PMID- 8800035
OWN - NLM
STAT- MEDLINE
DCOM- 19961018
LR  - 20190626
IS  - 0002-8703 (Print)
IS  - 0002-8703 (Linking)
VI  - 132
IP  - 3
DP  - 1996 Sep
TI  - Severely symptomatic mitral stenosis with a low gradient: a case for 
      low-technology medicine.
PG  - 628-32
AB  - We have observed a group of patients with mitral valve disease and severe 
      symptoms but also with low transmitral gradients and normal cardiac outputs who 
      defy the traditional hemodynamic explanation of mitral stenosis. We performed a 
      10-year retrospective chart review of all mitral valve replacements at our 
      institution to further characterize this population. The study group consisted of 
      16 of 132 patients (12%) with symptomatically severe (New York Heart Association 
      [NYHA] class 3.3 +/- 0.5) mitral stenosis but a low (< 10 mm Hg) transmitral 
      gradient, a normal cardiac output (4.8 +/- 1.2 L/min), and a preserved valve area 
      (1.6 +/- 0.4 cm2). Sixteen patients were randomly chosen from the remaining group 
      to serve as a comparison population. Study patients were noted to have less 
      atrial fibrillation, lower wedge and mean pulmonary artery pressures, and a 
      higher incidence of subvalvular disease identified at the time of surgery than 
      did the comparison population. Left ventricular end-diastolic pressure and 
      cardiac output did not differ. Study patients did well with surgery and reported 
      an excellent functional benefit. We believe that this subgroup of patients with 
      mitral valve disease is important, may be missed by using conventional criteria 
      of valve area to determine timing of surgical intervention, and may have their 
      symptoms primarily because of subvalvular disease. Further and perhaps most 
      important, this group illustrates the ongoing need for careful clinical 
      assessment skills and judgement in the face of ever-increasing technology.
FAU - Rayburn, B K
AU  - Rayburn BK
AD  - Department of Medicine, Bowman Gray School of Medicine, Winston-Salem, NC 
      27157-1045, USA.
FAU - Fortuin, N J
AU  - Fortuin NJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
SB  - IM
MH  - Adult
MH  - Atrial Fibrillation/physiopathology
MH  - *Blood Pressure
MH  - *Cardiac Output
MH  - Clinical Competence
MH  - Diastole
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Valve Diseases/complications/surgery
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Medical Laboratory Science
MH  - Middle Aged
MH  - Mitral Valve/pathology/physiopathology
MH  - Mitral Valve Stenosis/*physiopathology/surgery
MH  - Pulmonary Artery
MH  - Pulmonary Wedge Pressure
MH  - Retrospective Studies
MH  - Ventricular Function, Left
MH  - Ventricular Pressure
EDAT- 1996/09/01 00:00
MHDA- 1996/09/01 00:01
CRDT- 1996/09/01 00:00
PHST- 1996/09/01 00:00 [pubmed]
PHST- 1996/09/01 00:01 [medline]
PHST- 1996/09/01 00:00 [entrez]
AID - S0002-8703(96)90248-3 [pii]
AID - 10.1016/s0002-8703(96)90248-3 [doi]
PST - ppublish
SO  - Am Heart J. 1996 Sep;132(3):628-32. doi: 10.1016/s0002-8703(96)90248-3.