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Sample records for pelo doppler mitral

  1. Pulsed Doppler echocardiographic analysis of mitral regurgitation after myocardial infarction.

    PubMed

    Loperfido, F; Biasucci, L M; Pennestri, F; Laurenzi, F; Gimigliano, F; Vigna, C; Rossi, E; Favuzzi, A; Santarelli, P; Manzoli, U

    1986-10-01

    In 72 patients with previous myocardial infarction (MI), mitral regurgitation (MR) was assessed by pulsed-wave Doppler echocardiography and compared with physical and 2-dimensional echocardiographic findings. MR was found by Doppler in 29 of 42 patients (62%) with anterior MI, 11 of 30 (37%) with inferior MI (p less than 0.01) and in none of 20 normal control subjects. MR was more frequent in patients who underwent Doppler study 3 months after MI than in those who underwent Doppler at discharge (anterior MI = 83% vs 50%, p less than 0.01; inferior MI = 47% vs 27%, p = not significant). Of 15 patients who underwent Doppler studies both times, 3 (all with anterior MI) had MR only on the second study. Of the patients with Doppler MR, 12 of 27 (44%) with a left ventricular (LV) ejection fraction (EF) greater than 30% and 1 of 13 (8%) with an EF of 30% or less (p less than 0.01) had an MR systolic murmur. Mitral prolapse or eversion and papillary muscle fibrosis were infrequent in MI patients, whether or not Doppler MR was present. The degree of Doppler MR correlated with EF (r = -0.61), LV systolic volume (r = 0.47), and systolic and diastolic mitral anulus circumference (r = 0.52 and 0.51, respectively). Doppler MR was present in 24 of 28 patients (86%) with an EF of 40% or less and in 16 of 44 (36%) with EF more than 40% (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Non-invasive diagnosis of mitral regurgitation by Doppler echocardiography.

    PubMed Central

    Blanchard, D; Diebold, B; Peronneau, P; Foult, J M; Nee, M; Guermonprez, J L; Maurice, P

    1981-01-01

    The value of Doppler echocardiography for the non-invasive diagnosis of mitral regurgitation was studied blindly in 161 consecutive invasively investigated adult patients. Regurgitation was graded from 0 to 3 at selective left ventricular angiography. The Doppler echocardiographic examination was considered to be positive when a disturbed systolic flow was found within the left atrium behind the aorta or the anterior leaflet of the mitral valve. The test was considered to be negative in the absence of a regurgitant jet. The level of the signal to noise ratio was checked by the recording of the ventricular filling flow. The study was performed in 131 cases from the left side of the sternum and in 101 cases from the apex. There were no false positives and thus the specificity was 100 per cent. The 20 false negatives were all in patients with grade 1 regurgitation. Thus only some (33%) instances of mild regurgitation were misdiagnosed, and the sensitivity for moderate to severe mitral regurgitation was 100 per cent. PMID:7236465

  3. [Pulsed echo-Doppler evaluation of regurgitant fraction in mitral valve insufficiency].

    PubMed

    Tribouilloy, C; Slama, M A; Kugener, H; Dufossé, H; Rey, J L; Lesbre, J P

    1991-09-01

    The aim of this study was to evaluate the validity of Doppler echocardiographic evaluation of the regurgitant fraction in pure mitral insufficiency. The Doppler echocardiographic measurement of systemic flow was made at the level of the aortic ring, and the mitral flow by the method of integration of instantaneous flow proposed by Touche. In a preliminary study, we demonstrated a close correlation between forward aortic and mitral flow in 20 normal subjects (r = 0.94; SD = 0.31 l/mn; y = 0.98 x -0.004). We then studied a group of 38 patients with pure isolated mitral regurgitation. Five patients were excluded because of the poor quality of the echocardiographic documents. The hemodynamic regurgitant fraction was determined by measuring pulmonary flow by thermodilution and the left ventricular outflow by digitised angiography. The average Doppler and hemodynamic regurgitant fractions were 46.6 +/- 18% and 42 +/- 17% respectively. There was a close correlation between the Doppler and hemodynamic values (r = 0.91; SD = 7.8%; y = 0.97 x + 5.7). The correlations were also good between Doppler regurgitant fraction and the four angiographic grades of regurgitation (r = 0.88). A statistically significant difference was observed between the Doppler regurgitant fractions of Grades I and II and of Grades III and IV (p less than 0.001). In addition, the ratio of mitral VTI/aortic VTI gave a useful index of regurgitation in pure mitral insufficiency. When the ratio was greater than 1.3 the regurgitant fraction was over 40% with a sensitivity of 79% and a specificity of 86%. Finally, this study shows that pure, isolated mitral regurgitation can be evaluated by Doppler echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Chronic mitral regurgitation and Doppler estimation of left ventricular filling pressures in patients with heart failure

    NASA Technical Reports Server (NTRS)

    Temporelli, P. L.; Scapellato, F.; Corra, U.; Eleuteri, E.; Firstenberg, M. S.; Thomas, J. D.; Giannuzzi, P.

    2001-01-01

    Previous studies relating Doppler parameters and pulmonary capillary wedge pressures (PCWP) typically exclude patients with severe mitral regurgitation (MR). We evaluated the effects of varying degrees of chronic MR on the Doppler estimation of PCWP. PCWP and mitral Doppler profiles were obtained in 88 patients (mean age 55 +/- 8 years) with severe left ventricular (LV) dysfunction (mean ejection fraction 23% +/- 5%). Patients were classified by severity of MR. Patients with severe MR had greater left atrial areas, LV end-diastolic volumes, and mean PCWPs and lower ejection fractions (each P <.01). In patients with mild MR, multiple echocardiographic parameters correlated with PCWP; however, with worsening MR, only deceleration time strongly related to PCWP. From stepwise multivariate analysis, deceleration time was the best independent predictor of PCWP overall, and it was the only predictor in patients with moderate or severe MR. Doppler-derived early mitral deceleration time reliably predicts PCWP in patients with severe LV dysfunction irrespective of degree of MR.

  5. Chronic mitral regurgitation and Doppler estimation of left ventricular filling pressures in patients with heart failure

    NASA Technical Reports Server (NTRS)

    Temporelli, P. L.; Scapellato, F.; Corra, U.; Eleuteri, E.; Firstenberg, M. S.; Thomas, J. D.; Giannuzzi, P.

    2001-01-01

    Previous studies relating Doppler parameters and pulmonary capillary wedge pressures (PCWP) typically exclude patients with severe mitral regurgitation (MR). We evaluated the effects of varying degrees of chronic MR on the Doppler estimation of PCWP. PCWP and mitral Doppler profiles were obtained in 88 patients (mean age 55 +/- 8 years) with severe left ventricular (LV) dysfunction (mean ejection fraction 23% +/- 5%). Patients were classified by severity of MR. Patients with severe MR had greater left atrial areas, LV end-diastolic volumes, and mean PCWPs and lower ejection fractions (each P <.01). In patients with mild MR, multiple echocardiographic parameters correlated with PCWP; however, with worsening MR, only deceleration time strongly related to PCWP. From stepwise multivariate analysis, deceleration time was the best independent predictor of PCWP overall, and it was the only predictor in patients with moderate or severe MR. Doppler-derived early mitral deceleration time reliably predicts PCWP in patients with severe LV dysfunction irrespective of degree of MR.

  6. Doppler echocardiographic measurement of cardiac output using the mitral orifice method.

    PubMed Central

    Zhang, Y; Nitter-Hauge, S; Ihlen, H; Myhre, E

    1985-01-01

    Cardiac output was determined in 20 patients with various cardiac conditions by measuring the cross sectional area of the mitral orifice by echocardiography and the transmitral flow by the Doppler technique. Cardiac output was calculated by multiplying the corrected mitral orifice area by the maximum diastolic velocity integral recorded by the pulsed mode. The results were compared with that obtained by the Fick method. The correlation for cardiac output by the two techniques was high in the whole group, particularly in patients without mitral regurgitation. There was also a good correlation for stroke volume determined by the two methods. Cardiac output was significantly overestimated by the continuous mode and in patients with mitral regurgitation. These results show that the mitral orifice method provides a new and reliable approach to the non-invasive measurement of cardiac output. Images PMID:3966956

  7. Evaluation of an elliptical area technique for calculating mitral blood flow by Doppler echocardiography.

    PubMed Central

    Goldberg, S J; Dickinson, D F; Wilson, N

    1985-01-01

    To evaluate a method for measuring blood flow through the mitral valve 18 normal subjects and 19 patients with cardiac disease in whom mitral and aortic blood flows were identical were studied. Initially the mitral ring area was planimetered from the echocardiographic image, but the results of area calculation using the mathematical formula for the area of an ellipse were found to approximate to within 8% of the planimetered result in most cases. The formula was therefore used if the ring appeared elliptical on the cross sectional echo image, and other shapes were planimetered. Mitral velocity, aligned with flow in three planes, was recorded just distal to the ring. Mitral flow calculated using the elliptical technique correlated closely with flow measured in the ascending aorta by the Doppler technique and also with systemic flow measured by the Fick method at cardiac catheterisation in 10 patients. The mitral flow technique that assumed a circular orifice correlated almost as well with Doppler aortic flow and with Fick flow but overestimated flow by a mean of 1446 ml, whereas the elliptical method had a mean error of only 138 ml. Both methods correlated well with standards, but the elliptical method was easy to apply and gave a better correlation with comparison reference values. Images PMID:4015919

  8. Anterior mitral valve aneurysm perforation secondary to aortic valve endocarditis detected by Doppler colour flow mapping.

    PubMed

    Decroly, P; Vandenbossche, J L; Englert, M

    1989-02-01

    We report a case of mitral valve aneurysm formation and perforation, secondary to Streptococcus sanguis endocarditis of the aortic valve. Aneurysm formation was documented by cross-sectional echocardiography and its perforation was established by Doppler colour flow mapping, and subsequently confirmed at surgery.

  9. Non-invasive measurement of the regurgitant fraction by pulsed Doppler echocardiography in isolated pure mitral regurgitation.

    PubMed

    Tribouilloy, C; Shen, W F; Slama, M A; Dufossé, H; Choquet, D; Marek, A; Lesbre, J P

    1991-10-01

    To assess the usefulness of pulsed Doppler echocardiography as a method of measuring the regurgitant fraction in patients with mitral regurgitation. Twenty controls and 27 patients with isolated mitral regurgitation underwent Doppler studies. In the patients the study was performed within 48 hours of cardiac catheterisation. Aortic outflow was measured in the centre of the aortic annulus, and mitral inflow was derived from the flow velocity at the tip of the leaflets and the area of the elliptical mitral opening. The regurgitant fraction was calculated as the difference between the two flows divided by the mtiral inflow. In the 20 controls the two flows were almost identical (mitral inflow, 4.44 (SD 0.88) l/min; aortic outflow, 4.58 (SD 0.84) l/min), with a mean regurgitant fraction of 4.2 (SD 8.4)%. In patients with mitral regurgitation, the mitral inflow was significantly higher than the aortic outflow (8.8 (3.6) v 4.3 (1.1) l/min). In most patients the Doppler-derived regurgitant fraction (45.8 (19.2)%) accorded closely with the regurgitant fraction (41.3 (SD 17.8)%) determined by the haemodynamic technique. Pulsed Doppler echocardiography, with an instantaneous velocity-valve area method for calculating mitral inflow, reliably measured the severity of regurgitation in patients with mitral regurgitation.

  10. Non-invasive measurement of the regurgitant fraction by pulsed Doppler echocardiography in isolated pure mitral regurgitation.

    PubMed Central

    Tribouilloy, C; Shen, W F; Slama, M A; Dufossé, H; Choquet, D; Marek, A; Lesbre, J P

    1991-01-01

    OBJECTIVE--To assess the usefulness of pulsed Doppler echocardiography as a method of measuring the regurgitant fraction in patients with mitral regurgitation. PATIENTS AND METHODS--Twenty controls and 27 patients with isolated mitral regurgitation underwent Doppler studies. In the patients the study was performed within 48 hours of cardiac catheterisation. Aortic outflow was measured in the centre of the aortic annulus, and mitral inflow was derived from the flow velocity at the tip of the leaflets and the area of the elliptical mitral opening. The regurgitant fraction was calculated as the difference between the two flows divided by the mtiral inflow. RESULTS--In the 20 controls the two flows were almost identical (mitral inflow, 4.44 (SD 0.88) l/min; aortic outflow, 4.58 (SD 0.84) l/min), with a mean regurgitant fraction of 4.2 (SD 8.4)%. In patients with mitral regurgitation, the mitral inflow was significantly higher than the aortic outflow (8.8 (3.6) v 4.3 (1.1) l/min). In most patients the Doppler-derived regurgitant fraction (45.8 (19.2)%) accorded closely with the regurgitant fraction (41.3 (SD 17.8)%) determined by the haemodynamic technique. CONCLUSION--Pulsed Doppler echocardiography, with an instantaneous velocity-valve area method for calculating mitral inflow, reliably measured the severity of regurgitation in patients with mitral regurgitation. Images PMID:1747280

  11. [Calculation of the mitral valve area with the proximal convergent flow method with Doppler-color in patients with mitral stenosis].

    PubMed

    Aguilar, J A; Summerson, C; Flores, D; Espinosa, R A; Enciso, R; Badui, E; Hurtado, R

    1994-01-01

    In this study we evaluate prospectively a new color Doppler method for calculating the mitral valve area based on identifying a blue-red aliasing interfase proximal to the orifice, corresponding to the flow convergence region (FCR). This method can be used to calculate areas using the continuity equation. We studied 61 patients with stenosis. The mitral valve area was calculated using pressure half-time (PHT) Doppler method which were compared with values that obtained by the FCR method, according to the following formula. AVM (cm2) = 2 pi r2 x VN/Vmax; where "r" is the FCR radius measured from the orifice to the first color aliasing (blue-red interface); VN is Nyquist velocity and Vmax is the peak flow velocity by continuous wave Doppler. Twenty three patients had pure mitral stenosis and 38 double mitral lesion. Twenty patients were on sinus rhythm while 41 in atrial fibrillation. Calculated mitral valve area using the FCR method correlated well with mitral valve area determined by PHT method at a correlation coefficient of r = 0.96 (y = 0.097 x + 54.9, SEE = 0.10 cm2, p < 0.001). MVA by FCR ranged from 0.4 to 2.5 cm2 (mean = 1.19 cm2). MVA by PHT ranged from 0.42 to 2.48 cm2 (mean = 1.15 cm2). Color Doppler FCR method provides an accurate estimate of effective mitral valve area and may be useful as an alternative to the pressure half-time method. The calculated mitral valve area by the FCR method is not influenced by the presence of mitral regurgitation nor atrial fibrillation.

  12. Local intense mosaic pattern at site of flail mitral leaflet: report of a new color Doppler sign.

    PubMed

    Khouzam, Rami N; D'Cruz, Ivan A; Minderman, Daniel; Kaiser, Jacqueline

    2005-10-01

    Color flow Doppler has been useful in diagnosing the presence and severity of mitral regurgitation (MR). We noted a hitherto unreported sign of MR due to flail mitral leaflet: intense local mosaic pattern at the site of the flail leaflet. This sign was seen well in 11 of 14 patients (79%) with the two-dimensional echocardiographic features of flail mitral leaflet, all with moderate or severe MR. In 3 other patients, the sign was absent; two of those had flail mitral leaflet with severe MR. No local mosaic pattern was seen on color Doppler in 20 other patients with MR but no flail mitral leaflet. We speculate that the focal intense mosaic color Doppler morphology may have been caused by intrusion of the flail leaflet into the MR stream, or to a Coanda-like effect of the MR jet "adhering" to the flail leaflet.

  13. Automated assessment of mitral regurgitant volume and regurgitant fraction by a newly developed digital color Doppler velocity profile integration method.

    PubMed

    Hozumi, T; Yoshida, K; Akasaka, T; Takagi, T; Yamamuro, A; Yagi, T; Yoshikawa, J

    1997-11-15

    Recent development of the automated cardiac flow measurement (ACFM) method has provided automated measurement of stroke volume and cardiac output by spatial and temporal integration of digital Doppler velocity profile data. The purpose of this study was to evaluate the clinical usefulness of the ACFM method using digital color Doppler velocity profile integration in the assessment of mitral regurgitant volume and regurgitant fraction from measurements of both aortic outflow and mitral inflow volumes. We calculated both aortic outflow and mitral inflow volumes from the apical approach with the ACFM and pulsed Doppler (PD) methods in 20 patients with isolated mitral regurgitation. Mitral regurgitant volume and regurgitant fraction were calculated by the following equation: mitral regurgitant volume = (mitral inflow volume) - (aortic outflow volume), % regurgitant fraction = (mitral regurgitant volume)/(mitral inflow volume) x 100. Mitral regurgitant volume and regurgitant fraction were compared with that determined by the PD method. Mitral regurgitant volume measurement by the ACFM method showed a good correlation with that measured by the PD method (r = 0.90, y = 0.77x + 11.6, SEE = 9.0 ml); the mean differences between PD and ACFM measurements was -1.7 +/- 12.5 ml. Regurgitant fraction estimated by the ACFM method correlated well with that of the PD method (r = 0.92, y = 0.98x + 2.1, SEE = 8.8%). The mean difference for the measurement of regurgitant fraction between the PD and ACFM methods was 0.8 +/- 6.6%. Total time required for mitral regurgitant volume calculation in 1 cardiac cycle by the ACFM method was significantly shorter than that of the PD method (126 +/- 15 seconds vs 228 +/- 36 seconds, p <0.01). In conclusion, the newly developed ACFM method is simple, quick, and accurate in the automated assessment of mitral regurgitant volume and regurgitant fraction.

  14. Determination of left ventricular inflow by pulsed Doppler echocardiography: influence of mitral orifice area and blood velocity measurements.

    PubMed

    Tribouilloy, C; Slama, M; Shen, W F; Choquet, D; Delonca, J; Mertl, C; Dufosse, H; Lesbre, J P

    1991-01-01

    Pulsed Doppler echocardiography was performed in 30 patients to assess the influence of mitral orifice area and velocity on the determination of mitral stroke volume and inflow. Aortic forward stroke volume and outflow were measured at the centre of the aortic annulus, and compared with mitral flow measurements calculated by three methods. Both mitral stroke volume and inflow derived from an instantaneous velocity-area method showed an excellent correlation with aortic flow measurements. The other two methods, which determined mitral stroke volume and inflow based on a mean mitral valve area and diastolic velocity integral, significantly underestimated mitral flow measurements. This study indicates that the instantaneous velocity-area method offers a reliable means for quantitating left ventricular inflow.

  15. Arrhythmias in mitral valve prolapse: relation to anterior mitral leaflet thickening, clinical variables, and color Doppler echocardiographic parameters.

    PubMed

    Zuppiroli, A; Mori, F; Favilli, S; Barchielli, A; Corti, G; Montereggi, A; Dolara, A

    1994-11-01

    Atrial and ventricular arrhythmias have been reported with variable incidence in symptomatic patients with mitral valve prolapse (MVP). The role of clinical and echocardiographic parameters as predictors for arrhythmias still needs to be clarified. One hundred nineteen consecutive patients (56 women and 63 men, mean age 40 +/- 17 years) with echocardiographically diagnosed MVP were examined. A complete echocardiographic study (M-mode, two-dimensional, and Doppler) and 24-hour electrocardiographic monitoring were performed in all patients. Complex atrial arrhythmias (CAAs) included atrial couplets, atrial tachycardia, and paroxysmal or sustained atrial flutter or fibrillation. Complex ventricular arrhythmias (CVAs) included multiform ventricular premature contractions (VPCs), VPC couplets, and runs of three or more sequential VPCs (salvos of ventricular tachycardia). The relation between complex arrhythmias and clinical parameters (age and gender) and echocardiographic parameters (left atrial and left ventricular dimensions, anterior mitral leaflet thickness [AMLT], and presence and severity of mitral regurgitation) was evaluated by multiple logistic regression analysis. CAA were present in 14% of patients and CVA in 30%. According to multiple logistic modeling, CAA correlated separately in the univariate analysis with age, presence of MR, and left ventricular and left atrial diameters; age was the only independent predictor (p < 0.001). CVA, in the univariate analysis, correlated with age, female gender, left ventricular end-diastolic diameter, and AMLT; only female gender and AMLT were independent predictors in the multivariate analysis (p < 0.01). The incidence of mitral regurgitation (59%) was higher than expected in a general population of MVP patients.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. [A simplified method of continuous-wave Doppler noninvasive assessment of ventricular relaxation in mitral insufficiency].

    PubMed

    García Lledó, J A; Moya Mur, J L; Balaguer Recena, J; Novo García, E; Correa Gorospe, C; Jorge, P; Barea Navarro, R; Boquete, L

    1998-08-01

    The minimum value of dP/dT is a parameter of diastolic function that can be estimated noninvasively by analyzing the profile of velocity of the mitral regurgitant jet, recorded by continuous-wave Doppler. This estimation requires a complex analysis of the curves that impedes its practical use. Our objective was to validate a simplified method to estimate noninvasively the value of dP/dTmin when mitral regurgitation exists. We calculated the pendient of the profile of velocity of the curve of mitral regurgitation during its deceleration, between 3 and 1.5 m/s, an interval that defines a difference in pressure using the formula delta p = (4v2(1) - 4v2(2)). We divided this interval by the time needed by the jet to decelerate from 3 to 1.5 m/s, obtaining the rate of pressure decay, in mmHg/s. We provoked mitral regurgitation in five pigs and registered dP/dT and the curve velocity of mitral regurgitation simultaneously, by micromanometer-tipped catheter and continuous-wave Doppler, respectively. The rate of pressure decay was calculated on the mitral regurgitation curve. We obtained 29 simultaneous registers. The coefficient for the correlationship between dP/dT and the rate of pressure decay was with an r value of 0.62 (p < 0.0001). The rate of pressure decay underestimated systematically the value of dP/dT. Intra and interobserver variability of TDP was 9 and 11%, respectively. This study validates a simplified method to estimate dP/dT noninvasively, with acceptable correlation with invasive measurements and adequate reproducibility.

  17. Stroke volume and mitral annular velocities. Insights from tissue Doppler imaging.

    PubMed

    Bruch, C; Stypmann, J; Gradaus, R; Breithardt, G; Wichter, T

    2004-10-01

    The aim of this study was to assess the impact of stroke volume (SV) on mitral annular velocities derived from tissue Doppler imaging (TDI). To this end, conventional echocardiographic variables and TDI derived mitral annular velocities (S', E', A') were obtained in 14 patients (pts) with increased SV (due to primary mitral (n=12) (ISV group)), in 41 pts with reduced SV (due to ischemic (n=27) or dilated cardiomyopathy (n=9) or hypertensive heart disease (n=5) (RSV group)) and 29 asymptomatic controls with normal SV (CON group). Systolic (S') and early diastolic (E') mitral annular velocities were elevated in the ISV group in the comparison to the CON group, but were significantly reduced in the RSV group. Late diastolic annular velocities (A') did not differ between the ISV and the CON group, but were lowest in the RSV group. On simple linear regression analysis, SV was significantly related to S' (r=0.74, p<0.001), to E' (r=0.74, p<0.001) and to A' (r=0.43, p<0.01). On multiple regression analysis, SV was a stronger independent predictor of S' and E' than conventional systolic or diastolic echocardiographic variables. Thus, stroke volume has a significant impact on TDI derived systolic (S') and early diastolic (E') mitral annular velocities. This should be considered, when TDI is used in the evaluation of LV performance or in the estimation of filling pressures.

  18. Revascularization alone or combined with suture annuloplasty for ischemic mitral regurgitation. Evaluation by color Doppler echocardiography.

    PubMed Central

    Czer, L S; Maurer, G; Bolger, A F; DeRobertis, M; Chaux, A; Matloff, J M

    1996-01-01

    To determine the effectiveness of revascularization alone or combined with mitral valve repair for ischemic mitral regurgitation, we performed color Doppler echocardiography intraoperatively before and after cardiopulmonary bypass in 49 patients (mean age, 70 +/- 9 years) with concomitant mitral regurgitation and coronary artery disease (triple vessel or left main in 88%; prior infarction in 90%). After revascularization alone (n = 25), the mitral annulus diameter (2.88 +/- 0.44 cm vs 2.88 +/- 0.44 cm), leaflet-to-annulus ratio (1.44 +/- 0.30 vs 1.44 +/- 0.29), and mitral regurgitation grade (1.7 +/- 0.9 vs 1.8 +/- 0.7) remained unchanged (p = NS, postpump vs prepump); mitral regurgitation decreased by 2 grades in only 1 patient (4%). After combined revascularization and mitral valve suture annuloplasty (Kay-Zubiate; n = 24), the annulus diameter decreased (to 2.57 +/- 0.45 cm from 3.11 +/- 0.43 cm), the leaflet-to-annulus ratio increased (to 1.46 +/- 0.25 from 1.20 +/- 0.21), and the mitral regurgitation grade decreased significantly (to 0.9 +/- 0.9 from 2.8 +/- 1.0) (p < 0.01); mitral regurgitation decreased by 2 grades or more (successful repair) in 75%. The origin of the jet correlated with the site of prior infarction (p < 0.05), being inferior in cases of posterior or inferior infarction (67%), and central or broad in cases of combined anterior and inferior infarction (70%). Despite a slightly higher 30-day mortality in the repair group (p = 0.10), there was no significant difference in survival between the 2 surgical groups at 5 years or 8 years. Therefore, in this study of patients with mitral regurgitation and coronary artery disease, reduction in regurgitation grade with revascularization alone was infrequent. Concomitant suture annuloplasty significantly reduced regurgitation by reestablishing a more normal relationship between the leaflet and annulus sizes. The failure rate after suture annuloplasty was 25%; alternative repair techniques such as ring

  19. Assessment of severity of mitral regurgitation by measuring regurgitant jet width at its origin with transesophageal Doppler color flow imaging.

    PubMed

    Tribouilloy, C; Shen, W F; Quéré, J P; Rey, J L; Choquet, D; Dufossé, H; Lesbre, J P

    1992-04-01

    The ability of transesophageal color Doppler echocardiography to provide high-resolution images of both cardiac structure and blood flow in real time is advantageous for many clinical purposes. This study was performed to determine the utility of the regurgitant jet width at its origin measured by transesophageal Doppler color flow imaging in the assessment of severity of mitral regurgitation. Sixty-three consecutive patients with mitral regurgitation underwent transesophageal color Doppler examination, and the diameter of regurgitant jet at its origin was measured. Both right and left cardiac catheterizations were performed within 24 hours of Doppler studies, and angiographic grading of mitral regurgitation and regurgitant stroke volume were evaluated. There was a close relation between the jet diameter at its origin measured by transesophageal Doppler color flow imaging and the angiographic grade of mitral regurgitation (r = 0.86, p less than 0.001). A jet diameter of 5.5 mm or more identified severe mitral regurgitation (grade III or IV) with a sensitivity of 92%, specificity of 92%, and positive and negative predictive values of 88% and 95%, respectively. In 31 patients with isolated mitral regurgitation, the jet diameter correlated well with the regurgitant stroke volume determined by a combined hemodynamic-angiographic method (r = 0.85, p less than 0.001). A jet diameter of 5.5 mm or more identified a regurgitant stroke volume of 60 ml or more with a sensitivity of 88%, specificity of 93%, and positive and negative predictive values of 94% and 87%, respectively. The regurgitant jet width at its origin measured by transesophageal Doppler color flow imaging provides a simple and useful method of measuring the severity of mitral regurgitation, and it may allow differentiation between mild and severe mitral regurgitation.

  20. Application of color Doppler flow mapping to calculate orifice area of St Jude mitral valve

    NASA Technical Reports Server (NTRS)

    Leung, D. Y.; Wong, J.; Rodriguez, L.; Pu, M.; Vandervoort, P. M.; Thomas, J. D.

    1998-01-01

    BACKGROUND: The effective orifice area (EOA) of a prosthetic valve is superior to transvalvular gradients as a measure of valve function, but measurement of mitral prosthesis EOA has not been reliable. METHODS AND RESULTS: In vitro flow across St Jude valves was calculated by hemispheric proximal isovelocity surface area (PISA) and segment-of-spheroid (SOS) methods. For steady and pulsatile conditions, PISA and SOS flows correlated with true flow, but SOS and not PISA underestimated flow. These principles were then used intraoperatively to calculate cardiac output and EOA of newly implanted St Jude mitral valves in 36 patients. Cardiac output by PISA agreed closely with thermodilution (r=0.91, Delta=-0.05+/-0.55 L/min), but SOS underestimated it (r=0.82, Delta=-1.33+/-0.73 L/min). Doppler EOAs correlated with Gorlin equation estimates (r=0.75 for PISA and r=0.68 for SOS, P<0.001) but were smaller than corresponding in vitro EOA estimates. CONCLUSIONS: Proximal flow convergence methods can calculate forward flow and estimate EOA of St Jude mitral valves, which may improve noninvasive assessment of prosthetic mitral valve obstruction.

  1. Application of color Doppler flow mapping to calculate orifice area of St Jude mitral valve

    NASA Technical Reports Server (NTRS)

    Leung, D. Y.; Wong, J.; Rodriguez, L.; Pu, M.; Vandervoort, P. M.; Thomas, J. D.

    1998-01-01

    BACKGROUND: The effective orifice area (EOA) of a prosthetic valve is superior to transvalvular gradients as a measure of valve function, but measurement of mitral prosthesis EOA has not been reliable. METHODS AND RESULTS: In vitro flow across St Jude valves was calculated by hemispheric proximal isovelocity surface area (PISA) and segment-of-spheroid (SOS) methods. For steady and pulsatile conditions, PISA and SOS flows correlated with true flow, but SOS and not PISA underestimated flow. These principles were then used intraoperatively to calculate cardiac output and EOA of newly implanted St Jude mitral valves in 36 patients. Cardiac output by PISA agreed closely with thermodilution (r=0.91, Delta=-0.05+/-0.55 L/min), but SOS underestimated it (r=0.82, Delta=-1.33+/-0.73 L/min). Doppler EOAs correlated with Gorlin equation estimates (r=0.75 for PISA and r=0.68 for SOS, P<0.001) but were smaller than corresponding in vitro EOA estimates. CONCLUSIONS: Proximal flow convergence methods can calculate forward flow and estimate EOA of St Jude mitral valves, which may improve noninvasive assessment of prosthetic mitral valve obstruction.

  2. Double mitral valve orifice. Two-dimensional and Doppler echocardiographic diagnosis.

    PubMed

    Solorio, S; Badui, E; Yáñez, M; Enciso, R; Rodríguez, L; Quintero, L R

    1996-01-01

    The purpose of this study was to demonstrate the usefulness of two-dimensional and Doppler echocardiography for diagnosing double mitral valve orifices (DMVO) in addition to identifying associated pathologies. We report five cases, three male and two female with an age ranging from 4 to 44 years old (mean age: 17 years), with the diagnosis of DMVO according to the following characteristics: using two-dimensional echocardiography on the short parasternal axis, both orifices were observed; apical in which the "seagull sign" was identified in both chambers, in addition to identifying the flows of each orifice by pulsed and codified color Doppler obtaining the corresponding gradients. With respect to the associated pathologies, all patients presented some type of malformation, such as subaortic ring, patent ductus arteriosus, coarctation of the aorta, bicuspid aorta and pulmonary stenosis. Using the color Doppler echocardiography allows an adequate anatomical and functional definition of DMVO.

  3. Proximal flow convergence method by three-dimensional color Doppler echocardiography for mitral valve area assessment in rheumatic mitral stenosis.

    PubMed

    de Agustin, Jose Alberto; Mejia, Hernan; Viliani, Dafne; Marcos-Alberca, Pedro; Gomez de Diego, Jose Juan; Nuñez-Gil, Ivan Javier; Almeria, Carlos; Rodrigo, Jose Luis; Luaces, Maria; Garcia-Fernandez, Miguel Angel; Macaya, Carlos; Perez de Isla, Leopoldo

    2014-08-01

    The two-dimensional (2D) proximal isovelocity surface area (PISA) method has important technical limitations for mitral valve orifice area (MVA) assessment in mitral stenosis (MS), mainly the geometric assumptions of PISA shape and the requirement of an angle correction factor. Single-beat real-time three-dimensional (3D) color Doppler imaging allows the direct measurement of PISA without geometric assumptions or the requirement of an angle correction factor. The aim of this study was to validate this method in patients with rheumatic MS. Sixty-three consecutive patients with rheumatic MS were included. MVA was assessed using the transthoracic 2D and 3D PISA methods. Planimetry of MVA (2D and 3D) and the pressure half-time method were used as reference methods. The 3D PISA method had better correlations with the reference methods (with 2D planimetry, r = 0.85, P < .001; with 3D planimetry, r = 0.89, P < .001; and with pressure half-time, r = 0.85, P < .001) than the conventional 2D PISA method (with 2D planimetry, r = 0.63, P < .001; with 3D planimetry, r = 0.66, P < .001; and with pressure half-time, r = 0.68, P < .001). In addition, a consistent significant underestimation of MVA using the conventional 2D PISA method was observed. A high percentage (30%) of patients with nonsevere MS by 3D planimetry were misclassified by the 2D PISA method as having severe MS (effective regurgitant orifice area < 1 cm(2)). In contrast, the 3D PISA method had 94% agreement with 3D planimetry. Good intra- and interobserver agreement for 3D PISA measurements were observed, with intraclass correlation coefficients of 0.95 and 0.90, respectively. MVA assessment using PISA by single-beat real-time 3D color Doppler echocardiography is feasible in the clinical setting and more accurate than the conventional 2D PISA method. Copyright © 2014 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  4. Differentiation of constrictive pericarditis from restrictive cardiomyopathy using mitral annular velocity by tissue Doppler echocardiography.

    PubMed

    Ha, Jong-Won; Ommen, Steve R; Tajik, A Jamil; Barnes, Marion E; Ammash, Naser M; Gertz, Morie A; Seward, James B; Oh, Jae K

    2004-08-01

    This study evaluated the diagnostic role of early diastolic mitral annular velocity (E') by tissue Doppler echocardiography for differentiating constrictive pericarditis from restrictive cardiomyopathy (primary restrictive cardiomyopathy and cardiac amyloidosis). The study group consisted of 75 patients (53 men, 22 women; mean age 62 years, range 27 to 87). Of these, 23 patients had surgically confirmed constrictive pericarditis, 38 had biopsy-proved systemic amyloidosis and typical echocardiographic features of cardiac involvement, and 14 had primary restrictive cardiomyopathy. Standard mitral inflow characteristics were measured. Tissue Doppler echocardiography was used to measure E' at the septal annulus. E' was significantly higher in patients with constrictive pericarditis than in those with primary restrictive cardiomyopathy or cardiac amyloidosis (12.3 vs 5.1 cm/second, p <0.001). An E' cut-off value > or =8 cm/second resulted in 95% sensitivity and 96% specificity for the diagnosis of constrictive pericarditis. There was no overlap of E' between patients who had constrictive pericarditis and those who had cardiac amyloidosis. In a subgroup analysis of restrictive cardiomyopathy, E' of patients who had cardiac amyloidosis was significantly lower than that of patients who had primary restrictive cardiomyopathy (4.6 vs 6.3 cm/second, p <0.001). Thus, E' velocity can distinguish between constrictive pericarditis and restrictive cardiomyopathy with a specific cut-off value in patients with clinical and echocardiographic evidence of diastolic heart failure.

  5. Diastolic Function Evaluations by Tissue Doppler Imaging in Patients With Mitral Valve Prolapse

    PubMed Central

    Salehi, Rezvaneh; Javanshir, Elnaz; Enamzadeh, Elgar

    2013-01-01

    Background Tissue Doppler imaging (TDI) is a new echocardiographic imaging technique that is believed to be superior to older conventional techniques in assessing abnormalities of cardiac function in many conditions affecting the heart. There are very limited data regarding the role of TDI in evaluating patients with mitral valve prolapse (MVP). Current study evaluates diastolic function in patients with MVP by this method. Methods From November 2009 to April 2011, one hundred and ten adults matched for age and sex and without structural heart disease were studied in two groups, with and without MVP, at Madani Heart Center, Tabriz, Iran. TDI was performed at the basal-lateral wall and S, E, E’, A, and A’ velocities, as well as the E/A and E’/A’ ratios were measured. Mitral annular systolic velocity and early diastolic (E’) velocities were measured lateral corner of mitral valve in apical 4-chamber view. Results Patients with MVP had higher left atrium volume (42.31 ± 10.47 vs. 35.19 ± 9.15 cm3; P < 0.001) and deceleration time (186.70 ± 26.00 vs. 176.89 ± 20.36 ms; P = 0.03). Diastolic dysfunction, although seemed more prevalent in MVP group (14.54%) than normal subjects (5.45%), the difference was not statistically significant between groups (P = 0.11). Conclusion Left atrial volume and deceleration time of mitral valve inflow was significantly higher in MVP which could be indicative of early stages of diastolic dysfunction in patients with MVP. However, larger follow-up studies are required to evaluate clinical significance of our findings in these patients.

  6. Doppler echocardiographic characteristics of normal and dysfunctioning prosthetic valves in the tricuspid and mitral position.

    PubMed Central

    Pye, M; Weerasana, N; Bain, W H; Hutton, I; Cobbe, S M

    1990-01-01

    The Doppler echocardiographic characteristics of 70 prosthetic valves in 35 patients are reported. Twenty nine patients had a Björk-Shiley prosthesis in both mitral and tricuspid positions and six had Carpentier-Edwards valves in both sites. Five of the patients had abnormal tricuspid prostheses on the basis of clinical and echocardiographic criteria. Pulsed wave Doppler echocardiography was used in all examinations. The pressure half times for the normal tricuspid prosthetic valves, 105 (40) ms (Björk-Shiley) and 97 (53) ms (Carpentier-Edwards), were significantly longer than those of normal mitral prosthetic valves, 75 (18) ms (Björk-Shiley) and 83 (15) ms (Carpentier-Edwards). The range of pressure half times for the abnormal tricuspid valves (237-530 ms) was distinct from that of the apparently normal tricuspid prosthetic valves (38-197 ms). There was an increase in the peak velocity of the obstructed tricuspid prosthetic valves (1.69 (0.12) m/s) in comparison with normal prostheses (1.06 (0.26) m/s). The normal range of pressure half times for the Björk-Shiley and Carpentier-Edwards valves in the mitral position is not applicable to the same valves in the tricuspid position. The valve appears to function well with very long pressure half times but a pressure half time of greater than 200 ms coupled with a peak velocity of greater than 1.60 ms without significant valve regurgitation indicates tricuspid obstruction of the tricuspid prosthetic valve. PMID:2310643

  7. [A methodological study of measuring quantitatively turbulent shear stree downstream of mitral stenosis in vivo using Doppler echocardiography].

    PubMed

    Zhang, Guimin; Shi, Yingkang; Tang, Hong; Zhang, Eryong; Guo, Zhongsan; Fan, Yubo; Pu, Fang; Zengzhi

    2002-01-01

    In order to establish a method for measuring quantitatively turbulent shear stress (TSS) downstream of mitral stenosis in vivo based on Doppler echocardiography and computer-aided image analysis, we used doppler echocardiography to record the spectrum of flow velocity downstream of mitral valve at several locations in normal persons and in patients with mitral stenosis. With the computer-aided analysis of spectrum images, the magnitude of TSS was measured at the locations. The results demonstrate that no matter how severe the mitral stenosis is, the TSS and relative turbulent intensity(Irel) at the central locations of jet are lower than those at the marginal ones. A significant difference in the quantitative items of TSS, Irel and flow field uniformity between normal persons and patients with varying-degree of mitral stenosis was noticed (P < 0.05). There was a significant correlation between these items and effective orifice area (EOA), and we found that the smaller EOA is, the more severe the extent of stenosis is and the greater the magnitude of both TSS and Irel are, and that the highest magnitude of TSS is focused on the marginal area of jet. These results indicate that there is an obvious correlation between TSS(measured by Doppler echocardiography combined with computer-aided image analysis) and flow field uniformity. They can coincidently reveal the hemodynamic changes resulting from mitral stenosis of varied severeness, implying that our method could exactly depict the magnitude of TSS downstream of mitral stenosis in vivo and is non-invasive and good for anti-disturbance. The method can be used to analyze quantitatively TSS in the flow field of heart valve in patients with valvular diseases.

  8. Accuracy and pitfalls of early diastolic motion of the mitral annulus for diagnosing constrictive pericarditis by tissue Doppler imaging.

    PubMed

    Sengupta, Partho P; Mohan, Jagdish C; Mehta, Vimal; Arora, Ramesh; Pandian, Natesa G; Khandheria, Bijoy K

    2004-04-01

    Mitral annular velocities are reportedly useful in diagnosing constrictive pericarditis (CP); however, their exact efficacy in larger clinical settings remains unevaluated. This study reexamined the role of longitudinal tissue Doppler imaging in diagnosing CP in clinical practice. Tissue velocity imaging (GE Vingmed System Five) was performed in 122 subjects (87 referred with clinically suspected CP and 35 age- and sex-matched controls). Of the 87 subjects with suspected CP, 45 (51.7%) had CP confirmed at surgery, 11 (12.6%) had restrictive heart disease, 20 (23.0%) had right heart failure due to cor pulmonale, and the other 11 (12.6%) had old pericardial effusions and no hemodynamic evidence of constriction on follow-up echocardiography. Of the 45 patients with CP, mitral early diastolic (Ea) annular velocities from septal and lateral regions were normal (>/=8 cm/s) in 40 (88.9%) and decreased (<8 cm/s) in 1 or both regions in 5 (3 with left ventricular systolic dysfunction, 2 with extensive mitral annular calcification). Of 11 patients with restrictive cardiomyopathy, 8 (72.7%) had reduced Ea (<8 cm/s) and 3 showed normal Ea velocity in 1 or both corners of the mitral annulus. All except 2 patients with right-sided heart failure from cor pulmonale and those with previous pericardial effusion had normal Ea velocities. A normal Ea velocity improved recognition of CP, particularly in the presence of nondiagnostic 2-dimensional or transmitral flow-Doppler imaging. The overall sensitivity and specificity for diagnosing CP using tissue Doppler incrementally with M-mode, 2-dimensional, and transmitral flow Doppler were 88.8% and 94.8%, respectively. Mitral annular velocities help with diagnosis and differentiation of CP in most cases, except in the presence of extensive annular calcification, left ventricular systolic dysfunction, or segmental nonuniformity in myocardial velocities.

  9. Feasibility of Doppler hemodynamic evaluation of primary and secondary mitral regurgitation during exercise echocardiography.

    PubMed

    Coisne, Augustin; Levy, Franck; Malaquin, Dorothée; Richardson, Marjorie; Quéré, Jean Paul; Montaigne, David; Tribouilloy, Christophe

    2015-02-01

    Exercise transthoracic echocardiography (ExE) was recently proposed to evaluate tolerance and help risk stratification of mitral regurgitation (MR). Few data are available on the feasibility of Doppler echocardiographic recordings at exercise in daily practice in both secondary and primary MR. Comprehensive resting and ExE were performed in 72 unselected patients (age 59 ± 15 years, 62 % men), with no or minimal symptoms, with at least moderate (mean effective regurgitant orifice area (ERO) = 36 ± 14 mm(2)) primary or secondary MR in two French university hospitals. At rest, quantification of ERO was more challenging in semi-supine position than in classic left lateral decubitus position (55/72; 76 % vs 66/72; 92 %; p = 0.012), particularly in mitral valve (MV) prolapse (35/47; 74 %). During exercise, ERO was only obtained in 30/55 (55 %) patients and was more difficult to assess in MV prolapse than in rheumatic or ischemic MR (respectively in 43, 67 and 88 %, p = 0.046). At peak exercise, ERO was more frequently obtained in symptomatic than asymptomatic patients (77 vs 37 %, p = 0.046) because peak heart rate was lower (113 ± 20 vs 133 ± 23 bpm, p = 0.026). Systolic pulmonary artery pressure (SPAP) was obtained in 69 patients (96 %) at rest and in 60 patients (83 %) at peak exercise (Pex). LV contractile reserve (CR), monitored in all patients (100 %), was found in 51/72 patients (71 %). In daily ExE, monitoring of the CR and SPAP appeared less challenging than MR quantification by the PISA method. Monitoring of ERO was more feasible in ischemic MR than in MV prolapse.

  10. Tissue Doppler of early mitral filling correlates with simulated volume loss in healthy subjects.

    PubMed

    Moore, Christopher L; Tham, Edward T; Samuels, Kathleen J; McNamara, Robert L; Galante, Nicholas J; Stachenfeld, Nina; Shelley, Kirk; Dziura, James; Silverman, David G

    2010-11-01

    The accurate noninvasive assessment of preload in emergency department (ED) patients remains elusive. Point-of-care ultrasound (US) imaging, particularly evaluation of the inferior vena cava (IVC), has been shown to be qualitatively helpful. Doppler and tissue Doppler are now routinely available on ED US equipment, but few studies have looked at the correlation of dynamic changes in these parameters in a controlled model of hypovolemia. Our objective was to examine the correlation of Doppler parameters to simulated volume loss in healthy subjects using a lower-body negative pressure (LBNP) model and to compare these measurements to commonly used IVC measurements of preload. Twelve paid volunteers with no known cardiovascular disease between the ages of 23 and 31 years old (mean ± SD = 25.5 ± 2.5 years old) were recruited. Hypovolemia was simulated using graduated LBNP levels with measurements taken at 0, -30, and -60 mm Hg and lower pressures as tolerated. Vital signs were monitored in all patients. US measurements recorded at each negative pressure level included IVC maximum (IVC(max)) and minimum (IVC(min)) dimensions; early (E) and late (A) transmitral filling velocities using pulsed-wave spectral Doppler; and early (E') and late (A') tissue Doppler velocities at the septal ((sep)) and lateral ((lat)) mitral annulus, using pulsed-wave tissue Doppler. Lower-body negative pressure correlated significantly and positively within subjects for all US parameters except for the A filling wave. E'(lat) and E'(sep) showed the strongest correlation with R² values of 0.749 (95% confidence interval [CI] = 0.577 to 0.854) and 0.738 (95% CI = 0.579 to 0.875) respectively, followed by A'(sep) 0.674 (95% CI = 0.416 to 0.845), IVC(max) 0.638 (95% CI = 0.425 to 0.806), A'(lat) 0.547 (95% CI = 0.280 to 0.802), IVC(min) 0.512 (95% CI = 0.192 to 0.777), and E 0.478 (95% CI = 0.187 to 0.762). Ratios correlated only moderately with LBNP level, including E/ E'(lat) R² of 0.430 (95

  11. [Color Doppler identification of early diastolic turbulence in the left atrium in patients with mitral valve insufficiency: persistence of regurgitation or inertia phenomenon?].

    PubMed

    D'Angelo, G; Moro, E; Nicolosi, G L; Dall'Aglio, V; Mimo, R; Mangano, S; Zanuttini, D

    1990-08-01

    Color Doppler flow mapping represents the most recent non invasive diagnostic tool for the visualization of intracardiac blood flow. By using the color Doppler flow mapping technique, two independent observers identified the persistence of turbulence in early diastole inside the left atrium in a selected group of 8 patients (3 F and 5 M) with mitral insufficiency. All the patients had moderate or severe mitral insufficiency, due to dilated cardiomyopathy and/or ischemic cardiomyopathy and/or valvular disease. The persistence of early diastolic turbulence inside the left atrium was documented and confirmed by using 30 degrees color sector images, which show the highest possible frame rate. The frame by frame analysis facilitated the identification of two simultaneous flow velocities during early diastole, after the mitral valve was open. The first flow was anterograde and was coded as a red signal; it flowed from the mitral valve into the left ventricle and represented early diastolic left ventricular filling. The second flow was retrograde, and was coded as a blue mosaic signal, due to turbulent aliased jet, extending from the mitral valve into the left atrium, away from the transducer. The interpretation of these two dimensional color Doppler findings is uncertain. We believe, however, that these turbulent velocity signals which persist in early diastole and flow from the mitral valve into the left atrium are probably caused by inertial blood flow due to the impact of regurgitant mitral jets during the previous systole.

  12. Value of combined cross sectional and Doppler echocardiography in the detection of left ventricular pseudoaneurysm after mitral valve replacement.

    PubMed Central

    Kupari, M; Verkkala, K; Maamies, T; Härtel, G

    1987-01-01

    The development of a left ventricular pseudoaneurysm is a rare complication of heart surgery. Until recently it has been impossible to detect without an angiographic study of the left ventricle. A combination of cross sectional and Doppler ultrasound studies led to the correct diagnosis in two patients with left ventricular pseudoaneurysms after mitral valve replacement. Cross sectional echocardiography showed a posterolateral echo-free space confined only by the pericardium and communicating with the left ventricle through a defect in the ventricular wall, and Doppler echocardiography confirmed the presence of blood flow in this cavity. This Doppler finding is critical if the perforation is too small to be identified reliably by cross sectional imaging. Surgical repair of the pseudoaneurysm can be undertaken without invasive studies if the echocardiographic findings are unequivocal and there is no reason to suspect the integrity of the circumflex coronary artery. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 PMID:3620242

  13. Transesophageal Doppler echocardiographic study of pulmonary venous flow pattern in severe mitral stenosis and the changes following balloon mitral valvuloplasty.

    PubMed

    Srinivasa, K H; Manjunath, C N; Dhanalakshmi, C; Patil, C B; Venkatesh, H V

    2000-02-01

    The studies of pulmonary venous flow-pattern in mitral stenosis (MS) have given conflicting data about the type of abnormality. This study was undertaken to assess the pulmonary venous flow-pattern in severe MS and to study the changes occurring after balloon mitral valvuloplasty (BMV). There were 51 patients of MS with sinus rhythm with the mean age of 32.5+/-9.35 years, 18 males and 33 females. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were performed before and after BMV. Pulmonary venous flow was recorded by TEE from left upper pulmonary vein (PV). Peak velocities (V) and velocity time integrals (VTI) of systolic wave (S), diastolic wave (D), and atrial reversal wave (A) were measured. The S(v)/D(v) and S(VTI)/D(VTI) were calculated. Mitral valve area (MVA) increased from 0.81+/-0.18 cm(2) to 2.02+/-0.46 cm(2), left atrium (LA) mean decreased from 28.55+/-6.68 mmHg to 13.88+/-4.89 mmHg, and cardiac output increased from 3.1+/-0.86 L/min to 3.7+/-1.02 L/min. The S, D, and A velocities increased from 33.84+/-13.55 cm/s, 37.24+/-11.55 cm/s, and 20.53+/-6.7 cm/s to 59.86+/-18.25 cm/s, 48.43+/- 12.55 cm/s, and 24. 94+/-9.14 cm/s, respectively. The VTIs of S, D, and A waves increased from 4.88+/-2.24 cm, 6+/-2.45 cm, and 2+/-0.88 cm to 10.46+/-4.23 cm, 8.82+/-3.61 cm, and 2.34+/-1.29 cm, respectively. MS leads to reduction in pulmonary flow velocities during all the phases. Successful BMV resulted in improvement of all these velocities, with improvement in systolic fraction being the maximum. These improved flows after BMV appear to be secondary to reduction in LA pressure and improved cardiac output.

  14. Quantification of mitral regurgitation: comparison between transthoracic and transesophageal color Doppler flow mapping.

    PubMed

    Mimo, R; Sparacino, L; Nicolosi, G; D'Angelo, G; Dall'Aglio, V; Lestuzzi, C; Pavan, D; Cervesato, E; Zanuttini, D

    1991-11-01

    We reviewed transthoracic (TTE) and transesophageal (TEE) echocardiograms of 100 consecutive patients: 63 male, 37 female, mean age 50 years (range 16-83 years), 32 with neoplastic disease, 18 aortic disease, 28 mitral valve disease, and 22 with other diseases. Absence or presence of mitral regurgitation (defined as mild, moderate, or severe) was assessed. TEE showed mild mitral regurgitation in 26 patients where TTE was negative. The overall estimate of regurgitant lesion severity was concordant at TEE and TTE in 64% of cases. The overall estimate of regurgitant lesion severity was also greater by one grade in 1% of cases at TTE, and in 35% of cases at TEE. Maximal digitized jet areas were 3.60 +/- 6.35 cm 2 at TTE and 3.04 +/- 3.79 cm 2 at TEE (P = NS). Correlation was r = 0.69 (TEE = 0.41 TTE + 1.55; P less than 0.001). TEE yielded a higher prevalence of mitral regurgitation than TTE with a trend toward greater overall estimate of mitral regurgitation at the semi-quantitative analysis. TTE and TEE showed similar mean results at the quantitative assessment of maximal jet areas. However, a highly significant random variability was observed in quantifying mitral regurgitation at TEE.

  15. Are the Current Doppler Echocardiography Criteria Able to Discriminate Mitral Bileaflet Mechanical Heart Valve Malfunction? An In Vitro Study.

    PubMed

    Evin, Morgane; Guivier-Curien, Carine; Pibarot, Philippe; Kadem, Lyes; Rieu, Régis

    2016-05-01

    Malfunction of bileaflet mechanical heart valves in the mitral position could either be due to patient-prosthesis mismatch (PPM) or leaflet obstruction. The aim of this article is to investigate the validity of current echocardiographic criteria used for diagnosis of mitral prosthesis malfunction, namely maximum velocity, mean transvalvular pressure gradient, effective orifice area, and Doppler velocity index. In vitro testing was performed on a double activation left heart duplicator. Both PPM and leaflet obstruction were investigated on a St. Jude Medical Master. PPM was studied by varying the St. Jude prosthesis size (21, 25, and 29 mm) and stroke volume (70 and 90 mL). Prosthesis leaflet obstruction was studied by partially or totally blocking the movement of one valve leaflet. Mitral flow conditions were altered in terms of E/A ratios (0.5, 1.0, and 1.5) to simulate physiologic panel of diastolic function. Maximum velocity, effective orifice area, and Doppler velocity index are shown to be insufficient to distinguish normal from malfunctioning St. Jude prostheses. Doppler velocity index and effective orifice area were 1.3 ± 0.49 and 1.83 ± 0.43 cm(2) for testing conditions with no malfunction below the 2.2 and 2 cm(2) thresholds (1.19 cm(2) for severe PPM and 1.23 cm(2) for fully blocked leaflet). The mean pressure gradient reached 5 mm Hg thresholds for several conditions of severe PPM only (6.9 mm Hg and mean maximum velocity value: 183.4 cm/s) whereas such value was never attained in the case of leaflet obstruction. In the case of leaflet obstruction, the maximum velocity averaged over the nine pulsed-wave Doppler locations increased by 38% for partial leaflet obstruction and 75% for a fully blocked leaflet when compared with normal conditions. Current echocardiographic criteria might be suboptimal for the detection of bileaflet mechanical heart valve malfunction. Further developments and investigations are required in order

  16. Effects of first myocardial infarction on left ventricular systolic and diastolic function with the use of mitral annular velocity determined by pulsed wave doppler tissue imaging.

    PubMed

    Alam, M; Wardell, J; Andersson, E; Samad, B A; Nordlander, R

    2000-05-01

    This study was undertaken to assess the effect of a first myocardial infarction (MI) on the systolic and diastolic velocity profiles of the mitral annulus determined by pulsed wave Doppler tissue imaging and thereby evaluate left ventricular (LV) function after MI. Seventy-eight patients with a first MI were examined before discharge. Peak systolic, peak early diastolic, and peak late diastolic velocities were recorded at 4 different sites on the mitral annulus corresponding to the septum, anterior, lateral, and inferior sites of the left ventricle. In addition, the amplitude of mitral annular motion at the 4 above LV sites, the ejection fraction, and conventional Doppler diastolic parameters were recorded. Nineteen age-matched healthy subjects served as controls. Compared with healthy subjects, the MI patients had a significantly reduced peak systolic velocity at the mitral annulus, especially at the infarction sites. A relatively good linear correlation was found between the ejection fraction and the mean systolic velocity from the 4 LV sites (r = 0.74, P <.001). The correlation was also good when the mean peak systolic mitral annular velocity was tested against the magnitude of the mean mitral annular motion (r = 0.77, P <.001). When the patients were divided into 2 different groups with respect to an ejection fraction > or =0.50 or <0.50, a cutoff point of mean systolic mitral annular velocity of > or =7.5 cm/s had a sensitivity of 79% and a specificity of 88% in predicting a preserved global LV systolic function. Similar to systolic velocities, the early diastolic velocity was also reduced, especially at the infarction sites. The peak mitral annular early diastolic velocity correlated well with both LV ejection fraction (r =.66, P <.001) and mean systolic mitral annular motion (r = 0.68, P <.001). However, no correlation existed between the early diastolic velocity and conventional diastolic Doppler parameters. The reduced peak systolic mitral annular velocity

  17. Prognostication of valvular aortic stenosis using tissue Doppler echocardiography: underappreciated importance of late diastolic mitral annular velocity.

    PubMed

    Poh, Kian-Keong; Chan, Mark Yan-Yee; Yang, Hong; Yong, Quek-Wei; Chan, Yiong-Huak; Ling, Lieng H

    2008-05-01

    Intact left atrial booster pump function helps maintain cardiac compensation in patients with aortic valve stenosis (AS). Because late diastolic mitral annular (A') velocity reflects left atrial systolic function, we hypothesized that A' velocity correlates with plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) level and clinical outcome in AS. We prospectively enrolled 53 consecutive patients (median age 74 years) with variable degrees of AS, in sinus rhythm, and left ventricular ejection fraction greater than 50%. Indices of valvular stenosis, left ventricular diastolic dysfunction, and mitral annular motion were correlated with plasma NT-proBNP and a composite clinical end point comprising cardiac death and symptom-driven aortic valve replacement. Tissue Doppler echocardiographic parameters, including early diastolic (E') velocity and A' velocity and ratio of early diastolic transmitral (E) to E' velocity (E/E') at the annular septum correlated better with NT-proBNP levels than body surface area-indexed aortic valve area. Eighteen patients had the composite end point, which was univariately predicted by body surface area-indexed aortic valve area, NT-proBNP, and all tissue Doppler echocardiographic indices. This outcome was most strongly predicted by the combination of septal A' velocity and E/E' ratio in bivariate Cox modeling. Septal annular A' velocity less than 9.6 cm/s was associated with significantly reduced event-free survival (Kaplan Meier log rank = 27.3, P < .0001) and predicted the end point with a sensitivity, specificity, and accuracy of 94%, 80%, and 85%, respectively. In patients with AS and normal ejection fraction, annular tissue Doppler echocardiographic indices may better reflect the physiologic consequences of afterload burden on the left ventricle than body surface area-indexed aortic valve area. Lower A' velocity is a predictor of cardiac death and need for valve surgery, suggesting an important role for compensatory left atrial

  18. Mitral inertance in humans: critical factor in Doppler estimation of transvalvular pressure gradients

    NASA Technical Reports Server (NTRS)

    Nakatani, S.; Firstenberg, M. S.; Greenberg, N. L.; Vandervoort, P. M.; Smedira, N. G.; McCarthy, P. M.; Thomas, J. D.

    2001-01-01

    The pressure-velocity relationship across the normal mitral valve is approximated by the Bernoulli equation DeltaP = 1/2 rhoDeltav(2) + M. dv/dt, where DeltaP is the atrioventricular pressure difference, rho is blood density, v is transmitral flow velocity, and M is mitral inertance. Although M is indispensable in assessing transvalvular pressure differences from transmitral flow, this term is poorly understood. We measured intraoperative high-fidelity left atrial and ventricular pressures and simultaneous transmitral flow velocities by using transesophageal echocardiography in 100 beats (8 patients). We computed mean mitral inertance (M) by M = integral((DeltaP)-(1/2 x rho v(2))dt/integral(dv/dt)dt and we assessed the effect of the inertial term on the transmitral pressure-flow relation. ranged from 1.03 to 5.96 g/cm(2) (mean = 3.82 +/- 1.22 g/cm(2)). DeltaP calculated from the simplified Bernoulli equation (DeltaP = 1/2. rhov(2)) lagged behind (44 +/- 11 ms) and underestimated the actual peak pressures (2.3 +/- 1.1 mmHg). correlated with left ventricular systolic pressure (r = -0.68, P < 0.0001) and transmitral pressure gradients (r = 0.65, P < 0.0001). Because mitral inertance causes the velocity to lag significantly behind the actual pressure gradient, it needs to be considered when assessing diastolic filling and the pressure difference across normal mitral valves.

  19. Mitral inertance in humans: critical factor in Doppler estimation of transvalvular pressure gradients

    NASA Technical Reports Server (NTRS)

    Nakatani, S.; Firstenberg, M. S.; Greenberg, N. L.; Vandervoort, P. M.; Smedira, N. G.; McCarthy, P. M.; Thomas, J. D.

    2001-01-01

    The pressure-velocity relationship across the normal mitral valve is approximated by the Bernoulli equation DeltaP = 1/2 rhoDeltav(2) + M. dv/dt, where DeltaP is the atrioventricular pressure difference, rho is blood density, v is transmitral flow velocity, and M is mitral inertance. Although M is indispensable in assessing transvalvular pressure differences from transmitral flow, this term is poorly understood. We measured intraoperative high-fidelity left atrial and ventricular pressures and simultaneous transmitral flow velocities by using transesophageal echocardiography in 100 beats (8 patients). We computed mean mitral inertance (M) by M = integral((DeltaP)-(1/2 x rho v(2))dt/integral(dv/dt)dt and we assessed the effect of the inertial term on the transmitral pressure-flow relation. ranged from 1.03 to 5.96 g/cm(2) (mean = 3.82 +/- 1.22 g/cm(2)). DeltaP calculated from the simplified Bernoulli equation (DeltaP = 1/2. rhov(2)) lagged behind (44 +/- 11 ms) and underestimated the actual peak pressures (2.3 +/- 1.1 mmHg). correlated with left ventricular systolic pressure (r = -0.68, P < 0.0001) and transmitral pressure gradients (r = 0.65, P < 0.0001). Because mitral inertance causes the velocity to lag significantly behind the actual pressure gradient, it needs to be considered when assessing diastolic filling and the pressure difference across normal mitral valves.

