Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report 100 cases of mitral commissurotomy in children, 15-years-old or less, suffering from rheumatic mitral stenosis. Mitral stenosis in children is characterised by the severity of functional impairment and the considerable radiological, electocardiological and haemodynamic changes, with pulmonary arterial hypertension which is always present and often well marked. The early results of mitral commissurotomy are very satisfactory with clinical improvement and a low mortality. But, in the long term, we have seen progressive deterioration in the clinical state of these patients resulting from re-stenosis or from the progression of another valve lesion. Three problems have been discussed. First, the progression of the rheumatic process which seems to account to a large extent for the late failures of mitral commissurotomy in children. Secondly, the problem of tricuspid insufficiency, which is often associated with mitral stenosis in childhood and which usually disappears during the post-operative period. Finally, the problem of pre-capillary pulmonary arterial hypertension which always showed a tendency towards regression.
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PMID:[Mitral commissurotomy in children. Apropos of 100 cases]. 10 82

Thrombus formation in the left atrium and left ventricle is primarily due to stasis of blood which causes activation of the coagulation system. Migration of thrombotic material into the circulation depends on the dynamic forces of the circulation. Atrial fibrillation is the commonest underlying cardiac disorder predisposing to thromboembolism. Rheumatic mitral stenosis, left atrial enlargement, prior myocardial infarction, hypertension, and echocardiographic left ventricular hypertrophy are risk factors for thromboembolic stroke in elderly patients with chronic atrial fibrillation. Non-valvular atrial fibrillation accounts for 45% of cardiac sources of thromboembolic stroke and includes patients with ischemic heart disease, hypertension, thyrotoxic heart disease, hypertrophic cardiomyopathy, chronic sinoatrial disorder, and idiopathic atrial fibrillation. 15% of cardiac sources of thromboembolic stroke are associated with acute myocardial infarction, 10% with left ventricular aneurysm and mural thrombi remote from an acute myocardial infarction, 10% with rheumatic valvular heart disease, and 10% with prosthetic cardiac valves. Mitral valve prolapse, mitral annular calcium, nonischemic cardiomyopathies, infective endocarditis, nonbacterial thrombotic endocarditis, left atrial myxoma, paradoxical embolism associated with congenital heart disease, calcific aortic stenosis, and complex atherosclerotic plaque within the proximal aorta also contribute to thromboembolism.
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PMID:Etiology and pathogenesis of thromboembolism. 176 43

Patients with rheumatic mitral stenosis often have no pulmonary oedema despite considerably increased pulmonary venous pressure. Pulmonary microvascular permeability was measured non-invasively by a previously validated method of double isotope scintigraphy with indium-113m and technetium-99m. This permits calculation of an index reflecting transferrin efflux and thus, indirectly, the microvascular permeability. Fifteen patients with severe mitral stenosis (defined as valve area less than 1.0 cm2) were compared with a control group of 11 patients with mild coronary artery disease. The permeability index was significantly lower in patients with mitral stenosis than in the control group. Furthermore, the extent of reduction of the permeability index correlated with the severity of mitral stenosis as reflected by the Gorlin valve area. This finding may account for the relative resistance of these patients to pulmonary oedema despite chronic pulmonary venous hypertension.
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PMID:Pulmonary microvascular permeability in patients with severe mitral stenosis. 186 52

Clinical, hemodynamic and operative findings of 125 children, up to the age of 12 years, were analysed to determine if the severity of pulmonary venous and arterial hypertension correlated with the severity of rheumatic mitral stenosis. Moderately severe to severe pulmonary venous and arterial hypertension was found in almost three-quarters of the patients. Operative findings indicated critical mitral stenosis in 69% of the cases. In India, following rheumatic fever, some patients follow an unusually rapid course in developing mitral stenosis severe enough to require operative treatment, even at the age of six years.
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PMID:Severity of rheumatic mitral stenosis in children. 174 1

Spontaneous (nontraumatic, noninfectious) rupture and/or dissection of the pulmonary trunk or secondary pulmonary arteries in the setting of pulmonary hypertension is rarely considered as a cause of sudden death. Systemic-to-pulmonary vascular shunts and rheumatic mitral stenosis have been the most common predisposing factors, occurrence in association with recurrent thromboembolic hypertension rarely having been documented. Recently, we had the opportunity to study a 52-year-old white woman with catheterization-proved "primary" pulmonary hypertension who died suddenly with cardiac tamponade from rupture/dissection of the pulmonary trunk, and who had morphological evidence of extensive thromboembolic pulmonary vascular disease.
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PMID:Fatal dissection of the pulmonary trunk. An obscure consequence of chronic pulmonary hypertension. 306 6

Closed mitral valvotomy for rheumatic mitral stenosis was performed on 126 pregnant women (average duration of pregnancy c. 21 weeks), 91% of whom were in NYHA functional class III or IV. Associated functional tricuspid regurgitation was present in 47 (37%) of the women, and 102 (81%) had critical mitral stenosis (digitally assessed valve area less than 1 cm2). There was no surgical mortality. Postoperatively 84% of the women were in NYHA class I. Clinical evidence of pulmonary artery hypertension and tricuspid regurgitation regressed postoperatively in most patients. Full-term normal delivery was achieved in 82% of the pregnancies, with total fetal mortality 6%. There were no congenital abnormalities and the infants' progress was normal. At 5-year follow-up 86% of the women were in NYHA class I or II and at 10 years the figure was 60%. The restenosis rate was 2%/year and the late mortality 3.3%. Closed mitral valvotomy during pregnancy thus was safe and reliable, giving significant functional and clinical improvement without adversely affecting the fetus.
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PMID:Closed mitral valvotomy during pregnancy. A 20-year experience. 338 43

