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Mitral stenosis

added by ohtusabes

Mitral stenosis
Posted By: ohtusabes (1517 days ago)

Hi Jörg. Thank you very much for your comments.

I agree
with you in near all points:

PG is understimated...and
probably because it is a load dependent parameter ...Atrial kick
exists because he is not in AF...look at mitral inflow spectrum.../>PHT is like a moderate stenosis but I must be made planimetry in
PSAX (I don´t do because the short axis was not really good)
agree with anticoagulation!
I think too that in sum to rheumatic
origen it is a lot of calcium (look at subvalvular apparatus)/>
If you look doppler arterial waveform in contralateral lower
limb...the flow is triphasic (or biphasic), and some parietal
irregularities, little thing... flow is good...arteries are near
normal...no plaques exists!...so, in fact, with this echocardiogram
and a probably cardioembolic source and near normal arteries in
contralateral leg (and no symptoms of intermitent claudication) the
thrombotic mechanism is less likely...

And, agree with you,
TEE is mandatory.

I´m not sure if IVS is asyncronous or
hipo-akinetic in basal and medium portions...very difficult to say in
context of LBBB induced by pacemaker...anyway, independent of DDDR
pacemaker I think IVS in this portions is not thickening...but,
Feigenbaum in his book says that it is a very difficult appreciation
to do in context of LBBB and make some tips about it to differenciate
LBBB, pacemaker and diskinesia of IVS...and finally says that it is
very difficult inclusive to experienced echocardiographer...and I´m a
simple intensivist! ahahaha)

Best wishes

Posted By: Emmel (1517 days ago)

Hello Pablo,

Very teaching clip. In my opinion it is a
cardioembolic origin. Mitral stenosis (I think that there is a
postrheumatic origin of mitral stenosis because of doming and
thickening of apex of anterior mitral cup), dilateated left atrium
with altered haemodynamic of blood flow prä-mitral-valve.
PGmean of about 4,21 mmHg isn´t impressive (I think, it is
underexistimated because of loosing atrial contraction because of
dilatated atrium), but the MVA of about 1,15 qcm (measured with PHT
and Hatle-formula) shows us the "disaster" of middle-grade
In Germany there is the recommendation of
oral anticoagulation for that case (middle-grade-mitral-valve-stenosis
and dilatated left atrium). The risk of cardioembolic complication is
very high.
Why the surgeons think, that there is a thrombotic
origin of AAO? I see now high grade peripheral arterial occlusive
Is there a mild asynchrone contraction of LV because of
RV-stimulation by DDDR-pacemaker?
In my opinion DDDR with high
portio of ventricular pacing with moderat or high-grade mitral
stenosis is a bad combination (but it is dependent on the location of
RV-lead: septum or RV-apex), because of altered haemodynamic of
A TEE would be very interesting!
Thank you very
much for that interesting and in my opinion very teaching case!/>What is your opinion of your case? I´m very interesting in!/>
Best wishes!
Very good demonstration of the whole

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Added: 30-01-2013
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70 yo, male, po patient right femoropopliteal bypass because acute arterial occlusion (AAO). Vascular surgeon says the origin of AAO is thrombotic...but...TTE shows mild to moderate Mitral stenosis: look to anterior mitral valve doming, aliasing in mitral inflow, moderately enlarged LA...and no thrombi in LA (but is not TEE)...in contralateral lower limb triphasic spectral doppler waveform ...What do you think? thrombotic or cardioembolic? (he have implanted a DDDR permanent pacemaker a cup of years ago)

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