  20. Pivotal role of bedside Doppler echocardiography in the assessment of patients with acute heart failure and mitral regurgitation.

    PubMed

    Ennezat, Pierre Vladimir; Bellouin, Annaïk; Maréchaux, Sylvestre; Juthier, Francis; Fayad, Georges; Vincentelli, André; Berrébi, Alain; Auffray, Jean Luc; Bauchart, Jean Jacques; Mouquet, Frédéric; Montaigne, David; Asseman, Philippe; Le Jemtel, Thierry H; Pibarot, Philippe

    2009-01-01

    Patients presenting with mitral regurgitation and acute heart failure remain a challenge for the clinicians. Bedside echocardiography ascertains the functional or primary nature of mitral regurgitation, thereby allowing to focus therapy on the left ventricle and mitral valve apparatus in patients with functional mitral regurgitation and to hasten mitral valve repair or replacement when acute heart failure results from primary mitral regurgitation. This short article reviews the evaluation by bedside echocardiography to guide management of these patients. Copyright 2009 S. Karger AG, Basel.

  1. Three-dimensional color Doppler transesophageal echocardiography for mitral paravalvular leak quantification and evaluation of percutaneous closure success.

    PubMed

    Franco, Eduardo; Almería, Carlos; de Agustín, Jose Alberto; Arreo Del Val, Viviana; Gómez de Diego, José Juan; García Fernández, Miguel Ángel; Macaya, Carlos; Pérez de Isla, Leopoldo; Garcia, Eulogio

    2014-11-01

    Three-dimensional (3D) color Doppler transesophageal echocardiography (TEE) enables accurate planimetry of the effective regurgitant orifice (ERO) of a mitral paravalvular leak (PVL). The aim of this study was to evaluate the usefulness of this method to quantify paravalvular regurgitation and to assess percutaneous PVL closure success, compared with 3D planimetry of PVLs without using color-flow images (3D anatomic regurgitant orifice [ARO]). Forty-six patients (59 mitral PVLs) who underwent 3D TEE to evaluate the indication of PVL closure procedure were retrospectively included. Receiver operating characteristic curves were compared to identify degree III and IV paravalvular regurgitation of 3D color ERO and 3D ARO measures. Forty patients underwent percutaneous PVL closure procedures; analysis was conducted to determine whether the undersizing of the closure devices according to 3D color ERO and 3D ARO measures was associated with PVL closure failure. Three-dimensional ERO measures showed better areas under the curve than 3D ARO measures and correlated better with the degree of paravalvular regurgitation. Three-dimensional color ERO major diameter ≥ 0.65 cm showed a positive predictive value of 87.1% and a negative predictive value of 94% to diagnose degree III and IV paravalvular regurgitation. For the 40 patients who underwent PVL closure procedures, the immediate technical success rate was 76.9%, and 1-year estimated survival was 69.5%. Closure device undersizing according to 3D color ERO length, but not other PVL measurements, was significantly associated with PVL closure failure (P = .007). Three-dimensional ERO was superior to 3D ARO at identifying the presence of degree III and IV paravalvular regurgitation. The undersizing of closure devices according to 3D color ERO length was associated with failed closure procedures. Confirmatory prospective studies are encouraged. Copyright © 2014 American Society of Echocardiography. Published by Elsevier Inc

  2. Differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation according to the severity and characteristics.

    PubMed

    Choi, Jaehuk; Heo, Ran; Hong, Geu-Ru; Chang, Hyuk-Jae; Sung, Ji Min; Shin, Sang Hoon; Cho, In Jeong; Shim, Chi-Young; Chung, Namsik

    2014-05-01

    The aim of this study is to explore the differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation (MR). Two-dimensional color Doppler echocardiography-based MR quantification has well-documented limitations. We consecutively enrolled 221 patients with MR. Adequate image quality was obtained by 2D- and 3D-color Doppler echocardiography in 211 (95.5%) patients. The quantitative differences between the MR volumes obtained by 2D- and 3D-proximal isovelocity surface area (PISA) were analyzed in various MR subgroups. In the validation cohort (n=52), MR volume obtained by 3D-PISA showed a better agreement with phase-contrast cardiac MRI than 2D-PISA (r=0.97 versus 0.84). In all 211 patients, 2D-PISA underestimated the MR volume when compared with 3D-PISA (52.4±19.6 versus 59.5±25.6 mL; P=0.005). A total of 33.3% with severe MR based on 3D-PISA were incorrectly assessed by 2D-PISA as having nonsevere MR. In the subgroup analysis, the MR severity (odds ratio, 6.96; 95% confidence interval, 3.04-15.94; P<0.001) and having an asymmetrical orifice (odds ratio, 11.48; 95% confidence interval, 3.72-35.4; P<0.001), and an eccentric jet (odds ratio, 3.82; 95% confidence interval, 1.27-11.48; P=0.017) were predictors of significant difference in MR volume (>15 mL) between 2D- and 3D-PISA methods. Quantification of MR by 3D-PISA method is clinically feasible and more accurate than the current 2D-PISA method. MR quantification by 2D-PISA significantly underestimated MR volume with severe, eccentric MR with an asymmetrical orifice. This article demonstrates that 3D-color Doppler echocardiography could be used as a valuable tool to confirm treatment strategy in patients with significant MR. © 2014 American Heart Association, Inc.

  3. Chronic pulmonary hypertension shortens the duration of mitral annular systolic and diastolic tissue Doppler signals.

    PubMed

    López-Candales, Angel; Edelman, Kathy; Gulyasy, Beth; Candales, Maria Dolores

    2012-03-01

    Some data suggests that both left ventricular (LV) systolic and diastolic function are impaired in patients with chronic pulmonary hypertension (cPH); however, a clear understanding of these specific abnormalities remains poorly characterized. LV systolic and diastolic function as well as LV myocardial performance index (MPI) were obtained and compared to total duration of mitral annular (MA) TDI systolic (MASTDId) and diastolic (MADTDId) measurements, corrected for heart rate, in 20 controls (Group I: mean 53 ± 18 years) and 30 patients (Group II: mean 55 ± 14 years) with cPH. Group II patients had relatively faster heart rates (75 ± 14 bpm vs. 63 ± 12 bpm; P < 0.003), higher LV ejection fraction (78 ± 10% vs. 68 ± 6%; P < 0.0004), similar MA systolic excursion (1.4 ± 0.2), unchanged MA TDI Ea/Aa ratios (0.86 ± 0.46 vs. 1.05 ± 0.41; P = 0.15), significantly higher LV MPI (0.98 ± 0.56 vs. 0.60 ± 0.11; P < 0.004), with a significantly shorter heart rate corrected MASTDId (251 ± 66 ms vs. 305 ± 30 ms; P < 0.001) and MADTDId (378 ± 87 ms vs. 497 ± 114 ms; P < 0.0001) than Group I. It appears that cPH shortens the total duration of both MA systolic and diastolic TDI intervals. Whether this is a result of altered LV geometry and/or confounded by the presence of relatively faster heart rates in cPH patients will require further study.

  4. Effect of percutaneous transvenous mitral commissurotomy on left atrial appendage function: an immediate and 6-month follow-up transesophageal Doppler study.

    PubMed

    Vijayvergiya, Rajesh; Sharma, Rajat; Shetty, Ranjan; Subramaniyan, Anand; Karna, Sunil; Chongtham, Dhanraj

    2011-11-01

    The left atrial appendage (LAA) is a common site of thrombus formation and is the source of systemic thromboembolism in patients with rheumatic mitral stenosis. LAA contractile dysfunction is a common finding in these patients. The aim of this study was to assess immediate and 6-month follow-up LAA function by transesophageal Doppler echocardiography in patients who underwent percutaneous transvenous mitral commissurotomy (PTMC). Forty-seven consecutive patients with symptomatic critical mitral stenosis who underwent PTMC were enrolled. All had underwent transthoracic and transesophageal echocardiography before, 24 hours after, and 6 months after PTMC. Pulse Doppler velocities of the LAA were measured, including peak early diastolic (E wave), peak late diastolic (A wave), and peak systolic (S wave). The corresponding tissue Doppler velocities of the LAA, including peak early diastolic (E(LAA)), peak late diastolic (A(LAA)), and peak systolic (S(LAA)), were also measured. LAA ejection fraction was measured using the modified Simpson's method. The mean age of the 47 enrolled patients was 31.7 ± 10.26 years. Thirty-eight patients were in sinus rhythm, and the remaining nine were in atrial fibrillation. PTMC was successful in all patients. The pulse Doppler velocities of the LAA at baseline, after PTMC, and at 6-month follow-up were as follows: for the E wave, 15.29 ± 2.26, 17.02 ± 2.25, and 17.97 ± 2.55 cm/sec, respectively (P < .001); for the A wave 22.45 ± 4.11, 24.19 ± 4.21, and 25.99 ± 4.51 cm/sec, respectively (P < .001); and for the S wave, 28.52 ± 4.37, 31.45 ± 5.37, and 33.06 ± 4.99 cm/sec, respectively (P < .001). The corresponding tissue Doppler velocities of LAA were as follows: for E(LAA), 4.65 ± 0.91, 5.28 ± 0.85, and 5.80 ± 0.84 cm/sec, respectively (P < .001); for A(LAA), 6.67 ± 1.12, 7.33 ± 1.17, and 7.88 ± 1.22 cm/sec, respectively (P < .001); and for S(LAA), 4.67 ± 1.12, 5.52 ± 1.18, 6.07 ± 1.11 cm/sec, respectively (P < .001

  5. Tissue Doppler-Derived Myocardial Acceleration during Isovolumetric Contraction Predicts Pulmonary Capillary Wedge Pressure in Patients with Significant Mitral Regurgitation.

    PubMed

    Omar, Alaa Mabrouk Salem; Abdel-Rahman, Mohamed Ahmed; Khorshid, Hazem; Helmy, Mostafa; Raslan, Hala; Rifaie, Osama

    2015-08-01

    The aim of this study was to determine whether isovolumic contraction velocity (IVV) and acceleration (IVA) predict pulmonary capillary wedge pressure (PCWP) in mitral regurgitation. Forty-four patients with mitral regurgitation were studied. PCWP was invasively measured. IVV, IVA and the ratio IVRT/Te'-E (where IVRT = isovolumic relaxation time, and Te'-E = time difference between the onset of mitral annular e' and mitral flow E waves) were measured. Mean age was 59.2 ± 13.3 y. Twenty-six patients had an ejection fraction ≥55%, and 18 patients had an ejection fraction <55%. IVRT/Te'-E was impossible in 11 patients because Te'-E = zero. PCWP correlated with IVV, IVA and IVRT/Te'-E; overall (r = -0.714, -0.892 and, -0.752, all p < 0.001), ejection fraction ≥55 (r = -0.467, -0.749, -0.639, p = 0.016, <0.001, 0.003) and ejection fraction <55% (r = -0.761, -0.911 and -0.833, all p < 0.001). Similar correlations were found for sinus and atrial fibrillation. Our study suggests that IVV and IVA correlate with PCWP in patients with mitral regurgitation irrespective of systolic function or rhythms and, thus, can be alternatives to the tedious IVRT/Te'-E, especially when impossible because Te'-E = 0. Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  6. Two-slope ascending arm of the early trans-mitral flow velocity Doppler wave in patients with heart failure and preserved ejection fraction.

    PubMed

    Dori, Guy; Egbaria, Muhammad A; Jabaren, Mohamed

    2014-12-01

    Trans-mitral flow velocity (TMFV) examination is a standard echocardiographic measure for assessing diastolic function of the heart. Typically, the Doppler signal representing the early rapid filling phase of the left ventricle (LV), termed: E wave, is triangular. The ascending arm of the E wave (EWAA) represents blood accelerating into the LV from the left atrium (LA), whereas the descending arm reflects blood decelerating as the LV fills and resists further filling. The slope of EWAA is linear, starting at TMFV of zero cm/s (prior to mitral valve opening) and building to peak E wave value. The physical meaning of a single slope is that blood acceleration is constant with time. Little data exist regarding the significance of the shape of EWAA. It is hypothesized that in heart failure with preserved ejection fraction (HFPEF) the EWAA displays 2 slopes. A first steeper slope followed by a second less steep slope reaching peak E wave. The different slopes represent a change in the composition of driving forces propelling blood from LA to LV. It is hypothesized that the first steeper slope of EWAA represents a set of driving force including a force termed: diastolic suction, whereas in the second slope diastolic suction has already dissipated. This 2-slope phenomenon is not expected in healthy subjects because the assumed underlying mechanism is not operative.

  7. Direct quantification of mitral regurgitant flow volume by real-time three-dimensional echocardiography using dealiasing of color Doppler flow at the vena contracta.

    PubMed

    Plicht, Björn; Kahlert, Philipp; Goldwasser, Ranny; Janosi, Rolf-Alexander; Hunold, Peter; Erbel, Raimund; Buck, Thomas

    2008-12-01

    Real-time 3-dimensional color Doppler echocardiographic (RT3DE) imaging has recently been demonstrated to provide accurate direct measurement of vena contracta area (VCA). The quantification of mitral regurgitant (MR) flow directly at the lesion using color Doppler echocardiography, however, has been prevented because of multiple aliasing from high flow velocities. Recent studies, however, have demonstrated that flow at the vena contracta is laminar, with a narrow velocity spectrum that should allow the dealiasing of color Doppler flow velocities for the accurate measurement of MR flow. This hypothesis was tested in an in vitro flow model and initial patient application, with magnetic resonance imaging (MRI) used as a reference. In an in vitro flow model, MR jets of flow rates from 5 to 60 mL/s were produced through asymmetric orifices of 0.2 to 0.6 cm(2). From RT3DE data sets, MR flow was calculated by the automated integration of the nonaliased color Doppler velocities over the VCA, with aliasing avoided by maximum baseline shift. Aliased flow was calculated as VCA times the Nyquist velocity times the number of aliasing transitions derived from the maximum continuous-wave Doppler velocity. Total MR flow was calculated as the sum of nonaliased and aliased flow. This approach was also clinically evaluated in 23 patients for the measurement of MR stroke volume against MRI and the hemispheric and hemielliptic proximal isovelocity surface area methods. In vitro RT3DE imaging of VCA was feasible in all flow stages without color Doppler aliasing. Flow rates calculated from RT3DE data sets showed excellent correlation with actual flow rates (r = 0.99), with a mean difference of -0.05 +/- 0.5 mL/s (not significant by t test). In vivo, good correlation and agreement were found between MR stroke volume by dealiasing and MRI (r = 0.91, -1.8 +/- 7.1 mL; not significant by t test), with better correlation and agreement compared with hemispheric proximal isovelocity surface

  8. Direct measurement of proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography in mitral regurgitation: a validation study.

    PubMed

    de Agustín, Jose Alberto; Marcos-Alberca, Pedro; Fernandez-Golfin, Covadonga; Gonçalves, Alexandra; Feltes, Gisela; Nuñez-Gil, Ivan Javier; Almeria, Carlos; Rodrigo, Jose Luis; Perez de Isla, Leopoldo; Macaya, Carlos; Zamorano, Jose

    2012-08-01

    The two-dimensional (2D) proximal isovelocity surface area (PISA) method has some technical limitations, mainly the geometric assumptions of PISA shape required to calculate effective regurgitant orifice area (EROA). Recently developed single-beat, real-time three-dimensional (3D) color Doppler imaging allows direct measurement of PISA without geometric assumptions. The aim of this study was to validate this novel method in patients with chronic mitral regurgitation (MR). Thirty-three patients were included, 25 (75.7%) with degenerative MR and eight (24.2%) with functional MR. EROA and regurgitant volume were assessed using transthoracic 2D and 3D PISA methods. The quantitative Doppler method and 3D transesophageal echocardiographic planimetry of EROA were used as reference methods. Both EROA and regurgitant volume assessed using the 3D PISA method had better correlations with the reference methods than conventional 2D PISA. A consistent significant underestimation of EROA and regurgitant volume using 2D PISA was observed, particularly in the assessment of eccentric jets. On the basis of 3D transesophageal echocardiographic planimetry of EROA, 14 patients had severe MR (EROA ≥ 0.4 cm(2)). Of these 14 patients, 42.8% (6 of 14) were underestimated as having nonsevere MR (EROA ≤ 0.4 cm(2)) by the 2D PISA method. In contrast, the 3D PISA method had 92.9% (13 of 14) agreement with 3D transesophageal planimetry in classifying severe MR. Good intraobserver and interobserver agreement for 3D PISA measurements was observed, with intraclass correlation coefficients of 0.96 and 0.92, respectively. Direct measurement of PISA without geometric assumptions using single-beat, real-time 3D color Doppler echocardiography is feasible in the clinical setting. MR quantification using this methodology is more accurate than the conventional 2D PISA method. Copyright © 2012 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  9. Real-time three-dimensional color doppler evaluation of the flow convergence zone for quantification of mitral regurgitation: Validation experimental animal study and initial clinical experience

    NASA Technical Reports Server (NTRS)

    Sitges, Marta; Jones, Michael; Shiota, Takahiro; Qin, Jian Xin; Tsujino, Hiroyuki; Bauer, Fabrice; Kim, Yong Jin; Agler, Deborah A.; Cardon, Lisa A.; Zetts, Arthur D.; hide

    2003-01-01

    BACKGROUND: Pitfalls of the flow convergence (FC) method, including 2-dimensional imaging of the 3-dimensional (3D) geometry of the FC surface, can lead to erroneous quantification of mitral regurgitation (MR). This limitation may be mitigated by the use of real-time 3D color Doppler echocardiography (CE). Our objective was to validate a real-time 3D navigation method for MR quantification. METHODS: In 12 sheep with surgically induced chronic MR, 37 different hemodynamic conditions were studied with real-time 3DCE. Using real-time 3D navigation, the radius of the largest hemispherical FC zone was located and measured. MR volume was quantified according to the FC method after observing the shape of FC in 3D space. Aortic and mitral electromagnetic flow probes and meters were balanced against each other to determine reference MR volume. As an initial clinical application study, 22 patients with chronic MR were also studied with this real-time 3DCE-FC method. Left ventricular (LV) outflow tract automated cardiac flow measurement (Toshiba Corp, Tokyo, Japan) and real-time 3D LV stroke volume were used to quantify the reference MR volume (MR volume = 3DLV stroke volume - automated cardiac flow measurement). RESULTS: In the sheep model, a good correlation and agreement was seen between MR volume by real-time 3DCE and electromagnetic (y = 0.77x + 1.48, r = 0.87, P <.001, delta = -0.91 +/- 2.65 mL). In patients, real-time 3DCE-derived MR volume also showed a good correlation and agreement with the reference method (y = 0.89x - 0.38, r = 0.93, P <.001, delta = -4.8 +/- 7.6 mL). CONCLUSIONS: real-time 3DCE can capture the entire FC image, permitting geometrical recognition of the FC zone geometry and reliable MR quantification.

  10. Endothelial-mediated coronary flow reserve and its relation to mitral annular tissue Doppler velocities in offspring of hypertensive parents.

    PubMed

    Mahfouz, Ragab A; Dwidar, Ashraf Elsaied; El Tahlawi, Mohammad A

    2011-11-01

    Although coronary flow reserve (CFR) is reduced in hypertensive patients, data regarding the endothelial response of coronary vasomotion and its relation to left ventricular (LV) function in their offspring is limited. To investigate the endothelial response of coronary flow, using cold pressor test (CPT), in offspring of hypertensive parents and its impact on LV diastolic function. The study population consisted of 32 healthy young offspring (mean age 23.5 ± 7.1 years) of hypertensive parents and 26 aged matched volunteers (healthy offspring of normotensive parents) as controls. Coronary blood flow velocities were recorded in all subjects at rest and after CPT; a stimulus that can be considered totally endothelium-dependent. CFR was calculated as the ratio of hyperemic-to-resting diastolic peak velocities. Doppler echocardiographic assessment was performed using both conventional and tissue Doppler assessment. Coronary diastolic peak velocities at rest was comparable between the two groups (27.1 ± 6.2 vs 26.4 ± 5.8; P > 0.05); but the velocities were significantly lower after CPT in offspring of hypertensive parents (P < 0.02), with highly significant lower CFR (P < 0.0001). Conventional echo-Doppler variables were comparable in both groups, whereas tissue Doppler assessment demonstrated significant LV diastolic dysfunction among offspring of hypertensive parents. The CPT-CFR was significantly correlated to tissue Doppler diastolic dysfunction in this group (For Em, Am and Em/Am, r was 0.65, 0.59 and 0.61, respectively, and P < 0.001). Offspring of hypertensive parents have coronary endothelial dysfunction that appears in response to physiological stimuli (CPT). The coronary endothelial dysfunction is associated with latent LV diastolic dysfunction. © 2011, Wiley Periodicals, Inc.

  11. A novel technique to predict pulmonary capillary wedge pressure utilizing central venous pressure and tissue Doppler tricuspid/mitral annular velocities.

    PubMed

    Uemura, Kazunori; Inagaki, Masashi; Zheng, Can; Li, Meihua; Kawada, Toru; Sugimachi, Masaru

    2015-07-01

    Assessing left ventricular (LV) filling pressure (pulmonary capillary wedge pressure, PCWP) is an important aspect in the care of patients with heart failure (HF). Physicians rely on right ventricular (RV) filling pressures such as central venous pressure (CVP) to predict PCWP, assuming concordance between CVP and PCWP. However, the use of this method is limited because discordance between CVP and PCWP is observed. We hypothesized that PCWP can be reliably predicted by CVP corrected by the relationship between RV and LV function, provided by the ratio of tissue Doppler peak systolic velocity of tricuspid annulus (S(T)) to that of mitral annulus (S(M)) (corrected CVP:CVP·S(T)/S(M)). In 16 anesthetized closed-chest dogs, S T and S M were measured by transthoracic tissue Doppler echocardiography. PCWP was varied over a wide range (1.8-40.0 mmHg) under normal condition and various types of acute and chronic HF. A significantly stronger linear correlation was observed between CVP·S(T)/S(M) and PCWP (R2 = 0.78) than between CVP and PCWP (R2 = 0.22) (P < 0.01). Receiver-operating characteristic (ROC) analysis indicated that CVP·S(T)/S(M) >10.5 mmHg predicted PCWP >18 mmHg with 85% sensitivity and 88% specificity. Area under ROC curve for CVP·S T/S M to predict PCWP >18 mmHg was 0.93, which was significantly larger than that for CVP (0.66) (P < 0.01). Peripheral venous pressure (PVP) corrected by S T/S M (PVP·S(T)/S(M) also predicted PCWP reasonably well, suggesting that PVP·S(T)/S (M) may be a minimally invasive alternative to CVP·S(T)/S(M) In conclusion, our technique is potentially useful for the reliable prediction of PCWP in HF patients.

  12. Haemodynamic insights into the effects of ischaemia and cycle length on tissue Doppler-derived mitral annulus diastolic velocities.

    PubMed

    Nagueh, Sherif F; Rao, Liyun; Soto, Julia; Middleton, Katherine J; Khoury, Dirar S

    2004-02-01

    In the present study, we performed simultaneous epicardial echocardiography and left heart catheterization on ten adult dogs to investigate the effects of ischaemia and tachycardia on the mitral annulus early (E(a)) and late (A(a)) diastolic velocities and the haemodynamic mechanisms involved. Left atrial pressure and left ventricular (LV) volumes and pressures were measured with 5 French Millar catheters. In each dog, inferior vena cava occlusion was used to alter preload and circumflex coronary artery occlusion was applied to induce ischaemia at two different cycle lengths: 450 and 550 ms. At both cycle lengths, ischaemia resulted in a reduction in LV relaxation, LV global and ipsilateral systolic function, transmitral pressure gradient (TMG), E(a) and A(a) ( P <0.05). The shorter cycle length was associated with a shorter tau (time constant of LV relaxation), reduced TMG and reduced septal and lateral E(a) ( P <0.05 for all variables). Both septal and lateral A(a) were significantly increased ( P <0.05). Ischaemia influences E(a) through changes in LV relaxation, global and regional systolic function and TMG. An increase in heart rate reduces E(a), but increases A(a).

  13. Contrasting effect of similar effective regurgitant orifice area in mitral and tricuspid regurgitation: a quantitative Doppler echocardiographic study.

    PubMed

    Tribouilloy, Christophe M; Enriquez-Sarano, Maurice; Capps, Mary Ann; Bailey, Kent R; Tajik, A Jamil

    2002-09-01

    We compared the effect of similar effective regurgitant orifice (ERO) areas in tricuspid regurgitation (TR) and mitral regurgitation (MR) on hemodynamics and volume overload, and examined the impact on grading of TR and MR severity. In a prospective study, 95 patients with TR in sinus rhythm were compared with 95 patients with MR in sinus rhythm matched for ERO area, age, and body surface area. We found that similar ERO area was associated with decreased volume overload in TR compared with MR. There were more women with TR than with MR, but comparison stratified by sex confirmed that regurgitant volume (RVol) was smaller in TR than in MR for similar ERO area. However, patients with systolic venous flow reversal (hepatic for TR and pulmonary for MR) had lower RVol but similar ERO area in TR compared with MR. Therefore, optimal diagnostic thresholds for severe regurgitation (maximum sum of sensitivity and specificity) in TR and MR were different for RVol (45 and 60 mL/beat, respectively) but similar for ERO area (40 mm(2)). We conclude that similar ERO areas induce less RVol in TR than in MR because of the decreased driving force in TR, but have similar consequences with regard to venous flow reversal. Therefore, a similar ERO area grading scheme can be used, and an ERO area of 40 mm(2) or greater is consistent with severe regurgitation in both TR and MR.

  14. In vitro validation of real-time three-dimensional color Doppler echocardiography for direct measurement of proximal isovelocity surface area in mitral regurgitation.

    PubMed

    Little, Stephen H; Igo, Stephen R; Pirat, Bahar; McCulloch, Marti; Hartley, Craig J; Nosé, Yukihiko; Zoghbi, William A

    2007-05-15

    The 2-dimensional (2D) color Doppler (2D-CD) proximal isovelocity surface area (PISA) method assumes a hemispheric flow convergence zone to estimate transvalvular flow. Recently developed 3-dimensional (3D)-CD can directly visualize PISA shape and surface area without geometric assumptions. To validate a novel method to directly measure PISA using real-time 3D-CD echocardiography, a circulatory loop with an ultrasound imaging chamber was created to model mitral regurgitation (MR). Thirty-two different regurgitant flow conditions were tested using symmetric and asymmetric flow orifices. Three-dimensional-PISA was reconstructed from a hand-held real-time 3D-CD data set. Regurgitant volume was derived using both 2D-CD and 3D-CD PISA methods, and each was compared against a flow-meter standard. The circulatory loop achieved regurgitant volume within the clinical range of MR (11 to 84 ml). Three-dimensional-PISA geometry reflected the 2D geometry of the regurgitant orifice. Correlation between the 2D-PISA method regurgitant volume and actual regurgitant volume was significant (r(2) = 0.47, p <0.001). Mean 2D-PISA regurgitant volume underestimate was 19.1 +/- 25 ml (2 SDs). For the 3D-PISA method, correlation with actual regurgitant volume was significant (r(2) = 0.92, p <0.001), with a mean regurgitant volume underestimate of 2.7 +/- 10 ml (2 SDs). The 3D-PISA method showed less regurgitant volume underestimation for all orifice shapes and regurgitant volumes tested. In conclusion, in an in vitro model of MR, 3D-CD was used to directly measure PISA without geometric assumption. Compared with conventional 2D-PISA, regurgitant volume was more accurate when derived from 3D-PISA across symmetric and asymmetric orifices within a broad range of hemodynamic flow conditions.

  15. Doppler-derived left ventricular negative dP/dt as a predictor of atrial fibrillation or ischemic stroke in patients with degenerative mitral regurgitation and normal ejection fraction.

    PubMed

    Yi, Jeong-Eun; Lee, Dong-Hyeon; Cho, Eun Joo; Jeon, Hui-Kyung; Jung, Hae-Ok; Youn, Ho-Joong

    2014-03-01

    The aim of this study was to investigate the role of Doppler-derived left ventricular (LV) -dP/dt in predicting atrial fibrillation (AF) or ischemic stroke in patients with moderate to severe degenerative mitral regurgitation (MR). Doppler-derived LV -dP/dt was determined from the continuous-wave Doppler spectrum of the MR jet (-dP/dt = 32/time between 3 and 1 m/sec) in 80 patients (mean age 59 ± 16 years, 41% men) with moderate to severe degenerative MR, normal LV ejection fraction (LVEF ≥ 60%), and sinus rhythm at diagnosis. Events were defined as new AF or ischemic stroke. During a mean follow-up of 18 ± 13 months, there were 9 events (6 new AF, 3 ischemic strokes). Univariate analysis showed that older age, decreased LV -dP/dt, increased LV mass index, and left atrial volume index (LAVI), shortened deceleration time (DT), reduced A' velocity, and elevated E/E' ratio, prolongation of pulmonary venous (PV) atrial reversal (AR) flow duration relative to mitral inflow A-wave duration (AR-Adur) were associated with events. In multivariate Cox regression analysis, Doppler-derived LV -dP/dt (for each 100 mmHg/sec increase, hazard ratio: 0.165, 95% confidence interval: 0.036-0.761, P = 0.021) and E/E' (hazard ratio: 0.820, 95% confidence interval: 0.682-0.987, P = 0.036) were significant independent predictors of AF or ischemic stroke. Doppler-derived LV -dP/dt is independently associated with the occurrence of AF or ischemic stroke in patients with moderate to severe degenerative MR and provides additional prognostic information. © 2013, Wiley Periodicals, Inc.

  16. Mitral stenosis (image)

    MedlinePlus

    Mitral stenosis is a heart valve disorder that narrows or obstructs the mitral valve opening. Narrowing of the mitral ... the body. The main risk factor for mitral stenosis is a history of rheumatic fever but it ...

  17. Quantitation of mitral regurgitation.

    PubMed

    Topilsky, Yan; Grigioni, Francesco; Enriquez-Sarano, Maurice

    2011-01-01

    Mitral regurgitation (MR) is the most frequent valve disease. Nevertheless, evaluation of MR severity is difficult because standard color flow imaging is plagued by considerable pitfalls. Modern surgical indications in asymptomatic patients require precise assessment of MR severity. MR severity assessment is always comprehensive, utilizing all views and methods. Determining trivial/mild MR is usually easy, based on small jet and flow convergence. Specific signs of severe MR (pulmonary venous flow systolic reversal or severe mitral lesion) are useful but insensitive. Quantitative methods, quantitative Doppler (measuring stroke volumes) and flow convergence (aka PISA method), measure the lesion severity as effective regurgitant orifice (ERO) and volume overload as regurgitant volume (RVol). Interpretation of these numbers should be performed in context of specific MR type. In organic MR (intrinsic valve lesions) ERO ≥ 0.40 cm(2) and RVol ≥ 60 mL are associated with poor outcome, while in functional MR ERO ≥ 0.20 cm(2) and RVol ≥ 30 mL mark reduced survival. While MR assessment should always be comprehensive, quantitative assessment of MR provides measures that are strongly predictive of outcome and should be the preferred approach. The ERO and RVol measured by these methods require interpretation in causal context to best predict outcome and determine MR management. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Transventricular mitral valve operations.

    PubMed

    Joseph Woo, Y; McCormick, Ryan C

    2011-10-01

    We report transventricular mitral valve operations in 2 patients with severe mitral regurgitation and postinfarction left ventricular rupture and pseudoaneurysm. The first patient had direct papillary muscle involvement necessitating replacement of the mitral valve. The second patient had indirect mitral involvement allowing for placement of an atrial mitral annuloplasty ring via the left ventricle. Both patients showed no mitral valve regurgitation after replacement or repair and had uneventful postoperative recoveries. These cases demonstrate a feasible, alternative, transventricular approach to mitral valve replacement and repair.

  19. Mitral valve repair for traumatic mitral regurgitation.

    PubMed

    Fujii, Taro; Kogure, Shuhei; Muro, Takashi; Okada, Yukikatsu

    2016-06-01

    Mitral valve injury after blunt chest trauma is a rare clinical condition. We describe a case of mitral valve repair for severe mitral regurgitation due to blunt chest trauma 5 years previously. A 22-year-old man was referred to our hospital for surgical correction of severe mitral regurgitation. Echocardiography demonstrated a partial tear of the anterolateral papillary muscle which lacerated to the apex. The entire anterolateral part of the mitral valve including the anterior commissure and posterior leaflets had prolapsed. Reimplantation of the papillary muscle to the posterior left ventricular wall and ring annuloplasty were successfully performed without residual regurgitation.

  20. Comparison of direct planimetry of mitral valve regurgitation orifice area by three-dimensional transesophageal echocardiography to effective regurgitant orifice area obtained by proximal flow convergence method and vena contracta area determined by color Doppler echocardiography.

    PubMed

    Altiok, Ertunc; Hamada, Sandra; van Hall, Silke; Hanenberg, Mehtap; Dohmen, Guido; Almalla, Mohammed; Grabskaya, Eva; Becker, Michael; Marx, Nikolaus; Hoffmann, Rainer

    2011-02-01

    Direct measurement of anatomic regurgitant orifice area (AROA) by 3-dimensional transesophageal echocardiography was evaluated for analysis of mitral regurgitation (MR) severity. In 72 patients (age 70.6 ± 13.3 years, 37 men) with mild to severe MR, 3-dimensional transesophageal echocardiography and transthoracic color Doppler echocardiography were performed to determine AROA by direct planimetry, effective regurgitant orifice area (EROA) by proximal convergence method, and vena contracta area (VCA) by 2-dimensional color Doppler echocardiography. AROA was measured with commercially available software (QLAB, Philips Medical Systems, Andover, Massachusetts) after adjusting the first and second planes to reveal the smallest orifice in the third plane where planimetry could take place. AROA was classified as circular or noncircular by calculating the ratio of the medial-lateral distance above the anterior-posterior distance (≤1.5 compared to >1.5). AROA determined by direct planimetry was 0.30 ± 0.20 cm², EROA determined by proximal convergence method was 0.30 ± 0.20 cm², and VCA was 0.33 ± 0.23 cm². Correlation between AROA and EROA (r = 0.96, SEE 0.058 cm²) and between AROA and VCA (r = 0.89, SEE 0.105 cm²) was high considering all patients. In patients with a circular regurgitation orifice area (n = 14) the correlation between AROA and EROA was better (r = 0.99, SEE 0.036 cm²) compared to patients with noncircular regurgitation orifice area (n = 58, r = 0.94, SEE 0.061 cm²). Correlation between AROA and EROA was higher in an EROA ≥0.2 cm² (r = 0.95) than in an EROA <0.2 cm² (r = 0.60). In conclusion, direct measurement of MR AROA correlates well with EROA by proximal convergence method and VCA. Agreement between methods is better for patients with a circular regurgitation orifice area than in patients with a noncircular regurgitation orifice area. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. The use of three-dimensional echocardiography for the evaluation of and treatment of mitral stenosis.

    PubMed

    de Agustin, Jose A; Nanda, Navin C; Gill, Edward A; de Isla, Leopoldo Pérez; Zamorano, Jose L

    2007-05-01

    To date, mitral stenosis has been evaluated by both hemodynamic data derived from catheterization as well as 2D and Doppler echocardiography. However, the advent of real-time 3D echocardiography has allowed more precise measurement of the mitral valve orifice by planimetry. In addition, evaluation of the mitral commissures prior to and after percutaneous mitral valvuloplasty is greatly aided by 3D echocardiography. Here we discuss these subjects as well as provide specific clinical trials that support the use of real-time 3D echocardiography for the evaluation and treatment of mitral stenosis.

  2. Mitral Valve Disease

    MedlinePlus

    ... Tricuspid Valve Disease Cardiac Rhythm Disturbances Thoracic Aortic Aneurysm Pediatric and Congenital Heart Disease Heart abnormalities that are ... Transplantation End-stage Lung Disease Adult Lung Transplantation Pediatric Lung ... Aortic Aneurysm Mitral Valve Disease Overview The mitral valve is ...

  3. Mitral Valve Prolapse

    PubMed Central

    Rosser, Walter W.

    1992-01-01

    The author discusses the pathophysiology of mitral valve prolapse and provides guidelines to identify and treat low-to high-risk mitral valve prolapse. An approach to diagnosing bacterial endocarditis and its prophylaxis are also discussed. The author reviews mitral valve prolapse syndrome and the risk of sudden death.

  4. Three-Directional Evaluation of Mitral Flow in the Rat Heart by Phase-Contrast Cardiovascular Magnetic Resonance.

    PubMed

    Skårdal, Kristine; Espe, Emil K S; Zhang, Lili; Aronsen, Jan Magnus; Sjaastad, Ivar

    2016-01-01

    Determination of mitral flow is an important aspect in assessment of cardiac function. Traditionally, mitral flow is measured by Doppler echocardiography which suffers from several challenges, particularly related to the direction and the spatial inhomogeneity of flow. These challenges are especially prominent in rodents. The purpose of this study was to establish a cardiovascular magnetic resonance (CMR) protocol for evaluation of three-directional mitral flow in a rodent model of cardiac disease. Three-directional mitral flow were evaluated by phase contrast CMR (PC-CMR) in rats with aortic banding (AB) (N = 7) and sham-operated controls (N = 7). Peak mitral flow and deceleration rate from PC-CMR was compared to conventional Doppler echocardiography. The accuracy of PC-CMR was investigated by comparison of spatiotemporally integrated mitral flow with left ventricular stroke volume assessed by cine CMR. PC-CMR portrayed the spatial distribution of mitral flow and flow direction in the atrioventricular plane throughout diastole. Both PC-CMR and echocardiography demonstrated increased peak mitral flow velocity and higher deceleration rate in AB compared to sham. Comparison with cine CMR revealed that PC-CMR measured mitral flow with excellent accuracy. Echocardiography presented significantly lower values of flow compared to PC-CMR. For the first time, we show that PC-CMR offers accurate evaluation of three-directional mitral blood flow in rodents. The method successfully detects alterations in the mitral flow pattern in response to cardiac disease and provides novel insight into the characteristics of mitral flow.

  5. Mitral valve repair for ischemic mitral regurgitation.

    PubMed

    Mohebali, Jahan; Chen, Frederick Y

    2015-05-01

    Mitral valve repair for ischemic mitral valve regurgitation remains controversial. In moderate mitral regurgitation (MR), controversy exists whether revascularization alone will be adequate to restore native valve geometry or whether intervention on the valve (repair) should be performed concomitantly. When MR is severe, the need for valve intervention is not disputed. Rather, the controversy is whether repair versus replacement should be undertaken. In contrast to degenerative or myxomatous disease that directly affects leaflet integrity and morphology, ischemic FMR results from a distortion and dilation of native ventricular geometry that normally supports normal leaflet coaptation. To address this, the first and most crucial step in successful valve repair is placement of an undersized, complete remodeling annuloplasty ring to restore the annulus to its native geometry. The following article outlines the steps for repair of ischemic mitral regurgitation.

  6. Instantaneous transmitral flow using Doppler and M-mode echocardiography: comparison with radionuclide ventriculography.

    PubMed

    Hoit, B D; Rashwan, M; Verba, J; Pretorius, T; Sahn, D J; Bhargava, V

    1989-08-01

    To improve the accuracy of Doppler echocardiographic indices of left ventricular filling, we derived two indices of instantaneous transmitral flow with the use of Doppler velocities and M-mode echocardiography. These indices were calculated from the product of pulsed Doppler mitral velocities and either the excursion of the anterior mitral leaflet or the separation of both mitral leaflets as measures of the changing mitral orifice area. The derived flow indices and the mitral velocities alone were compared to left ventricular filling as determined by radionuclide ventriculography in 24 patients. When compared as areas under the matched decile divisions of the derived filling sequences by linear regression analysis, the relationship for combined Doppler and M-mode versus radionuclide left ventricular filling was closer to the line of identity (slope = 0.98 and 0.94 using the anterior mitral leaflet and both mitral leaflets, respectively, both p = NS versus the line of identity) than was the relationship for mitral velocities alone versus radionuclide left ventricular filling (slope = 0.74, p less than 0.05 versus the line of identity). The instantaneous mitral volume flow indices more closely resemble the time course and shape of radionuclide left ventricular filling curves than do mitral velocities alone, and the application of these indices should assist the quantitative description by Doppler echocardiography of left ventricular filling.

  7. Opening snap and isovolumic relaxation period in relation to mitral valve flow in patients with mitral stenosis. Significance of A2--OS interval.

    PubMed Central

    Kalmanson, D; Veyrat, C; Bernier, A; Witchitz, S; Chiche, P

    1976-01-01

    In 15 patients with pure or predominant mitral stenosis and in a control group of 11 patients without mitral stenosis the blood flow velocity through the mitral valve orifice was recorded by means of a directional Doppler ultrasound velocity catheter introduced transeptally and positioned in the orifice of the mitral valve. A simultaneous surface phonocardiogram was obtained. The timing of the mitral opening snap in relation to the blood velocity record of the flow through the valve supported the hypothesis that the opening snap is due to a sudden tensing of the valve leaflets by the chordae tendineae. Determination of the exact time of mitral valve opening, made possible by the blood velocity record, led to the division of the classical A2-0S interval (aortic valve closure to opening snap) into two components representing respectively the diastolic isovolumic relaxation period and the time of excursion of the mitral valve cusps. The durations of the isovolumic relaxation period were compared with those in the control patients and were found to correlate with the severity of the mitral stenosis, whereas those of the excursion time of the mitral cusps were influenced by the presence or absence of mitral valve calcification. PMID:1259828

  8. [Modern mitral valve surgery].

    PubMed

    Bothe, W; Beyersdorf, F

    2016-04-01

    At the beginning of the 20th century, Cutler and Levine performed the first successful surgical treatment of a stenotic mitral valve, which was the only treatable heart valve defect at that time. Mitral valve surgery has evolved significantly since then. The introduction of the heart-lung machine in 1954 not only reduced the surgical risk, but also allowed the treatment of different mitral valve pathologies. Nowadays, mitral valve insufficiency has become the most common underlying pathomechanism of mitral valve disease and can be classified into primary and secondary mitral insufficiency. Primary mitral valve insufficiency is mainly caused by alterations of the valve (leaflets and primary order chords) itself, whereas left ventricular dilatation leading to papillary muscle displacement and leaflet tethering via second order chords is the main underlying pathomechanism for secondary mitral valve regurgitation. Valve reconstruction using the "loop technique" plus annuloplasty is the surgical strategy of choice and normalizes life expectancy in patients with primary mitral regurgitation. In patients with secondary mitral regurgitation, implanting an annuloplasty is not superior to valve replacement and results in high rates of valve re-insufficiency (up to 30 % after 3 months) due to ongoing ventricular dilatation. In order to improve repair results in these patients, we add a novel subvalvular technique (ring-noose-string) to the annuloplasty that aims to prevent ongoing ventricular remodeling and re-insufficiency. In modern mitral surgery, a right lateral thoracotomy is the approach of choice with excellent repair and cosmetic results.

  9. Problem: Mitral Valve Regurgitation

    MedlinePlus

    ... Stroke Vascular Health Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Problem: Mitral Valve Regurgitation Updated:Sep 21,2016 What is mitral valve ... blood flows from the ventricle through the aortic valve — as it should — and some blood flows ...

  10. Normal Echocardiographic Measurements in a Korean Population Study: Part II. Doppler and Tissue Doppler Imaging

    PubMed Central

    Choi, Jin-Oh; Shin, Mi-Seung; Kim, Mi-Jeong; Jung, Hae Ok; Park, Jeong Rang; Sohn, Il Suk; Kim, Hyungseop; Park, Seong-Mi; Yoo, Nam Jin; Choi, Jung Hyun; Kim, Hyung-Kwan; Cho, Goo-Yeong; Lee, Mi-Rae; Park, Jin-Sun; Shim, Chi Young; Kim, Dae-Hee; Shin, Dae-Hee; Shin, Gil Ja; Shin, Sung Hee; Kim, Kye Hun; Park, Jae-Hyeong; Lee, Sang Yeub; Kim, Woo-Shik

    2016-01-01

    Background Hemodynamic and functional evaluation with Doppler and tissue Doppler study as a part of comprehensive echocardiography is essential but normal reference values have never been reported from Korean normal population especially according to age and sex. Methods Using Normal echOcaRdiographic Measurements in a KoreAn popuLation study subjects, we obtained normal reference values for Doppler and tissue Doppler echocardiography including tricuspid annular velocities according to current guidelines and compared values according to gender and age groups. Results Mitral early diastolic (E) and late diastolic (A) velocity as well as E/A ratio were significantly higher in women compared to those in men. Conversely, mitral peak systolic and late diastolic annular velocity in both septal and lateral mitral annulus were significantly lower in women compared to those in men. However, there were no significant differences in both septal and lateral mitral early diastolic annular (e') velocity between men and women. In both men and women, mitral E velocity and its deceleration time as well as both E/A and E/e' ratio considerably increased with age. There were no significant differences in tricuspid inflow velocities and tricuspid lateral annular velocities between men and women except e' velocity, which was significantly higher in women compared to that in men. However, changes in both tricuspid inflow and lateral annular velocities according to age were similar to those in mitral velocities. Conclusion Since there were significant differences in Doppler and tissue Doppler echocardiographic variables between men and women and changes according to age were even more considerable in both gender groups, normal Doppler echocardiographic values should be differentially applied based on age and sex. PMID:27358707

  11. Mitral Valve Prolapse.

    ERIC Educational Resources Information Center

    Bergy, Gordon G.

    1980-01-01

    Mitral valve prolapse is the most common heart disease seen in college and university health services. It underlies most arrhythmia and many chest complaints. Activity and exercise restrictions are usually unnecessary. (Author/CJ)

  12. Mitral Valve Prolapse.

    ERIC Educational Resources Information Center

    Bergy, Gordon G.

    1980-01-01

    Mitral valve prolapse is the most common heart disease seen in college and university health services. It underlies most arrhythmia and many chest complaints. Activity and exercise restrictions are usually unnecessary. (Author/CJ)

  13. [Ischaemic mitral insufficiency].

    PubMed

    Messas, E

    2004-06-01

    Ischaemic mitral insufficiency (IMI) due to regurgitation of an anatomically normal valve, due to dysfunction directly related to myocardial ischaemia, is observed in over 20% of post-infarction patients and is associated with a doubling of the risk of death. The responsibility of ventricular remodelling with displacement of the papillary muscles in the genesis of IMI has been demonstrated experimentally. 3-D echocardiography has improved our understanding of the central role of geometrical changes of the subvalvular apparatus. The inconsistent results of surgery using an undersized mitral annulus have led to the search for alternative techniques. The correction of mitral insufficiency at coronary bypass surgery is a current topic of research. The application of new techniques of mitral valvuloplasty seems more effective and should provide an answer to this problem.

  14. Tissue Doppler characterization of cardiac phenotype in mouse.

    PubMed

    Fayssoil, Abdallah

    2009-10-01

    Mice allow biologists to study various genes playing a role in cardiac function and pathophysiological situations. Echocardiography is a non-invasive tool for assessing cardiac phenotype. Because of load dependence of conventional parameters (left ventricular shortening fraction, left ventricular ejection fraction and mitral pulsed Doppler), we have to perform Doppler tissular velocity imaging and strain imaging for the characterization of cardiomyopathies mice models.

  15. Ultrasonic Doppler measurement of renal artery blood flow

    NASA Technical Reports Server (NTRS)

    Freund, W. R.; Beaver, W. L.; Meindl, J. D.

    1976-01-01

    Studies were made of (1) blood flow redistribution during lower body negative pressure (LBNP), (2) the profile of blood flow across the mitral annulus of the heart (both perpendicular and parallel to the commissures), (3) testing and evaluation of a number of pulsed Doppler systems, (4) acute calibration of perivascular Doppler transducers, (5) redesign of the mitral flow transducers to improve reliability and ease of construction, and (6) a frequency offset generator designed for use in distinguishing forward and reverse components of blood flow by producing frequencies above and below the offset frequency. Finally methodology was developed and initial results were obtained from a computer analysis of time-varying Doppler spectra.

  16. Intraoperative application of geometric three-dimensional mitral valve assessment package: a feasibility study.

    PubMed

    Mahmood, Feroze; Karthik, Swaminathan; Subramaniam, Balachundhar; Panzica, Peter J; Mitchell, John; Lerner, Adam B; Jervis, Karinne; Maslow, Andrew D

    2008-04-01

    To study the feasibility of using 3-dimensional (3D) echocardiography in the operating room for mitral valve repair or replacement surgery. To perform geometric analysis of the mitral valve before and after repair. Prospective observational study. Academic, tertiary care hospital. Consecutive patients scheduled for mitral valve surgery. Intraoperative reconstruction of 3D images of the mitral valve. One hundred and two patients had 3D analysis of their mitral valve. Successful image reconstruction was performed in 93 patients-8 patients had arrhythmias or a dilated mitral valve annulus resulting in significant artifacts. Time from acquisition to reconstruction and analysis was less than 5 minutes. Surgeon identification of mitral valve anatomy was 100% accurate. The study confirms the feasibility of performing intraoperative 3D reconstruction of the mitral valve. This data can be used for confirmation and communication of 2-dimensional data to the surgeons by obtaining a surgical view of the mitral valve. The incorporation of color-flow Doppler into these 3D images helps in identification of the commissural or perivalvular location of regurgitant orifice. With improvements in the processing power of the current generation of echocardiography equipment, it is possible to quickly acquire, reconstruct, and manipulate images to help with timely diagnosis and surgical planning.

  17. Tissue Doppler imaging in cardiac sarcoidosis.

    PubMed

    Smedema, J P

    2008-07-01

    A middle-aged African lady, who presented with ventricular tachycardias, mitral valve regurgitation and congestive heart failure, was diagnosed with cardiac sarcoidosis. Tissue Doppler imaging demonstrated abnormalities suggestive of myocardial scar, which was confirmed by contrast-enhanced cardiac magnetic resonance.

  18. [Valvular surgery for an exercise-induced functional mitral regurgitation in heart failure and preserved ejection fraction: a case study].

    PubMed

    Attari, M; Legrand, M; Philippe, C; Rosak, P

    2013-08-01

    We here report the case of a 67-year-old woman with moderate mitral regurgitation without significant structural abnormalities that get worse during severe recurrent heart failures and preserved ejection fraction with concomitant paroxysmal atrial fibrillation. Atrial fibrillation became permanent and despite a well-controlled cardiac frequency, new heart failure episodes occurred. Exercise doppler echocardiography showed that the mechanism of this mitral regurgitation was a two leaflet mitral tenting. We discuss here the different mechanisms that could induce these kinds of mitral regurgitation with excessive tenting. We emphasize the interest of early detection by exercise doppler echocardiography even when a triggering factor like atrial fibrillation seems to be involved. We also discuss the interest of mitral valve replacement for these patients.

  19. Percutaneous mitral valve repair for mitral regurgitation.

    PubMed

    Block, Peter C

    2003-02-01

    Mitral regurgitation (MR) associated with, ischemic, and degenerative (prolapse) disease, contributes to left ventricular (LV) dysfunction due to remodeling, and LV dilation, resulting in worsening of MR. Mitral valve (MV) surgical repair has provided improvement in survival, LV function and symptoms, especially when performed early. Surgical repair is complex, due to diverse etiologies and has significant complications. The Society for Thoracic Surgery database shows that operative mortality for a 1st repair is 2% and for re-do repair is 4 times that. Cardiopulmonary bypass and cardiac arrest are required. The attendant morbidity prolongs hospitalization and recovery. Alfieri simplified mitral repair using an edge-to-edge technique which subsequently has been shown to be effective for multiple etiologies of MR. The MV leaflers are typically brought together by a central suture producing a double orifice MV without stenosis. Umana reported that MR decreased from grade 3.6 +/- 0.5 to 0.8 +/- 0.4 (P < 0.0001) and LV ejection fraction increased from 33 +/- 13% to 45 +/- 11% (P = 0.0156). In 121 patients, Maisano reported freedom from re-operation of 95 +/- 4.8% with up to 6 year follow-up. Oz developed a MV "grasper" that is directly placed via a left ventriculotomy and coapts both leaflets which are then fastened by a graduated spiral screw. An in-vitro model using explanted human valves showed significant reduction in MR and in canine studies, animals followed by serial echo had persistent MV coaptation. At 12 weeks the device was endothelialized. These promising results have paved the way for a percutaneous or minimally invasive-off pump mitral repair. Evalve has developed catheter-based technology, which, by apposing the edges of a regurgitant MV, results in edge-to-edge repair. Release of the device is done after echo and fluoroscopic evaluation under normal loading conditions. If the desired effect is not produced the device can be repositioned or retrieved

  20. Severe hemolytic anemia after repair of primum septal defect and cleft mitral valve.

    PubMed

    Alehan, D; Doğan, R; Ozkutlu, S; Elshershari, H; Gümrük, F

    2001-01-01

    Two cases are described in which severe mechanical hemolytic anemia developed after surgical repair of primum atrial septal defect (ASD) and cleft mitral valve. In both cases there was residual mitral regurgitation after repair. Moderate mitral regurgitation and collision of the regurgitant jet with the teflon patch used for repair of the primum ASD were detected by color-Doppler echocardiography imaging. Laboratory tests showed normochromic normocytic anemia, increased indirect serum bilirubin, decreased plasma haptoglobin and hemoglobinuria. The peripheral blood smear contained numerous fragmented red cells. Following another surgical correction of the mitral valve (repair or mitral valve replacement), there was no more hemolysis. The two presented cases show that foreign materials in association with localized intracardiac turbulence may cause severe hemolysis.

  1. Acute Multiple Cerebral Infarction in a Patient with an Accessory Mitral Valve

    PubMed Central

    Misumi, Ikuo; Nagao, Asako; Iwamoto, Katsuya; Honda, Tsuyoshi; Ishii, Masanobu; Ueyama, Hidetsugu; Maeda, Yasushi; Ishizaki, Masatoshi; Kurisaki, Ryoichi; Okazaki, Toshio; Yamashita, Tetsuji; Fujimoto, Akiko; Honda, Yumi

    2017-01-01

    A 96-year-old woman developed hemiparesis 2 weeks after orthopedic surgery. Magnetic resonance imaging revealed multiple cerebral infarctions in the bilateral hemisphere. Transthoracic echocardiography revealed a mobile structure attached to the anterior mitral leaflet that protruded toward the left ventricular outflow tract. The structure was identified as an accessory mitral valve. Doppler echocardiography showed that there was no significant left ventricular outflow obstruction. This is a rare case of a silent accessory mitral valve that was detected after multiple cerebral infarctions. PMID:28090044

  2. Ischemic mitral valve prolapse

    PubMed Central

    Cristiano, Spadaccio; Nenna, Antonio; Chello, Massimo

    2016-01-01

    Ischemic mitral prolapse (IMP) is a pathologic entity encountered in about one-third among the patients undergoing surgery for ischemic mitral regurgitation (IMR). IMP is generally the result of a papillary muscle injury consequent to myocardial, but the recent literature is progressively unveiling a more complex pathogenesis. The mechanisms underlying its development regards the impairment of one or more components of the mitral apparatus, which comprises the annulus, the chordae tendineae, the papillary muscle and the left ventricular wall. IMP is not only a disorder of valvular function, but also entails coexistent aspects of a geometric disturbance of the mitral valve configuration and of the left ventricular function and dimension and a correct understanding of all these aspects is crucial to guide and tailor the correct therapeutic strategy to be adopted. Localization of prolapse, anatomic features of the prolapsed leaflets and the subvalvular apparatus should be carefully evaluated as also constituting the major determinants defining patient’s outcomes. This review will summarize our current understanding of the pathophysiology and clinical evidence on IMP with a particular focus on the surgical treatment. PMID:28149574

  3. Quantitation of the mitral tetrahedron in patients with ischemic heart disease using real-time three-dimensional echocardiography to evaluate the geometric determinants of ischemic mitral regurgitation.

    PubMed

    Hsuan, Chin-Feng; Yu, Hsi-Yu; Tseng, Wei-Kung; Lin, Lung-Chun; Hsu, Kwan-Lih; Wu, Chau-Chung

    2013-05-01

    Ischemic mitral regurgitation (IMR) is common in ischemic heart disease and results in poor prognosis. However, the exact mechanism of IMR has not been fully elucidated. Quantitation of the mitral tetrahedron using three-dimentianl (3D) echocardiography is capable of evaluating the geometric determinants and mechanisms of IMR. Forty patients with a history of ST-elevation myocardial infarction at least 6 months earlier were studied. Parameters of mitral deformation and global left ventricular (LV) function and shape were evaluated by 2-dimensional echocardiography. The effective regurgitant orifice (ERO) of IMR was obtained by the quantitative continuous-wave Doppler technique. Three-dimensional (3D) echocardiography was applied to assess the mitral tetrahedron. Mitral valvular tenting area (P < 0.001), mitral annular area (P = 0.032), dilation of the LV in diastole, impairment of the LV ejection fraction, and volume of the spherically shaped LV in systole were greater in patients with an ERO ≥20 mm(2) than in those with an ERO <20 mm(2). In the mitral tetrahedron, only the interpapillary muscle roots distance showed a significant difference (P = 0.004). Multivariate analysis with the logistic regression model showed the systolic mitral tenting area (odds ratio [OR]: 280.49, 95% confidence interval [CI]: 4.59-1.72 × 10(4), P = 0.007) and interpapillary muscle distance (OR: 1.50, 95% CI: 1.03-2.19, P = 0.036) to be independent factors in predicting significant IMR (ERO ≥20 mm(2)). 3D echocardiography can be effectively applied in measuring the mitral tetrahedron and evaluating the mechanism of IMR. Mitral valvular tenting and interpapillary muscle distance are 2 independent factors of significant IMR. © 2013 Wiley Periodicals, Inc.

  4. The "Polar Light Sign" is a useful tool to detect discrete membranous supravalvular mitral stenosis.

    PubMed

    Hertwig, Christine; Haas, Nikolaus A; Habash, Sheeraz; Hanslik, Andreas; Kececioglu, Deniz; Sandica, Eugen; Laser, Kai-Thorsten

    2015-02-01

    Mitral valve stenosis caused by a discrete supravalvular membrane is a rare congenital malformation haemodynamically leading to significant mitral valve stenosis. When the supravalvular mitral stenosis consists of a discrete supravalvular membrane adherent to the mitral valve, it is usually not clearly detectable by routine echocardiography. We report about the typical echocardiographic finding in three young patients with this rare form of a discrete membranous supravalvular stenosis caused by a membrane adherent to the mitral valve. These cases present a typical echocardiographic feature in colour Doppler generated by the pathognomonic supramitral flow acceleration. Whereas typical supravalvular mitral stenosis caused by cor triatriatum or a clearly visible supravalvular ring is easily detectable by echocardiography, a discrete supravalvular membrane adjacent to the mitral valve leaflets resembling valvular mitral stenosis is difficult to differentiate by routine echocardiography. In our opinion, this colour phenomenon does resemble the visual impression of polar lights in the northern hemisphere; owing to its typical appearance, it may therefore be named as "Polar Light Sign". This phenomenon may help to detect this anatomical entity by echocardiography in time and therefore improve the prognosis for repair.

  5. Mitral valve repair is not always needed in patients with functional mitral regurgitation undergoing coronary artery bypass grafting and/or aortic valve replacement

    PubMed Central

    Lindeboom, J.E.; Jaarsma, W.; Kelder, J.C.; Morshuis, W.J.; Visser, C.A.

    2005-01-01

    Background and aim Functional mitral regurgitation (FMR) is defined as mitral regurgitation in the absence of intrinsic valvular abnormalities. We prospectively evaluated the effect of coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR), without additional mitral valve repair, on the degree of moderate or severe FMR. Study design and methods From a cohort of 2829 patients undergoing CABG and/or AVR in the St. Antonius Hospital, 67 patients were identified with moderate or severe FMR by transthoracic and transoesophageal Doppler echocardiography. Results Two out of the 67 patients (3%) died perioperatively. During follow-up (3-18 months) mitral regurgitation decreased by one grade in 29 patients, by two grades in 28, by three grades in five patients and remained unchanged in one patient (p=0.0001). Of all patients, 85% had grade I mitral regurgitation or less. Grade II mitral regurgitation remained in nine patients with a previous large myocardial infarction and/or annular calcifications. NYHA class improved from 3.1+0.5 to 1.4+0.4 (p=0.0001). Ejection fraction increased from 46 to 55% (p=0.0001). Overall, left atrial and left ventricular end-diastolic dimensions decreased significantly. In contrast, no decrease in dimensions was seen in patients with postoperative grade II mitral regurgitation. Conclusion FMR may improve significantly following CABG and/or AVR, although a previous large myocardial infarction and/or annular calcifications may affect outcome. PMID:25696484

  6. Comprehensive echocardiographic assessment of normal mitral Medtronic Hancock II, Medtronic Mosaic, and Carpentier-Edwards Perimount bioprostheses early after implantation.

