KORELASI ANTARA INTERVAL S2-OPENING SNAP DAN MITRAL VALVE AREA YANG DIIDENTIFIKASI DENGAN COLOR SPECTROGRAPH PHONOCARDIOGRAPHY  PADA PASIEN MITRAL STENOSIS

Abstract: Color spectrograph phonocardiography (CSP) is a method for recording heart sounds by using a digital stethoscope. The recorded result can be analyzed by using a soft ware. CSP can identify the opening snap (OS) and measure the S2-OS interval. This study aimed to determine the correlation between adjusted S2-OS to the mitral valve area (MVA) in mitral stenosis (MS) patients. The samples were MS patients admitted to the ICCU and the ward of Prof. Dr. R.D. Kandou Hospital, Manado. Patients with atrial fibrillation were excluded. Every patient underwent echocardiography and CSP to obtain the MVA and S2-OS interval. The adjusted S2-OS interval is the S2-OS interval divided by the number of heart beats (milisecond/beat per minute). Variables were analyzed by using the Pearson correlation test. The results showed that there were 14 MS patients involved in this study. There was a strong correlation between adjusted S2-OS interval and MVA. Estimated MVA was obtained by using the formula MVA = -1.358 + 2.07. Conclusion: The adjusted S2-OS interval was strongly correlated to the MVA of MS Patients and could predict the MVA value. Keywords: color spectrograph phonocardiography, S2-OS interval, mitral valve area, mitral stenosis, echocardiography. Abstrak: Color spectrograph phonocardiography (CSP) merupakan metode merekam bunyi jantung dengan menggunakan stetoskop digital. Hasil rekaman ini dapat dianalisis dengan piranti lunak. CSP dapat mengidentifikasi opening snap (OS) dan mengukur interval S2 – OS. Penelitian ini bertujuan untuk mendeteksi korelasi antara interval S2-OS yang sudah disesuaikan dengan mitral valve area (MVA) pada pasien mitral stenosis (MS). Sampel penelitian ialah pasien mitral stenosis yang dirawat di ICCU dan bangsal BLU RSUP Prof. Dr. R.D. Kandou Manado. Pasien dengan atrial fibrilasi dieksklusi. Masing-masing pasien menjalani pemeriksaan echocardiography dan CSP untuk memperoleh MVA dan interval S2-OS. Interval S2-OS yang telah disesuaikan adalah interval S2-OS yang dibagi dengan denyut jantung (milidetik/denyut jantung per menit). Variabel-variabel tersebut dianalisis dengan menggunakan analisis korelasi Pearson. Hasil penelitian memperlihatkan sebanyak 14 pasien mitral stenosis diikutsertakan dalam penelitian. Terdapat korelasi sangat kuat antara interval S2-OS yang telah disesuaikan dengan MVA. Estimasi MVA dapat diperoleh dari persamaan MVA = -1,358 + 2,07.(Interval S2-OS yang telah disesuaikan). Simpulan: Interval S2-OS yang telah disesuaikan memiliki korelasi yang sangat kuat dengan MVA pada pasien-pasien mitral stenosis. Interval S2-OS yang telah disesuaikan dapat memperkirakan nilai MVA. Kata kunci: color spectrograph phonocardiography, interval S2-OS, mitral valve area, mitral stenosis, echocardiography.

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Assessment of Rheumatic Mitral Stenosis severity by Mitral Leaflet Separation Index

Nepalese Heart Journal ◽

10.3126/njh.v16i2.26316 ◽

2019 ◽

Vol 16 (2) ◽

pp. 41-46

Author(s):

Rajan Paudel ◽

Ram Kishor Sah ◽

Man Bahadur KC ◽

Deewakar Sharma ◽

Arun Maskey ◽

...

