Non-rheumatic annular mitral stenosis: prevalence and characteristics

Akram, Mohammad Raza; Chan, Tze Yuan; McAuliffe, S.J.G.; Chenzbraun, Adrian

doi:10.1093/ejechocard/jen179

Cited by 56 publications

(43 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When acute pulmonary edema is identified by lung ultrasound, but the point-of-care echocardiography does not reveal clear systolic or diastolic dysfunction, evaluation of the mitral valve should be considered [3][4][5][6][7]. Color Doppler evaluation of valvular pathology has been demonstrated to be accurate when assessing patients in the echocardiography lab [8].…”

Section: Discussionmentioning

confidence: 99%

“…When acute pulmonary edema is present, but point-of-care echocardiography does not demonstrate systolic or diastolic dysfunction, evaluation of the mitral valve should be performed [3][4][5][6][7]. Mitral stenosis, the obstruction of left ventricular inflow at the level of the mitral valve, is typically a progressive process that can lead to acute decompensation.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Simplified Point-of-Care Echocardiographic Method to Detect Critical Mitral Stenosis in the Patient with Undifferentiated Acute Pulmonary Edema

Gardner¹,

Mantuani²,

Nagdev³

2016

J Eme Med Int Care

View full text Add to dashboard Cite

A 41-year-old female who recently emigrated from Honduras, presented to the emergency department with a history and physical exam suggestive of pelvic inflammatory disease. During her initial evaluation, the patient received a 2L intravenous bolus of normal saline for tachycardia and presumed volume depletion. Soon after, the patient became acutely dyspneic and was noted to have bilateral crackles on pulmonary auscultation.Because of the patient's rapid clinical deterioration and acute dyspnea, POCUS examination was performed [1,2]. The patient's inferior vena cava was noted to be plethoric with minimal respiratory variation. Lung ultrasound confirmed diffuse bilateral B-lines consistent with pulmonary edema. The patient was unable to tolerate laying in the left lateral decubitus position to obtain an apical four chamber examination. Thus, only a parasternal long axis view in the upright seated position was obtained. The parasternal long axis view did not indicate impaired systolic or diastolic function, but rather a dilated left atrium and a "hockey stick" appearance of the anterior mitral valve leaflet, suggestive of mitral stenosis (Video).To confirm the potential dysfunction of the mitral valve, M-mode measurement was performed across the anterior leaflet. A normal mitral valve anterior leaflet, when examined with M-mode, will demonstrate the characteristic two-peaks of the E and A waves, correlating with the phases of early filling and atrial kick (Figure 1). In mitral stenosis, this physiology is distorted as the valve movement is restricted secondary to stenosis. This pathology leads to a "table top" appearance of the valve in M-mode (Figure 2), characteristic of mitral stenosis. In this case, identification of the characteristic "table top" appearance in M-mode, in addition to the findings of a dilated left atrium and a "hockey stick" appearance of the anterior leaflet, led to the rapid and accurate diagnosis of mitral stenosis. An AbstractPoint-of-care ultrasound (POCUS) is an important tool for emergency medicine providers in identifying the presence and etiology of undifferentiated acute pulmonary edema [1,2]. When acute pulmonary edema is present, but point-of-care echocardiography does not demonstrate systolic or diastolic dysfunction, evaluation of the mitral valve should be performed [3][4][5][6][7]. Mitral stenosis, the obstruction of left ventricular inflow at the level of the mitral valve, is typically a progressive process that can lead to acute decompensation. Establishing the diagnosis of mitral stenosis with point-of-care echocardiography in the emergency department can be challenging as assessment of the mitral valve has traditionally required advanced color Doppler echocardiographic skills [8]. Effective POCUS techniques should be simple, rapid, and accurate, without requiring advanced techniques not known to the average provider. Utilizing M-mode across the mitral valve is an often overlooked and simple technique that can rapidly identify mitral stenosis, and in the correct clinical set...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Simplified Point-of-Care Echocardiographic Method to Detect Critical Mitral Stenosis in the Patient with Undifferentiated Acute Pulmonary Edema

Gardner¹,

Mantuani²,

Nagdev³

2016

J Eme Med Int Care

View full text Add to dashboard Cite

show abstract

“…There is a risk of systemic non-thrombotic embolism of calcified material in such cases during the natural course of the disease and also at the time of percutaneous or surgical intervention [5] . MAC is usually associated with mitral stenosis because of restricted posterior mitral leaflet and annulus movement [6] . However, the index case had a thickened, retracted, poorly aligned posterior leaflet resulting into severe mitral regurgitation.…”

Section: Discussionmentioning

confidence: 99%

Severe mitral annular calcification in rheumatic heart disease: A rare presentation

Vijayvergiya

Vaiphei²,

Rana

2012

WJC

View full text Add to dashboard Cite

Severe mitral annular calcification (MAC) is frequently seen in patients with advanced age and chronic kidney disease, but it is rare in rheumatic heart disease (RHD). We hereby report a case of 45�year�old female with chronic RHD, who had severe MAC and mitral regur� gitation�� luoroscopy revealed a "crown"�like severe calcification of the mitral annulus. Autopsy of the heart revealed a calcified posterior mitral annulus, fused commissures, and calcified nodules at the atrial aspect of the mitral valve��

show abstract

“…9 Another retrospective study reports DMS as the pathogenesis in 12 patients (18.5%) among 70 patients with MS encountered in a tertiary care center. 10 Furthermore, 2 of these 12 patients had a coexisting grade 2 or 3 MR. Among patients noted to have mitral valve calcification on multidetector computed tomography, echocardiographic assessment revealed DMS in 26% of cases.…”

Section: Epidemiologymentioning

confidence: 99%

Degenerative Mitral Stenosis

et al. 2016

View full text Add to dashboard Cite

Abstract-Degenerative mitral stenosis (DMS) is an important cause of mitral stenosis, developing secondary to severe mitral annular calcification. With the increase in life expectancy and improved access to health care, more patients with DMS are likely to be encountered in developed nations. These patients are generally elderly with multiple comorbidities and often are high-risk candidates for surgery. The mainstay of therapy in DMS patients is medical management with heart rate control and diuretic therapy. Surgical intervention might be delayed until symptoms are severely limiting and cannot be managed by medical therapy. Mitral valve surgery is also challenging in these patients because of the presence of extensive calcification. Hence, there is a need to develop an alternative percutaneous treatment approach for patients with DMS who are otherwise inoperable or at high risk for surgery. In this review, we summarize the available data on the epidemiology of DMS and diagnostic considerations and current treatment strategies for these patients.

show abstract

Non-rheumatic annular mitral stenosis: prevalence and characteristics

Abstract: AMS is more frequent than that is assumed and is associated with risk factors for coronary artery disease. AMS is generally mild and PHT may be less accurate for MVA calculation than in RMS.

Cited by 56 publications

References 17 publications

A Simplified Point-of-Care Echocardiographic Method to Detect Critical Mitral Stenosis in the Patient with Undifferentiated Acute Pulmonary Edema

A Simplified Point-of-Care Echocardiographic Method to Detect Critical Mitral Stenosis in the Patient with Undifferentiated Acute Pulmonary Edema

Severe mitral annular calcification in rheumatic heart disease: A rare presentation

Degenerative Mitral Stenosis

Contact Info

Product

Resources

About