P5452Pregnancy risk in women with severe aortic stenosis (original) (raw)
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Risk Stratification and Mortality in Mitral Stenosis Patients
ACI (Acta Cardiologia Indonesiana)
Background: Rheumatic mitral stenosis is the most common valvular abnormalities found in developing countries. Mortality risk in those populations was poorly investigated. In addition, hemodynamic, morphological, and mechanical factors that influence or predict outcome of rheumatic mitral stenosis have not been identified. Aims: To determine predictive factors affecting outcome in rheumatic mitral stenosis patients. Method: This retrospective cohort study was conducted at the National General Hospital Dr. Sardjito, Yogyakarta, Indonesia. The study recruited patients from the Valvular Heart Disease Registry from May 2014 to November 2020. New York Heart Association (NYHA) functional classification, invasive or surgical treatment, and incidence of death were recorded. The baseline rhythm from electrocardiography (ECG) was categorized as sinus rhythm and atrial fibrillation or atrial flutter. Based on the findings of trans thoracal echocardiography (TTE), subjects who had moderate to s...
International Journal of Angiology, 2019
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.
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...
Frontiers in Surgery
Background: Clinical decision-making in symptomatic patients after mitral valve (MV) repair remains challenging as echocardiographic reference values are lacking. In native MV disease intervention is recommended for mean transmitral pressure gradient (TPG) >15 mmHg or systolic pulmonary artery pressure (SPAP) >60 mmHg at peak exercise. Insight into standard stress echo parameters after MV repair may therefore aid to clinical decision-making during follow-up. hypothesis: Stress echocardiography derived parameters in asymptomatic patients after successful MV repair differ from current guidelines for native valves. Material and methods: In 25 patients (NYHA I) after MV repair stress echocardiography was performed on a semi-supine bicycle. Doppler flow records and MV related hemodynamics at rest and peak were obtained. Linear regression analysis was performed for mean TPG and SPAP at peak, using predetermined variables and confounders. results: Mean TPG at rest (3.2 ± 1.4 mmHg) significantly increased at peak (15.0 ± 3.4 mmHg) but was always <25 mmHg. Mean SPAP at rest (21.4 ± 3.8 mmHg) significantly increased at peak (41.8 ± 8.9 mmHg) but was never >57 mmHg. Only the indexed MV ring diameter was inversely correlated to mean TPG at peak in a multivariable model. conclusion: In contrast to current recommendations in native MV disease, our data indicate that the standard value for mean TPG during stress echocardiography in asymptomatic patients after successful MV repair was above the guideline threshold of 15 mmHg in >50%, but always <25 mmHg. For SPAP, patients never reached the guideline cutoff (60 mmHg). Long-term follow-up data are needed to provide insight in clinical consequences. Baseline stress echocardiography may indicate individual reference values to compare with during follow-up. clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT02371863?term= chamuleau+AND+Mitral&rank=1.
Journal of the American College of Cardiology, 2019
Background: Mitral stenosis (MS) frequently coexists in patients with severe aortic stenosis (sAS). However, the impact of aortic valve replacement (AVR) on MS is unknown. Methods: We retrospectively investigated patients who underwent AVR or transcatheter AVR (TAVR) for sAS from 2008 to 2015. Transmitral gradient by Doppler echocardiography ≥ 4 mmHg was identified as MS; patients were stratified according to mitral valve area (MVA, by continuity equation) as > or ≤ 2.0 cm 2. We compared MVA before and after AVR in patients with MS. We investigated the clinical outcomes of patients with vs. without MS using 1:2 matching for age, sex, LVEF, percent with TAVR and year of AVR. Results: Of 204 patients with sAS and MS (age 76 ± 9 years), 198 could be matched with 390 with sAS without MS. In those with MS, MVA increased after AVR in 126 (62%). Among all MS patients, the mean MVA increased after AVR (2.0 ± 0.5 to 2.3 ± 0.7 cm 2 , p < 0.01). Increase in stroke volume (SV) was a predictor for increase of MVA (odds ratio 7.1, 95% CI 3.3-15, p<0.01). Of 109 (55%) patients with MVA≤2 cm 2 , MVA increased to > 2.0 cm 2 after AVR in 53 and remained ≤ 2.0 cm 2 in 56. Patients with MS had poorer prognosis compared with those without MS (Figure). MVA ≤ 2.0 cm 2 after AVR was an independent predictor of overall mortality (hazard ratio 1.6, 95% CI 1.1-2.4, p=0.024). Conclusion: MVA by CE improved with increase of SV after AVR in two-thirds patients with sAS and MS. Patients with MS, especially MVA ≤ 2.0 cm 2 after AVR had higher mortality compared with those without MS.
