Superiority of 3D planimetry over pressure half-time method for the assessment of mitral valve area after percutaneous edge-to-edge mitral repair.

INTRODUCTION AND OBJECTIVES: There is limited evidence to identify the most accurate method for measuring the mitral valve area (MVA) after percutaneous edge-to-edge mitral repair. Our objective was to evaluate the optimal method in this context and its correlation with the mean transmitral gradient. METHODS: A registry of patients undergoing percutaneous mitral repair was conducted, analyzing different methods of measuring MVA and their correlation with the mean gradient. RESULTS: We analyzed data from 167 patients. The mean age was 76±10.3 years, 54% were men, and 46% were women. Etiology was degenerative in 45%, functional in 39%, and mixed in 16%. Postclip MVA measurements were 1.89±0.60 cm2 using pressure half-time (PHT), 2.87±0.83 cm2 using 3D planimetry, and the mean gradient was 3±1.19mmHg. MVA using 3D planimetry showed a stronger correlation with the mean gradient (r=0.46, P<.001) than MVA obtained by PHT (r=0.19, P=.048). Interobserver agreement was also higher with 3D planimetry than with PHT (intraclass correlation coefficient of 0.90 vs 0.81 and variation coefficient of 9.6 vs 19.7%, respectively). CONCLUSIONS: Our study demonstrates that the PHT method significantly underestimates MVA after clip implantation compared with direct measurement using transesophageal 3D planimetry. The latter method also correlates better with postimplantation gradients and has less interobserver variability. These results suggest that 3D planimetry is a more appropriate method for assessing postclip mitral stenosis.

Optimizing Percutaneous Mitral Valvuloplasty for Rheumatic Mitral Stenosis　- Clinical Significance of Changes in Mitral Valve Area.

BACKGROUND: Percutaneous mitral valvuloplasty (PMV) is a standard treatment for severe rheumatic mitral stenosis (RMS). However, the prognostic significance of the change in mitral valve area (∆MVA) during PMV is not fully understood.Methods and Results: This study analyzed data from the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, which included 3,140 patients with severe RMS. We focused on patients with severe RMS undergoing their first PMV. Changes in echocardiographic parameters, including MVA quantified before and after PMV, and composite outcomes, including mitral valve reintervention, heart failure admission, stroke, and all-cause death, were evaluated. An optimal result was defined as a postprocedural MVA ≥1.5 cm2without mitral regurgitation greater than Grade II. Of the 308 patients included in the study, those with optimal results and ∆MVA >0.5 cm² had a better prognosis (log-rank P<0.001). Patients who achieved optimal results but with ∆MVA ≤0.5 cm² had a greater risk of composite outcomes than those with optimal outcomes and ∆MVA >0.5 cm² (nested Cox regression analysis, hazard ratio 2.27; 95% confidence interval 1.09-4.73; P=0.028). CONCLUSIONS: Achieving an increase in ∆MVA of >0.5 cm2was found to be correlated with improved outcomes. This suggests that, in addition to achieving traditional optimal results, targeting an increase in ∆MVA of >0.5 cm2could be a beneficial objective in PMV treatment for RMS.

Relationship between echocardiographic parameters and ALBI score in patients with rheumatic mitral stenosis.

An increase in the volume and pressure of the heart chambers has been shown to increase liver stiffness. The Albumin-Bilirubin (ALBI) score is useful and easy-to-use for objectively assessing liver function. There is no information in the literature regarding changes in ALBI scores in patients with rheumatic mitral stenosis (MS). The aim of our study was to investigate changes in ALBI score and its clinical impact in patients with MS. Of the 247 patients analyzed, 54 were excluded from the study. The remaining 193 patients with MS were divided into two groups: Group I (64 patients with mitral valve area > 1.5 cm2 and mean transmitral gradient < 10 mmHg) and Group II (129 patients with mitral valve area ≤ 1.5 cm2 and mean transmitral gradient ≥ 10 mmHg). The ALBI score was calculated based on serum albumin and total bilirubin levels using the following formula: ALBI= (log10 bilirubin [µmol/L] × 0.66) + (albumin [g/L] × - 0.085). A significant correlation was found between the ALBI score and mitral valve area in patients with MS (r = - 0.479, p < 0.001*) (Table 4; Fig. 3A). An ALBI score greater than - 2.61 was associated with severe MS (mitral valve area < 1.5 cm2), with a sensitivity of 72% and a specificity of 69% (Area under the ROC curve = 0.726; p < 0.001; 95% CI 0.650-0.802) (Fig. 4A). A significant correlation was found between the ALBI score and mean transmitral gradient in patients with MS (r = 0.476; p < 0.001*) (Table 4; Fig. 3B). An ALBI score greater than - 2.57 was associated with severe MS (mean transmitral gradient < 10 mmHg), with a sensitivity of 65% and a specificity of 67% (Area under the ROC curve = 0.684; p < 0.001; 95% CI 0.608-0.759) (Fig. 4B). In multivariate linear regression analysis, mitral valve area and mean transmitral gradient were significantly associated with increased ALBI scores (p < 0.05). Mitral valve area, mean transmitral gradient, and NT-proBNP levels were significantly associated with the ALBI score. The ALBI score could provide an information about the severity of MS. The ALBI score is a simple, evidence-based, objective, and discriminatory method for assessing liver function in patients with MS.Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.Authors and their respective affiliations are correctly identified.

