mitral regurgitation – ABC CARDIOL

ABC

Original Article

Improvement in left ventricular dysfunction after surgical correction of mitral regurgitation

Antônio Sérgio Cordeiro da Rocha et al. Nazareth de Novaes da Rocha Rita de Cássia Villela Soares Marialda Coimbra … Rosana Grandelle Ramos Clara Weksler Fernando Eugênio Cruz Filho Celso Garcia da Silveira Paulo Roberto Dutra da Silva

OBJECTIVE: To evaluate whether left ventricular end-systolic (ESD) diameters £ 51mm in patients (pt) with severe chronic mitral regurgitation (MR) are predictors of a poor prognosis after mitral valve surgery (MVS). METHODS: Eleven pt (aged 36±13 years) were studied in the preoperative period (pre), median of 36 days; in the early postoperative period (post1), median of 9 days; and in the late postoperative period (post2), mean of 38.5±37.6 months. Clinical and echocardiographic data were gathered from each pt with MR and systolic diameter ³51mm (mean = 57±4mm) to evaluate the result of MVS. Ten patients were in NYHA Class III/IV. RESULTS: All but 2 pt improved in functional class. Two pt died from heart failure and infectious endocarditis 14 and 11 months, respectively, after valve replacement. According to ejection fraction (EF) in post2, we identified 2 groups: group 1 (n=6), whose EF decreased in post1, but increased in post2 (p=0.01) and group 2 (n=5), whose EF decreased progressively from post1 to post2 (p=0.10). All pt with symptoms lasting £ 48 months had improvement in EF in post2 (p=0.01). CONCLUSION: ESD ³51mm are not always associated with a poor prognosis after MVS in patients with MR. Symptoms lasting up to 48 months are associated with improvement in left ventricular function.

Read Full Article

ABC

Artigo Original

Sensitivity and specificity of B-type natriuretic peptide for identifying symptomatic and asymptomatic patients with severe mitral regurgitation

Zilda Machado Meneghelo et al. Hélio M. Magalhães Auristela I. O. Ramos Jorge Eduardo Assef … Davi Costa Le Bihau Nivia A. de Campos Salvarani Angela Tavares Paes Romeu S. Meneghelo

OBJECTIVE: To assess the sensitivity and specificity of B-type natriuretic peptide (BNP) for identifying symptomatic and asymptomatic patients with severe chronic mitral regurgitation followed up on an outpatient care basis. METHODS: A group of patients with mitral regurgitation underwent electrocardiography, chest teleradiography, venous blood withdrawal, and transthoracic echocardiography. Based on an analysis of the echocardiographic variables, 62 patients had mild and moderate mitral regurgitation (GI) and 34 had severe mitral regurgitation (GII). The discriminating capacity of the BNP for detecting patients with severe mitral regurgitation was assessed by use of ROC curves. RESULTS: The patients’ ages ranged from 15 to 63 (mean, 31.7) years, and of the 96 patients, 71 (73%) were females. The BNP values ranged from 0.00 pg/mL to 193 pg/mL. The mean BNP values in GI and GII patients were 18.10 ± 0.74 pg/mL and 50.54 ± 1.46 pg/mL, respectively (P=0.001). The cutoff point for identifying severe mitral regurgitation was 15.40 pg/mL for the best balance between sensitivity and specificity, which were 0.73 and 0.74, respectively. The cutoff point for identifying symptomatic patients with severe mitral regurgitation was 28.40 pg/mL for the best balance between sensitivity and specificity, which were 0.78 and 0.83, respectively. CONCLUSION: The BNP values capable of identifying asymptomatic and symptomatic patients with severe mitral regurgitation are lower than 100 pg/mL, which is considered for the diagnosis of heart failure.

Read Full Article

ABC

Original Article

Mildly symptomatic chronic mitral regurgitation. Analysis of left ventricular systolic function and mitral regurgitant fraction under pharmacological influence: echocardiographic study

Ivan Romero Rivera et al. Valdir Ambrósio Moisés Antonio Carlos Carvalho Angelo Amato V. de Paola

OBJECTIVE: To study echocardiographic parameters of left ventricular systolic function and valvar regurgitation under pharmacological influence in mildly symptomatic patients with chronic mitral regurgitation (MR). METHODS: We carried out a double-blind placebo controlled study in 12 patients with MR, mean aged 12.5 years old, who were randomized in 4 phases: A) digoxin; B) enalapril; C) digoxin + enalapril; D) placebo. The medication was administered for 30 days in each phase, and the following variables were analyzed: shortening and ejection fractions, wall stress index of left ventricle, left ventricular meridional end-systolic wall stress, Doppler-derived mean rate of left ventricular pressure rise (mean dP/dt), stroke volume and MR jet area. The clinical variables analysed were heart rate and systemic arterial pressure. RESULTS: No significant variation was observed in the clinical variables analysed. The shortening and ejection fraction, the mean dP/dt and stroke volume significantly increased and the wall stress index of left ventricle, the meridional left ventricular end systolic wall stress and the mitral regurgitation jet area decreased in the phases with medication as compared with that in the placebo phase. CONCLUSION: The parameters of left ventricular systolic function improved significantly and the degree of MR decreased with the isolated administration of digoxin or enalapril in mildly symptomatic patients with chronic MR. The combination of the drugs, however, did not show better results.

