scholarly journals Pulmonary Hypertension in Mitral Valve Disease -- Rheumatic Mitral Stenosis Versus Organic Mitral Regurgitation: The Doppler-Echocardiographic Study Revisited

2021 ◽  
Author(s):  
Nithima Ratanasit ◽  
Khemajira Karaketklang ◽  
Prayuth Rasmeehirun ◽  
Roongthip Chanwanitkulchai
Keyword(s):  
Pulmonary Hypertension ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Pulmonary Artery ◽  
Mitral Valve Disease ◽  
Mitral Stenosis ◽  
Severe Disease ◽  
Pulmonary Regurgitation ◽  
Valve Disease ◽  
Volume Index

Abstract Purpose: The aims of the study were to determine the factors associated with PH among patients with mitral valve disease, and the similarities and differences in the subgroups of mitral stenosis (MS) and mitral regurgitation (MR). Methods: Patients with isolated moderate to severe organic mitral valve disease were prospectively enrolled. Pulmonary hypertension (PH) was defined echocardiographically as pulmonary artery systolic pressure > 50 mmHg. Patients with MS who had mitral valve area > 1.5 cm2 and patients with MR who had effective regurgitant orifice area < 20 mm2 were excluded. Results: There were 318 patients (mean age 54.3 ± 15.5 years, 57.6% female, 66.7% MR). PH was present in 119 (37.4%) patients (48.1% and 31.8% in MS and MR, respectively). Severe mitral valve disease was reported in 245 (77.0%) patients. Left atrial (LA) diameter and pulmonary artery pressure were significantly higher in patients with MS. Dyspnea, LA volume index, significant tricuspid and pulmonary regurgitation, severe mitral valve disease and the presence of MS were independently associated with PH. Among patients with MS, LA volume index and severe disease were independently associated with PH. Significant tricuspid and pulmonary regurgitation, LA volume index and severe disease were independently associated with PH in patients with MR. Conclusions: PH is common in patients with mitral valve disease. LA volume index and severe disease were, in common, independently associated with PH in patients with mitral valve disease and in the subgroups of MS and MR.

scholarly journals The assessment of mitral valve disease: a guideline from the British Society of Echocardiography

2021 ◽  
Author(s):  
Shaun Robinson ◽  
Liam Ring ◽  
Daniel X Augustine ◽  
Sushma Rekhraj ◽  
David Oxborough ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Disease ◽  
Mitral Stenosis ◽  
Imaging Techniques ◽  
Transoesophageal Echocardiography ◽  
Valve Disease ◽  
British Society ◽  
Primary Indication ◽  
Echocardiographic Assessment

Mitral valve disease is common. Mitral regurgitation is the second most frequent indication for valve surgery in Europe and despite the decline of rheumatic fever in western societies, mitral stenosis of any aetiology is a regular finding in all echo departments. Mitral valve disease is therefore one of the most common pathologies encountered by echocardiographers, as both a primary indication for echocardiography and a secondary finding when investigating other cardiovascular disease processes. Transthoracic and transoesophageal echocardiography (TOE) play a crucial role in the assessment of mitral valve disease and are essential to identifying the aetiology, mechanism and severity of disease and for helping determine the appropriate timing and method of intervention. This guideline, from the British Society of Echocardiography (BSE), describes the assessment of mitral regurgitation and mitral stenosis and replaces previous BSE guidelines describing the echocardiographic assessment of mitral anatomy prior to mitral valve repair surgery and percutaneous mitral valvuloplasty. It provides a comprehensive description of the imaging techniques (and their limitations) employed in the assessment of mitral valve disease. It describes a step-wise approach to identifying: aetiology and mechanism, disease severity, reparability and secondary effects on chamber geometry, function and pressures. Advanced echocardiographic techniques are described for both transthoracic and transoesophageal modalities, including TOE and exercise testing.

scholarly journals Transcatheter Mitral Valve Replacement for Treating Native Mitral Valve Disease: Current Status

2020 ◽  
Vol 47 (4) ◽  
pp. 271-279
Author(s):  
Yan Chen ◽  
Junjie Hu ◽  
Shunqiang Wu ◽  
San Zhang ◽  
Kaiqin Wu ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Disease ◽  
Mitral Stenosis ◽  
Valve Disease ◽  
Technical Success Rate ◽  
Transcatheter Mitral Valve Replacement ◽  
Transapical Access

