A 66-year-old female with a 1-month history of increasing fatigue, dyspnea on exertion, and palpitations presented with clinical signs of heart failure. Chest computed tomography (CT) revealed a large, mobile left atr...A 66-year-old female with a 1-month history of increasing fatigue, dyspnea on exertion, and palpitations presented with clinical signs of heart failure. Chest computed tomography (CT) revealed a large, mobile left atrial (LA) mass attached to the mitral valve causing severe mitral stenosis and mitral regurgitation. The mass was surgically debulked and the mitral valve was replaced. Pathology revealed a poorly differentiated malignant spindle cell neoplasm with diffuse nuclear positivity of MDM2 and multifocal positivity of CDK4, consistent with intimal sarcoma. This case seeks to describe an uncommon presentation of a rare malignancy, and the surgical and medical management of the disease.展开更多
Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvemen...Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvement usually occurs in childhood and it is progressive leading to diffuse thickening and fibrosis at leaflet edges and thus differentiated from other patterns of valve damage. Background of this case report revealed the bicuspid nature of the aortic valve due to rheumatic commissural fusion and analysis of echocardiographic parameters in combined lesions of both aortic and mitral valves with severe LV (left ventricular) dysfunction. Left ventricular (LV) and left atrial (LA) dilations predisposing to the formation of smoke (SEC-spontaneous echo contrast) in LV and LA as a consequence of mitral and aortic valve disease are illustrated by 2D echocardiographic imaging in this 41-year-old male.展开更多
Objective To analyse the risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Methods From January 2001 to December 2008,2277 patients with rheumatic mitral stenosis underwent operations...Objective To analyse the risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Methods From January 2001 to December 2008,2277 patients with rheumatic mitral stenosis underwent operations in our hospital. There were 737 males and 1540 females,the age ranged from 19 to 84 years [average (50.9 ±10.2) years]. Left atrial thrombosis group展开更多
<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Percutaneous mitral balloon valvuloplasty is the main</spa...<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Percutaneous mitral balloon valvuloplasty is the main</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">procedure in mitral stenosis (MS). It can replace surgical commissurotomy in many cases;however, mitral regurgitation (MR) remains the major procedure complication.</span></span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">This study was conducted to investigate</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">predictors of MR as a complication following</span><b></b><span style="font-family:Verdana;">percutaneous mitral valvuloplasty (PMV) using multitrack balloon technique.</span></span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">This cohort study was conducted at both Menoufia University Hospital and Mabaret Misr Elkadima Hospital. We enrolled 121 patients with moderate to severe MS who were subjected to</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">PMV using multitrack balloon technique during the period from October 2017 to October 2019. Transthoracic echocardiographic evaluation was performed for all patients before and after the procedure. Patients who developed severe MR post procedure were compared with other patients to identify important distinction points.</span></span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Most patients (N = 109, </span><span style="font-family:;" "=""><span style="font-family:Verdana;">90.1%) developed no/mild MR (group A), whereas 12 (9.9%) patients developed severe MR (group B) after PMV. Those who developed severe MR had significantly higher weight, height, body mass index, and body surface area (P value < 0.001 for each). Also, there was a significant difference between both groups regarding pre-operative Wilkins score (8.7 ± 1.3 for severe MR versus 7.9 ± 1.2 for No/Mild MR, P = 0.046). Patients who developed severe MR had higher incidence of other valvular lesions such as mild aortic regurgitation (91.7% versus 36.7%, P < 0.001), higher mitral valve (MV) commissural calcification (50.0% versus 14.7%, P = 0.008), pre-operative MR (100.0% versus</span><a name="page2"></a><span style="font-family:Verdana;"> 35.8%, P < 0.001), higher prevalence of atrial fibrillation (100.0% versus 38.5%, P < 0.001). Regarding balloon sizing, it was significantly higher among patients who developed severe MR compared with those having mild or no MR (P = 0.001). Multivariate regression analysis identified MV balloon sizing (OR 3.877, CI 95% 1.131</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">13.289, P = 0.031) and MV commissural asymmetry of calcification (OR 67.48, CI 95% 5.759</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">790.72, P = 0.001) as significant predictors of outcomes of MV commissurotomy.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Mitral valve calcification, balloon sizing, and MV asymmetry are significant factors that can predict the development of MR after balloon valvuloplasty.</span>展开更多
