Adult ; Balloon Dilatation/*methods ; Comparative Study ; Female ; Human ; Male ; Middle Age ; Mitral Valve Stenosis/*therapy

OBJECTIVETo evaluate the efficacy and safety of interventional therapy in structural heart diseases in 38 PLA hospitals.

METHODSData including patient number underwent interventional therapy for structural heart disease, procedure details, immediate procedural complications were retrospectively collected in all the military hospitals between January 2005 and December 2006.

RESULTSSuccessful interventional therapy was achieved in 8692 out of 8862 patients (98.08%) with structural heart disease. Transcatheter closure of ventricular septal defect (VSD), atrial septal defect (ASD) and patent ductus arteriosus (PDA), and percutaneous balloon dilatation of mitral valve stenosis (MS) and pulmonary valve stenosis (PS) were the most performed procedures (97.99%). Up to 91.23% patients underwent transcatheter closure with domestic devices. The incidence of procedure-related complications was 4.33% (n = 384) which were most frequently associated with VSD closure. The commonest procedural complications included conduction blockades (n = 260), residue shunt (n = 42), device detachment (n = 30) and tricuspid incompetence (n = 22). Although the procedures performed in 2005 and 2006 increased 57.32% compared with those in 2003 and 2004, the success rate and the incidence of complications remained unchanged.

CONCLUSIONPercutaneous treatment of structural heart disease is a safe and feasible alternative to surgery. Simulate complications arise long after the treatment, which suggests the importance of long-term follow-up for those patients who hare undergone interventional therapy.

Catheterization ; Heart Defects, Congenital ; epidemiology ; therapy ; Hospitals, Military ; statistics & numerical data ; Humans ; Military Personnel ; Mitral Valve Stenosis ; epidemiology ; therapy ; Pulmonary Valve Stenosis ; epidemiology ; therapy ; Surveys and Questionnaires ; Treatment Outcome

We performed percutaneous mitral balloon valvuloplasty (PMV) in 367 patients to compare the effectiveness of PMV between patients with mitral restenosis after surgical commissurotomy (group 1) and patients with unoperated mitral stenosis (group 2). Twenty-two had undergone closed or open mitral commissurotomy 11.2 years before. There were no significant differences in clinical profiles between the two groups. The mitral valve area was increased from 1.0 +/- 0.8 to 1.8 +/- 0.6 cm2 in group 1 and 0.9 +/- 0.3 to 2.0 +/- 0.7 cm2 in group 2 (p> 0.05). The mitral gradient was decreased from 14 +/- 5.9 to 6 +/- 2.6 mmHg in group 1 and 18 +/- 7.0 to 7 +/- 5.3 mmHg in group 2 (p> 0.05). The increment of mitral regurgitation and significant left to right shunt after PMV were not significantly different (10% versus 14.7%, 5% versus 10.4% respectively). Optimal results were attained in 75% of the patients in group 1 and in 84.3% of the patients in group 2 (p> 0.05). These results suggest PMV in mitral restenosis after surgical commissurotomy may be safe in selected patients and may be equally effective as in unoperated mitral stenosis.
Adult ; *Balloon Dilatation ; Comparative Study ; Evaluation Studies ; Female ; Human ; Male ; Middle Age ; Mitral Valve/*surgery ; Mitral Valve Stenosis/surgery/*therapy ; Recurrence

OBJECTIVETo investigate the short and long-term outcome post percutaneous balloon mitral valvuloplasty (PBMV) in mitral valve stenosis patients with different mitral valve morphology.

METHODSMitral valve morphology was graded according to the Wilkins scoring system, 385 eligible patients were divided into echocardiographic scores > 8 group (n = 125) and ≤ 8 group (n = 260). Patients were followed up after PBMV according to the improved Inoue method.