Transcatheter mitral valve replacement is increasingly being used as a treatment for high-risk patients who have native mitral valve disease; however, no comprehensive studies on its effectiveness have been reported. We therefore searched the literature for reports on patients with native mitral valve disease who underwent transcatheter access treatment. We found 40 reports, published from September 2013 through April 2017, that described the cases of 66 patients (mean age, 71 ± 12 yr; 30 women; 30 patients with mitral stenosis, 34 with mitral regurgitation, and 2 mixed) who underwent transcatheter mitral valve replacement. We documented their baseline clinical characteristics, comorbidities, diagnostic imaging results, procedural details, and postprocedural results. Access was transapical in 41 patients and transseptal in 25. The 30-day survival rate was 82.5%. The technical success rate (83.3% overall) was slightly but not significantly better in patients who had mitral regurgitation than in those who had mitral stenosis. Transapical access procedures resulted in fewer valve-in-valve implantations than did transseptal access procedures (P=0.026). These current results indicate that transcatheter mitral valve replacement is feasible in treating native mitral disease. The slightly higher technical success rate in patients who had mitral regurgitation suggests that a valve with a specific anchoring system is needed when treating mitral stenosis. Our findings indicate that transapical access is more reliable than transseptal access and that securely anchoring the valve is still challenging in transseptal access.

scholarly journals Characterization of Degenerative Mitral Valve Disease: Differences between Fibroelastic Deficiency and Barlow’s Disease

2021 ◽  
Vol 8 (2) ◽  
pp. 23
Author(s):  
Aniek L. van Wijngaarden ◽  
Boudewijn P. T. Kruithof ◽  
Tommaso Vinella ◽  
Daniela Q. C. M. Barge-Schaapveld ◽  
Nina Ajmone Marsan
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Disease ◽  
Patient Management ◽  
Valve Disease ◽  
Common Cause ◽  
Barlow’S Disease ◽  
Primary Mitral Regurgitation ◽  
Fibroelastic Deficiency

Degenerative mitral valve disease causing mitral valve prolapse is the most common cause of primary mitral regurgitation, with two distinct phenotypes generally recognized with some major differences, i.e., fibroelastic deficiency (FED) and Barlow’s disease. The aim of this review was to describe the main histological, clinical and echocardiographic features of patients with FED and Barlow’s disease, highlighting the differences in diagnosis, risk stratification and patient management, but also the still significant gaps in understanding the exact pathophysiology of these two phenotypes.

Enhance Smooth Muscle Cells Apoptosis Associated With Pulmonary Arterial Remodeling in Dogs Affected With Pulmonary Hypertension Secondary to Degenerative Mitral Valve Disease

2021 ◽  
Author(s):  
Siriwan Sakarin ◽  
Anudep Rungsipipat ◽  
Sirilak Disatian Surachetpong
Keyword(s):  
Pulmonary Hypertension ◽  
Smooth Muscle ◽  
Mitral Valve ◽  
Pulmonary Artery ◽  
Smooth Muscle Cells ◽  
Mitral Valve Disease ◽  
Caspase 3 ◽  
Muscle Cells ◽  
Pulmonary Arterial ◽  
Medial Thickening

Abstract Background: Degenerative mitral valve disease (DMVD) is the most common cause of pulmonary hypertension (PH) in dogs. Medial thickening of the pulmonary artery is a major histopathological change in PH. A decrease in apoptosis of pulmonary arterial smooth muscle cells (SMCs) may be the cause of medial thickening. This study aimed to demonstrate the expression of apoptosis molecules in the pulmonary artery of dogs affected with PH secondary to DMVD (DMVD+PH) compared to DMVD without PH (DMVD) and healthy dogs (control). Lung samples were collected from three groups including control (n=5), DMVD (n=7) and DMVD+PH (n=7) groups. Masson trichrome and apoptotic proteins including Bax, Bcl2 and caspase-3 and -8, were stained. Results: The medial thickness in the DMVD and DMVD+PH groups was greater than in the control group and it was greatest in the DMVD+PH group. Bax, Bcl2 and caspase-3 and -8 were expressed mainly in the medial layer of the pulmonary artery. The percentages of Bax and caspase-3 and -8 positive cells were higher in the DMVD group compared to the DMVD+PH group, whereas the percentage of Bcl2-positive cells was increased in the DMVD and DMVD+PH groups. These findings suggested that apoptosis of pulmonary arterial SMCs occurred mainly in the DMVD group and decreased dramatically in the DMVD+PH group. Conclusions: An increase in the medial thickness in dogs affected with PH secondary to DMVD may occur due to a decrease in apoptosis of pulmonary arterial SMCs.