Infective endocarditis (IE) is the infection of inner endothelial layer of the heart including the heart valves and it may present as rapidly progressive or manifest itself as subacute or chronic disease. The epidemio...Infective endocarditis (IE) is the infection of inner endothelial layer of the heart including the heart valves and it may present as rapidly progressive or manifest itself as subacute or chronic disease. The epidemiology of infective endocarditis has been changed over the past few decades and the incidence of IE in children in United States and Canada is 1 in 1250 pediatric hospital admissions in the early 1980s. At least 70% of infective endocarditis in children occurs with congenital heart disease whereas rheumatic heart disease in southern states of India and the degenerative mitral valve disease (myxomatous, mitral valve prolapse) in the western countries are the most underlying predisposing conditions to infective endocarditis in adolescents. The characteristic lesion of infective endocarditis is “vegetation” and a “large” vegetation >10 mm in size has been reported with an incidence of 15.9% - 62.5% in patients. The significance of vegetation size has been a subject of discussion for many years to predict the embolic episodes. Background of this case study illustrated the varying size and shape of giant vegetation attached to the anterior leaflet of mitral valve in an underlying rheumatic mitral valvulitis and its consequence of valve damage such as chordal rupture, flail leaflet and mitral regurgitation with a description of anatomic features and echocardiographic manifestations in a 10-year-old female child.展开更多
BACKGROUND Rheumatic heart disease(RHD)is an autoimmune disease that leads to irreversible valve damage and heart failure.Surgery is an effective treatment;however,it is invasive and carries risks,restricting its broa...BACKGROUND Rheumatic heart disease(RHD)is an autoimmune disease that leads to irreversible valve damage and heart failure.Surgery is an effective treatment;however,it is invasive and carries risks,restricting its broad application.Therefore,it is essential to find alternative nonsurgical treatments for RHD.CASE SUMMARY A 57-year-old woman was assessed with cardiac color Doppler ultrasound,left heart function tests,and tissue Doppler imaging evaluation at Zhongshan Hospital of Fudan University.The results showed mild mitral valve stenosis with mild to moderate mitral and aortic regurgitation,confirming a diagnosis of rheumatic valve disease.After her symptoms became severe,with frequent ventricular tachycardia and supraventricular tachycardia>200 beats per minute,her physicians recommended surgery.During a 10-day preoperative waiting period,the patient asked to be treated with traditional Chinese medicine.After 1 week of this treatment,her symptoms improved significantly,including resolution of the ventricular tachycardia,and the surgery was postponed pending further follow-up.At 3-month follow-up,color Doppler ultrasound showed mild mitral valve stenosis with mild mitral and aortic regurgitation.Therefore,it was determined that no surgical treatment was required.CONCLUSION Traditional Chinese medicine treatment effectively relieves symptoms of RHD,particularly mitral valve stenosis and mitral and aortic regurgitation.展开更多
Background Although acute rheumatic fever and rheumatic heart disease are now rare in affluent populations,they remain major health issues in developing countries such as China. Rheumatic mitral stenosis is the most c...Background Although acute rheumatic fever and rheumatic heart disease are now rare in affluent populations,they remain major health issues in developing countries such as China. Rheumatic mitral stenosis is the most common valvular disease during pregnancy. Some patients can receive percutaneous balloon mitral valvuloplastyduring pregnancy and obtain good outcomes. Methods A retrospective study of 14 women undergoing percutaneous balloon mitral valvuloplasty with rheumatic mitral valve stenosis during pregnancy in our hospital from Jan 2014 to Oct 2019 was conducted. The maternal and fetal outcomes were analyzed. Results Percutaneous balloon mitral valvuloplasty was successful in all patients with significant improvement in their mitral valve area(pre-operation:0.83±0.21 cm^2 and post-operation:1.64±0.27 cm^2,P<0.05). Pulmonary artery systolic pressure(pre-operation:69.62±28.27 mmHg and post-operation:37.23±12.65 mmHg,P<0.05)was significantly decreased. All 14 patients had an uneventful course afterthe operation. The total number of newborns was 14,none of whom required intensive care monitoring,and no malformations were found. Conclusions Percutaneous balloon mitral valvuloplasty performed during pregnancy with necessary precautions is feasible and effectivefor the mother and mightbe safe forthe fetus. There is marked symptomatic relief,along with good maternal and fetal outcomes.展开更多
文摘A 66-year-old female with a 1-month history of increasing fatigue, dyspnea on exertion, and palpitations presented with clinical signs of heart failure. Chest computed tomography (CT) revealed a large, mobile left atrial (LA) mass attached to the mitral valve causing severe mitral stenosis and mitral regurgitation. The mass was surgically debulked and the mitral valve was replaced. Pathology revealed a poorly differentiated malignant spindle cell neoplasm with diffuse nuclear positivity of MDM2 and multifocal positivity of CDK4, consistent with intimal sarcoma. This case seeks to describe an uncommon presentation of a rare malignancy, and the surgical and medical management of the disease.
