Comparison of two patients with mitral stenosis and importance of sinus rhythm: case report

Abstract

Abstract. We present two woman patients have rheumatic mitral stenosis (MS). They complained of about shortness of breath and palpitation. First patient, she had had two stroke without any sequela (respectively 7 years and 4 years ago). And she has atrial fibrillation (AF) in electrocardiography (ECG). Another woman patient didn’t have any complaint before. Latter patient has sinus tachycardia in ECG. Transthoracic echocardiography (TTE) disclosed severe mitral valve stenosis and left atrial dilatation in both patients. But first patient has multiple thrombus in left atrium. Mitral valve surgery was suggested for both patients. In conclusion maintenance of sinus rhythm, in the patients who had MS, is very important for both the protection of left atrial thrombus and the reduction of the development of systemic embolus related to it.

Key words: mitral stenosis, sinus rhythm, atrial fibrillation, left atrial thrombus

Keywords

• mitral stenosis, sinus rhythm, atrial fibrillation, left atrial thrombus

Kaynakça

1. Otto CM, Bonow RO. Valvular heart disease. In: Braunwald E. (ed) Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. Philadelphia, Saunders 2008, pp1646-1656.
2. Vora A, Karnad D, Goyal V, et al. Control of rate versus rhythm in rheumatic atrial fibrillation: a randomized study. Indian Heart J 2004; 56: 110116.
3. Moore AG. Rheumatic Heart Disease. In: Murphy JG, Lloyd MA. (eds) Mayo Clinic Cardiology, (3rd ed). Rochester, Mayo Clinic Scientific Pres 2007, pp 549-554.
4. Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet 2009; 374: 1271-1283.
5. Rowe JC, Bland EF, Sprague HB, Whıte PD. The course of mitral stenosis without surgery: ten-and twenty-year perspectives. Ann Intern Med 1960; 52: 741-749.
6. Braunwald E, Moscovitz HL, Mram SS, et al. The hemodynamics of the left side of the heart as studied by simultaneous left atrial, left ventricular, and aortic pressures; particular reference to mitral stenosis. Circulation 1955; 12: 69-81.
7. Krasuski RA, Assar MD, Wang A, et al. Usefulness of percutaneous balloon mitral commissurotomy in preventing the development of atrial fibrillation in patients with mitral stenosis. Am J Cardiol 2004; 93: 936-939.
8. Coulshed N, Epstein EJ, McKendrick CS, Galloway RW, Walker E. Systemic embolism in mitral valve disease. Br Heart J 1970; 32: 26-34.

9. Langerveld J, van Hemel NM, Kelder JC, et al. Long-term follow-up of cardiac rhythm after percutaneous mitral balloon valvotomy. Does atrial fibrillation persist? Europace 2003; 5: 47-53.
10. Hu CL, Jiang H, Tang QZ, et al. Comparison of rate control and rhythm control in patients with atrial fi brillation after percutaneous mitral balloon valvotomy: a randomised controlled study. Heart 2006; 92: 1096–1101.
11. Erbay AR, Turhan H, Yasar AS, et al. Effects of long-term beta-blocker therapy on P-wave duration and dispersion in patients with rheumatic mitral stenosis. International Journal of Cardiology 2005; 102: 33-37.
12. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused Update Incorporated Into the 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): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation 2008;118: e564.
13. Chiang CW, Lo SK, Cheng NJ, et al. Predictors of systemic embolism in patients with mitral stenosis. A prospective study. Ann Intern Med 1988; 128: 885-889.
14. Otto CM. Surgical and percutaneous intervention for mitral stenosis. In: Otto CM. (ed) Valvular Heart Disease, (2nd ed.) Philadelphia: Saunders 2004, pp 272-276.