Conduction defects and mitral annulus calcification.

Nair, Chandra K.; Runco, Vincent; Everson, Gregory T.; Boghairi, Anoush; Mooss, Aryan N.; Mohiuddin, Syed M.; Sketch, Michael H.

doi:10.1136/hrt.44.2.162

Cited by 43 publications

(8 citation statements)

References 19 publications

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“…In an echocardiographic study where clinical significance of MAC was investigated, and increased frequency of conduction disorders have been reported in cases with MACs larger than 5 mm. [5] In a study performed by Tuzcu et al [6] in patients without fluoroscopically detected MAC, higher PMBV success, and lower complication rates when compared with cases with MAC have been demonstrated. In our patient, mild degree of MAC was detected, and calcific plaques involving conduction system might have caused damage during the procedure.…”

Section: Discussionmentioning

confidence: 94%

Delayed cardiac asystole after percuteneous mitral balloon valvuloplasty

Bayar

Yüksel

Kuş

et al. 2013

Arch Turk Soc Cardiol

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Percutaneous mitral balloon valvuloplasty (PMBV) is the preferred treatment in mitral stenosis patients with appropriate valve anatomy, but it may cause arrhythmic complications rarely. In the literature, the mortality rate associated with PMBV has been reported as 1%, and a small number of patients developed atrioventricular block during the process. In this report, we describe a 53-year-old female patient with severe rheumatic mitral stenosis who developed Mobitz type 2 atrioventricular block and asystole after a successful PMBV operation. Sinus rhythm was achieved with atropine in this patient. It was thought that the arrhythmia resulted from calcified plaques on the mitral valve or from conduction system damage due to high balloon pressure during the process. For the recognition and treatment of possible arrhythmic complications, it is important to monitor patients in the intensive care unit for at least 24 hours after PMBV.

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Section: Discussionmentioning

confidence: 94%

Delayed cardiac asystole after percuteneous mitral balloon valvuloplasty

Bayar

Yüksel

Kuş

et al. 2013

Arch Turk Soc Cardiol

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“…The increased sympathetic activity and decreased parasympathetic tone could be detrimental and contribute to the higher cardiovascular mortality rate in patients with MAC (1,24). Possible mechanisms by which MAC may impact HRV may be due to that MAC might cause restriction of mitral annular motion and dilatation necessary for normal valvular motion resulting in abnormal mitral inflow velocities (25), degenerative process within the mitral annulus associated with or accompanied by a "sclerodegenerative process" within the conduction system or within the intrinsic cardiac nerves and cardiac receptors (26,27), and increased left atrial size (28,29).…”

Section: Discussionmentioning

confidence: 99%

Impaired heart rate variability in patients with mitral annular calcification: an observational study

Kurtoğlu¹,

Aktürk²,

Korkmaz³

et al. 2013

Anadolu Kardiyol Derg

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Objective: The aim of the present study was to study time indices of heart rate variability (HRV) in patients with mitral annular calcification (MAC). Methods: A cross-sectional observational study was performed. Fifty patients with echocardiographic evidence of MAC and 50 age-and gender-matched control subjects without echocardiographic evidence of MAC were included. All the study participants underwent 2-dimensional echocardiographic examinations and 24-hour Holter monitoring for HRV analysis. Student-t, Mann-Whitney U and Chi-square tests were used for statistical analysis. Results: Hypertension and coronary artery disease were more common in the MAC group than in the control group. All HRV parameters including mean RR interval, SDNN, SDANN, SDNN index, pNN50 and RMSSD were reduced in the MAC group when compared with the control group (p<0.05 for all). In hypertensive subgroup, all HRV parameters except mean RR interval were diminished in patients with MAC when compared with those without MAC (p<0.05 for all). In non-hypertensive subgroup, all HRV parameters were also diminished in patients with MAC when compared with those without MAC. In the subgroup of patients with coronary artery disease, patients had lower HRV parameters except mean RR interval, pNN50 and RMSSD in comparison to those without MAC (p<0.05 for all). In the subgroup of patients without coronary artery disease, all HRV parameters were depressed in patients with MAC in comparison to those without MAC (p<0.05 for all). Conclusion: Our findings indicate that MAC was associated with reduced heart rate variability which possibly reflects decreased parasympathetic tone with a predominant activity of the sympathetic tone. (Anadolu Kardiyol Derg 2013; 13: 668-74) Key words: Mitral annular calcification, heart rate variability, autonomic dysfunction Original Investigation Özgün Araşt›rma 668ÖZET Amaç: Çalışmanın amacı mitral annüler kalsifikasyonu (MAK) olan hastalarda kalp hızı değişkenliği (KHD) parametrelerini incelemektir. Yöntemler: Çalışma enine kesitli gözlemsel amaçlı planlandı. Ekokardiyografik olarak MAK tespit edilmiş 50 hasta ile MAK'ı olmayan 50 hasta çalışmaya dahil edildi. Tüm hastalara iki boyutlu transtorasik ekokardiyografi ve KHD analizi için 24 saatlik Holter monitorizasyonu uygulandı. İstatistiksel analiz için Student-t, Mann-Whitney U ve Ki-kare testleri kullanıldı. Bulgular: Hipertansiyon ve koroner arter hastalığı MAK grubunda kontrol grubuna göre daha yüksekti. Ortalama RR süresi, SDNN, SDANN, SDNN indeksi, pNN50 ve RMSSD'yi içeren tüm HRV parametreleri MAK grubunda kontrol grubuna göre azalmış saptandı (p<0,05). Hipertansiyon alt grubunda, ortalama RR süresi dışında diğer tüm HRV parametreleri MAK'lı hastalarda MAK'ı olmayanlara göre azalmış saptandı. Hipertansiyon olmayan hasta alt grubunda ise, tüm HRV parametreleri MAK'lı hastalarda MAK'ı olmayanlara göre yine azalmış saptandı (p<0,05). Koroner arter hastalığı olan hastaların alt grubunda, ortalama RR süresi, pNN50 ve RMSSD dışında tüm HRV parametreleri MAK'lı has...