    PubMed

    Blauwet, Lori A; Malouf, Joseph F; Connolly, Heidi M; Hodge, David O; Evans, Katie N; Herges, Regina M; Sundt, Thoralf M; Miller, Fletcher A

    2010-06-01

    Normal Doppler-derived hemodynamic data for mitral valve bioprostheses are limited. To establish parameters for identifying normal function for each of the 3 types of bioprostheses examined, we conducted a comprehensive, retrospective, two-dimensional, and Doppler echocardiographic assessment of 179 patients who underwent implantation of the Medtronic Hancock II or the Medtronic Mosaic (Medtronic, Inc, Minneapolis, MN) porcine mitral valve bioprosthesis or the Carpentier-Edwards Perimount (Edwards Lifesciences LLC, Irvine, CA) bovine pericardial mitral valve bioprosthesis. All bioprostheses were normal by clinical examination, intraoperative transesophageal echocardiography, and postoperative transthoracic echocardiography. Regardless of valve type and body surface area, the pressure half-time was < 124 ms in all patients. Mean gradient < 9.5 mm Hg, mitral E velocity < 2.6 m/s, mitral valve prosthesis time-velocity integral < 69 cm, and ratio of the mitral valve prosthesis time-velocity integral to the left ventricular outflow tract time-velocity integral < 3.4 were recorded in nearly all patients. These cutoff values (mean + 2 standard deviation) are specific, but not sensitive, for identifying mitral valve prosthesis dysfunction. Prostheses with hemodynamic values that are higher than these cutoff values are likely dysfunctional, but in select cases, mitral valve prosthesis dysfunction may be present even when hemodynamic values are lower than these thresholds. Copyright 2010 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  7. Pulmonary venous flows reflect changes in left atrial hemodynamics during mitral balloon valvotomy

    NASA Technical Reports Server (NTRS)

    Yalcin, Fatih; El-Amrousy, Mahmoud; Muderrisoglu, Haldun; Korkmaz, Mehmet; Flachskampf, Frank; Tuzcu, Murat; Garcia, Mario G.; Thomas, James D.

    2002-01-01

    Patients with mitral stenosis have usually blunted pulmonary venous (PV) flow, because of decreased mitral valve area and diastolic dysfunction. The authors compared changes in Doppler PV velocities by using transesophageal echocardiography (TEE) against hemodynamics parameters before and after mitral balloon valvotomy to observe relevance of PV velocities and endsystolic left atrial (LA) pressure-volume relationship. In 25 patients (aged 35 +/- 17 years) with mitral stenosis in sinus rhythm, changes in LA pressure and volumes were compared with PV velocities before and after valvotomy. Mitral valve area, mitral gradients, and deceleration time were obtained. Mitral valve area and mitral gradients changed from 1 +/- 0.2 cm2 and 14.6 +/- 5.4 mmHg to 1.9 +/- 0.3 cm2 and 6.3 +/- 1.7 mmHg, respectively (p<0.001). AR peak reverse flow velocity and AR duration decreased from 29 +/- 13 cm/s and 110 =/- 30 msec to 19 +/- 6 cm/s and 80 +/- 29 msec respectively (p<0.001). Transmitral Doppler E wave deceleration time decreased from 327 +/- 85 to 209 +/- 61 s and cardiac output increased from 4.2 +/- 1.0 to 5.2 +/- 1.1 L/minute (p<0.001). The changes in LA pressure were correlated with changes in S/D (r=0.57, p<0.05). The changes in endsystolic LA pressure-volume relationship were also correlated with changes in S/D (r=0.52, p<0.05). Endsystolic LA pressure-volume relationship decreased after mitral balloon valvotomy, as a result of a large decrease in pressure. PV systolic/diastolic (S/D) waves ratio reflects endsystolic LA pressure-volume relationship and may be used as another indicator of successful valvotomy.

  8. Pulmonary venous flows reflect changes in left atrial hemodynamics during mitral balloon valvotomy

    NASA Technical Reports Server (NTRS)

    Yalcin, Fatih; El-Amrousy, Mahmoud; Muderrisoglu, Haldun; Korkmaz, Mehmet; Flachskampf, Frank; Tuzcu, Murat; Garcia, Mario G.; Thomas, James D.

    2002-01-01

    Patients with mitral stenosis have usually blunted pulmonary venous (PV) flow, because of decreased mitral valve area and diastolic dysfunction. The authors compared changes in Doppler PV velocities by using transesophageal echocardiography (TEE) against hemodynamics parameters before and after mitral balloon valvotomy to observe relevance of PV velocities and endsystolic left atrial (LA) pressure-volume relationship. In 25 patients (aged 35 +/- 17 years) with mitral stenosis in sinus rhythm, changes in LA pressure and volumes were compared with PV velocities before and after valvotomy. Mitral valve area, mitral gradients, and deceleration time were obtained. Mitral valve area and mitral gradients changed from 1 +/- 0.2 cm2 and 14.6 +/- 5.4 mmHg to 1.9 +/- 0.3 cm2 and 6.3 +/- 1.7 mmHg, respectively (p<0.001). AR peak reverse flow velocity and AR duration decreased from 29 +/- 13 cm/s and 110 =/- 30 msec to 19 +/- 6 cm/s and 80 +/- 29 msec respectively (p<0.001). Transmitral Doppler E wave deceleration time decreased from 327 +/- 85 to 209 +/- 61 s and cardiac output increased from 4.2 +/- 1.0 to 5.2 +/- 1.1 L/minute (p<0.001). The changes in LA pressure were correlated with changes in S/D (r=0.57, p<0.05). The changes in endsystolic LA pressure-volume relationship were also correlated with changes in S/D (r=0.52, p<0.05). Endsystolic LA pressure-volume relationship decreased after mitral balloon valvotomy, as a result of a large decrease in pressure. PV systolic/diastolic (S/D) waves ratio reflects endsystolic LA pressure-volume relationship and may be used as another indicator of successful valvotomy.

  9. How Is Mitral Valve Prolapse Treated?

    MedlinePlus

    ... page from the NHLBI on Twitter. How Is Mitral Valve Prolapse Treated? Most people who have mitral valve ... all hospitals offer this method. Valve Repair and Valve Replacement In mitral valve surgery, the valve is repaired or replaced. ...

  10. [Echocardiographic and Doppler echocardiographic characterization of left ventricular diastolic function].

    PubMed

    Muscholl, M; Dennig, K; Kraus, F; Rudolph, W

    1990-12-01

    For noninvasive assessment of diastolic ventricular function, in addition to echocardiography, more recently, in particular, Doppler echocardiography has been employed. M-mode echocardiogram velocity curves for diameter changes as well as Doppler-echocardiographically registered velocity curves of mitral flow characterize the temporal changes of diastolic flow into the left ventricle. They represent the overall result of factors which influence diastolic filling and are functions of the temporal course of the pressure difference between left atrium and left ventricle. Registration of M-mode and Doppler echocardiograms: For determination of M-mode parameters which should describe left ventricular diastolic function, in addition to the motion of the mitral valve, the left ventricular contours of septum and posterior wall between mitral leaflets and papillary muscles are recorded together with the ECG. For evaluation of the index of atrial emptying, an M-mode registration is obtained from the region of the aortic root. Determination of the Doppler echocardiographic parameters is based on analysis of the blood flow velocity in the region of the mitral valve in the apical four-chamber view with the pulsed Doppler method. Additionally, simultaneous to the Doppler curve, a phonocardiogram is registered or, alternatively, a continuous-wave Doppler registration is obtained which delineates the left ventricular outflow signal and the artefact of mitral valve opening. Parameters for characterization of left ventricular diastolic filling: The first peak of the velocity curve of the diameter change in the M-mode echocardiogram corresponds with the maximal diameter change resulting from early-diastolic filling and the second peak with the maximal diameter change of the left ventricle associated with atrial filling. From this curve as well as the diameter curve relative to time and the mitral valve motion, the times for isovolumetric relaxation as well as the rapid, slow and

  11. Morphofunctional Abnormalities of Mitral Annulus and Arrhythmic Mitral Valve Prolapse

    PubMed Central

    Basso, Cristina; De Lazzari, Manuel; Rizzo, Stefania; Cipriani, Alberto; Giorgi, Benedetta; Lacognata, Carmelo; Rigato, Ilaria; Migliore, Federico; Pilichou, Kalliopi; Cacciavillani, Luisa; Bertaglia, Emanuele; Frigo, Anna Chiara; Bauce, Barbara; Corrado, Domenico; Thiene, Gaetano; Iliceto, Sabino

    2016-01-01

    Background— Arrhythmic mitral valve prolapse (MVP) is characterized by myxomatous leaflets and left ventricular (LV) fibrosis of papillary muscles and inferobasal wall. We searched for morphofunctional abnormalities of the mitral valve that could explain a regional mechanical myocardial stretch. Methods and Results— Thirty-six (27 female patients; median age: 44 years) arrhythmic MVP patients with LV late gadolinium enhancement on cardiac magnetic resonance and no or trivial mitral regurgitation, and 16 (6 female patients; median age: 40 years) MVP patients without LV late gadolinium enhancement were investigated by morphofunctional cardiac magnetic resonance. Mitral annulus disjunction (median: 4.8 versus 1.8 mm; P<0.001), end-systolic mitral annular diameters (median: 41.2 versus 31.5; P=0.004) and end-diastolic mitral annular diameters (median: 35.5 versus 31.5; P=0.042), prevalence of posterior systolic curling (34 [94%] versus 3 [19%]; P<0.001), and basal to mid LV wall thickness ratio >1.5 (22 [61%] versus 4 [25%]; P=0.016) were higher in MVP patients with late gadolinium enhancement than in those without. A linear correlation was found between mitral annulus disjunction and curling (R=0.85). A higher prevalence of auscultatory midsystolic click (26 [72%] versus 6 [38%]; P=0.018) was also noted. Histology of the mitral annulus showed a longer mitral annulus disjunction in 50 sudden death patients with MVP and LV fibrosis than in 20 patients without MVP (median: 3 versus 1.5 mm; P<0.001). Conclusions— Mitral annulus disjunction is a constant feature of arrhythmic MVP with LV fibrosis. The excessive mobility of the leaflets caused by posterior systolic curling accounts for a mechanical stretch of the inferobasal wall and papillary muscles, eventually leading to myocardial hypertrophy and scarring. These mitral annulus abnormalities, together with auscultatory midsystolic click, may identify MVP patients who would need arrhythmic risk stratification. PMID

  12. Morphofunctional Abnormalities of Mitral Annulus and Arrhythmic Mitral Valve Prolapse.

    PubMed

    Perazzolo Marra, Martina; Basso, Cristina; De Lazzari, Manuel; Rizzo, Stefania; Cipriani, Alberto; Giorgi, Benedetta; Lacognata, Carmelo; Rigato, Ilaria; Migliore, Federico; Pilichou, Kalliopi; Cacciavillani, Luisa; Bertaglia, Emanuele; Frigo, Anna Chiara; Bauce, Barbara; Corrado, Domenico; Thiene, Gaetano; Iliceto, Sabino

    2016-08-01

    Arrhythmic mitral valve prolapse (MVP) is characterized by myxomatous leaflets and left ventricular (LV) fibrosis of papillary muscles and inferobasal wall. We searched for morphofunctional abnormalities of the mitral valve that could explain a regional mechanical myocardial stretch. Thirty-six (27 female patients; median age: 44 years) arrhythmic MVP patients with LV late gadolinium enhancement on cardiac magnetic resonance and no or trivial mitral regurgitation, and 16 (6 female patients; median age: 40 years) MVP patients without LV late gadolinium enhancement were investigated by morphofunctional cardiac magnetic resonance. Mitral annulus disjunction (median: 4.8 versus 1.8 mm; P<0.001), end-systolic mitral annular diameters (median: 41.2 versus 31.5; P=0.004) and end-diastolic mitral annular diameters (median: 35.5 versus 31.5; P=0.042), prevalence of posterior systolic curling (34 [94%] versus 3 [19%]; P<0.001), and basal to mid LV wall thickness ratio >1.5 (22 [61%] versus 4 [25%]; P=0.016) were higher in MVP patients with late gadolinium enhancement than in those without. A linear correlation was found between mitral annulus disjunction and curling (R=0.85). A higher prevalence of auscultatory midsystolic click (26 [72%] versus 6 [38%]; P=0.018) was also noted. Histology of the mitral annulus showed a longer mitral annulus disjunction in 50 sudden death patients with MVP and LV fibrosis than in 20 patients without MVP (median: 3 versus 1.5 mm; P<0.001). Mitral annulus disjunction is a constant feature of arrhythmic MVP with LV fibrosis. The excessive mobility of the leaflets caused by posterior systolic curling accounts for a mechanical stretch of the inferobasal wall and papillary muscles, eventually leading to myocardial hypertrophy and scarring. These mitral annulus abnormalities, together with auscultatory midsystolic click, may identify MVP patients who would need arrhythmic risk stratification. © 2016 The Authors.

  13. Modeling the Mitral Valve

    NASA Astrophysics Data System (ADS)

    Kaiser, Alexander

    2016-11-01

    The mitral valve is one of four valves in the human heart. The valve opens to allow oxygenated blood from the lungs to fill the left ventricle, and closes when the ventricle contracts to prevent backflow. The valve is composed of two fibrous leaflets which hang from a ring. These leaflets are supported like a parachute by a system of strings called chordae tendineae. In this talk, I will describe a new computational model of the mitral valve. To generate geometry, general information comes from classical anatomy texts and the author's dissection of porcine hearts. An MRI image of a human heart is used to locate the tips of the papillary muscles, which anchor the chordae tendineae, in relation to the mitral ring. The initial configurations of the valve leaflets and chordae tendineae are found by solving solving an equilibrium elasticity problem. The valve is then simulated in fluid (blood) using the immersed boundary method over multiple heart cycles in a model valve tester. We aim to identify features and mechanisms that influence or control valve function. Support from National Science Foundation, Graduate Research Fellowship Program, Grant DGE 1342536.

  14. Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation.

    PubMed

    Kron, Irving L; Hung, Judy; Overbey, Jessica R; Bouchard, Denis; Gelijns, Annetine C; Moskowitz, Alan J; Voisine, Pierre; O'Gara, Patrick T; Argenziano, Michael; Michler, Robert E; Gillinov, Marc; Puskas, John D; Gammie, James S; Mack, Michael J; Smith, Peter K; Sai-Sudhakar, Chittoor; Gardner, Timothy J; Ailawadi, Gorav; Zeng, Xin; O'Sullivan, Karen; Parides, Michael K; Swayze, Roger; Thourani, Vinod; Rose, Eric A; Perrault, Louis P; Acker, Michael A

    2015-03-01

    The Cardiothoracic Surgical Trials Network recently reported no difference in the primary end point of left ventricular end-systolic volume index at 1 year postsurgery in patients randomized to repair (n = 126) or replacement (n = 125) for severe ischemic mitral regurgitation. However, patients undergoing repair experienced significantly more recurrent mitral regurgitation than patients undergoing replacement (32.6% vs 2.3%). We examined whether baseline echocardiographic and clinical characteristics could identify those who will develop moderate/severe recurrent mitral regurgitation or die. Our analysis includes 116 patients who were randomized to and received mitral valve repair. Logistic regression was used to estimate a model-based probability of recurrence or death from baseline factors. Receiver operating characteristic curves were constructed from these estimated probabilities to determine classification cut-points maximizing accuracy of prediction based on sensitivity and specificity. Of the 116 patients, 6 received a replacement before leaving the operating room; all other patients had mild or less mitral regurgitation on intraoperative echocardiogram after repair. During the 2-year follow-up period, 76 patients developed moderate/severe mitral regurgitation or died (53 mitral regurgitation recurrences, 13 mitral regurgitation recurrences and death, and 10 deaths). The mechanism for recurrent mitral regurgitation was largely mitral valve leaflet tethering. Our model (including age, body mass index, sex, race, effective regurgitant orifice area, basal aneurysm/dyskinesis, New York Heart Association class, history of coronary artery bypass grafting, percutaneous coronary intervention, or ventricular arrhythmias) yielded an area under the receiver operating characteristic curve of 0.82. The model demonstrated good discrimination in identifying patients who will survive 2 years without recurrent mitral regurgitation after mitral valve repair. Although our

  15. Doppler and the Doppler Effect.

    DTIC Science & Technology

    1984-06-01

    Doppler Applications Doppler Effect Roemer Doppler Principle Bradley Relative motion Velocity History Light Velocity 20. ABSTRACT (Continue on reverse...of Colorado, Boulder, CO 11-14 Jan 1984 5 1. Historical Background The astronomer Olaf Roemer determined the velocity of light in 1676 from time...approached Jupiter and longer when it receded from Jupiter. In effect, Roemer used a Doppler method in determining the velocity of light . [2 ] In 1727

  16. Lipomatous hamartoma of mitral valve.

    PubMed

    Bhat, Seetharama P S; Gowda, Girish S L; Chikkatur, Raghavendra; Nanjappa, Manjunath C

    2016-01-01

    Primary cardiac tumors are very rare, and tumors arising from cardiac valves are extremely rare. We present a case of lipomatous hamartoma of the mitral valve in a young female. This is the 6th case of lipomatous hamartoma of the mitral valve to be reported. We discuss the operative and histopathological findings.

  17. The Diagnosis of Mitral Stenosis

    PubMed Central

    Munroe, D. S.; Rally, C. R.

    1963-01-01

    The diagnosis of classical mitral stenosis is easy, but many pitfalls lead to over-diagnosis or under-diagnosis. These have been considered in detail and variations in symptoms and signs have been illustrated by case histories. Such variations include: (1) Embolism producing the Leriche syndrome; (2) mitral stenosis with insignificant hemodynamic effect; (3) myxoma masquerading as mitral stenosis; (4) mitral stenosis without apical murmurs, and (5) mitral stenosis with a systolic murmur predominant or alone. In cases of combined mitral and aortic stenosis, the history, radiographic configuration, and incidence of hemoptysis, edema, bronchitis, embolism and atrial fibrillation resemble such findings in cases of isolated mitral stenosis, but the auscultatory signs of the latter may be obscured. The degree of aortic stenosis is difficult to determine in cases of combined stenosis. In the diagnosis of re-stenosis the condition of the valve at the first commissurotomy, the precise procedure performed and the degree of regurgitation produced are of prime importance. Congenital mitral stenosis is rare and is associated with a high incidence of other defects. PMID:13936649

  18. Evaluation of mitral valve replacement anchoring in a phantom

    NASA Astrophysics Data System (ADS)

    McLeod, A. Jonathan; Moore, John; Lang, Pencilla; Bainbridge, Dan; Campbell, Gordon; Jones, Doug L.; Guiraudon, Gerard M.; Peters, Terry M.

    2012-02-01

    Conventional mitral valve replacement requires a median sternotomy and cardio-pulmonary bypass with aortic crossclamping and is associated with significant mortality and morbidity which could be reduced by performing the procedure off-pump. Replacing the mitral valve in the closed, off-pump, beating heart requires extensive development and validation of surgical and imaging techniques. Image guidance systems and surgical access for off-pump mitral valve replacement have been previously developed, allowing the prosthetic valve to be safely introduced into the left atrium and inserted into the mitral annulus. The major remaining challenge is to design a method of securely anchoring the prosthetic valve inside the beating heart. The development of anchoring techniques has been hampered by the expense and difficulty in conducting large animal studies. In this paper, we demonstrate how prosthetic valve anchoring may be evaluated in a dynamic phantom. The phantom provides a consistent testing environment where pressure measurements and Doppler ultrasound can be used to monitor and assess the valve anchoring procedures, detecting pararvalvular leak when valve anchoring is inadequate. Minimally invasive anchoring techniques may be directly compared to the current gold standard of valves sutured under direct vision, providing a useful tool for the validation of new surgical instruments.

  19. Application of the flow convergence region method to the determination of stroke volume and cardiac output in patients with mitral stenosis.

    PubMed

    Horibe, N; Matsumoto, M; Deng, Y B

    1996-04-01

    This study was undertaken to investigate the feasibility and accuracy of determination of stroke volume and cardiac output by calculating transmitral flow volume using the flow convergence region method in patients with mitral stenosis. Fifty-six patients with rheumatic mitral stenosis were studied using imaging and Doppler echocardiography. Aliasing velocities of 20 to 23 cm/s were used to record the flow vonvergence region proximal to the stenotic mitral orifice. The stroke volume (mL) was calculated by multiplying peak transmitral flow rate which was obtained using an angle-corrected hemispheric flow convergence equation, by transmitral velocity time integral (cm) divided by peak transmitral velocity (cm/s) recorded using continuous wave Doppler method. Stroke volume calculated using the flow convergence region method was not significantly different from that calculated using aortic Doppler two-dimensional echocardiographic method in 39 patients with pure mitral stenosis (75+/-19 [mean+/-1SD] versus 73+/-19 mL, P=0.12), and from that calculated using pulmonic Doppler two-dimensional echocardiographic method in nine patients with mitral stenosis with associated>2+ aortic regurgitation (77+/-12 versus 75+/-14 mL, P=0.49). No significant difference existed between the cardiac output obtained using the flow convergence region method and that obtained using Fick method in 12 patients with pure mitral stenosis. The stroke volume was overestimated by the flow convergence region method when compared with those obtained using aortic Doppler two-dimensional echocardiographic method in patients with mitral stenosis with associated >2+ mitral regurgitation (123+/-40 versus 67+/-15 mL, P=0.001). The present study provided an alternative way to calculate the stroke volume and cardiac output in patients with mitral stenosis.

  20. Floppy Mitral Valve (FMV) - Mitral Valve Prolapse (MVP) - Mitral Valvular Regurgitation and FMV/MVP Syndrome.

    PubMed

    Boudoulas, Konstantinos Dean; Pitsis, Antonios A; Boudoulas, Harisios

    2016-01-01

    Mitral valve prolapse (MVP) results from the systolic movement of a portion(s) or segment(s) of the mitral valve leaflet(s) into the left atrium during left ventricular (LV) systole. It should be emphasised that MVP alone, as defined by imaging techniques, may comprise a non-specific finding because it also depends on the LV volume, myocardial contractility and other LV hemodynamics. Thus, a floppy mitral valve (FMV) should be the basis for the diagnosis of MVP. Two types of symptoms may be defined in these patients. In one group, symptoms are directly related to progressive mitral regurgitation and its complications. In the other group, symptoms cannot be explained only by the degree of mitral regurgitation alone; neuroendocrine dysfunction has been implicated for the explanation of symptoms in this group of patients that today is referred as the FMV/MVP syndrome. When significant mitral regurgitation is present in a patient with FMV/MVP, surgical intervention is recommended. In patients with a prohibitive risk for surgery, transcatheter mitral valve repair using a mitraclip device may be considered. Furthermore, transcatheter mitral valve replacement may represent an option in the near future as clinical trials are underway. In this brief review, the current concepts related to FMV/MVP and FMV/MVP syndrome will be discussed.

  1. Mitral Valve Annuloplasty

    PubMed Central

    Rausch, Manuel K.; Bothe, Wolfgang; Kvitting, John-Peder Escobar; Swanson, Julia C.; Miller, D. Craig; Kuhl, Ellen

    2012-01-01

    Mitral valve annuloplasty is a common surgical technique used in the repair of a leaking valve by implanting an annuloplasty device. To enhance repair durability, these devices are designed to increase leaflet coaptation, while preserving the native annular shape and motion; however, the precise impact of device implantation on annular deformation, strain, and curvature is unknown. Here we quantify how three frequently used devices significantly impair native annular dynamics. In controlled in vivo experiments, we surgically implanted eleven flexible-incomplete, eleven semi-rigid-complete, and twelve rigid-complete devices around the mitral annuli of 34 sheep, each tagged with 16 equally-spaced tantalum markers. We recorded four-dimensional marker coordinates using biplane videofluoroscopy, first with device and then without, which were used to create mathematical models using piecewise cubic splines. Clinical metrics (characteristic anatomical distances) revealed significant global reduction in annular dynamics upon device implantation. Mechanical metrics (strain and curvature fields) explained this reduction via a local loss of anterior dilation and posterior contraction. Overall, all three devices unfavorably reduced annular dynamics. The flexible-incomplete device, however, preserved native annular dynamics to a larger extent than the complete devices. Heterogeneous strain and curvature profiles suggest the need for heterogeneous support, which may spawn more rational design of annuloplasty devices using design concepts of functionally graded materials. PMID:22037916

  2. Application of FFT analyzed cardiac Doppler signals to fuzzy algorithm.

    PubMed

    Güler, Inan; Hardalaç, Firat; Barişçi, Necaattin

    2002-11-01

    Doppler signals, recorded from the output of tricuspid, mitral, and aorta valves of 60 patients, were transferred to a personal computer via 16-bit sound card. The fast Fourier transform (FFT) method was applied to the recorded signal from each patient. Since FFT method inherently cannot offer a good spectral resolution at highly turbulent blood flows, it sometimes leads to wrong interpretation of cardiac Doppler signals. In order to avoid this problem, firstly six known diseased heart signals such as hypertension, mitral stenosis, mitral failure, tricuspid stenosis, aorta stenosis, aorta insufficiency were introduced to fuzzy algorithm. Then, the unknown heart diseases from 15 patients were applied to the same fuzzy algorithm in order to detect the kinds of diseases. It is observed that the fuzzy algorithm gives true results for detecting the kind of diseases.

  3. Mitral valve surgery - minimally invasive

    MedlinePlus

    ... 2 centimeters) each. The surgeon uses a special computer to control robotic arms during the surgery. A ... heart and mitral valve are displayed on a computer in the operating room. You will need a ...

  4. Mitral Valve Prolapse (For Parents)

    MedlinePlus

    ... Atrial Septal Defect Ventricular Septal Defect Heart and Circulatory System Congenital Heart Defects Getting an EKG (Video) Your Heart & Circulatory System Heart Murmurs Marfan Syndrome Mitral Valve Prolapse EKG ( ...

  5. Mitral Valve Prolapse (For Parents)

    MedlinePlus

    ... be cleared by the doctor to participate in sports. This may involve some additional tests. Although any heart condition can be frightening, mitral valve prolapse likely will not have any effect on your child's everyday life and activities. If ...

  6. Mitral Annular Systolic Velocities Predict Left Ventricular Wall Motion Abnormality During Dobutamine Stress Echocardiography

    PubMed Central

    Sharif, Dawod; Sharif-Rasslan, Amal; Shahla, Camilia

    2011-01-01

    Background Longitudinal systolic left ventricular contraction is complementary to the radial performance and can be assessed using tissue Doppler imaging (TDI). This study was performed to evaluate the contribution of mitral annular systolic velocities using TDI after dobutamine stress echocardiography (DSE). Methods and Results Fifty subjects with suspected coronary artery disease and chest pain were examined, using DSE as usual, as well as TDI imaging of the mitral annulus at the septal, lateral, inferior, anterior, posterior regions and the proximal anteroseptal region from the apical views, before and immediately after DSE. In 24 subjects the study was normal, while wall motion abnormality was seen in 26, 9 of them only after DSE. Mitral annular systolic velocity at the 6 locations increased significantly after DSE both in normal subjects and in those with wall motion abnormality (WMA). After DSE mitral annular septal systolic velocity in normals, 19.2 ± 3.8 cm/sec, was higher than in those with WMA, 14.6 ± 2.5 cm/sec, P < 0.0003. Post-DSE mitral systolic velocity was senstive and accurate in predicting WMA. Conclusions Systolic mitral TDI velocities increase after DSE, however to a lesser extent in those with wall motion abnormality, and can differentiate them from normal subjects.

  7. Doppler echocardiography

    SciTech Connect

    Labovitz, A.J.; Williams, G.A.

    1988-01-01

    The authors are successful in presenting a basic book on clinical quantitative Doppler echocardiography. It is not intended to be a comprehensive text, but it does cover clinical applications in a succinct fashion. Only the more common diseases in the adult are considered. The subjects are presented logically and are easy to comprehend. The illustrations are good, and the book is paperbound. The basic principles of Doppler echocardiography are presented briefly. The book ends with chapters on left ventricular function (stroke volume and cardiac output), congenital heart disease, and color Doppler echo-cardiography. There are numerous references and a good glossary and index.

  8. Measurement of aortic regurgitation by Doppler echocardiography.

    PubMed Central

    Zhang, Y; Nitter-Hauge, S; Ihlen, H; Rootwelt, K; Myhre, E

    1986-01-01

    In an attempt to develop a new approach to the non-invasive measurement of aortic regurgitation, transmitral volumetric flow (MF) and left ventricular total stroke volume (SV) were measured by Doppler and cross sectional echocardiography in 23 patients without aortic valve disease (group A) and in 26 patients with aortic regurgitation (group B). The transmitral volumetric flow was obtained by multiplying the corrected mitral orifice area by the diastolic velocity integral, and the left ventricular total stroke volume was derived by subtracting the left ventricular end systolic volume from the end diastolic volume. The aortic regurgitant fraction (RF) was calculated as: RF = 1 - MF/SV. In group A there was a close agreement between the transmitral volumetric flow and the left ventricular total stroke volume, and the difference between the two measurements did not differ significantly from zero. In group B the left ventricular total stroke volume was significantly larger than the transmitral volumetric flow, and there was good agreement between the regurgitant fractions determined by Doppler echocardiography and radionuclide ventriculography. Discrepancies between the two techniques were found in patients with combined aortic and mitral regurgitation or a low angiographic left ventricular ejection fraction (less than 35%). The effective cardiac output measured by Doppler echocardiography accorded well with that measured by the Fick method. Doppler echocardiography provides a new and promising approach to the non-invasive measurement of aortic regurgitation. PMID:3947478

  9. Doppler tissue imaging for assessing left ventricular diastolic dysfunction in heart transplant rejection

    PubMed Central

    Stengel, S; Allemann, Y; Zimmerli, M; Lipp, E; Kucher, N; Mohacsi, P; Seiler, C

    2001-01-01

    OBJECTIVE—To test the hypothesis that diastolic mitral annular motion velocity, as determined by Doppler tissue imaging and left ventricular diastolic flow propagation velocity, is related to the histological degree of heart transplant rejection according to the International Society of Heart and Lung Transplantation (ISHLT).
METHODS—In 41 heart transplant recipients undergoing 151 myocardial biopsies, the following Doppler echocardiographic measurements were performed within one hour of biopsy: transmitral and pulmonary vein flow indices; mitral annular motion velocity indices; left ventricular diastolic flow propagation velocity.
RESULTS—Late diastolic mitral annular motion velocity (ADTI) and mitral annular systolic contraction velocity (SCDTI) were higher in patients with ISHLT < IIIA than in those with ISHLT ⩾ IIIA (ADTI, 8.8 cm/s v 7.7 cm/s (p = 0.03); SCDTI, 19.3 cm/s v 9.3 cm/s (p < 0.05)). Sensitivity and specificity of ADTI < 8.7 cm/s (the best cut off value) in predicting significant heart transplant rejection were 82% and 53%, respectively. Early diastolic mitral annular motion velocity (EDTI) and flow propagation velocity were not related to the histological degree of heart transplant rejection.
CONCLUSIONS—Doppler tissue imaging of the mitral annulus is useful in diagnosing heart transplant rejection because a high late diastolic mitral annular motion velocity can reliably exclude severe rejection. However, a reduced late diastolic mitral annular motion velocity cannot predict severe rejection reliably because it is not specific enough.


Keywords: heart transplant rejection; diastolic function; Doppler tissue imaging; echocardiography PMID:11559685

  10. Aortic or Mitral Valve Replacement With the Biocor and Biocor Supra

    ClinicalTrials.gov

    2016-03-09

    Aortic Valve Insufficiency; Aortic Valve Regurgitation; Aortic Valve Stenosis; Aortic Valve Incompetence; Mitral Valve Insufficiency; Mitral Valve Regurgitation; Mitral Valve Stenosis; Mitral Valve Incompetence

  11. [Mitral valve repair with the MitraClip following surgical mitral annuloplasty failure].

    PubMed

    Picard, F; Tadros, V-X; Millán, X; Asgar, A W

    2016-10-28

    Mitral repair using the MitraClip device is on ongoing expansion and has been evaluated in different patterns of mitral regurgitation. Nevertheless, surgical approaches to mitral regurgitation remain the standard of care, at least in absence of contraindication. We report the first Canadian experience of mitral valve repair with the MitraClip following surgical mitral annuloplasty failure. Therapeutic considerations and potential challenges are discussed.

  12. Minimally Invasive Mitral Valve Surgery II

    PubMed Central

    Wolfe, J. Alan; Malaisrie, S. Chris; Farivar, R. Saeid; Khan, Junaid H.; Hargrove, W. Clark; Moront, Michael G.; Ryan, William H.; Ailawadi, Gorav; Agnihotri, Arvind K.; Hummel, Brian W.; Fayers, Trevor M.; Grossi, Eugene A.; Guy, T. Sloane; Lehr, Eric J.; Mehall, John R.; Murphy, Douglas A.; Rodriguez, Evelio; Salemi, Arash; Segurola, Romualdo J.; Shemin, Richard J.; Smith, J. Michael; Smith, Robert L.; Weldner, Paul W.; Lewis, Clifton T. P.; Barnhart, Glenn R.; Goldman, Scott M.

    2016-01-01

    Abstract Techniques for minimally invasive mitral valve repair and replacement continue to evolve. This expert opinion, the second of a 3-part series, outlines current best practices for nonrobotic, minimally invasive mitral valve procedures, and for postoperative care after minimally invasive mitral valve surgery. PMID:27654406

  13. MitraClip Therapy for Mitral Regurgitation: Secondary Mitral Regurgitation.

    PubMed

    Feldman, Ted; Mehta, Arjun; Guerrero, Mayra; Levisay, Justin P; Salinger, Michael H

    2016-01-01

    Therapy for mitral regurgitation (MR) has been synonymous with mitral valve surgery. Operative approaches for degenerative MR repair have been associated with excellent results, with durable long term outcomes. Surgery for functional MR has been less successful. MitraClip has shown promise for functional MR, especiall in patinets who are high risk for surgery. The aggregate of nonrandomized global experience with MitraClip in functional MR has been consistent in showing improvements in symptoms and left ventricular remodeling. It remains to be seen how MitraClip therapy will compare with best medical therapy. The COAPT trial will clarify this question.

  14. Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease.

    PubMed

    David, Tirone E

    2015-09-01

    Degenerative diseases of the mitral valve (MV) are the most common cause of mitral regurgitation in the Western world and the most suitable pathology for MV repair. Several studies have shown excellent long-term durability of MV repair for degenerative diseases. The best follow-up results are obtained with isolated prolapse of the posterior leaflet, however even with isolated prolapse of the anterior leaflet or prolapse of both leaflets the results are gratifying, particularly in young patients. The freedom from reoperation on the MV at 15 years exceeds 90% for isolated prolapse of the posterior leaflet and it is around 70-85% for prolapse of the anterior leaflet or both leaflets. The degree of degenerative change in the MV also plays a role in durability of MV repair. Most studies have used freedom from reoperation to assess durability of the repair but some studies that examined valve function late after surgery suggest that recurrent mitral regurgitation is higher than estimated by freedom from reoperation. We can conclude that MV repair for degenerative mitral regurgitation is associated with low probability of reoperation for up to two decades after surgery. However, almost one-third of the patients develop recurrent moderate or severe mitral regurgitation suggesting that surgery does not arrest the degenerative process.

  15. Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease

    PubMed Central

    2015-01-01

    Degenerative diseases of the mitral valve (MV) are the most common cause of mitral regurgitation in the Western world and the most suitable pathology for MV repair. Several studies have shown excellent long-term durability of MV repair for degenerative diseases. The best follow-up results are obtained with isolated prolapse of the posterior leaflet, however even with isolated prolapse of the anterior leaflet or prolapse of both leaflets the results are gratifying, particularly in young patients. The freedom from reoperation on the MV at 15 years exceeds 90% for isolated prolapse of the posterior leaflet and it is around 70-85% for prolapse of the anterior leaflet or both leaflets. The degree of degenerative change in the MV also plays a role in durability of MV repair. Most studies have used freedom from reoperation to assess durability of the repair but some studies that examined valve function late after surgery suggest that recurrent mitral regurgitation is higher than estimated by freedom from reoperation. We can conclude that MV repair for degenerative mitral regurgitation is associated with low probability of reoperation for up to two decades after surgery. However, almost one-third of the patients develop recurrent moderate or severe mitral regurgitation suggesting that surgery does not arrest the degenerative process. PMID:26539345

  16. Occurrence of mitral valve insufficiency in clinically healthy Beagle dogs.

    PubMed

    Vörös, Károly; Szilvási, Viktória; Manczur, Ferenc; Máthé, Ákos; Reiczigel, Jenő; Nolte, Ingo; Hungerbühler, Stephan

    2015-12-01

    Chronic degenerative valve disease (CDVD) is the most common cardiac disease in dogs, usually resulting in mitral valve insufficiency (MVI). The goal of this study was to investigate the occurrence of MVI in clinically healthy Beagle populations. A total of 79 adult healthy Beagles (41 females and 38 males; age: 5.6 ± 2.7 years, range 1.4 to 11.7 years) were examined. The diagnosis of MVI was based on the detection of a systolic murmur heard above the mitral valve, and was confirmed by colour flow Doppler (CFD) echocardiography. Systolic mitral valve murmurs were detected in 20/79 dogs (25.3%), of them 11 males and 9 females with no statistically significant gender difference (P = 0.6059). The strength of the murmur on the semi-quantitative 0/6 scale yielded intensity grade 1/6 in 10 dogs, grade 2/6 in 4 dogs, and grade 3/6 in 6 dogs. Mild to moderate MVI was detected by CFD in all these 20 dogs with systolic murmurs. Of them, 17 dogs had mild and 3 demonstrated moderate MVI, showing 10-30% and 30-50% regurgitant jets compared to the size of the left atrium, respectively. The age of dogs with MVI was 7.1 ± 2.3 years, which was significantly different from that of dogs without MVI (5.1 ± 2.7 years, P = 0.0029). No significant differences in body weight (P = 0.1724) were found between dogs with MVI (13.8 ± 2.8 kg) and those without MVI (12.8 ± 3.0 kg). Mitral valve disease causing MVI is relatively common in Beagle dogs, just like in other small breed dogs reported in the literature.

  17. Mitral disc-valve variance

    PubMed Central

    Berroya, Renato B.; Escano, Fernando B.

    1972-01-01

    This report deals with a rare complication of disc-valve prosthesis in the mitral area. A significant disc poppet and struts destruction of mitral Beall valve prostheses occurred 20 and 17 months after implantation. The resulting valve incompetence in the first case contributed to the death of the patient. The durability of Teflon prosthetic valves appears to be in question and this type of valve probably will be unacceptable if there is an increasing number of disc-valve variance in the future. Images PMID:5017573

  18. Recent developments in percutaneous mitral valve treatment.

    PubMed

    La Canna, Giovanni; Denti, Paolo; Buzzatti, Nicola; Alfieri, Ottavio

    2016-01-01

    In recent years, various percutaneous techniques have been introduced for the treatment of mitral regurgitation (MR), including direct leaflet repair, annuloplasty and left ventricular remodeling. Percutaneous mitral repair targets both primary degenerative and secondary mitral valve regurgitation and may be considered in selected high-surgical-risk patients. The assessment of mitral functional anatomy by echocardiography and computed tomography is crucial when selecting the appropriate repair strategy, according to the regurgitant valve lesion and the surrounding anatomy. The ongoing clinical use of new devices in annuloplasty and percutaneous mitral valve replacement is a promising new scenario in the treatment of MR that goes beyond the conventional surgical approach.

  19. Finite Element Modeling of Mitral Valve Repair

    PubMed Central

    Morgan, Ashley E.; Pantoja, Joe Luis; Weinsaft, Jonathan; Grossi, Eugene; Guccione, Julius M.; Ge, Liang; Ratcliffe, Mark

    2016-01-01

    The mitral valve is a complex structure regulating forward flow of blood between the left atrium and left ventricle (LV). Multiple disease processes can affect its proper function, and when these diseases cause severe mitral regurgitation (MR), optimal treatment is repair of the native valve. The mitral valve (MV) is a dynamic structure with multiple components that have complex interactions. Computational modeling through finite element (FE) analysis is a valuable tool to delineate the biomechanical properties of the mitral valve and understand its diseases and their repairs. In this review, we present an overview of relevant mitral valve diseases, and describe the evolution of FE models of surgical valve repair techniques. PMID:26632260

  20. Diagnostic value of mitral annular velocity for constrictive pericarditis in the absence of respiratory variation in mitral inflow velocity.

    PubMed

    Ha, Jong-Won; Oh, Jae K; Ommen, Steve R; Ling, Lieng H; Tajik, A Jamil

    2002-12-01

    Respiratory variation of 25% or more in transmitral early diastolic filling (E) velocity is a well-recognized diagnostic feature of constrictive pericarditis (CP) that is useful for distinguishing it from restrictive cardiomyopathy. However, a subset of patients with CP do not exhibit the typical respiratory change. Recent data showed that mitral annular (E') velocity measured by Doppler tissue echocardiography (DTE) is markedly reduced in patients with restrictive cardiomyopathy whereas E' velocity is well-preserved in CP. This study evaluated the role of DTE for the diagnosis of CP when there is no characteristic respiratory variation of E velocity. From September 1999 to March 2001, 19 patients (17 men, 2 women; mean age, 57 +/- 13 years) with surgically confirmed CP underwent comprehensive echocardiography preoperatively, including pulsed wave and DTE examination with simultaneous recording of respiration. Nine (47%) of the 19 patients had less than 25% respiratory variation in E velocity. There was no significant difference in mitral inflow peak velocity, deceleration time, early-to-late ventricular filling ratio, and E' velocity between patients with and patients without respiratory variation of E velocity of 25% or more. Regardless of the presence or absence of a significant respiratory variation of E velocity, E' velocity was relatively normal (mean, 12 +/- 4 cm/s) in all patients with CP. In conclusion, E' velocity is well preserved in patients with isolated CP even when there is no characteristic respiratory variation of E velocity. Thus, when the respiratory variation in Doppler E velocity is blunted or absent during the evaluation of suspected CP in patients with restrictive mitral inflow velocity, preserved E' velocity shown by DTE should support the diagnosis of CP over a primary myocardial disease.

  1. Rare Case of Unileaflet Mitral Valve.

    PubMed

    Shah, Jainil; Jain, Tarun; Shah, Sunay; Mawri, Sagger; Ananthasubramaniam, Karthikeyan

    2016-06-01

    Unileaflet mitral valve is the rarest of the congenital mitral valve anomalies and is usually life threatening in infancy due to severe mitral regurgitation (MR). In most asymptomatic individuals, it is mostly due to hypoplastic posterior mitral leaflet. We present a 22-year-old male with palpitations, who was found to have an echocardiogram revealing an elongated anterior mitral valve leaflet with severely hypoplastic posterior mitral valve leaflet appearing as a unileaflet mitral valve without MR. Our case is one of the 11 reported cases in the literature so far. We hereby review those cases and conclude that these patients are likely to be at risk of developing worsening MR later in their lives.

  2. CMR predictors of mitral regurgitation in mitral valve prolapse.

    PubMed

    Delling, Francesca N; Kang, Lih Lisa; Yeon, Susan B; Kissinger, Kraig V; Goddu, Beth; Manning, Warren J; Han, Yuchi

    2010-10-01

    We sought to assess the correlation between mitral valve characteristics and severity of mitral regurgitation (MR) in subjects with mitral valve prolapse (MVP) undergoing cardiac magnetic resonance (CMR) imaging. Compared with extensive echocardiographic studies, CMR predictors of MVP-related MR are unknown. The severity of MR at the time of diagnosis has prognostic implication for patients; therefore, the identification of determinants of MR and its progression may be important for risk stratification, follow-up recommendations, and surgical decision making. Seventy-one MVP patients (age 54 ± 11 years, 58% males, left ventricular [LV] ejection fraction 65 ± 5%) underwent cine CMR to assess annular dimensions, maximum systolic anterior and posterior leaflet displacement, papillary muscle (PM) distance to coaptation point and prolapsed leaflets, as well as diastolic anterior and posterior leaflet thickness and length, and LV volumes and mass. Velocity-encoded CMR was used to obtain aortic outflow and to quantify MR volume. Using multiple linear regression analysis including all variables, LV mass (p < 0.001), anterior leaflet length (p = 0.006), and posterior displacement (p = 0.01) were the best determinants of MR volume with a model-adjusted R(2) = 0.6. When the analysis was restricted to valvular characteristics, MR volume correlated with anterior mitral leaflet length (p < 0.001), posterior mitral leaflet displacement (p = 0.003), posterior leaflet thickness (p = 0.008), and the presence of flail (p = 0.005) with a model-adjusted R(2) = 0.5. We also demonstrated acceptable intraobserver and interobserver variability in these measurements. Anterior leaflet length, posterior leaflet displacement, posterior leaflet thickness, and the presence of flail are the best CMR valvular determinants of MVP-related MR. The acceptable intraobserver and interobserver variability of our measurements confirms the role of CMR as an imaging modality for assessment of MVP patients

  3. Echocardiographic Assessment of Degenerative Mitral Stenosis: A Diagnostic Challenge of an Emerging Cardiac Disease.

    PubMed

    Oktay, Ahmet Afşşin; Gilliland, Yvonne E; Lavie, Carl J; Ramee, Stephen J; Parrino, Patrick E; Bates, Michael; Shah, Sangeeta; Cash, Michael E; Dinshaw, Homeyar; Qamruddin, Salima

    2017-03-01

    Degenerative mitral stenosis (DMS) is characterized by decreased mitral valve (MV) orifice area and increased transmitral pressure gradient due to chronic noninflammatory degeneration and subsequent calcification of the fibrous mitral annulus and the MV leaflets. The "true" prevalence of DMS in the general population is unknown. DMS predominantly affects elderly individuals, many of whom have multiple other comorbidities. Transcatheter MV replacement techniques, although their long-term outcomes are yet to be tested, have been gaining popularity and may emerge as more effective and relatively safer treatment option for patients with DMS. Echocardiography is the primary imaging modality for evaluation of DMS and related hemodynamic abnormalities such as increased transmitral pressure gradient and pulmonary arterial pressure. Classic echocardiographic techniques used for evaluation of mitral stenosis (pressure half time, proximal isovelocity surface area, continuity equation, and MV area planimetry) lack validation for DMS. Direct planimetry with 3-dimensional echocardiography and color flow Doppler is a reasonable technique for determining MV area in DMS. Cardiac computed tomography is an essential tool for planning potential interventions or surgeries for DMS. This article reviews the current concepts on mitral annular calcification and its role in DMS. We then discuss the epidemiology, natural history, differential diagnosis, mechanisms, and echocardiographic assessment of DMS.

  4. [Homografts for mitral valve replacement in florid endocarditis--an alternative to prosthetic replacement].

    PubMed

    Gulbins, H; Kreuzer, E; Haushofer, M; Uhlig, A; Reichart, B

    1999-05-01

    Homografts for valve replacement are indicated in acute valve endocarditis. It is assumed that they possess anti-infective properties. Homografts are an established indication in aortic valve replacement. We present our early results with homografts for mitral valve replacement in acute endocarditis. Between July 1996 and March 1998 we used cryopreserved homografts for mitral valve replacement in seven patients. In three cases (age 24, 42, and 34 years) the indication was an acute endocarditis with subsequent severe mitral valve insufficiency. The size of the required homograft was measured preoperatively using transesophageal echocardiography. For implantation the technique described by A. Carpentier was used; for stabilization of the mitral anulus a valvular ring (Physio) was implanted. Follow-up was done every six months including clinical and echocardiographical examinations. After the first postoperative year an Ultrafast-CT was done in addition. One patient had complete mitral valve replacement, in the other two cases the diseased parts of the valve were completely excised and the valve was repaired using a partial homograft. There were no perioperative deaths. In the follow-ups, up to 24 months of uneventful homograft function was documented by echocardiography; no insufficiency > degree I was seen on color Doppler echocardiography. At the last follow-up (mean follow-up 16 months, range 12 to 24 months) the average mitral valve orifice was 2.5 +/- 0.5 cm2, the mean pressure gradient 2.8 +/- 0.8 mm Hg. In Ultrafast-CT no morphological abnormalities of the mitral valves and no dilatation of the left ventricle were seen. There were no signs of a recurrence of the endocarditis in any patient during the follow-up period. Homografts for mitral valve replacement are an interesting alternative to prosthetic valve replacement, especially in younger patients. In cases with acute endocarditis, in which mechanical prosthesis should not be used, a reconstruction or

  5. Two-dimensional echocardiographic determination of left atrial emptying volume: a noninvasive index in quantifying the degree of nonrheumatic mitral regurgitation.

    PubMed

    Ren, J F; Kotler, M N; DePace, N L; Mintz, G S; Kimbiris, D; Kalman, P; Ross, J

    1983-10-01

    Several noninvasive techniques, including radionuclide angiography and Doppler echocardiography, have attempted to measure the regurgitant volume in patients with mitral regurgitation; however, none of these techniques are entirely satisfactory. Utilizing a computerized light pen method for tracing the left atrial endocardial border during systole and diastole in two orthogonal planes (apical four and two chamber views), biplane volume determinations were calculated in 12 normal subjects and 30 patients with nonrheumatic mitral regurgitation. Left atrial emptying volume determinations were performed by subtracting the left atrial end-diastolic volume from the left atrial end-systolic volume. The degree of mitral regurgitation was visually assessed as normal (0, trivial, Group I, 12 patients), mild (1+, Group II, 4 patients), moderate (2+, Group III, 8 patients), moderately severe (3+, Group IV, 12 patients) and severe (4+, Group V, 6 patients) by contrast left ventricular angiography and also quantitatively by regurgitant fraction at cardiac catheterization. All 18 patients with moderately severe (Group IV) and severe (Group V) mitral regurgitation had a left atrial emptying volume greater than 40 ml compared with none of the normal subjects and patients with mild (Group II) or moderate (Group III) mitral regurgitation. There was good correlation between left atrial emptying volume and mitral regurgitant fraction (r = 0.85, p less than 0.01). Thus, in patients with nonrheumatic mitral regurgitation, left atrial emptying volume is useful in separating mild from severe mitral regurgitation.

  6. Robotically assisted mitral valve replacement.

    PubMed

    Gao, Changqing; Yang, Ming; Xiao, Cangsong; Wang, Gang; Wu, Yang; Wang, Jiali; Li, Jiachun

    2012-04-01

    In the present study, we determined the safety and efficacy of robotic mitral valve replacement using robotic technology. From January 2007 through March 2011, more than 400 patients underwent various types of robotic cardiac surgery in our department. Of these, 22 consecutive patients underwent robotically assisted mitral valve replacement. Of the 22 patients with isolated rheumatic mitral valve stenosis (9 men and 13 women), the mean age was 44.7 ± 19.8 years (range, 32-65). Preoperatively, all patients underwent a complete workup, including coronary angiography and transthoracic echocardiography. Of the 22 patients, 15 had concomitant atrial fibrillation. The surgical approach was through 4 right-side chest ports with femoral perfusion. Aortic occlusion was performed with a Chitwood crossclamp, and antegrade cardioplegia was administered directly by way of the anterior chest. Using 3 port incisions in the right side of the chest and a 2.5- to 3.0-cm working port, all the procedures were completed with the da Vinci S robot. All patients underwent successful robotic surgery. Of the 22 patients, 16 received a mechanical valve and 6 a tissue valve. The mean cardiopulmonary bypass time and aortic crossclamp time was 137.1 ± 21.9 minutes (range, 105-168) and 99.3 ± 17.9 minutes (range, 80-133), respectively. No operative deaths, stroke, or other complications occurred, and no incisional conversions were required. After surgery, all the patients were followed up echocardiographically. Robotically assisted mitral valve replacement can be performed safely in patients with isolated mitral valve stenosis, and surgical results are excellent. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  7. Early Clinical Outcome of Mitral Valve Replacement Using a Newly Designed Stentless Mitral Valve for Failure of Initial Mitral Valve Repair.

    PubMed

    Nishida, Hidefumi; Kasegawa, Hitoshi; Kin, Hajime; Takanashi, Shuichiro

    2016-12-21

    Here we report the early outcome of mitral valve replacement using a newly designed stentless mitral valve for failure of initial mitral valve repair. Mitral valve plasty (MVP) for mitral regurgitation is currently a standard technique performed worldwide. However, whether mitral valve repair should be performed for patients with advanced leaflet damage or complicated pathology remains controversial. Mitral valve replacement might be feasible for patients who have undergone failed initial MVP; however, it is not an optimal treatment because of poor valve durability and the need for anticoagulative therapy. We report two cases of successful mitral valve replacement using a newly designed stentless mitral valve made of fresh autologous pericardium, which may have a potential benefit over mitral valve repair or mitral valve replacement with a mechanical or bioprosthetic valve.

  8. Mitral valve plasty for mitral regurgitation after blunt chest trauma.

    PubMed

    Kumagai, H; Hamanaka, Y; Hirai, S; Mitsui, N; Kobayashi, T

    2001-06-01

    A 21 year-old woman was admitted to our hospital because of chest and back pain after blunt chest trauma. On admission, consciousness was clear and a physical examination showed labored breathing. Her vital signs were stable, but her breathing gradually worsened, and artificial respiration was started. The chest roentgenogram and a subsequent chest computed tomographic scans revealed contusions, hemothorax of the left lung and multiple rib fractures. A transthoracic echocardiography (TTE) revealed normal left ventricular wall motion and mild mitral regurgitation (MR). TTE was carried out repeatedly, and revealed gradually progressive MR and prolapse of the posterior medial leaflet, although there was no congestive heart failure. After her general condition had recovered, surgery was performed. Intraoperative transesophageal echocardiography (TEE) revealed torn chordae at the posterior medial leaflet. The leaflet where the chorda was torn was cut and plicated, and posterior mitral annuloplasty was performed using a prosthetic ring. One month later following discharge, the MR had disappeared on TTE.

  9. [Determination of cardiac output by Doppler ultrasonics. Principle, techniques and limitations].

    PubMed

    Tribouilloy, C; Caze, F; Rey, J L; Marek, A; Quere, J P; Dufosse, H; Lesbre, J P

    1991-10-01

    The development of quantitative applications of Doppler ultrasound for the measurement of cardiac output was a lengthy and difficult process. These applications call for rigor of the part of the ultrasound cardiographer and a sufficiently echoic patient. Numerous studies have demonstrated the reliability of Doppler ultrasound in determining aortic flow. A high degree of consensus has emerged for measuring aortic areas and velocities at the ring. Doppler ultrasound quantification of the pulmonary flow has been validated in children. In adults, measurement of the pulmonary ring is often difficult and may lead to major errors in the estimation of the flow rates. The determination of mitral flow is also possible, either at the ring or at the tip of the mitral funnel. A few publications highlight the value of Doppler ultrasound in evaluation of tricuspid flow, however, these results require confirmation.

  10. Mitral Valve Replacement After Failed Mitral Ring Insertion With or Without Leaflet/Chordal Repair for Pure Mitral Regurgitation.

    PubMed

    Roberts, William C; Moore, Meagan; Ko, Jong Mi; Hamman, Baron L

    2016-06-01

    Mitral repair operations for correction of pure mitral regurgitation (MR) are generally quite successful. Occasionally, however, the reparative procedure incompletely corrects the MR or the MR recurs. From March 1993 to January 2016, twenty nine patients had mitral valve replacement after the initial mitral repair operation, and observations in them were analyzed. All 29 patients at the repair operation had an annular ring inserted and later (<1 year in 6 and >1 year in 21) mitral valve replacement. The cause of the MR before the repair operation appears to have been prolapse in 16 patients (55%), secondary (functional) in 12 (41%) (ischemic in 5), and infective endocarditis which healed in 1 (3%). At the replacement operation the excised anterior mitral leaflet was thickened in all 29 patients. Some degree of stenosis appeared to have been present in 16 of the 29 patients before the replacement operation, although only 10 had an echocardiographic or hemodynamic recording of a transvalvular gradient; at least 11 patients had restricted motion of the posterior mitral leaflet; 10, ring dehiscence; 2, severe hemolysis; and 2, left ventricular outflow obstruction. In conclusion, there are multiple reasons for valve replacement after earlier mitral repair. Uniformly, at the time of the replacement, the mitral leaflets were thickened by fibrous tissue. Measurement of the area enclosed by the 360° rings and study of the excised leaflet suggest that the ring itself may have contributed to the leaflet scarring and development of some transmitral stenosis.

  11. Effect of food intake on commonly used pulsed Doppler and tissue Doppler measurements.

    PubMed

    Dencker, Magnus; Björgell, Ola; Hlebowicz, Joanna

    2011-09-01

    This study evaluates the effect of food intake on commonly used pulsed Doppler and tissue Doppler measurements. Twenty-three healthy subjects aged 25.6 ± 4.5 years were investigated. A wide selection of pulsed Doppler and tissue Doppler variables were measured before a standardized meal as well as and 30 and 110 minutes afterwards. The following variables increased significantly (P < 0.05) 30 minutes after food intake: left ventricular stroke volume, left ventricular cardiac output, left ventricular outflow velocity-time integral, peak of early diastolic (E) and late diastolic (A) mitral flow velocities, pulmonary vein peak velocities in systole (S) and in diastole (D), S/D, pulsed tissue Doppler peak systolic velocities, and late diastolic velocities. Deceleration time of E-wave decreased significantly (P < 0.05). The change in measured variables between fasting and 30 minutes after the food intake ranged from 7% to 28%. There were no significant (P > 0.05) changes in E/A, early diastolic tissue Doppler velocities (e'), and E/e'. Most, but not all variables returned to baseline values 110 minutes after food intake. This study shows that food intake affects several echocardiographic variables used to routinely assess diastolic function and hemodynamics. Further studies are warranted in older healthy subjects and in patients with various cardiac diseases to determine whether the findings are reproducible in such populations. © 2011, Wiley Periodicals, Inc.

  12. Successful balloon mitral valvotomy in a rare coexistence of Ebstein's anomaly and rheumatic mitral stenosis.

    PubMed

    Sidhu, Navdeep Singh; Kondethimmanahally Rangaiah, Sunil Kumar; Ramesh, Dwarikaprasad; Manjunath, Cholenahally Nanjappa

    2016-05-05

    Co-existence of Ebstein's anomaly of the tricuspid valve with rheumatic mitral stenosis is a very rare occurrence. We report the case of a young man who presented with progressive dyspnoea and was found to have rheumatic mitral stenosis with pulmonary hypertension and Ebstein's anomaly of the tricuspid valve. The patient underwent successful balloon mitral valvotomy resulting in marked improvement of symptoms.

  13. Incremental value of combining systolic mitral annular velocity and time difference between mitral inflow and diastolic mitral annular velocity to early diastolic annular velocity for differentiating constrictive pericarditis from restrictive cardiomyopathy.

    PubMed

    Choi, Eui-Young; Ha, Jong-Won; Kim, Jin-Mi; Ahn, Jeong-Ah; Seo, Hye-Sun; Lee, Jee-Hyun; Rim, Se-Joong; Chung, Namsik

    2007-06-01

    Although normal or exaggerated early diastolic mitral annular velocity (E') provides an excellent specificity for differentiating constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM), its sensitivity has been shown to be lower, especially in patients with CP who had underlying myocardial abnormality. This study sought to evaluate the incremental value of systolic mitral annular velocity (S') and time difference between onset of mitral inflow and onset of E' (T(E'-E)) for differentiation between CP and RCM. This study included 44 participants (28 male, 16 female; mean age 47 years, range 10-76): 17 patients with CP, 12 with RCM, and 15 control subjects. Standard mitral inflow Doppler and tissue Doppler echocardiography were performed. E' (9.5 +/- 1.7 vs 4.7 +/- 1.6 cm/s, P < .001) and S' (7.7 +/- 1.3 vs 4.6 +/- 1.9 cm/s, P < .001) were significantly higher, whereas T(E'-E) (21.0 +/- 32.0 vs 53.1 +/- 30.4 milliseconds, P = .02) was significantly shorter in patients with CP than with RCM. Diagnostic accuracy of E' for differentiation of CP from RCM was higher than S' or T(E'-E) (area under curve 0.99 vs 0.87 vs 0.74, respectively). E' of 8 cm/s had excellent specificity (100%) for differentiation of CP from RCM but sensitivity (70%) was relatively low. However, when combining E' with S' and T(E'-E), the sensitivity could be increased when compared with E' alone (70% with E', 88% with E' + S', and 94% with E' + S' + T(E'-E)), P = .001). In conclusion, the measurement of S' and T(E'-E) can be helpful for differentiating between CP and RCM by providing incremental diagnostic information to E'.

  14. [Immediate Results of Mitral Valve Surgery in Asymptomatic Patients With Severe Mitral Regurgitation Due to Degenerative Mitral VaIve Disease].

    PubMed

    Nazarov, V M; Afanasyev, A V; Zheleznev, S I; Bogachev-Prokophiev, A V; Demin, I I; Karaskov, A M

    2015-01-01

    Degenerative mitral valve disease nowadays is the most common cause of mitral insufficiency in developed countries and is associated with high morbidity and mortality. In the last decades repairing the mitral valve has become the operation of choice for treatment of the mitral valve prolapse, enabling to improve the geometry and function of the left ventricle and long-term survival. Nevertheless, the problem of choice of method of management of severe mitral regurgitation in asymptomatic patients with degenerative mitral valve disease remains unsolved. In this article we present immediate results of a prospective comparative study of mitral valve surgery in asymptomatic and symptomatic patients in dependence on NYHA class of heart failure.

