Echocardiographic Assessment of Degenerative Mitral Stenosis: A Diagnostic Challenge of an Emerging Cardiac Disease

Oktay, Ahmet; Gilliland, Yvonne; Lavie, Carl J.; Ramee, Stephen; Parrino, Patrick E.; Bates, Michael; Shah, Sangeeta; Cash, Michael; Dinshaw, Homeyar; Qamruddin, Salima

doi:10.1016/j.cpcardiol.2017.01.002

Cited by 28 publications

(11 citation statements)

References 81 publications

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“…33 In degenerative MS, mitral valve area assessment using the continuity equation, provided it is not associated with more than mild AR or MR, 34 and direct planimetry with three-dimensional echocardiography and colorflow Doppler are acceptable techniques for determining mitral valve area. 35 In selected cases, catheterization using the Gorlin-derived method may be used for AS and MS valve area determination, in the absence of concomitant regurgitation.…”

Section: Aortic Stenosis and Mitral Stenosismentioning

confidence: 99%

Aortic Stenosis with Other Concomitant Valvular Disease

Unger

Tribouilloy

2020

Cardiology Clinics

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Multiple valve disease involving aortic stenosis and mixed aortic valve disease are frequent clinical scenarios. Multiple valve disease and mixed aortic valve disease may be associated with diagnostic pitfalls as a result of hemodynamic interactions. Mixed aortic valve disease should be managed according to the predominant lesion; however, combined moderate aortic stenosis and regurgitation may have significant clinical impact requiring surgery. There is currently no evidence-based management strategy for multiple valve disease, and a caseby-case approach should be adopted by the heart valve team. Decision making should include assessment of each individual lesion, global repercussions, operative risk, life expectancy, natural history of the untreated valvular lesion, and suitability for valve repair and/or transcatheter valve procedures.

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Section: Aortic Stenosis and Mitral Stenosismentioning

confidence: 99%

Aortic Stenosis with Other Concomitant Valvular Disease

Unger

Tribouilloy

2020

Cardiology Clinics

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“…Echocardiography has a relatively low specificity for distinguishing calcium from dense collagen. 24 In addition, the standard parasternal short-axis view, which is usually used to quantify the severity of MAC, does not visualize the anterior mitral annulus. This may lead to underestimation of the severity of MAC.…”

Section: How Can Mac Be Assessed In Cases Of Mitral Valve Disease?mentioning

confidence: 99%

Mitral annulus calcification: current management and future challenges

Carino

Agostinelli

Qarra

et al. 2019

Asian Cardiovasc Thorac Ann

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Mitral annulus calcification is a chronic degenerative process in the fibrous base of the mitral valve. Assessment and treatment of mitral valve disease in patients with severe mitral annulus calcification is challenging, and a multimodal approach is helpful to delineate its severity and anatomic features, and to guide the therapeutic strategy. This article reviews the current literature to provide a clinically relevant description of mitral annulus calcification, analyze the diagnostic pathway of a patient with mitral annulus calcification, and summarize the therapeutic options.

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“…Calcification of the mitral valve (MV) annulus and leaflets is an increasingly common cause of MV stenosis (MS). 1,2 Mitral annular calcification (MAC) has four principal pathophysiological mechanisms: degeneration, atherosclerosis, increased MV stress, and abnormal calcium-phosphate metabolism. 3 These processes lead to dystrophic calcification, increased lipid peroxidation, and chronic expression of transforming growth factor-β and inflammatory cytokines that promote phenotypic trans-differentiation of valvular interstitial cells into osteoblast-like cells.…”

Section: Introductionmentioning

confidence: 99%

“…Calcification of the mitral valve (MV) annulus and leaflets is an increasingly common cause of MV stenosis (MS) 1,2 . Mitral annular calcification (MAC) has four principal pathophysiological mechanisms: degeneration, atherosclerosis, increased MV stress, and abnormal calcium–phosphate metabolism 3 .…”

Section: Introductionmentioning

confidence: 99%

Dimensionless index of the mitral valve for evaluation of degenerative mitral stenosis

Oktay¹,

Riehl

Kachur³

et al. 2020

Echocardiography

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Purpose: Degenerative mitral stenosis (DMS) is an increasingly recognized cause of mitral stenosis. The goal of this study was to compare echocardiographic differences between DMS and rheumatic mitral stenosis (RMS), identify echocardiographic variables reflective of DMS severity, and propose a dimensionless mitral stenosis index (DMSI) for assessment of DMS severity. Methods: This is a single-center, retrospective cohort study. We included patients with at least mild MS and a mean transmitral pressure gradient (TMPG) ≥4 mm Hg. Mitral valve area by the continuity equation (MVA CEQ) was used as an independent reference. The DMSI was calculated as follows: DMSI = VTI LVOT / VTI MV. All-cause mortality data were collected retrospectively. Results: A total of 64 patients with DMS and 24 patients with RMS were identified. MVA CEQ was larger in patients with DMS (1.43 ± 0.4 cm 2) than RMS (0.9 ± 0.3 cm 2) by ~0.5 cm 2 (P = <.001), and mean TMPG was lower in the DMS group (6.0 ± 2 vs 7.9 ± 3 mm Hg, P = .003). A DMSI of ≤0.50 and ≤0.351 was associated with MVA CEQ ≤1.5 and MVA CEQ ≤1.0 cm 2 (P < .001), respectively. With the progression of DMS from severe to very severe, there was a significant drop in DMSI. There was a nonsignificant trend toward worse survival in patients with MVA CEQ ≤1.0 cm 2 and DMSI ≤0.35, suggesting severe stenosis severity. Conclusion: Our results show that TMPG correlates poorly with MVA in patients with DMS. Proposed DMSI may serve as a simple echocardiographic indicator of hemodynamically significant DMS.

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Echocardiographic Assessment of Degenerative Mitral Stenosis: A Diagnostic Challenge of an Emerging Cardiac Disease

Cited by 28 publications

References 81 publications

Aortic Stenosis with Other Concomitant Valvular Disease

Aortic Stenosis with Other Concomitant Valvular Disease

Mitral annulus calcification: current management and future challenges

Dimensionless index of the mitral valve for evaluation of degenerative mitral stenosis

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