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Scoring system derived from description of the above four parameters with a score of 1 for near-normal and 4 for the extensive involvement. An echocardiographic score of 8 or less, predicts better outcome of percutaneous mitral valvuloplasty. (Table modified from Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF. Percutaneous balloon dilation of the mitral valve: An analysis of echocardiographic variables related to outcome and the mechanism of dilation. Br Heart J 1988;60:299-308.)

Scoring system derived from description of the above four parameters with a score of 1 for near-normal and 4 for the extensive involvement. An echocardiographic score of 8 or less, predicts better outcome of percutaneous mitral valvuloplasty. (Table modified from Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF. Percutaneous balloon dilation of the mitral valve: An analysis of echocardiographic variables related to outcome and the mechanism of dilation. Br Heart J 1988;60:299-308.)

long-standing pulmonary hypertension, changes in the right ventricle may occur (e.g., hypertrophy, enlargement, decrement in function, and shifting of the interventricular septum toward the LV as right-sided pressures approach or exceed left-sided pressures) (Fig. 4; see also Chapter 18).

Pressure Gradients

As the MV orifice becomes increasingly stenotic, higher-pressure gradients are necessary to "move" blood from the LA to the LV. These gradients can be measured and used as a means to estimate the hemodynamic significance of mitral stenosis.

deflated balloon

Valvuloplasty . a balloon , at full inflation deflated balloon

Valvuloplasty . a balloon , at full inflation

Fig. 3. (A) Echocardiographic features of rheumatic mitral stenosis in a 42-yr-old Haitian female with atrial fibrillation and multiple embolic episodes. Chronically increased left atrial pressures in mitral stenosis leads to left atrial dilatation (Fig. 3A) and atrial fibrillation. These predispose to thrombus formation. Note the left atrial enlargement in parasternal long axis (PLAX) and apical four-chamber (A4C) views. The right atrium was also enlarged. (B) Spontaneous echocontrast (curved arrows) was not visible on transthoracic examination in the patient (A), but was visualized as "swirling smoke" within the left atrium and left atrial appendage on transesophageal echocardiography (B). Note the clot in the left atrial appendage (straight arrow). (C) Transthoracic and Transesophageal views during percutaneous mitral balloon valvuloplasty for mitral stenosis. (D,E) Simultaneous left ventricular and pulmonary capillary wedge pressure tracings pre- and postpercutaneous balloon valvuloplasy in a patient with mitral stenosis. The pressure gradient across the stenotic valve decreased immediately post mitral balloon valvuloplasty. (Please see companion DVD for corresponding video.)

Pressure Gradient After Valvuloplasty

Fig. 3. (A) Echocardiographic features of rheumatic mitral stenosis in a 42-yr-old Haitian female with atrial fibrillation and multiple embolic episodes. Chronically increased left atrial pressures in mitral stenosis leads to left atrial dilatation (Fig. 3A) and atrial fibrillation. These predispose to thrombus formation. Note the left atrial enlargement in parasternal long axis (PLAX) and apical four-chamber (A4C) views. The right atrium was also enlarged. (B) Spontaneous echocontrast (curved arrows) was not visible on transthoracic examination in the patient (A), but was visualized as "swirling smoke" within the left atrium and left atrial appendage on transesophageal echocardiography (B). Note the clot in the left atrial appendage (straight arrow). (C) Transthoracic and Transesophageal views during percutaneous mitral balloon valvuloplasty for mitral stenosis. (D,E) Simultaneous left ventricular and pulmonary capillary wedge pressure tracings pre- and postpercutaneous balloon valvuloplasy in a patient with mitral stenosis. The pressure gradient across the stenotic valve decreased immediately post mitral balloon valvuloplasty. (Please see companion DVD for corresponding video.)

Pressure gradients across the MV are determined by placing the continuous-wave (CW) Dopplerprobe across the MV orifice. The Doppler interrogation should be performed parallel to the direction of blood flow, in order to avoid underestimating the gradient.

The measurements that are reported most frequently are the peak and mean gradients (Figs. 5 and 6). Of the

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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