  15. A complex transcatheter mitral valve replacement and repair for the treatmemt of refractory severe mitral regurgitation.

    PubMed

    Condado, Jose F; Babaliaros, Vasilis C; Thourani, Vinod H; Jensen, Hanna K; Kim, Dennis W; Kaebnick, Brian W; Block, Peter C; Lerakis, Stamatios

    2017-01-23

    Hybrid transcatheter Mitral Valve-in-Ring and Mitral Valve-in-Valve procedures can be an alternative to traditional surgical valve replacement in patients with high surgical risk. We present a case of a 65-year-old male with recurrent severe mitral regurgitation (MR) that failed two traditional surgical attempts due to severe chest fibrosis. We performed a mitral valve-in ring replacement with a Sapien valve followed by a mitral valve-in-valve replacement with a Melody valve. Patient had a residual paravalvular leak that was closed with a vascular plug. Our case proves that is feasible to treat selected patients with MR using a hybrid transcatheter approach.

  16. Percutaneous Rescue for Critical Mitral Stenosis Late After Mitral Valve Repair.

    PubMed

    Salenger, Rawn; Diao, Xavier; Dawood, Murtaza Y; Herr, Daniel L; Sample, George A; Pichard, Augusto; Gammie, James S

    2016-11-01

    We report a case of catastrophic hemodynamic compromise secondary to pannus ingrowth and severe mitral stenosis occurring years after repair of a nonrheumatic mitral valve. The initial repair included closure of a posterior leaflet cleft and implantation of an annuloplasty ring. We describe a hybrid treatment strategy for this severely compromised patient, which included initial placement of a right ventricular assist device followed by percutaneous balloon mitral valvuloplasty and, eventually, a definitive mitral valve reoperation. This case report reinforces the importance of routine clinical and echocardiographic follow-up for patients after mitral valve repair, and it includes the description of a novel therapeutic approach.

  17. A Remnant Mitral Subvalvular Apparatus Mimicking Aortic Valve Vegetation after Mitral Valve Replacement

    PubMed Central

    Kim, Hyun-Jin; Kim, Kyung-Hee; Choi, Jae-Sung; Kim, Jun-Sung; Kim, Myung-A

    2012-01-01

    Preservation of the subvalvular apparatus has the merits of postoperative outcomes during mitral valve replacement for mitral regurgitation. We performed mitral valve replacement with anterior and posterior leaflet chordal preservation in a 65-year-old woman. On the 2nd postoperative day, routine postoperative trans-thoracic echocardiography showed an unknown aortic subvalvular mobile mass. We report a case of a remnant mitral subvalvular apparatus detected by echocardiography after chordal preserving mitral valve replacement which was confused with postoperative aortic valve vegetation. PMID:22509443

  18. Successful treatment of double-orifice mitral stenosis with percutaneous balloon mitral commissurotomy.

    PubMed

    Patted, Suresh V; Halkati, Prabhu C; Ambar, Sameer S; Sattur, Ameet G

    2012-01-01

    Double-orifice mitral valve (DOMV) is an uncommon congenital anomaly, being present in 0.05% of the general population. The isolated occurrence of this anomaly is very rare and, to our knowledge, no data are currently available on the incidence of an isolated DOMV. A DOMV is characterized by a mitral valve with a single fibrous annulus with 2 orifices opening into the left ventricle (LV). Subvalvular structures, especially the tensor apparatus, invariably show various degrees of abnormality. It can substantially obstruct mitral valve inflow or cause mitral valve incompetence. We present a rare case of nineteen-year-old male who underwent percutaneous mitral balloon commissurotomy in stenotic DOMV.

  19. Doppler flowmeter

    DOEpatents

    Karplus, Henry H. B.; Raptis, Apostolos C.

    1983-01-01

    A Doppler flowmeter impulses an ultrasonic fixed-frequency signal obliquely into a slurry flowing in a pipe and a reflected signal is detected after having been scattered off of the slurry particles, whereby the shift in frequencies between the signals is proportional to the slurry velocity and hence slurry flow rate. This flowmeter filters the Doppler frequency-shift signal, compares the filtered and unfiltered shift signals in a divider to obtain a ratio, and then further compares this ratio against a preset fractional ratio. The flowmeter utilizes a voltage-to-frequency convertor to generate a pulsed signal having a determinable rate of repetition precisely proportional to the divergence of the ratios. The pulsed signal serves as the input control for a frequency-controlled low-pass filter, which provides thereby that the cutoff frequency of the filtered signal is known. The flowmeter provides a feedback control by minimizing the divergence. With the cutoff frequency and preset fractional ratio known, the slurry velocity and hence flow will also be determinable.

  20. Doppler flowmeter

    DOEpatents

    Karplus, H.H.B.; Raptis, A.C.

    1981-11-13

    A Doppler flowmeter impulses an ultrasonic fixed-frequency signal obliquely into a slurry flowing in a pipe and a reflected signal is detected after having been scattered off of the slurry particles, whereby the shift in frequencies between the signals is proportional to the slurry velocity and hence slurry flow rate. This flowmeter filters the Doppler frequency-shift signal, compares the filtered and unfiltered shift signals in a divider to obtain a ratio, and then further compares this ratio against a preset fractional ratio. The flowmeter utilizes a voltage-to-frequency convertor to generate a pulsed signal having a determinable rate of repetition precisely proportional to the divergence of the ratios. The pulsed signal serves as the input control for a frequency-controlled low-pass filter, which provides thereby that the cutoff frequency of the filtered signal is known. The flowmeter provides a feedback control by minimizing the divergence. With the cutoff frequency and preset fractional ratio known, the slurry velocity and hence flow will also be determinable.

  1. Percutaneous mitral valvotomy in rheumatic mitral stenosis: a new approach.

    PubMed Central

    Commeau, P; Grollier, G; Huret, B; Foucault, J P; Potier, J C

    1987-01-01

    Three patients with rheumatic mitral stenosis were treated with percutaneous mitral valvotomy. A Brockenbrough catheter was advanced transseptally into the left atrium and then into the left ventricle over a long guide wire. An angle wire loop retriever was advanced through a 10 Fr straight catheter via the femoral artery into the left ventricle. The retriever was used to catch the flexible end of the long guide wire. This end of the long guide wire was then drawn out of the right femoral artery by the retriever through the straight catheter. The straight catheter was left in the descending aorta; the Brockenbrough catheter was removed and a 7 Fr balloon catheter was introduced percutaneously over the long guide wire through the femoral vein. This balloon catheter was used for interatrial septal dilatation and right femoral venous dilatation. In two patients this catheter was replaced over the long guide wire with a 9 Fr Schneider-Medintag Grüntzig catheter (3 X 12 mm diameter when inflated) and in the other by a Mansfield (18 mm diameter when inflated). The procedure was well tolerated in these three patients and there were no complications. Haemodynamic function improved, there was appreciable decrease in dyspnoea, and exercise tolerance was increased. This procedure has several advantages: the balloon is more easily positioned through the mitral valve; the stability of the balloon during inflation is improved by traction at both ends of the long guide wire; and there is the option of rapidly exchanging one balloon for a larger one over the long guide wire. This technique seems to be less arrhythmogenic and results in less blood loss because manual compression of the femoral vessels after the procedure is easier. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 PMID:3620253

  2. Degenerative mitral valve regurgitation: best practice revolution

    PubMed Central

    Adams, David H.; Rosenhek, Raphael; Falk, Volkmar

    2010-01-01

    Degenerative mitral valve disease often leads to leaflet prolapse due to chordal elongation or rupture, and resulting in mitral valve regurgitation. Guideline referral for surgical intervention centres primarily on symptoms and ventricular dysfunction. The recommended treatment for degenerative mitral valve disease is mitral valve reconstruction, as opposed to valve replacement with a bioprosthetic or mechanical valve, because valve repair is associated with improved event free survival. Recent studies have documented a significant number of patients are not referred in a timely fashion according to established guidelines, and when they are subjected to surgery, an alarming number of patients continue to undergo mitral valve replacement. The debate around appropriate timing of intervention for asymptomatic severe mitral valve regurgitation has put additional emphasis on targeted surgeon referral and the need to ensure a very high rate of mitral valve repair, particularly in the non-elderly population. Current clinical practice remains suboptimal for many patients, and this review explores the need for a ‘best practice revolution’ in the field of degenerative mitral valve regurgitation. PMID:20624767

  3. Robotic Mitral Valve Replacement in Pectus Excavatum.

    PubMed

    Onan, Burak; Bakir, Ihsan

    2016-05-01

    Exposure of the mitral valve can be challenging using conventional sternotomy and thoracotomy incisions in patients with pectus deformity. We report the use of a robotic approach to replace a rheumatic mitral valve in a patient with pectus excavatum. doi: 10.1111/jocs.12740 (J Card Surg 2016;31:306-308). © 2016 Wiley Periodicals, Inc.

  4. Mitral valve disease—morphology and mechanisms

    PubMed Central

    Levine, Robert A.; Hagége, Albert A.; Judge, Daniel P.; Padala, Muralidhar; Dal-Bianco, Jacob P.; Aikawa, Elena; Beaudoin, Jonathan; Bischoff, Joyce; Bouatia-Naji, Nabila; Bruneval, Patrick; Butcher, Jonathan T.; Carpentier, Alain; Chaput, Miguel; Chester, Adrian H.; Clusel, Catherine; Delling, Francesca N.; Dietz, Harry C.; Dina, Christian; Durst, Ronen; Fernandez-Friera, Leticia; Handschumacher, Mark D.; Jensen, Morten O.; Jeunemaitre, Xavier P.; Le Marec, Hervé; Le Tourneau, Thierry; Markwald, Roger R.; Mérot, Jean; Messas, Emmanuel; Milan, David P.; Neri, Tui; Norris, Russell A.; Peal, David; Perrocheau, Maelle; Probst, Vincent; Pucéat, Michael; Rosenthal, Nadia; Solis, Jorge; Schott, Jean-Jacques; Schwammenthal, Ehud; Slaugenhaupt, Susan A.; Song, Jae-Kwan; Yacoub, Magdi H.

    2016-01-01

    Mitral valve disease is a frequent cause of heart failure and death. Emerging evidence indicates that the mitral valve is not a passive structure, but—even in adult life—remains dynamic and accessible for treatment. This concept motivates efforts to reduce the clinical progression of mitral valve disease through early detection and modification of underlying mechanisms. Discoveries of genetic mutations causing mitral valve elongation and prolapse have revealed that growth factor signalling and cell migration pathways are regulated by structural molecules in ways that can be modified to limit progression from developmental defects to valve degeneration with clinical complications. Mitral valve enlargement can determine left ventricular outflow tract obstruction in hypertrophic cardiomyopathy, and might be stimulated by potentially modifiable biological valvular–ventricular interactions. Mitral valve plasticity also allows adaptive growth in response to ventricular remodelling. However, adverse cellular and mechanobiological processes create relative leaflet deficiency in the ischaemic setting, leading to mitral regurgitation with increased heart failure and mortality. Our approach, which bridges clinicians and basic scientists, enables the correlation of observed disease with cellular and molecular mechanisms, leading to the discovery of new opportunities for improving the natural history of mitral valve disease. PMID:26483167

  5. Parachute deformity of the mitral valve

    PubMed Central

    Bett, J. H. N.; Stovin, P. G. I.

    1969-01-01

    A case of parachute deformity of the mitral valve, a rare congenital form of mitral stenosis characterized by insertion of the chordae tendineae into a single posterior papillary muscle, is described in an 11-year-old girl. The eleven other cases in the English literature are reviewed. Images PMID:5348334

  6. Minimally Invasive Mitral Valve Surgery I

    PubMed Central

    Ailawadi, Gorav; Agnihotri, Arvind K.; Mehall, John R.; Wolfe, J. Alan; Hummel, Brian W.; Fayers, Trevor M.; Farivar, R. Saeid; Grossi, Eugene A.; Guy, T. Sloane; Hargrove, W. Clark; Khan, Junaid H.; Lehr, Eric J.; Malaisrie, S. Chris; Murphy, Douglas A.; Rodriguez, Evelio; Ryan, William H.; Salemi, Arash; Segurola, Romualdo J.; Shemin, Richard J.; Smith, J. Michael; Smith, Robert L.; Weldner, Paul W.; Goldman, Scott M.; Lewis, Clifton T. P.; Barnhart, Glenn R.

    2016-01-01

    Abstract Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection. PMID:27654407

  7. Mitral valve disease--morphology and mechanisms.

    PubMed

    Levine, Robert A; Hagége, Albert A; Judge, Daniel P; Padala, Muralidhar; Dal-Bianco, Jacob P; Aikawa, Elena; Beaudoin, Jonathan; Bischoff, Joyce; Bouatia-Naji, Nabila; Bruneval, Patrick; Butcher, Jonathan T; Carpentier, Alain; Chaput, Miguel; Chester, Adrian H; Clusel, Catherine; Delling, Francesca N; Dietz, Harry C; Dina, Christian; Durst, Ronen; Fernandez-Friera, Leticia; Handschumacher, Mark D; Jensen, Morten O; Jeunemaitre, Xavier P; Le Marec, Hervé; Le Tourneau, Thierry; Markwald, Roger R; Mérot, Jean; Messas, Emmanuel; Milan, David P; Neri, Tui; Norris, Russell A; Peal, David; Perrocheau, Maelle; Probst, Vincent; Pucéat, Michael; Rosenthal, Nadia; Solis, Jorge; Schott, Jean-Jacques; Schwammenthal, Ehud; Slaugenhaupt, Susan A; Song, Jae-Kwan; Yacoub, Magdi H

    2015-12-01

    Mitral valve disease is a frequent cause of heart failure and death. Emerging evidence indicates that the mitral valve is not a passive structure, but--even in adult life--remains dynamic and accessible for treatment. This concept motivates efforts to reduce the clinical progression of mitral valve disease through early detection and modification of underlying mechanisms. Discoveries of genetic mutations causing mitral valve elongation and prolapse have revealed that growth factor signalling and cell migration pathways are regulated by structural molecules in ways that can be modified to limit progression from developmental defects to valve degeneration with clinical complications. Mitral valve enlargement can determine left ventricular outflow tract obstruction in hypertrophic cardiomyopathy, and might be stimulated by potentially modifiable biological valvular-ventricular interactions. Mitral valve plasticity also allows adaptive growth in response to ventricular remodelling. However, adverse cellular and mechanobiological processes create relative leaflet deficiency in the ischaemic setting, leading to mitral regurgitation with increased heart failure and mortality. Our approach, which bridges clinicians and basic scientists, enables the correlation of observed disease with cellular and molecular mechanisms, leading to the discovery of new opportunities for improving the natural history of mitral valve disease.

  8. Echocardiographic determinants of mitral early flow propagation velocity.

    PubMed

    Barbier, Paolo; Grimaldi, Antonio; Alimento, Marina; Berna, Giovanni; Guazzi, Maurizio D

    2002-09-15

    Transmitral color Doppler early diastolic flow propagation velocity (Vp) has been correlated with the left ventricular (LV) relaxation time constant tau in dilated cardiomyopathy and ischemic heart disease. The aim of this study was to investigate the independent influence of LV systolic function and geometry, and of LV relaxation, on Vp in an unselected outpatient population. We studied 30 normal subjects and 130 patients (hypertensive LV hypertrophy, aortic valve stenosis or prosthesis, hypertrophic cardiomyopathy, coronary artery disease, dilated cardiomyopathy, aortic or mitral valve regurgitation). In all, we noninvasively measured LV geometry, mass, systolic function, wall motion dyssynergy, and diastolic function (abnormal relaxation or restrictive LV Doppler filling patterns). The Vp was similar in normal subjects and in patients (51 +/- 14 vs 53 +/- 25 cm/s). In normal subjects, the determinants of Vp at multiple regression analysis were isovolumic relaxation time, 2-dimensional cardiac index, and mitral E-wave velocity-time integral. In all, the main determinants were LV ejection fraction, percent of segmental wall dyssynergy, and isovolumic relaxation time and age. The Vp was highest in hypertrophic (75 +/- 25 cm/s, p <0.05 vs normal subjects) and lowest in dilated (35 +/- 13 cm/s, p = NS) cardiomyopathy. During multivariate analysis of variance, percent of wall dyssynergy (but not diffuse LV hypokinesia) independently reduced Vp (p = 0.02). The latter was not influenced by the LV filling pattern. Thus, in an unselected clinical population, prolonged relaxation per se does not influence Vp if LV systolic dysfunction and/or wall dyssynergy is absent-the latter factors are important independent determinants of Vp, which is determined by multiple factors.

  9. The origin and clinical significance of the signal opposite to the mitral E-wave: a simple and novel indicator of left ventricular filling pressure.

    PubMed

    Makita, Yuko; Okamoto, Mitsunori; Yoshida, Naoyasu; Hashimoto, Masaki; Shintani, Yumiko; Kajihara, Kenta; Nakano, Yukiko; Kihara, Yasuki

    2011-07-01

    We noted a low-velocity signal opposite to the early diastolic transmitral flow (E) by pulsed Doppler echocardiography. The purpose of this study was to examine the origin and significance of this signal. The background of the signal remains uncertain. We studied 59 adult patients (34 men and 25 women; mean age, 58.9 [20.2] years) without mitral valve heart disease. Mitral E-wave velocity and the signal (EW) opposite the E-wave were measured by pulsed Doppler echocardiography. Early diastolic mitral valve ring motion velocity (Ea) was measured by pulsed tissue Doppler echocardiography. Pulmonary capillary wedge pressure (PCWP) was measured by a Swan-Ganz catheter in 34 of the 59 patients. A blue signal was observed during early diastole from the mitral valve ring to the mitral orifice areas by color tissue Doppler echocardiography. The velocity profile method revealed the same direction and time between peak Ea and EW. Peak EW positively correlated with Ea (r = 0.67, P < 0.01). There were significant positive correlations between mean PCWP and E/Ea (r = 0.61, P < 0.01) and E/EW (r = 0.59, P < 0.01). E/EW was significantly greater in patients with PCWP > 12 mmHg than in patients with PCWP ≤ 12 mmHg (5.6 [1.3] cm/s vs. 4.3 [0.9] cm/s, P < 0.01). EW may be related to mitral valve ring motion, and the E/EW ratio may be a noninvasive simple parameter for assessing left ventricular filling pressure. © 2011, Wiley Periodicals, Inc.

  10. Misconceptions and Facts About Mitral Regurgitation.

    PubMed

    Argulian, Edgar; Borer, Jeffrey S; Messerli, Franz H

    2016-09-01

    Mitral regurgitation is a common heart valve disease. It is defined to be primary when it results from the pathology of the mitral valve apparatus itself and secondary when it is caused by distortion of the architecture or function of the left ventricle. Although the diagnosis and management of mitral regurgitation rely heavily on echocardiography, one should bear in mind the caveats and shortcomings of such an approach. Clinical decision making commonly focuses on the indications for surgery, but it is complex and mandates precise assessment of the mitral pathology, symptom status of the patient, and ventricular performance (right and left) among other descriptors. It is important for healthcare providers at all levels to be familiar with the clinical picture, diagnosis, disease course, and management of mitral regurgitation. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. R-R interval variations influence the degree of mitral regurgitation in dogs with myxomatous mitral valve disease.

    PubMed

    Reimann, M J; Møller, J E; Häggström, J; Markussen, B; Holen, A E W; Falk, T; Olsen, L H

    2014-03-01

    Mitral regurgitation (MR) due to myxomatous mitral valve disease (MMVD) is a frequent finding in Cavalier King Charles Spaniels (CKCSs). Sinus arrhythmia and atrial premature complexes leading to R-R interval variations occur in dogs. The aim of the study was to evaluate whether the duration of the R-R interval immediately influences the degree of MR assessed by echocardiography in dogs. Clinical examination including echocardiography was performed in 103 privately-owned dogs: 16 control Beagles, 70 CKCSs with different degree of MR and 17 dogs of different breeds with clinical signs of congestive heart failure due to MMVD. The severity of MR was evaluated in apical four-chamber view using colour Doppler flow mapping (maximum % of the left atrium area) and colour Doppler M-mode (duration in ms). The influence of the ratio between present and preceding R-R interval on MR severity was evaluated in 10 consecutive R-R intervals using a linear mixed model for repeated measurements. MR severity was increased when a short R-R interval was followed by a long R-R interval in CKCSs with different degrees of MR (P<0.005 when adjusted for multiple testing). The relationship was not significant in control dogs with minimal MR and in dogs with severe MR and clinical signs of heart failure. In conclusion, MR severity increases in long R-R intervals when these follow a short R-R interval in CKCSs with different degrees of MR due to asymptomatic MMVD. Thus, R-R interval variations may affect the echocardiographic grading of MR in CKCSs.

  12. Pituitary Apoplexy Following Mitral Valvuloplasty

    PubMed Central

    Kim, Young Ha; Son, Dong Wuk; Cha, Seung Heon

    2015-01-01

    Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome caused by the sudden enlargement of a pituitary adenoma secondary to hemorrhage or infarction. Pituitary apoplexy after cardiac surgery is a very rare perioperative complication. Factors associated with open heart surgery that may lead to pituitary apoplexy include hemodynamic instability during cardiopulmonary bypass and systemic heparinization. We report a case of pituitary apoplexy after mitral valvuloplasty with cardiopulmonary bypass. After early pituitary tumor resection and hormonal replacement therapy, the patient made a full recovery. PMID:25932297

  13. Assessment of left ventricular systolic and diastolic function by tissue Doppler analysis in patients with hypertension with or without hyperuricemia.

    PubMed

    Tavil, Yusuf; Kaya, Mehmet Gungor; Sen, Nihat; Tacoy, Gulten; Okyay, Kaan; Yazici, Huseyin Ugur; Yalcin, Mehmet Ridvan; Cengel, Atiye

    2008-04-01

    Hyperuricemia (HU) is a well-recognized risk factor for cardiovascular diseases. The independence of this association from other confounding factors has remained controversial. The possible contributory effect of HU to myocardial impairment produced by hypertension (HT), however, has not been clarified yet. The study was designed to assess the left ventricular (LV) systolic and diastolic function in patients with HT with or without HU. Tissue Doppler imaging (TDI) was used for detailed analysis as this method was superior to other conventional echocardiographic techniques. The study participants consisted of 27 patients (men 56%, mean age+/-SD; 55+/-10 years) with HT without HU, and 27 patients with HT with HU (men 62%, mean age+/-SD; 56+/-9 years), and 27 age-matched healthy control participants (men 57%, mean age+/-SD; 53+/-11 years). Cardiac functions were determined using echocardiography, comprising standard two-dimensional and conventional Doppler and TDI. Peak systolic myocardial velocity at mitral annulus (Sm), mitral inflow velocities and early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), peak systolic mitral annular velocity, Em/Am, and myocardial performance index were calculated by TDI. Mitral inflow velocities and tissue Doppler-derived mitral annular diastolic velocities were significantly different in the patient groups (HT without HU and HT with HU) compared with the control cases. Tissue Doppler-derived myocardial performance index (LV-MPI) was significantly impaired in the patient groups compared with those of the control's (0.48+/-0.09, 0.53+/-0.07, and 0.39+/-0.07, respectively, P<0.001). Significant differences were also observed between the patients who had HT without HU and the patients who had HT with HU regarding LV-MPI. Significant correlations were observed between the serum uric acid levels and LV function parameters.

  14. Transcatheter mitral valve repair in osteogenesis imperfecta associated mitral valve regurgitation.

    PubMed

    van der Kley, Frank; Delgado, Victoria; Ajmone Marsan, Nina; Schalij, Martin J

    2014-08-01

    Osteogenesis imperfecta is associated with increased prevalence of significant mitral valve regurgitation. Surgical mitral valve repair and replacement are feasible but are associated with increased risk of bleeding and dehiscence of implanted valves may occur more frequently. The present case report describes the outcomes of transcatheter mitral valve repair in a patient with osteogenesis imperfecta. A 60 year-old patient with osteogenesis imperfecta and associated symptomatic moderate to severe mitral regurgitation underwent transthoracic echocardiography which showed a nondilated left ventricle with preserved systolic function and moderate to severe mitral regurgitation. On transoesophageal echocardiography the regurgitant jet originated between the anterolateral scallops of the anterior and posterior leaflets (A1-P1). Considering the comorbidities associated with osteogenesis imperfecta the patient was accepted for transcatheter mitral valve repair using the Mitraclip device (Abbott vascular, Menlo, CA). Under fluoroscopy and 3D transoesophageal echocardiography guidance, a Mitraclip device was implanted between the anterolateral and central scallops with significant reduction of mitral regurgitation. The postoperative evolution was uneventful. At one month follow-up, transthoracic echocardiography showed a stable position of the Mitraclip device with no mitral regurgitation. Transcatheter mitral valve repair is feasible and safe in patients with osteogenesis imperfecta and associated symptomatic significant mitral regurgitation. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  15. Recurrent stuck mitral valve: eosinophilia an unusual pathology.

    PubMed

    Awasthy, Neeraj; Bhat, Yasser; Radhakrishnan, S; Sharma, Rajesh

    2015-03-01

    Eosinophilia is a very unusual and rare cause of thrombosis of prosthetic mitral valve. We report a 10-year-old male child of recurrent stuck prosthetic mitral valve. The child underwent mitral valve replacement for severe mitral regurgitation secondary to Rheumatic heart disease. He had recurrent prosthetic mitral valve thrombosis, despite desired INR levels. There was associated eosinophilia. The child was treated on the lines of tropical eosinophilia with oral prednisolone and diethylcarbamazine, the eosinophil count dropped significantly with no subsequent episode of stuck mitral valve. We discuss the management of recurrent stuck mitral valve and also eosinophilia as a causative factor for the same.

  16. Cardiogenic unilateral pulmonary oedema in an infant with severe residual mitral regurgitation.

    PubMed

    Joong, Anna; Lai, Wyman W; Ferris, Anne

    2017-01-01

    An infant with residual severe mitral regurgitation following mitral commissurotomy developed cardiogenic unilateral pulmonary oedema and subsegmental atelectasis that resolved with mechanical mitral valve replacement.

  17. Surgical treatment of moderate ischemic mitral regurgitation.

    PubMed

    Smith, Peter K; Puskas, John D; Ascheim, Deborah D; Voisine, Pierre; Gelijns, Annetine C; Moskowitz, Alan J; Hung, Judy W; Parides, Michael K; Ailawadi, Gorav; Perrault, Louis P; Acker, Michael A; Argenziano, Michael; Thourani, Vinod; Gammie, James S; Miller, Marissa A; Pagé, Pierre; Overbey, Jessica R; Bagiella, Emilia; Dagenais, François; Blackstone, Eugene H; Kron, Irving L; Goldstein, Daniel J; Rose, Eric A; Moquete, Ellen G; Jeffries, Neal; Gardner, Timothy J; O'Gara, Patrick T; Alexander, John H; Michler, Robert E

    2014-12-04

    Ischemic mitral regurgitation is associated with increased mortality and morbidity. For surgical patients with moderate regurgitation, the benefits of adding mitral-valve repair to coronary-artery bypass grafting (CABG) are uncertain. We randomly assigned 301 patients with moderate ischemic mitral regurgitation to CABG alone or CABG plus mitral-valve repair (combined procedure). The primary end point was the left ventricular end-systolic volume index (LVESVI), a measure of left ventricular remodeling, at 1 year. This end point was assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized as the lowest LVESVI rank. At 1 year, the mean LVESVI among surviving patients was 46.1±22.4 ml per square meter of body-surface area in the CABG-alone group and 49.6±31.5 ml per square meter in the combined-procedure group (mean change from baseline, -9.4 and -9.3 ml per square meter, respectively). The rate of death was 6.7% in the combined-procedure group and 7.3% in the CABG-alone group (hazard ratio with mitral-valve repair, 0.90; 95% confidence interval, 0.38 to 2.12; P=0.81). The rank-based assessment of LVESVI at 1 year (incorporating deaths) showed no significant between-group difference (z score, 0.50; P=0.61). The addition of mitral-valve repair was associated with a longer bypass time (P<0.001), a longer hospital stay after surgery (P=0.002), and more neurologic events (P=0.03). Moderate or severe mitral regurgitation was less common in the combined-procedure group than in the CABG-alone group (11.2% vs. 31.0%, P<0.001). There were no significant between-group differences in major adverse cardiac or cerebrovascular events, deaths, readmissions, functional status, or quality of life at 1 year. In patients with moderate ischemic mitral regurgitation, the addition of mitral-valve repair to CABG did not result in a higher degree of left ventricular reverse remodeling. Mitral-valve repair was associated with a reduced prevalence of moderate or

  18. COMPARISON OF ARTIFICIAL NEOCHORDAE AND NATIVE CHORDAL TRANSFER IN THE REPAIR OF A FLAIL POSTERIOR MITRAL LEAFLET: AN EXPERIMENTAL STUDY

    PubMed Central

    Padala, Muralidhar; Cardinau, Benedicte; Gyoneva, Lazarina I.; Thourani, Vinod H.

    2013-01-01

    BACKGROUND Surgical reconstruction of a flail posterior leaflet is a routine mitral valve repair, the techniques for which have evolved from leaflet resection to leaflet preservation. Artificial ePTFE neochordae are frequently used to stabilize the flail leaflet, and seldom translocation of the native secondary chordae of the valve to the leaflet free edge is used. In this study, we sought to investigate the efficacy of the two techniques to correct posterior leaflet prolapse and reduce mitral regurgitation, and quantify the acute post-repair leaflet kinematics. METHODS Adult porcine mitral valves (N =7) were studied in a pulsatile left heart experimental model in which isolated P2 flail was mimicked by marginal chordal transection. Baseline conditions were established in each valve under normal conditions (control), and followed by induction of isolated P2 flail by transecting the two marginal chordae on the posterior leaflet free edge (disease). The flail posterior leaflet was reconstructed using artificial neochordae (repair 1) and then native chordal translocation (repair 2). Reduction in leaflet flail, changes in mitral regurgitation fraction, leaflet coaptation length, and posterior leaflet mobility were measured using B-mode echocardiography or color doppler. RESULTS At baseline, all the valves were competent with no mitral regurgitation. After transection of the marginal chordae on the posterior leaflet, isolated P2 flail was evident with 13.7±13% regurgitation. Reconstruction with artificial neochordae eliminated leaflet flail and reduced mitral regurgitation to 3.2± 2.8%, and with chordal translocation leaflet flail was corrected and mitral regurgitation was measured at 2.3±2.6%. Using either repair techniques, leaflet coaptation and mobility of the repaired leaflets were adequate and comparable to the baseline measurements. CONCLUSIONS Comparable reduction leaflet flail and regurgitation, and restoration of physiological leaflet coaptation with the

  19. Transcatheter mitral valve repair therapies for primary and secondary mitral regurgitation.

    PubMed

    Al Amri, Ibtihal; van der Kley, Frank; Schalij, Martin J; Ajmone Marsan, Nina; Delgado, Victoria

    2015-03-01

    Mitral regurgitation is one of the most prevalent valvular heart diseases and its prevalence is related to population aging. Elderly patients with age-associated co-morbidities have an increased risk for conventional mitral valve surgery. Transcatheter mitral valve repair has emerged as a feasible and safe alternative in patients with contraindications for surgery or high operative risk. Several transcatheter mitral repair technologies have been developed during the last decade. While the development of some devices was abandoned due to suboptimal results, others demonstrated to be safe and effective and have been included in current practice guidelines. Not all technologies are suitable for all mitral anatomies and regurgitation mechanisms. Therefore, accurate evaluation of mitral valve anatomy and function are pivotal to the success of these therapies. Cardiac imaging plays a central role in selecting patients, guiding the procedure and evaluating the durability of the repair at follow-up.

  20. Percutaneous repair or surgery for mitral regurgitation.

    PubMed

    Feldman, Ted; Foster, Elyse; Glower, Donald D; Glower, Donald G; Kar, Saibal; Rinaldi, Michael J; Fail, Peter S; Smalling, Richard W; Siegel, Robert; Rose, Geoffrey A; Engeron, Eric; Loghin, Catalin; Trento, Alfredo; Skipper, Eric R; Fudge, Tommy; Letsou, George V; Massaro, Joseph M; Mauri, Laura

    2011-04-14

    Mitral-valve repair can be accomplished with an investigational procedure that involves the percutaneous implantation of a clip that grasps and approximates the edges of the mitral leaflets at the origin of the regurgitant jet. We randomly assigned 279 patients with moderately severe or severe (grade 3+ or 4+) mitral regurgitation in a 2:1 ratio to undergo either percutaneous repair or conventional surgery for repair or replacement of the mitral valve. The primary composite end point for efficacy was freedom from death, from surgery for mitral-valve dysfunction, and from grade 3+ or 4+ mitral regurgitation at 12 months. The primary safety end point was a composite of major adverse events within 30 days. At 12 months, the rates of the primary end point for efficacy were 55% in the percutaneous-repair group and 73% in the surgery group (P=0.007). The respective rates of the components of the primary end point were as follows: death, 6% in each group; surgery for mitral-valve dysfunction, 20% versus 2%; and grade 3+ or 4+ mitral regurgitation, 21% versus 20%. Major adverse events occurred in 15% of patients in the percutaneous-repair group and 48% of patients in the surgery group at 30 days (P<0.001). At 12 months, both groups had improved left ventricular size, New York Heart Association functional class, and quality-of-life measures, as compared with baseline. Although percutaneous repair was less effective at reducing mitral regurgitation than conventional surgery, the procedure was associated with superior safety and similar improvements in clinical outcomes. (Funded by Abbott Vascular; EVEREST II ClinicalTrials.gov number, NCT00209274.).

  1. Challenging mitral valve repair for double-orifice mitral valve with noncompaction of left ventricular myocardium.

    PubMed

    Yamasaki, Manabu; Misumi, Hiroyasu; Abe, Kohei; Kawazoe, Kohei

    2017-02-25

    Double-orifice mitral valve (DOMV) is a relatively rare cardiac anomaly. Although usually associated with various cardiac anomalies, co-presence of DOMV and noncompaction of left ventricular myocardium (NCLVM) is extremely rare. Here, we present a 24-year-old male who underwent mitral valve repair using artificial chordae and annuloplasty at the posterior commissure for severe mitral regurgitation (MR), resulting from flail anterior leaflet of the larger postero-medial orifice and dilatation of left ventricle with NCLVM. One year later, he underwent second mitral valve repair for recurrence of MR. Further endoscopic evaluation of the left ventricle, and reinforcement via artificial ring, enabled us to achieve repair.

  2. Transapical Mitral Valve Replacement for Mixed Native Mitral Stenosis and Regurgitation.

    PubMed

    Bedzra, Edo; Don, Creighton W; Reisman, Mark; Aldea, Gabriel S

    2016-08-01

    A 71-year-old man presented with New York Heart Association (NYHA) class IV heart failure. He had undergone transapical mitral valve replacement for mixed mitral stenosis and mitral regurgitation. At the 1 month follow-up, the patient reported symptom resolution. An echocardiogram revealed a low gradient and no regurgitation. Our case shows that with careful multidisciplinary evaluation, preoperative planning, and patient selection, percutaneous mitral intervention can become an alternative therapy for high-risk patients who cannot undergo conventional surgical therapy.

  3. Right ventricular diastolic dysfunction in arterial systemic hypertension: analysis by pulsed tissue Doppler.

    PubMed

    Cicala, S; Galderisi, M; Caso, P; Petrocelli, A; D'Errico, A; de Divitiis, O; Calabrò, R

    2002-06-01

    This study analyses right ventricular longitudinal function in arterial systemic hypertension by pulsed tissue Doppler. Thirty normotensives and 30 hypertensives, free of cardiac drugs, underwent standard Doppler echocardiography and pulsed tissue Doppler of right ventricular lateral tricuspid annulus and left ventricular lateral mitral annulus. By tissue Doppler, systolic and diastolic measurements were obtained. Hypertensives had higher left ventricular mass and impaired Doppler diastolic indexes, without changes of global systolic function. Tissue Doppler showed reduction of right ventricular E/A ratio and prolongation of relaxation time in comparison with controls (both P<0.00001). In the overall population, the length of tissue Doppler derived right ventricular relaxation time was positively related to right ventricular anterior wall thickness while right ventricular E/A ratio was positively related to E/A ratio of left ventricular mitral annulus (both P<0.00001). These relations remained significant even after adjusting for clinical and echocardiographic confounders by separate multivariate models. Arterial systemic hypertension is associated to right ventricular longitudinal diastolic dysfunction. This dysfunction involves the prolongation of active relaxation, which is independently associated with the degree of right ventricular hypertrophy and the impairment of passive wall properties, which is mainly due to ventricular interaction occurring under left ventricular pressure overload conditions. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

  4. Patient-specific indirectly 3D printed mitral valves for pre-operative surgical modelling

    NASA Astrophysics Data System (ADS)

    Ginty, Olivia; Moore, John; Xia, Wenyao; Bainbridge, Dan; Peters, Terry

    2017-03-01

    Significant mitral valve regurgitation affects over 2% of the population. Over the past few decades, mitral valve (MV) repair has become the preferred treatment option, producing better patient outcomes than MV replacement, but requiring more expertise. Recently, 3D printing has been used to assist surgeons in planning optimal treatments for complex surgery, thus increasing the experience of surgeons and the success of MV repairs. However, while commercially available 3D printers are capable of printing soft, tissue-like material, they cannot replicate the demanding combination of echogenicity, physical flexibility and strength of the mitral valve. In this work, we propose the use of trans-esophageal echocardiography (TEE) 3D image data and inexpensive 3D printing technology to create patient specific mitral valve models. Patient specific 3D TEE images were segmented and used to generate a profile of the mitral valve leaflets. This profile was 3D printed and integrated into a mold to generate a silicone valve model that was placed in a dynamic heart phantom. Our primary goal is to use silicone models to assess different repair options prior to surgery, in the hope of optimizing patient outcomes. As a corollary, a database of patient specific models can then be used as a trainer for new surgeons, using a beating heart simulator to assess success. The current work reports preliminary results, quantifying basic morphological properties. The models were assessed using 3D TEE images, as well as 2D and 3D Doppler images for comparison to the original patient TEE data.

  5. Cardiac involvement in Sydenham's chorea: clinical and Doppler echocardiographic findings.

    PubMed

    Elevli, M; Celebi, A; Tombul, T; Gökalp, A S

    1999-10-01

    Sydenham's chorea is often encountered in pure form, but it may also occur in association with carditis. Recently, it has been reported that silent, mild valvular regurgitation has been encountered in patients with rheumatic fever manifested by isolated polyarthritis and pure chorea. We studied 22 children with Sydenham's chorea to determine clinical and subclinical heart involvement at the time of the initial diagnosis. Ages of the patients ranged from 6-19 y (mean 13.14+/-3.0), and the female/male ratio was 3.4:1. All patients were evaluated by clinical and echocardiographic examination with respect to heart involvement. Carditis was detected in only 5 of 22 patients (23%) by auscultation. Clinical valvular involvement was determined: mitral regurgitation in three and combined mitral and aortic regurgitation in two. The frequency of valvular involvement increased significantly to 63% 2(14/22) after adding silent mitral regurgitation detected by colour Doppler echocardiography (chi2=7.50, p=0.0062). We found that clinically inaudible, but echocardiographically significant, mild valvular regurgitation was frequent in patients with pure chorea. It is concluded that colour Doppler echocardiography may be useful in detecting silent valvular regurgitation and in deciding the duration of prophylaxis.

  6. Color-coded Doppler imaging of systolic flow patterns in hypertrophic cardiomyopathy.

    PubMed

    Tencate, F J; Mayala, A P; Vletter, W B; Roelandt, J

    1985-01-01

    We studied 11 patients with hypertrophic cardiomyopathy by color Doppler echocardiography (Group I: 6 patients with outflow obstruction, and Group II: 5 patients without outflow obstruction) to assess systolic structure and function as observed by cross-sectional echocardiography in relation to the flow dynamics. The structure and function included systolic anterior motion of mitral valve (SAM), midsystolic aortic valve closure (AoC), systolic cavity obliteration and the presence and timing of mitral incompetence. Their occurrence and timing was related to presence of aortic systolic flow and presence of turbulence. While all patients in Group I had SAM and turbulence, none of the patients in Group II had SAM nor turbulence. Early mitral incompetence appearing before SAM and turbulence, occurred in all patients of Group I and in none of Group II. Midsystolic aortic valve closure was only present in Group I and blood flow was unilaterally directed so that only 60% of aortic cross-sectional area showed blood flow. We conclude that mitral incompetence in hypertrophic cardiomyopathy in early systole is common when outflow gradient is present and is independent of mitral incompetence of mid- and late systole. During SAM, turbulence in the subaortic area and mid and late mitral incompetence occurred simultaneously. The midsystolic aortic valve closure was related to the unilaterally directed blood flow through the aortic cross-sectional area.

  7. Mitral Valve Clip for Treatment of Mitral Regurgitation: An Evidence-Based Analysis

    PubMed Central

    Ansari, Mohammed T.; Ahmadzai, Nadera; Coyle, Kathryn; Coyle, Doug; Moher, David

    2015-01-01

    Background Many of the 500,000 North American patients with chronic mitral regurgitation may be poor candidates for mitral valve surgery. Objective The objective of this study was to investigate the comparative effectiveness, harms, and cost-effectiveness of percutaneous mitral valve repair using mitral valve clips in candidates at prohibitive risk for surgery. Data Sources We searched articles in MEDLINE, Embase, and the Cochrane Library published from 1994 to February 2014 for evidence of effectiveness and harms; for economic literature we also searched NHS EED and Tufts CEA registry. Grey literature was also searched. Review Methods Primary studies were sought from existing systematic reviews that had employed reliable search and screening methods. Newer studies were sought by searching the period subsequent to the last search date of the review. Two reviewers screened records and assessed study validity. We used the Cochrane risk of bias tool for randomized, generic assessment for non-randomized studies, and the Phillips checklist for economic studies. Results Ten studies including 1 randomized trial were included. The majority of the direct comparative evidence compared the mitral valve clip repair with surgery in patients not particularly at prohibitive surgical risk. Irrespective of degenerative or functional chronic mitral regurgitation etiology, evidence of effectiveness and harms is inconclusive and of very low quality. Very-low-quality evidence indicates that percutaneous mitral valve clip repair may provide a survival advantage, at least during the first 1 to 2 years, particularly in medically managed chronic functional mitral regurgitation. Because of limitations in the design of studies, the cost-effectiveness of mitral valve clips in patients at prohibitive risk for surgery also could not be established. Limitations Because of serious concerns of risk of bias, indirectness, and imprecision, evidence is of very low quality. Conclusions No meaningful

  8. Parabolic resection for mitral valve repair.

    PubMed

    Drake, Daniel H; Drake, Charles G; Recchia, Dino

    2010-02-01

    Parabolic resection, named for the shape of the cut edges of the excised tissue, expands on a common 'trick' used by experienced mitral surgeons to preserve tissue and increase the probability of successful repair. Our objective was to describe and clinically analyze this simple modification of conventional resection. Thirty-six patients with mitral regurgitation underwent valve repair using parabolic resection in combination with other techniques. Institution specific mitral data, Society of Thoracic Surgeons data and preoperative, post-cardiopulmonary bypass (PCPB) and postoperative echocardiography data were collected and analyzed. Preoperative echocardiography demonstrated mitral regurgitation ranging from moderate to severe. PCPB transesophageal echocardiography demonstrated no regurgitation or mild regurgitation in all patients. Thirty-day surgical mortality was 2.8%. Serial echocardiograms demonstrated excellent repair stability. One patient (2.9%) with rheumatic disease progressed to moderate regurgitation 33 months following surgery. Echocardiography on all others demonstrated no or mild regurgitation at a mean follow-up of 22.8+/-12.8 months. No patient required mitral reintervention. Longitudinal analysis demonstrated 80% freedom from cardiac death, reintervention and greater than moderate regurgitation at four years following repair. Parabolic resection is a simple technique that can be very useful during complex mitral reconstruction. Early and intermediate echocardiographic studies demonstrate excellent results.

  9. Classification of mitral insufficiency and stenosis using MLP neural network and neuro-fuzzy system.

    PubMed

    Barýpçý, Necaattin; Ergün, Uçman; Ilkay, Erdoğan; Serhatlýoğlu, Selami; Hardalaç, Firat; Güler, Inan

    2004-10-01

    Cardiac Doppler signals recorded from mitral valve of 60 patients were transferred to a personal computer by using a 16-bit sound card. The power spectral density (PSD) was applied to the recorded signal from each patient. In order to do a good interpretation and rapid diagnosis, PSD values classified using multilayer perceptron (MLP) and neuro-fuzzy system. Our findings demonstrated that 93.33% classification success rate was obtained from MLP, 90% classification success rate was obtained from neuro-fuzzy system. The classification results show that MLP offers best results in the case of diagnosis.

  10. The Mitral Valve Prolapsus: Quantification of the Regurgitation Flow Rate by Experimental Time-Dependant PIV

    NASA Astrophysics Data System (ADS)

    Billy, F.; Coisne, D.; Sanchez, L.; Perrault, R.

    2001-10-01

    Color Doppler is routinely used for visualisation of intra cardiac flows and quantification of valvular heart disease, Nevertheless the 2D visualization of a complex 3D phenomenon is the major limitation of this technique, In particular, in clinical setting, the flow rate calculation upstream a regurgitant orifice (i,e, mitral valve insufficiency), assumes that the velocity field in the convergent region have hemispheric shapes and introduce miscalculation specially in case of prolaps regurgitant orifices, The main objective of this study was to characterize the dynamic 3D velocity field of the convergent region upstream a prolaps model of regurgitant orifice based on 2D time dependent PIV reconstruction.

  11. Double-orifice mitral valve treated by percutaneous balloon valvuloplasty.

    PubMed

    Varghese, Thomas George; Revankar, Vinod Raghunath; Papanna, Monica; Srinivasan, Harshini

    2016-07-01

    Double-orifice mitral valve is an rare anomaly characterized by a mitral valve with a single fibrous annulus and 2 orifices that open into the left ventricle. It is often associated with other congenital anomalies, most commonly atrioventricular canal defects, and rarely associated with a stenotic or regurgitant mitral valve. A patient who was diagnosed with congenital double-orifice mitral valve with severe mitral stenosis was treated successfully by percutaneous balloon mitral valvotomy rather than the conventional open surgical approach, demonstrating the utility of percutaneous correction of this anomaly.

  12. An evaluation of the use of new Doppler methods for detecting longitudinal function abnormalities in a pacing-induced heart failure model

    NASA Technical Reports Server (NTRS)

    Tabata, Tomotsugu; Cardon, Lisa A.; Armstrong, Guy P.; Fukamach, Kiyotaka; Takagaki, Masami; Ochiai, Yoshie; McCarthy, Patrick M.; Thomas, James D.

    2003-01-01

    BACKGROUND: Doppler tissue echocardiography and color M-mode Doppler flow propagation velocity have proven useful in evaluating cross-sections of patients with left ventricular (LV) dysfunction, but experience with serial changes is limited. Purpose and methods: We tested their use by evaluating the temporal changes of LV function in a pacing-induced congestive heart failure model. Rapid ventricular pacing was initiated and maintained in 20 dogs for 4 weeks. Echocardiography was performed at baseline and weekly during brief pacing cessation. RESULTS: With rapid pacing, LV volume significantly increased and ejection fraction (57%-28%), stroke volume (37-18 mL), and mitral annulus systolic velocity (16.1-6.6 cm/s) by Doppler tissue echocardiography significantly decreased, with ejection fraction and mitral annulus systolic velocity closely correlated (r = 0.706, P <.0001). In contrast to the mitral inflow velocities, mitral annulus early diastolic velocity decreased steadily (12.3-7.3 cm/s) resulting in a dramatic decrease in mitral annulus early/late (1.22-0.57) diastolic velocity with no tendency toward pseudonormalization. The color M-mode Doppler flow propagation velocity also showed significant steady decrease (57-24 cm/s) throughout the pacing period. Multiple regression analysis chose mitral annulus systolic velocity (r = 0.895, P <.0001) and propagation velocity (r = 0.782, P <.0001) for the most important factor predicting LV systolic and diastolic function, respectively. CONCLUSIONS: Doppler tissue echocardiography and color M-mode Doppler flow could evaluate the serial deterioration in LV dysfunction throughout the pacing period. These were more useful in quantifying progressive LV dysfunction than conventional ehocardiographic techniques, and were probably relatively independent of preload. These techniques could be suitable for longitudinal evaluation in addition to the cross-sectional study.

  13. An evaluation of the use of new Doppler methods for detecting longitudinal function abnormalities in a pacing-induced heart failure model

    NASA Technical Reports Server (NTRS)

    Tabata, Tomotsugu; Cardon, Lisa A.; Armstrong, Guy P.; Fukamach, Kiyotaka; Takagaki, Masami; Ochiai, Yoshie; McCarthy, Patrick M.; Thomas, James D.

    2003-01-01

    BACKGROUND: Doppler tissue echocardiography and color M-mode Doppler flow propagation velocity have proven useful in evaluating cross-sections of patients with left ventricular (LV) dysfunction, but experience with serial changes is limited. Purpose and methods: We tested their use by evaluating the temporal changes of LV function in a pacing-induced congestive heart failure model. Rapid ventricular pacing was initiated and maintained in 20 dogs for 4 weeks. Echocardiography was performed at baseline and weekly during brief pacing cessation. RESULTS: With rapid pacing, LV volume significantly increased and ejection fraction (57%-28%), stroke volume (37-18 mL), and mitral annulus systolic velocity (16.1-6.6 cm/s) by Doppler tissue echocardiography significantly decreased, with ejection fraction and mitral annulus systolic velocity closely correlated (r = 0.706, P <.0001). In contrast to the mitral inflow velocities, mitral annulus early diastolic velocity decreased steadily (12.3-7.3 cm/s) resulting in a dramatic decrease in mitral annulus early/late (1.22-0.57) diastolic velocity with no tendency toward pseudonormalization. The color M-mode Doppler flow propagation velocity also showed significant steady decrease (57-24 cm/s) throughout the pacing period. Multiple regression analysis chose mitral annulus systolic velocity (r = 0.895, P <.0001) and propagation velocity (r = 0.782, P <.0001) for the most important factor predicting LV systolic and diastolic function, respectively. CONCLUSIONS: Doppler tissue echocardiography and color M-mode Doppler flow could evaluate the serial deterioration in LV dysfunction throughout the pacing period. These were more useful in quantifying progressive LV dysfunction than conventional ehocardiographic techniques, and were probably relatively independent of preload. These techniques could be suitable for longitudinal evaluation in addition to the cross-sectional study.

  14. Papillary Muscle Free Strain in Patients with Severe Degenerative and Functional Mitral Regurgitation.

    PubMed

    Kılıcgedik, Alev; Kahveci, Gokhan; Gurbuz, Ahmet Seyfeddin; Karabay, Can Yucel; Guler, Ahmet; Efe, Suleyman Cagan; Aung, Soe Moe; Arslantas, Ugur; Demir, Serdar; Izgi, Ibrahim Akin; Kirma, Cevat

    2017-04-01

    . Papillary muscle dysfunction plays a small role in severe MR due to degenerative or functional causes and papillary muscle functions in general seems to follow left ventricular function. PPM is the most affected PM in severe mitral regurgitation in both groups of DMR and FMR. O papel da função do músculo papilar na regurgitação mitral grave com fração de ejeção do ventrículo esquerdo preservada e reduzida e o método de escolha para avaliar PM ainda são objetos de controvérsia. Avaliar e comparar a função dos músculos papilares entre pacientes com insuficiência mitral funcional e degenerativa pelo método free strain. 64 pacientes com insuficiência mitral grave - 39 pacientes com insuficiência mitral degenerativa grave (grupo IMD) e 25 com insuficiência mitral funcional grave (grupo IMF) - e 30 indivíduos controle (grupo controle) foram incluídos no estudo. A função dos músculos papilares foi avaliada pelo método free strain a partir de imagens apicais quatro-câmaras do músculo papilar anterolateral (MPA) e imagens apicais três-câmaras do músculo papilar posteromedial (MPP). Strains circunferenciais e longitudinais globais do ventrículo esquerdo foram avaliados por meio de imagens bidimensionais a partir do rastreamento de conjunto de pontos de cinza (speckle tracking). O strain longitudinal global do ventrículo esquerdo (grupo IMD, -17 [-14,2/-20]; grupo IMF, -9 [-7/-10,7]; grupo controle, -20 [-18/-21] p < 0,001); strain circunferencial global do ventrículo esquerdo (grupo IMD, -20 [-14,5/-22,7]; grupo IMF, -10 [-7/-12]; grupo controle, -23 [-21/-27,5] p < 0,001) e strains de músculos papilares (MPP; grupo IMD, -30,5 [-24/-46,7]; grupo IMF, -18 [-12/-30]; grupo controle; -43 [-34,5/-39,5] p < 0,001; MPA; grupo IMD, (-35 [-23,5/-43]; grupo IMF, -20 [-13,5/-26]; grupo controle, -40 [-32,5/-48] p < 0,001) mostraram-se significativamente diferentes nos grupos. MPA e MPP mostraram-se altamente correlacionados com a FEVE (p < 0,001, p < 0

  15. Tissue Doppler Imaging in the Estimation of Intracardiac Filling Pressure in Decompensated Patients with Advanced Systolic Heart Failure

    PubMed Central

    Mullens, Wilfried; Borowski, Allen G; Curtin, Ronan J; Thomas, James D; Tang, W. H. Wilson

    2011-01-01

    Background Early transmitral velocity / tissue Doppler mitral annular early diastolic velocity (E/Ea) has been correlated with pulmonary capillary wedge pressure (PCWP) in a wide variety of cardiac conditions. The objective of this study was to determine the reliability of mitral E/Ea for predicting PCWP in patients admitted for advanced decompensated heart failure (ADHF). Methods and Results Prospective consecutive patients with ADHF (ejection fraction [EF] ≤30%, NYHA class III-IV symptoms) underwent simultaneous echocardiographic and hemodynamic evaluation on admission and after 48 hours of intensive medical therapy. A total of 106 patients were included (mean age 57 ±12 years, EF 24 ±8%, PCWP 21 ±7 mmHg, mitral E/Ea 20 ±12). There was a lack of correlation between mitral E/Ea and PCWP, particularly in those with larger LV volumes, more impaired cardiac indices, and the presence of cardiac resynchronization therapy. Overall, mitral E/Ea was similar among patients with PCWP > and ≤ 18 mmHg, and sensitivity and specificity for mitral E/Ea > 15 to identify a PCWP > 18 mmHg was 66% and 50%, respectively. Contrary to prior reports, we did not observe any direct association between changes in PCWP and changes in mitral E/Ea. Conclusion In decompensated patients with advanced systolic heart failure, tissue Doppler derived mitral E/Ea may not be as reliable in predicting intracardiac filling pressures, particularly in those with larger LV volumes, more impaired cardiac indices, and the presence of cardiac resynchronization therapy. PMID:19075104

  16. Biological versus prosthetic ring in mitral-valve repair: enhancement of mitral annulus dynamics and left-ventricular function with pericardial annuloplasty at long term.

    PubMed

    Borghetti, V; Campana, M; Scotti, C; Domenighini, D; Totaro, P; Coletti, G; Pagani, M; Lorusso, R

    2000-04-01

    The effects of different annuloplasty rings on mitral annulus dynamics and left-ventricular (LV) function after mitral-valve repair (MVR) are still controversial. This study sought to compare biological versus prosthetic rigid rings for annular remodelling in MVR at long term. Forty-four consecutive patients were retrospectively enrolled. All patients had isolated posterior-leaflet prolapse and underwent identical surgical mitral-valve reconstruction (quadrangular resection of the posterior leaflet associated with annuloplasty). Twenty-three patients underwent mitral annuloplasty with an autologous pericardial ring (group I), whereas 21 patients had MVR with a Carpentier-Edwards rigid ring (group II). No differences existed between the groups in terms of pre-operative patient profile. Post-operative LV systolic indices have been assessed by two-dimensional echocardiography at rest and during supine bicycle exercise. Mitral annular motion has been examined by means of the extent of mitral annulus systolic excursion (MASE), as measured in four longitudinal LV segments (anterior, inferior, septal and lateral). Mean and peak trans-mitral flow velocities (TMFV) have been also evaluated by continuous-wave Doppler. The mean follow-up did not differ between the groups, those being 41+/-12 months in group I (range17-65 months) and 46+/-15 months in group II (range 23-83 months), respectively. Post-operative echocardiographic study did not show significant mitral regurgitation at rest or at peak exercise in any patient. ANOVA analysis for repeated measures showed a significant interaction in peak TMFV (F((1,42))=5.23; P=0.03), and in left-ventricular ejection fraction (LVEF; F((1,42))=7.61, P=0.01). The analysis of contrasts showed a significant increase in TMFV in both groups (group I from 1.22+/-0.22 to 1.79+/-0.32 m/s, t=-8.8, P<0.0001; and group II from 1.19+/-0.17 to 1.96+/-0.33 m/s, t=-12.8, P<0.0001). Recruitment of LVEF reserve during exercise was observed only in

  17. Successful Treatment of Double-Orifice Mitral Stenosis with Percutaneous Balloon Mitral Commissurotomy

    PubMed Central

    Patted, Suresh V.; Halkati, Prabhu C.; Ambar, Sameer S.; Sattur, Ameet G.

    2012-01-01

    Double-orifice mitral valve (DOMV) is an uncommon congenital anomaly, being present in 0.05% of the general population. The isolated occurrence of this anomaly is very rare and, to our knowledge, no data are currently available on the incidence of an isolated DOMV. A DOMV is characterized by a mitral valve with a single fibrous annulus with 2 orifices opening into the left ventricle (LV). Subvalvular structures, especially the tensor apparatus, invariably show various degrees of abnormality. It can substantially obstruct mitral valve inflow or cause mitral valve incompetence. We present a rare case of nineteen-year-old male who underwent percutaneous mitral balloon commissurotomy in stenotic DOMV. PMID:24826244

  18. Transesophageal color Doppler evaluation of obstructive lesions using the new "Quasar" technology.

    PubMed

    Fan, P; Nanda, N C; Gatewood, R P; Cape, E G; Yoganathan, A P

    1995-01-01

    Due to the unavoidable problem of aliasing, color flow signals from high blood flow velocities cannot be measured directly by conventional color Doppler. A new technology termed Quantitative Un-Aliased Speed Algorithm Recognition (Quasar) has been developed to overcome this limitation. Employing this technology, we used transesophageal color Doppler echocardiography to investigate whether the velocities detected by the Quasar would correlate with those obtained by continuous-wave Doppler both in vitro and in vivo. In the in vitro study, a 5.0 MHz transesophageal transducer of a Kontron Sigma 44 color Doppler flow system was used. Fourteen different peak velocities calculated and recorded by color Doppler-guided continuous-wave Doppler were randomly selected. In the clinical study, intraoperative transesophageal echocardiography was performed using the same transducer 18 adults (13 aortic valve stenosis, 2 aortic and 2 mitral stenosis, 2 hypertrophic obstructive cardiomyopathy and 1 mitral valve stenosis). Following each continuous-wave Doppler measurement, the Quasar was activated, and a small Quasar marker was placed in the brightest area of the color flow jet to obtain the maximum mean velocity readout. The maximum mean velocities measured by Quasar closely correlated with maximum peak velocities obtained by color flow guided continuous-wave Doppler in both in vitro (0.53 to 1.65 m/s, r = 0.99) and in vivo studies (1.50 to 6.01 m/s, r = 0.97). We conclude that the new Quasar technology can accurately measure high blood flow velocities during transesophageal color Doppler echocardiography. This technique has the potential of obviating the need for continuous-wave Doppler.

  19. Emergency mitral valve replacement for acute severe mitral regurgitation following balloon mitral valvotomy: pathophysiology of hemodynamic collapse and peri-operative management issues.

    PubMed

    Bayya, Praveen Reddy; Varma, Praveen Kerala; Raman, Suneel Puthuvassery; Neema, Praveen Kumar

    2014-01-01

    Severe mitral regurgitation (MR) following balloon mitral valvotomy (BMV) needing emergent mitral valve replacement is a rare complication. The unrelieved mitral stenosis is compounded by severe MR leading to acute rise in pulmonary hypertension and right ventricular afterload, decreased coronary perfusion, ischemia and right ventricular failure. Associated septal shift and falling left ventricular preload leads to a vicious cycle of myocardial ischemia and hemodynamic collapse and needs to be addressed emergently before the onset of end organ damage. In this report, we describe the pathophysiology of hemodynamic collapse and peri-operative management issues in a case of mitral valve replacement for acute severe MR following BMV.

