Rheumatic Mitral stenosis

Lock JE, Khalilullah M, Shrivastava S, et al, Percutaneous catheter commissurotomy in rheumatic mitral stenosis. N Engl J Med 1985 3 13(24) 1515-1518. 

Most of the above-reported observations in animals have been confirmed in man. Taquini (47) utilized 80-100-mg. doses of allocryptopine injected intramuscularly in 4 patients with auricular fibrillation and in two with auricular flutter. All but one patient with auricular fibrillation converted to normal sinus rhythm within 30 min. These patients had associated rheumatic mitral stenosis, myocardial infarctions, or hypertension. 

Brunton s findings were quickly applied to the therapy of patients with heart disease. Drummond (102) used a tincture of Erythrophleum in two cases of congestive heart failure due to rheumatic mitral stenosis or insufficiency. He noted a desirable decrease in pulse rate, a disappearance of pulse deficit, an increase in blood pressure, and diuresis. Overdosage did cause a temporary cessation of urine flow. Drummond believed that Erythrophleum would be useful in therapy to slow the pulse rate, make the heart rhythm more regular, and increase the force of cardiac systole but but implied that digitalis acted with greater certainty and regularity. 

Clinicians from Hong Kong reported a case of potential danshen-warfarin interaction in a 48-year-old female with a history of rheumatic heart disease, atrial fibrillation, and mitral stenosis (11). The patient underwent successful transvenous mitral valvuloplasty for management of her medical conditions, and was discharged with 1 mg warfarin, as well as... 

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. 

Mitral stenosis is seen typically as a consequence of chronic rheumatic fever. Isolated congenital mitral stenosis is very rare and not suitable for balloon valvuloplasty. Clinical symptoms depend on the degree of obstruction. Dyspnea, atrial fibrillation, embolic events, pulmonary edema, and right heart decompensation may occur and are all indications for treatment. Surgery and catheter intervention provide similar results. Balloon valvuloplasty produces best results in patients with little or no calcification of the mitral leaflets (20—23). 

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,... 

The classic publication of Frey (17) epitomizes most of the information known today about the therapy of auricular fibrillation with quinidine. He converted to normal sinus rhythm 6 of 10 patients whose auricular fibrillation was complicated by atherosclerosis, mitral stenosis or insufficiency, and rheumatic fever or congestive failure. These patients included other arrhythmias such as auricular flutter or ventricular extra systoles. Some had been digitalized. Conversion occurred after 1.0 to 1.4 g. quinidine given over 2 to 8 days. Frey (33) also distinguished between patients with paroxysmal auricular fibrillation and the more stubborn continuous fibrillation. In this latter group of patients, many of whom had serious cardiac damage, quinidine converted 11/22 to normal rhythm. 

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

Heart failure, chronic obstructive pulmonary disease, thyrotoxicosis, constrictive pericarditis, ischemic heart disease, sepsis, pulmonary embolus, rheumatic heart disease, hypertension, mitral stenosis, atrial irritation, or complication of coronary bypass or valve replacement surgery. 

Isolated tricuspid stenosis is very rare and almost always associated with chronic rheumatic fever. Techniques to dilate this valve are based on those for mitral dilation. 

---