Risk Stratification and Mortality in Mitral Stenosis Patients (original) (raw)
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Profile and prediction of severity of rheumatic mitral stenosis in children
Medical Journal of Indonesia, 1996
Di negara-negara berkembang seperti Indonesia, penyakit jantung reumatik (PJR) masih merupakan masalah kesehatan masyarakat. Stenosis mitral rewnatik (SMR) dapat terjadi dengan cepat dan SMR berat dapat timbul pada umur sedini 15 tahun di negara Asia-Afrika. Pemeriksaan fisik tidak culcup akarat untuk menentukan derajat berat SMR Penelitian ini untuk nengetahui gambaran klinis SMR pada analç gambaran EKG dan foto Roentgen dada yang mungkin dapat memperkirakan derajat berat SMR sesuai ekolcardiografi. Telah dilakuknn penelitian 'cross-sectional' pada 28 pasien SMR di Bagian IJnu Kesehatan Anak RSCM. Ilnur rata-rata adolah I 3,5 tahun Dua pasien tidak dapat disertakan dalan uji diagnostik karena peneriksaan yang belutn lengknp. Derajat berat SMR berdasarkan pengukuran luos latup mitral dcngan ekolurdiografi 2 D digolongl<nn dalant derajat ringan, sedang dan berat masing-rnasing terdapat pada 1, 15 dan 1O pasien. Prakiraan derajat berat SMR berdasarlcan RVH dan MD pada EKG tnenunjukan spesifisitas 75% dan nilai duga negatif 85,7%. Prakiraan derajat berat SMR berdasarl<an analisis foto Roentgen dada tnenunjuklran sercitifitas 80%, spesifisitas 81,2% sedangkan nilai duga negatif adatah 86,7%. Konbinasi peneriksaan EKG atau Foto Roentgen dada menuniulan sensitifitas yang tinggi yaim 9O%, yang berguna untuk menapis pasien SMR di daerah yang tidak nenpunyai fasilitas ekolcardiografi. Nilai duga negatif peneriksaan lambinasi adalah 92%, yang berarti bila tidak didapatkan tanda SMR bera pada EKG atauloto Roentgen dada, l<emungkinan besar bukan SMR berat-
Yonsei medical journal, 2018
We determined factors associated with long-term outcomes of patients who underwent successful percutaneous mitral balloon valvuloplasty (PMV). Between August 1980 and May 2013, 1187 patients underwent PMV at Severance Hospital, Seoul, Korea. A total of 742 patients who underwent regular clinic visits for more than 10 years were retrospectively analyzed. The endpoints consisted of repeated PMV, mitral valve (MV) surgery, and cardiovascular-related death. The optimal result, defined as a post-PMV mitral valve area (MVA) >1.5 cm² and mitral regurgitation ≤Grade II, was obtained in 631 (85%) patients. Over a mean follow up duration of 214±50 months, 54 (7.3%) patients underwent repeat PMV, 4 (0.5%) underwent trido-PMV, and 248 (33.4%) underwent MV surgery. A total of 33 patients (4.4%) had stroke, and 35 (4.7%) patients died from cardiovascular-related reasons. In a multivariate analysis, echocardiographic score [p=0.003, hazard ratio=1.56, 95% confidence interval (CI): 1.01-2.41] an...
Anatomical and Hemodynamic Evaluation of Mitral Stenosis Patients with Echocardiography
Bioscientia Medicina : Journal of Biomedicine and Translational Research
Mitral stenosis (MS) is the most common valvular heart disease encountered in developing countries. The cause of MS is almost always chronic rheumatic heart disease. Echocardiography is the single most important diagnostic tool in the evaluation of MS. The objectives are to confirm the etiology, to assess the severity of stenosis, to recommend the type and timing of intervention, to assess other valvular lesions, presence of thrombus, and vegetation. According to current guidelines and recommendations for clinical practice, the severity of MS should not be defined by a single value but rather be assessed by a multimodality approach that determines valve areas, mean Doppler gradients, and pulmonary arterial pressures. The European Society of Echocardiography/American Society of Echocardiography (EAE/ASE) recommendations of measurement method for clinical practice were categorized into three level of recommendations. Mitral valve area (MVA) can be assessed by planimetry using either 2...
