Mitral Valve Disease and Mitral Valvotomy

Goodwin, J. F.; Hunter, J.; Cleland, W. P.; Davies, L. G.; Steiner, R. E.

doi:10.1136/bmj.2.4939.573

Cited by 66 publications

(26 citation statements)

References 27 publications

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“…McKeown (1953) has shown that the pathology of the left atrial biopsy is representative of the changes in the myocardium of the ventricle, yet discrepancy between the biopsy and the clinical findings has been the general rule. No correlation was found between the atrial biopsy and the subsequent clinical course by Baker et al (1955) or by Goodwin et al (1955). The same percentage of positive biopsies was found in the patients in whom restenosis occurred as in the whole series in Likoff and Uricchio's (1958) cases.…”

Section: Discussionmentioning

confidence: 60%

Mitral Valvotomy and Restenosis

Wilcken¹

1960

BMJ

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DIABETIC NEPHROPATHY MEDICAUTISHRNAL 681with diabetic nephropathy and to demonstrate by needle biopsy studies the pathogenic relationship of these defects to the development of the renal lesions.Cases of diabetic nephropathy showed hypoalbuminaemia, hyperglobulinaemia, hypercholesterolaemia in many instances, a rise in the protein-bound serum polysaccharides, hyponatraemia, and hyperkalaemia. The urine showed excessive amounts of 17-hydroxycorticosteroids and low values of 17-ketosteroids. Most patients with diabetic nephropathy could not retain the greater part of a test-dose of vitamin B12 administered parenterally.The following endocrine and metabolic disturbances are believed to be probably responsible for the development of the renal lesions: a disturbance in protein metabolism resulting in a rise in a2 and ,Bglobulins; a disturbance in lipid metabolism causing lipaemia and especially a rise in the smaller aggregates of the serum lipoproteins; a disturbance in carbohydrate metabolism leading to a rise in the serum polysaccharide; excessive glucocorticoid activity; and inability to retain vitamin B,2'The high serum mucopolysaccharides are probably related to the development of the lesions of diffuse and nodular glomerulosclerosis. The occurrence of restenosis after an adequate mitral valvotomy has been questioned, but reports in the literature of well-documented cases imply that it does undoubtedly occur (Jordan and Hellems, 1952; Keyes and Lam, 1954 Donzelot;Santy et al., 1954;McKusick, 1955;Glenn and Dineen, 1956). However, the true incidence of restenosis is not known. In many patients apparent restenosis has been attributed to inadequate initial valvotomy. Thus Harken and Black (1955) have declared that restenosis is most uncommon. Glover et al. (1955) have seen no case of restenosis following valvotomy in their series.From their experience in a review of 250 cases subjected to mitral valvotomy followed from one to six years, Turner and Fraser (1956) felt that refusion of the commissures must be very rare. Of their cases five had second valvotomies and three more were under consideration at the time of writing. It was the opinion of the surgeon that in no case had refusion occurred, but that the original split had been inadequate. On the other hand, Belcher (1958) described 12 cases in which revalvotomies were undertaken, and drew a

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Section: Discussionmentioning

confidence: 60%

Mitral Valvotomy and Restenosis

Wilcken¹

1960

BMJ

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“…Left atrial size was assessed in four grades (0-III) according to the criteria of Goodwin et al 12 The appearance of the upper lobe pulmonary veins was assessed in four grades according to Simon. '3 Assessment of chest radiograph was impossible in one patient who had previously undergone left pneumonectomy and thoracoplasty for tuberculosis.…”

