NET ATRIOVENTRICULAR COMPLIANCE a PROMISING PARAMETER IN ASESING RHEUMATIC MITRAL STENOSIS

NET ATRIOVENTRICULAR COMPLIANCE: A PROMISING PARAMETER IN ASSESING RHEUMATIC MITRAL STENOSIS Abdullah Al – Shafi Majumder MBBS,MD,FACC,FRCP,FESC,FSCAI Director and Professor of Cardiology, NICVD, Dhaka [...]... rheumatic heart diseases 1984 Rheumatic heart diseases in Bangladesh and Japan, JICA, Dhaka, pp 1-9 • Recent data shows almost same prevalence of MS among Rheumatic heart diseases 2013, Patients register, NICVD, Dhaka Rheumatic mitral valvular heart disease • In the setting of mitral stenosis, increased transmitral gradient results in an elevation of left atrial pressure and then its backward transmission... Outline • • • • • • • • Background Rheumatic mitral valvular heart disease Concept of Compliance Net atrioventricular compliance (Cn) Methods of measuring Cn Prognostic significance of Cn Promising aspects of Cn in management of MS Limitations of Cn as a parameter Rheumatic mitral valvular heart disease • Rheumatic mitral valvular heart disease is a chronic manifestation of rheumatic carditis, which may... • • Background Rheumatic mitral valvular heart disease Concept of Compliance Net atrioventricular compliance (Cn) Methods of measuring Cn Prognostic significance of Cn Promising aspects of Cn in management of MS Limitations of Cn as a parameter BACKGROUND In patients with mitral stenosis, the occurrence of  Pulmonary arterial hypertension,  Symptoms, and  Adverse outcomes do not always correlate... between the left atrial pressure and valve orifice or between left atrial pressure and pulmonary artery pressure • It is due to the complex interactions between mitral orifice area, left atrial compliance and pulmonary compliance American Heart Journal.1977; 94: 73-80 Rheumatic mitral valvular heart disease • MS is best described as a disease continuum, with no single value that can define its severity... prevalence of rheumatic heart disease reporting 0.14/1000 in Japan, 1.86/1000 in China, 0.5/1000 in Korea, 4.5/1000 in India Circulation,2009, 119, pp.211-219 • A community based study showed the prevalence of rheumatic heart disease is 1.3 per 1000 in rural Bangladesh Tropical Doctor,2005, 35, pp 160-161 Rheumatic mitral valvular heart disease • Mitral stenosis (MS) is the commonest (54%) of all rheumatic. .. transmission predisposes patients to pulmonary venous and finally pulmonary arterial hypertension, which is known to be the main mechanism for exercise intolerance and the development of dyspnea Circulation 2000;102:2378-84 Rheumatic mitral valvular heart disease • A wide spectrum of LA pressures exists in patients with mitral stenosis despite nearly similar mitral valve area • A linear relationship does not... BACKGROUND • Net atrioventricular compliance (Cn) is a relatively new parameter in the assessment of rheumatic MS patients • Number of studies has been conducted to decide how far Cn correlates with PA pressure estimated by Doppler echocardiography in patients with moderate to severe MS • We shall discuss some of the basic aspects of Cn and its implications in the management of rheumatic mitral stenosis. .. specifically, a wide variation in pulmonary pressures for the same range of mitral obstruction emphasizes the need to identify key factors implicated in the development of pulmonary hypertension and functional limitation in MS Am J Cardiol 1996;78:1060–1062 Outline • • • • • • • • Background Rheumatic mitral valvular heart disease Concept of Compliance Net atrioventricular compliance (Cn) Methods of measuring... may occur in 90% cases of rheumatic fever at 3 years of age to around 30% in adolescence Davidsons principles and Practice of Medicine.21th ed, Edinburg: Churchill livingstone Elesvier, pp.521-640 Rheumatic mitral valvular heart disease • It is estimated that there are over 15 million cases of RHD worldwide, with 282,000 new cases and 233,000 deaths annually Carapetis, et al (2005) • Several studies... 3 days after PTMC of the 1st patient • She walked from ground floor to 3rd floor without any assistance & without feeling any shortness of breath • Echocardiography 3 days after PTMC revealed… Her MVA was 1.8 sq cm, mean trans mitral pressure gradient was 6 mmHg, PASP was 51 mm Hg, E wave down slope was 4.5 sq m : her net atrioventricular compliance was 5 ml/mm Hg 3 days after PTMC of the 2nd patient . NET ATRIOVENTRICULAR COMPLIANCE: A PROMISING PARAMETER IN ASSESING RHEUMATIC MITRAL STENOSIS Abdullah Al – Shafi Majumder MBBS,MD,FACC,FRCP,FESC,FSCAI Director and Professor of Cardiology,. of Compliance • Net atrioventricular compliance (Cn) • Methods of measuring Cn • Prognostic significance of Cn • Promising aspects of Cn in management of MS • Limitations of Cn as a parameter. Echocardiography 3 days after PTMC revealed… His MVA was 1.7 sq cm, mean trans mitral pressure gradient was 4 mmHg, PASP was 26 mm Hg, E wave down slope was 1.9 sq m. : his net atrioventricular compliance