Left Atrial Pressure Pulse in Mitral Valve Disease

Abstract

Left atrial pressures were determined by transbronchial puncture in 53 patients with mitral valve disease of proved type, and were analyzed by several methods. Two new methods of analysis, the rate of the y descent divided by the mean left atrial pressure, and the y descent for each 0.1-second interval divided by the mean left atrial pressure afforded the best separation of the patients with mitral insufficiency from those with mitral stenosis requiring a commissurotomy. In the presence of predominant mitral stenosis, however, the severity of accompanying mitral regurgitation could not be assessed.IT HAS been well established that mitral valve disease and experimentally produced mitral valvular lesions alter the contour of the left atrial pressure pulse.'-6 The purpose of this investigation was to evaluate the usefulness of several previously describedl-4 and 3 new methods of analysis of the left atrial pressure in distinguishing patients with predominant mitral insufficiency from those with predominant stenosis. This study is based on the preoperative left atrial pressure curves of 53 patients with mitral valve disease of proved type. MATERIALOf the patients studied, 39 were found at operation to have significant mitral stenosis. In 32 of these patients there was either no palpable regurgitation or a minimal jet considered by the surgeon to be of little functional significance. Seven of the 39 patients with mitral stenosis were found to have, in addition, "significant" mitral insufficiency. This was evidenced by the presence of a regurgitant jet of moderate or severe intensity. The valve orifice in each of the 39 patients with mitral stenosis (including those with combined mitral stenosis and insufficiency) was less than 1 cm. in diameter and a commissurotomy was indicated and performed.Fourteen patients had essentially pure mitral insufficiency. In 7 patients this diagnosis was established at operation or autopsy. The other 7 patients presented classic clinical, roentgenologic, and electrocardiographic findings of mitral insufficiency and at left heart catheterization were shown to have no diastolic gradient across the mitral valve.

The Third Heart Sound in Mitral Regurgitation

“…disabled from mitral valvular disease when the mitral orifice measures 2-0 cm. or more (Nixon and Wooler, 1961), and is absent in severe stenosis (Braunwald et al, 1955;Morrow et al, 1957).…”

Transseptal catheterization 1992: It is here to stay

“…Once the bronchoscope had reached the canna, a long needle with suitable distal bend was advanced through the device to puncture both the trachea and the LA. Introduced by Facquet et al [3] in Europe in 1952, use of the method was continued in the United States by Allison and Linden [4] in 1953 and Morrow et al [5] in 1957. At approximately the same time, in 1954, Radner [6] described an extension of his practice of suprasternal aortic puncture.…”

Equalization rate: a haemodynamic method for evaluation of mitral stenosis.

“…The rate of the descent of the atrial pressure from the peak of the V wave to the nadir of the Y descent divided by the left atrial mean pressure (Morrow et al, 1957).…”

“…The rate of the descent of the atrial pressure from the peak of the V wave to a point 0-1 sec. later divided by the left atrial mean pressure (Morrow et al, 1957). (B) Mitral orifice area was calculated by the Gorlin Formula utilizing the simultaneously recorded left atrial and left ventricular pressures to determine the mean mitral diastolic gradient (Gorlin and Gorlin, 1951). The constant used was 0 85 since this was found to be more consistent with the surgical assessment of the orifice area than the traditional 0-7.…”