Mitral valve sub valvular apparatus preservation in pure or predominant rheumatic mitral stenosis

Myocardial fibrosis in rheumatic mitral stenosis (MS) is caused by chronic inflammatory process. Its occurrence may lead to hemodynamic problems, especially after cardiac surgery. Myocardial fibrosis predicts worse morbidity after cardiac surgery, notably in coronary heart disease and aortic valve abnormalities. However, this issue has not been explored yet among patients with rheumatic MS.The aim of the study was to investigate prognostic impact of myocardial fibrosis to postoperative morbidity after mitral valve surgery in patients with rheumatic MS.This is a prospectively enrolled observational study of 47 consecutive rheumatic MS patients. All patients had preoperative evaluation with cardiac magnetic resonance imaging (CMR) including late gadolinium enhancement (LGE) protocol for left ventricular myocardial fibrosis assessment prior to mitral valve surgery. All patients were followed during hospitalization period. Postoperative morbidities were defined as stroke, renal failure, and prolonged mechanical ventilation.This study involved 33 women (70.2%) and 14 men (29.8%) with a mean age of 46 ± 10 years. Preoperative myocardial fibrosis was identified in 43 patients (91.5%). Estimated fibrosis volume ranged from 0% to 12.8% (median 2.8%). Postoperative morbidities occurred in 11 patients (23.4%). Significant mean difference of myocardial fibrosis volume was observed between patients with and without morbidity after mitral valve surgery (5.97 ± 4.16% and 3.12 ± 2.62%, p = 0.04). This significant association was allegedly influenced by different postoperative hemodynamic changes between the two groups.More extensive myocardial fibrosis is associated with postoperative morbiditiy after mitral valve surgery in patients with rheumatic MS.

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Three-dimensional proximal flow convergence automatic calculation for determining mitral valve area in rheumatic mitral stenosis

Echocardiography ◽

10.1111/echo.13558 ◽

2017 ◽

Vol 34 (7) ◽

pp. 1002-1009 ◽

Cited By ~ 2

Author(s):

Francisco Sampaio ◽

Ricardo Ladeiras-Lopes ◽

João Almeida ◽

Paulo Fonseca ◽

Ricardo Fontes-Carvalho ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Three Dimensional ◽

Automatic Calculation ◽

Mitral Valve Area ◽

Rheumatic Mitral Stenosis ◽

Flow Convergence ◽

Valve Area

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A novel method to measure mitral valve area in patients with rheumatic mitral stenosis using three-dimensional transesophageal echocardiography: Feasibility and validation

Echocardiography ◽

10.1111/echo.13786 ◽

2017 ◽

Vol 35 (3) ◽

pp. 368-374 ◽

Cited By ~ 10

Author(s):

Hani M. Mahmoud Elsayed ◽

Mohamed Hassan ◽

Michael Nagy ◽

Alaaeldin Amin ◽

Ahmed Elguindy ◽

...

Keyword(s):

Mitral Valve ◽

Transesophageal Echocardiography ◽

Mitral Stenosis ◽

Three Dimensional ◽

Mitral Valve Area ◽

Rheumatic Mitral Stenosis ◽

Novel Method ◽

Valve Area

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Mechanisms of increase in mitral valve area and influence of anatomic features in double-balloon, catheter balloon valvuloplasty in adults with rheumatic mitral stenosis: a Doppler and two-dimensional echocardiographic study.

Circulation ◽

10.1161/01.cir.76.3.628 ◽

1987 ◽

Vol 76 (3) ◽

pp. 628-636 ◽

Cited By ~ 103

Author(s):

C L Reid ◽

C R McKay ◽

P A Chandraratna ◽

D T Kawanishi ◽

S H Rahimtoola

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Balloon Catheter ◽

Balloon Valvuloplasty ◽

Two Dimensional ◽

Mitral Valve Area ◽

Double Balloon ◽

Rheumatic Mitral Stenosis ◽

Echocardiographic Study ◽

Valve Area

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Two-dimensional and Doppler echocardiographic determinants of the natural history of mitral valve narrowing in patients with rheumatic mitral stenosis: Implications for follow-up

Journal of the American College of Cardiology ◽

10.1016/0735-1097(92)90280-z ◽

1992 ◽

Vol 19 (5) ◽

pp. 968-973 ◽

Cited By ~ 54

Author(s):

Stephen P.F. Gordon ◽

Pamela S. Douglas ◽

Patricia C. Come ◽

Warren J. Manning

Keyword(s):

Mitral Valve ◽

Natural History ◽

Mitral Stenosis ◽

Two Dimensional ◽

Rheumatic Mitral Stenosis ◽

History Of

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Successful Percutaneous Mitral Valve Balloon Valvuloplasty during Third Trimester

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1488 ◽

2017 ◽

Vol 9 (2) ◽

pp. 182-184

Author(s):

G Sindhu Sree ◽

Mamatha Shivanagappa ◽

Nandish Manoli

Keyword(s):

Mitral Valve ◽

Cesarean Section ◽

Mitral Stenosis ◽

Lower Limbs ◽

Balloon Valvuloplasty ◽

Class Iii ◽

Third Trimester ◽

Common Procedure ◽

Rheumatic Mitral Stenosis ◽

Lower Segment Cesarean Section

ABSTRACT Rheumatic mitral stenosis is the most common acquired valvular lesion in pregnant women. The overall mortality is 1%, but can go up to 5% in those patients with New York Heart Association class III and IV symptoms. Percutaneous mitral balloon valvuloplasty (PMBV) is the procedure of choice in the treatment of rheumatic mitral stenosis. The PMBV is usually done in the first or second trimester, but in the third trimester, PMBV is a less common procedure. A 24-year-old gravida 2 para 1 living 1 with 35 weeks of gestation with previous lower segment cesarean section (LSCS) presented with breathlessness and swelling of lower limbs. Evaluation revealed rheumatic mitral stenosis of moderate severity with moderate mitral regurgitation with cardiac failure. Hence, PMBV was done, which resulted in increase of mitral valve area from 0.6 to 1.7 cm2. She had marked symptomatic improvement, and cesarean section was done at 36 weeks 5 days for previous LSCS with preterm premature rupture of membranes. The postoperative period was uneventful. Our report reinforces the fact that third trimester PMBV is safe and effective during pregnancy with no untoward effect on the fetus. How to cite this article Shivanagappa M, Sree GS, Roy P, Manoli N. Successful Percutaneous Mitral Valve Balloon Valvuloplasty during Third Trimester. J South Asian Feder Obst Gynae 2017;9(2):182-184.

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