Rheumatic mitral stenosis in Children: more accelerated course in sub-Saharan Patients
BMC Cardiovascular Disorders, 2013
Background: Mitral stenosis, one of the grave consequences of rheumatic heart disease, was generally considered to take decades to evolve. However, several studies from the developing countries have shown that mitral stenosis follows a different course from that seen in the developed countries. This study reports the prevalence, severity and common complications of mitral stenosis in the first and early second decades of life among children referred to a tertiary center for intervention. Methods: Medical records of 365 patients aged less than 16 and diagnosed with rheumatic heart disease were reviewed. Mitral stenosis was graded as severe (mitral valve area < 1.0 cm 2), moderate (mitral valve area 1.0-1.5 cm 2) and mild (mitral valve area > 1.5 cm 2). Results: Mean age at diagnosis was 10.1 ± 2.5 (range 3-15) years. Of the 365 patients, 126 (34.5%) were found to have mitral stenosis by echocardiographic criteria. Among children between 6-10 years, the prevalence of mitral stenosis was 26.5%. Mean mitral valve area (n = 126) was 1.1 ± 0.5 cm 2 (range 0.4-2.0 cm 2). Pure mitral stenosis was present in 35 children. Overall, multi-valvular involvement was present in 330 (90.4%). NYHA functional class was II in 76% and class III or IV in 22%. Only 25% of patients remember having symptoms of acute rheumatic fever. Complications at the time of referral include 16 cases of atrial fibrillation, 8 cases of spontaneous echo contrast in the left atrium, 2 cases of left atrial thrombus, 4 cases of thrombo-embolic events, 2 cases of septic emboli and 3 cases of airway compression by a giant left atrium. Conclusion: Rheumatic mitral stenosis is common in the first and early second decades of life in Ethiopia. The course appeared to be accelerated resulting in complications and disability early in life. Echocardiography-based screening programs are needed to estimate the prevalence and to provide support for strengthening primary and secondary prevention programs.
R Rheumatic mitral stenosis in Children: more accelerated course in sub-Saharan Patients
Background: Mitral stenosis, one of the grave consequences of rheumatic heart disease, was generally considered to take decades to evolve. However, several studies from the developing countries have shown that mitral stenosis follows a different course from that seen in the developed countries. This study reports the prevalence, severity and common complications of mitral stenosis in the first and early second decades of life among children referred to a tertiary center for intervention. Methods: Medical records of 365 patients aged less than 16 and diagnosed with rheumatic heart disease were reviewed. Mitral stenosis was graded as severe (mitral valve area < 1.0 cm 2 ), moderate (mitral valve area 1.0-1.5 cm 2 ) and mild (mitral valve area > 1.5 cm 2 ). Results: Mean age at diagnosis was 10.1 ± 2.5 (range 3-15) years. Of the 365 patients, 126 (34.5%) were found to have mitral stenosis by echocardiographic criteria. Among children between 6-10 years, the prevalence of mitral stenosis was 26.5%. Mean mitral valve area (n = 126) was 1.1 ± 0.5 cm 2 (range 0.4-2.0 cm 2 ). Pure mitral stenosis was present in 35 children. Overall, multi-valvular involvement was present in 330 (90.4%). NYHA functional class was II in 76% and class III or IV in 22%. Only 25% of patients remember having symptoms of acute rheumatic fever. Complications at the time of referral include 16 cases of atrial fibrillation, 8 cases of spontaneous echo contrast in the left atrium, 2 cases of left atrial thrombus, 4 cases of thrombo-embolic events, 2 cases of septic emboli and 3 cases of airway compression by a giant left atrium. Conclusion: Rheumatic mitral stenosis is common in the first and early second decades of life in Ethiopia. The course appeared to be accelerated resulting in complications and disability early in life. Echocardiography-based screening programs are needed to estimate the prevalence and to provide support for strengthening primary and secondary prevention programs.