A study of Clinical Profile and in Hospital Outcomes of patients undergoing Percutaneous Transvenous Mitral Commissurotomy at a Tertiary Care Center of Nepal.

Introduction: Rheumatic heart disease (RHD), is a common cause of mitral stenosis (MS) in developing nations. As per current recommendation, Percutaneous Transvenous Mitral Commissurotomy (PTMC) is advised as a Class IA (I-Class Of Recommendation, COR; A-Level Of Evidence, LOE) indication in patients with symptomatic severe mitral stenosis. We aim to examine the clinical profile and in-hospital results of PTMC for mitral stenosis. Methods: A cross-sectional retrospective study was conducted at Manmohan Cardiothoracic Vascular and Transplant Center from April 2020 to May 2022. A structured questionnaire was used to collect the data and ethical approval for conducting the study was taken from the Institutional Review Committee (IRC) of Institute of Medicine (IOM). The data was collected in Microsoft Excel (Ver. 2013). For statistical analysis, SPSS 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) Association was measured using a parametric and non-parametric test (depending upon the distribution of data) and p value < 0.05 was considered significant. Results: A total of 104 patients who met the inclusion criteria underwent PTMC during the study period. The mean age group of the patient was 41.7 ± 12.5 years, of which 23 (22.1%) were males and 81 (78.9%) were females. Mean mitral valve area prior to PTMC was 0.98 ± 0.19 mm2 that increased to 1.69 ± 0.19 mm2 after the procedure and it was statistically significant (p=<0.001). The post PTMC MVA varied with PTMC Wilkin's score with less than or equal to 8 having favorable outcomes. Conclusion: Successful PTMC is highly influenced by the patients' increasing age, valve morphology (calcification, thickness, mobility), Left atrial dimensions, Pre PTMC mitral valve area, Degree of Baseline mitral regurgitation. Post procedure development of MR is usually well tolerated but rarely be severe enough requiring surgical valve replacement.

Diagnostic Role of Incidental Premature Contractions During Doppler Echocardiography.

Cardiac sonographers often perceive premature beats as a limiting factor during echocardiography because they alter filling and contractility, and loops recorded during or after a premature contraction are often discarded. Here we present 2 cases in which the incidental occurrence of premature beats on Doppler echocardiography contributed to the diagnosis. (Level of Difficulty: Intermediate.).

Invasive Hemodynamic Predictors of Survival in Patients With Mitral Stenosis Secondary to Mitral Annular Calcification.

Background The aim of this study was to establish prognostic hemodynamic parameters in patients with mitral stenosis secondary to mitral annular calcification. Methods and Results A retrospective cohort of 105 patients undergoing transseptal catheterization for hemodynamic evaluation of mitral annular calcification-related mitral stenosis between 2004 and 2020 was studied. Mitral valve gradient (MVG) and mitral valve area (MVA; calculated by the Gorlin formula) were measured using direct left atrial and left ventricular pressures. The median age of the patients was 70.3 years (58.4-76.7 years), and 53.3% were women. The median MVA was 1.7 cm2 (1.3-2.3 cm2) and MVG was 7.3 mm Hg (5.3-10.3 mm Hg); left ventricular end-diastolic pressure was 17.6±28.3 mm Hg. During a median of 2.1 years (0.7-4.5 years), there were 63 deaths; 1- and 5-year survival were 76% and 40%, respectively. There was no association between left ventricular end-diastolic pressure and survival. After adjusting for age and comorbidities, both MVA (hazard ratio [HR], 0.50 per cm2; 95% CI, 0.34-0.73) and MVG (HR, 1.1 per mm Hg; 95% CI, 1.05-1.20) were independent predictors of death. Atrial fibrillation was also independently associated with mortality. When added to a combined model, MVA remained associated with death (HR, 0.51 per cm2; 95% CI, 0.33-0.79) while MVG was not. Conclusions In patients with mitral annular calcification-related mitral stenosis, survival was poor. MVA and MVG were independently associated with death, but MVA was a better predictor of outcomes.