  20. Effects of Mitral Annulus Remodeling Following MitraClip Procedure on Reduction of Functional Mitral Regurgitation.

    PubMed

    Hidalgo, Francisco; Mesa, Dolores; Ruiz, Martín; Delgado, Mónica; Rodríguez, Sara; Pardo, Laura; Pan, Manuel; López, Amador; Romero, Miguel A; Suárez de Lezo, José

    2016-11-01

    The percutaneous mitral valve repair procedure (MitraClip) appears to reduce mitral annulus diameter in patients with functional mitral regurgitation, but the relationship between this and regurgitation severity has not been demonstrated. The aim of this study was to determine the effect of mitral annulus remodeling on the reduction of mitral regurgitation in patients with functional etiology. The study included all patients with functional mitral regurgitation treated with MitraClip at our hospital until January 2015. Echocardiogram (iE33 model, Philips) was performed in all patients immediately after device positioning. Changes in the mitral annulus correlated with mitral regurgitation severity, as assessed using the effective regurgitant orifice area. The study included 23 patients (age, 65±14 years; 74% men; left ventricular ejection fraction, 31%±13%; systolic pulmonary artery pressure, 47±10 mmHg). After the procedure, the regurgitant orifice area decreased by 0.30 cm(2)±0.04 cm(2) (P<.0005), from a baseline of 0.49 cm(2)±0.09 cm(2). Anteroposterior diameter decreased by 3.14 mm±1.01 mm (P<.0005) from a baseline of 28.27 mm±4.9 mm, with no changes in the intercommissural diameter (0.50 mm±0.91 mm vs 40.68 mm±4.7 mm; P=.26). A significant association was seen between anteroposterior diameter reduction and regurgitant orifice area reduction (r=.49; P=.020). In patients with functional mitral regurgitation, the MitraClip device produces an immediate reduction in the anteroposterior diameter. This remodeling may be related to the reduction in mitral regurgitation. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  1. Comparison of new Doppler echocardiographic methods to differentiate constrictive pericardial heart disease and restrictive cardiomyopathy.

    PubMed

    Rajagopalan, N; Garcia, M J; Rodriguez, L; Murray, R D; Apperson-Hansen, C; Stugaard, M; Thomas, J D; Klein, A L

    2001-01-01

    This study assesses how the newer modalities of tissue Doppler echocardiography and color M-mode flow propagation compare with respiratory variation of Doppler flow in distinguishing between constrictive pericarditis and restrictive cardiomyopathy. We studied 30 patients referred for further evaluation of diastolic function who had a diagnosis of constrictive pericarditis or restrictive cardiomyopathy established by diagnostic tests, including clinical assessment, magnetic resonance imaging, cardiac catheterization, endomyocardial biopsy, and surgical findings. Nineteen patients had constrictive pericarditis and 11 had restrictive cardiomyopathy. We performed 2-dimensional transesophageal echocardiography combined with pulsed-wave Doppler of the pulmonary veins and mitral inflow with respiratory monitoring, tissue Doppler echocardiography of the lateral mitral annulus, and color M-mode flow propagation of left ventricular filling. Respiratory variation of the mitral inflow peak early (peak E) velocity of > or =10% predicted constrictive pericarditis with 84% sensitivity and 91% specificity and variation in the pulmonary venous peak diastolic (peak D) flow velocity of > or =18% distinguished constriction with 79% sensitivity and 91% specificity. Using tissue Doppler echocardiography, a peak early velocity of longitudinal expansion (peak Ea) of > or =8.0 cm/s differentiated patients with constriction from restriction with 89% sensitivity and 100% specificity. A slope of > or =100 cm/s for the first aliasing contour in color M-mode flow propagation predicted patients with constriction with 74% sensitivity and 91% specificity. Thus, the newer methods of tissue Doppler echocardiography and color M-mode flow propagation are equivalent and complimentary with Doppler respiratory variation in distinguishing between constrictive pericarditis and restrictive cardiomyopathy. The additive role of the new methods needs to be established in difficult cases of constrictive

  2. The assessment of cardiac functions by tissue Doppler-derived myocardial performance index in patients with Behcet's disease.

    PubMed

    Tavil, Yusuf; Ozturk, Mehmet Akif; Sen, Nihat; Kaya, Mehmet Gungor; Hizal, Fatma; Poyraz, Fatih; Turfan, Murat; Onder, Meltem; Gurer, Mehmet Ali; Cengel, Atiye

    2008-03-01

    Vascular involvement is one of the major characteristics of Behcet's disease (BD). However, there are controversial findings regarding cardiac involvement in BD. Although early reports demonstrated that there is diastolic dysfunction in BD, conflicting results were found in the following trials. Hence, a new method for more objectively estimating the cardiac functions is needed. For this aim, we used high-usefulness tissue Doppler echocardiography for detailed analysis of cardiac changes in BD patients because this method was superior to other conventional echocardiographic techniques. The study population included 42 patients with BD (19 men, 23 women; mean age, 35 +/- 10 years, mean disease duration, 2.7 +/- 1.6 years) and 30 healthy subjects (14 men, 16 women; mean age, 38 +/- 7 years). Cardiac functions were determined using echocardiography, comprising standard two-dimensional and conventional Doppler and tissue Doppler imaging (TDI). Peak systolic myocardial velocity at mitral annulus, early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), Em/Am, and myocardial performance index (MPI) were calculated by TDI. The conventional echocardiographic parameters and tissue Doppler measurements were similar between the groups. Tissue Doppler derived mitral relaxation time was longer (75 +/- 13 vs 63 +/- 16 msn, p = 0.021) in patients with BD. There was statistically significant difference between the two groups regarding left ventricular MPI (0.458 +/- 0.072 vs 0.416 +/- 0.068%, p = 0.016), which were calculated from tissue Doppler systolic time intervals. There was also significant correlation between the disease duration and MPI (r = 0.38, p = 0.017). We have demonstrated that tissue Doppler-derived myocardial left ventricular relaxation time and MPI were impaired in BD patients, although systolic and diastolic function parameters were comparable in the patients and controls.

  3. Determinants of exercise-induced changes in mitral regurgitation in patients with coronary artery disease and left ventricular dysfunction.

    PubMed

    Lancellotti, Patrizio; Lebrun, Frédéric; Piérard, Luc A

    2003-12-03

    We sought to examine the determinants of exercise-induced changes in ischemic mitral regurgitation (MR) in patients with left ventricular (LV) dysfunction. In the post-myocardial infarction (MI) phase, ischemic MR contributes to worsening of symptoms and of LV dysfunction. In this study, 70 patients in the chronic, post-MI phase, with LV ejection fraction <45% and at least mild MR, underwent semi-supine exercise Doppler echocardiography. The effective regurgitant orifice (ERO) of MR was quantified at rest and during exercise. Exercise-induced changes in ERO were compared with changes in mitral deformation and in local and global LV remodeling. The wide range of exercise-induced ERO changes that were observed was unrelated to the degree of MR at rest (r = 0.20). Effective regurgitant orifice changes correlated best with changes in mitral deformation (i.e., differences in systolic mitral tenting area, systolic annular area, and coaptation height) (p < 0.0001). Posterior displacement of the papillary muscles was associated with larger changes in the ERO in both infarct groups. In patients with inferior MI, a decrease in the ERO was related to improvement in wall motion (r = 0.68). The independent predictors of ERO changes during exercise were changes in systolic annular area for all infarct categories, in tenting area and wall motion score in the global population and those with inferior infarction, and in apical displacement of mitral leaflets for patients with anterior MI. The degree of MR at rest is unrelated to exercise-induced changes in EROs, which are related to those in local LV remodeling and in mitral deformation but not those in global LV function.

  4. Myocardial Tissue Doppler Velocity in Child Growth

    PubMed Central

    Choi, Sun-Ha; Kim, Nam Kyun; Jung, Jo Won; Choi, Jae Young

    2016-01-01

    Background In adults, tissue Doppler imaging (TDI) is a recommended component of routine echocardiography. However, TDI velocities are less accepted in pediatrics, due to their strong variability and age dependence in children. This study examines the distribution of myocardial tissue Doppler velocities in healthy children to assess the effect of age with cardiac growth on the various echocardiographic measurements. Methods Total 144 healthy children were enrolled in this study. They were recruited from the pediatric outpatient clinic for routine well-child visits. The statistical relationships between age and TDI values were analyzed. Also, the statistical relationships between body surface area (BSA) and TDI values, left ventricle end-diastolic dimension (LVEDD) and TDI values were analyzed. Also, we conducted multivariate analysis of cardiac growth parameters such as, age, BSA, LVEDD and TDI velocity data. Results All of the age, BSA, and LVEDD had positive correlations with deceleration time (DT), pressure half-time (PHT), peak early diastolic myocardial velocity, peak systolic myocardial velocity, and had negative correlations with peak late diastolic velocity (A) and the ratio of trans-mitral inflow velocity to early diastolic velocity of mitral annulus (E/E'). In the multivariate analysis, all of the age, BSA, and LVEDD had positive correlations with DT, PHT, and negative correlations with A and E/E'. Conclusion The cardiac growth parameters related alterations of E/E' may suggest that diastolic myocardial velocities are cardiac growth dependent, and diastolic function has positive correlation with cardiac growth in pediatric group. This cardiac growth related myocardial functional variation would be important for assessment of cardiac involvement either in healthy and sick child. PMID:27081443

  5. Exuberant accessory mitral valve tissue with possible true parachute mitral valve: a case report.

    PubMed

    Nikolic, Aleksandra; Joksimovic, Zoran; Jovovic, Ljiljana

    2012-09-11

    A parachute mitral valve is defined as a unifocal attachment of mitral valve chordae tendineae independent of the number of papillary muscles. Data from the literature suggests that the valve can be distinguished on the basis of morphological features as either a parachute-like asymmetrical mitral valve or a true parachute mitral valve. A parachute-like asymmetrical mitral valve has two papillary muscles; one is elongated and located higher in the left ventricle. A true parachute mitral valve has a single papillary muscle that receives all chordae, as was present in our patient. Patients with parachute mitral valves during childhood have multilevel left-side heart obstructions, with poor outcomes without operative treatment. The finding of a parachute mitral valve in an adult patient is extremely rare, especially as an isolated lesion. In adults, the unifocal attachment of the chordae results in a slightly restricted valve opening and, more frequently, valvular regurgitation. A 40-year-old Caucasian female patient was admitted to a primary care physician due to her recent symptoms of heart palpitation and chest discomfort on effort. Transthoracic echocardiography showed chordae tendineae which were elongated and formed an unusual net shape penetrating into left ventricle cavity. The parasternal short axis view of her left ventricle showed a single papillary muscle positioned on one side in the posteromedial commissure receiving all chordae. Her mitral valve orifice was slightly eccentric and the chordae were converting into a single papillary muscle. Mitral regurgitation was present and it was graded as moderate to severe. Her left atrium was enlarged. There were no signs of mitral stenosis or a subvalvular ring. She did not have a bicuspid aortic valve or coarctation of the ascending aorta. The dimensions and systolic function of her left ventricle were normal. Our patient had a normal body habitus, without signs of heart failure. Her functional status was graded

  6. Exuberant accessory mitral valve tissue with possible true parachute mitral valve: a case report

    PubMed Central

    2012-01-01

    Introduction A parachute mitral valve is defined as a unifocal attachment of mitral valve chordae tendineae independent of the number of papillary muscles. Data from the literature suggests that the valve can be distinguished on the basis of morphological features as either a parachute-like asymmetrical mitral valve or a true parachute mitral valve. A parachute-like asymmetrical mitral valve has two papillary muscles; one is elongated and located higher in the left ventricle. A true parachute mitral valve has a single papillary muscle that receives all chordae, as was present in our patient. Patients with parachute mitral valves during childhood have multilevel left-side heart obstructions, with poor outcomes without operative treatment. The finding of a parachute mitral valve in an adult patient is extremely rare, especially as an isolated lesion. In adults, the unifocal attachment of the chordae results in a slightly restricted valve opening and, more frequently, valvular regurgitation. Case presentation A 40-year-old Caucasian female patient was admitted to a primary care physician due to her recent symptoms of heart palpitation and chest discomfort on effort. Transthoracic echocardiography showed chordae tendineae which were elongated and formed an unusual net shape penetrating into left ventricle cavity. The parasternal short axis view of her left ventricle showed a single papillary muscle positioned on one side in the posteromedial commissure receiving all chordae. Her mitral valve orifice was slightly eccentric and the chordae were converting into a single papillary muscle. Mitral regurgitation was present and it was graded as moderate to severe. Her left atrium was enlarged. There were no signs of mitral stenosis or a subvalvular ring. She did not have a bicuspid aortic valve or coarctation of the ascending aorta. The dimensions and systolic function of her left ventricle were normal. Our patient had a normal body habitus, without signs of heart failure

  7. DOPPLER WEATHER SYSTEM

    SciTech Connect

    Berlin, Gary J.

    2002-08-05

    The SRS Doppler Weather System consists of a Doppler Server, A Master Server (also known as the Weather Server), several Doppler Slave Servers, and client-side software program called the Doppler Radar Client. This system is used to display near rel-time images taken from the SRS Weather Center's Doppler Radar computer. The Doppler Server is software that resides on the SRS Doppler Computer. It gathers raw data, 24-bit color weather images via screen scraping ever five minutes as requested by the Master Server. The Doppler Server then reduces the 24-bit color images to 8-bit color using a fixed color table for analysis and compression. This preserves the fidelity of the image color and arranges the colors in specific order for display. At the time of color reduction, the white color used for the city names on the background images are remapped to a different index (color) of white that the white on the weather scale. The Weather Server places a time stamp on the image, then compresses the image and passes it to all Doppler Slave servers. Each of the Doppler Slave servers mainitain a circular buffer of the eight most current images representing the last 40 minutes of weather data. As a new image is added, the oldest drops off. The Doppler Radar Client is an optional install program for any site-wide workstation. When a Client session is started, the Client requests Doppler Slave server assignment from the Master Server. Upon its initial request to the Slave Server, the Client obtains all eight current images and maintains its own circular buffer, updating its images every five minutes as the Doppler Slave is updated. Three background reference images are stored as part of the Client. The Client brings up the appropriate background image, decompresses the doppler data, and displays the doppler data on the background image.

  8. A computer model of early diastolic filling through the mitral valve.

    PubMed

    Waite, L; Veres, G; Fine, J; Szabó, G

    2011-03-01

    The current paper presents a computer model of early diastolic (E-wave) left ventricular filling through the mitral valve. It is believed that this lumped-parameter model will be clinically useful, for example in the diagnosis of diastolic dysfunction. The model is based on the solution of the ordinary differential equations describing flow through the mitral valve, as well as equations that model the intrinsic and extrinsic behaviour of a mitral valve with variable orifice area (mimicking the opening and closing of the valve leaflets). The model was developed and calibrated using porcine data. The model has now been further validated in 12 canine trials. Values are reported of canine atrial and ventricular stiffness, active relaxation characteristics, valve natural frequency, damping coefficient, and effective orifice area measured by solving the inverse problem to obtain a best-fit match between canine empirical and simulated waveforms. The best fit was determined by minimizing the error between the simulated and empirical pressure and velocity waveforms using a minimized sum-of-squares figure of merit. The paper also presents human data addressing the feasibility of using the model in man, with Doppler velocity waveforms as the primary input to the model. The paper reports parameters measured in human patients by solving the inverse problem.

  9. Bioprosthetic mitral valve dysfunction due to native valve preserving procedure.

    PubMed

    Matsuno, Yukihiro; Mori, Yoshio; Umeda, Yukio; Takiya, Hiroshi

    2016-03-01

    Mitral valve replacement with preservation of the mitral leaflets and subvalvular apparatus is considered to maintain left ventricular geometry and function and reduce the risk of myocardial rupture. However, the routine use of this technique may lead to early complications such as left ventricular outflow tract obstruction and even mitral inflow obstruction, requiring reoperation. We describe a rare case of bioprosthetic mitral valve dysfunction caused by a native valve preserving procedure.

  10. Unusual redo mitral valve replacement for bleeding in Glanzmann thrombasthenia.

    PubMed

    Garcia-Villarreal, Ovidio A; Fernández-Ceseña, Ernesto; Solano-Ricardi, Mercedes; Aguilar-García, Alma L; Vega-Hernández, Raquel; Del Angel-Soto, Gustavo

    2016-01-01

    We report the case of 23-year-old man with mitral valve regurgitation and Glanzmann thrombasthenia, who underwent mechanical mitral valve replacement. Warfarin therapy was devastating, causing bilateral hemothorax, pericardial effusion, gastrointestinal bleeding, and hematuria. Redo mitral valve replacement with a biological prosthesis was required to resolve this critical situation. To our knowledge, this is the first report of mitral valve replacement in Glanzmann thrombasthenia, highlighting the danger of oral anticoagulation in this pathology.

  11. Acute severe mitral regurgitation. Pathophysiology, clinical recognition, and management.

    PubMed

    DePace, N L; Nestico, P F; Morganroth, J

    1985-02-01

    Acute severe mitral regurgitation often goes unrecognized as an emergency requiring prompt, lifesaving treatment. Its causes, physical signs, natural history, echocardiographic features, and findings on chest roentgenography, electrocardiography, and nuclear scintigraphic scanning are reviewed. Acute severe mitral insufficiency can be differentiated from chronic severe mitral insufficiency by noninvasive two-dimensional echocardiography. M-mode echocardiography is a valuable tool in evaluating mitral prosthetic paravalvular regurgitation.

  12. Minimally invasive, robotic, and off-pump mitral valve surgery.

    PubMed

    Woo, Y Joseph; Rodriguez, Evelio; Atluri, Pavan; Chitwood, W Randolph

    2006-01-01

    A significant transformation is occurring in the management of mitral valve disease. Earlier surgery is now recommended. Mitral valve repair is the standard of care, and newer methods of reconstructing the mitral valve are developing. Surgery with videoscopic assistance can be effectively performed without sternotomy. Robotics systems are gaining wider adoption. Implantable devices to repair or replace the mitral valve off-pump and percutaneously are emerging.

  13. [Diagnosis and differential therapy of mitral stenosis].

    PubMed

    Fassbender, D; Schmidt, H K; Seggewiss, H; Mannebach, H; Bogunovic, N

    1998-11-01

    Clinical symptoms and diagnostic findings in patients with mitral stenosis are usually determined by the extent of the stenosis. Compared to a normal mitral valve area (MVA) of > 4 cm2, MVA in patients with severe mitral stenosis is usually reduced to < 1.5 cm2. In older patients symptoms are frequently influenced by concomitant diseases (e.g. atrial fibrillation, arterial hypertension or lung disease). An important diagnostic element besides anamnesis, auscultation, ECG and chest X-ray is echocardiography, which is required in order to measure non-invasively and reliably the mitral valve gradient (MVG), the MVA and morphologic changes to the valves, as well as concomitant valvular disease, ventricular functions and, where appropriate, left-atrial thrombi. In addition to the surgical treatment of patients with severe mitral stenosis, which has been an established procedure for 50 years, percutaneous balloon mitral valvuloplasty (MVP) has recently established itself as an alternative option. At the current time, the Inoue technique seems to display the most advantages. Following transseptal puncture, the Inoue balloon is guided transvenously into the left atrium and then into the left ventricle using a special support wire. The balloon is short and soft. Its special unfolding character enables it to be placed securely in the mitral valve without any risk of ventricular perforation (Figure 1). As with surgical commissurotomy, balloon valvuloplasty leads to a separation of fused commissures. This results in a significant reduction of MVG, accompanied by an increase in the MVA (Figure 2). The results and success of MVP are influenced by the morphology of the valves and the changes to the subvalvular apparatus. In randomized studies, the results of surgical commissurotomy were comparable with those of balloon mitral valvulotomy. In our hospital, an increase in MVA from 1.0 to 1.8 cm2 could be achieved in 899 patients (mean age 56 +/- 3 years). In younger patients with

  14. Mitral Valve Prolapse in Persons with Down Syndrome.

    ERIC Educational Resources Information Center

    Pueschel, Siegfried M.; Werner, John Christian

    1994-01-01

    Examination of 36 home-reared young adults with Down's syndrome found that 20 had abnormal echocardiographic findings. Thirteen had mitral valve prolapse, three had mitral valve prolapse and aortic insufficiency, two had only aortic insufficiency, and two had other mitral valve disorders. Theories of pathogenesis and relationship to exercise and…

  15. Right Atrial Clot Formation Early after Percutaneous Mitral Balloon Valvuloplasty

    PubMed Central

    Ateş, Ahmet Hakan; Aksakal, Aytekin; Yücel, Huriye; Atasoy Günaydın, İlksen; Ekbul, Adem; Yaman, Mehmet

    2016-01-01

    Mitral balloon valvuloplasty which has been used for the treatment of rheumatic mitral stenosis (MS) for several decades can cause serious complications. Herein, we presented right atrial clot formation early after percutaneous mitral balloon valvuloplasty which was treated successfully with unfractioned heparin infusion. PMID:28105049

  16. Endovascular balloon versus transthoracic aortic clamping for minimally invasive mitral valve surgery: impact on cerebral microemboli.

    PubMed

    Maselli, Daniele; Pizio, Raffaella; Borelli, Gabriele; Musumeci, Francesco

    2006-04-01

    To evaluate micro embolic events occurrence during minimally invasive mitral valve procedures, comparing balloon endovascular aortic occlusion (Group I) and transthoracic aortic clamping technique (Group II), 36 patients (20 in Group I and 16 in Group II) undergoing minimally invasive mitral valve surgery were selected by CT scan and Doppler studies for absence of atherosclerotic disease at aortic, coronary or peripheral level. Assignment to one of the two groups was made on the basis of surgeon's preference. Continuous automated intra-operative transcranial Doppler was used to monitor micro embolic events during five operative steps: cardiopulmonary bypass (CPB) setup, time interval from CPB start until aortic clamp positioning, first minute after clamp-on, first minute after clamp-off, first ten minutes after CPB weaning start. More embolic events were observed in Group II than in Group I (total 143.4+/-30.6 per patient vs. 78.9+/-28.6 per patient). A large amount of embolic events occurring mainly when the aortic clamp was positioned and released accounted for the observed differences. In a low risk population for embolic events occurrence, endovascular balloon aortic clamping determined less embolic signals than transthoracic aortic clamping.

  17. [Interventional mitral valve replacement. Current status].

    PubMed

    Lutter, G; Frank, D

    2016-02-01

    Approximately 30 % of patients suffering from severe valvular heart disease, such as mitral valve regurgitation are non-compliant to the gold standard of minimally invasive surgery, reconstruction or valve replacement. The number of these mostly old patients with severe comorbidities is increasing; therefore, transcatheter interventions have been developed to address an unmet clinical need and may be an alternative therapeutic option to the reference standard. Apart from the successful MitraClip therapy, alternative transcatheter reconstruction technologies are being developed. As with transcatheter aortic valve implantation (TAVI) procedures, the off-pump implantation of a valved stent into the mitral position mainly via a transapical approach will be of great benefit. Recently, the feasibility of transcatheter mitral valved stent implantation in high-risk patients has already been reported.

  18. Acute mitral regurgitation in Takotsubo cardiomyopathy.

    PubMed

    Bouabdallaoui, Nadia; Wang, Zhen; Lecomte, Milena; Ennezat, Pierre V; Blanchard, Didier

    2015-04-01

    Takotsubo cardiomyopathy (TTC) is a well-recognised entity that commonly manifests with chest pain, ST segment abnormalities and transient left ventricular apical ballooning without coronary artery obstructive disease. This syndrome usually portends a favourable outcome. In the rare haemodynamically unstable TTC patients, acute mitral regurgitation (MR) related to systolic anterior motion (SAM) of the mitral valve and left ventricular outflow tract obstruction (LVOTO) is to be considered. Bedside echocardiography is key in recognition of this latter condition as vasodilators, inotropic agents or intra-aortic balloon counter-pulsation worsen the patient's clinical status. We discuss here a case of TTC where nitrate-induced subaortic obstruction and mitral regurgitation led to haemodynamic instability.

  19. Transcatheter mitral valve implantation: a brief review.

    PubMed

    Mylotte, Darren; Piazza, Nicolo

    2015-09-01

    In the last year transcatheter mitral valve implantation (TMVI) has seen a major jump in development. This technique offers the potential to treat a great number of elderly and/or high-risk patients with severe mitral regurgitation (MR). Such patients are declined surgical intervention either because the institutional Heart Team considers the risk of intervention to exceed the potential benefit, or because the patients and their families believe the morbidity of mitral surgery to be excessive. The advent of a less invasive transcatheter treatment could, therefore, potentially appeal to both clinicians and patients alike. In this overview paper, we describe briefly these recent developments in TVMI technologies as an introduction to the dedicated TVMI technical device parade later in this supplement.

  20. Surgical Treatment of Congenital Mitral Valve Dysplasia.

    PubMed

    Vida, Vladimiro L; Carrozzini, Massimiliano; Padalino, Massimo; Milanesi, Ornella; Stellin, Giovanni

    2016-05-01

    Congenital mitral valve (MV) dysplasia is a relatively rare and highly complex cardiac disease. We present our results and illustrate the techniques used to repair these valves. Between 1972 and 2014, 100 consecutive patients underwent surgical repair of congenital MV dysplasia at our institution. Predominant MV regurgitation was present in 53 patients (53%) whereas mitral stenosis was prevalent in 47 (47%). There were five early (5%) and eight late deaths (9%). Actuarial survival was 95%, 94%, and 93% at 5, 10, and 20 years, respectively. Sixteen patients (18%) required reintervention due to subsequent MV dysfunction. Actuarial freedom from reintervention for MV dysfunction was 95%, 92%, and 89% at 5, 10, and 20 years, respectively. The mechanism underlying the valve dysfunction in congenital mitral valve dysplasia is multifactorial and requires the application of a variety of surgical techniques for repair. doi: 10.1111/jocs.12743 (J Card Surg 2016;31:352-356). © 2016 Wiley Periodicals, Inc.

  1. Christian Doppler and the Doppler effect

    NASA Astrophysics Data System (ADS)

    Toman, Kurt

    1984-04-01

    A summary is given of Doppler's life and career. He was born 180 years ago on November 29, 1803, in Salzburg, Austria. He died on March 17, 1853 in Venice. The effect bearing his name was first announced in a presentation before the Royal Bohemian Society of the Sciences in Prague on May 25, 1842. Doppler considered his work a generalization of the aberration theorem as discovered by Bradley. With it came the inference that the perception of physical phenomena can change with the state of motion of the observer. Acceptance of the principle was not without controversy. In 1852, the mathematician Petzval claimed that no useful scientific deductions can be made from Doppler's elementary equations. In 1860, Ernst Mach resolved the misunderstanding that clouded this controversy. The Doppler effect is alive and well. Its role in radio science and related disciplines is enumerated.

  2. Use of three-dimensional transesophageal echocardiography to evaluate mitral valve morphology for risk stratification prior to mitral valvuloplasty.

    PubMed

    Francis, Loren; Finley, Alan; Hessami, Walead

    2017-02-01

    Mitral stenosis is often managed percutaneously with an interventional procedure such as balloon commissurotomy. Although this often results in an increased mitral valve area and improved clinical symptoms, this procedure is not benign and may have serious complications including the development of hemodynamically significant mitral valve regurgitation. Multiple scoring systems have been developed to attempt to risk stratify these patients prior to their procedure.

  3. Mitral valve repair over five decades

    PubMed Central

    2015-01-01

    It has become evident that mitral valve (MV) repair is the preferable treatment for the majority of patients presenting with severe mitral regurgitation (MR). This success clearly testifies that the surgical procedure is accessible, reproducible and is carrying excellent long-lasting results. From the pre-extracorporeal circulation’s era to the last percutaneous approaches, a large variety of techniques have been proposed to address the different features of MV diseases. This article aimed at reviewing chronologically the development of these dedicated techniques through their origins and the debates that they generated in the literature. PMID:26309841

  4. Severe mitral regurgitation due to an extraordinary heart defect.

    PubMed

    García-Ropero, Álvaro; Cortés García, Marcelino; Aldamiz Echevarría, Gonzalo; Farré Muncharaz, Jerónimo

    2016-09-01

    A previously non-described cause of mitral regurgitation is presented. An asymptomatic 50-year old male who was casually diagnosed of mitral valve Barlow's disease underwent cardiac surgery due to severe mitral regurgitation. In the operating theatre, a longitudinal fissure of 1.5-2.0 cm length, along the posterior mitral leaflet, was found responsible for the insufficiency. This defect had features of a potential congenital origin and it was successfully repaired with direct suture. Whether it is an atypical mitral cleft, a variation of Barlow's morphology spectrum or a new congenital heart defect remains unclear.

  5. Novel Annular and Subvalvular Enlargement in Congenital Mitral Valve Replacement.

    PubMed

    Carroll, Nels D; Beers, Kevin M; Maldonado, Elaine M; Calhoon, John H; Husain, S Adil

    2016-09-01

    Reparative procedures are not always feasible in congenitally abnormal mitral valves. Mechanical prosthesis has been accepted as the choice for valve replacement in the pediatric population. This report describes a case of congenital mitral valve disease requiring mitral valve replacement. The infant's mitral valve annulus was not amenable to placement of the smallest available mechanical prosthesis. The approach used here for annular and subvalvular enlargement facilitated implantation of a larger prosthesis for congenital mitral valve replacement. Five-year outcomes in a single patient may indicate broader applicability and avoidance of patient-prosthesis mismatch. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Doppler flowmetry in preeclampsia.

    PubMed

    Zahumensky, J

    2009-01-01

    The purpose of this study was to summarize the new published data on the Doppler flowmetry in preeclampsia. We summarize the new published data on the Doppler flowmetry in uteroplacental, fetoplacental and fetal circulation in preeclampsia. The present review summarized the results of clinical research on the Doppler flowmetry in the screening of risk of preclampsia, in the diagnosis of preclampsia and in the fetal risk in preclampsia (Ref. 19). Full Text (Free, PDF) www.bmj.sk.

  7. Advances in Doppler OCT

    PubMed Central

    Liu, Gangjun; Chen, Zhongping

    2014-01-01

    We review the principle and some recent applications of Doppler optical coherence tomography (OCT). The advances of the phase-resolved Doppler OCT method are described. Functional OCT algorithms which are based on an extension of the phase-resolved scheme are also introduced. Recent applications of Doppler OCT for quantification of flow, imaging of microvasculature and vocal fold vibration, and optical coherence elastography are briefly discussed. PMID:24443649

  8. Advanced Doppler tracking experiments

    NASA Technical Reports Server (NTRS)

    Armstrong, J. W.

    1989-01-01

    The Doppler tracking method is currently the only technique available for broadband gravitational wave searches in the approx. 10(exp -4) to 10(exp -1) Hz low frequency band. A brief review is given of the Doppler method, a discussion of the main noise sources, and a review of experience with current spacecraft and the prospects for sensitivity improvements in an advanced Doppler tracking experiment.

  9. Ventricular septal defect after myocardial infarction: assessment by cross sectional echocardiography with pulsed wave Doppler scanning.

    PubMed Central

    MacLeod, D; Fananapazir, L; de Bono, D; Bloomfield, P

    1987-01-01

    Eight patients who developed a ventricular septal defect after myocardial infarction were assessed by cross sectional echocardiography and pulsed wave Doppler scanning. Cross sectional echocardiography visualised the defect in four patients and gave an accurate assessment of global and regional left ventricular function in all eight. In all patients pulsed wave Doppler scanning detected turbulent flow at the apex of the right ventricle or adjacent to a wall motion abnormality affecting the interventricular septum. Pulsed wave Doppler detected coexisting mitral regurgitation in one patient and tricuspid regurgitation in another two. In all patients a left to right shunt was confirmed by oximetry and the location of the defect was identified by angiography or at operation or necropsy. Cross sectional echocardiography in combination with pulsed wave Doppler scanning is useful in the rapid bedside evaluation of patients with ventricular septal defect after myocardial infarction. Images Fig PMID:3663420

  10. Mitral Valve Stenosis after Open Repair Surgery for Non-rheumatic Mitral Valve Regurgitation: A Review.

    PubMed

    Shabsigh, Muhammad; Lawrence, Cassidy; Rosero-Britton, Byron R; Kumar, Nicolas; Kimura, Satoshi; Durda, Michael Andrew; Essandoh, Michael

    2016-01-01

    Mitral stenosis (MS) after mitral valve (MV) repair is a slowly progressive condition, usually detected many years after the index MV surgery. It is defined as a mean transmitral pressure gradient (TMPG) >5 mmHg or a mitral valve area (MVA) <1.5 cm(2). Pannus formation around the mitral annulus or extending to the mitral leaflets is suggested as the main mechanism for developing delayed MS after MV repair. On the other hand, early stenosis is thought to be a direct result of an undersized annuloplasty ring. Furthermore, in MS following ischemic mitral regurgitation (MR) repair, subvalvular tethering is the hypothesized pathophysiology. MS after MV repair has an incidence of 9-54%. Several factors have been associated with a higher risk for developing MS after MV repair, including the use of flexible Duran annuloplasty rings versus rigid Carpentier-Edwards rings, complete annuloplasty rings versus partial bands, small versus large anterior leaflet opening angle, and anterior leaflet tip opening length. Intraoperative echocardiography can measure the anterior leaflet opening angle, the anterior leaflet tip opening dimension, the MVA and the mean TMPG, and may help identify patients at risk for developing MS after MV repair.

  11. Mitral Valve Stenosis after Open Repair Surgery for Non-rheumatic Mitral Valve Regurgitation: A Review

    PubMed Central

    Shabsigh, Muhammad; Lawrence, Cassidy; Rosero-Britton, Byron R.; Kumar, Nicolas; Kimura, Satoshi; Durda, Michael Andrew; Essandoh, Michael

    2016-01-01

    Mitral stenosis (MS) after mitral valve (MV) repair is a slowly progressive condition, usually detected many years after the index MV surgery. It is defined as a mean transmitral pressure gradient (TMPG) >5 mmHg or a mitral valve area (MVA) <1.5 cm2. Pannus formation around the mitral annulus or extending to the mitral leaflets is suggested as the main mechanism for developing delayed MS after MV repair. On the other hand, early stenosis is thought to be a direct result of an undersized annuloplasty ring. Furthermore, in MS following ischemic mitral regurgitation (MR) repair, subvalvular tethering is the hypothesized pathophysiology. MS after MV repair has an incidence of 9–54%. Several factors have been associated with a higher risk for developing MS after MV repair, including the use of flexible Duran annuloplasty rings versus rigid Carpentier–Edwards rings, complete annuloplasty rings versus partial bands, small versus large anterior leaflet opening angle, and anterior leaflet tip opening length. Intraoperative echocardiography can measure the anterior leaflet opening angle, the anterior leaflet tip opening dimension, the MVA and the mean TMPG, and may help identify patients at risk for developing MS after MV repair. PMID:27148540

  12. Successful surgical repair of the parachute mitral valve with mitral valve regurgitation.

    PubMed

    Shiraishi, Manabu; Yamaguchi, Atsushi; Adachi, Hideo

    2012-01-01

    A 65-year-old woman with exercise-related dyspnea was admitted to our hospital. Transthoracic echocardiography demonstrated a large anomalous papillary muscle that originated from the posterior wall of the left ventricle and severe mitral valve regurgitation in systole. Cleft suture, 5-0 polytetrafluoroethylene sutures from a single papillary muscle to the anterior commissure leaflet (AC), 5-0 polypropylene sutures between AC and A1, and between A1 and A2, the double-orifice technique, and ring plasty with 32-mm semi-rigid ring was performed. Postoperative echocardiography showed an improvement in severe mitral valve regurgitation. At the 2-month follow-up, the patient was in good health. In the present case, the elderly patient with an isolated parachute mitral valve but without any other cardiac anomaly and presenting with mitral valve regurgitation is extremely rare. This case of mitral valvuloplasty for a parachute mitral valve with a single papillary muscle in an elderly woman has not been reported before.

  13. Acute Haemodialysis-induced Changes in Tissue Doppler Echocardiography Parameters.

    PubMed

    Sağ, Saim; Yeşilbursa, Dilek; Yıldız, Abdulmecit; Dilek, Kamil; Sentürk, Tunay; Serdar, Osman Akın; Aydınlar, Ali

    2014-09-01

    Tissue Doppler imaging (TDI) is a method that determines the tissue motion and velocity within the myocardium. To characterize acute haemodialysis (HD)-induced changes in TDI-derived indices for patients that have end-stage renal disease (ESRD). Cross sectional study. Conventional echocardiography and TDI methods were applied to study ESRD patients (n=58) before and after HD. Pulmonary venous flow, mitral inflow, and TDI signals of the lateral and septal mitral annulus were examined for the determination of altered left-ventricular diastolic filling parameters. Flow velocities from early- (E) and late-atrial (A) peak transmitral; peak pulmonary vein systolic (S) and diastolic (D); and myocardial peak systolic (Sm) and peak early (Em) and late (Am) diastolic mitral annular velocities were also assessed for changes. Transmitral E and A velocities and the E/A ratio decreased significantly after HD (p<0.001). Pulmonary vein S (p<0.001) and D (p<0.001) velocities decreased, and S/D ratios increased significantly (p=0.027). HD led to a reduction in septal Em (p<0.001), lateral Em (p=0.006), and Am (p<0.001) velocities. Contrary to the decreases in Em and Am, the Em/Am ratio remained unchanged. A single HD session was associated with an acute deterioration in the diastolic parameters. Since the Em/Am ratio remained unchanged, we conclude that this index is a relatively load-independent measure of diastolic function in HD patients.

  14. Non-rheumatic `subvalvar' mitral regurgitation

    PubMed Central

    Caves, P. K.; Paneth, M.

    1973-01-01

    Thirty-seven patients with non-rheumatic subvalvar mitral regurgitation are reported, representing 16% of all patients with mitral regurgitation submitted to open operation over a five-and-a-half-year period. In 22 older patients with `idiopathic' chordal lesions, the commonest finding was rupture of chordae to the posterior leaflet. The aortic leaflet chordae were most frequently involved following myocardial infarction (7 patients) or bacterial endocarditis (3 patients). Three other younger patients had ruptured chordae and two patients had rupture of the posteromedial papillary muscle following acute myocardial infarction. The mitral valve was repaired in 16 patients with ruptured chordae, of whom only eight obtained a satisfactory late result. In the other 21 patients the valve was replaced with a mounted aortic homograft or a Starr-Edwards prosthesis. It is concluded that mitral valve repair should be reserved for patients with symmetrical rupture of the chordae controlling the centre of the posterior leaflet, as regurgitation may reappear after other forms of repair due to progressive rupture of other abnormal chordae or breakdown of the repair. The early and late mortality in the patients with a definite antecedent myocardial infarction was much higher than in the other groups, and emergency valve replacement soon after rupture of the papillary muscle was unsuccessful in both patients. Images PMID:4731107

  15. Minimally Invasive Mitral Valve Surgery III

    PubMed Central

    Lehr, Eric J.; Guy, T. Sloane; Smith, Robert L.; Grossi, Eugene A.; Shemin, Richard J.; Rodriguez, Evelio; Ailawadi, Gorav; Agnihotri, Arvind K.; Fayers, Trevor M.; Hargrove, W. Clark; Hummel, Brian W.; Khan, Junaid H.; Malaisrie, S. Chris; Mehall, John R.; Murphy, Douglas A.; Ryan, William H.; Salemi, Arash; Segurola, Romualdo J.; Smith, J. Michael; Wolfe, J. Alan; Weldner, Paul W.; Barnhart, Glenn R.; Goldman, Scott M.; Lewis, Clifton T. P.

    2016-01-01

    Abstract Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program. PMID:27662478

  16. Mitral Valve Prolapse in Young Patients.

    ERIC Educational Resources Information Center

    McFaul, Richard C.

    1987-01-01

    A review of research regarding mitral valve prolapse in young children indicates that up to five percent of this population have the condition, with the majority being asymptomatic and requiring reassurance that the condition usually remains mild. Beta-blocking drugs are prescribed for patients with disabling chest pain, dizziness, palpitation, or…

  17. [Mitral valve prolapse and cusp elasticity].

    PubMed

    Curti, H J; Ferreira, M C; Silveira, S A; Sanches, P C; Carvalhal, S

    1994-06-01

    To verify if systolic bulging of floppy mitral cusps can to elastic behavior of their myxomatous collagen tissue. Five hearts with floppy mitral valves obtained from autopsies were distended with air (20 to 250 mmHg) through a catheter connected to the left ventricle. It was observed if some area of the atrial surface of the coapted cusps showed variable bulging according to the variation of air injection pressures. Molding of those surfaces (gypsum) allowed the same kind of analysis by other four researches. It was analyzed the cut surfaces of these radially sectioned molds. Lately, isolated tendinae chords were submitted to repeated tractions and observed if they exhibited elastic behavior. Histological study defined the presence of collagen myxomatous degeneration and quantified the amount of elastic tissue. In no case it was detected elastic bulding of mitral cusps. Cut surfaces of the molds confirmed that no increment of the prominent areas occurred, even in those regions with extensive, histologically confirmed, myxomatous substitution of the native collagen tissue. Increment of the degree of mitral bulging occurring during ventricular systole can not be ascertained to cusp elasticity but probably to papilar muscle traction.

  18. Management of mitral regurgitation in Marfan syndrome: Outcomes of valve repair versus replacement and comparison with myxomatous mitral valve disease.

    PubMed

    Helder, Meghana R K; Schaff, Hartzell V; Dearani, Joseph A; Li, Zhuo; Stulak, John M; Suri, Rakesh M; Connolly, Heidi M

    2014-09-01

    The study objective was to evaluate patients with Marfan syndrome and mitral valve regurgitation undergoing valve repair or replacement and to compare them with patients undergoing repair for myxomatous mitral valve disease. We reviewed the medical records of consecutive patients with Marfan syndrome treated surgically between March 17, 1960, and September 12, 2011, for mitral regurgitation and performed a subanalysis of those with repairs compared with case-matched patients with myxomatous mitral valve disease who had repairs (March 14, 1995, to July 5, 2013). Of 61 consecutive patients, 40 underwent mitral repair and 21 underwent mitral replacement (mean [standard deviation] age, 40 [18] vs 31 [19] years; P = .09). Concomitant aortic surgery was performed to a similar extent (repair, 45% [18/40] vs replacement, 43% [9/21]; P = .87). Ten-year survival was significantly better in patients with Marfan syndrome with mitral repair than in those with replacement (80% vs 41%; P = .01). Mitral reintervention did not differ between mitral repair and replacement (cumulative risk of reoperation, 27% vs 15%; P = .64). In the matched cohort, 10-year survival after repair was similar for patients with Marfan syndrome and myxomatous mitral disease (84% vs 78%; P = .63), as was cumulative risk of reoperation (17% vs 12%; P = .61). Patients with Marfan syndrome and mitral regurgitation have better survival with repair than with replacement. Survival and risk of reoperation for patients with Marfan syndrome were similar to those for patients with myxomatous mitral disease. These results support the use of mitral valve repair in patients with Marfan syndrome and moderate or more mitral regurgitation, including those having composite replacement of the aortic root. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  19. Is Doppler tissue velocity during early left ventricular filling preload independent?

    NASA Technical Reports Server (NTRS)

    Yalcin, F.; Kaftan, A.; Muderrisoglu, H.; Korkmaz, M. E.; Flachskampf, F.; Garcia, M.; Thomas, J. D.

    2002-01-01

    BACKGROUND: Transmitral Doppler flow indices are used to evaluate diastolic function. Recently, velocities measured by Doppler tissue imaging have been used as an index of left ventricular relaxation. OBJECTIVE: To determine whether Doppler tissue velocities are influenced by alterations in preload. METHODS: Left ventricular preload was altered in 17 patients (all men, mean (SD) age, 49 (8) years) during echocardiographic measurements of left ventricular end diastolic volume, maximum left atrial area, peak early Doppler filling velocity, and left ventricular myocardial velocities during early filling. Preload altering manoeuvres included Trendelenberg (stage 1), reverse Trendelenberg (stage 2), and amyl nitrate (stage 3). Systolic blood pressure was measured at each stage. RESULTS: In comparison with baseline, left ventricular end diastolic volume (p = 0.001), left atrial area (p = 0.003), peak early mitral Doppler filling velocity (p = 0.01), and systolic blood pressures (p = 0.001) were all changed by preload altering manoeuvres. Only left ventricular myocardial velocity during early filling remained unchanged by these manoeuvres. CONCLUSIONS: In contrast to standard transmitral Doppler filling indices, Doppler tissue early diastolic velocities are not significantly affected by physiological manoeuvres that alter preload. Thus Doppler tissue velocities during early left ventricular diastole may provide a better index of diastolic function in cardiac patients by providing a preload independent assessment of left ventricular filling.

  20. Is Doppler tissue velocity during early left ventricular filling preload independent?

    NASA Technical Reports Server (NTRS)

    Yalcin, F.; Kaftan, A.; Muderrisoglu, H.; Korkmaz, M. E.; Flachskampf, F.; Garcia, M.; Thomas, J. D.

    2002-01-01

    BACKGROUND: Transmitral Doppler flow indices are used to evaluate diastolic function. Recently, velocities measured by Doppler tissue imaging have been used as an index of left ventricular relaxation. OBJECTIVE: To determine whether Doppler tissue velocities are influenced by alterations in preload. METHODS: Left ventricular preload was altered in 17 patients (all men, mean (SD) age, 49 (8) years) during echocardiographic measurements of left ventricular end diastolic volume, maximum left atrial area, peak early Doppler filling velocity, and left ventricular myocardial velocities during early filling. Preload altering manoeuvres included Trendelenberg (stage 1), reverse Trendelenberg (stage 2), and amyl nitrate (stage 3). Systolic blood pressure was measured at each stage. RESULTS: In comparison with baseline, left ventricular end diastolic volume (p = 0.001), left atrial area (p = 0.003), peak early mitral Doppler filling velocity (p = 0.01), and systolic blood pressures (p = 0.001) were all changed by preload altering manoeuvres. Only left ventricular myocardial velocity during early filling remained unchanged by these manoeuvres. CONCLUSIONS: In contrast to standard transmitral Doppler filling indices, Doppler tissue early diastolic velocities are not significantly affected by physiological manoeuvres that alter preload. Thus Doppler tissue velocities during early left ventricular diastole may provide a better index of diastolic function in cardiac patients by providing a preload independent assessment of left ventricular filling.

  1. [Late ventricular potentials and mitral valve prolapse].

    PubMed

    Babuty, D; Charniot, J C; Delhomme, C; Fauchier, L; Fauchier, J P; Cosnay, P

    1994-03-01

    In order to determine the predictive value for ventricular arrhythmias of ventricular late potentials (LP) in mitral valve prolapse (MVP) the authors performed high amplification signal-averaging ECG (SA) and 24 hours ambulatory ECG (Holter) monitoring in 68 consecutive patients (34 men, 34 women, average age 48 +/- 17.7 years) with echocardiographically diagnosed MVP. Patients with bundle branch block or associated cardiac disease were excluded. Echocardiography showed 26 patients to have floppy mitral valves (38.2%), 50 patients to have posterior deplacement > or = 5 mm of the mitral valves in systole (73.5%) and 35 patients to have mitral regurgitation (51.4%). Holter monitoring showed 17 patients without ventricular extrasystoles (VES), 15 had Lown Grade I, 6 had Lown Grade II, 3 had Lown Grade III, 15 had Lown Grade IV A and 12 had Lown Grade IV B ventricular arrhythmias. Therefore, 30 patients had complex ventricular arrhythmias (> or = Lown Grade III) and 13 patients had spontaneous non-sustained ventricular tachycardia (NSVT) (one patient had NSVT on resting ECG but not on Holter monitoring). Eighteen patients had LP (26.5%). The incidence of complex ventricular arrhythmias was higher in patients with mitral regurgitation (62.8% versus 27.7%; p < 0.005) whereas the incidence of NSVT was not significantly different (25.7% versus 17.1%; p = 0.15). On the other hand, the frequency of complex ventricular arrhythmias was not significantly different in the presence or absence of LP (61.1% versus 40%: NS) whereas the incidence of NSVT was higher in patients with LP (44.4% versus 10%; p < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

  2. [Doppler echocardiography in assessing mechanical and biological heart valve prostheses].

    PubMed

    Minardi, G; Di Segni, M; Boccardi, L; Ferrari, O; Giovannini, E

    1988-02-01

    The study was performed to assess Doppler echocardiographic features of mitral and aortic prosthetic valves of different types with both normal and abnormal function. Two hundred and twenty-three patients with 250 prostheses were studied. Two hundred eight valves (111 mitral, 95 aortic and 2 tricuspid) were considered to be functioning normally after clinical examination, phonocardiography and M-mode and 2D echocardiography. This group enabled us to define normal Doppler echocardiographic findings for different types of prosthesis. In mitral position, peak (p) and mean (m) gradients were lower for disc prostheses and higher for ball and biological prosthetic valves; values of effective orifice area (A), calculated by pressure half-time method, were lower for biological and ball prostheses and higher in disc valves. Results were as follows: St. Jude (p 10.6 mmHg, m 3.9 mmHg, A 2.7 cm2), Duromedics (p 10.6, m 4.3, A 2.8), Björk-Shiley (p 10.4, m 4, A 2.3), Omniscience (p 14.2, m 6.2, A 2.1), Starr-Edwards (p 15.9, m 5.4, A 2.1), Hancock (p 14.7, m 6, A 2), Carpentier (p 13.2, m 5.4, A 1.9). Mild regurgitation, considered "physiological", was found in 2/8 Carpentier valves and in 3/34 St. Jude prostheses. In aortic valves lower peak gradients were found in Lillehei (18.3 mmHg), St. Jude (23.8 mmHg), Björk-Shiley (26 mmHg), Duromedics (27 mmHg) and higher values in Starr-Edwards (30.2 mmHg), Hancock (30 mmHg) and Omniscience (35.5 mmHg) prostheses. Mild regurgitation, considered "physiological", was found in 17% of Omniscience valves, 21% of Hancock, 33% of Duromedics, 45% of St. Jude, 60% of Björk-Shiley prostheses. Hancock mitral valves implanted for over 7 years had a mean gradient higher than valves with a shorter period of implantation (7.6 vs 4.85 mmHg, p less than 0.1), whereas the effective orifice area was similar. Hancock aortic valves implanted for over 7 years had a peak gradient slightly higher than the other group (implantation less than 7 years

  3. The impairment of the parasympathetic modulation is involved in the age-related change in mitral E/A ratio.

    PubMed

    Nakabo, Ayumi; Goda, Akiko; Masaki, Mitsuru; Otsuka, Misato; Yoshida, Chikako; Eguchi, Akiyo; Hirotani, Shinichi; Lee-Kawabata, Masaaki; Tsujino, Takeshi; Masuyama, Tohru

    2014-05-01

    The mitral early to late diastolic flow velocity ratio (E/A ratio) is age-dependent. It has been considered that its age dependency reflects the age-related lengthening of left ventricular (LV) relaxation; however, the change in E/A ratio is far larger than that expected from those in LV relaxation. We hypothesized that an age-related reduction of the parasympathetic activity increases left atrial (LA) contractility, and that this accounts for the age-related change in E/A ratio. (1) Exercise stress test was performed in 61 normal subjects (age range, 8-80 years, mean, 40 years) to assess heart rate (HR) recovery because slowed HR recovery indicates lowered parasympathetic activity. There were good interrelations among age, E/A ratio, and HR recovery. Among those aged ≤30 years, the age no longer correlated with E/A ratio or HR recovery, but there was a significant correlation between HR recovery and E/A ratio (r = 0.44, p < 0.05). (2) Pulsed Doppler and two-dimensional speckle tracking echocardiography (2DSTE) were performed before and after administration of parasympathetic blockade (atropine) in ten young healthy subjects. LA booster pump function was assessed with LA emptying index calculated by 2DSTE. LA emptying index was calculated from ([LA volume before the atrial contraction - minimal LA volume]/LA volume before the atrial contraction) × 100. Atropine increased mitral A velocity (p < 0.001) and LA emptying index (p < 0.05) along with a decrease in E/A ratio (p < 0.001). Parasympathetic withdrawal enhances LA contraction and increases mitral A velocity, which likely cause a reciprocal decrease in mitral E velocity and E/A ratio. Thus, parasympathetic deactivation with aging should be closely involved in the age-related change in mitral E/A ratio.

  4. Assessment of myocardial deformation: Predicting medium-term left ventricular dysfunction after surgery in patients with chronic mitral regurgitation.

    PubMed

    de Agustín, José A; Pérez de Isla, Leopoldo; Núñez-Gil, Iván J; Vivas, David; Manzano, María del C; Marcos-Alberca, Pedro; Fernández-Golfín, Covadonga; Corros, Cecilia; Almería, Carlos; Rodrigo, José L; Aubele, Adalia; Herrera, Dionisio; Rodríguez, Enrique; Macaya, Carlos; Zamorano, José

    2010-05-01

    The development of left ventricular dysfunction after mitral valve replacement is a common problem in patients with chronic severe mitral regurgitation. Assessment of myocardial deformation enables myocardial contractility to be accurately estimated. Our aim was to compare the value of the preoperative strain and strain rate derived by either speckle-tracking echocardiography or tissue Doppler imaging (TDI) for predicting the medium-term decrease in left ventricular ejection fraction (LVEF) following surgery. This prospective study involved 38 consecutive patients with chronic severe mitral regurgitation who were scheduled for mitral valve replacement. The longitudinal strain and strain rate in the interventricular septum were measured preoperatively using speckle-tracking echocardiography and TDI. The LVEF was determined preoperatively and postoperatively using 3-dimensional echocardiography. Echocardiographic assessments were performed in the 48 hours prior to surgery and 6 months postoperatively. The patients' mean age was 59.9+/-11.3 years and 10 (29.4%) were male. Both speckle-tracking echocardiography and TDI were found to be predictors of a >10% decrease in LVEF at 6 months. However, the predictive value of speckle-tracking echocardiography was greater than that of TDI. The longitudinal strain at baseline in the interventricular septum as measured by speckle-tracking echocardiography was the most powerful predictor; the area under the curve was 0.85 and the optimal cut-off value was -0.11. Speckle-tracking echocardiography can be used to predict a decrease in LVEF over the medium term after mitral valve replacement. Moreover, the predictive accuracy of speckle-tracking echocardiography was greater than that of TDI.

  5. Echocardiography of congenital mitral valve disorders: echocardiographic-morphological comparisons.

    PubMed

    Silverman, Norman H

    2014-12-01

    I surveyed our echocardiographic database of the years between 1998 and 2012 for congenital abnormalities of the mitral valve in patients over 14 years. A total of 249 patients with mitral valve abnormalities were identified. Abnormalities included clefts in the mitral valve in 58 patients, double orifice of the mitral valve in 19, mitral stenosis with two papillary muscles in 72, and mitral stenosis with one papillary muscle in 51 patients. Supravalvar rings were found in 35 patients with a single papillary muscle, and mitral stenoses with two papillary muscles were found in 22 patients. Mitral prolapse occurred in 44 patients and mitral valvar straddle in five patients. The patients were evaluated by all modalities of ultrasound available over the course of time. Although some lesions were isolated, there were many lesions in which more than one mitral deformity presented in the same patient. The patients are presented showing anatomical correlation with autopsy specimens, some of which came from the patients in this series, and others matched to show correlative anatomy. These lesions remain rare as a group and continue to have high morbidity and mortality.

  6. Isolated Mitral Cleft in Trisomy 21: An Initially 'Silent' Lesion.

    PubMed

    Thankavel, Poonam P; Ramaciotti, Claudio

    2016-02-01

    Congenital cardiac anomalies are common in trisomy 21, and transthoracic echocardiogram within the first month of life is recommended. While a cleft mitral valve associated with atrioventricular septal defect has been well defined in this population, the prevalence of isolated mitral valve cleft has not been previously reported. The aim of our study was to define the occurrence of isolated mitral cleft in the first echocardiogram of patients with trisomy 21. This retrospective chart review examined echocardiographic data on all Trisomy 21 patients <1 year of age obtained during January 1, 2010, to May 1, 2014, at our institution. Images were reviewed by one of the authors with no knowledge of the official diagnosis. In addition to evaluation for isolated mitral valve cleft, data obtained included presence of additional congenital heart defects and need for surgical intervention. A total of 184 patients (median age 5 days) were identified. Isolated mitral cleft was identified in 12 patients (6.5 %). Four were diagnosed retrospectively (33 %). Only one had mitral regurgitation on initial echocardiogram. Seven required surgery for closure of ventricular septal defects. Isolated mitral cleft is present in an important number of neonates with Trisomy 21. Mitral regurgitation is often absent in the neonatal period and should not be used as a reliable indicator of absence of valve abnormality. Careful attention should be directed toward the mitral valve during the first echocardiogram to exclude an isolated cleft, which can lead to progressive mitral regurgitation.

  7. The Cognitive Doppler.

    ERIC Educational Resources Information Center

    Kozoil, Micah E.

    1989-01-01

    Discusses the learning needs of students in the concrete operational stage in mathematics. Identifies the phenomenon of reduced cognitive performance in an out-of-class environment as the "Cognitive Doppler." Suggests methods of reducing the pronounced effects of the Cognitive Doppler by capitalizing on the students' ability to memorize…

  8. Doppler ultrasound monitoring technology.

    PubMed

    Docker, M F

    1993-03-01

    Developments in the signal processing of Doppler ultrasound used for the detection of fetal heart rate (FHR) have improved the operation of cardiotocographs. These developments are reviewed and the advantages and disadvantages of the various Doppler and signal processing methods are compared.

  9. The Cognitive Doppler.

    ERIC Educational Resources Information Center

    Kozoil, Micah E.

    1989-01-01

    Discusses the learning needs of students in the concrete operational stage in mathematics. Identifies the phenomenon of reduced cognitive performance in an out-of-class environment as the "Cognitive Doppler." Suggests methods of reducing the pronounced effects of the Cognitive Doppler by capitalizing on the students' ability to memorize…

  10. Mitral valve repair versus replacement in simultaneous aortic and mitral valve surgery

    PubMed Central

    Urban, Marian; Pirk, Jan; Szarszoi, Ondrej; Skalsky, Ivo; Maly, Jiri; Netuka, Ivan

    2013-01-01

    BACKGROUND: Double valve replacement for concomitant aortic and mitral valve disease is associated with substantial morbidity and mortality. Excellent results with valve repair in isolated mitral valve lesions have been reported; therefore, whether its potential benefits would translate into better outcomes in patients with combined mitral-aortic disease was investigated. METHODS: A retrospective observational study was performed involving 341 patients who underwent aortic valve replacement with either mitral valve repair (n=42) or double valve replacement (n=299). Data were analyzed for early mortality, late valve-related complications and survival. RESULTS: The early mortality rate was 11.9% for valve repair and 11.0% for replacement (P=0.797). Survival (± SD) was 67±11% in mitral valve repair with aortic valve replacement and 81±3% in double valve replacement at five years of follow-up (P=0.187). The percentage of patients who did not experience major adverse valve-related events at five years of follow-up was 83±9% in those who underwent mitral valve repair with aortic valve replacement and 89±2% in patients who underwent double valve replacement (P=0.412). Age >70 years (HR 2.4 [95% CI 1.1 to 4.9]; P=0.023) and renal dysfunction (HR 1.9 [95% CI 1.2 to 3.7]; P=0.01) were independent predictors of decreased survival. CONCLUSIONS: In patients with double valve disease, both mitral valve repair and replacement provided comparable early outcomes. There were no significant differences in valve-related reoperations, anticoagulation-related complications or prosthetic valve endocarditis. Patient-related factors appear to be the major determinant of late survival, irrespective of the type of operation. PMID:24294032

  11. Echocardiographic anatomy of the mitral valve in healthy dogs and dogs with myxomatous mitral valve disease.

    PubMed

    Wesselowski, S; Borgarelli, M; Menciotti, G; Abbott, J

    2015-06-01

    To further characterize the echocardiographic anatomy of the canine mitral valve apparatus in normal dogs and in dogs affected by myxomatous mitral valve disease (MMVD). Twenty-two normal dogs and 60 dogs with MMVD were prospectively studied. The length (AMVL), width (AMVW) and area (AMVA) of the anterior mitral valve leaflet were measured in the control group and the affected group, as were the diameters of the mitral valve annulus in diastole (MVAd) and systole (MVAs). The dogs with MMVD were staged based on American College of Veterinary Internal Medicine (ACVIM) guidelines and separated into groups B1 and B2/C. All measurements were indexed to body weight based on empirically defined allometric relationships. There was a statistically significant relationship between all log10 transformed mitral valve dimensions and body weight. The AMVL, AMVW, AMVA, MVAd and MVAs were all significantly greater in the B2/C group compared to the B1 and control groups. The AMVW was also significantly greater in the B1 group compared to the control group. Interobserver % coefficient of variation (% CV) was <10% for AMVL, AMVA, MVAd and MVAs, but was 29.6% for AMVW. Intraobserver % CV was <10.4% for all measurements. Measurements of the anterior mitral valve leaflet and the mitral valve annulus in the dog can be indexed to body weight based on allometric relationships. Preliminary reference intervals have been proposed over a range of body sizes. Relative to normal dogs, AMVL, AMVW, AMVA, MVAd and MVAs are greater in patients with advanced MMVD. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. Joint Agency Doppler Technology Tests.

    DTIC Science & Technology

    DOPPLER RADAR, *METEOROLOGICAL RADAR, *EARLY WARNING SYSTEMS, DAMAGE, HAZARDS, NETWORKS, REAL TIME, RADAR, IDENTIFICATION, RELIABILITY, HAIL, AIR FORCE FACILITIES, DOPPLER SYSTEMS, AIRPORTS, WARNING SYSTEMS, TORNADOES .

