Echocardiography of Mitral Stenosis
Wolfgang Fehske MD
Associate Professor of Medicine Head
Department of Cardiology, St. Vinzenz-Hospital, Cologne, Germany
Search for more papers by this authorWolfgang Fehske MD
Associate Professor of Medicine Head
Department of Cardiology, St. Vinzenz-Hospital, Cologne, Germany
Search for more papers by this authorJürgen Haase MD, PhD, FESC, FACC
Professor of Medicine Consultant Cardiologist
Kardiocentrum Frankfurt, Klinik Rotes Kreuz, Frankfurt/Main, Germany
Search for more papers by this authorHans-Joachim Schäfers MD, PhD
Professor of Surgery Chair
Department of Thoracic and Cardiovascular Surgery, University Hospital Saarland, Homburg/Saar, Germany
Search for more papers by this authorHorst Sievert MD, FESC, FACC
Professor of Medicine Head
Department of Cardiology, CardioVascular Center Frankfurt, Frankfurt, Germany
Search for more papers by this authorRon Waksman MD, FACC
Professor of Medicine Associate Director Director
Division of Cardiology, Washington, DC, USA
Experimental Cardiology, Washington Hospital Center, Washington, DC, USA
Search for more papers by this authorSummary
This chapter contains sections titled:
-
Introduction
-
Pathophysiology of mitral stenosis
-
Echocardiographic parameters used within the guidelines
-
The echocardiographic examination
-
References
References
- Edler I (1955) The diagnostic use of ultrasound in heart disease. Med Scand 308(Suppl.): 32.
- Bonow R, Carabello B, Kanu C, et al. (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation 114: e84–231.
- Vahanian A, Baumgartner H, Bax J, et al. (2007) Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 28: 230–268.
- Hugenholtz PG, Ryan TJ, Stein SW, & Belmann WH (1962) The spectrum of pure mitral stenosis: hemodynamic studies in relation to clinical disability. Am J Cardiol 10: 773–784.
- Shaw TR, Sutaria N, & Prendergast B (2003) Clinical and haemodynamic profiles of young, middle aged, and elderly patients with mitral stenosis undergoing mitral balloon valvotomy. Heart 89: 1430–1436.
- Selzer A & Cohn KE (1972) Natural history of mitral stenosis: a review. Circulation 45: 878–890.
- Bahl V, Chandra S, Talwar K, Kaul U, Sharma S, & Wasir H (1995) Balloon mitral valvotomy in patients with systemic and suprasystemic pulmonary artery pressures. Cathet Cardiovasc Diagn 36: 211–215.
- Friedensohn A, Stryjer D, & Schlesinger Z (1983) Myocardial ischemia in mitral stenosis with normal coronary arteries. Heart Lung 12: 653–655.
- Carroll JD & Feldman T (1993) Percutaneous mitral balloon valvotomy and the new demographics of mitral stenosis. JAMA 270: 1731–1736.
- Otto C & Bonow R (2008) Valvular heart disease–mitral stenosis. In: Libby P, Bonow R, Mann D, & Zipes D (eds). Braunwald's Heart Disease, 8th edn. Philadelphia: Saunders Elsevier, pp. 1646–1656.
- Rich S & McLaughlin V (2008) Pulmonary hypertension. In: Libby P, Bonow R, Mann D, & Zipes D (eds). Braunwald's Heart Disease, 8th edn. Philadelphia: Saunders Elsevier, p. 1903.
- Jebavy P, Hurych J, & Widimsky J (1978) Influence of pulmonary hypertension on pulmonary diffusing capacity in patients with mitral stenosis. Respiration 35: 1–7.
- Sagie A, Freitas N, Padial L, et al. (1996) Doppler echocardio-graphic assessment of long-term progression of mitral stenosis in 103 patients: valve area and right heart disease. J Am Coll Cardiol 28: 472–479.
- Gordon SP, Douglas PS, Come PC, & Manning WJ (1992) Two-dimensional and Doppler echocardiographic determinants of the natural history of mitral valve narrowing in patients with rheumatic mitral stenosis: implications for follow-up. J Am Coll Cardiol 19: 968–973.