Measurement of mitral valve area by direct three dimensional planimetry compared to multiplanar reconstruction in patients with rheumatic mitral stenosis.

Mitral valve area (MVA) measurement by three-dimensional transesophageal echocardiography (3D-TEE) has a crucial role in the evaluation of mitral stenosis (MS) severity. Three-dimensional direct (3D-direct) planimetry has been proposed as a new technique to measure mitral valve area. This study aimed to compare the 3D-direct mitral valve planimetry to conventional three-dimensional multiplanar reconstruction (3D-MPR) in severe MS using 3D-TEE. In this cross-sectional, prospective study; 149 patients with severe MS who were referred for transesophageal echocardiography in Shahid Madani Hospital (Tabriz Iran), just before percutaneous transmitral commissurotomy (PTMC), recruited consecutively. All patients underwent 2D transthoracic echocardiography (2D-TTE) and 3D-TEE in a single session before PTMC. During 2D-TTE planimetry, pressure half time (PHT), and proximal isovelocity surface area (PISA) were applied to measure the MVA. Transmitral mean pressure gradient (MPG) was measured. During 3D-TEE, MVA planimetry was carried out with both 3D-direct and 3D-MPR methods. 3D-direct was applied from both atrial and ventricular views. The consistency of MVA measurements with 3D-direct, 3D-MPR, and 2D-TTE methods was statistically investigated. Our sample consisted of 109 (73.2%) women and 40 (26.8%) men. The mean age was 51.75 ± 9.81 years. The agreement between 3D-direct and 3D-MPR planimetry was significant and moderate (0.99 ± 0.29 cm2 vs. 1.12 ± 0.26 cm2, intraclass correlation = 0.716, p value = 0.001).The accuracy of the 3D-direct method reduced significantly compared to the MPR method at MVA > 1.5 cm2. The maximum difference between two methods was observed in cases with MVAs larger than 1.5 cm2. MVA measured with the 3D-MPR method was significantly correlated with a 2D-TTE method, with a moderate agreement (intraclass correlation = 0.644, p value = 0.001). Also, 2D-TTE and 3D-direct TEE techniques yielded significantly consistent measurements of the MVA (1.06 ± 0.026 cm2 vs. 0.99 ± 0.29 cm2, intraclass correlation = 0.787, p value = 0.001); however, with a slight overestimation of the MVA by the former with a net difference of 0.06 ± 0.013 cm2. Mitral valve pressure gradient (MPG) had no significant correlation with planimetry results. A significant inverse correlation was seen between the MVA and pulmonary arterial systolic pressure. 3D-direct planimetry has an acceptable agreement with 3D-MPR planimetry at MVA less than 1.5 cm2, but their correlation decreases significantly at MVA above 1.5 cm2. 3D-direct planimetry underestimates MVA compared to 3D-MPR, especially at MVA above 1.5 cm2. It seems that the saddle shape of mitral valve, interferes with 3D-direct measurement of commissures at moderate MS. The 2D-TTE planimetry has generally acceptable accuracy, but its correlation to the 3D-TEE methods is significantly reduced in cases with moderate to severe MS (i.e. MVA > 1.0 cm2).

Anatomical and Technical Predictors of Three-Dimensional Mitral Valve Area Reduction After Transcatheter Edge-To-Edge Repair.