Section: Non-rheumatic Sub-valvar Mitralmentioning

confidence: 99%

Nonrheumatic Subvalvular Mitral Regurgitation

1973

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Thirty-three patients are reported with nonrheumatic mitral regurgitation due to rupture or stretching of the chordae tendinaeae or papillary muscles. Nineteen (58%) had no definite predisposing etiological factors (average age 59 years). Six (19%) had a previous myocardial infarction. It is proposed that rupture or stretching of the chordae resulted from degenerative or ischemic changes in the chordae and/or papillary muscles. Six young patients had ruptured chordae from other causes. Two patients had myocardial infarction resulting in rupture of the posteromedial papillary muscle.Characteristic clinical findings included progressive dyspnea of sudden onset, sinus rhythm, systolic thrill, accentuated pulmonary valve closure sound, third heart sound, and widely propagated pansystolic murmur. The electrocardiogram frequently showed inferolateral ischemic changes. Plain chest radiographs usually showed a normal-sized heart and left atrium in patients in sinus rhythm. At cardiac catheterization a characteristic high V wave in the pulmonary artery wedge pressure was seen in 88% of patients. The left ventricular end-diastolic pressure was highest in the six postinfarct patients in whom the ejection fraction was significantly low.

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“…The diagnoses of mitral stenosis, mitral regurgitation, and combined lesions were made from the now welldescribed symptomatology, physical signs, and radiology of these variations of rheumatic heart disease. The size of the mitral orifice was deteruined by the surgeon's finger; a method has been described by Goodwin et al,6 who expressed the size of the orifice in terms of the distance between the comnmissures. They arranged their cases in…”

Section: Methodsmentioning

confidence: 99%

Bronchoscopic Method for Measuring Left Atrial Pressure

Gunning

1958

Circulation

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The possibility is examined that measurements from the records of left atrial pressure obtained by direct puncture of the left atrium through the bronchoscope might help in the diagnosis of mitral disease. The left atrial pressure records of 156 patients have been analyzed and the results are presented.IT WAS suggested that the record of left atrial pressure, obtained through the bronchoscope, might help to differentiate between mitral stenosis and mitral regurgitation and also to distinguish those patients in whom the mitral lesion is not the major cause of the symptoms.'The validity of these suggestions has been tested in a series of 156 patients. METHODThe apparatus used was the same as that prexviouslv described by Allison and Linden.`2 The manometer system was damped only by the puncturing needle and the degree of damping was 60 to 70 per cent of the critical value. It must be emphasized that in a system of this type no other damping is required. If, to eliminate artifacts, further damping is applied by electric or mechanical means, the amplitude of the recorded pressure pulse will be reduced, and inaccuracies of an unknown degree will occur.The Patient. At rapid heart rates the records of the left atrial pressure contours are less acemirate: (1) because the ratio of the frequency of the impressed force to the natural frequency of the manometer system is large and this causes distortion; and (2) [n all tracings an electrocardiogram and a phonocardiogram were recorded to facilitate the recognition of the individual waves of the pressure pulse contours. The method of measuring the records has been described previously,' but is briefly reviewed. The cardiac cycles to be examined were chosen from those that occurred during the expiratory phase. Pressures were then measured at 2 points in the atrial cycle: at the "Z" point,4 which is a point on the atrial pressure curve just before the beginning of the "c" wave, and at the top of the "v" wave. These 2 points of the atrial pressure curve correspond to the beginning and end of ventricular systole. A calculation was then made of the "miitral value" as described and discussed previously:' the difference between the pressures at the "V" and the "'' points (P,-Pz) is expressed as a percentage of the pressure at the top of the "v?' wave (P.). It is important to select the correct points on the curve at which to measure the pressures; these are illustrated in figure 1, which shows records froiii patients with sinus rhythm and with atrial fibrillation.Selection of Material. The records of patients accepted for this study were taken in order according to the numbers in the departmental files; but this is not truly an unselected series, as mere attendance at a thoracic surgical clinic infers some degree of selection.The cases were divided into groups, first according to the clinical diagnosis and, second, according to the findings at operation. The diagnoses of mitral stenosis, mitral regurgitation, and combined lesions were made from the now welldescribed symptomatology,...

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Mitral Valve Disease and Mitral Valvotomy

Cited by 66 publications

References 27 publications

Mitral Valvotomy and Restenosis

Mitral Valvotomy and Restenosis

Nonrheumatic Subvalvular Mitral Regurgitation

Bronchoscopic Method for Measuring Left Atrial Pressure

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