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“…The dcific deposits commonly extend from heavily calcified stenotic aortic valves or mitral valve annular calcium, or a combination (Figs. [3][4][5][6]. The main penetrating bundle of His is located near the noncoronary cusp of the aortic valve and near the base of the anterior leatlet of the mild valve.…”

Section: Atrioventricular Block Secondarycausesmentioning

confidence: 99%

Anatomy, histology, and pathology of the cardiac conduction system—part VI

Waller

Gering

Branyas

et al. 1993

Clinical Cardiology

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Summary: Various pathologic conditions producing atrioventricular block are reviewed. Calcific atrioventricular block (aortic stenosis, mitral valve annular calcium), active infective endocarditis ("ring" abscess), acute and healed myocarditis, various collagen-vascular diseases, amyloidosis, and tumors are reviewed as causes of atrioventricular block. Various diseases producing bundle-branch block a~ also discussed.Key wods: calcification, atrioventricular block, bundle-branch block, amyloidosis, aortic stenosis, myocarditis IntmductionSpecialized tissues of the heart are responsible for initiation and conduction of the cardiac impulse. Despite careful clinical and n m p s y analyses, clinical and histologic studies of the human conduction system do not always mrrelate. Established clinical arrhythmias or heart block may lack precise anatomic substrates, or pathologic changes may be observed in hearts of patients without clinical evidence of arrhythmia or abnormal conduction. Part VI of this six-part series describes various pathologic conditions affecting the conduction system such as calcific deposits, acute myocarditis, and infective endocarditis. Address for reprints:Bruce Waller, M.D. (Figs. 3-6). The main penetrating bundle of His is located near the noncoronary cusp of the aortic valve and near the base of the anterior leatlet of the mild valve.When these areas have massive amounts of calcific deposits, the risk of atrioventricular block developing is i n - (Fig. 3). The clinical association of "senile" massive m i d annular calcium and atrioventricular block was described by Rytand and Lipsitch3 and further delineated by Kom and associates." Patients with echocardiographic evidence of mitral annular calcium have an increased incidence of conduction abnormalities when compared with control^.^ Soft tissue calcification resulting from various causes of hyperralcemia may also produce atrioventricular block?Active infective endocarditis ("ring" abscess): One complication of active infective endocarditis is the extension of the valvular infection to adjacent portions of the myocardium, and in particular to the conduction system (Fig. 7). Of 119 patients with active infective endocarditis studied by Amett and Robem at nmpsy? 50 (42%) had ring abscesses (4 native right-sided, 24 native left-sided, and 22 p t h e t i c valves). Of the 50 patients with ring abscesses, at least 15 (30%) had major involvement of the conduction system, with clinical evidence of complete heart block in 9 patients. Amett and Roberts6 have emphasized that either complete atrioventricular block or a high degree of heart block appearing suddenly in a patient with infective endocarditis is strongly suggestive of the presence of a ring abscess that has extended into the m a of the atrioventricular node or penetrating bundle. In addition, the appearance of right or left bundle-bmch block during infective endocarditis is also highly suggestive of a ring abscess with extension into the most cephalad portion of the muscular ventricular septu...

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Conduction defects and mitral annulus calcification.

Cited by 43 publications

References 19 publications

Delayed cardiac asystole after percuteneous mitral balloon valvuloplasty

Delayed cardiac asystole after percuteneous mitral balloon valvuloplasty

Impaired heart rate variability in patients with mitral annular calcification: an observational study

Anatomy, histology, and pathology of the cardiac conduction system—part VI

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