BACKGROUND: Among current transcatheter therapies for the treatment of mitral regurgitation, the MitraClip (MC; Abbott Vascular, Abbott Park, IL) system is the most commonly used. MitraClip implantation is usually contraindicated in patients with a mitral valve area (MVA) < 4.0 cm2. However, little is known about the real impact of MC implantation on MVA. Our goal was to investigate the factors influencing MVA reduction and derive the minimal MVA required to prevent the development of a clinically significant mitral stenosis (MVA < 1.5 cm2) in different clinical scenarios. METHODS: Using three-dimensional data sets, the annulus and leaflet anatomy and MVA before clip implantation (MVABC) were assessed. After each MC implant (NTR or XTR), the relative MVA reduction and the absolute residual MVA were measured and their predictors evaluated. RESULTS: The present analysis included 116 patients. An MC XTR was the first device implanted in 50% of the subjects, and 53% were treated with a single implant. The MVA reduction following one XTR was 57% ± 7% versus 52% ± 8% after one NTR (P = .001). A lower MVA reduction was observed when the MC was placed commissural/central versus paracentral (50% ± 8% vs 57% ± 7%, P < .0001). After a second device, the additional MVA reduction was higher when creating a triple-compared with a double-orifice morphology (34% ± 11% vs 25% ± 9%, P = .001). The MVA after one MC correlated with MVABC as well as with the clip type and position (r = 0.91, P < .0001). The MVABC, orifice morphology, and first device position predicted MVA after two implants (r = 0.82, P < .0001). Based on the mathematical relationship between these parameters, the minimal MVABC needed in eight different clinical scenarios was summarized in a decision algorithm: the values ranged from 3.5 to 4.7 cm2 for one and 4.5 to 6.3 cm2 for two MC strategies. CONCLUSIONS: The minimal native MVA preventing clinically relevant MS after transcatheter edge-to-edge repair is predicted by the number and location of clip(s), orifice morphology, and device type. Based on these parameters, an algorithm has been derived to optimize patient selection and preprocedural planning.

Correlation between mitral valve area and left atrial function in rheumatic mitral valve stenosis patients.

BACKGROUND: Rheumatic heart disease (RHD) continues to be one of the leading causes of cardiovascular morbidity and mortality. The mitral valve frequently develops mitral stenosis (MS), and it is the most prevalent valve lesion in patients with chronic RHD. Left atrial (LA) functional impairment is associated with rheumatic MS. AIM: The aim of this study was to evaluate the association between LA function and mitral valve area (MVA) in rheumatic MS patients, and to assess the echocardiographic parameters in sinus rhythm and atrial fibrillation (AF) patients. METHODS: This was a cross-sectional, descriptive study that involved patients with rheumatic MS. Patients underwent a standard 12-lead electrocardiogram and echocardiographic examination. MVA was assessed and correlated with LA function. Comparison was made between sinus rhythm and AF patients. RESULTS: Eighty-one patients with rheumatic MS were included in this study, with 71.6% of them having associated MR. MVA showed a statistically highly significant positive correlation with LA and right ventricular (RV) function, and a statistically significant/highly significant negative correlation with their dimensions. A higher percentage of patients with severe MS was in AF (58.1%). CONCLUSIONS: There was a positive correlation between LA function and MVA in rheumatic MS patients. AF was related to the severity of MS.

Mitral Arcade With Anomalous Papillary Muscles: Rare Cause of Mitral Stenosis in a Young Adult.

We present the case of a symptomatic young woman with mitral stenosis and regurgitation due to a congenital mitral arcade. Multimodality imaging with echocardiography and computed tomography were used for diagnosis and surgical planning. The patient underwent successful bioprosthetic valve replacement. (Level of Difficulty: Intermediate.).

Efficacy and safety of percutaneous mitral balloon valvotomy in patients with mitral stenosis: A systematic review and meta-analysis.

AIMS: Percutaneous mitral balloon valvotomy PMBV is an acceptable alternative to Mitral valve surgery for patients with mitral stenosis. The purpose of this study was to explore the immediate results of PMBV with respect to echocardiographic changes, outcomes, and complications, using a meta-analysis approach. METHODS: MEDLINE, and EMBASE databases were searched (01/2012 to 10/2018) for original research articles regarding the efficacy and safety of PMBV. Two reviewers independently screened references for inclusion and abstracted data including article details and echocardiographic parameters before and 24-72 h after PMBV, follow-up duration, and acute complications. Disagreements were resolved by third adjudicator. Quality of all included studies was evaluated using the Newcastle-Ottawa Scale NOS. RESULTS: 44/990 references met the inclusion criteria representing 6537 patients. Our findings suggest that PMBV leads to a significant increase in MVA (MD = 0.81 cm2; 0.76-0.87, p < 0.00001), LVEDP (MD = 1.89 mmHg; 0.52-3.26, p = 0.007), LVEDV EDV (MD = 5.81 ml; 2.65-8.97, p = 0.0003) and decrease in MPG (MD = -7.96 mmHg; -8.73 to -7.20, p < 0.00001), LAP (MD = -10.09 mmHg; -11.06 to -9.12, p < 0.00001), and SPAP (MD = -15.55 mmHg; -17.92 to -13.18, p < 0.00001). On short term basis, the pooled overall incidence estimates of repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post-PMBV stroke, and systemic thromboembolism were 0.5%, 2%, 1.4%, 0.4%, and 0.7%% respectively. On long term basis, the pooled overall incidence estimates of repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post-PMBV stroke, systemic thromboembolism were 5%, 11.5%, 5.5%, 2.7%, and 1.7% respectively. CONCLUSION: PMBV represents a successful approach for patients with mitral stenosis as evidenced by improvement in echocardiographic parameters and low rate of complications.