Keyword(s):

Mitral Valve ◽

Strong Correlation ◽

Mitral Stenosis ◽

Mitral Leaflet ◽

Cross Sectional ◽

Mitral Valve Leaflet ◽

Separation Index ◽

Mitral Valve Area ◽

Stenosis Severity ◽

Valve Area

Background and Aims: Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic reasons. Measurement of Mitral valve area (MVA) by planimetry is gold standard and accurate but is highly operator dependent. Pressure Half Time (PHT) is affected by hemodynamic significance. In this Study we evaluated severity of mitral stenosis by mitral leaflet separation index (MLS index, MLSI). This new index could be useful surrogate measure of the MVA. Methods: This is a hospital based, cross-sectional observational study carried out in Shahid Gangalal National Heart Centre (SGNHC), Kathmandu, Nepal. Study included 82 patients with Rheumatic MS who had undergone echocardiographic examination from July 2018 to December 2018. The maximal separation of the mitral valve leaflet tips was measured from inner edge to inner edge in end diastole in the parasternal long axis and apical 4-chamber views. These two parameters were averaged to yield the MLSI. The index was compared with mitral valve area determined by planimetry method and PHT. Results: Of the 82 study subjects, majority were females 72 (85.4%). The mean age of study patients was 37.33±11.56 years. 30.5% had mild MS by planimetry, 31.7% had moderate MS and 37.8% had severe MS. There was a very strong correlation between MLS index and MVA by planimetry ( r = 0.89, p<0.001) and MVA by PHT (r=0.95, p<0.001). MLS index less than 0.73 cm can predict severe MS with 93.2% sensitivity and 89.3% specificity. On the other hand MLS index more than 1.035cm can predict mild MS with 70% sensitivity and 89.3% specificity. Strong correlation exists between MLS index and MV severity in presence atrial fibrillation (AF) (r=0.879) for planimetry and (r=0.835) for PHT and in presence of coexisting mitral regurgitation (MR) (r=0.89) for planimetry and (r=0.86) for PHT. Conclusion: MLSI has a strong correlation with MVA by planimetry and PHT. So, it can be used as a reliable method to assess severity of mitral stenosis and is a simple and easily obtainable. It has good correlation even in presence of AF and MR.

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Effect of atrial fibrillation and mitral regurgitation on calculated mitral valve area in mitral stenosis

The American Journal of Cardiology ◽

10.1016/0002-9149(86)90849-0 ◽

1986 ◽

Vol 57 (8) ◽

pp. 634-638 ◽

Cited By ~ 49

Author(s):

Robert J. Bryg ◽

George A. Williams ◽

Arthur J. Labovitz ◽

Umit Aker ◽

Harold L. Kennedy

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Stenosis ◽

Mitral Valve Area ◽

Valve Area

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Mitral Valve Area Influences the Impact of Atrial Fibrillation onto Quality of Life among Patients with Mitral Stenosis

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2013.08.684 ◽

2013 ◽

Vol 62 (18) ◽

pp. C244

Author(s):

Mehmet Birhan YILMAZ ◽

Güllü Amioğlu ◽

Okan Onur Turgut ◽

Nuryıl Yılmaz ◽

İzzet Tandoğan

Keyword(s):

Quality Of Life ◽

Atrial Fibrillation ◽

Mitral Valve ◽

Mitral Stenosis ◽

Mitral Valve Area ◽

The Impact ◽

Valve Area

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Mitral Leaflet Separation Index in Assessing the Severity of Mitral Stenosis

ISRN Cardiology ◽

10.5402/2011/768097 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Joby K. Thomas ◽

T. M. Anoop ◽

Gailin B. Sebastian ◽

Kim George ◽

Raju George

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Mitral Stenosis ◽

Continuity Equation ◽

Half Time ◽

Mitral Leaflet ◽

Proximal Isovelocity Surface Area ◽

Mitral Valve Area ◽

Surrogate Measure ◽

Valve Area

Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic reasons. The mitral valve area (MVA) can be measured by planimetry, pressure half-time, continuity equation, and proximal isovelocity surface area methods. In this study, we propose a novel yet simple, independent measure of MS severity–the mitral leaflet separation (MLS) index. This new index could be a useful surrogate measure of the MVA. This index would also help when there is a discrepancy between severities of MS estimated by existing methods, in the presence of atrial fibrillation and in the presence of mitral regurgitation.