RESULTSPBMV was successful in 370 patients, the success rate of PBMV in > 8 group was significantly lower than in ≤ 8 group (92.8% vs. 97.7%, P < 0.05). Hemodynamic parameters improved significantly in both groups (all P < 0.05) at 6 months post PBMV. Compared to pre-PBMV, improvement on left atrial mean pressure [(14.22 ± 5.02) mm Hg vs. (15.44 ± 5.19) mm Hg (1 mm Hg = 0.133 kPa)], pulmonary artery systolic pressure [(26.13 ± 9.27) mm Hg vs. (31.93 ± 9.98) mm Hg], mitral valve gradient [(9.21 ± 4.11) mm Hg vs. (10.16 ± 4.21) mm Hg] and area of mitral valve orifice [(1.02 ± 0.15) cm(2) vs. (1.20 ± 0.22) cm(2)] post PBMV was less in > 8 group (116 cases) than those in ≤ 8 group (254 cases, all P < 0.05). Three hundreds and fifty three patients were followed up for (78 ± 20) months. Echocardiographic parameters post PBMV improved significantly in both groups compared with the pre-PBMV values during follow-up (all P < 0.05). However, left atrial mean pressure, pulmonary artery systolic pressure, mitral valve gradient and area of mitral valve orifice in > 8 group (108 cases) improved less than those in ≤ 8 group (245 cases) [(13.28 ± 5.06) mm Hg vs. (14.77 ± 5.17) mm Hg, (21.19 ± 9.17) mm Hg vs. (28.92 ± 9.91) mm Hg, (7.30 ± 4.40) mm Hg vs. (9.16 ± 4.28) mm Hg, (0.92 ± 0.17) cm(2) vs. (1.07 ± 0.20) cm(2); all P < 0.05]. The incidence of mitral restenosis was also significantly higher in > 8 group than in ≤ 8 group (20.4% vs. 8.2%, P < 0.05).

CONCLUSIONSThe mitral valve morphology played a key role on the outcome post PBMV in patients with mitral valve stenosis. Patients with lower echocardiographic scores benefit more from PBMV than patients with higher echocardiographic scores.

Adolescent ; Adult ; Aged ; Balloon Valvuloplasty ; methods ; Female ; Humans ; Male ; Middle Aged ; Mitral Valve ; anatomy & histology ; diagnostic imaging ; Mitral Valve Stenosis ; diagnostic imaging ; therapy ; Treatment Outcome ; Ultrasonography ; Young Adult

OBJECTIVETo observe the outcome of percutaneous balloon mitral valvuloplasty (PBMV) in patients with rheumatic mitral valve stenosis.

METHODSFrom April 1992 to November 2008, 1768 patients underwent PBMV in our hospital.Clinical and echocardiographic follow up data were analyzed in 426 patients from April 1992 to August 1998. Left atrial pressure and the mitral valve gradient (MVG) were measured before and immediately after PBMV in all patients.

RESULTSPBMV was successful in 1748 out of 1768 patients (98.86%). Left atrial pressure decreased from (38 +/- 7) mm Hg (1 mm Hg = 0.133 kPa) to (12 +/- 4) mm Hg (P < 0.001), MVG decreased from (28 +/- 6) mm Hg to (8 +/- 3) mm Hg (P < 0.001) and the area of the mitral valve increased from (0.98 +/- 0.26) cm(2) to (1.97 +/- 0.39) cm(2) (P < 0.001) post PBMV. The main complications included death (n = 2), acute pericardial effusion (n = 1), severe mitral regurgitation (n = 12), cerebral embolism (n = 2) and pulmonary edema (n = 1). Ten years follow up was finished in 426 patients and 288 patients (67.6%) were still in NYHA class Ior II without mitral valve replace operation or repeated PBMV, restenosis was evidenced in 140 patients (33.3%) and 31 patients dead (7.5%).

CONCLUSIONPBMV was an effective therapy option for patients with rheumatic mitral valve stenosis.

Catheterization ; adverse effects ; Echocardiography ; Follow-Up Studies ; Humans ; Mitral Valve Stenosis ; therapy ; Rheumatic Heart Disease ; therapy ; Treatment Outcome

OBJECTIVETo observe the long-term outcome of repeat percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral restenosis.

METHODSThirty-nine patients with mitral restenosis post fist PBMV received repeat PBMV with the improved Inoue method. Patients were followed up for 12 to 146 months.