Indonesian Journal of Cardiology
Background: Rheumatic mitral stenosis (RMS) is the cause of mitral valve disease commonly found in developing countries. Determining severity of RMS is very important, related with prognosis and management of the disease. Current echocardiography methods have advantages and disadvantages in determining the severity of RMS. Posterior to anterior mitral valve leaflets length ratio (PMVL/ AMVL ratio) was proposed to be one of the semi-quantitative measurement which offered a simple, easy and accurate method in determining the severity of RMS. The aim of this study was to see the association of posterior to anterior mitral valve leaflets length ratio with severity of rheumatic mitral stenosis. Methods: This was a cross-sectional descriptive analytic study. The subjects were all patients with rheumatic mitral stenosis who underwent echocardiography examination to measure the PMVL/AMVL ratio as well as determining the severity based on mitral valve area (MVA) planimetry. One-way ANOVA analytic test was used to assess the association of ratio PMVL/AMVL and severity of the RMS. Results: Of 71 patients included in this study, there were 19 mild RMS, 19 moderate RMS and 33 severe RMS patients. Majority of the subjects were female with age range from 38 to 43 years and have atrial fibrillation. From echocardiography examination, the mean EF +/-55% with increased LAVI and SPAP according to the severity of the RMS (LAVI; 44±1.3 vs. 55±1.5 vs. 74±1.7 ml/m 2 SPAP; 29±1.2 vs. 46±9.0 vs. 68±1.4 mmHg). There was a significant difference in the length of PMVL in mild, moderate and severe RMS (28±5.6 vs. 22±4.0 vs. 17±5.2 mm; p<0.001), but no significant difference in the length of AMVL (33±5.5 vs 33±5.4 vs 32±5.1mm; p=0.93) respectively. The PMVL/AMVL ratio had statistically significant association with severity of RMS (p<0.001). Conclusion: The PMVL/AMVL ratio is significantly associated with severity of RMS.
BMC Cardiovascular Disorders, 2021
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 ...
Journal of Ayub Medical College, 2020
Mitral stenosis (MS) is a prevalent disease in the developing world. It is a preventable disease associated with considerably high morbidity and mortality rates. Myocarditis secondary to rheumatic MS can cause left ventricular (LV) dysfunction. In majority of the case this LV dysfunction is subclinical. Recent development in imaging techniques like tissue Doppler imaging (TDI) and strain imaging enabled us to detect subclinical LV dysfunction. One such example is Global Longitudinal Strain (GLS), which is a reliable mean of assessing LV dysfunction in patients diagnosed with mitral stenosis. This study is design to determine the frequency of subclinical LV dysfunction in patients presenting with severe MS of rheumatic etiology in our institute. Objective of the study was to determine frequency of subclinical LV dysfunction by mean GLS in patients with isolated severe Rheumatic MS having normal LV Ejection fraction measured by 2D/M-mode echocardiography. It was an observational cross...
2016
OBJECTIVES We sought to evaluate the impact of dobutamine stress echocardiography (DSE) in patients with known rheumatic mitral stenosis (MS) in order to assess its safety, feasibility, and prognostic correlation to well-known clinical outcomes. BACKGROUND Noninvasive prognostic assessment of MS still represents an unresolved task in patients with clinically challenging disease. METHODS Dobutamine stress echocardiography was performed in 53 patients with MS (8 males; age 37.4 11.3 years) with no major complications. RESULTS During follow-up (60.5 11.0 months), 29 patients presented with clinical events: 16 hospitalizations, seven cases of acute pulmonary edema, and six symptomatic supraventricular arrhythmias. On multivariate analysis, the diastolic mitral valve mean gradient at peak DSE (DSE-MG) was the best predictor of clinical events (p 0.008), especially in patients with moderate disease (p 0.001). The best performance of DSE for the detection of clinical events was obtained at...