- Iung B, Baron G, Butchart E, et al. (2003) A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J 24: 1231–1243.
- Voelker W (2004) [A structured report data set for documentation of echocardiographic studies—Update (2004)]. Z Kardiol 93: 987–1004.
- Evangelista A, Flachskampf F, Lancellotti P, et al. (2008) European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr 9: 438–448.
- Lang R, Bierig M, Devereux R, et al. (2006) Recommendations for chamber quantification. Eur J Echocardiogr 7: 79–108.
- Sanchez P, Rodriguez-Alemparte M, Inglessis I, & Palacios I (2005) The impact of age in the immediate and long-term outcomes of percutaneous mitral balloon valvuloplasty. J Interv Cardiol 18: 217–225.
- Ramondo A, Napodano M, Fraccaro C, Razzolini R, Tarantini G, & Iliceto S (2006) Relation of patient age to outcome of percutaneous mitral valvuloplasty. Am J Cardiol 98: 1493–1500.
- Iung B & Vahanian A (2002) The long-term outcome of balloon valvuloplasty for mitral stenosis. Curr Cardiol Rep 4: 118–124.
- Kasner M, Westermann D, Steendijk P, et al. (2007) Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation 116: 637–647.
- Surdacki A, Legutko J, Turek P, Dudek D, Zmudka K, & Dubiel J (1996) Determinants of depressed left ventricular ejection fraction in pure mitral stenosis with preserved sinus rhythm. J Heart Valve Dis 5: 1–9.
- Bargiggia GS, Tronconi L, Sahn DJ, et al. (1991) A new method for quantitation of mitral regurgitation based on color flow Doppler imaging of flow convergence proximal to regurgitant orifice. Circulation 84: 1481–1489.
- Skjaerpe T, Hegrenaes L, & Hatle L (1985) Noninvasive estimation of valve area in patients with aortic stenosis by Doppler ultrasound and two-dimensional echocardiography. Circulation 72: 810–818.
- Rodriguez L, Thomas JD, Monterroso V, et al. (1993) Validation of the proximal flow convergence method. Calculation of orifice area in patients with mitral stenosis. Circulation 88: 1157–1165.
- Sengupta P, Mohan J, Mehta V, et al. (2004) Effects of percutaneous mitral commissurotomy on longitudinal left ventricular dynamics in mitral stenosis: quantitative assessment by tissue velocity imaging. J Am Soc Echocardiogr 17: 824–818.
- Ozdemir K, Altunkeser B, Gok H, Icli A, & Temizhan A (2002) Analysis of the myocardial velocities in patients with mitral stenosis. J Am Soc Echocardiogr 15: 1472–1478.
- Dogan S, Aydin M, Gursurer M, Dursun A, Onuk T, & Madak H (2006) Prediction of subclinical left ventricular dysfunction with strain rate imaging in patients with mild to moderate rheumatic mitral stenosis. J Am Soc Echocardiogr 19: 243–248.
- Berger M (2004) Natural history of mitral stenosis and echocardiographic criteria and pitfalls in selecting patients for balloon valvuloplasty. Adv Cardiol 41: 87–94.
- Silaruks S, Thinkhamrop B, Tantikosum W, Wongvipaporn C, Tatsanavivat P, & Klungboonkrong V (2002) A prognostic model for predicting the disappearance of left atrial thrombi among candidates for percutaneous transvenous mitral commissurotomy. J Am Coll Cardiol 39: 886–891.
- Flachskampf FA, Decoodt P, Fraser AG, Daniel WG, & Roelandt JR (2001) Guidelines from the Working Group. Recommendations for performing transesophageal echocardiography. Eur J Echocardiogr 2: 8–21.
- Topsakal R, Eryol N, Ozdogru I, et al. (2004) Color Doppler tissue imaging to evaluate left atrial appendage function in patients with mitral stenosis in sinus rhythm. Echocardiography 21: 235–240.
