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@#Rheumatic mitral stenosis is one of the most common cardiac valvulopathies in our country, which is relatively rare in European and American countries. Medical therapy is reserved mainly for the treatment of complications, which can not fundamentally change the valve structure. Only surgical treatments can correct these valve lesions, including closed mitral commissurotomy, percutaneous balloon mitral valvuloplasty, mitral valve repair under direct vision and mitral valve replacement. Numerous studies demonstrate that valve repair provides better long-term results, though it occupies a low proportion clinically. This article reviewed domestic and foreign literature concerning surgical treatments for patients with rheumatic mitral stenosis to provide some reference for the peers.
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Background:Objective of the study was to provide insight on the immune response in patients of rheumatic heart disease, mitral stenosis and evaluation of various cytokines in pulmonary hypertension secondary to rheumatic heart disease.Methods:Total 163 subjects, more than 18 year of age, were enrolled in this study. 84 subjects with rheumatic mitral stenosis (group A) diagnosed on two-dimensional echocardiography (2D echo)and 79 normal healthy volunteers(group B). Patients with mitral stenosis were further divided into subgroups based on severity of mitral stenosis [mitral valve area (MVA >1 cm2 and MVA <1 cm2)(subgroup Aa and Ab)]and presence or absence of pulmonary hypertension [pulmonary arterial systolic pressure (PASP >36 mm Hg)(subgroup Ac and Ad)]. Interleukins IL-6, IL-10, IL-18, tumour necrosis factor alpha (TNF-?)andhigh-sensitivity C-reactive protein (hs-CRP)levels were assessed in both groups.Results:Mean IL-6, IL-10, IL-18, TNF-? and hs-CRP in group A and group B was 6.57�53 and 2.73�p?0.001), 8.185�8 and 3.51�86(p?0.001), 136.31�.0 and 47.96�76(p?0.001), 21.26�.59 and 5.36�57(p?0.001), 4.69�3 and 2.63�22(p?0.008) respectively. On subgroup analysis mean TNF-? in subgroup Aa was 20.71�.84, while in subgroup Ab was 7.56�93 (p?0.001). Mean IL-10 in subgroup Ac and Ad was 8.74�29 and 7.47�82, respectively. Differences in levels of other cytokines in these subgroups were not found statistically significant.Conclusions:This study finds increased IL-6, IL-10, IL-18, TNF-? and hs-CRP levels in subjects with rheumatic mitral stenosis. Subjects with severe mitral stenosis had increased TNF-? levels. Subjects of mitral stenosis having pulmonary hypertension had increased IL-10 levels.
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Abstract: Introduction: Prevalence of mitral stenosis of rheumatic etiology has diminished. However, in Mexico there are some regions where still represents a health issue in productive population. Percutaneous valvuloplasty has become the treatment of choice in those with favorable anatomy. When successful immediate results are obtained, adequate long-term results are predicted. Objective: To determine the clinical and echocardiographic factors associated with the immediate success of percutaneous mitral valvuloplasty. Material and methods: A comparative and retrospective cross-sectional, observational study. Clinical records of patients treated with percutaneous valvuloplasty between 2000-2016 were reviewed. We studied clinical, echocardiographic, and procedural factors associated with immediate success. Descriptive and inferential statistics were used with SPSS v2.4 package. Results: A total of 363 patients. Female gender 287 (79.1%), age 50.8 ± 10.9 years. Functional class II 218 (60.1%). Atrial fibrillation 201 (55.4%). Previous procedure 78 (21.5%). Wilkins score 8-10: 228 (62.8%). Previous moderate mitral insufficiency 20 (5.5%). Inoue Balloon used in 343 (94.5%). We achieved success in 309 (85.1%), 26 had complications (7.16%), one death. We observed an increased number of complications in patients with pulmonary hypertension (> 60 mmHg) (p = 0.01), transvalvular gradient (mean > 10 mmHg) (p = 0.049), previous moderate mitral regurgitation (p = 0.001), and procedures with double-balloon (p = 0.001). We identified as unfavorable predictors of the procedure with statistical significance: Wilkins score 8-10 points (OR 2.6, 95% CI, 1.3-5.2) and previous moderate mitral regurgitation (OR 3.3, 95% CI, 1.28-8.93). Conclusion: Similar results were obtained with previous studies (success, complications and mortality). Only the Wilkins score greater than 8 points and the previous moderate mitral regurgitation were unfavorable predictors for the success of the procedure.
