ABSTRACT
The studies of pulmonary venous flow-pattern in mitral stenosis (MS) have given conflicting data about the type of abnormality. This study was undertaken to assess the pulmonary venous flow-pattern in severe MS and to study the changes occurring after balloon mitral valvuloplasty (BMV). There were 51 patients of MS with sinus rhythm with the mean age of 32.5+/-9.35 years, 18 males and 33 females. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were performed before and after BMV. Pulmonary venous flow was recorded by TEE from left upper pulmonary vein (PV). Peak velocities (V) and velocity time integrals (VTI) of systolic wave (S), diastolic wave (D), and atrial reversal wave (A) were measured. The S(v)/D(v) and S(VTI)/D(VTI) were calculated. Mitral valve area (MVA) increased from 0.81+/-0.18 cm(2) to 2.02+/-0.46 cm(2), left atrium (LA) mean decreased from 28.55+/-6.68 mmHg to 13.88+/-4.89 mmHg, and cardiac output increased from 3.1+/-0.86 L/min to 3.7+/-1.02 L/min. The S, D, and A velocities increased from 33.84+/-13.55 cm/s, 37.24+/-11.55 cm/s, and 20.53+/-6.7 cm/s to 59.86+/-18.25 cm/s, 48.43+/- 12.55 cm/s, and 24. 94+/-9.14 cm/s, respectively. The VTIs of S, D, and A waves increased from 4.88+/-2.24 cm, 6+/-2.45 cm, and 2+/-0.88 cm to 10.46+/-4.23 cm, 8.82+/-3.61 cm, and 2.34+/-1.29 cm, respectively. MS leads to reduction in pulmonary flow velocities during all the phases. Successful BMV resulted in improvement of all these velocities, with improvement in systolic fraction being the maximum. These improved flows after BMV appear to be secondary to reduction in LA pressure and improved cardiac output.
Subject(s)
Catheterization , Echocardiography, Doppler, Pulsed/methods , Echocardiography, Transesophageal , Mitral Valve Stenosis/physiopathology , Mitral Valve/diagnostic imaging , Pulmonary Veins/physiopathology , Adult , Blood Flow Velocity/physiology , Cardiac Catheterization , Cardiac Output , Female , Humans , Male , Mitral Valve Stenosis/diagnostic imaging , Mitral Valve Stenosis/therapy , Myocardial Contraction , Prognosis , Pulmonary Veins/diagnostic imaging , Pulmonary Wedge Pressure/physiologyABSTRACT
The efficacy and safety of percutaneous transvenous mitral commissurotomy performed by the Inoue technique is well known. In cases with critical mitral stenosis and when there is abnormal bulge of the interatrial septum, the usual direct method of crossing the mitral valve may not be successful. In such cases alternative over-the-wire techniques to cross the mitral valve have been advocated by various authors. In this report of 32 cases, we present our experience with the modified and simplified version of over-the-wire technique of crossing the mitral valve in technically difficult cases. This technique involves direct positioning of a pigtail Inoue wire into the left ventricle through the Mullin sheath followed by introduction of an Inoue catheter over the wire. The mitral valve could be crossed in 30 cases (93.75%). There were no major complications attributable to this technique. Frequent ventricular premature beats (100%) and episodes of nonsustained ventricular tachycardia (90%) were seen in most of the cases. We conclude that our modification of the over-the-wire technique is safe, effective, and does not require any additional accessories. Using this technique, percutaneous transvenous mitral commissurotomy could be performed, even in difficult cases wherein the conventional method of crossing the mitral valve has failed.