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Significance of Mitral M-Mode Vp (Velocity Propagation) for Estimating Mitral Valve Area and Severity in Mitral Stenosis

ACI (Acta Cardiologia Indonesiana) ◽

10.22146/aci.44544 ◽

2019 ◽

Vol 5 (1) ◽

pp. 1

Author(s):

Bertha Gabriela Napitupulu ◽

Harris Hasan

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Pearson Correlation ◽

High Temporal Resolution ◽

Moderate Correlation ◽

Strong Negative Correlation ◽

Mitral Inflow ◽

Mitral Valve Area ◽

Standard Procedures ◽

Valve Area

Background: Confirming mitral valve area (MVA) by planimetry is one of the standard procedures for assessing mitral stenosis but MVA were frequently need to be confirmed by other echocardiography parameters that only available in sophisticated centers. Our aim was to evaluate the significance of a simple mitral inflow color M-mode velocity propagation (Vp) for estimating MVA and MS severity.Methods: The best color view of MS jet were taken from apical 4 chamber, the nyquist limit were adjusted for aliasing the central highest velocity, then M-mode were applied to MV to calculate Vp by measuring the slope of the blue jet with the first aliasing velocity. MVA,PHT and mean transmitral gradient were analyzed with Pearson correlation and linear regression. Predictive discrimination value of Vp were analyzed by ROC.Results: Thirty one MS patients had mean MVA planimetry 0.99 ± 0.35 cm2 and mean Vp 64.49 ± 21.63 cm/s. Vp that were found to have a strong negative correlation with MVA (Spearman rho -0.865, p < 0.01). Vp had a good predictive discrimination value as from AUC 0.931. Vp were found to have a moderate correlation with MVA by PHT ( Spearman rho -0.621, p <0.01). Vp more than 55 cm/s had 93.8% sensitivity and 86.7% specificity to distinguish severe MS.Conclusions: By making use of the high temporal resolution of M-mode, a simple color Mitral M-Mode Vp were found statistically significant for estimating MVA severity in MS. Interventional decision for MS could also consider Vp for its strong correlation with MVA on MS, especially for helping on targeting moderate to severe MS in rural and limited centers.

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Assessment of Mitral Valve Area in Patients with Mitral Stenosis and Atrial Fibrillation

Journal of the Korean Society of Echocardiography ◽

10.4250/jkse.1996.4.2.168 ◽

1996 ◽

Vol 4 (2) ◽

pp. 168

Author(s):

Nam Gyu Park ◽

Nam Ju Kwak ◽

Ki Won Choi ◽

Hye Young Kim ◽

Sang Moo Jung ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Mitral Stenosis ◽

Mitral Valve Area ◽

Valve Area

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Mid-term (up to 12 years) clinical and echocardiographic outcomes of percutaneous transvenous mitral commissurotomy in patients with rheumatic mitral stenosis

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02175-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yahya Dadjo ◽

Maryam Moshkani Farahani ◽

Reza Nowshad ◽

Mohsen Sadeghi Ghahrodi ◽

Alireza Moaref ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Protective Factor ◽