- Karakaya O, Turkmen M, Bitigen A, et al. (2006) Effect of percutaneous mitral balloon valvuloplasty on left atrial appendage function: a Doppler tissue study. J Am Soc Echocardiogr 19: 434–437.
- Gurlertop Y, Yilmaz M, Acikel M, et al. (2004) Tissue Doppler properties of the left atrial appendage in patients with mitral valve disease. Echocardiography 21: 319–324.
- Cayly M, Kanadasi M, Demir M, & Acarturk E (2006) Mitral annular systolic velocity reflects the left atrial appendage function in mitral stenosis. Echocardiography 23: 546–552.
- Bauer F, Verdonck A, Schuster I, et al. (2005) Left atrial appendage function analyzed by tissue Doppler imaging in mitral stenosis: effect of afterload reduction after mitral valve commissurotomy. J Am Soc Echocardiogr 18: 934–939.
- Cayli M, Acarturk E, Kanadasi M, & Demir M (2007) Annular systolic velocity predicts the presence of spontaneous echo contrast in mitral stenosis patients with sinus rhythm. Clin Cardiol 30: 459–463.
- Sosland R, Vacek J, & Gorton M (2007) Congenital mitral stenosis: a rare presentation and novel approach to management. J Thorac Cardiovasc Surg 133: 572–573.
- Chu J, Levine R, Chua S, et al. (2008) Assessing mitral valve area and orifice geometry in calcific mitral stenosis: a new solution by real-time three-dimensional echocardiography. J Am Soc Echocardiogr 21: 1006–1009.
- Akram M, Chan T, McAuliffe S, & Chenzbraun A (2009) Non-rheumatic annular mitral stenosis: prevalence and characteristics. Eur J Echocardiogr 10: 103–105.
- Wilkins G, Weyman A, Abascal V, Block P, & Palacios I (1988) Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J 60: 299–308.
- Abascal V, Wilkins G, O'Shea J, et al. (1990) Prediction of successful outcome in 130 patients undergoing percutaneous balloon mitral valvotomy. Circulation 82: 448–456.
- Reid C, Chandraratna P, Kawanishi D, Kotlewski A, & Rahimtoola S (1989) Influence of mitral valve morphology on double-balloon catheter balloon valvuloplasty in patients with mitral stenosis. Analysis of factors predicting immediate and 3-month results. Circulation 80: 515–524.
- Turgeman Y, Atar S, Feldman A, et al. (2005) “Frozen” posterior mitral leaflet in rheumatic mitral stenosis: incidence and impact on outcome of balloon mitral commissurotomy. J Heart Valve Dis 14: 282–285.
- Fawzy M, Shoukri M, Hassan W, Nambiar V, Stefadouros M, & Canver C (2007) The impact of mitral valve morphology on the long-term outcome of mitral balloon valvuloplasty. Catheter Cardiovasc Interv 69: 40–46.
- Fawzy M, Fadel B, Al-Sergani H, et al. (2007) Long-term results (up to 16.5 years) of mitral balloon valvuloplasty in a series of 518 patients and predictors of long-term outcome. J Interv Cardiol 20: 66–72.
- Padial L, Abascal V, Moreno P, Weyman A, Levine R, & Palacios I (1999) Echocardiography can predict the development of severe mitral regurgitation after percutaneous mitral valvuloplasty by the Inoue technique. Am J Cardiol 83: 1210–1213.
- Sutaria N, Shaw T, Prendergast B, & Northridge D (2006) Transoesophageal echocardiographic assessment of mitral valve commissural morphology predicts outcome after balloon mitral valvotomy. Heart 92: 52–57.
- Iung B, Cormier B, Ducimetiere P, et al. (1996) Immediate results of percutaneous mitral commissurotomy. A predictive model on a series of 1514 patients. Circulation 94: 2124–2130.
- Perez DIL, Casanova C, Almeria C, et al. (2007) Which method should be the reference method to evaluate the severity of rheumatic mitral stenosis? Gorlin's method versus 3D-echo. Eur J Echocardiogr 8: 470–473.
