythm disturbance highlights the limitations of the Doppler‐derived pressure half‐time method in evaluating the valve area, and the different behavior of the diastolic regurgitation across the two atrioventricular valves.

Constrictive pericarditis after cardiac surgery

Forty-five patients were identified as having constrictive pericarditis after cardiac surgery. The mean patient age was 61 years (range, 40 to 77 years). Twenty-three of 37 patients with adequate clinical information were reported to have had a diagnosis of postpericardiotomy syndrome after the original surgery. The mean interval from original surgery to presentation with constriction was 23.4 months (range, 1 to 204 months). Computerized tomography was helpful in establishing a diagnosis of constriction in 23 of 29 patients (79%). Bypass graft patency was 93% (85 of 91 grafts). Severe pulmonary hypertension (pulmonary artery systolic pressure ≥ 60 mm Hg) was present in nine patients; 8 had coexistent valvular disease (seven cases of mitral valve disease, and aortic valve disease in one). Thirty-seven of the 45 patients underwent pericardial stripping, 28 of whom experienced marked symptomatic improvement. One patient had persistent right heart failure, which was not documented to be secondary to constriction. Four patients had persistent constrictive physiologic conditions. Three of these patients had more extensive pericardial stripping and showed clinical improvement. Four patients (11%) died within 30 days of stripping. Eight patients received medical therapy alone. The decision to treat patients medically was based either on favorable response to medical therapy (five patients), or poor general clinical status.

Mitral valve disease in young; Review of surgical treatment

In India rheumatic mitral valve disease in younger age group continues unabated. The present study consists of 170 cases of mitral valve disease in young, operated upon at Military Hospital (Cardiothoracic Centre), Pune, during the last 10 years. The clinical electro-cardiographic and roentgenographic findings are presented. Echocardiographic and haemodynamic studies were performed in a few cases. 136 cases underwent closed mitral valvotomy and in 34 cases open heart surgery was performed. Closed mitral valvotomy achieved satisfying results in majority of the cases of mitral stenosis. Open heart surgery was considered when there was gross mitral regurgitation, multivalvular disease or left atrial thrombus. Closed mitral valvotomy continues to be the treatment of choice in the majority of the cases in this age group.

A study of embolism in mitral valve disease and atrial fibrillation.

A number of possible risk factors, clinical, radiological, biochemical, and social have been examined in one group of 34 cases of mitral valve disease and four of lone atrial fibrillation, all of whom gave a history of embolism, and also in a group of 24 cases of mitral valve disease who gave no such history. All were on long-term anticoagulant treatment. Comparison of the two groups disclosed no features that would distinguish those who ran the greater risk of embolism from the remainder other than that the men in the former group were older and of shorter stature. At comparable age, the women with a history of embolism had smaller left atria. Examination of a special group of nine patients who had had embolism despite anticoagulant treatment also disclosed no special features, other than a greater age at the time of their first embolism. Fibrinolytic activity was less and the level of beta thromboglobulin was greater than normal in both groups. Those with proven risk of embolism were not distinguished by higher values of this platelet protein. Neither variable correlated with the type of heart disease. No positive association was found between cigarette smoking and the risk of embolism. Embolism was significantly more likely to occur between 0801 and 1600 hours than at other times of day.

P wave analysis in 2464 orthogonal electrocardiograms from normal subjects and patients with atrial overload.

The purpose of this study was to establish limits of normal for P wave measurements, and to propose criteria for routine electrocardiographic readings and for multivariate analysis to recognize left atrial overload (LAO) and right atrial overload (RAO) in the orthogonal electrocardiogram (ECG). Frank ECG's were obtained from 2464 subjects, including 580 normals, 164 patients with mitral valve disease (MVD) forming the LAO group, and 623 with chronic lung disease (CLD) as the RAO sample. Each group was divided into training and test sets. Using a digital computer, 120 different P wave measurements were computed for each ECG to find optimal discriminators between normal (N), LAO, and RAO. In the training set of MVD, using three scalar measurements, LAO was recognized in 57% with 3% false positives. These criteria diagnosed LAO in 70% of the test cases of MVD. Four discriminators identified RAO in 30% and 37% of training and test cases of CLD with 11% false positives. A set of 15 measurements obtained by multivariate analysis was used in a classification in which the three groups, N, LAO, and RAO were considered simultaneously. Ninety-four percent N, 74% LAO, and 45% RAO in the training sets, and 95%, 71%, and 24% in N, LAO, and RAO test sets were correctly identified. An attempt was made to correlate the rate of recognition of LAO with the degree of LAO estimated by cardiac catheterization. Data reported in the present study can serve as standard for P wave analysis in the Frank ECG.