Cardiac Events ◽

Mitral Valve Area ◽

Adverse Cardiac Events ◽

Percutaneous Transvenous Mitral Commissurotomy ◽

Mitral Commissurotomy ◽

Valve Area

Abstract Background Rheumatic heart disease (RHD) is still a concerning issue in developing countries. Among delayed RHD presentations, rheumatic mitral valve stenosis (MS) remains a prevalent finding. Percutaneous transvenous mitral commissurotomy (PTMC) is the intervention of choice for severe mitral stenosis (MS). We aimed to assess the mid-term outcome of PTMC in patients with immediate success. Methods In this retrospective cohort study, out of 220 patients who had undergone successful PTMC between 2006 and 2018, the clinical course of 186 patients could be successfully followed. Cardiac-related death, undergoing a second PTMC or mitral valve replacement (MVR) were considered adverse cardiac events for the purpose of this study. In order to find significant factors related to adverse cardiac outcomes, peri-procedural data for the studied patients were collected.The patients were also contacted to find out their current clinical status and whether they had continued secondary antibiotic prophylaxis regimen or not. Those who had not suffered from the adverse cardiac events were additionally asked to undergo echocardiographic imaging, in order to assess the prevalence of mitral valve restenosis, defined as mitral valve area (MVA) < 1.5 cm2 and loss of ≥ 50% of initial area gain. Results During the mean follow-up time of 5.69 ± 3.24 years, 31 patients (16.6% of patients) had suffered from adverse cardiac events. Atrial fibrillation rhythm (p = 0.003, HR = 3.659), Wilkins echocardiographic score > 8 (p = 0.028, HR = 2.320) and higher pre-procedural systolic pulmonary arterial pressure (p = 0.021, HR = 1.031) were three independent predictors of adverse events and immediate post-PTMC mitral valve area (IMVA) ≥ 2 cm2 (p < 0.001, HR = 0.06) was the significant predictor of event-free outcome. Additionally, follow-up echocardiographic imaging detected mitral restenosis in 44 patients (23.6% of all patients). The only statistically significant protective factor against restenosis was again IMVA ≥ 2 cm2 (p = 0.001, OR = 0.240). Conclusion The mid-term results of PTMC are multifactorial and may be influenced by heterogeneous peri-procedural determinants. IMVA had a great impact on the long-term success of this procedure. Continuing secondary antibiotic prophylaxis was not a protective factor against adverse cardiac events in this study. (clinicaltrial.gov registration: NCT04112108).

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Two-dimensional transesophageal echocardiographic determination of mitral valve area in adults with mitral stenosis

American Heart Journal ◽

10.1016/0002-8703(94)90055-8 ◽

1994 ◽

Vol 127 (5) ◽

pp. 1348-1353 ◽

Cited By ~ 6

Author(s):

Marcus F Stoddard ◽

Charles R Prince ◽

Nasar M Ammash ◽

John L Goad

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Two Dimensional ◽

Mitral Valve Area ◽

Valve Area

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Closed Mitral Valvotomy for Mitral Stenosis in Mirror Image Dextrocardia

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239500300211 ◽

1995 ◽

Vol 3 (2) ◽

pp. 75-77 ◽

Cited By ~ 1

Author(s):

Gutti Ramasubrahmanyam ◽

Dronamraju Dilip ◽

Pirovam Venkat Ramnarayan ◽

Raju Subramaniam Iyer ◽

Kothapalle Venugopal Naidu

Keyword(s):

Mitral Valve ◽

Surgical Approach ◽

Mitral Stenosis ◽

Mirror Image ◽

Abnormal Position ◽

Mitral Valve Area ◽

Anterolateral Thoracotomy ◽

Mitral Valvotomy ◽

Valve Area

A 22-year-old female with mirror image dextrocardia and rheumatic valvular mitral stenosis underwent closed mitral valvotomy using a Tubb's dilator with good results. Despite abnormal position of situs, the surgical approach was simple through right anterolateral thoracotomy, and the operator's hands were mirror image to that of levocardia valvotomy in certain steps. Preoperative mitral valve area was 0.8 cm2, and peak and mean diastolic gradients were 21 and 15 mmHg respectively. Postoperatively, valve area improved to 2.16 cm2, and peak and mean diastolic gradients were 8 and 3.1 mmHg, respectively.

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