- Zamorano J, Perez dIL, Sugeng L, et al. (2004) Non-invasive assessment of mitral valve area during percutaneous balloon mitral valvuloplasty: role of real-time 3D echocardiography. Eur Heart J 25: 2086–2091.
- Valocik G, Kamp O, Mannaerts H, & Visser C (2007) New quantitative three-dimensional echocardiographic indices of mitral valve stenosis: new 3D indices of mitral stenosis. Int J Cardiovasc Imaging 23: 707–716.
- Messika-Zeitoun D, Brochet E, Holmin C, et al. (2007) Three-dimensional evaluation of the mitral valve area and commissural opening before and after percutaneous mitral commissurotomy in patients with mitral stenosis. Eur Heart J 28: 72–79.
- Henry W, Griffith J, Michaelis L, McIntosh C, Morrow A, & Epstein S (1975) Measurement of mitral orifice area in patients with mitral valve disease by real-time, two-dimensional echo-cardiography. Circulation 51: 827–831.
- Hatle L (1984) Noninvasive assessment of valve lesions with Doppler ultrasound. Herz 9: 213–221.
- Faletra F, Pezzano A, Fusco R, et al. (1996) Measurement of mitral valve area in mitral stenosis: four echocardiographic methods compared with direct measurement of anatomic orifices. J Am Coll Cardiol 28: 1190–1197.
- Holmin C, Messika-Zeitoun D, Mezalek A, et al. (2007) Mitral leaflet separation index: a new method for the evaluation of the severity of mitral stenosis? Usefulness before and after percutaneous mitral commissurotomy. J Am Soc Echocardiogr 20: 1119–1124.
- Hatle L, Angelsen B, & Tromsdal A (1979) Noninvasive assessment of atrioventricular pressure half-time by Doppler ultrasound. Circulation 60: 1096–1104.
- Hatle L (1990) Doppler echocardiographic evaluation of mitral stenosis. Cardiol Clin 8: 233–247.
- Abascal V, Moreno P, Rodriguez L, et al. (1996) Comparison of the usefulness of Doppler pressure half-time in mitral stenosis in patients < 65 and > or = 65 years of age. Am J Cardiol 78: 1390–1393.
- Smith M, Wisenbaugh T, Grayburn P, Gurley J, Spain M, & De MA (1991) Value and limitations of Doppler pressure half-time in quantifying mitral stenosis: a comparison with micro-manometer catheter recordings. Am Heart J 121(2 Pt 1): 480–488.
- Moro E, Nicolosi G, Zanuttini D, Cervesato E, & Roelandt J (1988) Influence of aortic regurgitation on the assessment of the pressure half-time and derived mitral-valve area in patients with mitral stenosis. Eur Heart J 9: 1010–1017.
- Flachskampf F, Weyman A, Gillam L, Liu C, Abascal V, & Thomas J (1990) Aortic regurgitation shortens Doppler pressure half-time in mitral stenosis: clinical evidence, in vitro simulation and theoretic analysis. J Am Coll Cardiol 16: 396–404.
- Schwammenthal E, Vered Z, Agranat O, Kaplinsky E, Rabinowitz B, & Feinberg MS (2000) Impact of atrioventricular compliance on pulmonary artery pressure in mitral stenosis: an exercise echocardiographic study. Circulation 102: 2378–2384.
- Flachskampf FA, Weyman AE, Guerrero JL, & Thomas JD (1992) Calculation of atrioventricular compliance from the mitral flow profile: analytic and in vitro study. J Am Coll Cardiol 19: 998–1004.
- Kim H, Kim Y, Hwang S, et al. (2008) Hemodynamic and prognostic implications of net atrioventricular compliance in patients with mitral stenosis. J Am Soc Echocardiogr 21: 482–486.
- Bennis A, Drighil A, & Tribouilloy C, Chraibi N (2002) Clinical application in routine practice of the proximal flow convergence method to calculate the mitral surface area in mitral valve stenosis. Int J Cardiovasc Imaging 18: 443–451.
- Sunil RT, Krishnan M, Koshy C, et al. (2005) Comparison of proximal isovelocity surface area method and pressure half time method for evaluation of mitral valve area in patients undergoing balloon mitral valvotomy. Echocardiography 22: 707–712.