  13. Mitral annulus morphologic and functional analysis using real time tridimensional echocardiography in patients submitted to unsupported mitral valve repair

    PubMed Central

    Guedes, Marco Antônio Vieira; Pomerantzeff, Pablo Maria Alberto; Brandão, Carlos Manuel de Almeida; Vieira, Marcelo Luiz Campos; Tarasoutchi, Flávio; Spinola, Pablo da Cunha; Jatene, Fábio Biscegli

    2015-01-01

    Introduction Mitral valve repair is the treatment of choice to correct mitral insufficiency, although the literature related to mitral valve annulus behavior after mitral repair without use of prosthetic rings is scarce. Objective To analyze mitral annulus morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique. Methods Fourteen patients with mitral valve insufficiency secondary to mixomatous degeneration that were submitted to mitral valve repair with the Double Teflon technique were included. Thirteen patients were in FC III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistical analysis was made by repeated measures ANOVA test and was considered statistically significant P<0.05. Results There were no deaths, reoperation due to valve dysfunction, thromboembolism or endocarditis during the study. Posterior mitral annulus demonstrated a significant reduction in immediate postoperative period (P<0.001), remaining stable during the study, and presents a mean of reduction of 25.8% comparing with preoperative period. There was a significant reduction in anteroposterior and mediolateral diameters in the immediate postoperative period (P<0.001), although there was a significant increase in mediolateral diameter between immediate postoperative period and 1 year. There was no difference in mitral internal area variation over the cardiac cycle during the study. Conclusion Segmentar annuloplasty reduced the posterior component of mitral annulus, which remained stable in a 1-year-period. The variation in mitral annulus area during cardiac cycle remained stable during the study. PMID:26313723

  14. Left ventricular radial colour and longitudinal pulsed-wave tissue Doppler echocardiography in 39 healthy domestic pet rabbits.

    PubMed

    Casamian-Sorrosal, Domingo; Saunders, Richard; Browne, William; Elliot, Sarah; Fonfara, Sonja

    2014-10-01

    This paper reports radial colour and longitudinal mitral annulus pulsed-wave tissue Doppler findings in a large cohort of healthy, adult pet rabbits. Thirty-nine rabbits (22 Dwarf Lops, 14 French Lops and three Alaskans) underwent conscious echocardiography. The median age of the rabbits was 22 months and the median weight was 2.8 kg (Dwarf Lop 2.4 kg/French Lop 6.0 kg). Adequate radial colour and longitudinal pulsed-wave tissue Doppler traces were obtained in 100% and 85% of cases, respectively. Most systolic tissue Doppler parameters were significantly higher in French Lops than in Dwarf Lops. Separation of mitral inflow diastolic waves was present in 40% of cases using conventional spectral Doppler and in >60% of cases using pulsed-wave tissue Doppler which could be beneficial when evaluating diastolic function in rabbits. This study can be used as a reference for normal echocardiographic tissue Doppler values for adult rabbits undergoing conscious echocardiography in clinical practice.

  15. Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation

    PubMed Central

    Marak, Creticus P.; Joy, Parijat S.; Gupta, Pragya; Guddati, Achuta K.

    2013-01-01

    Diffuse alveolar hemorrhage (DAH) can be caused by several etiologies including vasculitis, drug exposure, anticoagulants, infections, mitral valve stenosis, and regurgitation. Chronic mitral valve regurgitation (MR) has been well documented as an etiological factor for DAH, but there have been only a few cases which have reported acute mitral valve regurgitation as an etiology of DAH. Acute mitral valve regurgitation can be a life-threatening condition and often requires urgent intervention. In rare cases, acute mitral regurgitation may result in a regurgitant jet which is directed towards the right upper pulmonary vein and may specifically cause right-sided pulmonary edema and right-sided DAH. Surgical repair of the mitral valve results in rapid resolution of DAH. Acute MR should be considered as a possible etiology in patients presenting with unilateral pulmonary edema, hemoptysis, and DAH. PMID:24383034

  16. Mitral valve repair for ischemic mitral regurgitation: lessons from the Cardiothoracic Surgical Trials Network randomized study.

    PubMed

    Mihos, Christos G; Santana, Orlando

    2016-01-01

    Approximately 30% to 50% of patients will develop ischemic mitral regurgitation (MR) after a myocardial infarction, which is a result of progressive left ventricular remodeling and dysfunction of the subvalvular apparatus, and portends a poor long-term prognosis. Surgical treatment is centered on mitral valve repair utilizing a restrictive annuloplasty, or valve replacement with preservation of the subvalvular apparatus. In the recent Cardiothoracic Surgical Trials Network (CSTN) study, patients with severe ischemic MR were randomized to mitral valve repair with a restrictive annuloplasty versus chordal-sparing valve replacement, and concomitant coronary artery bypass grafting, if indicated. At 2-year follow-up, mitral valve repair was associated with a significantly higher incidence of moderate or greater recurrent MR and heart failure, with no difference in the indices of left ventricular reverse remodeling, as compared with valve replacement. The current appraisal aims to provide insight into the CSTN trial results, and discusses the evidence supporting a pathophysiologic-guided repair strategy incorporating combined annuloplasty and subvalvular repair techniques to optimize the outcomes of mitral valve repair in ischemic MR.

  17. Ultrasound based mitral valve annulus tracking for off-pump beating heart mitral valve repair

    NASA Astrophysics Data System (ADS)

    Li, Feng P.; Rajchl, Martin; Moore, John; Peters, Terry M.

    2014-03-01

    Mitral regurgitation (MR) occurs when the mitral valve cannot close properly during systole. The NeoChordtool aims to repair MR by implanting artificial chordae tendineae on flail leaflets inside the beating heart, without a cardiopulmonary bypass. Image guidance is crucial for such a procedure due to the lack of direct vision of the targets or instruments. While this procedure is currently guided solely by transesophageal echocardiography (TEE), our previous work has demonstrated that guidance safety and efficiency can be significantly improved by employing augmented virtuality to provide virtual presentation of mitral valve annulus (MVA) and tools integrated with real time ultrasound image data. However, real-time mitral annulus tracking remains a challenge. In this paper, we describe an image-based approach to rapidly track MVA points on 2D/biplane TEE images. This approach is composed of two components: an image-based phasing component identifying images at optimal cardiac phases for tracking, and a registration component updating the coordinates of MVA points. Preliminary validation has been performed on porcine data with an average difference between manually and automatically identified MVA points of 2.5mm. Using a parallelized implementation, this approach is able to track the mitral valve at up to 10 images per second.

  18. Acute pericarditis as a complication of percutaneous mitral balloon valvulotomy.

    PubMed

    Turhan, Hasan; Basar, Nurcan; Yasar, Ayse Saatci; Erbay, Ali Riza; Atak, Ramazan

    2006-01-01

    During the past two decades, percutaneous mitral balloon valvulotomy (PMBV) has been frequently used, with high success and low complication rates, in the treatment of patients with moderate to severe rheumatic mitral stenosis. The case is reported of a patient with severe rheumatic mitral stenosis who developed acute pericarditis two days after successful PMBV. To the best of the authors' knowledge, this is the first such case to be reported.

  19. En face view of the mitral valve: definition and acquisition.

    PubMed

    Mahmood, Feroze; Warraich, Haider Javed; Shahul, Sajid; Qazi, Aisha; Swaminathan, Madhav; Mackensen, G Burkhard; Panzica, Peter; Maslow, Andrew

    2012-10-01

    A 3-dimensional echocardiographic view of the mitral valve, called the "en face" or "surgical view," presents a view of the mitral valve similar to that seen by the surgeon from a left atrial perspective. Although the anatomical landmarks of this view are well defined, no comprehensive echocardiographic definition has been presented. After reviewing the literature, we provide a definition of the left atrial and left ventricular en face views of the mitral valve. Techniques used to acquire this view are also discussed.

  20. Finite element analysis to model complex mitral valve repair.

    PubMed

    Labrosse, Michel; Mesana, Thierry; Baxter, Ian; Chan, Vincent

    2016-01-01

    Although finite element analysis has been used to model simple mitral repair, it has not been used to model complex repair. A virtual mitral valve model was successful in simulating normal and abnormal valve function. Models were then developed to simulate an edge-to-edge repair and repair employing quadrangular resection. Stress contour plots demonstrated increased stresses along the mitral annulus, corresponding to the annuloplasty. The role of finite element analysis in guiding clinical practice remains undetermined.

  1. Mitral Valve Prolapse or, What to Ignore in Cardiology

    PubMed Central

    Fallen, Ernest L.

    1981-01-01

    The presence of an isolated midsystolic click and/or late systolic murmur in an otherwise healthy young individual is a totally benign entity and represents a normal variation of mitral valve motion and function. There exists a very small subset of patients with mitral prolapse easily identified by certain clinical characteristics, who have distinct pathologic changes in their mitral valve leaflets and supporting structures. (Can Fam Physician 1981; 27:631-634). PMID:21289711

  2. Evolution of the concept and practice of mitral valve repair

    PubMed Central

    Tchantchaleishvili, Vakhtang; Rajab, Taufiek K.

    2015-01-01

    The first successful mitral valve repair was performed by Elliot Cutler at Brigham and Women’s Hospital in 1923. Subsequent evolution in the surgical techniques as well as multi-disciplinary cooperation between cardiac surgeons, cardiologists and cardiac anesthesiologists has resulted in excellent outcomes. In spite of this, the etiology of mitral valve pathology ultimately determines the outcome of mitral valve repair. PMID:26309840

  3. Acute aortic and mitral valve regurgitation following blunt chest trauma.

    PubMed

    Bernabeu, Eduardo; Mestres, Carlos A; Loma-Osorio, Pablo; Josa, Miguel

    2004-03-01

    Traumatic rupture of intracardiac structures is an uncommon phenomenon although there are a number of reports with regards to rupture of the tricuspid, mitral and aortic valves. We report the case of a 25-year-old patient who presented with acute aortic and mitral valve regurgitation of traumatic origin. Both lesions were seen separated by 2 weeks. Pathophysiology is reviewed. The combination of both aortic and mitral lesions following blunt chest trauma is almost exceptional.

  4. Quantification of mitral regurgitation by automated cardiac output measurement: experimental and clinical validation

    NASA Technical Reports Server (NTRS)

    Sun, J. P.; Yang, X. S.; Qin, J. X.; Greenberg, N. L.; Zhou, J.; Vazquez, C. J.; Griffin, B. P.; Stewart, W. J.; Thomas, J. D.

    1998-01-01

    OBJECTIVES: To develop and validate an automated noninvasive method to quantify mitral regurgitation. BACKGROUND: Automated cardiac output measurement (ACM), which integrates digital color Doppler velocities in space and in time, has been validated for the left ventricular (LV) outflow tract but has not been tested for the LV inflow tract or to assess mitral regurgitation (MR). METHODS: First, to validate ACM against a gold standard (ultrasonic flow meter), 8 dogs were studied at 40 different stages of cardiac output (CO). Second, to compare ACM to the LV outflow (ACMa) and inflow (ACMm) tracts, 50 normal volunteers without MR or aortic regurgitation (44+/-5 years, 31 male) were studied. Third, to compare ACM with the standard pulsed Doppler-two-dimensional echocardiographic (PD-2D) method for quantification of MR, 51 patients (61+/-14 years, 30 male) with MR were studied. RESULTS: In the canine studies, CO by ACM (1.32+/-0.3 liter/min, y) and flow meter (1.35+/-0.3 liter/min, x) showed good correlation (r=0.95, y=0.89x+0.11) and agreement (deltaCO(y-x)=0.03+/-0.08 [mean+/-SD] liter/min). In the normal subjects, CO measured by ACMm agreed with CO by ACMa (r=0.90, p < 0.0001, deltaCO=-0.09+/-0.42 liter/min), PD (r=0.87, p < 0.0001, deltaCO=0.12+/-0.49 liter/min) and 2D (r=0.84, p < 0.0001, deltaCO=-0.16+/-0.48 liter/min). In the patients, mitral regurgitant volume (MRV) by ACMm-ACMa agreed with PD-2D (r= 0.88, y=0.88x+6.6, p < 0.0001, deltaMRV=2.68+/-9.7 ml). CONCLUSIONS: We determined that ACM is a feasible new method for quantifying LV outflow and inflow volume to measure MRV and that ACM automatically performs calculations that are equivalent to more time-consuming Doppler and 2D measurements. Additionally, ACM should improve MR quantification in routine clinical practice.

  5. Quantification of mitral regurgitation by automated cardiac output measurement: experimental and clinical validation

    NASA Technical Reports Server (NTRS)

    Sun, J. P.; Yang, X. S.; Qin, J. X.; Greenberg, N. L.; Zhou, J.; Vazquez, C. J.; Griffin, B. P.; Stewart, W. J.; Thomas, J. D.

    1998-01-01

    OBJECTIVES: To develop and validate an automated noninvasive method to quantify mitral regurgitation. BACKGROUND: Automated cardiac output measurement (ACM), which integrates digital color Doppler velocities in space and in time, has been validated for the left ventricular (LV) outflow tract but has not been tested for the LV inflow tract or to assess mitral regurgitation (MR). METHODS: First, to validate ACM against a gold standard (ultrasonic flow meter), 8 dogs were studied at 40 different stages of cardiac output (CO). Second, to compare ACM to the LV outflow (ACMa) and inflow (ACMm) tracts, 50 normal volunteers without MR or aortic regurgitation (44+/-5 years, 31 male) were studied. Third, to compare ACM with the standard pulsed Doppler-two-dimensional echocardiographic (PD-2D) method for quantification of MR, 51 patients (61+/-14 years, 30 male) with MR were studied. RESULTS: In the canine studies, CO by ACM (1.32+/-0.3 liter/min, y) and flow meter (1.35+/-0.3 liter/min, x) showed good correlation (r=0.95, y=0.89x+0.11) and agreement (deltaCO(y-x)=0.03+/-0.08 [mean+/-SD] liter/min). In the normal subjects, CO measured by ACMm agreed with CO by ACMa (r=0.90, p < 0.0001, deltaCO=-0.09+/-0.42 liter/min), PD (r=0.87, p < 0.0001, deltaCO=0.12+/-0.49 liter/min) and 2D (r=0.84, p < 0.0001, deltaCO=-0.16+/-0.48 liter/min). In the patients, mitral regurgitant volume (MRV) by ACMm-ACMa agreed with PD-2D (r= 0.88, y=0.88x+6.6, p < 0.0001, deltaMRV=2.68+/-9.7 ml). CONCLUSIONS: We determined that ACM is a feasible new method for quantifying LV outflow and inflow volume to measure MRV and that ACM automatically performs calculations that are equivalent to more time-consuming Doppler and 2D measurements. Additionally, ACM should improve MR quantification in routine clinical practice.

  6. Doppler radar flowmeter

    DOEpatents

    Petlevich, Walter J.; Sverdrup, Edward F.

    1978-01-01

    A Doppler radar flowmeter comprises a transceiver which produces an audio frequency output related to the Doppler shift in frequency between radio waves backscattered from particulate matter carried in a fluid and the radiated radio waves. A variable gain amplifier and low pass filter are provided for amplifying and filtering the transceiver output. A frequency counter having a variable triggering level is also provided to determine the magnitude of the Doppler shift. A calibration method is disclosed wherein the amplifier gain and frequency counter trigger level are adjusted to achieve plateaus in the output of the frequency counter and thereby allow calibration without the necessity of being able to visually observe the flow.

  7. Mitral and tricuspid valve surgery for Coffin-Lowry syndrome.

    PubMed

    Yoshida, Takeshi; Ohashi, Takeki; Furui, Masato; Kageyama, Souichirou; Kodani, Noriko; Kobayashi, Yutaka; Hirai, Yasutaka; Sakakura, Reo

    2015-05-01

    Coffin-Lowry syndrome is a rare X-linked disorder characterized by craniofacial and skeletal abnormalities, mental retardation, short stature, and hypotonia. An 18-year-old man with morphologic features characteristic of Coffin-Lowry syndrome was referred to our institution for valve disease surgery for worsening cardiac failure. Echocardiography showed severe mitral valve regurgitation associated with tricuspid valve regurgitation. Mitral valve implantation with a biological valve and tricuspid annular plication with a ring was performed. The ascending aorta was hypoplastic. Both the mitral papillary muscle originating near the mitral annulus and the chordae were shortened. The patient's postoperative course was uneventful and his cardiac failure improved.

  8. Chimney technique for mitral valve replacement in children.

    PubMed

    González Rocafort, Álvaro; Aroca, Ángel; Polo, Luz; Rey, Juvenal; Villagrá, Fernando

    2013-11-01

    Severe mitral stenosis is unusual in children, but it represents an important challenge for surgeons because of the scarcity of solutions. Several mitral percutaneous and surgical valvuloplasties are performed repetitively to delay mitral valve replacement. Most of the time these procedures show discouraging results. When mitral valve replacement is performed, the annulus may not be large enough to fit a substitute. We present, to our best knowledge, a new technique to implant a large prosthesis in a small annulus without negatively affecting the opening of the leaflets.

  9. Robotic-assisted mitral valve repair: surgical technique.

    PubMed

    Algarni, Khaled D; Suri, Rakesh M; Daly, Richard C

    2014-01-01

    Robotic-assisted mitral valve repair represents the least invasive surgical approach currently available for anatomical mitral valve repair in patients with myxomatous mitral valve disease. Standard mitral valve repair techniques utilized during conventional sternotomy/right thoracotomy are exactly replicated with the robotic instrumentation through 1-2 cm port-like incisions with superior 3D visualization. This is performed on cardiopulmonary bypass by peripheral cannulation of the femoral vessels/right internal jugular vein. The ascending aorta is occluded with a transthoracic aortic cross-clamp. Antegrade cardioplegia is delivered centrally into the aortic root through a cardioplegia vent catheter. By replicating conventional mitral valve repair done via an open sternotomy approach, the quality of mitral valve repair is ensured while providing the patients with advantages of less invasive surgery including shorter hospital stay, rapid recovery and return to normal activities, less blood transfusion, superior cosmesis and complete elimination of sternotomy-related morbidities such as deep sternal wound infection and sternal dehiscence. We reviewed the first consecutive 200 patients undergoing robotic mitral valve repair at Mayo Clinic Rochester between 24 January 2008 and 28 January 2011. Successful mitral valve repair was completed in all patients. There were no early (30-day) deaths. One patient suffered a stroke (0.5%). One patient required reoperation for bleeding (0.5%). Two patients (1%) required reoperation for recurrent mitral regurgitation. Twelve patients (6%) required transfusion of allogeneic blood products. We have noted a significant reduction in operative times and resource utilization over time.

  10. Transcatheter Mitral Valve Repair Therapies: Evolution, Status and Challenges.

    PubMed

    Espiritu, Daniella; Onohara, Daisuke; Kalra, Kanika; Sarin, Eric L; Padala, Muralidhar

    2017-02-01

    Mitral regurgitation is a common cardiac valve lesion, developing from primary lesions of the mitral valve or secondary to cardiomyopathies. Moderate or higher severity of mitral regurgitation imposes significant volume overload on the left ventricle, causing permanent structural and functional deterioration of the myocardium and heart failure. Timely correction of regurgitation is essential to preserve cardiac function, but surgical mitral valve repair is often delayed due to the risks of open heart surgery. Since correction of mitral regurgitation can provide symptomatic relief and halt progressive cardiac dysfunction, transcatheter mitral valve repair technologies are emerging as alternative therapies. In this approach, the mitral valve is repaired either with sutures or implants that are delivered to the native valve on catheters introduced into the cardiovascular system under image guidance, through small vascular or ventricular ports. Several transcatheter mitral valve technologies are in development, but limited clinical success has been achieved. In this review, we present a historical perspective of mitral valve repair, review the transcatheter technologies emerging from surgical concepts, the challenges they face in achieving successful clinical application, and the increasing rigor of safety and durability standards for new transcatheter valve technologies.

  11. [Totally robotic mitral valve surgery in 60 cases].

    PubMed

    Yang, Ming; Gao, Chang-qing; Wang, Gang; Wang, Jia-li; Xiao, Cang-song; Wu, Yang

    2011-10-01

    To evaluate the safety and efficacy of robotic mitral valve surgery using da Vinci S system. We conducted a retrospective review of 60 robotic mitral surgeries from March 2007 to December 2010. Of the 60 patients, 44 underwent mitral valve repair and 16 received mitral valve replacement. The surgical approach was through 4 right chest ports with femoral and internal jugular vein cannulations. Transesophageal echocardiography was used intraoperatively to estimate the surgical results. None of the cases required a conversion to a median sternotomy. The mean cardiopulmonary bypass and cardiac arrest time was 132.2∓29.6 min and 88.1∓22.3 min for robotic mitral valve repair, and was 137.1∓21.9 min and 99.3∓17.4 min for robotic mitral valve replacement. Echocardiographic follow-up of all the patients revealed 3 cases of slight regurgitation in mitral valve repair group. In selected patients with mitral valve disease, robotic mitral surgery can be performed safely.

  12. Peri-procedural imaging for transcatheter mitral valve replacement

    PubMed Central

    Natarajan, Navin; Patel, Parag; Bartel, Thomas; Kapadia, Samir; Navia, Jose; Stewart, William; Tuzcu, E. Murat

    2016-01-01

    Mitral regurgitation (MR) has a high prevalence in older patient populations of industrialized nations. Common etiologies are structural, degenerative MR and functional MR secondary to myocardial remodeling. Because of co-morbidities and associated high surgical risk, open surgical mitral repair/replacement is deferred in a significant percentage of patients. For these patients transcatheter repair/replacement are emerging as treatment options. Because of the lack of direct visualization, pre- and intra-procedural imaging is critical for these procedures. In this review, we summarize mitral valve anatomy, trans-catheter mitral valve replacement (TMVR) options, and imaging in the context of TMVR. PMID:27054104

  13. Effect of the mitral valve on diastolic flow patterns

    SciTech Connect

    Seo, Jung Hee; Vedula, Vijay; Mittal, Rajat; Abraham, Theodore; Dawoud, Fady; Luo, Hongchang; Lardo, Albert C.

    2014-12-15

    The leaflets of the mitral valve interact with the mitral jet and significantly impact diastolic flow patterns, but the effect of mitral valve morphology and kinematics on diastolic flow and its implications for left ventricular function have not been clearly delineated. In the present study, we employ computational hemodynamic simulations to understand the effect of mitral valve leaflets on diastolic flow. A computational model of the left ventricle is constructed based on a high-resolution contrast computed-tomography scan, and a physiological inspired model of the mitral valve leaflets is synthesized from morphological and echocardiographic data. Simulations are performed with a diode type valve model as well as the physiological mitral valve model in order to delineate the effect of mitral-valve leaflets on the intraventricular flow. The study suggests that a normal physiological mitral valve promotes the formation of a circulatory (or “looped”) flow pattern in the ventricle. The mitral valve leaflets also increase the strength of the apical flow, thereby enhancing apical washout and mixing of ventricular blood. The implications of these findings on ventricular function as well as ventricular flow models are discussed.

  14. Mitral Regurgitation after Percutaneous Balloon Mitral Valvotomy in Patients with Rheumatic Mitral Stenosis: A Single-Center Study

    PubMed Central

    Aslanabadi, Naser; Toufan, Mehrnoush; Salehi, Rezvaneyeh; Alizadehasl, Azin; Ghaffari, Samad; Sohrabi, Bahram; Separham, Ahmad; Manafi, Ataolaah; Mehdizadeh, Mohammad Bagher; Habibzadeh, Afshin

    2014-01-01

    Abstract Background: Percutaneous balloon mitral valvotomy (BMV) is the gold standard treatment for rheumatic mitral stenosis (MS) in that it causes significant changes in mitral valve area (MVA) and improves leaflet mobility. Development of or increase in mitral regurgitation (MR) is common after BMV. This study evaluated MR severity and its changes after BMV in Iranian patients. Methods: We prospectively evaluated consecutive patients with severe rheumatic MS undergoing BMV using the Inoue balloon technique between February 2010 and January 2013 in Madani Heart Center, Tabriz, Iran. New York Heart Association (NYHA) functional class and echocardiographic and catheterization data, including MVA, mitral valve mean and peak gradient (MVPG and MVMG), left atrial (LA) pressure, pulmonary artery systolic pressure (PAPs), and MR severity before and after BMV, were evaluated. Results: Totally, 105 patients (80% female) at a mean age of 45.81 ± 13.37 years were enrolled. NYHA class was significantly improved after BMV: 55.2% of the patients were in NYHA functional class III before BMV compared to 36.2% after the procedure (p value < 0.001). MVA significantly increased (mean area = 0.64 ± 0.29 cm2 before BMV vs. 1.90 ± 0.22 cm2 after BMV; p value < 0.001) and PAPs, LA pressure, MVPG, and MVMG significantly decreased. MR severity did not change in 82 (78.1%) patients, but it increased in 18 (17.1%) and decreased in 5 (4.8%) patients. Patients with increased MR had a significantly higher calcification score (2.03 ± 0.53 vs.1.50 ± 0.51; p value < 0.001) and lower MVA before BMV (0.81 ± 0.23 vs.0.94 ± 0.18; p value = 0.010). There were no major complications. Conclusion: In our study, BMV had excellent immediate hemodynamic and clinical results inasmuch as MR severity increased only in some patients and, interestingly, decreased in a few. Our results, underscore BMV efficacy in severe MS. The echocardiographic calcification score was useful for identifying patients

  15. Mitral regurgitation after percutaneous balloon mitral valvotomy in patients with rheumatic mitral stenosis: a single-center study.

    PubMed

    Aslanabadi, Naser; Toufan, Mehrnoush; Salehi, Rezvaneyeh; Alizadehasl, Azin; Ghaffari, Samad; Sohrabi, Bahram; Separham, Ahmad; Manafi, Ataolaah; Mehdizadeh, Mohammad Bagher; Habibzadeh, Afshin

    2014-01-01

    Percutaneous balloon mitral valvotomy (BMV) is the gold standard treatment for rheumatic mitral stenosis (MS) in that it causes significant changes in mitral valve area (MVA) and improves leaflet mobility. Development of or increase in mitral regurgitation (MR) is common after BMV. This study evaluated MR severity and its changes after BMV in Iranian patients. We prospectively evaluated consecutive patients with severe rheumatic MS undergoing BMV using the Inoue balloon technique between February 2010 and January 2013 in Madani Heart Center, Tabriz, Iran. New York Heart Association (NYHA) functional class and echocardiographic and catheterization data, including MVA, mitral valve mean and peak gradient (MVPG and MVMG), left atrial (LA) pressure, pulmonary artery systolic pressure (PAPs), and MR severity before and after BMV, were evaluated. Totally, 105 patients (80% female) at a mean age of 45.81 ± 13.37 years were enrolled. NYHA class was significantly improved after BMV: 55.2% of the patients were in NYHA functional class III before BMV compared to 36.2% after the procedure (p value < 0.001). MVA significantly increased (mean area = 0.64 ± 0.29 cm(2) before BMV vs. 1.90 ± 0.22 cm(2) after BMV; p value < 0.001) and PAPs, LA pressure, MVPG, and MVMG significantly decreased. MR severity did not change in 82 (78.1%) patients, but it increased in 18 (17.1%) and decreased in 5 (4.8%) patients. Patients with increased MR had a significantly higher calcification score (2.03 ± 0.53 vs.1.50 ± 0.51; p value < 0.001) and lower MVA before BMV (0.81 ± 0.23 vs.0.94 ± 0.18; p value = 0.010). There were no major complications. In our study, BMV had excellent immediate hemodynamic and clinical results inasmuch as MR severity increased only in some patients and, interestingly, decreased in a few. Our results, underscore BMV efficacy in severe MS. The echocardiographic calcification score was useful for identifying patients likely to have MR development or MR increase after

  16. Staphylococcus caprae native mitral valve infective endocarditis

    PubMed Central

    Poyner, Jennifer; Olson, Ewan; Henriksen, Peter; Koch, Oliver

    2016-01-01

    Introduction: Staphylococcus caprae is a rare cause of infective endocarditis. Here, we report a case involving the native mitral valve in the absence of an implantable cardiac electronic device. Case presentation: A 76-year-old man presented with a 2 week history of confusion and pyrexia. His past medical history included an open reduction and internal fixation of a humeral fracture 17 years previously, which remained non-united despite further revision 4 years later. There was no history of immunocompromise or farm-animal contact. Two sets of blood culture bottles, more than 12 h apart, were positive for S. caprae. Trans-thoracic echocardiography revealed a 1×1.2 cm vegetation on the mitral valve, with moderate mitral regurgitation. Due to ongoing confusion, he had a magnetic resonance imaging brain scan, which showed a subacute small vessel infarct consistent with a thromboembolic source. A humeral SPECT-CT (single-photon emission computerized tomography-computerized tomography) scan showed no clear evidence of acute osteomyelitis. Surgical vegetectomy and mitral-valve repair were considered to reduce the risk of further systemic embolism and progressive valve infection. However, the potential risks of surgery to this patient led to a decision to pursue a cure with antibiotic therapy alone. He remained well 3 months after discharge, with repeat echocardiography demonstrating a reduction in the size of the vegetation (0.9 cm). Conclusion: Management of this infection was challenging due to its rarity and its unclear progression, complicated by the dilemma surrounding surgical intervention in a patient with a complex medical background. PMID:28348787

  17. Preservation versus non-preservation of mitral valve apparatus during mitral valve replacement: a meta-analysis of 3835 patients

    PubMed Central

    Sá, Michel Pompeu Barros de Oliveira; Ferraz, Paulo Ernando; Escobar, Rodrigo Renda; Martins, Wendell Santos; de Araújo e Sá, Frederico Browne Correia; Lustosa, Pablo César; Vasconcelos, Frederico Pires; Lima, Ricardo Carvalho

    2012-01-01

    Resection of the chordopapillary apparatus during mitral valve replacement has been associated with a negative impact on survival. Mitral valve replacement with the preservation of the mitral valve apparatus has been associated with better outcomes, but surgeons remain refractory to its use. To determine if there is any real difference in preservation vs non-preservation of mitral valve apparatus during mitral valve replacement in terms of outcomes, we performed a systematic review and meta-analysis using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles to search for clinical studies that compared outcomes (30-day mortality, postoperative low cardiac output syndrome or 5-year mortality) between preservation vs non-preservation during mitral valve replacement from 1966 to 2011. The principal summary measures were odds ratios (ORs) with 95% confidence interval and P-values (that will be considered statistically significant when <0.05). The ORs were combined across studies using a weighted DerSimonian–Laird random-effects model. The meta-analysis was completed using the software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, NJ, USA). Twenty studies (3 randomized and 17 non-randomized) were identified and included a total of 3835 patients (1918 for mitral valve replacement preservation and 1917 for mitral valve replacement non-preservation). There was significant difference between mitral valve replacement preservation and mitral valve replacement non-preservation groups in the risk of 30-day mortality (OR 0.418, P <0.001), postoperative low cardiac output syndrome (OR 0.299, P <0.001) or 5-year mortality (OR 0.380, P <0.001). No publication bias or important heterogeneity of effects on any outcome was observed. In conclusion, we found evidence that argues in favour of the preservation of mitral valve apparatus during mitral valve replacement. PMID:23027596

  18. Nonresectional Single-Suture Leaflet Remodeling for Degenerative Mitral Regurgitation Facilitates Minimally Invasive Mitral Valve Repair

    PubMed Central

    MacArthur, John W.; Cohen, Jeffrey E.; Goldstone, Andrew B.; Fairman, Alexander S.; Edwards, Bryan B.; Hornick, Matthew A.; Atluri, Pavan; Woo, Y. Joseph

    2014-01-01

    Background Both leaflet resection and neochordal construction are effective mitral repair techniques, but they may become incrementally time-consuming when using minimally invasive approaches. We have used a single-suture leaflet-remodeling technique of inverting the prolapsed or flail segment tissue into the left ventricle. This repair is straightforward, expeditious, and facilitates a minimally invasive approach. Methods Ninety-nine patients with degenerative mitral regurgitation (MR) underwent a minimally invasive single-suture repair of the mitral valve from May 2007 through December 2012. Preoperative and perioperative echocardiograms as well as patient outcomes were analyzed and compared with those obtained from patients undergoing minimally invasive mitral valve repair using quadrangular resection at the same institution during the same period. Results All 99 patients had a successful mitral repair through a sternal-sparing minimally invasive approach. Ninety-one of the 99 patients had zero MR on postoperative echocardiogram, and 8 of 99 had trace to mild MR. Patients in the nonresectional group had significantly shorter cardiopulmonary bypass and cross-clamp times compared with the quadrangular resection group (115.8 ± 41.7 minutes versus 144.9 ± 38.2 minutes; p < 0.001; 76.2 ± 28.1 minutes versus 112.6 ± 33.5 minutes; p < 0.001, respectively). The mean length of stay was 7.5 ± 3 days. All patients were discharged alive and free from clinical symptoms of MR. There have been no reoperations for recurrent MR on subsequent average follow-up of 1 year. Conclusions An effective, highly efficient, and thus far durable single-suture mitral leaflet-remodeling technique facilitates minimally invasive repair of degenerative MR. PMID:23932318

  19. Doppler Lidar (DL) Handbook

    SciTech Connect

    Newsom, RK

    2012-02-13

    The Doppler lidar (DL) is an active remote sensing instrument that provides range- and time-resolved measurements of radial velocity and attenuated backscatter. The principle of operation is similar to radar in that pulses of energy are transmitted into the atmosphere; the energy scattered back to the transceiver is collected and measured as a time-resolved signal. From the time delay between each outgoing transmitted pulse and the backscattered signal, the distance to the scatterer is inferred. The radial or line-of-sight velocity of the scatterers is determined from the Doppler frequency shift of the backscattered radiation. The DL uses a heterodyne detection technique in which the return signal is mixed with a reference laser beam (i.e., local oscillator) of known frequency. An onboard signal processing computer then determines the Doppler frequency shift from the spectra of the heterodyne signal. The energy content of the Doppler spectra can also be used to determine attenuated backscatter.

  20. Robotic Transcatheter Mitral Valve Replacement Using the Sapien XT in the Setting of Severe Mitral Annular Calcification.

    PubMed

    Koeckert, Michael S; Loulmet, Didier F; Williams, Mathew R; Neuburger, Peter J; Grossi, Eugene A

    2016-05-01

    We describe the use of the Sapien XT, placed in the mitral position using a totally endoscopic robotic approach in a 76-year-old man with extensive circumferential mitral calcifications and severe stenosis. The patient was at high risk for traditional open surgery and a large mitral valve annulus prevented safe transcatheter deployment due to size mismatch. Our novel approach offered a minimally invasive technique for native mitral valve replacement in a high-risk patient with anatomical constraints prohibitive to conventional approaches. doi: 10.1111/jocs.12737 (J Card Surg 2016;31:303-305). © 2016 Wiley Periodicals, Inc.

  1. [A case of death due to mitral regurgitation caused by traumatic mitral valve injury].

    PubMed

    Iwasaki, Y; Kojima, T; Yasui, W; Nagasawa, N; Yashiki, M

    1996-06-01

    A 51-year-old male, who had been driving a motor bicycle, was involved in a traffic accident with a trailer, and he died immediately after the accident. According to the external examination of the victim, no fatal injuries were found. The medico-legal autopsy revealed a rupture of the left side of the pericardium, and a tear of the posterior leaflet of the mitral valve. There were no injuries of the papillary muscles and chordae. The cause of death was due to traumatic mitral regurgitation.

  2. Impact of mitral valve geometry on hemodynamic efficacy of surgical repair in secondary mitral regurgitation.

    PubMed

    Padala, Muralidhar; Gyoneva, Lazarina I; Thourani, Vinod H; Yoganathan, Ajit P

    2014-01-01

    Mitral valve geometry is significantly altered secondary to left ventricular remodeling in non-ischemic and ischemic dilated cardiomyopathies. Since the extent of remodeling and asymmetry of dilatation of the ventricle differ significantly between individual patients, the valve geometry and tethering also differ. The study aim was to determine if mitral valve geometry has an impact on the efficacy of surgical repairs to eliminate regurgitation and restore valve closure in a validated experimental model. Porcine mitral valves (n = 8) were studied in a pulsatile heart simulator, in which the mitral valve geometry can be precisely altered and controlled throughout the experiment. Baseline hemodynamics for each valve were measured (Control), and the valves were tethered in two distinct ways: annular dilatation with 7 mm apical papillary muscle (PM) displacement (Tether 1, symmetric), and annular dilatation with 7 mm apical, 7 mm posterior and 7 mm lateral PM displacement (Tether 2, asymmetric). Mitral annuloplasty was performed on each valve (Annular Repair), succeeded by anterior leaflet secondary chordal cutting (Sub-annular Repair). The efficacy of each repair in the setting of a given valve geometry was quantified by measuring the changes in mitral regurgitation (MR), leaflet coaptation length, tethering height and area. At baseline, none of the valves was regurgitant. Significant leaflet tethering was measured in Tether 2 over Tether 1, but both groups were significantly higher compared to baseline (60.9 +/- 31 mm2 for Control versus 129.7 +/- 28.4 mm2 for Tether 1 versus 186.4 +/- 36.3 mm2 for Tether 2). Consequently, the MR fraction was higher in Tether 2 group (23.0 +/- 5.7%) than in Tether 1 (10.5 +/- 5.5%). Mitral annuloplasty reduced MR in both groups, but remnant regurgitation after the repair was higher in Tether 2. After chordal cutting a similar trend was observed with trace regurgitation in Tether 1 group at 3.6 +/- 2.8%, in comparison to 18.6 +/- 4

  3. Pulse subtraction Doppler

    NASA Astrophysics Data System (ADS)

    Mahue, Veronique; Mari, Jean Martial; Eckersley, Robert J.; Caro, Colin G.; Tang, Meng-Xing

    2010-01-01

    Recent advances have demonstrated the feasibility of molecular imaging using targeted microbubbles and ultrasound. One technical challenge is to selectively detect attached bubbles from those freely flowing bubbles and surrounding tissue. Pulse Inversion Doppler is an imaging technique enabling the selective detection of both static and moving ultrasound contrast agents: linear scatterers generate a single band Doppler spectrum, while non-linear scatterers generate a double band spectrum, one being uniquely correlated with the presence of contrast agents and non-linear tissue signals. We demonstrate that similar spectrums, and thus the same discrimination, can be obtained through a Doppler implementation of Pulse Subtraction. This is achieved by reconstructing a virtual echo using the echo generated from a short pulse transmission. Moreover by subtracting from this virtual echo the one generated from a longer pulse transmission, it is possible to fully suppress the echo from linear scatterers, while for non-linear scatterers, a signal will remain, allowing classical agent detection. Simulations of a single moving microbubble and a moving linear scatterer subject to these pulses show that when the virtual echo and the long pulse echo are used to perform pulsed Doppler, the power Doppler spectrum allows separation of linear and non-linear moving scattering. Similar results are obtained on experimental data acquired on a flow containing either microbubble contrast agents or linear blood mimicking fluid. This new Doppler method constitutes an alternative to Pulse Inversion Doppler and preliminary results suggest that similar dual band spectrums could be obtained by the combination of any non-linear detection technique with Doppler demodulation.

  4. Heritability of Mitral Regurgitation: Observations From the Framingham Heart Study and Swedish Population.

    PubMed

    Delling, Francesca N; Li, Xinjun; Li, Shuo; Yang, Qiong; Xanthakis, Vanessa; Martinsson, Andreas; Andell, Pontus; Lehman, Birgitta T; Osypiuk, Ewa W; Stantchev, Plamen; Zöller, Bengt; Benjamin, Emelia J; Sundquist, Kristina; Vasan, Ramachandran S; Smith, J Gustav

    2017-10-01

    Familial aggregation has been described for primary mitral regurgitation (MR) caused by mitral valve prolapse. We hypothesized that heritability of MR exists across different MR subtypes including nonprimary MR. Study participants were FHS (Framingham Heart Study) Generation 3 (Gen 3) and Gen 2 cohort participants and all adult Swedish siblings born after 1932 identified in 1997 and followed through 2010. MR was defined as ≥ mild regurgitation on color Doppler in FHS and from International Classification of Diseases codes in Sweden. We estimated the association of sibling MR with MR in Gen 2/Gen 3/Swedish siblings. We also estimated heritability of MR in 539 FHS pedigrees (7580 individuals). Among 5132 FHS Gen 2/Gen 3 participants with sibling information, 1062 had MR. Of siblings with sibling MR, 28% (500/1797) had MR compared with 17% (562/3335) without sibling MR (multivariable-adjusted odds ratio, 1.20; 95% confidence interval [CI], 1.01-1.43; P=0.04). When we combined parental and sibling data in FHS pedigrees, heritability of MR was estimated at 0.15 (95% CI, 0.07-0.23), 0.12 (95% CI, 0.04-0.20) excluding mitral valve prolapse, and 0.44 (95% CI, 0.15-0.73) for ≥ moderate MR only (all P<0.05). In Sweden, sibling MR was associated with a hazard ratio of 3.57 (95% CI, 2.21-5.76; P<0.001) for development of MR. Familial clustering of MR exists in the community, supporting a genetic susceptibility common to primary and nonprimary MR. Further studies are needed to elucidate the common regulatory pathways that may lead to MR irrespective of its cause. © 2017 American Heart Association, Inc.

  5. Determinants of functional mitral regurgitation severity in patients with ischemic cardiomyopathy versus nonischemic dilated cardiomyopathy.

    PubMed

    Konstantinou, Dimitrios M; Papadopoulou, Klio; Giannakoulas, George; Kamperidis, Vasilis; Dalamanga, Emmanouela G; Damvopoulou, Efthalia; Parcharidou, Despina G; Karamitsos, Theodoros D; Karvounis, Haralambos I

    2014-01-01

    Functional mitral regurgitation (MR) is prevalent among patients with left ventricular (LV) dysfunction and is associated with a poorer prognosis. Our aim was to assess the primary determinants of MR severity in patients with ischemic cardiomyopathy (ICM) and nonischemic dilated cardiomyopathy (DCM). Patients with functional MR secondary to ICM (n = 55) and DCM (n = 48) were prospectively enrolled. Effective regurgitant orifice (ERO) area, global LV remodeling, regional wall-motion abnormalities, and mitral apparatus deformity indices were assessed utilizing conventional and tissue Doppler echocardiography. ICM patients had more severe MR compared with DCM patients despite similar ejection fraction and functional status (ERO = 0.16 ± 0.08 cm(2) vs. ERO = 0.12 ± 0.70 cm(2) , respectively, P = 0.002). Regional myocardial systolic velocities in mid-inferior and mid-lateral wall were negatively correlated with ERO in ICM and DCM patients, respectively. Multivariate analysis identified coaptation height as the only independent determinant of ERO in both groups. In a subset of ICM patients (n = 9) with relatively high ERO despite low coaptation height, a higher prevalence of left bundle branch block was detected (88.9% vs. 46.7%, P = 0.02). Functional MR severity was chiefly determined by the extent of mitral apparatus deformity, and coaptation height can provide a rapid estimation of MR severity in heart failure patients. Additional contributory mechanisms in ICM patients include depressed myocardial systolic velocities in posteromedial papillary muscle attaching site and evidence of global LV dyssynchrony. © 2013, Wiley Periodicals, Inc.

  6. Echocardiographic evaluation of mitral stenosis using diastolic posterior left ventricular wall motion.

    PubMed

    Wise, J R

    1980-05-01

    The slope of the posterior left ventricular wall motion in diastole (LVDS) was determined by echocardiography in 25 normal subjects and 21 patients with mitral stenosis. Patients with mitral stenosis had reduced LVDS that was related to the degree of mitral stenosis determined by calculated mitral valve area (r = 0.92). The mitral valve area correlated more closely with the LVDS than with the left atrial emptying index derived from the posterior aortic wall motion. Three patients with mitral stenosis had an increased LVDS after mitral valvotomy or mitral valve replacement. One patient with a stenotic mitral valve prosthesis had reduced LVDS. The results of this study suggest that analysis of the LVDS would be useful in predicting the severity of mitral stenosis and may be beneficial in evaluating patients with suspected prosthetic mitral valve malfunction.

  7. Prognostic value of pulmonary hypertension in patients undergoing surgery for degenerative mitral valve disease with leaflet prolapse.

    PubMed

    Nozohoor, Shahab; Hyllén, Snejana; Meurling, Carl; Wierup, Per; Sjögren, Johan

    2012-11-01

    The aim of this study was to evaluate the impact of pulmonary hypertension (PH) on early and late outcomes following surgery in patients with degenerative mitral regurgitation. The study included 270 patients who had undergone isolated mitral valve surgery (MVS) for leaflet prolapse during 1998 to 2010. Pulmonary artery systolic pressure (PASP) was measured with Doppler echocardiography pre- and postoperatively. The impact of PH (PASP > 50 mmHg) on mortality and the potential for postoperative resolution of preoperatively elevated PASP was retrospectively analyzed. The incidence of PH was 27% (n = 74/270). Postoperative normalization, or reduction of preoperative PASP, was demonstrated in 87% of the patients with PH at a median of two months (interquartile range 1 to 19). Absent improvement or a postoperative increase in PASP was independently predicted by age (OR 1.08, 95% CI 1.02-1.14, p = 0.010). Preoperative PH resulted in a fourfold higher risk of postoperative mortality (HR 4.3, 95% CI 1.1-17.4, p = 0.039) during the first three years of follow-up. PH is an independent predictor of mortality during the initial three years following MVS. The majority of patients with PH demonstrated a reduction of preoperatively elevated PASP following surgery and the increased risk of mortality gradually decreased after three years. Our findings support early admission for mitral valve surgery before the occurrence of PH. © 2012 Wiley Periodicals, Inc.

  8. Systemic thrombolysis: cure for prosthetic mitral valve thrombosis in the comorbid, non-surgical candidate.

    PubMed

    Beckord, Brian; Berkowitz, Robert; Espinoza, Cholene; Anand, Neil

    2014-05-30

    Severe haemolytic anaemia is a rare complication of prosthetic valve thrombosis (PVT). Emergent surgical replacement of the affected valve is normally the treatment of choice unless contraindicated, such as in high surgical risk patients. Systemic thrombolysis is the alternative to surgical valve replacement. The purpose of this report is to highlight the unique case of an elderly man with New York Heart Association class IV heart failure, history of extensive cardiopulmonary surgeries and haemorrhagic stroke, who presented with severe haemolytic anaemia secondary to prosthetic mitral valve thrombosis. After weighing the risks and benefits, our decision was to use systemic thrombolytic therapy, even in light of the patient's previous intracranial haemorrhage. Pretreatment and post-treatment Doppler echocardiography showed markedly reduced regurgitant jetting that ultimately resolved completely, thereby eliminating the underlying cause of haemolysis and achieving symptom resolution. 2014 BMJ Publishing Group Ltd.

  9. Functional Mitral Regurgitation: Appraising the Evidence Behind Recommended Treatment Strategies.

    PubMed

    Samad, Zainab; Velazquez, Eric J

    2016-12-01

    Functional mitral regurgitation (MR) is the most common type of MR encountered in clinical practice. Because the disease arises from the ventricular aspect of the mitral valve apparatus, treatment therapies are less defined and outcomes are poor. In this review, the state of evidence for medical and surgical therapy in functional MR is appraised. Future directions for research in this area are also defined.

  10. Single-Suture Neochorda-Folding Plasty for Mitral Regurgitation

    PubMed Central

    Park, Jong Myung; Je, Hyung Gon; Lee, Sang Kwon

    2016-01-01

    The single-suture neochorda-folding plasty technique is a modification of existing mitral valve repair techniques. In the authors’ experience, its simplicity, reliability, and versatility make it a useful technique for mitral valve repair, especially when a minimally invasive approach is used. PMID:26889453

  11. Myxomatous Mitral Valve with Prolapse and Flail Scallop

    PubMed Central

    Fan, Jerry; Timbrook, Alexa; Said, Sarmad; Babar, Kamran; Teleb, Mohamed; Mukherjee, Debabrata; Abbas, Aamer

    2016-01-01

    Summary Background Myxomatous mitral valve with prolapse are classically seen with abnormal leaflet apposition during contraction of the heart. Hemodynamic disorders can result from eccentric mitral regurgitation usually caused by chordae tendinae rupture or papillary muscle dysfunction. Echocardiography is the gold standard for evaluation of leaflet flail and prolapse due to high sensitivity and specificity. Though most mitral valve prolapse are asymptomatic those that cause severe regurgitation need emergent surgical intervention to prevent disease progression. Case Report We report a 54 year old Hispanic male who presented with progressively worsening dyspnea and palpitations. Initial evaluation was significant for atrial fibrillation on electrocardiogram with subsequent echocardiography revealing myxomatous mitral valve with prolapse. Following surgical repair of the mitral valve, the dyspnea and palpitations resolved. Conclusions Mitral valve prolapse is a common valvular abnormality but the pathogenic cause of myxomatous valves has not been elucidated. Several theories describe multiple superfamilies of proteins to be involved in the process. Proper identification of these severe mitral regurgitation due to these disease valves will help relieve symptomatic mitral valve prolapse patients. PMID:27279924

  12. Echocardiography in Transcatheter Aortic Valve Implantation and Mitral Valve Clip

    PubMed Central

    Luo, Huai

    2012-01-01

    Transcatheter aortic valve implantation and transcatheter mitral valve repair (MitraClip) procedures have been performed worldwide. In this paper, we review the use of two-dimensional and three-dimensional transesophageal echo for guiding transcatheter aortic valve replacement and mitral valve repair. PMID:23019387

  13. Pulmonary venous flow and mitral inflow velocity pattern in uncomplicated obesity: evidence for late diastolic dysfunction.

    PubMed

    Mureddu, G F; Celentano, A; Pasanisi, F; Greco, R; Rocco, A; Contaldo, F; de Simone, G

    2000-03-01

    Active left ventricular relaxation, assessed by Doppler isovolumic relaxation time, is impaired in obesity. There is little information on left ventricular passive properties during filling. To evaluate left ventricular late diastolic stiffness in obesity, Doppler echocardiographic interrogation of mitral inflow tract and pulmonary vein flow velocities were obtained from 47 normotensive, young obese subjects (11 males, 36 females) and 43 normotensive, young normal-weight volunteers (13 males, 30 females) of comparable age. After controlling the effect of blood pressure and left ventricular mass, isovolumic relaxation time was prolonged in obese subjects (p < 0.0001 vs normal-weight controls). No difference was found in transmitral peak early and late flow velocities. Obese subjects exhibited prolonged pulmonary vein reverse flow velocity during atrial contraction (p < 0.004), and a higher difference or ratio between duration of pulmonary reverse flow and duration of transmitral forward late flow (6 +/- 31 vs -20 +/- 39 ms or 1.06 +/- 0.3 vs 0.84 +/- 0.3, p < 0.002 and p < 0.001, respectively). These differences were also confirmed after controlling blood pressure and left ventricular mass. Non-invasively estimated left ventricular end-diastolic pressure was higher in obese subjects than in controls (p < 0.002). At multivariate analysis a higher body mass index was the sole predictor of prolonged difference between duration of pulmonary reverse flow and duration of transmitral forward late flow (beta = 0.38, p < 0.001). Obesity is associated with prolonged left ventricular active relaxation and abnormalities of filling pressure not detectable by the sole mitral inflow velocity pattern. These latter abnormalities are consistent with the presence of early increased left ventricular passive stiffness.

  14. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation.

    PubMed

    Acker, Michael A; Parides, Michael K; Perrault, Louis P; Moskowitz, Alan J; Gelijns, Annetine C; Voisine, Pierre; Smith, Peter K; Hung, Judy W; Blackstone, Eugene H; Puskas, John D; Argenziano, Michael; Gammie, James S; Mack, Michael; Ascheim, Deborah D; Bagiella, Emilia; Moquete, Ellen G; Ferguson, T Bruce; Horvath, Keith A; Geller, Nancy L; Miller, Marissa A; Woo, Y Joseph; D'Alessandro, David A; Ailawadi, Gorav; Dagenais, Francois; Gardner, Timothy J; O'Gara, Patrick T; Michler, Robert E; Kron, Irving L

    2014-01-02

    Ischemic mitral regurgitation is associated with a substantial risk of death. Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited. We randomly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitral-valve repair or chordal-sparing replacement in order to evaluate efficacy and safety. The primary end point was the left ventricular end-systolic volume index (LVESVI) at 12 months, as assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized below the lowest LVESVI rank. At 12 months, the mean LVESVI among surviving patients was 54.6±25.0 ml per square meter of body-surface area in the repair group and 60.7±31.5 ml per square meter in the replacement group (mean change from baseline, -6.6 and -6.8 ml per square meter, respectively). The rate of death was 14.3% in the repair group and 17.6% in the replacement group (hazard ratio with repair, 0.79; 95% confidence interval, 0.42 to 1.47; P=0.45 by the log-rank test). There was no significant between-group difference in LVESVI after adjustment for death (z score, 1.33; P=0.18). The rate of moderate or severe recurrence of mitral regurgitation at 12 months was higher in the repair group than in the replacement group (32.6% vs. 2.3%, P<0.001). There were no significant between-group differences in the rate of a composite of major adverse cardiac or cerebrovascular events, in functional status, or in quality of life at 12 months. We observed no significant difference in left ventricular reverse remodeling or survival at 12 months between patients who underwent mitral-valve repair and those who underwent mitral-valve replacement. Replacement provided a more durable correction of mitral regurgitation, but there was no significant between-group difference in clinical outcomes. (Funded by the National Institutes of Health and the Canadian Institutes of

  15. A Rare Case of Mitral Valve Prolapse in Endomyocardial Fibrosis.

    PubMed

    Xavier, Joseph; Haranal, Maruti Yamanappa; Reddy, Shashidhar Ranga; Suryaprakash, Sharadaprasad

    2016-09-01

    Mitral valve prolapse in endomyocardial fibrosis (EMF) is an unusual entity. Literature search reveals only 1 report of mitral valve prolapse assosiated with EMF. A 32-year-old woman, of African origin, who presented with features of right heart failure, was diagnosed to have mitral valve prolapse of rheumatic origin with severe mitral regurgitation and severe pulmonary hypertension (PAH). Intraoperative findings lead to the diagnosis of EMF. We report this rare case of mitral valve prolapse in EMF, in a geographical area where rheumatic heart disease is endemic, to showcase how a rare manifestation of EMF can be misdiagnosed as that of rheumatic heart disease. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Multiple purpose simulator using a natural porcine mitral valve.

    PubMed

    Arita, Makoto; Tono, Sumihiro; Kasegawa, Hitoshi; Umezu, Mitsuo

    2004-12-01

    An in vitro pulsatile simulator with a porcine mitral valve was developed in order to simulate physiologic and diseased mitral valve conditions. Evaluation of these conditions was conducted from a hydrodynamic and annulus behavior point of view. We found it possible to simulate mild "mitral valve prolapse" and to obtain quantitative data related to the condition. The diseased condition produced a 40% greater regurgitant volume than that observed under the normal condition (p < 0.0001). Regarding the leakage volume, the diseased condition exhibited about 2.6 times more leakage than the normal condition. The mitral valve simulator proposed in this study is considered fairly stable with respect to both hemodynamics and the behavior of the annulus, and it is an adequate simulator for modeling various types of normal and diseased mitral valve conditions.

  17. Percutaneous mitral valve repair with MitraClip.

    PubMed

    Cilingiroğlu, Mehmet; Salinger, Michael

    2012-03-01

    Over the last decade, several technologies have been developed for percutaneous repair of the mitral valve for patients with severe mitral regurgitation (MR) and at high-risk for the traditional open-heart mitral valve repair or replacement. Among them, MitraClip has emerged as the only clinically safe and effective method for percutaneous mitral valve repair. It is adapted from the surgical technique that was initially described by Dr. Alfieri and his group by placement of a suture approximating the edges of the mitral leaflets at the origin of the MR jet, leading to creation of so-called bow-tie or double orifice with significant reduction in the MR jet. Here, we review the details of the technology, its procedural perspective as well as currently available data for its safety and effectiveness on a case-based report.

  18. Congenital mitral valve lesions : Correlation between morphology and imaging

    PubMed Central

    Remenyi, Bo; Gentles, Tom L

    2012-01-01

    Congenital malformations of the mitral valve are often complex and affect multiple segments of the valve apparatus. They may occur in isolation or in association with other congenital heart defects. The majority of mitral valve malformations are not simply classified, and descriptive terms with historical significance (parachute, mitral, or arcade) often lack the specificity that cardiac surgeons demand as part of preoperative echocardiographic morphological assessment. This paper examines the strengths and limitations of commonly used descriptions and classification systems of congenitally malformed mitral valves. It correlates pathological, surgical, and echocardiographic findings. Finally, it makes recommendations for the systematic evaluation of the congenitally malformed mitral valve using segmental echocardiographic analysis to assist precise communication and optimal surgical management. PMID:22529594

  19. [Impact of mitral annuloplasty combined with surgical revascularization in ischemic mitral regurgitation].

    PubMed

    Tribak, M; Konaté, M; Ould Hbib, B; Konan, P; Mahfoudi, L; Hassani, A El; Daouda, A; Lachhab, F; Bendagha, N; Soufiani, A; Fila, J; Maghraoui, S; Bensouda, A; Marmade, L; Moughil, S

    2017-08-08

    Ischemic Mitral Regurgitation (IMR) is a serious complication of coronary artery disease and is associated with a poor prognosis. The optimal surgical treatment of IMR involves controversies in its indications and modalities. To determine whether mitral annuloplasty associated with surgical revascularization improved short and mid terms outcomes compared with revascularization alone in patients with IMR. Between January 2007 and January 2011, 81 patients operated on Department of Cardiovascular Surgery "B" were included in this study divided into 3 groups. Group 1: 28 patients with IMR had mitral valve surgery associated with surgical revascularization. Group 2: 26 patients with IMR had surgical revascularization without mitral valve surgery. Group 3: 27 patients without IMR had isolated revascularization. Clinical end-points were operative mortality, late mortality, postoperative functional status (NYHA), and the Effective Regurgitant Orifice (ERO) at last follow-up. The mean follow-up was 5 years for groups 1 and 2 and 4 years for group 3. There was no difference between the 3 groups regarding age, sex, cardiovascular risk factors, and extension of coronary artery disease. The Left Ventricle End Diastolic Diameter (LVEDD) and the Left Ventricle Ejection Fraction (LVEF) were slightly different. Late and operative mortality were higher in group 2 compared to groups 1 and 3. Postoperative functional status (NYHA) improved both in groups 1 and 2. In group 1, there was a decrease in ERO. Mitral annuloplasty combined to revascularization improves symptoms, postoperative ERO and short- and mid-term survival compared with revascularization alone. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  20. Parachute mitral valve: morphologic descriptors, associated lesions, and outcomes after biventricular repair.

    PubMed

    Marino, Bradley S; Kruge, Lydia E; Cho, Catherine J; Tomlinson, Ryan S; Shera, David; Weinberg, Paul M; Gaynor, J William; Rychik, Jack

    2009-02-01

    In "true" parachute mitral valve, mitral valve chordae insert into one papillary muscle. In parachute-like asymmetric mitral valve, most or all chordal attachments are to one papillary muscle. This study compared morphologic features, associated lesions, and palliation strategies of the two parachute mitral valve and dominant papillary muscle types and examined interventions and midterm outcomes in patients with biventricular circulation. Echocardiography and autopsy databases were reviewed to identify patients with "true" parachute mitral valve or parachute-like asymmetric mitral valve from January 1987 to January 2006. Predictors of palliation strategy in the entire cohort, mitral stenosis on initial echocardiogram, and mortality in the biventricular cohort were determined with logistic regression. Eighty-six patients with "true" parachute mitral valve (n = 49) or parachute-like asymmetric mitral valve (n = 37) were identified. Chordal attachments to the posteromedial papillary muscle were more common (73%). The presence "true" parachute mitral valve (P = .008), hypoplastic left ventricle (P < .001), and two or more left-sided obstructive lesions (P = .002) predicted univentricular palliation. Among 49 patients maintaining biventricular circulation at follow-up, 8 died median follow-up 6.4 years (7 days-17.8 years). Multivariate analysis revealed that "true" parachute mitral valve was associated with mitral stenosis on initial echocardiogram (P = .03), and "true" parachute mitral valve (P = .04) and conotruncal anomalies (P = .0003) were associated with mortality. Progressive mitral stenosis was found in 11 patients; 2 underwent mitral valve interventions, and 1 died. Nearly two thirds of this parachute mitral valve cohort underwent biventricular palliation. Some progression of mitral stenosis occurred, although mitral valve intervention was rare. "True" parachute mitral valve was associated with mitral stenosis on initial echocardiogram. "True" parachute mitral

  1. Abnormal Mitral Valve Dimensions in Pediatric Patients with Hypertrophic Cardiomyopathy.

    PubMed

    Schantz, Daryl; Benson, Lee; Windram, Jonathan; Wong, Derek; Dragulescu, Andreea; Yoo, Shi-Joon; Mertens, Luc; Friedberg, Mark; Al Nafisi, Bahiyah; Grosse-Wortmann, Lars

    2016-04-01

    The hearts of patients with hypertrophic cardiomyopathy (HCM) show structural abnormalities other than isolated wall thickening. Recently, adult HCM patients have been found to have longer mitral valve leaflets than control subjects. The aim of the current study was to assess whether children and adolescents with HCM have similar measureable differences in mitral valve leaflet dimensions when compared to a healthy control group. Clinical and echocardiographic data from 46 children with myocardial hypertrophy and a phenotype and/or genotype consistent with sarcomeric HCM were reviewed. Cardiac magnetic resonance imaging studies were evaluated. The anterior and posterior mitral valve leaflet lengths and myocardial structure were compared to 20 healthy controls. The anterior mitral valve was longer in the HCM group than in the control group (28.4 ± 4.9 vs. 25.2 ± 3.6 mm in control patients, p = 0.013) as was the posterior mitral valve leaflet (16.3 ± 3.0 vs. 13.1 ± 2.3 mm for controls <0.0001). There was no correlation between the resting left ventricular outflow tract gradient and anterior mitral valve leaflet length, nor was the anterior mitral valve leaflet longer in those with systolic anterior motion of the mitral valve compared to those without (28.9 ± 6.1 vs. 28.1 ± 4.5 mm, p = 0.61). Children and adolescents with HCM have abnormally long mitral valve leaflets when compared with healthy control subjects. These abnormalities do not appear to result in, or be due to, obstruction to left ventricular outflow. The mechanism of this mitral valve elongation is not clear but appears to be independent of hemodynamic disturbances.

