Angiocardiographic and Physiologic Correlations in Mitral Stenosis

DANIEL S. LUKAS, PETER R. MAHRER, ISRAEL STEINBERG
1958 Circulation  
With the use of the technics of angiocardiography and cardiac catheterization the relation of specific hemodynamnic abnormalities to alterations in cardiovascular anatomy in mitral valvular disease was investigated in 56 patients. IT IS well known that the left atrium and pulmonary artery are characteristically enlarged in mitral stenosis.1 2 However, the quantitative relationship of these anatomic abnormalities to the concomitant disturbances in cardiovascular hemodynamics has not been
more » ... The few anatomic-physiologic studies that are available are semiquantitative, since they are based on rough estimates of left atrial and pulmonary arterial size derived from fluoroscopy and conventional roentgenograms of the heart.3-5 Since angiocardiography delineates the cardiovascular structures and permits precise measurements, a quantitative method for comparison with the data obtained by cardiac catheterization in patients with mitral stenosis is available. Correlation of the findings derived from the 2 technics forms the basis of this report, an abstract of which has been published previously.6 MATERIALS AND METHODS Fifty-six patients with rheumatic mitral valvular disease who were undergoing evaluation for mitral valvuloplasty were selected on the basis of technically adequate angiocardiograms and the completeness of the data obtained by cardiac catheterization. In all instances cardiac catheterization and angiocardiography were performed within a short interval, usually within a week. Clinically each patient was in an optimum state, induced when necessary by vigorous medical therapy. Thirtythree were women; 23 were men. The ages varied from 21 to 56 years; the majority were in the fourth decade. 51 patients and was confirmed by operation in 47. Five patients had associated mitral insufficiency of a marked degree; this was verified by operation in 3 instances. The 56 patients were divided into 4 groups; group I consisted of 13 patients with pure mitral stenosis as determined by the most stringent criteria, notably, absence of an apical systolic murmur, absence of evidence of mitral insufficiency in the pulmonary "capillary" pressure tracing, and absence of a regurgitation jet at mitral valvuloplasty. The 13 patients in group II also had no palpable regurgitant jet at operation but had either an apical systolic murmur or some evidence of mitral insufficiency in the pulmonary "capillary" tracing. Group III was composed of 25 patients who exhibited a small regurgitant jet at operation or, if not operated upon, had an apical systolic murmur and significant evidence of mitral insufficiency in the pulmonary "capillary" tracing. Mitral stenosis, however, was the predominant lesion, clinically, hemodynamically, and at surgery. Group IV was composed of 5 patients with evidence of severe mitral insufficiency in addition to significant stenosis. Cardiac catheterization was performed by methods previously described.7 Frontal and left lateral angiocardiograms were made at a distance of 48 inches, usually at 1-second intervals with an exposure time of 1/30 to 1/10 second. The Fairchild roll-film cassette' and the F-X-R 12 by 12 inch roll-film magazine9 permitted multiple serial exposures. Immediately prior to angiocardiography the circulation time was determined by rapid injection of 3 ml. of Decholin in 15 ml. of saline via the Robb-Steinberg needle and stoep-cock unit1; 50 ml. of sodium acetrizoate (Sodium Urokon) were then injected rapidly and the central cardiovascular system was visualized. The outline of the opacified left atrium ( fig. 1 ) was traced and the enclosed area was measured with a self-compensating polar planimeter. Left atrial volume could be calculated from measurements of the horizontal, superior-inferior and anteroposterior axes of the left atrium as defined in the posterior-anterior and lateral angiocardiograms by applying the formula for an ellipsoid.
doi:10.1161/01.cir.17.4.567 pmid:13523768 fatcat:ef4p5qaac5anldzp2cs4hlksiy