RESULTSRepeat PBMV succeed in 36 out of 39 patients (92.3%). Immediately after repeat PBMV, clinical symptoms and left atrial mean pressure [LAP, (24.50+/-6.54) mm Hg (1 mm Hg=0.133 kPa) vs. (9.66+/-4.21) mm Hg], pulmonary artery systolic pressure [PASP, (58.12+/-12.68) mm Hg vs. (31.45+/-10.02) mm Hg], mitral valve gradient [MVG, (17.03+/-4.52) mm Hg vs. (7.79+/-4.07) mm Hg] and area of mitral valve orifice [MVA, (1.05+/-0.19) cm2 vs. (2.23+/-0.22) cm2] improved significantly compared to pre-PBMV (all P<0.05). Left atrial end-diastolic dimension (LAD) remained unchanged post operation [(4.71+/-0.75) cm vs. (4.07+/-0.69) cm, P>0.05]. Thirty six out of 39 cases could be followed up for a period between 12-146 months (69+/-23) months. Follow-up, data showed that MVA [(2.02+/-0.21) cm2 vs. (2.23+/-0.22) cm2] and MVG [(9.15+/-4.11) mm Hg vs. (7.79+/-4.07) mm Hg] were similar as those directly post operation (all P>0.05). Cardiac function and quality of life were also significantly improved in most patients during follow up.

CONCLUSIONRepeat PBMV is safe and effective for most patients with mitral restenosis.

Adult ; Catheterization ; Follow-Up Studies ; Humans ; Middle Aged ; Mitral Valve Stenosis ; therapy ; Prognosis ; Treatment Outcome ; Young Adult

OBJECTIVETo observe the outcome and assess related factors affecting left atrial remodeling after percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral valve stenosis.

METHODSFrom March 1998 to June 2002, there were 96 mitral valve stenosis patients who underwent PBMV in our hospital. Echocardiographic, 12 leads united electrocardiogram and other clinical datas were collected at preoperation, 1 week after operation, and 4 - 6 years after operation to retrospective analysis. Multiple stepwise regression analysis was used to assess controllable factors of left atrial remodeling.

RESULTSLeft atrial diameter reduced from (44.6 +/- 6.6) cm before PBMV to (42.8 +/- 6.5) cm (P > 0.05) 1 week after PBMV and enlarged to (47.2 +/- 5.7)cm (all P < 0.05) at the end of 4 - 6 years follow up post operation. The mitral valve area (MVA) increased from (1.06 +/- 0.32) cm2 before PBMV to (2.02 +/- 0.43) cm2 1 week after PBMV and (1.98 +/- 0.36) cm2 4 - 6 years post operation (all P < 0.05). Heart function assessed by NYHA classification improved significantly at 1 week and 4 - 6 years after surgery compared with pre-operation (P < 0.01). Multiple stepwise regression analysis showed that systolic blood pressure at 4 - 6 years after operation, MVA at 1 week after operation, preoperative atrial fibrillation, Wilkins score < or = 8, preoperative left atrial diameter were the independent predictive factors of left atrial remodeling at 4 - 6 years after PBMV.

CONCLUSIONSPBMV was an effective therapy option for patients with mitral valve stenosis. Systolic blood pressure at 4 - 6 years after operation, MVA at 1 week after operation, preoperative atrial fibrillation, Wilkins < or = 8, preoperative left atrial diameter are the predictive factors of left atrial remodeling after PBMV.

Adult ; Catheterization ; Female ; Heart Atria ; Humans ; Male ; Middle Aged ; Mitral Valve Stenosis ; therapy ; Prognosis ; Retrospective Studies ; Treatment Outcome