文摘Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvement usually occurs in childhood and it is progressive leading to diffuse thickening and fibrosis at leaflet edges and thus differentiated from other patterns of valve damage. Background of this case report revealed the bicuspid nature of the aortic valve due to rheumatic commissural fusion and analysis of echocardiographic parameters in combined lesions of both aortic and mitral valves with severe LV (left ventricular) dysfunction. Left ventricular (LV) and left atrial (LA) dilations predisposing to the formation of smoke (SEC-spontaneous echo contrast) in LV and LA as a consequence of mitral and aortic valve disease are illustrated by 2D echocardiographic imaging in this 41-year-old male.
文摘Objective To analyse the risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Methods From January 2001 to December 2008,2277 patients with rheumatic mitral stenosis underwent operations in our hospital. There were 737 males and 1540 females,the age ranged from 19 to 84 years [average (50.9 ±10.2) years]. Left atrial thrombosis group
文摘<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Percutaneous mitral balloon valvuloplasty is the main</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">procedure in mitral stenosis (MS). It can replace surgical commissurotomy in many cases;however, mitral regurgitation (MR) remains the major procedure complication.</span></span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">This study was conducted to investigate</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">predictors of MR as a complication following</span><b></b><span style="font-family:Verdana;">percutaneous mitral valvuloplasty (PMV) using multitrack balloon technique.</span></span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">This cohort study was conducted at both Menoufia University Hospital and Mabaret Misr Elkadima Hospital. We enrolled 121 patients with moderate to severe MS who were subjected to</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">PMV using multitrack balloon technique during the period from October 2017 to October 2019. Transthoracic echocardiographic evaluation was performed for all patients before and after the procedure. Patients who developed severe MR post procedure were compared with other patients to identify important distinction points.</span></span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Most patients (N = 109, </span><span style="font-family:;" "=""><span style="font-family:Verdana;">90.1%) developed no/mild MR (group A), whereas 12 (9.9%) patients developed severe MR (group B) after PMV. Those who developed severe MR had significantly higher weight, height, body mass index, and body surface area (P value < 0.001 for each). Also, there was a significant difference between both groups regarding pre-operative Wilkins score (8.7 ± 1.3 for severe MR versus 7.9 ± 1.2 for No/Mild MR, P = 0.046). Patients who developed severe MR had higher incidence of other valvular lesions such as mild aortic regurgitation (91.7% versus 36.7%, P < 0.001), higher mitral valve (MV) commissural calcification (50.0% versus 14.7%, P = 0.008), pre-operative MR (100.0% versus</span><a name="page2"></a><span style="font-family:Verdana;"> 35.8%, P < 0.001), higher prevalence of atrial fibrillation (100.0% versus 38.5%, P < 0.001). Regarding balloon sizing, it was significantly higher among patients who developed severe MR compared with those having mild or no MR (P = 0.001). Multivariate regression analysis identified MV balloon sizing (OR 3.877, CI 95% 1.131</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">13.289, P = 0.031) and MV commissural asymmetry of calcification (OR 67.48, CI 95% 5.759</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">790.72, P = 0.001) as significant predictors of outcomes of MV commissurotomy.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Mitral valve calcification, balloon sizing, and MV asymmetry are significant factors that can predict the development of MR after balloon valvuloplasty.</span>