- Messika-Zeitoun D, Meizels A, Cachier A, et al. (2005) Echocardiographic evaluation of the mitral valve area before and after percutaneous mitral commissurotomy: the pres sure half-time method revisited. J Am Soc Echocardiogr 18: 1409–1414.
- Lee T, Tseng C, Chiao C, et al. (2004) Clinical applicability for the assessment of the valvular mitral stenosis severity with Doppler echocardiography and the proximal isovelocity surface area (PISA) method. Echocardiography 21: 1–6.
- Uzun M & Yokusoglu M (2007) The PISA method simplified. Eur J Echocardiogr 8: 1–2; author reply 3.
- Messika-Zeitoun D, Cachier A, Brochet E, Cormier B, Iung B, & Vahanian A (2007) Evaluation of mitral valve area by the proximal isovelocity surface area method in mitral stenosis: could it be simplified? Eur J Echocardiogr 8: 116–121.
- Dahan M, Paillole C, Martin D, & Gourgon R (1993) Determinants of stroke volume response to exercise in patients with mitral stenosis: a Doppler echocardiographic study. J Am Coll Cardiol 21: 384–389.
- Eren M, Arikan E, Gorgulu S, et al. (2002) Relationship between resting parameters of the mitral valve and exercise capacity in patients with mitral stenosis: can the diastolic filling period predict exercise capacity? J Heart Valve Dis 11: 191–198.
- Klarich K, Rihal C, & Nishimura R (1996) Variability between methods of calculating mitral valve area: simultaneous Doppler echocardiographic and cardiac catheterization studies conducted before and after percutaneous mitral valvuloplasty. J Am Soc Echocardiogr 9: 684–690.
- Mohan J, Chawla R, & Arora R (1996) Methodological variation and agreement in assessing mitral valve orifice area by echo-Doppler methods in mitral stenosis. Indian Heart J 48: 653–657.
- Nakatani S, Masuyama T, Kodama K, Kitabatake A, Fujii K, & Kamada T (1988) Value and limitations of Doppler echocardiography in the quantification of stenotic mitral valve area: comparison of the pressure half-time and the continuity equation methods. Circulation 77: 78–85.
- Voelker W, Berner A, Regele B, et al. (1993) Effect of exercise on valvular resistance in patients with mitral stenosis. J Am Coll Cardiol 22: 777–782.
- Binder T, Rosenhek R, Porenta G, Maurer G, & Baumgartner H (2000) Improved assessment of mitral valve stenosis by volumetric real-time three-dimensional echocardiography. J Am Coll Cardiol 36: 1355–1361.
-
Langerveld J, Valocik G, Plokker H, et al. (2003) Additional value of three-dimensional transesophageal echocardiography for patients with mitral valve stenosis undergoing balloon valvuloplasty. J Am Soc Echocardiogr 16: 841–849.
10.1067/S0894-7317(03)00402-4 Google Scholar
- Singh V, Nanda N, Agrawal G, et al. (2003) Live three-dimensional echocardiographic assessment of mitral stenosis. Echocardiography 20: 743–750.
- Zamorano J, Cordeiro P, Sugeng L, et al. (2004) Real-time three-dimensional echocardiography for rheumatic mitral valve stenosis evaluation: an accurate and novel approach. J Am Coll Cardiol 43: 2091–2096.
- Sebag I, Morgan J, Handschumacher M, et al. (2005) Usefulness of three-dimensionally guided assessment of mitral stenosis using matrix-array ultrasound. Am J Cardiol 96: 1151–1156.
- de Agustin J, Nanda N, Gill E, de IL, & Zamorano J (2007) The use of three-dimensional echocardiography for the evaluation of and treatment of mitral stenosis. Cardiol Clin 25: 311–318.
- Poutanen T, Tikanoja T, Sairanen H, & Jokinen E (2006) Normal mitral and aortic valve areas assessed by three- and two-dimensional echocardiography in 168 children and young adults. Pediatr Cardiol 27: 217–225.