Read Full Article

ABC

Artigo Original

Quantification of mitral prosthesis regurgitation by transesophageal echocardiography. Evaluation of different methods

Cláudio Henrique Fischer et al. Orlando Campos Fº Valdir Ambrósio Moisés José Marconi Almeida Sousa … Cristiano Vieira Machado Edgar Bezerra de Lira Fº José Lázaro de Andrade Antonio Carlos de Camargo Carvalho Dirceu Vieira Santos Fº

PURPOSE: To evaluate the different methods for grading mitral regurgitation (MR) by transesophageal echocardiography (TEE) in patients with clinical suspicion of mitral prosthesis dysfunction. METHODS: Cardiac catheterization (Cath) was performed in 15 patients for grading the severity of prosthetic MR, divided in two groups based on the presence or absence of severe MR. Prosthetic MR was quantified by TEE using methods commonly used for MR of native valves: subjective assessment by color Doppler, objective assessment based on absolute jet area and on its relative area (jet area/left atrial area) and assessment based on the presence of systolic flow reversal in pulmonary vein. RESULTS: Prosthetic MR was mostly transprosthetic (14 patients) and eccentric (11 patients). There was significant correlation (p7cm²) and relative (jet area >35% of left atrial area) jet areas did not reveal significant correlation with the angiographic grade and showed clear underestimation by TEE when the last method was used. However, there was good correlation (p30% were considered as cut point. CONCLUSION: TEE correctly identified angiographic severe mitral prosthesis regurgitation, mainly by the presence of systolic flow reversal in pulmonary vein and subjective assessment. The estimation of severity of the prosthetic MR by absolute or relative jet area seems to be limited and should be used with caution due to eccentricity of the regurgitant jet, frequently seen in mitral prosthesis dysfunction.

Read Full Article

ABC

Artigo Original

Flail mitral valve leaflet diagnosed by transesophageal echocardiography. Report and evolution of 35 cases

Mônica M. C. Caldas et al. Lúcia M. A. Fenelon William A. M. Esteves Tamara Katina … Nilson Maia Márcia M. Barbosa

PURPOSE: To describe transesophageal echocardiographic findings in patients presenting with flail mitral valve and to obtain their clinical follow-up. METHODS: From January/93 to March/97, 1675 patients were submitted to transesophageal echocardiogram at our institution; 35 of them were diagnosed as having flail mitral valve and their clinical follow-up was obtained. RESULTS: Thirty-five patients with the diagnosis of flail mitral valve were studied. Mean age was 65±15 years (12-87) and 27 (77%) were male. The posterior leaflet was involved in 25 (71%) patients. Ruptured chordae tendineae was present in all but one patient in whom flail mitral valve was due to a very elongated and redundant chordae. The etiology was prolapse and/or mixomatous degeneration in 16 patients, degenerative in 10, ischemic in 5, rheumatic in 4 and endocarditis in 3. Mitral regurgitation was severe in 25 (71%) patients and moderate in 10 (29%). The mean follow-up was 375±395 days (1 to 1380). Nineteen patients were followed clinically and 16 were submitted to surgery (transesophageal echocardiogram findings were confirmed in all 16). Overall mortality was high (34%). Among the survivors, 17 are in NYHA class I and 6 in class II. CONCLUSION: The diagnosis of flail mitral valve by transesophageal echocardiography is accurate, allowing for the definition of its mechanism and etiology, as well as the evaluation of hemodynamic compromise. The observed high mortality at the time of diagnosis may be related to the severity of the disease causing the flail mitral valve. Although non-operated survivors are doing well, the observed low functional class in these patients may be related to the short period of follow-up.

Read Full Article

Improvement in left ventricular dysfunction after surgical correction of mitral regurgitation

Sensitivity and specificity of B-type natriuretic peptide for identifying symptomatic and asymptomatic patients with severe mitral regurgitation

Mildly symptomatic chronic mitral regurgitation. Analysis of left ventricular systolic function and mitral regurgitant fraction under pharmacological influence: echocardiographic study

Quantification of mitral prosthesis regurgitation by transesophageal echocardiography. Evaluation of different methods

Flail mitral valve leaflet diagnosed by transesophageal echocardiography. Report and evolution of 35 cases

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)