Resumen: Introducción: La prevalencia de estenosis mitral de etiología reumática ha disminuido. Sin embargo, en México hay regiones donde aún representa un problema de salud en la población productiva. La valvuloplastia percutánea se ha convertido en el tratamiento de elección en pacientes con anatomía favorable. Cuando se obtienen resultados inmediatos exitosos, se predicen resultados adecuados a largo plazo. Objetivo: Determinar factores clínicos y ecocardiográficos asociados con el éxito inmediato de la valvuloplastia mitral percutánea. Material y métodos: Estudio observacional, transversal, comparativo y retrospectivo. Se revisaron las historias clínicas de los pacientes tratados con valvuloplastia percutánea entre 2000-2016. Estudiamos los factores clínicos, ecocardiográficos y de procedimiento asociados con el éxito inmediato. Se utilizaron estadísticas descriptivas e inferenciales con el paquete SPSS v2.4. Resultados: Un total de 363 pacientes. Género femenino 287 (79.1%), edad 50.8 ± 10.9 años. Clase funcional II 218 (60.1%). Fibrilación auricular 201 (55.4%). Procedimiento previo 78 (21.5%). Puntaje de Wilkins 8-10: 228 (62.8%). Insuficiencia mitral moderada previa 20 (5.5%). Se utilizó Balón Inoue en 343 (94.5%). Logramos éxito en 309 (85.1%), 26 tuvieron complicaciones (7.16%), una muerte. Observamos un mayor número de complicaciones en pacientes con hipertensión pulmonar (> 60 mmHg) (p = 0.01), gradiente transvalvular (media > 10 mmHg) (p = 0.049), regurgitación mitral previa moderada (p = 0.001) y procedimientos con doble globo (p = 0.001). Se identificaron como predictores desfavorables del procedimiento con significación estadística: puntuación de Wilkins 8-10 puntos (OR 2.6, IC 95%, 1.3-5.2) y regurgitación mitral moderada previa (OR 3.3, IC 95%, 1.28-8.93). Conclusión: Se obtuvieron resultados similares con estudios previos (éxito, complicaciones y mortalidad). Sólo el puntaje de Wilkins mayor de 8 puntos y la regurgitación mitral moderada previa fueron factores predictivos desfavorables para el éxito del procedimiento.
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Objectives: The present first-in-human study aimed to assess the feasibility of percutaneous balloon mitral valvuloplasty (PBMV) for the treatment of isolated mitral stenosis (MS) under echocardiography guidance only. Methods: Data were obtained from 24 consecutive patients with severe MS, who underwent PBMV from October 2016 to October 2017 under the guidance of echocardiography only. Outpatient follow-up including chest radiography, electrocardiography, and transthoracic echocardiography was conducted at 1, 3, 6 and 12 months post procedure. Results: PBMV was successful in all 24 patients under echocardiography guidance without radiation and contrast agent. Mitral transvalvular pressure gradient derived invasive catheterization measurement dropped from(15.0±5.1) mmHg to (6.7±2.9) mmHg (P<0.01). Mitral valve area increased from (0.8±0.1) cm2at pre-PBMV to (1.7±0.1) cm2post-PBMV (P<0.01). Mean balloon diameter was (26.7±1.2) mm. Mild mitral regurgitation developed in 8 patients. Mean follow-up duration was (7.4±3.1) months. At the last follow-up, mitral valve area remained high (1.6±0.1) cm2and mean transmitral pressure gradient remained low (9.0±4.3) mmHg. No pericardial effusion or peripheral vascular complications occurred. Conclusions: In this patient cohort, PBMV could be successfully performed with echocardiography as the single imaging guidance modality, this procedure is safe and effective and avoids the radiation exposure and contrast agent use.