Nepalese Heart Journal, 2016
Backgrounds and Aims: Factors affecting outcome of mitral valve replacement in rheumatic population of Nepal is unknown. The aim of this study was to identify the predictors of in-hospital mortality in patients undergoing mitral or double valve replacement in Nepal. Methods: A retrospective observational study was designed to evaluate the outcome of patients who underwent mitral valve replacement with or without concomitant other valvular surgery during a period of one year in a tertiary care cardiac centre in Nepal. Data were analysed to find the significant predictors of in-hospital mortality. Results: A total of 411 patients fulfilled the inclusion criteria. The overall in-hospital mortality was 4.1% (95% CI 2.18-6.02). A cutoff value for higher mortality obtained using ROC curve for age was 37.5 years; and for duration of mechanical ventilation was 8.5 hours. Multivariate logistic regression model identified increasing age (>37.5 years), OR 2.05 (95% CI 0.77-5.45), p=0.001; NYHA Class III and IV, OR 15.18 (95%CI 0.9-54.53), p<0.001; presence of left atrial thrombus, OR 4.96 (95% CI 1.49-16.43), p=0.003; tricuspid regurgitation grade III and IV, OR 2.62 (95% CI 0.95-7.24), p=0.004; re-exploration for bleeding, OR 8.62 (95% CI 1.60-46.32), p=0.03; left ventricular ejection fraction (≤40%), OR 8.22 (95% CI 2.62-25.72), p=0.001; inotrope score >20, OR 9.90 (95% CI 3.48-28.15), p<0.001; duration of mechanical ventilation >8.5 hours, OR 22.96 (95% CI 5.15-52.10), p<0.001; and stay in the intensive care unit > 2 days, OR 1.31 (95% CI 0.49-3.46), p<0.001 as predictors of mortality. Conclusion: Age, NYHA Class, severe tricuspid regurgitation, presence of left atrial clot, re-exploration for bleeding, decreasing left ventricular ejection fraction, high inotrope score, longer duration of mechanical ventilation, and longer stay in the intensive care unit were identified as the independent predictors of in-hospital mortality.
European Journal of Cardio-Thoracic Surgery, 2003
Objective: The early and mid-term impact of functional mitral regurgitation (MR) in patients undergoing isolated aortic valve replacement (AVR) for aortic stenosis remains unresolved. Method: Through our institutional databank, using a case-match study, we identified 58 patients with MR grades 0-1 and 58 patients with MR grades 2-3 (patients matched for sex, age, ejection fraction (EF), NYHA, diabetes, and CVA). Data were collected prospectively (mean duration of follow-up: 3.2^2.4 years). Results: Perioperative morbidity (re-operation for bleeding, low cardiac output, CVA, renal failure) was comparable among groups. Difference in mortality between the two groups was non-significant (7.0 vs. 3.5%, P ¼ 0:67 in groups MR 2-3 vs. 0-1, respectively). At early echocardiographic follow-up, 7/58 patients (12.1%) within group MR grades 0-1 increased their MR to grades 2-3; among which only two remained with MR grades 2-3 at mid-term follow-up. Within MR group 2-3, 18/58 (31.0%) remained with MR grades 2-3 among which 7/18 (38.9%) decreased of at least one grade at follow-up. Eight year actuarial survival was comparable in both groups: MR grades 0-1 ¼ 60.9% vs. MR grades 2-3 ¼ 55.0%; P ¼ 0:1. Actuarial survival of patients with MR grades 2-3 postoperatively was similar to patients with MR grades 0-1 (MR grades 0-1 ¼ 59.0%, MR grades 2-3 ¼ 58.9%, P ¼ NS). Conclusions: Presence of preoperative moderate functional MR (grades 2-3) in patients undergoing isolated AVR for aortic stenosis regresses in the majority of patients postoperatively and has no significant impact on perioperative morbidity or mortality, nor mid-term survival. Thus, moderate functional MR should be treated conservatively in the majority of patients especially in the elderly subjected to isolated AVR for aortic stenosis.
