[Left ventricular blood filling in patients with severe mitral stenosis: comparisons before and soon after percutaneous transluminal mitral commissurotomy].
To clarify the effects of mitral obstruction on left ventricular (LV) diastolic blood filling, 15 patients with tight mitral stenosis (each mitral valve area was less than 1.5 cm2) were studied. Each selected patient underwent successful percutaneous transluminal mitral commissurotomy (PTMC), which resulted in a 1.5 fold increase in each mitral valve area. LV pressure, left atrial (LA) pressure and cardiac output were measured before and immediately after PTMC. Left ventriculography was performed before and immediately after PTMC. The ventriculogram was traced frame by frame for one cardiac cycle. The LV volume curve was obtained from the traced image using a computer. The LV end-diastolic and end-systolic volumes (EDVI, ESVI), and ejection fraction in the subsequent cardiac cycle were calculated. The diastolic filling period was divided into 3 equal parts: namely, early, mid-, and late diastole. The blood volume entering the LV during early, mid-, and late diastole, which indicated the filling properties of each part, were calculated. After successful PTMC, both the mitral valve area (1.1 +/- 0.3 cm2 to 1.9 +/- 0.6 cm2, p < 0.01) and the cardiac index (3.2 +/- 0.8 l/min/m2 to 3.6 +/- 1.1 l/min/m2, p < 0.05) increased with the decreases in the mean diastolic pressure gradients between the LA and LV (13.4 +/- 4.5 mmHg to 5.9 +/- 2.6 mmHg, p < 0.01). The blood volume entering the LV during early diastole increased significantly without significant change in the blood volume entering the LV during mid- and late diastole.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Internal Medicine, Keio University School of Medicine, Tokyo.
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S
Goto
S
S
Abe
M
M
Akaishi
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Yoshikawa
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Matsubara
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Ogawa
S
S
Handa
D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000209:etiology; D003971:Diastole; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000503:physiopathology* / Q000601:surgery; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology*