Medical and surgical management in a patient with severe mitral stenosis associated with permanent atrial fibrillation.
Keywords:
mitral stenosis, valvulopathy, atrial fibrillationAbstract
Mitral stenosis is the obstruction of the left ventricular inlet tract by a generally rheumatic mitral valve pathology. The most frequent symptoms are dyspnea on exertion, which can sometimes progress to acute pulmonary edema, and palpitations. Hemoptysis, systemic embolisms, thoracic pain, and signs and symptoms of right failure may also be observed. Medical treatment is aimed at reducing symptoms and avoiding the impact of increased left atrial pressure on the pulmonary circulation; while surgical treatment should be considered in those patients with a disabling symptomatology or when the valvular area is less than or equal to 1.5 cm2. This paper presents the case of a 42-year-old female with a diagnosis of severe mitral stenosis associated with atrial fibrillation. The clinical status, the evolution, the findings of ECG and ECO-2D are examined. The pertinent considerations are made to the medical and surgical management, based on the criteria of the patient studied.
Downloads
References
Harrison. Principios de medicina Interna. 2012. Decimoctava Edición- México.
Topol EJ. Textbook of Cardiovascular Medicine. Philadelphia: Lippincott-Raven Publishers; 1998.
Giménez O, Prezioso H, Lax J. Estenosis mitral. Cap Cardiol 2001; 5(5):232-76.
Dawkins D, Burke CM, Billingham M, Famison SW. Primary pulmonary hypertension and pregnancy. Chest 1986; 89:383-7.
Patton DE, Lee W, Cotton DB, Miller J, Carpenter RJ Jr, Huhta J, et al. Cyanotic maternal heart disease in pregnancy. ObstetGynecolSurv 1990; 45:594-600.
Prystowsky EN, Benson BW. Management of patients with atrial fibrillation. Circulation 1996; 93:1262-77.
Laupacis A, Albers G, Dalen J, Dunn M, Feinberg W, Ja¬cobson A. Antithrombotic therapy in atrial fibrillation. Chest 1995; 108(Suppl):352S-359S.
Turhan H, Yetkin E, Senen K, Yilmaz MB, Ileri M, Atak R. Effects of percutaneous mitral balloon valvuloplasty on p-wave dispersion in patients with mitral stenosis. Am J Cardiol 2002; 89:607-9?
Martin RP, Rakowski H, Kleiman JH, Beaver W, London E, Popp RL. Reliability and reproducibility of two-dimensional echocardio¬graph measurement of the stenotic mitral valve orifice area. Am J Cardiol 1979; 43:560-8
Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J 1988; 60:299-308.
Schlosshan D, Aggarwal G, Mathur G, Allan R, Cranney G. Real-time 3D transesophageal echocardiography for the evaluation or rheumatic mitral stenosis. JACC Cardiovasc Imaging 2011;4:580-8.
Dreyfus J, Brochet E, Lepage L, Attias D, Cueff C, Detaint D, et al. Real-time 3D transesophageal measurement of the mitral valve area in patients with mitral stenosis. Eur J Echocardiogr 2011; 12:750-5.
Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. Circulation 1997; 96:358-66.
26th Bethesda Conference. Recommendations for determining elegibility for competition in athletes with cardiovascular abnormali¬ties. J Am Coll Cardiol 1994; 24:845-99.
Werner G. Daniel, MD, Ulrich Nellessen. MD, Eberhard Schrbder. MD, Barbara Nonnast-Daniel, MD, Piotr Bednarski, MD, Peter Nikutta, MD, Paul R. Lichtlen, MD, Left atrial spontaneous echo contrast in mitral valve disease: An indicator for an increased thromboembolic risk Revista Journal of the American College of Cardiology Volume 11, Issue 6, June 1988, Pages 1204-121 https://doi.org/10.1016/0735-1097(88)90283-5
Black DW, Hopkins AP, Lee LCL, Walsh WF, Jacobson BM. Left atrial spontaneous echo contrast: a clinical and echocardiographic analysis. J Am Coll Cardiol 1991; 18:398-404.
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Rick A. Nishimura, Catherine M. Otto, Robert O. Bonow, Blase A. Carabello, John P. Erwin, Robert A. Guyton, Patrick T. O’Gara, Carlos E. Ruiz, Nikolaos J. Skubas, Paul Sorajja, Thoralf M. Sundt, James D. Thomas Circulation. 2014;129:2440-2492 https://doi.org/10.1161/CIR.0000000000000029
Edward A Gill, Basil Pittenger, Catherine M Otto Evaluación de la severidad y decisiones quirúrgicas en las valvulopatías. Rev Esp Cardiol. 2003; 56:900-14 - Vol. 56 Núm.09 DOI: 10.1157/13051618
Published
How to Cite
Issue
Section
Derechos del/de autor/es a partir del año de publicación
Esta obra está bajo la licencia:
Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)
Las opiniones expresadas por los autores no necesariamente reflejan la postura del editor de la publicación ni de la UCLA. Se autoriza la reproducción total o parcial de los textos aquí publicados, siempre y cuando se cite la fuente completa y la dirección electrónica de esta revista. Los autores(as) tienen el derecho de utilizar sus artículos para cualquier propósito siempre y cuando se realice sin fines de lucro. Los autores(as) pueden publicar en internet o cualquier otro medio la versión final aprobada de su trabajo, luego que esta ha sido publicada en esta revista.
