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Mitral stenosis from anatomy to therapeutical decision

Domenii publicaţii > Ştiinţe medicale + Tipuri publicaţii > Articol în revistã ştiinţificã

Autori: H. Muresian, G. Cerin, E. Bonacinas

Editorial: Ed Celsius ISSN 1583 - 3534, Romanian Journal of Cardiovascular Surgery, Vol. 1, nr. 1, 2002.

Rezumat:

Abstract
Mitral valve stenosis covers a large spectrum of pathological modifications and involves both the elements of the valve as well as adjacent structures. In the Western world, older patients come nowadays to the examining physician or to the surgeon raising more complex and complicated issues regarding both the diagnosis and the surgical therapy. A thorough knowledge of the normal anatomy of the mitral valve and respectively, of the pathological modifications that characterize the stenosis are of utmost importance, especially due to the fact that new anatomical and physiological elements are continuously added and that the classical concept of mitral valve stenosis has new significances. In the present study the authors have gathered data from wet-lab sessions and from the specimens collection at the Institute of Pathology at Niguarda Hospital Milan, Italy – focusing on the normal anatomy (with practical echographic and surgical applications) and on the pathological lesions that characterize the mitral valve stenosis. Dissections have been performed on 30 adult hearts of both sexes, belonging to patients deceased of non-cardiac pathology. In these, the normal anatomy has been reviewed with a critical approach. Macroscopic examination of the lesions has been performed on 25 explanted mitral valve specimens. The macroscopic and microscopic examination of heart specimens with mitral stenosis compelted the study. An integration of the data obtained, was made by comparing wet-lab data with clinical and echographic details, especially regarding the most debated topics of mitral stenosis nowadays.The authors demonstrate thus the interdependence of the various structures that constitute the so-called „Mitral Valvar Complex” and which includes: the valve leaflets, the chordae, the papillary muscles, the atrial and ventricular myocardium, the atrial and ventricular endocardium, the mitral-aortic continuity, „the annulus”, the fibrous skeleton of the heart – aiming towards a better systematization and offering a more comprehensive approach to the echographist as well as to the surgeon. The pathological aspects of the disease, are presented from simple, incipient lesions, towards the late, complicated ones while focusing not only on the mitral valvar apparatus but on the involvement of adjacent structures too. This latter aspect represents a real challenge for the cardiologist, as well as for the surgeon. A critical review of the therapeutical modalities and their indications is performed. The work has an important iconographical aspect, comprising new and unparalleled images.

Cuvinte cheie: mitral valve surgery echocardiography