Anomalous pulmonary venous drainage associated with mitral valve disease

Four cases of mitral stenosis associated with anomalous pulmonary venous return are described. In two of these cases there was severe mitral regurgitation as well. A pulmonary arteriovenous shunt was also found in one of these. A review of the records of patients admitted for cardiac catheterization revealed that in 0.42 per cent of the cases of mitral valve disease and 5.7 per cent of the cases of anomalous pulmonary venous drainage, both conditions were associated. The clinical, roentgenologic, electrocardiographic, and vectorcardiographic findings were predominantly characterized by the mitral valve disease. In every case, the diagnosis was established at cardiac catheterization. Hemodynamic studies were performed. These indicated that the circulatory consequences of the mitral valve disease were only little influenced by the anomalous pulmonary venous return.

Coronary arteriography in valvular heart disease.

Abstract. The authors have studied the preoperative coronary arteriograms in 60 operated cases of aortic valve disease, and in 58 cases of mitral valve disease, of whom two‐thirds have been operated on. Significant coronary artery changes were found only in two cases, both with aortic valvular disease. Angina pectoris was present in 33% of cases with aortic valve disease, most common in aortic stenosis, and in 16% of cases with mitral valve disease. The results show that in valvular heart disease angina pectoris only rarely is due to coronary artery disease. This holds at least for the age groups below 60 years of age, to which the majority of the cases in this series belonged.

P Wave Changes Reflecting Atrial Morphology

The P wave configuration was studied in the limb leads and in precordial leads V 1 and V 2 in 73 cases of atrial derangement. The cases studied consisted of five cases of pulmonary heart disease, nine cases of pulmonary stenosis, ten cases of interatrial septal defect and 49 cases of mitral valve disease. This total group, presenting predominant right-sided cardiac enlargement, demonstrated high peaked waves in the limb leads (2,8 mm.) with an average duration of 0.191 seconds and a high pressure positive component in leads V 1 and V 2 . C=1.94 mm. (height of positive component) 1.94 mm. (width of negative component). The depth of the negative component, E, was 0.30 mm. (depth of P wave in precordial lead V 1 or V 2 ). Hemodynamic and angiographic studies did not correlate with the above P wave changes, which were assumed to reflect right auricular enlargement. The mitral group showed a mean average of: Component A=0.13 sec. (height and duration of P in standard leads) Component B=3.06 mm. Component C=1.9 mm. (height of P wave) Component D=0.069 sec. (width of negative component) Component E=2.13 mm. (depth of P wave in precordial lead V 1 or V 2 ) Of the 49 cases with mitral valve disease, 35 (69.4 per cent) had corroborative hemodynamic angiographic findings. Thirteen out of 14 (99 per cent) of a sub-group with dominant mitral insufficiency presented positive angiographic and hemodynamic findings of left atrial enlargement. The group with mitral valve disease demonstrated differences of a significant degree in the E (depth of P wave in precordial lead V 1 or V 2 ) component—an average of 1.83 mm. for the “pure mitral stenosis” group and 2.54 mm. for the mitral insufficiency group. These studies would indicate the plausibility of the inference that a marked E component in leads V 1 and V 2 is consistent with left atrial enlargement and that a value of greater than 0.20 mm. indicates mitral insufficiency.

Phonocardiography in the assessment of mitral valve disease.

SUMMARYPhonocardiograms of 250 consecutive subjects of mitral valve disease have been examined. The findings in mild mitral stenosis and in predominant mitral incompetence are described.Seventy cases in which the state of the mitral valve was ascertained at operation have been analysed in more detail. The typical findings of “tight” mitral stenosis are described. Variations from this picture may occur where there is heavy mitral valve calcification, where severe pulmonary hypertension accompanies the development of a high pulmonary vascular resistance, and where there is significant aortic valve disease.The importance of the group of cases with severe pulmonary hypertension is emphasized. Cases in this group are often misdiagnosed, either because the signs are wrongly interpreted as being due to mitral incompetence or because the presence of mitral stenosis as the underlying cause of pulmonary hypertension is not recognized.The part played by phonocardiography in the diagnosis of these cases of mitral valve disease, and in the correct assessment of the state of the mitral valve in these and other cases, is stressed.