Heart, vessels and transplantation, 2022
Objective: Patients with rheumatic mitral stenosis, despite having normal left ventricular ejection fraction (LV EF), have ventricular dysfunction in the form of impaired longitudinal excursion. Tissue Doppler velocity is a useful indicator for assessment of long-axis ventricular shortening and lengthening. The aim of our study was to evaluate the effect of percutaneous balloon mitral valvuloplasty (PBMV) on LV function in rheumatic MS and to study echocardiographic parameters with M-Mode and Tissue Doppler Imaging pre PBMV, post PBMV and on follow-up to determine predictors of LV function. Methods: We analysed 52 patients with severe mitral stenosis with normal LV EF, who underwent PBMV at our institute. Baseline parameters of LV function were compared with immediate post PBMV and at three months follow up. Results: The mean age of the patients was 33.73 (10.87) years with female preponderance. The mean mitral valve area before PBMV was 0.92 (0.13) cm 2 which increased to 1.65 (0.21) cm 2 after PBMV and at 3 month it was 1.61 (0.23) cm 2 (p<0.001). LVEF before PBMV by modified Simpson's method was 55.45 (8.44)% and after PBMV, it was 55.58 (3.46)% and at 3 month it was 56.62 (2.46)% (p>0.05). Mitral valve E' was 8.71 (1.54) cm/s which increased to 10.13 (1.68) cm/s post PBMV and at 3 month it was 10.83 (1.34) cm/s (p<0.001).. Mitral annular systolic velocity (MASV), before PBMV was 7.90 (0.96) cm/s which increased to 9.31 (1.68) cm/s after PBMV and at 3 month it was 10.13 (0.96) cm/s (p<0.001). Myocardial performance index (MPI) before PBMV was 0.54 (0.48) which decreased post PBMV to 0.47 (0.06) and at 3 month it was 0.38 (0.04) (p=0.01). Pre PBMV MPI value <0.48 predicted improvement in LV function (sensitivity: 81%, specificity: 58.1%). Conclusion: Thus, PBMV leads to improvement in LV function in patients with severe MS with normal LV EF.
Degenerative Mitral Stenosis Versus Rheumatic Mitral Stenosis
The American Journal of Cardiology, 2020
Mitral stenosis is classically caused by rheumatic disease (RMS). However, degenerative mitral stenosis (DMS) is increasingly encountered, particularly in developed countries with aging populations. The aim of this study was to compare clinical and echocardiographic characteristics between the 2 entities. One hundred fifteen patients with DMS were identified from an echocardiographic database in the United States and compared with 510 patients with RMS from Seoul, Korea. All subjects had a mitral valve area (MVA) ≤2.5 cm 2 by continuity equation but were otherwise unselected. Patients with DMS were older and had more hypertension, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease than those with RMS. Atrial fibrillation was more common in RMS patients. Mean mitral valve gradient was slightly lower in DMS versus RMS (7.63 § 3.67 vs 8.50 § 4.23 mm Hg, p = 0.04) but MVA was strikingly higher in the DMS group (1.35 § 0.41 vs 0.95 § 0.38 cm 2 , p <0.0001). This appeared to be due to greater stroke volume in the DMS patients (70.4 § 19.7 vs 55.7 § 15.5 ml, p <0.0001). Indexed left atrial volume was greater in RMS (82.1 § 40.3 vs 57.9 § 21.4 ml, p <0.0001) while estimated pulmonary artery systolic pressure was greater in DMS (49.3 § 16.5 vs 39.4 § 13.6 mm Hg, p <0.0001). In conclusion, DMS patients are older and have more comorbidities than RMS patients. DMS presents with greater MVA relative to mean mitral valve gradient than RMS. This appears due to a higher stroke volume in DMS patients.