Page 122 - Clinical Pearls in Cardiology

110 Clinical Pearls in Cardiology

the opposite effects on the Graham-Steell’s murmur and
the apical mid-diastolic rumbling murmur of organic
mitral stenosis.
15. What are the criteria for balloon mitral valvotomy in
mitral stenosis?
All patients with mitral stenosis who have minor
symptoms should be treated medically with drugs like
diuretics. The definitive treatment of mitral stenosis is
by either balloon mitral valvotomy (BMV) or surgical
valvotomy (open or closed) or mitral valve replacement.
Intervention should be considered if the patient remains
symptomatic despite medical treatment or if pulmonary
hypertension develops. Criteria for balloon mitral
valvotomy include the following:
• Moderate to severe stenosis
• Isolated mitral stenosis without mitral regurgitation
• Mobile and non-calcified valve
• Left atrium without thrombus.
Closed or open surgical valvotomy is performed in
patients with mitral stenosis whose mitral valves are too
distorted or calcified for performing BMV. Mitral valve
replacement is required for patients with associated
regurgitation, extensive calcification, severe fibrosis and
subvalvular fusion, and in those who have undergone
previous valvotomy.
16. What is the most important auscultatory feature of the
murmur of tricuspid regurgitation?
The most important auscultatory feature of the
holosystolic murmur of tricuspid regurgitation heard in
the left 4th and 5th intercostal spaces is the inspiratory
increase in the intensity of the murmur. This inspiratory
augmentation is due to increased venous return. This sign
is called as the Carvallo’s sign. This sign is an important