Estenose Mitral ao 2D e 3D no JACC


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Stress Testing
Assessing mitral gradients and pulmonary pressures during stress (preferably exercise or alternatively dobutamine infusion) 45 provides additional information in asymptomatic patients or in patients in whom the symptoms and MS severity do not seem to correlate. In addition, stress testing is very helpful in evaluating women with MS who are contemplating pregnancy. Pregnancy causes an obligatory increase in cardiac output (transmitral flow), heart rate (shorter diastolic filling time), and total blood volume, each of which increases the MV transvalvular gradient and thus left atrial pressure.

Consequently, many women with MS often present with symptoms for the first time during pregnancy due to the increase in pulmonary venous pressure (secondary to increased left atrial pressure). Exercise stress testing is a useful way to assess how well MS patients will tolerate pregnancy. It further helps identify which patients may benefit from no therapy, beta-blockade, or prophylactic PMBV or even surgery before becoming pregnant.
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