Mitral valve stenosis

L Liter MVS mitral valve stenosis motor, vascular, and sensory... 

Al Zaibag M, Ribeiro PA, Al Kasab S, et al, Percutaneous double-balloon mitral valvotomy for rheumatic mitral-valve stenosis. Lancet 1986 I (8484) 757—761,... 

Sievert H, Kober G, Bussmann WD, et al, Catheter valvuloplasty in mitral valve stenosis. Dtsch Med Wochenschr 1989 ... 

Ribeiro PA, al Zaibag M, Abdullah M. Pulmonary artery pressure and pulmonary vascular resistance before and after mitral balloon valvotomy in 100 patients with severe mitral valve stenosis. Am Heart J 1993 125(4) I I 10-1114. 

A 70 year old alcoholic male with poor dental hygiene is to have his remaining teeth extracted for subsequent dentures. He has mitral valve stenosis with mild cardiac insufficiency and is being treated with capto-pril, digoxin and furosemide. The dentist decides that his medical history warrants prophylactic antibiotic therapy prior to the procedure and prescribes ... 

Answer B (Amoxicillin). The multiple extractions can lead to bacteremia while the mitral valve stenosis and cardiac insufficiency place him at risk for developing endocarditis. The present American Heart Association guidelines indicate amoxicillin (3 gm 1 hour prior to procedure and 1.5 gm 6 hours after original dose.) Vancomycin would only be appropriate if the patient was allergic to penicillins. Tetracycline and cotrimoxazole are bacteriostatic and not effective against the viridans group of Streptococci, the usual causative organism. Imipenem is also inappropriate since its spectrum is too broad. 

Djavidani B et al. (2005) Planimetry of mitral valve stenosis by magnetic resonance imaging. J Am Coll Cardiol 45 2048-2053... 

Mitral stenosis or regurgitation Mitral valve prolapse Chronic obstructive pulmonary disease Pulmonary embolism Idiopathic ("lone" atrial fibrillation) Thoracic surgery ... 

Causes of diastolic dysfunction (restriction in ventricular filling) are increased ventricular stiffness, ventricular hypertrophy, infiltrative myocardial diseases, myocardial ischemia and infarction, mitral or tricuspid valve stenosis, and pericardial disease (e.g., pericarditis, pericardial tamponade). 

Rheumatic mitral valve disease is associated with thromboembolic complications at reported rates of 1.5 to 4.7% per year the incidence in patients with mitral stenosis is approximately 1.5 to 2 times that in patients with mitral regurgitation. The presence of atrial fibrillation is the single most important risk factor for thromboembolism in valvular disease, increasing the incidence of thromboembolism in both mitral stenosis and regurgitation four- to sevenfold. In current practice, patients with nonrheumatic atrial fibrillation at low risk for thromboembolism based on clinical characteristics frequently are treated with aspirin. Warfarin therapy is considered in higher-risk patients, especially those with previous thromboembolism and in whom anticoagulation is not contraindicated due to preexisting conditions. 

Q13 Arterial emboli, which can block blood vessels and cause ischaemia or infarction in the tissues they affect, tend to originate in the left heart and are associated with valvular disease and dysrhythmias. Mitral stenosis is associated with abnormal atrial rhythm, particularly atrial fibrillation. Fibrillation and other rhythm abnormalities in the atria favour blood coagulation, resulting in production of thromboemboli which can move to distant parts of the circulation, such as the cerebral circulation. Thrombi could also form on surfaces of valves distorted by calcification and other abnormalities. In view of the risks of thromboembolism, it is usual to provide anticoagulant therapy to patients with mitral valve problems and atrial fibrillation. 

In October, 1981, a 39-year-old man with mitral stenosis was hospitalized for mitral valve replacement. 

Moderate-risk conditions Mitral valve prolapse with valvular regurgitation or leaflet thickening, isolated mitral stenosis, tricuspid-valve disease, pulmonary stenosis, and hypertrophic cardiomyopathy... 

Systolic dysfunction, or decreased contractility, can be caused by dilated cardiomyopathies, ventricular hypertrophy, or a reduction in muscle mass. Diastolic dysfunction, or restriction in ventricular filling, can be caused by increased ventricular stiffness, mitral or tricuspid valve stenosis, or pericardial disease. Both ventricular hypertrophy and myocardial ischemia can contribute to increased ventricular stiffness. Angiotensin II causes and/or exacerbates heart failure by increasing systemic vascular resistance, promoting sodium retention. 

In a single-center study, of 47 patients with unexplained restrictive valvular disease (aged 59 years, 42 women), 34 had previously taken benfluorex, 14 had used benfluorex alone, and 20 had used it in combination with another appetite suppressant [47 [. There was isolated mitral or aortic valve involvement in 19 and combined mitral and aortic involvement in 28. Valve stenosis and tricuspid... 

Cardiovascular In 63 liver transplant recipients, including 19 children, cardiovascular examinations, electrocardiography, and echocardiography after 3 months were normal, except for 2 children who developed tacrolimus-related cardiac complications [139 ]. One had hypertrophic obstructive cardiomyopathy and aortic valve stenosis and the other had aortic stenosis and mitral and tricuspid regurgitation. Both had high serum tacrolimus concentrations. 

Only a few reports exist that deal with the accuracy of MDCT for detecting and quantifying mitral valve disease, i.e., mitral valve regurgitation and/or stenosis (Alkadhi et al. 2006 Messika-Zeitoun et al. 2006) (Fig. 19.6). Very little information is available on the usefulness of MDCT for the diagnosis of pulmonary valve and tricuspid valve disease. Thus, the value of MDCT in diseases of the mitral valve, pulmonary valve, and tricuspid valve is still unclear, and echocar-... 

According to the 2006 ACC/AHA guidelines for the management of patients with valvular heart disease, mitral valve replacement (MVR) is recommended for patients with moderate to severe mitral stenosis (M VA <1.5 cm ), if the patient is not suitable for percutaneous mitral balloon valvulotomy and is not a high-risk candidate [17]. For chronic mitral regurgitation, MVR is only recommended if a patient with LV dysfunction (ejection fraction <0.60 and/or end systolic dimension >40 mm) is deemed not suitable for mitral valve repair. 

Possible severe heart failure if patient has cardiac disease, such as hypertrophic cardiomyopathy, mitral stenosis, rheumatic heart disease, or prosthetic mitral valve. 

Valve surgery with severe aortic stenosis or mitral regurgitation... 

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