  2. Application of Mitral Annular Systolic Displacements and Velocities for the Evaluation of Left Ventricular Systolic Function and Reserve

    PubMed Central

    Sharif, Dawod; Sharif-Rasslan, Amal; Shahla, Camilia; Rosenschein, Uri

    2011-01-01

    Background Mitral annular systolic displacement from M-mode echocardiography and velocity from tissue Doppler imaging reflect subendocardial longitudinal systolic LV performance and may precede radial abnormalities. The aim of this study is to evaluate the utility of mitral annular systolic displacement (D) and velocity (V) during dobutamine stress echocardiography (DSE) in detecting left ventricular (LV) functional reserve and wall motion abnormality (WMA). Methods and Results Fifty-nine subjects, 15 with resting WMA, underwent DSE and measurement of mitral systolic (D) and (V) before and immediately after DSE. Annular septal (D) was lower in those with WMA than in those without, at rest 10.5 ± 4 cm versus 13.2 ± 2 cm, p = 0.015, and after DSE, 11.7 ± 3.8 cm versus 14 ± 2.25 cm, p = 0.036, but without significant change after stress. Annular systolic (V) at rest with WMA was 9.7 ± 1.8 cm/sec and similar to those without, 11.25 ± 2.7 cm/sec. In both groups the velocity increased after DSE, 14.5 ± 4.5 cm/sec, p = 0.025 with WMA and 17.8 ± 3.2 cm/sec, p = 1.99 x 10-10 in those without WMA. Velocities after DSE were lower in those with WMA, p = 2.25 x 10-6. Conclusions To evaluate LV systolic performance mitral annular systolic longitudinal displacement is valuable at rest, but for assessment of LV functional reserve after stress velocities are better.

  3. Three-dimensional echocardiographic planimetry of maximal regurgitant orifice area in myxomatous mitral regurgitation: intraoperative comparison with proximal flow convergence

    NASA Technical Reports Server (NTRS)

    Breburda, C. S.; Griffin, B. P.; Pu, M.; Rodriguez, L.; Cosgrove, D. M. 3rd; Thomas, J. D.

    1998-01-01

    OBJECTIVES: We sought to validate direct planimetry of mitral regurgitant orifice area from three-dimensional echocardiographic reconstructions. BACKGROUND: Regurgitant orifice area (ROA) is an important measure of the severity of mitral regurgitation (MR) that up to now has been calculated from hemodynamic data rather than measured directly. We hypothesized that improved spatial resolution of the mitral valve (MV) with three-dimensional (3D) echo might allow accurate planimetry of ROA. METHODS: We reconstructed the MV using 3D echo with 3 degrees rotational acquisitions (TomTec) using a transesophageal (TEE) multiplane probe in 15 patients undergoing MV repair (age 59 +/- 11 years). One observer reconstructed the prolapsing mitral leaflet in a left atrial plane parallel to the ROA and planimetered the two-dimensional (2D) projection of the maximal ROA. A second observer, blinded to the results of the first, calculated maximal ROA using the proximal convergence method defined as maximal flow rate (2pi(r2)va, where r is the radius of a color alias contour with velocity va) divided by regurgitant peak velocity (obtained by continuous wave [CW] Doppler) and corrected as necessary for proximal flow constraint. RESULTS: Maximal ROA was 0.79 +/- 0.39 (mean +/- SD) cm2 by 3D and 0.86 +/- 0.42 cm2 by proximal convergence (p = NS). Maximal ROA by 3D echo (y) was highly correlated with the corresponding flow measurement (x) (y = 0.87x + 0.03, r = 0.95, p < 0.001) with close agreement seen (AROA (y - x) = 0.07 +/- 0.12 cm2). CONCLUSIONS: 3D echo imaging of the MV allows direct visualization and planimetry of the ROA in patients with severe MR with good agreement to flow-based proximal convergence measurements.

  4. Three-dimensional echocardiographic planimetry of maximal regurgitant orifice area in myxomatous mitral regurgitation: intraoperative comparison with proximal flow convergence

    NASA Technical Reports Server (NTRS)

    Breburda, C. S.; Griffin, B. P.; Pu, M.; Rodriguez, L.; Cosgrove, D. M. 3rd; Thomas, J. D.

    1998-01-01

    OBJECTIVES: We sought to validate direct planimetry of mitral regurgitant orifice area from three-dimensional echocardiographic reconstructions. BACKGROUND: Regurgitant orifice area (ROA) is an important measure of the severity of mitral regurgitation (MR) that up to now has been calculated from hemodynamic data rather than measured directly. We hypothesized that improved spatial resolution of the mitral valve (MV) with three-dimensional (3D) echo might allow accurate planimetry of ROA. METHODS: We reconstructed the MV using 3D echo with 3 degrees rotational acquisitions (TomTec) using a transesophageal (TEE) multiplane probe in 15 patients undergoing MV repair (age 59 +/- 11 years). One observer reconstructed the prolapsing mitral leaflet in a left atrial plane parallel to the ROA and planimetered the two-dimensional (2D) projection of the maximal ROA. A second observer, blinded to the results of the first, calculated maximal ROA using the proximal convergence method defined as maximal flow rate (2pi(r2)va, where r is the radius of a color alias contour with velocity va) divided by regurgitant peak velocity (obtained by continuous wave [CW] Doppler) and corrected as necessary for proximal flow constraint. RESULTS: Maximal ROA was 0.79 +/- 0.39 (mean +/- SD) cm2 by 3D and 0.86 +/- 0.42 cm2 by proximal convergence (p = NS). Maximal ROA by 3D echo (y) was highly correlated with the corresponding flow measurement (x) (y = 0.87x + 0.03, r = 0.95, p < 0.001) with close agreement seen (AROA (y - x) = 0.07 +/- 0.12 cm2). CONCLUSIONS: 3D echo imaging of the MV allows direct visualization and planimetry of the ROA in patients with severe MR with good agreement to flow-based proximal convergence measurements.

  5. Role of regional mechanical dyssynchrony as a determinant of functional mitral regurgitation in patients with left ventricular systolic dysfunction.

    PubMed

    Agricola, E; Oppizzi, M; Galderisi, M; Pisani, M; Meris, A; Pappone, C; Margonato, A

    2006-10-01

    To assess regional mechanical dyssynchrony as a determinant of the degree of functional mitral regurgitation (FMR). Tertiary cardiology clinic. 74 consecutive patients with left ventricular (LV) dysfunction (ejection fraction < 40%, mean 32.2 (SD 7.3)%) were evaluated. Effective regurgitant orifice (ERO) area, indices of mitral deformation (systolic valvular tenting, mitral annular contraction) and of global LV function and remodelling (ejection fraction, end systolic volume, sphericity index) and local remodelling (papillary-fibrosa distance, regional wall motion score index), and tissue Doppler-derived dyssynchrony index (DI) (regional DI, defined as the standard deviation of time to peak myocardial systolic contraction of eight LV segments supporting the papillary muscles attachment) were measured. All the assessed variables correlated significantly with ERO. By multivariate analysis, systolic valvular tenting was the strongest independent predictor of ERO (R(2) = 0.77, p = 0.0001), with a minor influence of papillary-fibrosa distance (R(2) = 0.77, p = 0.01) and regional DI (R(2) = 0.77, p = 0.03). Local LV remodelling (regional wall motion score index: R(2) = 0.58, p = 0.001; papillary-fibrosa distance: R(2) = 0.58, p = 0.002) and global remodelling indices (sphericity index: R(2) = 0.58, p = 0.003) were the main determinants of systolic valvular tenting, whereas regional DI did not enter into the model. Regional DI was an independent predictor of ERO (R(2) = 0.56, p = 0.005) in patients with non-ischaemic LV dysfunction but not in patients with ischaemic LV dysfunction when these groups were analysed separately. The degree of FMR is associated mainly with mitral deformation indices. The regional dyssynchrony also has an independent association with ERO but with a minor influence; however, it is not a determinant of FMR in patients with ischaemic LV dysfunction.

  6. Porcine mitral valve interstitial cells in culture.

    PubMed

    Lester, W; Rosenthal, A; Granton, B; Gotlieb, A I

    1988-11-01

    There are connective tissue cells present within the interstitium of the heart valves. This study was designed to isolate and characterize mitral valve interstitial cells from the anterior leaflet of the mitral valve. Explants obtained from the distal part of the leaflet, having been scraped free of surface endocardial cells, were incubated in medium 199 supplemented with 10% fetal bovine serum. Cells grew out of the explant after 3 to 5 days and by 3 weeks these cells were harvested and passaged. Passages 1 to 22 were characterized in several explant sets. The cells showed a growth pattern reminiscent of fibroblasts. Growth was dependent on serum concentration. Cytoskeletal localization of actin and myosin showed prominent stress fibers. Ultrastructural studies showed many elongated cells with prominent stress fibers and some gap junctions and few adherens junctions. There were as well cells with fewer stress fibers containing prominent Golgi complex and dilated endoplasmic reticulum. In the multilayered superconfluent cultures, the former cells tended to be on the substratum of the dish or surface of the multilayered culture, whereas the latter was generally located within the layer of cells. Extracellular matrix was prominent in superconfluent cultures, often within the layers as well. Labeling of the cells with antibody HHF 35 (Tsukada T, Tippens D, Gordon D, Ross R, Gown AM: Am J Pathol 126:51, 1987), which recognizes smooth muscle cell actin, showed prominent staining of the elongated stress fiber-containing cells and much less in the secretory type cells. These studies show that interstitial mitral valve cells can be grown in culture and that either two different cell types or one cell type with two phenotypic expressions is present in culture.

  7. Beating-heart Mitral Valve Chordal Replacement

    PubMed Central

    Laing, Genevieve; Dupont, Pierre E.

    2011-01-01

    Replacing open-heart surgical procedures with beating-heart interventions substantially decreases the trauma and risk of a procedure. One of the most challenging procedures to perform on the beating heart is valve repair. To address this need, this paper proposes a tool for replacing mitral valve chordae to correct regurgitation. The chordae is secured to the papillary muscle and leaflet using NiTi tissue anchors that also incorporate an internal adjustment mechanism to enable initial adjustment as well as subsequent readjustment of chordae length. Efficacy of the proposed tool for chordae replacement and reduction of regurgitation was demonstrated in an ex-vivo heart simulator. PMID:22254843

  8. Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse.

    PubMed

    Cameli, Matteo; Lisi, Matteo; Righini, Francesca Maria; Massoni, Alberto; Natali, Benedetta Maria; Focardi, Marta; Tacchini, Damiana; Geyer, Alessia; Curci, Valeria; Di Tommaso, Cristina; Lisi, Gianfranco; Maccherini, Massimo; Chiavarelli, Mario; Massetti, Massimo; Tanganelli, Piero; Mondillo, Sergio

    2013-02-15

    In patients with severe mitral regurgitation (MR) referred for cardiac surgery, left atrial (LA) remodeling and enlargement are accompanied by mechanical stress, mediated cellular hypertrophy, and interstitial fibrosis that finally lead to LA failure. Speckle tracking echocardiography is a novel non-Doppler-based method that allows an objective quantification of LA myocardial deformation, becoming useful for LA functional analysis. We conducted a study to evaluate the relation between the traditional and novel atrial indexes and the extent of ultrastructural alterations, obtained from patients with severe MR who were undergoing surgical correction of the valvular disease. The study population included 46 patients with severe MR, referred to our echocardiographic laboratory for a diagnostic examination before cardiac surgery. The global peak atrial longitudinal strain (PALS) was measured in all subjects by averaging all atrial segments. LA tissue samples were obtained from all patients. Masson's trichrome staining was performed to assess the extent of the fibrosis. The LA endocardial thickness was measured. A close negative correlation between the global PALS and grade of LA myocardial fibrosis was found (r = -0.82, p <0.0001), with poorer correlations for the LA indexed volume (r = 0.51, p = 0.01), LA ejection fraction (r = 0.61, p = 0.005), and E/E' ratio (0.14, p = NS). Of these indexes, global PALS showed the best diagnostic accuracy to detect LA fibrosis (area under the curve 0.89), and it appears to be a strong and independent predictor of LA fibrosis. Furthermore, we also demonstrated an inverse correlation between the global PALS and LA endocardial thickness (r = -0.66, p = 0.0001). In conclusion, in patients with severe MR referred for cardiac surgery, impairment of LA longitudinal deformation, as assessed by the global PALS, correlated strongly with the extent of LA fibrosis and remodeling. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Mitral valve prolapse, panic disorder, and chest pain.

    PubMed

    Alpert, M A; Mukerji, V; Sabeti, M; Russell, J L; Beitman, B D

    1991-09-01

    Mitral valve prolapse is a common cardiac disorder that can readily be diagnosed by characteristic auscultatory and echocardiographic criteria. Although many diseases have been associated with mitral valve prolapse, most affected individuals have the primary form of the disorder. Mitral valve prolapse is an inherited condition commonly associated with myxomatous degeneration of the mitral valve and its support structures. Complications of mitral valve prolapse, including cardiac arrhythmias, sudden death, infective endocarditis, severe mitral regurgitation (with or without chordae tendineae rupture), and cerebral ischemic events, occur infrequently considering the wide prevalence of the disorder. Panic disorder is a specific type of anxiety disorder characterized by at least three panic attacks within a 3-week period or one panic attack followed by fear of subsequent panic attacks for at least 1 month. It too is a common condition with a prevalence and age and gender distribution similar to that of mitral valve prolapse. Panic disorder and mitral valve prolapse share many nonspecific symptoms, including chest pain or discomfort, palpitations, dyspnea, effort intolerance, and pre-syncope. Chest pain is the symptom in both conditions that most commonly brings the patient to medical attention. The clinical description of chest pain in patients with mitral valve prolapse is highly variable, possibly reflecting multiple etiologies. Chest pain in panic disorder is usually characterized as atypical angina pectoris and as such bears resemblance to the chest pain commonly described by patients with mitral valve prolapse. Multiple investigative attempts to elucidate the mechanism of chest pain in both conditions have failed to identify a unifying cause. Review of the literature leaves little doubt that mitral valve prolapse and panic disorder frequently co-occur. Given the similarities in their symptomatology, a high rate of co-occurrence is, in fact, entirely predictable

  10. Penile Doppler ultrasonography revisited.

    PubMed

    Jung, Dae Chul; Park, Sung Yoon; Lee, Joo Yong

    2017-06-10

    Penile Doppler ultrasonography is a high-performing, noninvasive or minimally-invasive imaging modality that allows the depiction of the normal anatomy and macroscopic pathologic changes in real time. Moreover, functional changes in penile blood flow, as seen in erectile dysfunction (ED), can be analyzed using color Doppler ultrasonography (CDUS). This review article describes the normal sonographic anatomy of the penis, the sonographic technique for evaluating ED, the normal phases of erection, and the various causes of ED. Additionally, we describe the interpretation of different parameters and findings on penile CDUS for the diagnosis and classification of ED, priapism, and Peyronie disease.

  11. Doppler ion program description

    SciTech Connect

    Henline, P.

    1980-12-01

    The Doppler spectrometer is a conventional Czerny-Turner grating spectrometer with a 1024 channel multiple detector. Light is dispersed across the detector, and its output yields a spectrum covering approximately 200 A. The width of the spectral peak is directly proportional to the temperature of the emitting ions, and determination of the impurity ion temperature allows one to infer the plasma ion temperature. The Doppler ion software system developed at General Atomic uses a TRACOR Northern 1710-31 and an LSI-11/2. The exact configuration of Doublet III is different from TRACOR Northern systems at other facilities.

  12. Is minimally invasive thoracoscopic surgery the new benchmark for treating mitral valve disease?

    PubMed Central

    Goldstone, Andrew B.

    2016-01-01

    The treatment of mitral valve disease remains dynamic; surgeons and patients must now choose between many different surgical options when addressing mitral regurgitation and mitral stenosis. Notably, advances in imaging and surgical instrumentation allow surgeons to perform less invasive mitral valve surgery that spares the sternum. With favorable long-term data now emerging, we compare the benefits and risks of thoracoscopic mitral valve surgery with that through conventional sternotomy or surgery that is robot-assisted. PMID:27942489

  13. Acute Haemodialysis-induced Changes in Tissue Doppler Echocardiography Parameters

    PubMed Central

    Sağ, Saim; Yeşilbursa, Dilek; Yıldız, Abdulmecit; Dilek, Kamil; Şentürk, Tunay; Serdar, Osman Akın; Aydınlar, Ali

    2014-01-01

    Background: Tissue Doppler imaging (TDI) is a method that determines the tissue motion and velocity within the myocardium. Aims: To characterize acute haemodialysis (HD)-induced changes in TDI-derived indices for patients that have end-stage renal disease (ESRD). Study Design: Cross sectional study. Methods: Conventional echocardiography and TDI methods were applied to study ESRD patients (n=58) before and after HD. Pulmonary venous flow, mitral inflow, and TDI signals of the lateral and septal mitral annulus were examined for the determination of altered left-ventricular diastolic filling parameters. Flow velocities from early- (E) and late-atrial (A) peak transmitral; peak pulmonary vein systolic (S) and diastolic (D); and myocardial peak systolic (Sm) and peak early (Em) and late (Am) diastolic mitral annular velocities were also assessed for changes. Results: Transmitral E and A velocities and the E/A ratio decreased significantly after HD (p<0.001). Pulmonary vein S (p<0.001) and D (p<0.001) velocities decreased, and S/D ratios increased significantly (p=0.027). HD led to a reduction in septal Em (p<0.001), lateral Em (p=0.006), and Am (p<0.001) velocities. Contrary to the decreases in Em and Am, the Em/Am ratio remained unchanged. Conclusion: A single HD session was associated with an acute deterioration in the diastolic parameters. Since the Em/Am ratio remained unchanged, we conclude that this index is a relatively load-independent measure of diastolic function in HD patients. PMID:25337420

  14. Echocardiography in evaluation of mitral valve prostheses.

    PubMed

    Watts, E; Nomeir, A M; Barnes, R

    1975-06-01

    Thirty-three patients with mitral valve prostheses were studied with echocardiography in an effort to determine if this technique could be useful in detecting significant abnormalities. Recordings were obtained in the supine position with the transducer directed to record maximum excursion of the prosthesis. Echoes from the struts, poppet and sewing ring were readily recorded. Amplitude of excursion and opening and closing velocities of the poppet were measured. Fifty echocardiographic recordings were obtained from the 33 patients. Of the 33 patients studied, 22 were thought to have "normal" echo tracings while in 11, the tracings were considered "abnormal." Apparent abnormalities consisted of: 1) abnormal diastolic separation between the poppet and strut, 2) increased echoes near the poppet, strut or sewing ring and 3) a combination of both. There was only one instance of suspected "sticking" of the prosthesis. All patients who had "abnormal" studies except one developed complications associated with their prosthesis (90%) compared to only 36% in patients with "normal" tracings. Five patients in each group died. Autopsy studies are described and correlations with the echocardiographic findings are made. In low profile valves reduction in excursion of the disc may be an indication of malfunction. Echocardiography appears to be of value in the assessment of function of mitral valve prostheses.

  15. Repeat mitral valve replacement: 30-years' experience.

    PubMed

    Expósito, Víctor; García-Camarero, Tamara; Bernal, José M; Arnáiz, Elena; Sarralde, Aurelio; García, Iván; Berrazueta, José R; Revuelta, José M

    2009-08-01

    Prosthetic heart valve dysfunction is an acquired condition that carries a significant risk of emergency surgery. However, the long-term natural history of the condition is not well understood. Between 1974 and 2006, 1535 isolated mitral valve replacements were performed at our hospital (in-hospital mortality 5%). In total, 369 patients needed a second operation (in-hospital mortality 8.1%), while 80 (age 59.8+/-11.4 years) needed a third. The reasons for the third intervention were structural deterioration (67.5%), paravalvular leak (20%) and endocarditis (6.3%). Some 15 patients died in hospital (18.8%). After a mean follow-up period of 17.8 years, 21 patients needed another intervention (i.e., a fourth intervention). The actuarial reoperation-free rate at 20 years was 40.1+/-13.8%. The late mortality rate was 58.5% (18-year survival rate 15.4+/-5.4%). Indications for repeat mitral valve replacement must be judged on an individual basis given the high risk associated with surgery.

  16. Mitral Apparatus Assessment by Delayed Enhancement CMR – Relative Impact of Infarct Distribution on Mitral Regurgitation

    PubMed Central

    Chinitz, Jason S.; Chen, Debbie; Goyal, Parag; Wilson, Sean; Islam, Fahmida; Nguyen, Thanh; Wang, Yi; Hurtado-Rua, Sandra; Simprini, Lauren; Cham, Matthew; Levine, Robert A.; Devereux, Richard B.; Weinsaft, Jonathan W.

    2014-01-01

    Objectives To assess patterns and functional consequences of mitral apparatus infarction after acute MI (AMI). Background The mitral apparatus contains two myocardial components – papillary muscles and the adjacent LV wall. Delayed-enhancement CMR (DE-CMR) enables in-vivo study of inter-relationships and potential contributions of LV wall and papillary muscle infarction (PMI) to mitral regurgitation (MR). Methods Multimodality imaging was performed: CMR was used to assess mitral geometry and infarct pattern, including 3D DE-CMR for PMI. Echocardiography (echo) was used to measure MR. Imaging occurred 27±8 days post-AMI (CMR, echo within 1 day). Results 153 patients with first AMI were studied. PMI was present in 30% (n=46; 72% posteromedial, 39% anterolateral). When stratified by angiographic culprit vessel, PMI occurred in 65% of patients with left circumflex, 48% with right coronary, and only 14% of patients with left anterior descending infarctions (p<0.001). Patients with PMI had more advanced remodeling as measured by LV size and mitral annular diameter (p<0.05). Increased extent of PMI was accompanied by a stepwise increase in mean infarct transmurality within regional LV segments underlying each papillary muscle (p<0.001). Prevalence of lateral wall infarction was 3.0 fold higher among patients with, compared to those without, PMI (65% vs. 22%, p<0.001). Infarct distribution also impacted MR, with greater MR among patients with lateral wall infarction (p=0.002). Conversely, MR severity did not differ based on presence (p=0.19) or extent (p=0.12) of PMI, or by angiographic culprit vessel. In multivariable analysis, lateral wall infarct size (OR=1.20[CI=1.05–1.39], p=0.01) was independently associated with substantial (≥moderate) MR even after controlling for mitral annular (OR=1.22[1.04–1.43], p=0.01) and LV end-diastolic diameter (OR=1.11 [0.99–1.23], p=0.056). Conclusions PMI is common post-AMI, affecting nearly one-third of patients. PMI extent

  17. Mitral Valve Surgery: Current Minimally Invasive and Transcatheter Options.

    PubMed

    Ramlawi, Basel; Gammie, James S

    2016-01-01

    The mitral valve is a highly complex structure, the competency and function of which relies on the harmonious action of its component parts. Minimally invasive cardiac surgery (MICS) for mitral valve repair or replacement (MVR/r) has been performed successfully with incremental improvements in techniques over the past decade. These minimally invasive procedures, while attractive to patients and referring physicians, should meet the same high bar for optimal clinical outcomes and long-term durability of valve repair as traditional sternotomy procedures. The majority of MICS MVR/r procedures are performed via a right minithoracotomy approach with direct or camera-assisted visualization, with a minority of centers performing robotic MVR/r. Outcomes with MICS MVR/r have been shown to have similar morbidity and mortality rates as traditional sternotomy MV procedures but with the advantage of reduced transfusions, postoperative atrial fibrillation, and time to recovery. More recently, transcatheter mitral valve repair and replacement (TMVR/r) has become a reality. Percutaneous MV repair technology is currently FDA approved for patients with nonsurgical high-risk degenerative mitral regurgitation. Other TMVR/r technology is at various levels of preclinical and clinical investigation, although these devices are proving to be more challenging compared to transcatheter aortic valve replacement (TAVR) due to the significantly more complex mitral anatomy and the greater heterogeneity of mitral disease requiring treatment. In this article, we review current techniques for MICS MVR/r and upcoming catheter-based therapies for the mitral valve.

  18. Fluid-Structure Interaction Analysis of Ruptured Mitral Chordae Tendineae.

    PubMed

    Toma, Milan; Bloodworth, Charles H; Pierce, Eric L; Einstein, Daniel R; Cochran, Richard P; Yoganathan, Ajit P; Kunzelman, Karyn S

    2017-03-01

    The chordal structure is a part of mitral valve geometry that has been commonly neglected or simplified in computational modeling due to its complexity. However, these simplifications cannot be used when investigating the roles of individual chordae tendineae in mitral valve closure. For the first time, advancements in imaging, computational techniques, and hardware technology make it possible to create models of the mitral valve without simplifications to its complex geometry, and to quickly run validated computer simulations that more realistically capture its function. Such simulations can then be used for a detailed analysis of chordae-related diseases. In this work, a comprehensive model of a subject-specific mitral valve with detailed chordal structure is used to analyze the distinct role played by individual chordae in closure of the mitral valve leaflets. Mitral closure was simulated for 51 possible chordal rupture points. Resultant regurgitant orifice area and strain change in the chordae at the papillary muscle tips were then calculated to examine the role of each ruptured chorda in the mitral valve closure. For certain subclassifications of chordae, regurgitant orifice area was found to trend positively with ruptured chordal diameter, and strain changes correlated negatively with regurgitant orifice area. Further advancements in clinical imaging modalities, coupled with the next generation of computational techniques will enable more physiologically realistic simulations.

  19. Mitral Valve Surgery: Current Minimally Invasive and Transcatheter Options

    PubMed Central

    Ramlawi, Basel; Gammie, James S.

    2016-01-01

    The mitral valve is a highly complex structure, the competency and function of which relies on the harmonious action of its component parts. Minimally invasive cardiac surgery (MICS) for mitral valve repair or replacement (MVR/r) has been performed successfully with incremental improvements in techniques over the past decade. These minimally invasive procedures, while attractive to patients and referring physicians, should meet the same high bar for optimal clinical outcomes and long-term durability of valve repair as traditional sternotomy procedures. The majority of MICS MVR/r procedures are performed via a right minithoracotomy approach with direct or camera-assisted visualization, with a minority of centers performing robotic MVR/r. Outcomes with MICS MVR/r have been shown to have similar morbidity and mortality rates as traditional sternotomy MV procedures but with the advantage of reduced transfusions, postoperative atrial fibrillation, and time to recovery. More recently, transcatheter mitral valve repair and replacement (TMVR/r) has become a reality. Percutaneous MV repair technology is currently FDA approved for patients with nonsurgical high-risk degenerative mitral regurgitation. Other TMVR/r technology is at various levels of preclinical and clinical investigation, although these devices are proving to be more challenging compared to transcatheter aortic valve replacement (TAVR) due to the significantly more complex mitral anatomy and the greater heterogeneity of mitral disease requiring treatment. In this article, we review current techniques for MICS MVR/r and upcoming catheter-based therapies for the mitral valve. PMID:27127558

  20. [Percutaneous mitral commissurotomy using Inoue's balloon during pregnancy].

    PubMed

    Murillo, H; Ayala, F; Badui, E; Almazán, A; Solorio, S; Enciso, R; Madrid, R; Lepe, L; Rangel Abundis, A; Chávez, E

    1996-01-01

    The authors present three cases of pregnant women with symptomatic severe mitral stenosis with a mean age of 28.6 +/- 2.3 years, and during 27.6 +/- 1.52 weeks of pregnancy. Two patients were in class III and one in class IV of the New York Heart Association (NYHA). All patients had a mitral valvular area equal or less than 1 cm2, with a Wilkins score of 7 to 9 and mitral insufficiency grade I in two cases; two, had severe pulmonary arterial hypertension (mean > 50 mm Hg). After Percutaneous Mitral Valvuloplasty (PMV) the mitral valve measured by 2D echocardiography increased form 0.83 +/- 0.2 cm2 to 1.8 +/- 0.15 cm2; the mean transmitral gradient diminished from 13 +/- 3.4 mm Hg to 3.6 +/- 1.15 mm Hg; the degree of mitral insufficiency was no modified in neither case. Hemodynamic results revealed increasing of the mitral valve from 0.83 +/- 0.18 cm2 to 2.23 +/- 0.3 cm2; the mean mitral gradient decreased from 21.6 +/- 9 to 4.3 +/- 0.5 mm Hg; the mean left atrial pressure from 30 +/- 12 to 12.3 +/- 4 mm Hg; the mean pressure of the pulmonary artery diminished suddenly from 44.3 +/- 16 to 25.6 +/- 11 mm Hg. The average fluoroscopic time was 15.3 +/- 3 minutes. There were no complications. The patients were discharged 48 hours after the procedure and continued their pregnancies in class I NYHA, which resolved in a non complicated vaginal delivery with normal products. We conclude that PMV is a safe and useful therapy in pregnant patient with severe mitral stenosis refractory to medical treatment.

  1. The Doppler Pendulum Experiment

    ERIC Educational Resources Information Center

    Lee, C. K.; Wong, H. K.

    2011-01-01

    An experiment to verify the Doppler effect of sound waves is described. An ultrasonic source is mounted at the end of a simple pendulum. As the pendulum swings, the rapid change of frequency can be recorded by a stationary receiver using a simple frequency-to-voltage converter. The experimental results are in close agreement with the Doppler…

  2. The Doppler Pendulum Experiment

    ERIC Educational Resources Information Center

    Lee, C. K.; Wong, H. K.

    2011-01-01

    An experiment to verify the Doppler effect of sound waves is described. An ultrasonic source is mounted at the end of a simple pendulum. As the pendulum swings, the rapid change of frequency can be recorded by a stationary receiver using a simple frequency-to-voltage converter. The experimental results are in close agreement with the Doppler…

  3. Photonic doppler velocimetry

    SciTech Connect

    Lowry, M E; Molau, N E; Sargis, P D; Strand, O T; Sweider, D

    1999-01-01

    We are developing a novel fiber-optic approach to laser Doppler velocimetry as a diagnostic for high explosives tests. Using hardware that was originally developed for the telecommunications industry, we are able to measure surface velocities ranging from centimeters per second to kilometers per second. Laboratory measurements and field trials have shown excellent agreement with other diagnostics.

  4. Finnish Meteorological Institute Doppler Lidar

    SciTech Connect

    Ewan OConnor

    2015-03-27

    This doppler lidar system provides co-polar and cross polar attenuated backscatter coefficients,signal strength, and doppler velocities in the cloud and in the boundary level, including uncertainties for all parameters. Using the doppler beam swinging DBS technique, and Vertical Azimuthal Display (VAD) this system also provides vertical profiles of horizontal winds.

  5. Clinical application in routine practice of the proximal flow convergence method to calculate the mitral surface area in mitral valve stenosis.

    PubMed

    Bennis, Ahmed; Drighil, Abdennasser; Tribouilloy, Christophe; Drighil, Asmaa; Chraibi, Nacer

    2002-12-01

    Two-dimensional (2D) echocardiography planimetry, the Doppler pression half-time (PHT), and the continuity equation methods were used to estimate mitral valve area (MVA) in patients with mitral stenosis (MS). Recently, the proximal isovelocity surface area (PISA) method has been shown to be accurate for calculating MVA. The purpose of this study is (1) to compare in a large non-selected population the accuracy of the PISA and planimetry methods for echocardiographic estimation of MVA; (2) to determine the effect of atrial fibrillation (AF), Wilkins score, associated mitral regurgitation (MR), aortic regurgitation (AR), and of commissural calcifications on the accuracy of the PISA method. One hundred and eight consecutive patients with rheumatic MS were studied (76 females and 32 males; mean age: 36 +/- 12 years); 64 were in sinus rhythm; 51 had associated MR and 46 had AR. By the PISA method. MVA was calculated assuming a uniform radius flow convergence region along a hemispherical surface. The mean value of 2D MVA was 1.32 +/- 0.59 cm2 (0.4-3.1 cm2) and that of PISA MVA 1.33 +/- 0.62 cm2 (0.38-3 cm2). MVA calculated using the PISA method correlated well with 2D MVA (r = 0.93, y = 0.97x + 0.04, p < 0.0001, SEE = 0.21 cm2). The correlation was also good in patients with AF (r = 0.93, y = 0.99x + 0.03, p < 0.0001, SEE = 0.21 cm2), with MR (r = 0.94, y = 1.0 14x + 0.003, p < 0.0001, SEE = 0.19 cm2), with AR (r = 0.93, y = 0.90x + 0.11, p < 0.0001, SEE = 0.2 cm2), when Wilkins score was >8 (r = 0.92, = 0.96x + 0.06, p < 0.0001, SEE = 0.19 cm2), and in patients with commissural calcifications (r = 0.90, y = 0.88x + 0.009, p < 0.0001, SEE = 0.20 cm2). Our study shows that in routine practice, MVA calculated by the PISA method correlated well with the area obtained by planimetry even in the presence of commissural calcifications, associated MR, AR, AF and of high Wilkins score. Therefore, the PISA method provides a reliable measurement of the MVA in MS under different

  6. Usefulness of early diastolic mitral annular velocity to predict plasma levels of brain natriuretic peptide and transient heart failure development after device closure of atrial septal defect.

    PubMed

    Masutani, Satoshi; Taketazu, Mio; Mihara, Chihiro; Mimura, Yuko; Ishido, Hirotaka; Matsunaga, Tamotsu; Kobayashi, Toshiki; Senzaki, Hideaki

    2009-12-15

    Device closure of atrial septal defect (ASD) is sometimes followed by elevation of plasma brain natriuretic peptide (BNP), a marker of heart failure, and progression to heart failure. This study tested the hypothesis that the underlying diastolic dysfunction, assessed on tissue Doppler images (TDI) before device closure, can predict BNP level after ASD closure. The study subjects were 39 consecutive patients (age 27.5 +/- 16.3 years, range 5 to 63) who underwent device closure for ASD. Echocardiographic evaluation using TDI and 2-dimensional and pulse wave Doppler were performed, together with plasma BNP measurement 1 day before and 2 days after ASD closure. Before ASD closure, an age-dependent decrease was noted in left ventricular relaxation, assessed by early diastolic mitral annular velocity. ASD closure resulted in a decrease in early diastolic mitral annular velocity (from 14.7 to 12.3 cm/s, p <0.05) despite an increase in the left ventricular dimension (84% to 92% vs normal, p <0.05). These changes were associated with a parallel increase in BNP (17.9 to 48.4 pg/ml, p <0.05). Stepwise multivariate linear regression identified early diastolic mitral annular velocity before ASD closure and age as independent predictors of BNP levels after ASD closure (p <0.05). Consistent with this result, 2 patients with the lowest early diastolic mitral annular velocity developed exertional dyspnea after the procedure. In conclusion, our results indicate that TDI measurements could be useful to detect underlying diastolic dysfunction that can potentially cause heart failure after ASD closure and emphasize the importance of ASD closure at a young age before impairment of left ventricular relaxation.

  7. Echocardiographic analysis of a malfunctioning Davila-Sierra mitral valve.

    PubMed

    Tri, Terry B.; Gregoratos, Gabriel

    1981-03-01

    Although the Davila-Sierra mitral valve prosthesis was removed from the market nearly a decade ago, a number of patients still have this valve in place. We recently studied the echocardiographic features of a malfunctioning Davila-Sierra mitral valve prosthesis. Abnormalities that suggested improper functioning of the prosthesis included a markedly delayed poppet opening and an early diastolic hump believed to represent motion of the mitral annulus. Previously described echocardiographic indications of dys-function were not observed in our patient. We report the first known echocardiographic evaluation of a Davila-Sierra prosthesis.

  8. Echocardiographic analysis of a malfunctioning Davila-Sierra mitral valve

    PubMed Central

    Tri, Terry B.; Gregoratos, Gabriel

    1981-01-01

    Although the Davila-Sierra mitral valve prosthesis was removed from the market nearly a decade ago, a number of patients still have this valve in place. We recently studied the echocardiographic features of a malfunctioning Davila-Sierra mitral valve prosthesis. Abnormalities that suggested improper functioning of the prosthesis included a markedly delayed poppet opening and an early diastolic hump believed to represent motion of the mitral annulus. Previously described echocardiographic indications of dys-function were not observed in our patient. We report the first known echocardiographic evaluation of a Davila-Sierra prosthesis. Images PMID:15216230

  9. Ultrasonic colour Doppler imaging

    PubMed Central

    Evans, David H.; Jensen, Jørgen Arendt; Nielsen, Michael Bachmann

    2011-01-01

    Ultrasonic colour Doppler is an imaging technique that combines anatomical information derived using ultrasonic pulse-echo techniques with velocity information derived using ultrasonic Doppler techniques to generate colour-coded maps of tissue velocity superimposed on grey-scale images of tissue anatomy. The most common use of the technique is to image the movement of blood through the heart, arteries and veins, but it may also be used to image the motion of solid tissues such as the heart walls. Colour Doppler imaging is now provided on almost all commercial ultrasound machines, and has been found to be of great value in assessing blood flow in many clinical conditions. Although the method for obtaining the velocity information is in many ways similar to the method for obtaining the anatomical information, it is technically more demanding for a number of reasons. It also has a number of weaknesses, perhaps the greatest being that in conventional systems, the velocities measured and thus displayed are the components of the flow velocity directly towards or away from the transducer, while ideally the method would give information about the magnitude and direction of the three-dimensional flow vectors. This review briefly introduces the principles behind colour Doppler imaging and describes some clinical applications. It then describes the basic components of conventional colour Doppler systems and the methods used to derive velocity information from the ultrasound signal. Next, a number of new techniques that seek to overcome the vector problem mentioned above are described. Finally, some examples of vector velocity images are presented. PMID:22866227

  10. [A Case of Mitral Valvular Re-repair in a Patient with Hemolytic Anemia after Mitral Valvular Repair].

    PubMed

    Tomino, Mikiko; Miyata, Kazuto; Takeshita, Yuji; Kaneko, Koki; Kanazawa, Hiroko; Uchino, Hiroyuki

    2015-07-01

    A 54-year-old woman was admitted for mitral valvular repair. After folding plasty to A3, a 30 mm Cosgrove-Edwards ring was placed. There was no mitral regurgitation jet observed by transesophageal echocardiography (TEE) during the operation. However, high blood pressure was monitored and treated in the intensive care unit, hemolytic anemia developed, and the serum lactate dehydrogenase level was elevated. Two weeks after the operation, serum lactate dehydrogenase was again elevated. TEE showed mild mitral regurgitation and the regurgitation jet colliding with the annuloplasty ring. Multiple transfusions of red blood cells were required. Repeat surgery was therefore undertaken. Lam and associates previously studying patients on hemolysis after mitral valvular repair noted high grade mitral regurgitation jets fragmented or accelerated. In the present case, mitral regurgitation was mild, but the high velocity and manner of regurgitation (collision with the annuloplasty ring) could cause hemolytic anemia. In the present case, high blood pressure might have caused chordae rupture. Furthermore, a flexible ring, such as the Cosgrove-Edwards ring, is likely to cause hemolytic anemia. As contributing factors to hemolysis after mitral valvular repair, perioperative blood pressure management and type of ring are significant.

  11. Resolution of massive left atrial appendage thrombi with rivaroxaban before balloon mitral commissurotomy in severe mitral stenosis

    PubMed Central

    Li, Yuechun; Lin, Jiafeng; Peng, Chen

    2016-01-01

    Abstract Rationale: Data on nonvitamin K antagonist oral anticoagulant being used for the treatment of LAA thrombi are limited only in nonvalvular atrial fibrillation. There are no data on the antithrombotic efficacy and safety of nonvitamin K antagonist oral anticoagulant in the resolution of left atrial appendage (LAA) thrombi in patients with rheumatic mitral stenosis. Patient concerns: A 49-year-old woman with known rheumatic mitral stenosis and atrial fibrillation was referred for percutaneous transvenous mitral commissurotomy because of progressive dyspnea on exertion over a period of 3 months. Diagnoses: Transesophageal echocardiography (TEE) demonstrated a large LAA thrombus protruding into left atria cavity before the procedure. Interventions: Direct factor Xa (FXa) inhibitor rivaroxaban (20 mg/d) was started for the patient. After 3 weeks of rivaroxaban treatment TEE showed a relevantly decreased thrombus size, and a complete thrombus resolution was achieved after 5 weeks of anticoagulant therapy with the FXa inhibitor. Outcomes: To the best of our knowledge, this is the first documented case of large LAA thrombus resolution with nonvitamin K antagonist oral anticoagulant in severe mitral stenosis, and in which percutaneous transvenous mitral commissurotomy was performed subsequently. Lessons: The report indicated that rivaroxaban could be a therapeutic option for mitral stenosis patients with LAA thrombus. Further study is required before the routine use of rivaroxaban in patients with rheumatic mitral stenosis and atrial fibrillation. PMID:27930571

  12. Study of Effectiveness and Safety of Percutaneous Balloon Mitral Valvulotomy for Treatment of Pregnant Patients with Severe Mitral Stenosis

    PubMed Central

    Joshi, Hasit Sureshbhai; Deshmukh, Jagjeet Kishanrao; Prajapati, Jayesh Somabhai; Sahoo, Sibasis Shahsikant; Vyas, Pooja Maheshbhai

    2015-01-01

    Introduction In pregnant women mitral stenosis is the commonest cardiac valvular lesion. When it is present in majorly severe condition it leads to maternal and fetal morbidity and mortality. In mitral stenosis pregnancy can lead to development of heart failure. Aim To evaluate the safety and efficacy of balloon mitral valvulotomy (BMV) in pregnant females with severe mitral stenosis. Materials and Methods A total of 30 pregnant patients who underwent BMV were included in the study from July 2011 to November 2013. Clinical follow-up during pregnancy was done every 3 months until delivery and after delivery. The mean follow up time after BMV was 6.72±0.56 months. Results From the 30 pregnant females 14 (46.67%) and 16 (53.3%) patients underwent BMV during the third and second trimester of pregnancy respectively. The mean mitral valve area was 0.85+0.16 cm2 before BMV that increased to 1.60+0.27 cm2 (p<0.0001) immediately after BMV. Peak and mean diastolic gradients had decreased significantly within 48 hours after the procedure (p<0.001) but remained very much unchanged at 6.72 month period of follow-up. Two patients had an increase in mitral regurgitation by 2 grades. Conclusion During pregnancy BMV technique is safe and effective in patients with severe mitral stenosis. This results in marked symptomatic relief along with long term maternal and fetal outcomes. PMID:26816932

  13. Percutaneous mitral valve repair with MitraClip for severe functional mitral regurgitation.

    PubMed

    Yeo, Khung Keong; Ding, Zee Pin; Chua, Yeow Leng; Lim, Soo Teik; Sin, Kenny Yoong Kong; Tan, Jack Wei Chieh; Chiam, Paul Toon Lim; Hwang, Nian Chih; Koh, Tian Hai

    2013-01-01

    A 67-year-old Chinese woman with comorbidities of chronic obstructive lung disease, hypertension and prior coronary artery bypass surgery presented with severe functional mitral regurgitation (MR) and severely depressed left ventricular function. She was in New York Heart Association (NYHA) Class II-III. Due to high surgical risk, she was referred for percutaneous treatment with the MitraClip valve repair system. This procedure is typically performed via the femoral venous system and involves a transseptal puncture. A clip is delivered to grasp the regurgitant mitral valve leaflets and reduce MR. This was performed uneventfully in our patient, with reduction of MR from 4+ to 1+. She was discharged on post-procedure Day 2 and her NYHA class improved to Class I. This was the first successful MitraClip procedure performed in Asia and represents a valuable treatment option in patients with severe MR, especially those with functional MR or those at high surgical risk.

  14. Progression to moderate or severe mitral regurgitation after percutaneous transvenous mitral commissurotomy using stepwise inflation technique.

    PubMed

    Matsubara, T; Yamazoe, M; Tamura, Y; Tanabe, Y; Hori, T; Konno, T; Higuchi, K; Ida, T; Takemoto, M; Aizawa, Y

    1998-05-01

    Progression to moderate or severe mitral regurgitation (MR) was studied after Inoue balloon percutaneous transvenous mitral commissurotomy (PTMC) using the stepwise inflation technique, performed at increments of 1 mm of balloon diameter, in 49 consecutive patients with rheumatic mitral stenosis (aged from 32-73 years; 8 males, 41 females). The patients were classified on the basis of the degree of MR after PTMC, compared with that before PTMC, into either Group A, development of moderate or more severe (> or = grade 2) MR (n = 8) or Group B, no increase in MR or development of mild (grade 1) MR (n = 41). Progression to moderate or severe MR was significantly associated only with advanced age (60 +/- 8 vs 52 +/- 10 years, p < 0.05) and narrower mitral valve area (0.87 +/- 0.35 vs 1.11 +/- 0.29 cm2, p < 0.05), but other characteristics before PTMC were similar in both groups. There was no difference between the two groups in the total number and degree of balloon inflation. Immediately before the final inflation, the left atrial mean pressure and v wave pressure were decreased in smaller degrees in Group A compared with Group B (-2 +/- 2 vs -5 +/- 4 mmHg, p < 0.05; -2 +/- 2 vs -6 +/- 6 mmHg, p < 0.05, respectively). Thus, the stepwise inflations require careful monitoring of changes in the left atrial pressure and waveform to recognize the aggravation of MR, especially in older patients with severe stenosis. Patients who do not have a significant drop in left atrial mean pressure and v wave pressure during stepwise inflations of the balloon might be at risk of development of moderate or severe MR after further dilations.

  15. Single-centre experience with mitral valve repair in asymptomatic patients with severe mitral valve regurgitation†

    PubMed Central

    van Leeuwen, Wouter J.; Head, Stuart J.; de Groot-de Laat, Lotte E.; Geleijnse, Marcel L.; Bogers, Ad J.J.C.; Van Herwerden, Lex A.; Kappetein, A. Pieter

    2013-01-01

    OBJECTIVES Guidelines recommend surgical mitral valve repair in selected patients with asymptomatic severe mitral valve regurgitation (MR), but the role of repair remains a matter of debate. Survival analyses of operated asymptomatic patients have been reported, but long-term haemodynamics and quality of life are not well defined. The aim of this study was to report the long-term follow-up focusing on these aspects. METHODS Our database identified patients who underwent primary isolated mitral valve repair for severe MR and were asymptomatic by New York Heart Association Class I and in sinus rhythm. To obtain sufficient length of follow-up, only patients operated on before 2006 returned for an echocardiogram and quality-of-life assessment (SF-36). RESULTS Between May 1991 and December 2005, 46 asymptomatic patients with severe MR and a normal left ventricular function (ejection fraction >60%) were operated on. Mean age was 50.2 ± 13.2 years and 89% of patients were male. There were no operative deaths. Mean follow-up was 8.4 ± 3.9 years with 386 patient-years, survival was 93.3% at 12 years and comparable with the general age-matched Dutch population. Follow-up echocardiography showed that 92% had no to mild MR, and 3 patients had moderate MR. Left ventricular function was good/impaired/moderate in 66/29/5% of patients. Quality-of-life SF-36 assessment showed that mean physical and mental health components were 83 ± 17 and 79 ± 17, which was comparable with that of the general age- and gender-matched Dutch population. CONCLUSIONS Our experience shows that mitral valve repair for severe MR in asymptomatic patients is safe, and has satisfactory long-term survival with a low recurrence rate of MR, good left ventricular function, and excellent quality of life that is comparable with the general Dutch population. PMID:23442941

  16. Fully automated software for mitral annulus evaluation in chronic mitral regurgitation by 3-dimensional transesophageal echocardiography.

    PubMed

    Aquila, Iolanda; Fernández-Golfín, Covadonga; Rincon, Luis Miguel; González, Ariana; García Martín, Ana; Hinojar, Rocio; Jimenez Nacher, Jose Julio; Indolfi, Ciro; Zamorano, Jose Luis

    2016-12-01

    Three-dimensional (3D) transesophageal echocardiography (TEE) is the gold standard for mitral valve (MV) anatomic and functional evaluation. Currently, dedicated MV analysis software has limitations for its use in clinical practice. Thus, we tested here a complete and reproducible evaluation of a new fully automatic software to characterize MV anatomy in different forms of mitral regurgitation (MR) by 3D TEE.Sixty patients were included: 45 with more than moderate MR (28 organic MR [OMR] and 17 functional MR [FMR]) and 15 controls. All patients underwent TEE. 3D MV images obtained using 3D zoom were imported into the new software for automatic analysis. Different MV parameters were obtained and compared. Anatomic and dynamic differences between FMR and OMR were detected. A significant increase in systolic (859.75 vs 801.83 vs 607.78 mm; P = 0.002) and diastolic (1040.60 vs. 1217.83 and 859.74 mm; P < 0.001) annular sizes was observed in both OMR and FMR compared to that in controls. FMR had a reduced mitral annular contraction compared to degenerative cases of OMR and to controls (17.14% vs 32.78% and 29.89%; P = 0.007). Good reproducibility was demonstrated along with a short analysis time (mean 4.30 minutes).Annular characteristics and dynamics are abnormal in both FMR and OMR. Full 3D software analysis automatically calculates several significant parameters that provide a correct and complete assessment of anatomy and dynamic mitral annulus geometry and displacement in the 3D space. This analysis allows a better characterization of MR pathophysiology and could be useful in designing new devices for MR repair or replacement.

  17. Fully automated software for mitral annulus evaluation in chronic mitral regurgitation by 3-dimensional transesophageal echocardiography

    PubMed Central

    Aquila, Iolanda; Fernández-Golfín, Covadonga; Rincon, Luis Miguel; González, Ariana; García Martín, Ana; Hinojar, Rocio; Jimenez Nacher, Jose Julio; Indolfi, Ciro; Zamorano, Jose Luis

    2016-01-01

    Abstract Three-dimensional (3D) transesophageal echocardiography (TEE) is the gold standard for mitral valve (MV) anatomic and functional evaluation. Currently, dedicated MV analysis software has limitations for its use in clinical practice. Thus, we tested here a complete and reproducible evaluation of a new fully automatic software to characterize MV anatomy in different forms of mitral regurgitation (MR) by 3D TEE. Sixty patients were included: 45 with more than moderate MR (28 organic MR [OMR] and 17 functional MR [FMR]) and 15 controls. All patients underwent TEE. 3D MV images obtained using 3D zoom were imported into the new software for automatic analysis. Different MV parameters were obtained and compared. Anatomic and dynamic differences between FMR and OMR were detected. A significant increase in systolic (859.75 vs 801.83 vs 607.78 mm2; P = 0.002) and diastolic (1040.60 vs. 1217.83 and 859.74 mm2; P < 0.001) annular sizes was observed in both OMR and FMR compared to that in controls. FMR had a reduced mitral annular contraction compared to degenerative cases of OMR and to controls (17.14% vs 32.78% and 29.89%; P = 0.007). Good reproducibility was demonstrated along with a short analysis time (mean 4.30 minutes). Annular characteristics and dynamics are abnormal in both FMR and OMR. Full 3D software analysis automatically calculates several significant parameters that provide a correct and complete assessment of anatomy and dynamic mitral annulus geometry and displacement in the 3D space. This analysis allows a better characterization of MR pathophysiology and could be useful in designing new devices for MR repair or replacement. PMID:27930514

  18. Intentional Laceration of the Anterior Mitral Valve Leaflet to Prevent Left Ventricular Outflow Tract Obstruction During Transcatheter Mitral Valve Replacement

    PubMed Central

    Khan, Jaffar M.; Rogers, Toby; Schenke, William H.; Mazal, Jonathan R.; Faranesh, Anthony Z.; Greenbaum, Adam B.; Babaliaros, Vasilis C.; Chen, Marcus Y.; Lederman, Robert J.

    2017-01-01

    OBJECTIVES The authors propose a novel transcatheter transection of the anterior mitral leaflet to prevent iatrogenic left ventricular outflow tract (LVOT) obstruction during transcatheter mitral valve replacement (TMVR). BACKGROUND LVOT obstruction is a life-threatening complication of TMVR caused by septal displacement of the anterior mitral leaflet. METHODS In vivo procedures in swine were guided by biplane x-ray fluoroscopy and intracardiac echocardiography. Retrograde transaortic 6-F guiding catheters straddled the anterior mitral leaflet. A stiff 0.014-inch guidewire with polymer jacket insulation was electrified and advanced from the LVOT, through the A2 leaflet base, into the left atrium. The wire was snared and externalized, forming a loop that was energized and withdrawn to lacerate the anterior mitral leaflet. RESULTS The anterior mitral leaflet was successfully lacerated in 7 live and 1 post-mortem swine under heparinization. Lacerations extended to 89 ± 19% of leaflet length and were located within 0.5 ± 0.4 mm of leaflet centerline. The chordae were preserved and retracted the leaflet halves away from the LVOT. LVOT narrowing after benchtop TMVR was significantly reduced with intentional laceration of the anterior mitral leaflet to prevent LVOT obstruction than without (65 ± 10% vs. 31 ± 18% of pre-implantation diameter, p < 0.01). The technique caused mean blood pressure to fall (from 54 ± 6 mm Hg to 30 ± 4 mm Hg, p < 0.01), but blood pressure remained steady until planned euthanasia. No collateral tissue injury was identified on necropsy. CONCLUSIONS Using simple catheter techniques, the anterior mitral valve leaflet was transected. Cautiously applied in patients, this strategy can prevent anterior mitral leaflet displacement and LVOT obstruction caused by TMVR. PMID:27609260

  19. Doppler effect in optical velocimetry

    NASA Astrophysics Data System (ADS)

    Rinkevichius, Bronius S.

    1996-02-01

    The current state of the optical metrology based on the Doppler effect has been reviewed. Some historical and scientific information is given, in addition the contemporary optical methods of the velocity measurement using the Doppler effect are analyzed. The Doppler effect applications in astrophysics, plasma physics, investigations of gas and liquid flows, acoustics, mechanics of the deforming solid body and of the rotational motion are considered. The description is presented for the following techniques of the velocity measurement: laser Doppler anemometry, laser Doppler vibrometry, laser gyroscopy.

  20. Sinus Rhythm in Rheumatic Mitral Stenosis after Balloon Mitral Valvotomy: Is it Feasible?

    PubMed Central

    Shukla, Anand N; Shah, Saurin; Nayak, Vidya; Prabhu, Sridevi; Pai, Umesh

    2017-01-01

    Introduction Atrial Fibrillation (AF) is largely present in patients with rheumatic valvular disease, leading to hospitalizations. Aim We aimed to study the restoration and maintenance of Sinus Rhythm (SR) in rheumatic patients with Mitral Stenosis (MS) and AF after Balloon Mitral Valvotomy (BMV) and evaluated the factors which affect the maintenance of SR. Materials and Methods A total of 50 patients who underwent BMV at U. N. Mehta Institute of Cardiology and Research Centre from 2010 November to 2013 January were included in the study. Subsequently, all patients were treated with amiodarone and electrical cardioversion was applied in patients in whom it was necessary. The patients were followed for six months for conversion and maintenance of SR. Results Total 34 (68%) patients reverted to SR. Twelve patients reverted to SR with amiodarone and 22 patients with electrical cardioversion and amiodarone. Out of the total, 29 patients and 26 patients remained in SR at the end of follow up at 3 months and 6 months respectively. Conclusion Smaller Left Atrial (LA) size and greater Mitral Valve Area (MVA) are the chief predictors of restoration and maintenance of SR. Combining BMV with an aggressive anti-arrhythmic strategy offers the best prospect of rhythm control. PMID:28384905

  1. Dissection of the atrial wall after mitral valve replacement.

    PubMed Central

    Lukács, L; Kassai, I; Lengyel, M

    1996-01-01

    We describe an unusual sequela of mitral valve replacement in a 50-year-old woman who had undergone a closed mitral commissurotomy in 1975. She was admitted to our hospital because of mitral restenosis in November 1993, at which time her mitral valve was replaced with a mechanical prosthesis. On the 8th postoperative day, the patient developed symptoms of heart failure; transesophageal echocardiography revealed dissection and rupture of the left atrial wall. At prompt reoperation, we found an interlayer dissection and rupture of the atrial wall into the left atrium. We repaired the ruptured atrial wall with a prosthetic patch. The postoperative course was uneventful, and postoperative transesophageal echocardiography showed normal prosthetic valve function and no dissection. Images PMID:8680278

  2. Minimally Invasive, Nonsurgical Approach to Repairing Mitral Valve Leaks

    MedlinePlus

    Minimally Invasive, Nonsurgical Approach to Repairing Mitral Valve Leaks - David X. Zhao, MD Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2017 BroadcastMed, Inc. All rights ...

  3. MitraClip catheter-based mitral valve repair system.

    PubMed

    Jönsson, Anders; Settergren, Magnus

    2010-07-01

    The ongoing evolution of transcatheter valve technology is impressive. Mitral valve regurgitation is the most common type of heart valve insufficiency and mitral valve surgery is, next to aortic valve surgery, the second leading valvular surgical procedure in the western world. However, there is a large patient population suffering from mitral valve regurgitation that is currently not treated with heart surgery because of significant morbidity and mortality risks. This large underserved patient population could benefit from a less invasive treatment. The MitraClip system (Abbott Vascular, Menlo Park, CA, USA) is the first commercially available medical technology providing a catheter-based nonsurgical repair alternative for patients suffering from mitral valve regurgitation and has the greatest clinical experience compared with other alternative devices. The device is currently in late-stage clinical trials in the USA and has received the CE mark.

  4. [Intraoperative transesophageal echocardiography in patients undergoing robotic mitral valve replacement].

    PubMed

    Wang, Yao; Gao, Changqing; Xiao, Cangsong; Yang, Ming; Wang, Gang; Wang, Jiali; Shen, Yansong

    2012-12-01

    To retrospectively assess the value of intraoperative transesophageal echocardiography (TEE) during robotic mitral valve (MV) replacement. Intraoperative TEE was performed in 21 patients undergoing robotic MV replacement for severe rheumatic mitral stenosis between November 2008 and December 2010. During the procedure, TEE was performed to document the mechanism of rheumatic mitral stenosis (leaflet thickening and calcification, commissural fusion or chordal fusion) before cardiopulmonary bypass (CPB). During the establishment of peripheral CPB, TEE was used to guide the placement of the cannulae in the inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). After weaning from CPB, TEE was performed to evaluate the effect of the procedure. Accuracy of TEE was 100% for rheumatic mitral stenosis. All the cannuli in the SVC, IVC and AAO were located in the correct position. In all patients, TEE confirmed successful procedure. TEE is useful in the assessment of robotic MV replacement.

  5. Mitral valve aneurysm associated with aortic valve endocarditis and regurgitation.

    PubMed

    Raval, Amish N; Menkis, Alan H; Boughner, Derek R

    2002-01-01

    Mitral valve aneurysms are rare complications occurring most commonly in association with aortic valve infective endocarditis. [Decroly 1989, Chua 1990, Northridge 1991, Karalis 1992, Roguin 1996, Mollod 1997, Vilacosta 1997, Cai 1999, Vilacosta 1999, Teskey 1999, Chan 2000, Goh 2000, Marcos- Alberca 2000] While the mechanism of the development of this lesion is unclear, complications such as perforation can occur and lead to significant mitral regurgitation. [Decroly 1989, Karalis 1992, Teskey 1999, Vilacosta 1999]; The case of a 69-year-old male with Streptococcus Sanguis aortic valve endocarditis and associated anterior mitral leaflet aneurysm is presented. Following surgery, tissue pathology of the excised lesion revealed myxomatous degeneration and no active endocarditis or inflammatory cells. This may add support to the hypothesis that physical stress due to severe aortic insufficiency and structural weakening, without infection of the anterior mitral leaflet, can lead to the development of this lesion.

  6. Robotic mitral valve surgery: current limitations and future directions

    PubMed Central

    Suri, Rakesh; Mick, Stephanie; Mihaljevic, Tomislav

    2016-01-01

    Use of the surgical robot facilitates less invasive mitral valve surgery. Although multiple single center studies confirmed excellent results with robotically-assisted mitral valve surgery, both real and perceived limitations have slowed adoption of this technology. Some still question the safety and efficacy of robotically-assisted mitral valve surgery. However, present data suggests that robotic operations can be performed by specialized surgeons in appropriately selected patients without compromising results. That said, the robot does introduce additional procedural complexity related to management of cardiopulmonary bypass and myocardial protection. A direct approach to these challenges combined with careful patient selection enables the surgeon to obtain excellent results with robotically-assisted mitral valve surgery. PMID:27942490

  7. Mitral valve aneurysm: A serious complication of aortic valve endocarditis.

    PubMed

    Sousa, Maria João; Alves, Vasco; Cabral, Sofia; Antunes, Nuno; Pereira, Luís Sousa; Oliveira, Filomena; Silveira, João; Torres, Severo

    2016-11-01

    Mitral valve aneurysms are rare and occur most commonly in association with aortic valve endocarditis. Transesophageal echocardiography is the most sensitive imaging modality for the diagnosis of this entity and its potential complications, such as leaflet rupture and mitral regurgitation, which mandate prompt surgical intervention. We present the case of a 70-year-old male patient with aortic valve endocarditis complicated with a ruptured aneurysm of the anterior mitral valve leaflet and associated severe mitral regurgitation, diagnosed by transesophageal echocardiography, with impressive images. We hypothesized that the aneurysm developed through direct extension of infection from the aortic valve or from a prolapsing aortic vegetation, with abscess formation and subsequent rupture and drainage. This case highlights the importance of appropriate imaging for early detection and timely surgical intervention (repair or replacement) to prevent fatal outcomes. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. A pathoanatomic approach to the management of mitral regurgitation.