Prosthetic valve thrombosis(PVT) may be a life-threatening complication requiring prompt intervention. This is a case report of thrombolytic therapy for thrombosis of prosthetic mitral valve. A 47 year-old male admitted to the emergency room for abrupt onset of dyspnea. He had undergone mitral valve replacement(On-X valve, 29mm) for mitral stenosis 8 months ago. The patient's international normalized ratio(INR) on admission was 1.09. The mechanical clicks were muffled and rales were heard in both lung fields. A transesophageal echocardiography(TEE) revealed prosthetic valve thrombosis with increased transvalvular pressure gradient(34 mmHg). The patient's condition needed to intubation for mechanical ventilation due to hemodynamic compromise, however his wife and relatives refused the surgical intervention due to financial problems. The patient was transferred to the cardiac care unit and we decided to perform thrombolytic therapy. A bolus of 1,500,000 IU of urokinase was given, followed by a drip of 1,500,000 IU for 1 hour. The patient did not improved hemodynamically; therefore, we gave 100 mg of tissue plasminogen activator(t-PA) for over 2 hours. During that time mechanical clicks were audible and hemodynamics of the patient improved progressively. A TEE showed disappearance of thrombus and decreased pressure gradient(1.7 mmHg) after 6 hours of thrombolytic therapy. The patient was recovered without any neurologic sequale and was discharged with administration of warfarin.
Dyspnea ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Intubation ; Lung ; Male ; Middle Aged ; Mitral Valve Stenosis ; Mitral Valve* ; Plasminogen ; Respiration, Artificial ; Respiratory Sounds ; Spouses ; Thrombolytic Therapy* ; Thrombosis* ; Urokinase-Type Plasminogen Activator ; Warfarin

Prosthetic valve thrombosis(PVT) may be a life-threatening complication requiring prompt intervention. This is a case report of thrombolytic therapy for thrombosis of prosthetic mitral valve. A 47 year-old male admitted to the emergency room for abrupt onset of dyspnea. He had undergone mitral valve replacement(On-X valve, 29mm) for mitral stenosis 8 months ago. The patient's international normalized ratio(INR) on admission was 1.09. The mechanical clicks were muffled and rales were heard in both lung fields. A transesophageal echocardiography(TEE) revealed prosthetic valve thrombosis with increased transvalvular pressure gradient(34 mmHg). The patient's condition needed to intubation for mechanical ventilation due to hemodynamic compromise, however his wife and relatives refused the surgical intervention due to financial problems. The patient was transferred to the cardiac care unit and we decided to perform thrombolytic therapy. A bolus of 1,500,000 IU of urokinase was given, followed by a drip of 1,500,000 IU for 1 hour. The patient did not improved hemodynamically; therefore, we gave 100 mg of tissue plasminogen activator(t-PA) for over 2 hours. During that time mechanical clicks were audible and hemodynamics of the patient improved progressively. A TEE showed disappearance of thrombus and decreased pressure gradient(1.7 mmHg) after 6 hours of thrombolytic therapy. The patient was recovered without any neurologic sequale and was discharged with administration of warfarin.
Dyspnea ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Intubation ; Lung ; Male ; Middle Aged ; Mitral Valve Stenosis ; Mitral Valve* ; Plasminogen ; Respiration, Artificial ; Respiratory Sounds ; Spouses ; Thrombolytic Therapy* ; Thrombosis* ; Urokinase-Type Plasminogen Activator ; Warfarin

Changes in cardiac rehabilitation in the 1990s involved the development of different patterns of the delivery of rehabilitative care. Patients were offered with a choice of individual versus group and center-based versus home-based physical activity programs. The recent application of risk-stratification procedures for coronary patients has brought major changes in the delivery of cardiac rehabilitation exercise training. Patients considered at low risk are able to undertake less supervised rehabilitation in a safe manner. Contemporary cardiac rehabilitation programs provide several important core components, including baseline patient assessment, nutrition counseling, risk factor management, psychosocial management, and activity counseling. However, appropriately prescribed exercise therapy remains the cornerstone of these programs. Cardiac rehabilitation programs have been categorized as phase I (inpatient), phase II (up to 12 weeks of ECG monitoring), phase II (no ECG monitoring under clinical supervision), and phase IV(no ECG monitoring, professional supervision). Cardiac patients who have specific needs to consider when formulating the exercise prescription include those with a history of myocardial infarction and angina, congestive heart failure, mitral valve stenosis and cardiac transplantation. Finally, the goals of rehabilitative care should include improvement of the functional capacity to achieve functional independence with an emphasis on quality of life.
Counseling ; Electrocardiography ; Exercise Therapy ; Heart Failure ; Heart Transplantation ; Humans ; Mitral Valve Stenosis ; Motor Activity ; Myocardial Infarction ; Nutrition Assessment ; Prescriptions ; Quality of Life ; Rehabilitation* ; Risk Factors