Three-dimensional transesophageal echocardiography measurement of mitral valve area in patients with rheumatic mitral stenosis: multiplanar reconstruction or 3D direct planimetry?

3D direct planimetry is increasingly used in clinical practice as a rapid way to measure the mitral valve area (MVA) in patients with rheumatic mitral stenosis (MS) who underwent three-dimensional transesophageal echocardiography (3D-TEE). However, data on its accuracy and reliability are scarce. This study aimed to compare the MVA measurements obtained by 3D direct planimetry to the conventional technique multiplanar reconstruction (MPR) in MS patients using 3D-TEE. We retrospectively included 49 patients with rheumatic MS undergoing clinically-indicated 3D-TEE in the study. We determined the 3D direct planimetry measurements of MVA from the left atria aspect (MVALA) and the left ventricle aspect (MVALV), and compared those with the MPR method (MVAMPR). We also assessed the major and minor diameters of the mitral valve orifice using MPR and 3D direct planimetry. We found an excellent agreement between the MVA measurements obtained by the MPR method and 3D direct planimetry (MVALA and MVALV) [intraclass correlation coefficients (ICC) = 0.951 and 0.950, respectively]. However, the MVAMPR measurements were significantly larger than the MVALA and MVALV (p < 0.001; mean difference: 0.12 ± 0.15 cm2 and 0.11 ± 0.16 cm2, respectively).The inter-observer and intra-observer variability ICC were 0.875 and 0.856 for MVAMPR, 0.982 and 0.984 for MVALA, and 0.988 and 0.986 for MVALV, respectively. The major diameter measured by MPR (1.90 ± 0.42 cm) was significantly larger than that obtained by 3D direct planimetry (1.72 ± 0.35 cm for the LA aspect, p < 0.001; 1.73 ± 0.36 cm for the LV aspect, p < 0.001). The minor diameter measured by MPR (0.96 ± 0.25 cm) did not differ from that derived by 3D direct planimetry (0.94 ± 0.25 cm for the LA aspect, p = 0.07; 0.95 ± 0.27 cm for the LV aspect, p = 0.32). 3D direct planimetry provides highly reproducible measurements of MVA and yields data in excellent agreement with those obtained by the MPR method. The discrepancy between the two techniques may be due to differences in major diameter measurements of the mitral valve orifice.

Long-Term Prognosis of Patients Who Underwent Percutaneous Transvenous Mitral Commissurotomy for Mitral Stenosis.

The long-term prognosis for up to 20 years of patients who have undergone percutaneous transvenous mitral commissurotomy (PTMC) for mitral stenosis (MS) is unknown.We examined 77 of 93 patients (83%) with MS and who underwent PTMC from 1989 to 2002 at our institute, as well as the occurrence of either one of the following clinical endpoints until September 1, 2018: all-cause death or repeat intervention for the mitral valve.The mean follow-up duration was 20.5 ± 7.3 years. The mean age was 51 ± 11 years. Overall, the 20-year survival rate was 71% ± 5%; without any intervention, the 20-year survival rate was 40% ± 6%. In patients who achieved good immediate results (i.e., mitral valve area (MVA) of ≥ 1.5 cm2 without mitral regurgitation (MR) of > 2/4 after PTMC), the 20-year survival rate was 80% ± 6%; without any intervention, the 20-year survival rate was 54% ± 7%.In our 20-year observational study, patients who have undergone PTMC for MS had favorable prognosis, especially in those who achieved good immediate results. In those who had poor immediate results, careful follow-up is needed because they might have more clinical event and any intervention for the mitral valve.

Percutaneous Balloon Mitral Valvuloplasty During Antenatal Care and Apgar Score: The ANC-Valve Study.