Endothelial microparticles increase in mitral valve disease and impair mitral valve endothelial function

2013 ◽  
Vol 304 (7) ◽  
pp. E695-E702 ◽  
Author(s):  
Hong-Bo Ci ◽  
Zhi-Jun Ou ◽  
Feng-Jun Chang ◽  
Dong-Hong Liu ◽  
Guo-Wei He ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Endothelial Cells ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Disease ◽  
Healthy Subjects ◽  
Heat Shock Protein 90 ◽  
Valve Disease ◽  
No Production ◽  
Endothelial Microparticles

Mitral valve endothelial cells are important for maintaining lifelong mitral valve integrity and function. Plasma endothelial microparticles (EMPs) increased in various pathological conditions related to activation of endothelial cells. However, whether EMPs will increase in mitral valve disease and their relationship remains unclear. Here, 81 patients with mitral valve disease and 45 healthy subjects were analyzed for the generation of EMPs by flow cytometry. Human mitral valve endothelial cells (HMVECs) were treated with EMPs. The phosphorylation of Akt and endothelial nitric oxide synthase (eNOS), the association of eNOS and heat shock protein 90 (HSP90), and the generation of nitric oxide (NO) and superoxide anion (O2˙−) were measured. EMPs were increased significantly in patients with mitral valve disease compared with those in healthy subjects. EMPs were negatively correlated with mitral valve area in patients with isolated mitral stenosis. EMPs were significantly higher in the group with severe mitral regurgitation than those in the group with mild and moderate mitral regurgitation. Furthermore, EMPs were decreased dramatically in both Akt and eNOS phosphorylation and the association of HSP90 with eNOS in HMVECs. EMPs decreased NO production but increased O2˙− generation in HMVECs. Our data demonstrated that EMPs were significantly increased in patients with mitral valve disease. The increase of EMPs can in turn impair HMVEC function by inhibiting the Akt/eNOS-HSP90 signaling pathway. These findings suggest that EMPs may be a therapeutic target for mitral valve disease.

scholarly journals Mitral annulus dynamics in myxomatous mitral valve disease

2021 ◽  
Vol 31 (1) ◽  
pp. 66-75
Author(s):  
Maria-Magdalena Gurzun ◽  
Monica Rosca ◽  
Andreea Calin ◽  
Carmen Beladan ◽  
Marinela Serban ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Mitral Valve Disease ◽  
Current Trend ◽  
Mitral Annulus ◽  
Valve Disease ◽  
Valve Repair ◽  
Functional Changes ◽  
Different Types

Myxomatous mitral valve disease (MVD) is a common disorder in which the entire mitral valve apparatus seems to be involved. Mitral valve repair is nowadays the method of choice for the correction of mitral regurgitation but the optimal shape and flexibility of the annuloplasty ring remain controversial. Considering that myxomatous MVD covers a wide spectrum from limited fi bro-elastic deficiency to extensive Barlow disease, we presume that the mitral annulus morphological and functional changes are likely different in different types of myxomatous MVD. We analyze the 3-dimensional geometry and the dynamics of the mitral annulus in 110 patients with significant mitral regurgitation due to different types of myxomatous mitral valve disease and 40 normal subjects using 3D transesophageal echocardiography. The mitral annulus differs in patients with limited MVD, extensive MVD and in normal controls in terms of size, shape, and dynamics. Patients with limited MVD have larger, flatter, dysfunctional and more mobile mitral annulus compared to normal, while patients with extensive MVD have even larger, fl atter and more dysfunctional mitral annulus, with reduced mobility. The non-planar dynamics has different patterns during systole, according to the extension of MV disease. Our data may be important for the appropriate choose of annuloplasty mitral annulus in mitral valve repair, the current trend being to choose the ring according to the underlying pathology.

Use of Prostaglandin E1 to Treat Peri-Anaesthetic Pulmonary Hypertension Associated with Mitral Valve Disease

1993 ◽  
Vol 21 (3) ◽  
pp. 161-164 ◽  
Author(s):  
K Mikawa ◽  
N Maekawa ◽  
R Goto ◽  
H Yaku ◽  
K Nishina ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Mitral Valve ◽  
Glyceryl Trinitrate ◽  
Mitral Valve Disease ◽  
Prostaglandin E1 ◽  
Valve Disease ◽  
Prostaglandin E ◽  
Severe Pulmonary Hypertension ◽  
Critical Problem ◽  
Ventricular Afterload

Severe pulmonary hypertension (PH) can be a critical problem during and after cardiac surgery, since it increases right ventricular afterload resulting in decreased cardiac output. A case of pulmonary hypertension associated with mitral valve disease and resistant to glyceryl trinitrate therapy during surgery is reported. The case was treated successfully with prostaglandin E1 (PGE1), indicating that PGE1 can be used peri-operatively in a patient with refractory PH resistant to glyceryl trinitrate treatment.

R-R interval variations influence the degree of mitral regurgitation in dogs with myxomatous mitral valve disease

2014 ◽  
Vol 199 (3) ◽  
pp. 348-354 ◽  
Author(s):  
M.J. Reimann ◽  
J.E. Møller ◽  
J. Häggström ◽  
B. Markussen ◽  
A.E.W. Holen ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Disease ◽  
Valve Disease
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