- Flachskampf F & Klinghammer L (2008) Determination of stenotic mitral valve area: new, old, and gold standards. Eur J Echocardiogr 9: 321.
- Nishimura R, Rihal C, Tajik A, & Holmes D (1994) Accurate measurement of the transmitral gradient in patients with mitral stenosis: a simultaneous catheterization and Doppler echocardiographic study. J Am Coll Cardiol 24: 152–158.
- David D, Lang R, Marcus R, et al. (1991) Doppler echocardiographic estimation of transmitral pressure gradients and correlations with micromanometer gradients in mitral stenosis. Am J Cardiol 67: 1161–1164.
- Izgi C, Ozdemir N, Cevik C, et al. (2007) Mitral valve resistance as a determinant of resting and stress pulmonary artery pressure in patients with mitral stenosis: a dobutamine stress study. J Am Soc Echocardiogr 20: 1160–1166.
- Lee KS, Abbas AE, Khandheria BK, & Lester SJ (2007) Echocardiographic assessment of right heart hemodynamic parameters. J Am Soc Echocardiogr 20: 773–782.
- Skjaerpe T & Hatle L (1986) Noninvasive estimation of systolic pressure in the right ventricle in patients with tricuspid regurgitation. Eur Heart J 7: 704–710.
- Hatle L (1984) Maximal blood flow velocities—haemodynamic data obtained noninvasively with CW Doppler. Ultrasound Med Biol 10: 225–237.
- Lindqvist P, Calcutteea A, & Henein M (2008) Echocardiography in the assessment of right heart function. Eur J Echocardiogr 9: 225–234.
- Zoghbi WA, Enriquez-Sarano M, Foster E, et al. (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16: 777–802.
- Samad BA, Alam M, & Jensen-Urstad K (2002) Prognostic impact of right ventricular involvement as assessed by tricuspid annular motion in patients with acute myocardial infarction. Am J Cardiol 90: 778–781.
- Kjaergaard J, Petersen C, Kjaer A, Schaadt B, Oh J, & Hassager C (2006) Evaluation of right ventricular volume and function by 2D and 3D echocardiography compared to MRI. Eur J Echocardiogr 7: 430–438.
- Wang A, Krasuski R, Warner J, et al. (2002) Serial echocardio-graphic evaluation of restenosis after successful percutaneous mitral commissurotomy. J Am Coll Cardiol 39: 328–334.
- Lamia B, Teboul J, Monnet X, Richard C, & Chemla D (2007) Relationship between the tricuspid annular plane systolic excursion and right and left ventricular function in critically ill patients. Intensive Care Med 33: 2143–2149.
- Meluzin J, Spinarova L, Hude P, et al. (2005) Prognostic importance of various echocardiographic right ventricular functional parameters in patients with symptomatic heart failure. J Am Soc Echocardiogr 18: 435–444.
- Lanzarini L, Fontana A, Campana C, & Klersy C (2005) Two simple echo-Doppler measurements can accurately identify pulmonary hypertension in the large majority of patients with chronic heart failure. J Heart Lung Transplant 24: 745–754.
- Rayburn B & Fortuin N (1996) Severely symptomatic mitral stenosis with a low gradient: a case for low-technology medicine. Am Heart J 132: 628–632.
- Lev E, Sagie A, Vaturi M, Sela N, Battler A, & Shapira Y (2004) Value of exercise echocardiography in rheumatic mitral stenosis with and without significant mitral regurgitation. Am J Cardiol 93: 1060–1063.
- Choudhary S, Talwar S, Juneja R, & Kumar A (2001) Fate of mild aortic valve disease after mitral valve intervention. J Thorac Cardiovasc Surg 122: 583–586.
- Chen C, Cheng T, Chen J, Zhou Y, Mei J, & Ma T (1993) Percutaneous balloon mitral valvuloplasty for mitral stenosis with and without associated aortic regurgitation. Am Heart J 125: 128–137.
- Sanchez-Ledesma M, Cruz-Gonzalez I, Sanchez P, et al. (2008) Impact of concomitant aortic regurgitation on percutaneous mitral valvuloplasty: immediate results, short-term, and long-term outcome. Am Heart J 156: 361–366.