OBJECTIVES: The present study aimed to evaluate maternal and fetal outcomes in patients who underwent percutaneous balloon mitral valvuloplasty (PBMV) during antenatal care. METHODS: Analysis of 117 pregnant women who underwent PBMV for rheumatic mitral stenosis. Demographic, clinical, echocardiographic, hemodynamic, and Doppler examinations were performed. The pregnant women were stratified according to New York Heart Association classification. Apgar scores were recorded at 1, 5, and 10 minutes to assess the neonatal outcomes. RESULTS: In our study cohort, 74.36% underwent PBMV during their second trimester, at gestational age of 22.49 ± 5.82. Term birth, mode of delivery, birth weight, and Apgar score at 5 minutes were significantly associated with pregnancy and neonatal outcomes. Mitral valve area, mitral valve gradient, and pulmonary artery systolic pressure were significantly improved (P<.001) after PBMV. Pulmonary edema, medical termination of pregnancy, hypothyroidism, hepatitis B infection, pneumonia, and postprocedural delivery, as well as postprocedure severe mitral regurgitation requiring surgery in 2 patients, were the few complications observed. Mean fluoroscopy time was 4 minutes, 50 seconds, with 100% success rate. No maternal mortality was observed. CONCLUSION: PBMV is a safe and effective intervention for mitral stenosis in pregnant women, with favorable maternal and short-term neonatal outcomes. PBMV offers excellent results in terms of symptomatic relief, hemodynamic improvement, and 100% success rate. Hence, it could be regarded as a preferred choice of intervention in managing symptomatic moderate to severe rheumatic mitral stenosis in pregnant women.

Mitral leaflet separation index for mitral valve assessment during balloon mitral valvuloplasty.

OBJECTIVE: The objective of the study was to evaluate the accuracy of the mitral leaflet separation index (MLSI) in selected patients with mitral stenosis, before and after percutaneous balloon mitral valvuloplasty (PBMV), compared to conventional methods with transthoracic echocardiography [TTE]. METHODS: A prospective study was conducted in 30 patients, ages 20-60 years, with severe symptomatic mitral stenosis (MS) who had PBMV in the Cardiology Department, Zagazig University and National Heart Institute. A mean of three to five measurements of MLSI was taken in diastole in the parasternal long-axis and apical four-chamber views. The MLSI was re-measured 24-48 hours after PBMV. We calculated the correlation of the MLSI, pre and post BMV, with two-dimensional (2D) MV planimetry and pressure half-time (PHT) methods to assess MVA. RESULTS: There was a positive, highly significant correlation between pre PBMV 2D planimetry and MLSI (r = .665, P-value < .001) as well as post PBMV 2D planimetry and MLSI (r = .410, P-value = .025). A positive highly significant correlation was also noted between pre PBMV PHT and MLSI (r = .678, P-value <.001) and between post PBMV PHT and MLSI (r = .706, P-value <.001). CONCLUSION: Mitral leaflet separation index is an easy and reliable measurement for the assessment of mitral stenosis before and after PBMV.

Quality of life assessment after successful percutaneous transmitral commissurotomy and ascertain its relationship with gender / Evaluación de la calidad de vida tras comisurotomía mitral percutánea exitosa y determinación de su relación con el sexo

Abstract Background: percutaneous transmitral commissurotomy has become an ideal treatment option for mitral stenosis due to its less adverse events and more favorable outcomes. Patients improve symptomatically after percutaneous transmitral commissurotomy but we have minimal available data about the quality of life after percutaneous transmitral commissurotomy. Objective: to assess the quality of life after percutaneous transmitral commissurotomy through WHOQol scoring covering different aspects of life, to determine its correlation with a net gain in mitral valve area (MVA) and to ascertain its association with gender. Methods: it was a prospective cohort study carried out for a period of 15 months. A total of 100 patients with mitral stenosis who had successful percutaneous transmitral commissurotomy done were enrolled in the study. Among the total included, 4 patients were lost to follow up and data were collected from 96 patients. Quality of life was assessed before the procedure, at 1 month and 3 months follow up after percutaneous transmitral commissurotomy using WHOQol scoring questionnaire. Results: among 96 patients, 64 (67%) were females and 32 (33%) were males. WHOQol scoring improved significantly after percutaneous transmitral commissurotomy from 32.8±8.9 to 54.6±11.2 and 62.8± 9.7, after one month and 3 months respectively. There was a significant association between net gain of MVA and WHOQol scoring with an R value of 0.46 and p value of 0.03. There was no difference in group comparison of all the six domains between male and female patients. Conclusion: successful percutaneous transmitral commissurotomy improves the quality of life in mitral stenosis patients regardless of their gender and has a positive correlation with a net gain in mitral valve area.

