Natural History Of Mitral Stenosis Research Articles

TCT-613 Natural History of Mitral Stenosis in Patients with Mitral Annular Calcification

Mitral annular calcification (MAC) is recognized as a rare cause of mitral stenosis (MS). However, little is known regarding its natural history. In this study, we aimed to define the progression of MS in patients with severe versus non-severe MAC. Database for the years 1996 through 2013 was

Natural history of mitral stenosis and echocardiographic criteria and pitfalls in selecting patients for balloon valvuloplasty.

In summary, MS is a progressive disease characterized by a long latent period between the initial attack of acute rheumatic fever and the development of symptoms. For patients with MS who require mechanical relief of obstruction PMV is the preferred treatment and gives results comparable to surgical commissurotomy. Two-dimensional echocardiographic assessment of mitral valve morphology is the most important predictor of outcome. An echocardiographic score <8 predicts good immediate and long-term results. In patients undergoing PMV, TEE is useful for detecting left atrial and left atrial appendage thrombi, guiding transseptal puncture, assessing results and detecting complications.

Natural history of mitral stenosis: a review.

Natural history of mitral stenosis: a review.

The Natural History of Mitral Stenosis

The relationship between hemodynamic abnormalities and disability was studied with paired cardiac catheterizations nine to 69 months apart in ten patients with mitral stenosis. Left atrial and pulmonary arterial pressures and pulmonary vascular resistance increased in each patient; however, there was no consistent relationship between the progression of symptoms and the pulmonary vascular resistance. Changes in disability were most closely related to changes in pulmonary arterial and left atrial pressures. Comparable hemodynamic changes between studies also occurred during exercise. These data document the long-suspected relationship between progressive hemodynamic abnormalities and disability in patients with mitral stenosis.

Mitral Stenosis

THE VALUE of mitral valvotomy as a treatment of symptomatic mitral stenosis is an established fact.^1-6The effect of valvotomy on the natural history of mitral stenosis and an evaluation of the factors influencing survival after surgery will be the subject of this discussion. <h3>Material and Methods</h3> A prospective study of patients with predominant mitral stenosis undergoing mitral valve surgery was initiated by Drs. Borden, Baronofsky, and Richards⁷at the University of Minnesota Hospitals in 1950. This report is a follow up study of the initial 100 consecutive cases of mitral stenosis operated on between June 1950 and September 1953. Two patients originally treated have been lost to follow up. Table 1 indicates the preoperative clinical status of the patients according to the New York Heart Association classification. Patients were selected for surgery primarily for the relief of symptoms secondary to pulmonary hypertension. However, 20 patients were operated

Mitral stenosis. A long term postoperative follow-up.

THE VALUE of mitral valvotomy as a treatment of symptomatic mitral stenosis is an established fact. 1-6 The effect of valvotomy on the natural history of mitral stenosis and an evaluation of the factors influencing survival after surgery will be the subject of this discussion. Material and Methods A prospective study of patients with predominant mitral stenosis undergoing mitral valve surgery was initiated by Drs. Borden, Baronofsky, and Richards 7 at the University of Minnesota Hospitals in 1950. This report is a follow up study of the initial 100 consecutive cases of mitral stenosis operated on between June 1950 and September 1953. Two patients originally treated have been lost to follow up. Table 1 indicates the preoperative clinical status of the patients according to the New York Heart Association classification. Patients were selected for surgery primarily for the relief of symptoms secondary to pulmonary hypertension. However, 20 patients were operated

Natural History of Mitral Stenosis

Natural History of Mitral Stenosis

Quantitative effects of medical and surgical treatment of mitral stenosis on exercise tolerance

FTER four years of clinical experience A with mitral valve surgery the operative treatment is reported to be effective in relieving the symptoms and signs of pulmonary engorgement in from 50 to 80 per cent of the patients, with an over-all operative mortality of less than 15 per cent. tp4 The left auricular pressure may be lowered by enlarging the mitral valve orifice. 5 The postoperative improvement has been associated with a decrease in intensity of the diastolic murmur at the apex of the heart.6 Contrariwise, the absence of such changes, or the development of an apical systolic murmur of grade III intensity or greater, has been prognostic of a poor result.” The technic of venous catheterization of the heart and lungs has been employed to demonstrate a decrease in pulmonary arterial pressure and arteriolar resistance, together with a rise in cardiac output postoperatively. 7,8 Although patients often report improvement in exercise tolerance or functional working capacity,4 there has been no systematic study designed to quantitate either the degree or the rate of such improvement, and at the same time differentiate the effects of medical and surgical treatment of the heart disease. While there has been a tendency to urge operative treatment earlier in the natural history of mitral stenosis, a recent review indicated that “the mere presence of a mitral diastolic murmur without accompanying symptoms is not at this time sufficient reason to suggest surgery.“3 Hence there appears to be a need for an appropriate method of testing the severity of symptoms and disability in order to aid the clinical decision for or against surgery at any particular time in the course of mitral stenosis and its complications. Furthermore, since most of the operative mortality is associated with far advanced mitral heart disease, it would be helpful to know the minimal cardiac reserve that may be needed to withstand surgery. In an earlier report a treadmill exercise tolerance test was proposed to meet the clinical need for quantitative data on the physiologic responses to ordinary types of exercise.g The stress was standardized with respect to the speed and grade of walking, and limited in duration by motivation of the patient, the intensity of symptoms or, more arbitrarily, to ten minutes’ time. In the vast majority of patients tested motivation was appropriate and poor results were not due to this factor alone. The stress was proportional to body weight of each patient and represented a threefold increase in the oxygen requirement over the resting level. The test was sufficiently long to observe the optimal adaptations of re:piration and circulation to meet these requirements. Salient responses to exercise could be expressed quantitatively in terms of a ratio designated the “physical fitness index” (PFI). The PFI was derived from the duration of exercise, the average exercise respiratory efficiency (the difference in volumes per cent between the

Pulmonary Hypertension in Heart Disease

THE pulmonary circulation is of paramount importance in failure of the heart. The presence of dyspnea, orthopnea and hemoptysis and a diminution in vital capacity imply a profound change in the blood vessels of the lungs. Unfortunately, the pulmonary circulation, being effectively enclosed within the thorax, has proved inaccessible to quantitative measurements until recently. In spite of this lack of quantitative evidence, clinicians and pathologists have been able to deduce from indirect evidence the course of events in the pulmonary circulation in heart disease. The importance of hypertension of the pulmonary circulation in the natural history of mitral stenosis has . . .