- Reimold S & Rutherford J (2003) Clinical practice. Valvular heart disease in pregnancy. N Engl J Med 349: 52–59.
- Desai D, Adanlawo M, Naidoo D, Moodley J, & Kleinschmidt I (2000) Mitral stenosis in pregnancy: a four-year experience at King Edward VIII Hospital, Durban, South Africa. BJOG 107: 953–958.
- Esteves C, Munoz J, Braga S, et al. (2006) Immediate and long-term follow-up of percutaneous balloon mitral valvuloplasty in pregnant patients with rheumatic mitral stenosis. Am J Cardiol 98: 812–816.
- Sivadasanpillai H, Srinivasan A, Sivasubramoniam S, et al. (2005) Long-term outcome of patients undergoing balloon mitral valvotomy in pregnancy. Am J Cardiol 95: 1504–1506.
- Chiang C, Hsu L, Chu P, Ho W, Lo H, & Chang C (2003) Feasibility of simplifying balloon mitral valvuloplasty by obviating left-sided cardiac catheterization using on-line guidance with transesophageal echocardiography. Chest 123: 1957–1963.
- Trehan V, Mukhopadhyay S, Nigam A, et al. (2005) Mitral valvuloplasty by inoue balloon under transthoracic echocardiographic guidance. J Am Soc Echocardiogr 18: 964–969.
- Yap S, de JP, Ligthart J, Serruys P, & Roos-Hesselink J (2006) Percutaneous triple-valve balloon valvulotomy in a pregnant woman using intracardiac echocardiography: case report. J Heart Valve Dis 15: 459–464.
- Feldman T (2004) Intraprocedure guidance for percutaneous mitral valve interventions: TTE, TEE, ICE, or X-ray? Catheter Cardiovasc Interv 63: 395–396.
- Green N, Hansgen A, & Carroll J (2004) Initial clinical experience with intracardiac echocardiography in guiding balloon mitral valvuloplasty: technique, safety, utility, and limitations. Catheter Cardiovasc Interv 63: 385–394.
- Chiang C, Huang H, & Ko Y (2007) Echocardiography-guided balloon mitral valvotomy: transesophageal echocardiography versus intracardiac echocardiography. J Heart Valve Dis 16: 596–601.
- Thomas J, Wilkins G, Choong C, et al. (1988) Inaccuracy of mitral pressure half-time immediately after percutaneous mitral valvotomy. Dependence on transmitral gradient and left atrial and ventricular compliance. Circulation 78: 980–993.
- Reid CL & Rahimtoola SH (1991) The role of echocardiography/ Doppler in catheter balloon treatment of adults with aortic and mitral stenosis. Circulation 84(3 Suppl.): I240–249.
- Abascal VM, Wilkins GT, Choong CY, et al. (1988) Echocardio-graphic evaluation of mitral valve structure and function in patients followed for at least 6 months after percutaneous balloon mitral valvuloplasty. J Am Coll Cardiol 12: 606–615.
- Iung B, Garbarz E, Michaud P, et al. (1999) Late results of percutaneous mitral commissurotomy in a series of 1024 patients. Analysis of late clinical deterioration: frequency, anatomic findings, and predictive factors. Circulation 99: 3272–3278.
- Turgeman Y, Atar S, Suleiman K, Bloch L, & Rosenfeld T (2003) Percutaneous balloon mitral valvuloplasty in patients with severe mitral stenosis and low transmitral diastolic pressure gradient. Int J Cardiovasc Intervent 5: 200–205.
- Chmielak Z, Ruzyllo W, Demkow M, et al. (2002) Late results of percutaneous balloon mitral commissurotomy in patients with restenosis after surgical commissurotomy compared to patients with “de-novo” stenosis. J Heart Valve Dis 11: 509–516.
- Levine M, Weinstein J, Diver D, et al. (1989) Progressive improvement in pulmonary vascular resistance after percutaneous mitral valvuloplasty. Circulation 79: 1061–1067.