Resumen Antecedentes: La comisurotomía mitral percutánea se ha convertido en una opción terapéutica ideal para la estenosis mitral, debido a efectos menos adversos y a resultados más favorables. Los pacientes mejoran sintomáticamente tras la realización de esta técnica, aunque se dispone de escasos datos acerca de la calidad de vida tras su puesta en práctica. Objetivo: Evaluar la calidad de vida tras la comisurotomía mitral percutánea mediante la puntuación WHOQol, que cubre diferentes aspectos de la vida, para determinar su correlación con la ganancia neta del área valvular mitral (AVM), y determinar su asociación con el sexo. Métodos: Estudio prospectivo de cohorte durante un periodo de 15 meses, en el que se incluyeron 100 pacientes con estenosis mitral a quienes se les practicó con éxito comisurotomía mitral percutánea. De entre el total incluido, se perdieron 4 pacientes durante el estudio, por lo que se recolectaron datos de los 96 pacientes restantes. La calidad de vida se evaluó antes del procedimiento, y transcurridos un mes y tres meses de seguimiento, utilizando el cuestionario de puntuación WHOQol. Resultados: De los 96 pacientes, 64 (67%) eran mujeres y 32 (33%) varones. La puntuación WHOQol mejoró considerablemente tras la realización de la comisurotomía mitral percutánea, con valores de 32,8±8,9 a 54,6±11,2 y 62,8± 9,7, transcurridos uno y 3 meses, respectivamente. Se produjo una asociación significativa entre la ganancia neta de AVM y la puntuación WHOQol, con un valor R de 0,46 y un valor p de 0,03. No se produjo diferencia alguna en cuanto a la comparación grupal de los seis dominios entre varones y mujeres. Conclusión: La comisurotomía mitral percutánea exitosa mejora la calidad de vida de los pacientes de estenosis mitral, independientemente del sexo, y tiene una correlación positiva con la ganancia neta del área valvular mitral.

Level of agreement in three-dimensional planimetric measurement of mitral valve area between transthoracic and transesophageal echocardiography.

BACKGROUND: Echocardiographic measurement of mitral valve area (MVA) is critical prior to percutaneous transmitral commissurotomy (PTMC). This study aimed to compare the agreement between transthoracic (TTE) and transesophageal echocardiography (TEE) in three-dimensional (3D) planimetric measurement of the MVA among patients with severe mitral stenosis. METHODS: MVA was measured with planimetry in 105 patients before undergoing PTMC. 3D reconstruction was applied to both TTE and TEE examinations. The MVA values from four different methods of 3D reconstruction were compared to the average values of 3D methods in TEE as the gold standard measurement method for the MVA in this study. The agreement levels between the two examinations were evaluated and analyzed for various reconstruction methods. RESULTS: The mean age was 49 ± 12 years for 28 men and 77 women who were enrolled. The image quality was graded as "excellent" in 57% of 3D images obtained by TTE, while it was graded as "excellent" in 81% of 3D images obtained by TEE. The ventricular zooming method in TTE with a bias of -0.006 ± 0.065 cm2 (P < 0.0001) had the highest agreement with the 3D-MVA in TEE. While 2D-TTE and 3D-TEE measurements of the MVA (R = 0.91; P < 0.0001) were significantly correlated, 2D-TTE overestimated the MVA by 0.19 cm2 . CONCLUSION: Although the quality of 3D images was significantly better in TEE than those in TTE, a good agreement existed between the measured 3D-TTE and 3D-TEE studies. We also demonstrated that 2D-TTE overestimated the MVA compare to 3D-TEE.

Measurement of mitral valve area in patients with mitral stenosis by 3D echocardiography: A comparison between direct planimetry on 3D zoom and 3D quantification.