文摘Infective endocarditis (IE) is the infection of inner endothelial layer of the heart including the heart valves and it may present as rapidly progressive or manifest itself as subacute or chronic disease. The epidemiology of infective endocarditis has been changed over the past few decades and the incidence of IE in children in United States and Canada is 1 in 1250 pediatric hospital admissions in the early 1980s. At least 70% of infective endocarditis in children occurs with congenital heart disease whereas rheumatic heart disease in southern states of India and the degenerative mitral valve disease (myxomatous, mitral valve prolapse) in the western countries are the most underlying predisposing conditions to infective endocarditis in adolescents. The characteristic lesion of infective endocarditis is “vegetation” and a “large” vegetation >10 mm in size has been reported with an incidence of 15.9% - 62.5% in patients. The significance of vegetation size has been a subject of discussion for many years to predict the embolic episodes. Background of this case study illustrated the varying size and shape of giant vegetation attached to the anterior leaflet of mitral valve in an underlying rheumatic mitral valvulitis and its consequence of valve damage such as chordal rupture, flail leaflet and mitral regurgitation with a description of anatomic features and echocardiographic manifestations in a 10-year-old female child.
基金Supported by the National Natural Science Foundation of China Project,No.81904049.
文摘BACKGROUND Rheumatic heart disease(RHD)is an autoimmune disease that leads to irreversible valve damage and heart failure.Surgery is an effective treatment;however,it is invasive and carries risks,restricting its broad application.Therefore,it is essential to find alternative nonsurgical treatments for RHD.CASE SUMMARY A 57-year-old woman was assessed with cardiac color Doppler ultrasound,left heart function tests,and tissue Doppler imaging evaluation at Zhongshan Hospital of Fudan University.The results showed mild mitral valve stenosis with mild to moderate mitral and aortic regurgitation,confirming a diagnosis of rheumatic valve disease.After her symptoms became severe,with frequent ventricular tachycardia and supraventricular tachycardia>200 beats per minute,her physicians recommended surgery.During a 10-day preoperative waiting period,the patient asked to be treated with traditional Chinese medicine.After 1 week of this treatment,her symptoms improved significantly,including resolution of the ventricular tachycardia,and the surgery was postponed pending further follow-up.At 3-month follow-up,color Doppler ultrasound showed mild mitral valve stenosis with mild mitral and aortic regurgitation.Therefore,it was determined that no surgical treatment was required.CONCLUSION Traditional Chinese medicine treatment effectively relieves symptoms of RHD,particularly mitral valve stenosis and mitral and aortic regurgitation.
基金Guangdong Medical Research Foundation(No.A2017328)。
文摘Background Although acute rheumatic fever and rheumatic heart disease are now rare in affluent populations,they remain major health issues in developing countries such as China. Rheumatic mitral stenosis is the most common valvular disease during pregnancy. Some patients can receive percutaneous balloon mitral valvuloplastyduring pregnancy and obtain good outcomes. Methods A retrospective study of 14 women undergoing percutaneous balloon mitral valvuloplasty with rheumatic mitral valve stenosis during pregnancy in our hospital from Jan 2014 to Oct 2019 was conducted. The maternal and fetal outcomes were analyzed. Results Percutaneous balloon mitral valvuloplasty was successful in all patients with significant improvement in their mitral valve area(pre-operation:0.83±0.21 cm^2 and post-operation:1.64±0.27 cm^2,P<0.05). Pulmonary artery systolic pressure(pre-operation:69.62±28.27 mmHg and post-operation:37.23±12.65 mmHg,P<0.05)was significantly decreased. All 14 patients had an uneventful course afterthe operation. The total number of newborns was 14,none of whom required intensive care monitoring,and no malformations were found. Conclusions Percutaneous balloon mitral valvuloplasty performed during pregnancy with necessary precautions is feasible and effectivefor the mother and mightbe safe forthe fetus. There is marked symptomatic relief,along with good maternal and fetal outcomes.
