Effects of balloon mitral valvuloplasty on left atrial function in mitral stenosis as assessed by pressure–area relation
Christodoulos Stefanadis, MD, FESC, FACCa,
John Dernellis, MDa,
Costas Stratos, MDa,
Eleftherios Tsiamis, MDa,
Charalambos Vlachopoulos, MDa,
Konstantinos Toutouzas, MDa,
Spiros Lambrou, MDa,
Christos Pitsavos, MD, FESCa and
Pavlos Toutouzas, MD, FESC, FACCa
a Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
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Figure 1 Echocardiographic automatic boundary detection image (top) from a patient with mitral stenosis. The region of interest is drawn around the left atrium, and the instantaneous cavity area is displayed simultaneously with the ECG (bottom).
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Figure 3 LA area and simultaneous LA pressure and ECG (A). The LA pressure–area relation is composed of two loops: the A loop, expressing the LA pump function, and the V loop, expressing the LA reservoir function (B). During the filling period, the curve is directed upward and to the right, and after maximal pressure and area of the filling period have been reached, the curve turns clockwise and downward, corresponding to the passive emptying and, subsequently, active emptying phases. LA pressures and areas during the ascending limb of the V loop and the calculated monoexponential curve are also shown.
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Figure 4 Mean ± SD as well as individual data points and changes in the A loop, V loop and the LA chamber stiffness constant in the sinus rhythm and atrial fibrillation groups with mitral stenosis.
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Figure 5 Representative LA pressure–area loops from a normal subject (left top), a patient with lone atrial fibrillation (left bottom) and two patients, one with sinus rhythm (right top) and the other with atrial fibrillation (right bottom), with mitral stenosis before and after balloon mitral valvuloplasty.
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Figure 6 Relation between LV stroke volume index and LA A and V loops. The regression lines for all control subjects and patients both before and after the procedure are shown.
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