BACKGROUND: Measurement of the mitral valve area (MVA) in patients with mitral stenosis (MS) by 3D echocardiography (3DE) is usually done via 3D quantification (3DQ). The present study on patients with severe MS sought to evaluate the agreement regarding the MVA measurement between 3DQ and direct planimetry on 3D zoom and also between 3DE and 2DE. METHODS: Twenty-six patients (22 female, mean age:34.5 ± 14.0 years) with severe MS diagnosed by 2D transthoracic echocardiography(2DTTE) underwent 3D transesophageal echocardiography (3DTEE). Direct planimetry, the pressure half-time (PTH), and the continuity equation(CE) constituted 3 conventional 2DTTE methods, and 3DQ and direct planimetry on 3D zoom comprised two 3DTEE methods applied for the MVA measurement. Agreement between the 2D and 3D methods was assessed using the Bland-Altman plot and measuring the intra-class correlation coefficient (ICC). RESULTS: The mean MVA measured by 3DQ was significantly larger than that derived by direct planimetry on 3D zoom (0.935 ± 0.23 cm2 vs 0.846 ± 0.22 cm2 , respectively; P = 0.026). The agreement between 3DQ and 3D zoom for the MVA measurement was moderate to good by the Bland-Altman plot (ICC = 0.67). The mean MVA measured by 2DE (all 3 methods of direct planimetry, the PTH, and the CE) was significantly larger than that derived by 3DE (both methods of 3DQ and direct planimetry on 3D zoom) (all Ps < 0.05). A moderate agreement between 3DQ and 2D planimetry (ICC = 0.43) was found by the Bland-Altman plot. CONCLUSIONS: The MVA measurement by direct planimetry on 3D zoom showed a moderate-to-good agreement with 3DQ; it may, thus, be used in clinical practice as a simple method for the measurement of the MVA in patients with MS.

Three-dimensional transesophageal echocardiography vs cardiac magnetic resonance in the assessment of planimetric mitral valve area in rheumatic mitral stenosis.

AIM: Rheumatic heart disease is a common cause of valvular disease, especially in developing countries. Echocardiography is the gold standard investigation modality for cardiac valves. In rheumatic mitral stenosis (MS), three-dimensional transesophageal echocardiography (3D TEE) provides better alignment of the image plane at the mitral tips and more accurate and reproducible planimetric measurement of mitral valve area (MVA). Cardiac magnetic resonance (CMR) is a new method that provides evaluation of cardiac anatomy and function noninvasively. Previous studies showed strong correlation between planimetric MVA measured by two-dimensional transthoracic echocardiography and CMR. We aimed to compare the planimetric MVAs assessed by 3D TEE and CMR in rheumatic MS patients. To best of our knowledge, this is the first study that compares 3D TEE and CMR for the assessment of the planimetric MVA in rheumatic MS. METHODS: We retrospectively evaluated 28 rheumatic MS patients who underwent 3D TEE and ECG-gated CMR. 3D TEE planimetric MVAs were measured manually by multiplanar reconstruction (MPR) method and CMR planimetric MVAs were measured manually on short-axis cine images. Then, 3D TEE and CMR measurements were compared. RESULTS: A total of 28 patients' (mean age 44 ± 12, 82.1% female) planimetric 3D TEE MVAs (1.00 ± 0.20 cm2 ) and CMR MVAs (1.04 ± 0.17 cm2 ) were found to be highly correlated (P < 0.0001, r: 0.744) with Pearson correlation analysis. Bland-Altman analysis showed strong agreement between two techniques. CONCLUSION: For the diagnosis and the follow-up of rheumatic MS, planimetric CMR MVA is an alternative noninvasive method which highly correlates with planimetric 3D TEE MVA.

[Management of mitral valve stenosis during pregnancy at the Oran university hospital center: About 83 cases]. / Prise en charge du rétrécissement mitral durant la grossesse au centre hospitalo-universitaire d'Oran : à propos de 83 cas.

INTRODUCTION: The management of pregnancy in patients with mitral valve stenosis disease continues to pose a challenge to the clinician. OBJECTIVE: The aim of study was to evaluate the association between mitral valve stenosis and maternal and fetal out come. MATERIEL AND METHOD: Eighty-three pregnant women with mitral valve disease, followed-up from 2009 to 2012, were prospectively evaluated medical history, NYHA class assessment, ECG and echocardiography were performed during pregnancy and after delivery. RESULTS: Women with mitral stenosis had significantly clinical higher incidence of complications deterioration of clinical status was observed (44.57%, P=0.0001) congestive heart failure had observed (27.71%, P=0.0001), hospitalization (33.73%, P=0.0001), need of cardiac medications (53.75%, P=0.009), arrhythmias (16%, P<0.05), New born outcome, mitral stenosis had an effect on fetal outcome. We had increasing preterm, delivery (17.50%, P=0.018), hypotrophy (20.48%, P=0.001), intra-uterine growth retardation (12.04%, P=0.011) new born hospitalizations (13.25%, P=0.03) Increased maternal morbidity and unfavorable fetal outcome was seen mostly in patients with moderate and severe mitral stenosis. CONCLUSION: Pregnant with critical mitral stenosis form a high-risk groups of life-threatening complications. There is need for close maternal follow-up and fetal surveillance and repair of mitral stenosis should be performed before pregnancy.