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<p>We report a case of an 85-year-old woman with severe aortic insufficiency caused by structural valve deterioration (SVD) of Medtronic Freestyle stentless aortic bioprosthesis (Freestyle valve) complicated by rheumatic multivalvular heart disease. The patient received an aortic valve replacement by using the modified sub-coronary method with a 21 mm Freestyle stentless porcine valve (Medtronic Inc., Minneapolis, MN, USA), for severe aortic valve stenosis at of the age of 71. The patient developed severe heart failure 14.5 years after the surgery. She was admitted for severe aortic insufficiency caused by a leaflet injury (tear) of the Freestyle valve. She also had had rheumatic mitral stenosis and secondary tricuspid insufficiency with severe pulmonary hypertension. Therefore, treating her heart failure was difficult, but surgery was performed. The leaflets of the stentless bioprosthesis were resected. The insertion of the needle suture into the annulus of the stentless valve was difficult because of calcification of the tissue. An aortic root enlargement procedure was performed using a bovine pericardial patch, enabling the insertion of the needle suture into the Dacron cloth at the bottom of the stentless valve, with 2-0 Ethibond threads and single sutures. We successfully performed an aortic valve re-replacement using an Open Pivot Mechanical Heart Valve (OPHV) 16 mm AP (Medtronic, Minneapolis, MN, USA), which was implanted by using the partial valve-in-valve technique. Simultaneously, mitral valve commissurotomy and tricuspid annuloplasty were performed. The patient had an uneventful postoperative recovery.</p>
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Hasta el momento, la valoración de la severidad de la estenosis miral reumática ha estado basado en métodos Doppler, muy influenciares por las condiciones hemodinámicas del paciente y en métodos de planimetría valvular obtenida a partir de imágenes bidimensionales. La ecocardiografia 3D en tiempo real ha hecho su aparición en la rutina clínica diaria, proporcionando imágenes de alta calidad en tres dimensiones y requiriendo un muy corto período de tiempo para su adquisición. En el presente trabajo tratamos de realizar una puesta al día de la utilidad de esta técnica en la valoración de la severidad de la estenosis mitral reumática. Estos hallazgos están basados en la experiencia de nuestra Unidad de Imagen Cardiovascular del Hospital Clínico San Carlos de Madrid.
To date, the assessment of rheumatic mitral stenosis has been based on Doppler methods, which have a high dependence on the hemodinamic conditions and on the planimetry obtained from 2D echo images. Real Time 3D echocardiography has been implemented in the daily clinical practice. It provides high quality 3D images and the acquisition time is very short. In the present work, we try to show the "state of the art" of Real Time 3D echocardiography in the assessment of rheumatic mitral stenosis. These findings are based on the experience of our "Unidad de Imagen Cardiovascular" at the Hospital Clínico San Carlos de Madrid. (Arch Cardiol Mex 2005; 75:210-221).
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Female , Humans , Male , Middle Aged , Echocardiography, Three-Dimensional/methods , Mitral Valve Stenosis , Rheumatic Heart Disease , Echocardiography, Doppler , Evaluation Studies as Topic , Mitral ValveABSTRACT
In this paper, the presentations of 2D-color Doppler ultrasound imaging in 43 patients with rheumatic mitral lesion were studied before the replacement of artificial valve.The size of mitral opening, and several hemodynamic semiquan-titativc values were measured in diseased heart.Having analysed the features of valvular lesions, we consider that the 2D-color Doppler ultrasound can demonstrate the characteristics and ths degree of the valvular damage in one or several sections rapidly and directly. Therefore it is a very valuable method for diagnosing the rheumatic valvular lesion.