A total of 18 patients with pure rheumatic mitral stenosis between the ages of eight and 14 years (average 11.8 years) were studied. Left ventricular angiograms in the right anterior oblique view were obtained in each. Moderate to severe pulmonary arterial hypertension was present in all but one. The mean left ventricular end-systolic volume index was 25.4 +/- 8.5 ml/m2; it was increased in five patients. The mean left ventricular end-diastolic volume index was 64 +/- 13.5 ml/m2. It was normal in all except one patient, in whom it was increased to 91 ml/m2. The left ventricular stroke volume index, 39.6 +/- 8.8 ml/m2, was within the normal range. The left ventricular stroke volume index, 39.6 +/- 8.8 ml/m2, was within the normal range. The mean left ventricular ejection fraction was 0.61 +/- 0.09 ml, with a range of 0.44-0.72. The mean left ventricular ejection fraction was lower than normal (P less than 0.05). The ejection fraction was low in five of the 18 patients. Four of the five patients with an ejection fraction below 0.60 had severe pulmonary arterial hypertension. There was no correlation between the ejection fraction and left atrial pressure or the mitral valve area. Segmental contraction analysis in the five patients with a low ejection fraction showed global hypokinesia in four and segmental hypokinesia, involving predominantly the posterobasal segment, in one patient. Our study suggests that even children with pure mitral stenosis may have left ventricular dysfunction in the absence of active carditis.
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PMID:Left ventricular function in isolated rheumatic mitral stenosis in children. 374 34

The study of the microcirculation in lung and visceral pleura biopsies from patients with rheumatic mitral stenosis showed the involvement of all parts of the microcirculatory system including intra- and extravascular alterations and changes of the vascular wall as well as its lymphatic part. As the pressure in the small circulation circle increased and arterial hypertension established enhancement of the vascular reconstruction, rheological disturbances and dyscoagulation in the pulmonary microvessels took place. All this resulted in hemodynamic and metabolic homeostasis disturbances in the pulmonary artery system and, consequently, in the establishment of lung hypertension.
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PMID:[Microcirculation in rheumatic mitral stenosis (clinico-morphological research by lung biopsies)]. 397 21

Autopsy data of 58 cases (1958-1986) was analysed for cardiac lesions. The cases were divided into 2 groups; paediatric (23) and adult (35). The heart was normal in 8.7% and 20.5% of the above groups respectively. Rest of the cases showed left ventricular hypertrophy with variable dilatation. Obstructive lesion in the aorta and or renal arteries was present in 91.3% of paediatric and 80.0% of adult cases. Congestive cardiac failure was very common in paediatric group (60.8%) and was not seen in absence of obstructive lesion in the aorta or renal arteries. Histologically the aortic lesion was healed in 70% and 50% of paediatric and adult cases. The commonest additional lesion found, was coronary artery involvement in 11 cases (17%). Ostial stenosis was noted in 7 cases, including 2 in paediatric age group. Epicardial coronaries were involved in 4 cases with infarcts in 4. Aortic incompetence was rare (3.4%). Associated rheumatic mitral stenosis was seen in 2 and healed infective endocarditis in one. Histologically apart from the above mentioned lesions the myocardium showed essentially a response to hypertension. Focal lymphocytic infiltration was seen in 2 children and tuberculosis myocarditis in 3 adults. No case of any other type of myocarditics or cardiomyopathy was seen. In conclusion hypertension and coronary artery disease are the main factors responsible for myocardial failure but additional related or unrelated factors were present in 15.0% cases.
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PMID:Cardiac lesions in non-specific aorto-arteritis. An autopsy study. 798 78

The prevalence of coronary artery disease (CAD) and the incidence of new coronary events are similar in older men and women. Independent risk factors for new coronary events in older women include age, prior CAD, cigarette smoking, hypertension, diabetes mellitus, high serum total cholesterol and triglycerides, and low serum high-density lipoprotein cholesterol. Older women have a higher prevalence of hypertension than older men. In older women with hypertension, echocardiographic left ventricular hypertrophy is a powerful independent predictor of new coronary events, atherothrombotic brain infarction, and congestive heart failure (CHF). Older women have a higher prevalence of rheumatic mitral stenosis and of mitral annular calcium than older men. Older women and men have a similar prevalence of valvular aortic stenosis, aortic regurgitation, mitral regurgitation, hypertrophic cardiomyopathy, and idiopathic dilated cardiomyopathy. The prevalence and incidence of CHF increase with age. The prevalence of normal left ventricular ejection fraction associated with CHF increases with age and is higher in older women than in older men. The prevalence of chronic atrial fibrillation increases with age and is similar in older men and women. Atrial fibrillation is an independent predictor of new coronary events and thromboembolic stroke in older women. Older women with unexplained syncope should have 24-hour ambulatory electrocardiograms to determine whether pauses > 3 seconds are present, requiring permanent pacemaker implantation.
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PMID:Prevalence of heart disease in older women in a nursing home. 986 88


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