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Dimension and Functional Characteristics of Mitral Stenosis Patients: Pre-surgical Cardiac Magnetic Resonance Imaging Assesment

Author : DG Arilaksono, M. Kasim, CA. Atmadikoesoemah,E. Sahara,
Upload Date : 19-04-2018

Background: Valvular heart diseases (VHD) constitute a major cause of cardiovascular morbidity and mortality worldwide with rheumatic heart disease (RHD) being the most common causes in developing nations. Approximately 25% of all patients with RHD have isolated Mitral Stenosis (MS), and 40% have combined MS and MR. Although echocardiography remains to be the gold standard for the diagnosis of VHD, with advanced cardiac software, more advanced techniques, and faster imaging sequences, MRI may become a valuable procedure for investigation and follow-up of patients with valvular heart disease.

Method: A cross-sectional study was performed in 43 MS patients scheduled for surgical intervention during 4 months period. The studies were performed on a Philips Achieva 1.5 Tesla MRI machine and analyzed using Circle Cardiovascular Imaging 42 software application. Simpson’s disk summation  method were used  to analyze ventricle mass and volume. Demographic and clinical data obtained from the registry of cardiac MRI  and analyzed using SPSS version 22.

Results: Between October 2017 to January 2018, 43 patients was admitted to cardiac MRI department for pre-surgical assessment. Most of them are female (62.7%), below 50 years old (69.7%), and NYHA functional class II (72.1%).  The average of echocardiography parameters of the patients are following: LV Ejection fraction is 58±11.3%, TAPSE is 1.6 (1.0-3,1), MVA is 0.7 (0.3-1.8 cm), mMVG is 11.6±3.9, TVG is 51.5±22.5, PV AccT is 103.3±20.9 ms, and LA diameter is 52±14 cm. The average of Cardiac MR dimension and function evaluation revealed following: LVEDV is 121 (63-238) ml, LVEF is 47.7±13.11%, LV Mass is 65.5 (38-153) grams, RVEDV is 148.5 (64-1216) ml, RVEF is 43.6±12.27, and LAVi is 147.5 (65-1059). Of all 43 patients, 65% subjects showed reduced LVEF (normal LVEF range 56-78 for male and 56-87 for female), and 67.5% showed reduced RVEF (normal RVEF range 47-74 for male and 47-80 for female).

Conclusion: Cardiac MR imaging is a reliable method in patients with MS for diagnosis and follow up evaluation. However, further studies are necessary in order to conclude its role in prognostication of MS patients, especially those who were planned to undergo intervention.

KEYWORDS : Mitral stenosis, Rheumatic heart disease, Cardiac Magnetic Resonance Imaging

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