    PubMed

    Badhwar, Vinay; Smith, Anson J C; Cavalcante, João L

    2016-02-01

    Mitral regurgitation remains the most common global valvular heart disease. From otherwise unsuspecting healthy patients without overt symptoms to those with recalcitrant heart failure, mitral valve (MV) disease touches millions of patients per year. While MV prolapse without regurgitation remains benign, once regurgitation begins, quantification of severity is related to prognosis. Understanding the mechanism of regurgitation guides appropriate treatment. Current management guidelines emphasize early therapy after careful assessment of both anatomy and severity of mitral regurgitation. The objective of this review is to provide an update on the treatment of MV disease and to offer additional granularity on pathoanatomic decision making that may aid a more precise application of optimal guideline-directed therapy of primary and secondary mitral regurgitation.

  9. Severe mitral regurgitation unmasked after bilateral lung transplantation.

    PubMed

    Udoji, Timothy N; Force, Seth D; Pelaez, Andres

    2013-09-01

    Abstract A 33-year-old female patient with advanced idiopathic pulmonary artery hypertension underwent bilateral lung transplantation. The postsurgical course was complicated by prolonged mechanical ventilation and acute hypoxemia with recurrent episodes of pulmonary edema. An echocardiogram revealed improved right-sided pressures along with a dilated left atrium, a structurally normal mitral valve, and a new posterior-oriented severe mitral regurgitation. The patient's condition improved after treatment with arterial vasodilators and diuretics, and she has remained in World Health Organization functional class I after almost 36 months of follow-up. We hypothesize that cardiac ventricle remodeling and a geometric change in mitral valve apparatus after transplantation led to the hemodynamic changes and recurrent pulmonary edema seen in our patient. Our case is, to our knowledge, the second report of severe valvular regurgitation in a structurally normal mitral valve apparatus in the postoperative period and the first of a patient to be treated without valve replacement.

  10. Early Stabilization of Traumatic Aortic Transection and Mitral Valve Regurgitation

    PubMed Central

    Lambrechts, David L.; Wellens, Francis; Vercoutere, Rik A.; De Geest, Raf

    2003-01-01

    We report a case of life-threatening aortic transection with concomitant mitral papillary muscle rupture and severe lung contusion caused by a failed parachute jump. This blunt thoracic injury was treated by early stabilization with extracorporeal membrane oxygenation followed by successful delayed graft repair of the descending aorta and mitral valve replacement with a mechanical prosthesis. (Tex Heart Inst J 2003;30:65–7) PMID:12638675

  11. Severe rheumatic mitral stenosis: a 21st century medusa.

    PubMed

    Carrilho-Ferreira, Pedro; Pedro, Monica Mendes; Varela, Manuel Gato; Diogo, Antonio Nunes

    2011-09-12

    Although the prevalence of rheumatic fever has greatly decreased in developed countries, rheumatic mitral stenosis still causes significant morbidity and mortality. Symptomatic patients have a poor prognosis, with a 0 to 15% 10-year survival rate, particularly if percutaneous or surgical intervention are contraindicated or considered high risk. We present a case of severe rheumatic mitral stenosis with an evolution over 4 decades, in which exceptional venous distention has established.

  12. Isolated true parachute mitral valve in an asymptomatic elderly patient.

    PubMed

    Yamamoto, Tetsushi; Onishi, Tetsuari; Omar, Alaa Marbrouk Salem; Norisada, Kazuko; Tatsumi, Kazuhiro; Matsumoto, Kensuke; Hayashi, Nobuhide; Kinoshita, Shouhiro; Kawano, Seiji; Kawai, Hiroya; Hirata, Ken-Ichi; Kumagai, Shunichi

    2010-12-01

    We report the extremely rare case of a 73-year-old asymptomatic patient who has an isolated true parachute mitral valve (PMV). In the echocardiographic examination, the parasternal long-axis view showed a single papillary muscle. The short-axis view revealed the presence of a symmetric mitral valve orifice with all chordae attaching to a large anterolateral papillary muscle. Because detailed examination did not reveal the presence of other complications, this patient was diagnosed as an isolated true PMV.

  13. Reexamining contraindications for minimally invasive mitral valve surgery.

    PubMed

    Reade, Clifton C; Bower, Curtis E; Kypson, Alan P; Nifong, L Wiley; Wooden, William A; Chitwood, W Randolph

    2005-01-01

    Historically, contraindications to minimally invasive or robotic mitral valve surgery have included prior mastectomy, thoracic reconstruction, or chest radiation. However, we believe that by granting flexibility in the choice of skin incision site while performing careful dissection, surgeons can provide these patients the outstanding results afforded by a minithoracotomy. We present a patient who had undergone a prior mastectomy and radiation treatment in whom we performed a minimally invasive mitral valve repair through a right-sided minithoracotomy using the previous mastectomy incision.

  14. Anomalous left coronary artery from pulmonary artery with mitral stenosis.

    PubMed

    Das, Mrinalendu; Mahindrakar, Pallavi; Das, Debasis; Behera, Sukanta Kumar; Chowdhury, Saibal Roy; Bandyopadhyay, Biswajit

    2011-08-01

    The usual presentation of anomalous left coronary artery from pulmonary artery is severe left-sided heart failure and mitral valve insufficiency presenting during the first months of life. The manifestations of left heart failure may be masked if pulmonary artery pressure remains high. We believe this is a rarest of rare case of anomalous left coronary artery from pulmonary artery with severe mitral stenosis and pulmonary hypertension in which pulmonary hypertension, along with good collateral circulation helped to preserve left ventricular function.

  15. An airborne Doppler Lidar

    NASA Technical Reports Server (NTRS)

    Dimarzio, C. A.

    1980-01-01

    A pulsed CO2 Doppler Lidar, developed for airborne measurements of atmospheric wind fields, is described. In-flight tests show that the device can be successfully utilized in the detection and measurement of mountain-wave turbulence and wind shear, and in the generation of time histories of wind-field variations in smooth flight. This Lidar is in the process of being configured for measurement of the atmospheric flow fields surrounding severe convective storms.

  16. Laser Doppler anemometry

    NASA Technical Reports Server (NTRS)

    Johnson, Dennis A.

    1988-01-01

    The material in this NASA TM is to appear as a chapter on Laser Doppler Anemometry (LDA) in the AGARDograph entitled, A Survey of Measurements and Measuring Techniques in Rapidly Distorted Compressible Turbulent Boundary Layers. The application of LDA (specifically, the dual-beam, burst-counter approach) to compressible flows is discussed. Subjects treated include signal processing, particle light scattering and tracking, data reduction and sampling bias, and three-dimensional measurements.

  17. Laser double Doppler flowmeter

    NASA Astrophysics Data System (ADS)

    Poffo, L.; Goujon, J.-M.; Le Page, R.; Lemaitre, J.; Guendouz, M.; Lorrain, N.; Bosc, D.

    2014-05-01

    The Laser Doppler flowmetry (LDF) is a non-invasive method for estimating the tissular blood flow and speed at a microscopic scale (microcirculation). It is used for medical research as well as for the diagnosis of diseases related to circulatory system tissues and organs including the issues of microvascular flow (perfusion). It is based on the Doppler effect, created by the interaction between the laser light and tissues. LDF measures the mean blood flow in a volume formed by the single laser beam, that penetrate into the skin. The size of this measurement volume is crucial and depends on skin absorption, and is not directly reachable. Therefore, current developments of the LDF are focused on the use of always more complex and sophisticated signal processing methods. On the other hand, laser Double Doppler Flowmeter (FL2D) proposes to use two laser beams to generate the measurement volume. This volume would be perfectly stable and localized at the intersection of the two laser beams. With FL2D we will be able to determine the absolute blood flow of a specific artery. One aimed application would be to help clinical physicians in health care units.

  18. Doppler Optical Coherence Tomography

    PubMed Central

    Leitgeb, Rainer A.; Werkmeister, René M.; Blatter, Cedric; Schmetterer, Leopold

    2014-01-01

    Optical Coherence Tomography (OCT) has revolutionized ophthalmology. Since its introduction in the early 1990s it has continuously improved in terms of speed, resolution and sensitivity. The technique has also seen a variety of extensions aiming to assess functional aspects of the tissue in addition to morphology. One of these approaches is Doppler OCT (DOCT), which aims to visualize and quantify blood flow. Such extensions were already implemented in time domain systems, but have gained importance with the introduction of Fourier domain OCT. Nowadays phase-sensitive detection techniques are most widely used to extract blood velocity and blood flow from tissues. A common problem with the technique is that the Doppler angle is not known and several approaches have been realized to obtain absolute velocity and flow data from the retina. Additional studies are required to elucidate which of these techniques is most promising. In the recent years, however, several groups have shown that data can be obtained with high validity and reproducibility. In addition, several groups have published values for total retinal blood flow. Another promising application relates to non-invasive angiography. As compared to standard techniques such as fluorescein and indocyanine-green angiography the technique offers two major advantages: no dye is required and depth resolution is required is provided. As such Doppler OCT has the potential to improve our abilities to diagnose and monitor ocular vascular diseases. PMID:24704352

  19. Robotic mitral valve surgery: overview, methodology, results, and perspective

    PubMed Central

    2016-01-01

    Robotic mitral valve repair began in 1998 and has advanced remarkably. It arose from an interest in reducing patient trauma by operating through smaller incisions with videoscopic assistance. In the United States, following two clinical trials, the FDA approved the daVinci Surgical System in 2002 for intra-cardiac surgery. This device has undergone three iterations, eventuating in the current daVinci XI. At present it is the only robotic device approved for mitral valve surgery. Many larger centers have adopted its use as part of their routine mitral valve repair armamentarium. Although these operations have longer perfusion and arrest times, complications have been either similar or less than other traditional methods. Preoperative screening is paramount and leads to optimal patient selection and outcomes. There are clear contraindications, both relative and absolute, that must be considered. Three-dimensional (3D) echocardiographic studies optimally guide surgeons in operative planning. Herein, we describe the selection criteria as well as our operative management during a robotic mitral valve repair. Major complications are detailed with tips to avoid their occurrence. Operative outcomes from the author’s series as well as those from the largest experiences in the United States are described. They show that robotic mitral valve repair is safe and effective, as well as economically reasonable due to lower costs of hospitalization. Thus, the future of this operative technique is bright for centers adopting the “heart team” approach, adequate clinical volume and a dedicated and experienced mitral repair surgeon. PMID:27942486

  20. Role of Imaging Techniques in Percutaneous Treatment of Mitral Regurgitation.

    PubMed

    Li, Chi-Hion; Arzamendi, Dabit; Carreras, Francesc

    2016-04-01

    Mitral regurgitation is the most prevalent valvular heart disease in the United States and the second most prevalent in Europe. Patients with severe mitral regurgitation have a poor prognosis with medical therapy once they become symptomatic or develop signs of significant cardiac dysfunction. However, as many as half of these patients are inoperable because of advanced age, ventricular dysfunction, or other comorbidities. Studies have shown that surgery increases survival in patients with organic mitral regurgitation due to valve prolapse but has no clinical benefit in those with functional mitral regurgitation. In this scenario, percutaneous repair for mitral regurgitation in native valves provides alternative management of valvular heart disease in patients at high surgical risk. Percutaneous repair for mitral regurgitation is a growing field that relies heavily on imaging techniques to diagnose functional anatomy and guide repair procedures. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  1. [Atrial functional mitral regurgitation. Three-dimensional echocardiographic study].

    PubMed

    Hernández-Ramírez, José Miguel; Ortega-Trujillo, José Ramón

    2017-07-24

    Atrial fibrillation can lead to a left atrium remodeling and induce functional mitral regurgitation. The aim of this study is to establish what features of the mitral annulus are related to atrial functional mitral regurgitation. Retrospectively 29 patients with persistent atrial fibrillation and 36 controls in sinus rhythm were enrolled. The characteristics of the mitral annulus were analyzed by three-dimensional transesophageal echocardiography in both groups. 2D and 3D echocardiographic parameters were correlated with the effective regurgitant orifice. Patients with atrial fibrillation had larger left atrium volume, anteroposterior diameter at end-diastole and lower percentage of change in this diameter (P: 0.015, 0.019 and <0.001, respectively). In the multiple regression analysis the ellipticity index (β: -0.756, P: 0.004) and height-anterolateral-posteriomedial diameter ratio (β: -0704, P: 0.003) were independent parameters correlated with the effective regurgitant orifice (R(2): 0.699, P: 0.019) in patients with atrial fibrillation. Atrial fibrillation leads to atrial dilatation and alterations in the size and dynamic of the anteroposterior diameter, producing a circular mitral annulus. The independents determinants of atrial functional mitral regurgitation in the atrial fibrillation group were the ellipticity index and height-anterolateral-posteromedial diameter ratio. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  2. The short-term effect of nifedipine tocolysis on placental, fetal cerebral and atrioventricular Doppler waveforms.

    PubMed

    Guclu, S; Saygili, U; Dogan, E; Demir, N; Baschat, A A

    2004-12-01

    To evaluate the effect of nifedipine on placental and fetal middle cerebral and atrioventricular Doppler waveforms. Doppler waveforms of uterine (UtA), umbilical (UA) and middle cerebral (MCA) arteries and both atrioventricular valves were measured from 21 pregnant women/fetuses prior to and during nifedipine therapy for preterm labor. Maternal and fetal heart rates (FHR), maternal systolic and diastolic blood pressure, the Doppler pulsatility index and systolic/diastolic ratio of the UtA, UA and MCA were measured. The total time velocity integrals (TVI) of tricuspid and mitral valves and their E-wave/A-wave (E/A) TVI ratios were measured. Wilcoxon signed pairs test was used to compare the differences in Doppler parameters before and at 3 h after nifedipine loading up to a maximum dose of 40 mg. Fetal arterial and UtA Doppler parameters were not different before and after nifedipine therapy. Blood flow across the atrioventricular valves and the TVI were equally unaffected by nifedipine. The TVI x FHR product was also unchanged following nifedipine therapy. In women with otherwise uncomplicated pregnancies, nifedipine loading and tocolysis are generally well tolerated by the mother. Placental and fetal cerebral arterial blood flow, fetal systolic and diastolic cardiac function and downstream distribution of fetal cardiac output are unaffected by nifedipine loading. These results apply to women with unchanged vital parameters. Further studies are necessary to show long-term effects of nifedipine therapy and may help to refine choice of tocolytic agents.

  3. 3D Experimental and Computational Analysis of Eccentric Mitral Regurgitant Jets in a Mock Imaging Heart Chamber.

    PubMed

    Wang, Yifan; Quaini, Annalisa; Čanić, Sunčica; Vukicevic, Marija; Little, Stephen H

    2017-07-10

    Mitral valve regurgitation (MR) is a disorder of the heart in which the mitral valve does not close properly. This causes an abnormal leaking of blood backwards from the left ventricle into the left atrium during the systolic contractions of the left ventricle. Noninvasive assessment of MR using echocardiography is an ongoing challenge. In particular, a major problem are eccentric or Coanda regurgitant jets which hug the walls of the left atrium and appear smaller in the color Doppler image of regurgitant flow. This manuscript presents a comprehensive investigation of Coanda regurgitant jets and the associated intracardiac flows by using a combination of experimental and computational approaches. An anatomically correct mock heart chamber connected to a pulsatile flow loop is used to generate the physiologically relevant flow conditions, and the influence of two clinically relevant parameters (orifice aspect ratio and regurgitant volume) on the onset of Coanda effect is studied. A two parameter bifurcation diagram showing transition to Coanda jets is obtained, indicating that: (1) strong wall hugging jets occur in long and narrow orifices with moderate to large regurgitant volumes, and (2) short orifices with moderate to large regurgitant volumes produce strong 3D flow features such as vortex rolls, giving rise to the velocities that are orthogonal to the 2D plane associated with the apical color Doppler views, making them "invisible" to the single plane color Doppler assessment of MR. This is the first work in which the presence of vortex rolls in the left atrium during regurgitation is reported and identified as one of the reasons for under-estimation of regurgitant volume. The results of this work can be used for better design of imaging strategies in noninvasive assessment of MR, and for better understanding of LA remodeling that may be associated with the presence of maladapted vortex dynamics. This introduces a new concept in clinical imaging, which

  4. Impact of duration of mitral regurgitation on outcomes in asymptomatic patients with myxomatous mitral valve undergoing exercise stress echocardiography.

    PubMed

    Naji, Peyman; Asfahan, Fadi; Barr, Tyler; Rodriguez, L Leonardo; Grimm, Richard A; Agarwal, Shikhar; Thomas, James D; Gillinov, A Marc; Mihaljevic, Tomislav; Griffin, Brian P; Desai, Milind Y

    2015-02-11

    Significant mitral regurgitation (MR) typically occurs as holosystolic (HS) or mid-late systolic (MLS), with differences in volumetric impact on the left ventricle (LV). We sought to assess outcomes of degenerative MR patients undergoing exercise echocardiography, separated based on MR duration (MLS versus HS). We included 609 consecutive patients with ≥III+myxomatous MR undergoing exercise echocardiography: HS (n=487) and MLS (n=122). MLS MR was defined as delayed appearance of MR signal during mid-late systole on continuous-wave Doppler while HS MR occurred throughout systole. Composite events of death and congestive heart failure were recorded. Compared to MLS MR, HS MR patients were older (60±14 versus 53±14 years), more were males (72% versus 53%), and had greater prevalence of atrial fibrillation (16% versus 7%; all P<0.01). HS MR patients had higher right ventricular systolic pressure (RVSP) at rest (33±11 versus 27±9 mm Hg), more flail leaflets (36% versus 6%), and a lower number of metabolic equivalents (METs) achieved (9.5±3 versus 10.5±3), compared to the MLS MR group (all P<0.05). There were 54 events during 7.1±3 years of follow-up. On step-wise multivariable analysis, HS versus MLS MR (HR 4.99 [1.21 to 20.14]), higher LV ejection fraction (hazard ratio [HR], 0.94 [0.89 to 0.98]), atrial fibrillation (HR, 2.59 [1.33 to 5.11]), higher RVSP (HR, 1.05 [1.03 to 1.09]), and higher percentage of age- and gender-predicted METs (HR, 0.98 [0.97 to 0.99]) were independently associated with adverse outcomes (all P<0.05). In patients with ≥III+myxomatous MR undergoing exercise echocardiography, holosystolic MR is associated with adverse outcomes, independent of other predictors. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  5. Impact of Duration of Mitral Regurgitation on Outcomes in Asymptomatic Patients With Myxomatous Mitral Valve Undergoing Exercise Stress Echocardiography

    PubMed Central

    Naji, Peyman; Asfahan, Fadi; Barr, Tyler; Rodriguez, L. Leonardo; Grimm, Richard A.; Agarwal, Shikhar; Thomas, James D.; Gillinov, A. Marc; Mihaljevic, Tomislav; Griffin, Brian P.; Desai, Milind Y.

    2015-01-01

    Background Significant mitral regurgitation (MR) typically occurs as holosystolic (HS) or mid‐late systolic (MLS), with differences in volumetric impact on the left ventricle (LV). We sought to assess outcomes of degenerative MR patients undergoing exercise echocardiography, separated based on MR duration (MLS versus HS). Methods and Results We included 609 consecutive patients with ≥III+myxomatous MR undergoing exercise echocardiography: HS (n=487) and MLS (n=122). MLS MR was defined as delayed appearance of MR signal during mid‐late systole on continuous‐wave Doppler while HS MR occurred throughout systole. Composite events of death and congestive heart failure were recorded. Compared to MLS MR, HS MR patients were older (60±14 versus 53±14 years), more were males (72% versus 53%), and had greater prevalence of atrial fibrillation (16% versus 7%; all P<0.01). HS MR patients had higher right ventricular systolic pressure (RVSP) at rest (33±11 versus 27±9 mm Hg), more flail leaflets (36% versus 6%), and a lower number of metabolic equivalents (METs) achieved (9.5±3 versus 10.5±3), compared to the MLS MR group (all P<0.05). There were 54 events during 7.1±3 years of follow‐up. On step‐wise multivariable analysis, HS versus MLS MR (HR 4.99 [1.21 to 20.14]), higher LV ejection fraction (hazard ratio [HR], 0.94 [0.89 to 0.98]), atrial fibrillation (HR, 2.59 [1.33 to 5.11]), higher RVSP (HR, 1.05 [1.03 to 1.09]), and higher percentage of age‐ and gender‐predicted METs (HR, 0.98 [0.97 to 0.99]) were independently associated with adverse outcomes (all P<0.05). Conclusion In patients with ≥III+myxomatous MR undergoing exercise echocardiography, holosystolic MR is associated with adverse outcomes, independent of other predictors. PMID:25672368

  6. Growth of mitral annulus in the pediatric patient after suture annuloplasty of the entire posterior mitral annulus.

    PubMed

    Komoda, Takeshi; Huebler, Michael; Berger, Felix; Hetzer, Roland

    2009-08-01

    When mitral annuloplasty is performed in small children, room for annular growth should be allowed. However, it has not been reported how the valve develops after mitral annuloplasty of the entire posterior annulus. We report a case showing traces of annular growth at redo surgery. A female patient suffering from mitral valve insufficiency due to annular dilatation underwent modified Paneth plasty with Kay-Wooler commissural plication annuloplasty at the age of two years one month. In redo surgery 8.4 years after initial repair, enlargement of the commissural portion of the posterior annulus in addition to enlargement of the anterior leaflet and anterior annulus was observed. Modified Paneth plasty reinforced with a pericardial strip and Kay-Wooler annuloplasty of the posteromedial commissure were performed. Mitral orifice size measured with the Hegar dilator was 18 mm after the re-repair, increasing from 16 mm after the initial repair. Taking into account the normal mitral annulus diameter related to body surface area (BSA) of 16 mm at initial operation and 20 mm at redo surgery, the increase in mitral orifice size from 16 mm to 18 mm in this patient may be regarded as the annular growth in 8.4 years.

  7. Clinical applications of doppler ultrasound

    SciTech Connect

    Taylor, K.J.W.; Burns, P.N.; Well, P.N.T.

    1987-01-01

    This book introduces a guide to the physical principles and instrumentation of duplex Doppler ultrasound and its applications in obstetrics, gynecology, neonatology, gastroentology, and evaluation of peripheral vascular disease. The book provides information needed to perform Doppler ultrasound examinations and interpret the results. An introduction to Doppler physics and instrumentation is followed by a thorough review of hemodynamics, which explains the principles underlying interpretation of Doppler signals. Of special note is the state-of-the-art coverage of new applications of Doppler in recognition of high-risk pregnancy, diagnosis of intrauterine growth retardation, investigation of neonatal blood flow, evaluation of first-trimester pregnancy, and diagnosis of gastrointestinal disease. The book also offers guidelines on the use of Doppler ultrasound in diagnosing carotid disease, deep venous thrombosis, and aorta/femoral disease.

  8. Effects of acute ischemic mitral regurgitation on three-dimensional mitral leaflet edge geometry.

    PubMed

    Bothe, Wolfgang; Nguyen, Tom C; Ennis, Daniel B; Itoh, Akinobu; Carlhäll, Carl Johan; Lai, David T; Ingels, Neil B; Miller, D Craig

    2008-02-01

    Improved quantitative understanding of in vivo leaflet geometry in ischemic mitral regurgitation (IMR) is needed to improve reparative techniques, yet few data are available due to current imaging limitations. Using marker technology we tested the hypotheses that IMR (1) occurs chiefly during early systole; (2) affects primarily the valve region contiguous with the myocardial ischemic insult; and (3) results in systolic leaflet edge restriction. Eleven sheep had radiopaque markers sutured as five opposing pairs along the anterior (A(1)-E(1)) and posterior (A(2)-E(2)) mitral leaflet free edges from the anterior commissure (A(1)-A(2)) to the posterior commissure (E(1)-E(2)). Immediately postoperatively, biplane videofluoroscopy was used to obtain 4D marker coordinates before and during acute proximal left circumflex artery occlusion. Regional mitral orifice area (MOA) was calculated in the anterior (Ant-MOA), middle (Mid-MOA), and posterior (Post-MOA) mitral orifice segments during early systole (EarlyS), mid systole (MidS), and end systole (EndS). MOA was normalized to zero (minimum orifice opening) at baseline EndS. Tenting height was the distance of the midpoint of paired markers to the mitral annular plane at EndS. Acute ischemia increased echocardiographic MR grade (0.5+/-0.3 vs 2.3+/-0.7, p<0.01) and MOA in all regions at EarlyS, MidS, and EndS: Ant-MOA (7+/-10 vs 22+/-19 mm(2), 1+/-2 vs 18+/-16 mm(2), 0 vs 17+/-15 mm(2)); Mid-MOA (9+/-13 vs 25+/-17 mm(2), 3+/-6 vs 21+/-19 mm(2), 0 vs 25+/-17 mm(2)); and Post-MOA (8+/-10 vs 25+/-16, 2+/-4 vs 22+/-13 mm(2), 0 vs 23+/-13 mm(2)), all p<0.05. There was no change in MOA throughout systole (EarlyS vs MidS vs EndS) during baseline conditions or ischemia. Tenting height increased with ischemia near the central and the anterior commissure leaflet edges (B(1)-B(2): 7.1+/-1.8mm vs 7.9+/-1.7 mm, C(1)-C(2): 6.9+/-1.3mm vs 8.0+/-1.5mm, both p<0.05). MOA during ischemia was larger throughout systole, indicating that acute IMR

  9. EFFECTS OF ACUTE ISCHEMIC MITRAL REGURGITATION ON THREE DIMENSIONAL MITRAL LEAFLET EDGE GEOMETRY

    PubMed Central

    Bothe, Wolfgang; Nguyen, Tom C.; Ennis, Daniel B.; Itoh, Akinobu; Carlhäll, Carl Johan; Lai, David T.; Ingels, Neil B.; Miller, D. Craig

    2008-01-01

    Background: Improved quantitative understanding of in-vivo leaflet geometry in ischemic mitral regurgitation (IMR) is needed to improve reparative techniques, yet few data are available due to current imaging limitations. Using marker technology we tested the hypotheses that IMR: (1) Occurs chiefly during early-systole; (2) Affects primarily the valve region contiguous with the myocardial ischemic insult; and, (3) Results in systolic leaflet edge restriction. Methods: Eleven sheep had radiopaque markers sutured as five opposing pairs along the anterior (A1-E1) and posterior (A2-E2) mitral leaflet free-edges from the anterior commissure (A1-A2) to the posterior commissure (E1-E2). Immediately postoperatively, biplane videofluoroscopy was used to obtain 4-D marker coordinates before and during acute proximal left circumflex artery occlusion. Regional mitral orifice area (MOA) was calculated in the anterior (Ant-MOA), middle (Mid-MOA) and posterior (Post-MOA) mitral orifice segments during early-systole (EarlyS), mid-systole (MidS), and end-systole (EndS). MOA was normalized to zero (minimum orifice opening) at baseline EndS. Tenting height was the distance of the midpoint of paired markers to the mitral annular plane at EndS. . Results: Acute ischemia increased echocardiographic MR grade (0.5±0.3 vs. 2.3±0.7, p<0.01) and MOA in all regions at EarlyS, MidS and EndS: Ant-MOA (7±10 vs. 22±19mm2, 1±2 vs. 18±16mm2, 0 vs. 17±15mm2); Mid-MOA (9±13 vs. 25±17mm2, 3±6 vs. 21±19mm2, 0 vs. 25±17mm2); and Post-MOA (8±10 vs. 25±16, 2±4 vs. 22±13mm2, 0 vs. 23±13mm2), all p<0.05. There was no change in MOA throughout systole (EarlyS vs. MidS vs. EndS) during baseline conditions or ischemia. Tenting height increased with ischemia near the central and the anterior commissure leaflet edges (B1-B2: 7.1±1.8mm vs. 7.9±1.7mm, C1-C2: 6.9±1.3mm vs. 8.0±1.5mm, both p<0.05). Conclusions: (1) MOA during ischemia was larger throughout systole, indicating that acute IMR in

  10. Laser Doppler diagnostics for orthodontia

    NASA Astrophysics Data System (ADS)

    Ryzhkova, Anastasia V.; Lebedeva, Nina G.; Sedykh, Alexey V.; Ulyanov, Sergey S.; Lepilin, Alexander V.; Kharish, Natalia A.

    2004-06-01

    The results of statistical analysis of Doppler spectra of intensity fluctuations of light, scattered from mucous membrane of oral cavity of healthy volunteers and patients, abused by the orthodontic diseases, are presented. Analysis of Doppler spectra, obtained from tooth pulp of patients, is carried out. New approach to monitoring of blood microcirculation in orthodontics is suggested. Influence of own noise of Doppler measuring system on formation of the output signal is studied.

  11. Doppler echocardiographic description of double-inlet left ventricle in an Arabian horse.

    PubMed

    Sedacca, Cassidy D; Bright, Janice M; Boon, June

    2010-08-01

    Univentricular atrioventricular (AV) connections are rare and complex congenital cardiac anomalies in which both AV valves communicate into a large, common (single) receiving chamber. The common chamber can be of left, right, or mixed ventricular morphology. Although well documented in people, reports of the double-inlet ventricle malformation are rare in the veterinary literature. This report provides description of an Arabian horse with a double-inlet univentricular connection of left ventricular type, a hypoplastic subpulmonary right ventricle, two muscular ventricular septal defects, and a stenotic mitral valve. Transthoracic Doppler echocardiography enabled antemortem diagnosis, and provided an assessment of intracardiac hemodynamics. The findings indicate that Doppler echocardiography is a useful, noninvasive tool for evaluating equine patients with congenital univentricular AV connections, such as a double-inlet left ventricle.

  12. RT 3D TEE: Characteristics of Mitral Valve in Ischemic Mitral Regurgitation Evaluated by MVQ Program

    PubMed Central

    Kovalova, Sylva; Necas, Josef

    2011-01-01

    Aim To assess the changes of mitral valve (MV) in ischemic mitral regurgitation (IMR) using Mitral Valve Quantification (MVQ) program. Methods We examined 46 patients (18 women) with IMR aged 45-86 and a control group of 33 healthy individuals (14 women) aged 18-88. Following parameters were assessed: Area of minimal surface spanning annulus (A3), annulus height (h), tenting height (Th), exposed area of anterior (AL), posterior (PL) and both leaflets (BL), ejection fraction of the left ventricle (LV EF), regurgitation volume (RV) and BL/A3, AL/A3, PL/A3 ratios. The normal range of BL/A3 ratio was defined as the average ± 2SD of control group. The study group was separated into subgroup 1 with BL/A3 ratio within normal values and subgroup 2 with pathological BL/A3 ratio. Corresponding parameters of IMR group were compared to the controls and both subgroups were compared to each other using Student t-test. Results In IMR group, as compared to the controls, A3, AL, PL, BL as well as BL/A3, AL/A3, PL/A3 ratios and Th were significantly increased, conversely, h and LV EF was significantly decreased. In the subgroup 2 as compared to the subgroup 1 there was significant increase of Th, BL, AL and PL, while EF LV was significantly decreased. There was no significant difference between these subgroups in A3, h and RV. Conclusion In ischemic MV remodeling two stages were identified without relation to the severity of IMR. The first stage was mainly influenced by the LV dilatation while LV remodeling was more important in the second stage.

  13. Digital storage and analysis of color Doppler echocardiograms

    NASA Technical Reports Server (NTRS)

    Chandra, S.; Thomas, J. D.

    1997-01-01

    Color Doppler flow mapping has played an important role in clinical echocardiography. Most of the clinical work, however, has been primarily qualitative. Although qualitative information is very valuable, there is considerable quantitative information stored within the velocity map that has not been extensively exploited so far. Recently, many researchers have shown interest in using the encoded velocities to address the clinical problems such as quantification of valvular regurgitation, calculation of cardiac output, and characterization of ventricular filling. In this article, we review some basic physics and engineering aspects of color Doppler echocardiography, as well as drawbacks of trying to retrieve velocities from video tape data. Digital storage, which plays a critical role in performing quantitative analysis, is discussed in some detail with special attention to velocity encoding in DICOM 3.0 (medical image storage standard) and the use of digital compression. Lossy compression can considerably reduce file size with minimal loss of information (mostly redundant); this is critical for digital storage because of the enormous amount of data generated (a 10 minute study could require 18 Gigabytes of storage capacity). Lossy JPEG compression and its impact on quantitative analysis has been studied, showing that images compressed at 27:1 using the JPEG algorithm compares favorably with directly digitized video images, the current goldstandard. Some potential applications of these velocities in analyzing the proximal convergence zones, mitral inflow, and some areas of future development are also discussed in the article.

  14. Digital storage and analysis of color Doppler echocardiograms

    NASA Technical Reports Server (NTRS)

    Chandra, S.; Thomas, J. D.

    1997-01-01

    Color Doppler flow mapping has played an important role in clinical echocardiography. Most of the clinical work, however, has been primarily qualitative. Although qualitative information is very valuable, there is considerable quantitative information stored within the velocity map that has not been extensively exploited so far. Recently, many researchers have shown interest in using the encoded velocities to address the clinical problems such as quantification of valvular regurgitation, calculation of cardiac output, and characterization of ventricular filling. In this article, we review some basic physics and engineering aspects of color Doppler echocardiography, as well as drawbacks of trying to retrieve velocities from video tape data. Digital storage, which plays a critical role in performing quantitative analysis, is discussed in some detail with special attention to velocity encoding in DICOM 3.0 (medical image storage standard) and the use of digital compression. Lossy compression can considerably reduce file size with minimal loss of information (mostly redundant); this is critical for digital storage because of the enormous amount of data generated (a 10 minute study could require 18 Gigabytes of storage capacity). Lossy JPEG compression and its impact on quantitative analysis has been studied, showing that images compressed at 27:1 using the JPEG algorithm compares favorably with directly digitized video images, the current goldstandard. Some potential applications of these velocities in analyzing the proximal convergence zones, mitral inflow, and some areas of future development are also discussed in the article.

  15. Mutations in DCHS1 Cause Mitral Valve Prolapse

    PubMed Central

    Durst, Ronen; Sauls, Kimberly; Peal, David S; deVlaming, Annemarieke; Toomer, Katelynn; Leyne, Maire; Salani, Monica; Talkowski, Michael E.; Brand, Harrison; Perrocheau, Maëlle; Simpson, Charles; Jett, Christopher; Stone, Matthew R.; Charles, Florie; Chiang, Colby; Lynch, Stacey N.; Bouatia-Naji, Nabila; Delling, Francesca N.; Freed, Lisa A.; Tribouilloy, Christophe; Le Tourneau, Thierry; LeMarec, Hervé; Fernandez-Friera, Leticia; Solis, Jorge; Trujillano, Daniel; Ossowski, Stephan; Estivill, Xavier; Dina, Christian; Bruneval, Patrick; Chester, Adrian; Schott, Jean-Jacques; Irvine, Kenneth D.; Mao, Yaopan; Wessels, Andy; Motiwala, Tahirali; Puceat, Michel; Tsukasaki, Yoshikazu; Menick, Donald R.; Kasiganesan, Harinath; Nie, Xingju; Broome, Ann-Marie; Williams, Katherine; Johnson, Amanda; Markwald, Roger R.; Jeunemaitre, Xavier; Hagege, Albert; Levine, Robert A.; Milan, David J.; Norris, Russell A.; Slaugenhaupt, Susan A.

    2015-01-01

    SUMMARY Mitral valve prolapse (MVP) is a common cardiac valve disease that affects nearly 1 in 40 individuals1–3. It can manifest as mitral regurgitation and is the leading indication for mitral valve surgery4,5. Despite a clear heritable component, the genetic etiology leading to non-syndromic MVP has remained elusive. Four affected individuals from a large multigenerational family segregating non-syndromic MVP underwent capture sequencing of the linked interval on chromosome 11. We report a missense mutation in the DCHS1 gene, the human homologue of the Drosophila cell polarity gene dachsous (ds) that segregates with MVP in the family. Morpholino knockdown of the zebrafish homolog dachsous1b resulted in a cardiac atrioventricular canal defect that could be rescued by wild-type human DCHS1, but not by DCHS1 mRNA with the familial mutation. Further genetic studies identified two additional families in which a second deleterious DCHS1 mutation segregates with MVP. Both DCHS1 mutations reduce protein stability as demonstrated in zebrafish, cultured cells, and, notably, in mitral valve interstitial cells (MVICs) obtained during mitral valve repair surgery of a proband. Dchs1+/− mice had prolapse of thickened mitral leaflets, which could be traced back to developmental errors in valve morphogenesis. DCHS1 deficiency in MVP patient MVICs as well as in Dchs1+/− mouse MVICs result in altered migration and cellular patterning, supporting these processes as etiological underpinnings for the disease. Understanding the role of DCHS1 in mitral valve development and MVP pathogenesis holds potential for therapeutic insights for this very common disease. PMID:26258302

  16. Correction of anterior mitral prolapse: the parachute technique.

    PubMed

    Zannis, Konstantinos; Mitchell-Heggs, Laurens; Di Nitto, Valentina; Kirsch, Matthias E W; Noghin, Milena; Ghorayeb, Gabriel; Lessana, Arrigo

    2012-04-01

    To evaluate a new surgical technique for the correction of anterior mitral leaflet prolapse. From October 2006 to November 2011, 44 consecutive patients (28 males, mean age 55 ± 13 years) underwent mitral valve repair because of anterior mitral leaflet prolapse. Echocardiography was performed to evaluate the distance from the tip of each papillary muscle to the annular plane. A specially designed caliper was used to manufacture a parachute-like device, by looping a 4-0 polytetrafluoroethylene suture between a Dacron strip and Teflon felt pledget, according to the preoperative echocardiographic measurements. This parachute was then used to resuspend the anterior mitral leaflet to the corresponding papillary muscle. Of the 44 patients, 35 (80%) required concomitant posterior leaflet repair. Additional procedures were required in 16 patients (36%). The preoperative logistic European System for Cardiac Operative Risk Evaluation was 4.3 ± 6.9. The clinical and echocardiographic follow-up were complete. The total follow-up was 1031 patient-months and averaged 23.4 ± 17.2 months per patient. The overall mortality rate was 4.5% (n = 2). Also, 2 patients (4.5%) with recurrent mitral regurgitation required mitral valve replacement, 1 on the first postoperative day and 1 after 13 months. In the latter patient, histologic analysis showed complete endothelialization of the Dacron strip. At follow-up, all non-reoperated survivors (n = 40) were in New York Heart Association class I, with no regurgitation in 40 patients (93%) and grade 2+ mitral regurgitation in 3 (7%). This technique offers a simple and reproducible solution for correction of anterior leaflet prolapse. Echocardiography can reliably evaluate the length of the chordae. However, the long-term results must be evaluated and compared with other surgical strategies. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  17. Echocardiographic assessment of left ventricular filling after mitral valve surgery.

    PubMed Central

    St John Sutton, M G; Traill, T A; Ghafour, A S; Brown, D J; Gibson, D G

    1977-01-01

    In order to investigate the functional effects of mitral valve surgery, echocardiograms showing left ventricular dimension were recorded and digitised in 14 normal subjects and 129 patients after mitral valve surgery. Measurements were made of peak rate of increase of dimension (dD/dt) and duration of rapid filling, studies on left ventriculograms in 36 patients having shown close correlation between these values and changes in cavity volume. In 14 patients with mitral stenosis, peak dD/dt was reduced to 7-2 +/ 1-5 cm/s, and filling period prolonged to 330 +/- 65 ms, compared with normal (16-0 +/- 3-2 cm/s, and 160 +/- 50 ms, respectively), and after mitral valvotomy, these values improved significantly (10-4 +/- 2-7 cm/s and 245 +/- 55 ms). Characteristic abnormalities were found in 67 patients with mitral prostheses. Values for the Björk-Shiley (10-5 +/- 4-2 cm/s and 180 +/- 80 ms) and Hancock (10-3 +/- 3-7 cm/s, 245 +/- 80 ms) values were similar, and both superior to the Starr-Edwards (7-4 +/- 3-0 cm/s, 295 +/- 105 ms). Results after mitral valve repair in 30 cases were not significantly different from normal (14-4 +/- 5-0 cm/s, 170 +/- 50 ms). Values outside the 95 per cent confidence limits for the valve in question allowed diagnosis of value malfunction in 18 cases. The method is value in comparing different operative procedures and in following up patients after mitral valve surgery. PMID:603728

  18. Mutations in DCHS1 cause mitral valve prolapse.

    PubMed

    Durst, Ronen; Sauls, Kimberly; Peal, David S; deVlaming, Annemarieke; Toomer, Katelynn; Leyne, Maire; Salani, Monica; Talkowski, Michael E; Brand, Harrison; Perrocheau, Maëlle; Simpson, Charles; Jett, Christopher; Stone, Matthew R; Charles, Florie; Chiang, Colby; Lynch, Stacey N; Bouatia-Naji, Nabila; Delling, Francesca N; Freed, Lisa A; Tribouilloy, Christophe; Le Tourneau, Thierry; LeMarec, Hervé; Fernandez-Friera, Leticia; Solis, Jorge; Trujillano, Daniel; Ossowski, Stephan; Estivill, Xavier; Dina, Christian; Bruneval, Patrick; Chester, Adrian; Schott, Jean-Jacques; Irvine, Kenneth D; Mao, Yaopan; Wessels, Andy; Motiwala, Tahirali; Puceat, Michel; Tsukasaki, Yoshikazu; Menick, Donald R; Kasiganesan, Harinath; Nie, Xingju; Broome, Ann-Marie; Williams, Katherine; Johnson, Amanda; Markwald, Roger R; Jeunemaitre, Xavier; Hagege, Albert; Levine, Robert A; Milan, David J; Norris, Russell A; Slaugenhaupt, Susan A

    2015-09-03

    Mitral valve prolapse (MVP) is a common cardiac valve disease that affects nearly 1 in 40 individuals. It can manifest as mitral regurgitation and is the leading indication for mitral valve surgery. Despite a clear heritable component, the genetic aetiology leading to non-syndromic MVP has remained elusive. Four affected individuals from a large multigenerational family segregating non-syndromic MVP underwent capture sequencing of the linked interval on chromosome 11. We report a missense mutation in the DCHS1 gene, the human homologue of the Drosophila cell polarity gene dachsous (ds), that segregates with MVP in the family. Morpholino knockdown of the zebrafish homologue dachsous1b resulted in a cardiac atrioventricular canal defect that could be rescued by wild-type human DCHS1, but not by DCHS1 messenger RNA with the familial mutation. Further genetic studies identified two additional families in which a second deleterious DCHS1 mutation segregates with MVP. Both DCHS1 mutations reduce protein stability as demonstrated in zebrafish, cultured cells and, notably, in mitral valve interstitial cells (MVICs) obtained during mitral valve repair surgery of a proband. Dchs1(+/-) mice had prolapse of thickened mitral leaflets, which could be traced back to developmental errors in valve morphogenesis. DCHS1 deficiency in MVP patient MVICs, as well as in Dchs1(+/-) mouse MVICs, result in altered migration and cellular patterning, supporting these processes as aetiological underpinnings for the disease. Understanding the role of DCHS1 in mitral valve development and MVP pathogenesis holds potential for therapeutic insights for this very common disease.

  19. Quantitative Evaluation of Mitral Regurgitation Secondary to Mitral Valve Prolapse by Magnetic Resonance Imaging and Echocardiography.

    PubMed

    Le Goffic, Caroline; Toledano, Manuel; Ennezat, Pierre-Vladimir; Binda, Camille; Castel, Anne-Laure; Delelis, François; Graux, Pierre; Tribouilloy, Christophe; Maréchaux, Sylvestre

    2015-11-01

    The present prospective study was designed to evaluate the accuracy of quantitative assessment of mitral regurgitant fraction (MRF) by echocardiography and cardiac magnetic resonance imaging (cMRI) in the modern era using as reference method the blinded multiparametric integrative assessment of mitral regurgitation (MR) severity. 2-Dimensional (2D) and 3-dimensional (3D) MRF by echocardiography (2D echo MRF and 3D echo MRF) were obtained by measuring the difference in left ventricular (LV) total stroke volume (obtained from either 2D or 3D acquisition) and aortic forward stroke volume normalized to LV total stroke volume. MRF was calculated by cMRI using either (1) (LV stroke volume - systolic aortic outflow volume by phase contrast)/LV stroke volume (cMRI MRF [volumetric]) or (2) (mitral inflow volume - systolic aortic outflow volume)/mitral inflow volume (cMRI MRF [phase contrast]). Six patients had 1 + MR, 6 patients had 2 + MR, 12 patients had 3 + MR, and 10 had 4 + MR. A significant correlation was observed between MR grading and 2D echo MRF (r = 0.60, p <0.0001) and 3D echo MRF (r = 0.79, p <0.0001), cMRI MRF (volumetric) (r = 0.87, p <0.0001), and cMRI MRF (phase contrast r = 0.72, p <0.001). The accuracy of MRF for the diagnosis of MR ≥3+ or 4+ was the highest with cMRI MRF (volumetric) (area under the receiver-operating characteristic curve [AUC] = 0.98), followed by 3D echo MRF (AUC = 0.96), 2D echo MRF (AUC = 0.90), and cMRI MRF (phase contrast; AUC = 0.83). In conclusion, MRF by cMRI (volumetric method) and 3D echo MRF had the highest diagnostic value to detect significant MR, whereas the diagnostic value of 2D echo MRF and cMRI MRF (phase contrast) was lower. Hence, the present study suggests that both cMRI (volumetric method) and 3D echo represent best approaches for calculating MRF.

  20. ANP and BNP plasma levels in patients with rheumatic mitral stenosis after percutaneous balloon mitral valvuloplasty

    PubMed Central

    Rużyłło, Witold; Chmielak, Zbigniew; Opalińska-Ciszek, Ewa; Janas, Jadwiga; Hoffman, Piotr; Hryniewiecki, Tomasz; Grzybowski, Jacek

    2017-01-01

    Introduction Atrial (ANP) and B-type (BNP) natriuretic peptides are hormones secreted by the heart as a response to volume expansion and pressure overload. Aim To assess the changes of ANP and BNP after percutaneous balloon mitral valvuloplasty (PBMV) and to investigate factors associated with endpoints. Material and methods The study included 96 patients (90.7% females, age 51.6 ±12.2 years) with rheumatic mitral valve stenosis (mitral valve area (MVA) 1.18 (1.01–1.33) cm2, mean mitral gradient (MMG) 8.2 (7.1–9.2) mm Hg, NYHA 2.09 (1.9–2.5)). Patients were followed up for 29.1 months for the search of endpoints. Results The PBMV was successful in all cases. After the procedure MVA increased (1.18–1.78 cm2, p < 0.01) and pulmonary capillary wedge pressure (PCWP) decreased (29.8–21.8 mm Hg, p < 0.01). Concentration of ANP significantly rose 30 min after the PBMV (79.2 vs. 134.2 pg/ml, p = 0.012) and dropped significantly after 24 h (134.2 vs. 70.4 pg/ml, p = 0.01). Furthermore, after 36 months concentration of ANP did not differ from the baseline value (p = NS). BNP concentration at day 1 was lower than at baseline (94.5 vs. 80.2 pg/ml, p = 0.032). Moreover, during the follow-up period BNP continued to fall at all time points. In univariate analysis parameters associated with endpoint occurrence were baseline PAP (p = 0.023), baseline PCWP (p = 0.022), baseline NYHA (p = 0.041) and increase in 6-minute walk test (6MWT) (p = 0.043). In multivariate analysis the only factor associated with endpoint occurrence was baseline NYHA (HR = 1.52, 95% CI: –1.3–1.91, p = 0.022). Conclusions Patients with MS had increased levels of both BNP and ANP. Baseline NYHA class was found to be associated with outcomes after the procedure. PMID:28344613

  1. Impact of mitral geometry and global afterload on improvement of mitral regurgitation after trans-catheter aortic valve implantation

    PubMed Central

    Dworakowski, R; Kogoj, P; Reiken, J; Kenny, C; MacCarthy, P; Wendler, O; Monaghan, M J

    2016-01-01

    Objective To assess the impact of mitral geometry, left ventricular (LV) remodelling and global LV afterload on mitral regurgitation (MR) after trans-catheter aortic valve implantation (TAVI). Methods In this study, 60 patients who underwent TAVI were evaluated by 3D echocardiography at baseline, 1 month and 6 months after procedure. The proportional change in MR following TAVI was determined by examining the percentage change in vena contracta (VC) at 6 months. Patients having a significant reduction of at least 30% in VC were defined as good responders (GR) and the remaining patients were defined as poor responders (PR). Results After 6 months of TAVI, 27 (45%) patients were GR and 33 (55%) were PR. There was a significant decrease in 3DE-derived mitral annular diameter and area (P = 0.001), mitral valve tenting area (TA) (P = 0.05), and mitral papillary muscle dyssynchrony index (DSI) (P = 0.05) in the GR group. 3DE-derived LVESV (P = 0.016), LV mass (P = 0.001) and LV DSI, (P = 0.001) were also improved 6 months after TAVI. In addition, valvulo-arterial impedance (ZVA) was significantly higher at baseline in patients with PR (P = 0.028). 3DE-derived mitral annular area (β: 0.47, P = 0.04), mitral papillary DSI (β: −0.65, P = 0.012) and ZVA (β: 0.45, P = 0.028) were the strongest independent parameters that could predict the reduction of functional MR after TAVI. Conclusion GR patients demonstrate more regression in mitral annulus area and diameter after significant decrease in high LVEDP and trans-aortic gradients with TAVI. PR patients appear to have increased baseline ZVA, mitral valve tenting and restriction in mitral valve coaptation. These factors are important for predicting the impact of TAVI on pre-existing MR. PMID:27457965

  2. Neutrino Induced Doppler Broadening

    PubMed Central

    Jolie, J.; Stritt, N.

    2000-01-01

    When a nucleus undergoes beta decay via the electron capture reaction, it emits an electron neutrino. The neutrino emission gives a small recoil to the atom, which can be experimentally observed as a Doppler broadening on subsequently emitted gamma rays. Using the two-axis flat-crystal spectrometer GAMS4 and the electron capture reaction in 152Eu, the motion of atoms having an excess kinetic energy of 3 eV in the solid state was studied. It is shown how the motion of the atom during the first hundreds of femtoseconds can be reconstructed. The relevance of this knowledge for a new neutrino helicity experiment is discussed. PMID:27551591

  3. Laser Doppler velocimetry primer

    NASA Technical Reports Server (NTRS)

    Bachalo, William D.

    1985-01-01

    Advanced research in experimental fluid dynamics required a familiarity with sophisticated measurement techniques. In some cases, the development and application of new techniques is required for difficult measurements. Optical methods and in particular, the laser Doppler velocimeter (LDV) are now recognized as the most reliable means for performing measurements in complex turbulent flows. And such, the experimental fluid dynamicist should be familiar with the principles of operation of the method and the details associated with its application. Thus, the goals of this primer are to efficiently transmit the basic concepts of the LDV method to potential users and to provide references that describe the specific areas in greater detail.

  4. Impact of preserved myocardial contractile function in the segments attached to the papillary muscles on reduction in functional mitral regurgitation.

    PubMed

    Tatsumi, Kazuhiro; Tanaka, Hidekazu; Kataoka, Toshiya; Norisada, Kazuko; Onishi, Tetsuari; Kawai, Hiroya; Hirata, Ken-ichi

    2013-02-01

    Effectiveness of functional mitral regurgitation (FMR) in heart failure patients is of growing importance for patient prognosis. The purpose of this study was to investigate whether regional myocardial contractile function as assessed by tissue Doppler strain rate imaging can predict reduction in FMR caused by dobutamine. Fifty-one patients with depressed left ventricular (LV) ejection fraction (32 ± 9%) secondary to dilated cardiomyopathy and FMR underwent evaluation of effective regurgitant orifice (ERO) of FMR, mitral valve deformation, global LV remodeling, and regional myocardial contractile function assessed by longitudinal peak systolic strain rate (Ssr) in 6 mid-LV segments from standard apical views. We also determined the average Ssr of segments attached to the papillary muscles, that is, the inferior, inferolateral, and anterolateral segments (PM segments Ssr). Low-dose (10 μg/kg per minute) dobutamine-induced reduction in ERO was compared with baseline variables. Baseline valve tenting was associated with dobutamine-induced reduction in ERO (r = -0.30, P < 0.05). Receiver operating characteristic curve analysis showed that baseline valve tenting, LV sphericity index, inferior Ssr, inferolateral Ssr, and PM segments Ssr were predictors of dobutamine-induced ≥30% reduction in ERO. Importantly, only PM segments Ssr predicted dobutamine-induced ≥20% reduction in valve tenting with area under the curve of 0.67 (P < 0.05). Preserved myocardial contractile function in the segments attached to the PMs was associated with dobutamine-induced reduction in mitral valve tenting and FMR, suggesting that our findings are important for improvement in cardiac function and FMR with medical treatment. © 2012, Wiley Periodicals, Inc.

  5. Standard transthoracic echocardiography and transesophageal echocardiography views of mitral pathology that every surgeon should know

    PubMed Central

    Tan, Timothy C.

    2015-01-01

    The mitral valve is the most commonly diseased heart valve and the prevalence of mitral valve disease increases proportionally with age. Echocardiography is the primary diagnostic imaging modality used in the assessment of patients with mitral valve disease. It is a noninvasive method which provides accurate anatomic and functional information regarding the mitral valve and can identify the mechanism of mitral valve pathology. This is especially useful as it may guide surgical repair. This is increasingly relevant given the growing trend of patients undergoing mitral valve repair. Collaboration between cardiac surgeons and echocardiographers is critical in the evaluation of mitral valve disease and for identification of complex valvular lesions that require advanced surgical skill to repair. This article will provide an overview of transthoracic and transesophageal assessment of common mitral valve pathology that aims to aid surgical decision making. PMID:26539350

  6. Diastolic murmurs in the presence of Starr-Edwards mitral prosthesis.

    PubMed

    Schaffer, R A; McAnulty, J H; Starr, A; Rahimtoola, S H

    1975-03-01

    Diastolic murmurs associated with the Starr-Edwards mitral prosthesis have not been described previously. In this report, five patients with mitral prostheses are described in whom apical mid-diastolic and presystolic murmurs resulted from two different causes. Three patients had clots obstructing the prosthetic orifice. The other two had normally functioning protheses and moderately severe aortic insufficiency. The occurrence of mid-diastolic and presystolic murmurs in the presence of a normally functioning prosthetic mitral valve demonstrates that 1) the mid-diastolic Austin Flint murmur can occur in the absence of incomplete mitral valve opening, premature mitral valve closure, vibrating mitral leaflets, or relative mitral stenosis and 2) the presystolic Austin Flint murmur can occur in the absence of incomplete valve opening or presystolic mitral regurgitation. However, the presystolic murmur was associated with early closure movement of the presthetic poppet.

  7. Relief of mitral incompetence by selective intracoronary thrombolysis in hyperacute myocardial infarction.

    PubMed

    Keltai, M; Palik, I; Rozsa, Z; Szente, A

    1985-01-01

    Left ventriculography and coronary arteriography were performed in 47 patients with hyperacute myocardial infarction prior to recanalization of the infarct-related vessel. Mitral regurgitation was found in ten patients. After successful recanalization, left ventriculography was repeated in eight of the ten patients with mitral incompetence, and the mitral regurgitation had disappeared in seven. Selective intracoronary thrombolysis resulted in improved left ventricular function and disappearance of mitral incompetence.

  8. Determinants of Atrial Electromechanical Delay in Patients with Functional Mitral Regurgitation and Non-ischemic Dilated Cardiomyopathy.

    PubMed

    Bengi Bakal, Ruken; Hatipoglu, Suzan; Sahin, Muslum; Emiroglu, Mehmet Yunus; Bulut, Mustafa; Ozdemir, Nihal

    2014-01-01

    Atrial conduction time has important hemodynamic effects on ventricular filling and is accepted as a predictor of atrial fibrillation. In this study we assessed atrial conduction time in patients with non ischemic dilated cardiomyopathy (NIDCMP) and functional mitral regurgitation (MR) and aimed to determine factors predicting atrial conduction time prolongation. Sixty five patients with non ischemic dilated cardiomyopathy who have moderate to severe MR and 60 control subjects were included in the study. In addition to conventional echocardiographic measures used to asses left ventricle and MR, atrial electromechanical coupling (time interval from the onset of P wave on surface electrocardiogram [ECG] to the beginning of A wave interval with tissue Doppler echocardiography [PA]), intra- and interatrial electromechanical delay (intra and inter AEMD) were measured. The correlations between inter AEMD and left atrial (LA) size, MR volume, isovolumetric relaxation time (IVRT), deceleration time (DT), systolic pulmonary artery pressure (PAPs), E/A ratio and E/e' were very poor. Similarly, intra AEMD was not correlated to LA size , MR volume, IVRT, DT, PAPs, E/A ratio and E/e'. However, both inter AEMD and intra AEMD had good correlation with left ventricular mass index, tenting area (TA), tenting distance (TD), coaptation septal distance (CSD), sphericity index (SI). Prolongation of inter and intra AEMDs were found to be well correlated with parameters reflecting left ventricular and mitral annular remodeling.

  9. ANL Doppler flowmeter

    NASA Astrophysics Data System (ADS)

    Karplus, H. B.; Raptis, A. C.; Lee, S.; Simpson, T.

    1985-10-01

    A flowmeter has been developed for measuring flow velocity in hot slurries. The flowmeter works on an ultrasonic Doppler principle in which ultrasound is injected into the flowing fluid through the solid pipe wall. Isolating waveguides separate the hot pipe from conventional ultrasonic transducers. Special clamp-on high-temperature transducers also can be adapted to work well in this application. Typical flows in pilot plants were found to be laminar, giving rise to broad-band Doppler spectra. A special circuit based on a servomechanism sensor was devised to determine the frequency average of such a broad spectrum. The device was tested at different pilot plants. Slurries with particulates greater than 70 microns (0.003 in.) yielded good signals, but slurries with extremely fine particulates were unpredictable. Small bubbles can replace the coarse particles to provide a good signal if there are not too many. Successful operation with very fine particulate slurries may have been enhanced by the presence of microbubbles.

  10. Tricuspid regurgitation after successful mitral valve surgery

    PubMed Central

    Katsi, Vasiliki; Raftopoulos, Leonidas; Aggeli, Constantina; Vlasseros, Ioannis; Felekos, Ioannis; Tousoulis, Dimitrios; Stefanadis, Christodoulos; Kallikazaros, Ioannis

    2012-01-01

    The tricuspid valve (TV) is inseparably connected with the mitral valve (MV) in terms of function. Any pathophysiological condition concerning the MV is potentially a threat for the normal function of the TV as well. One of the most challenging cases is functional tricuspid regurgitation (TR) after surgical MV correction. In the past, TR was considered to progressively revert with time after left-sided valve restoration. Nevertheless, more recent studies showed that TR could develop and evolve postoperatively over time, as well as being closely associated with a poorer prognosis in terms of morbidity and mortality. Pressure and volume overload are usually the underlying pathophysiological mechanisms; structural alterations, like tricuspid annulus dilatation, increased leaflet tethering and right ventricular remodelling are almost always present when regurgitation develops. The most important risk factors associated with a higher probability of late TR development involve the elderly, female gender, larger left atrial size, atrial fibrillation, right chamber dilatation, higher pulmonary artery systolic pressures, longer times from the onset of MV disease to surgery, history of rheumatic heart disease, ischaemic heart disease and prosthetic valve malfunction. The time of TR manifestation can be up to 10 years or more after an MV surgery. Echocardiography, including the novel 3D Echo techniques, is crucial in the early diagnosis and prognosis of future TV disease development. Appropriate surgical technique and timing still need to be clarified. PMID:22457188

  11. Artificial intelligence in mitral valve analysis.

    PubMed

    Jeganathan, Jelliffe; Knio, Ziyad; Amador, Yannis; Hai, Ting; Khamooshian, Arash; Matyal, Robina; Khabbaz, Kamal R; Mahmood, Feroze

    2017-01-01

    Echocardiographic analysis of mitral valve (MV) has become essential for diagnosis and management of patients with MV disease. Currently, the various software used for MV analysis require manual input and are prone to interobserver variability in the measurements. The aim of this study is to determine the interobserver variability in an automated software that uses artificial intelligence for MV analysis. Retrospective analysis of intraoperative three-dimensional transesophageal echocardiography data acquired from four patients with normal MV undergoing coronary artery bypass graft surgery in a tertiary hospital. Echocardiographic data were analyzed using the eSie Valve Software (Siemens Healthcare, Mountain View, CA, USA). Three examiners analyzed three end-systolic (ES) frames from each of the four patients. A total of 36 ES frames were analyzed and included in the study. A multiple mixed-effects ANOVA model was constructed to determine if the examiner, the patient, and the loop had a significant effect on the average value of each parameter. A Bonferroni correction was used to correct for multiple comparisons, and P = 0.0083 was considered to be significant. Examiners did not have an effect on any of the six parameters tested. Patient and loop had an effect on the average parameter value for each of the six parameters as expected (P < 0.0083 for both). We were able to conclude that using automated analysis, it is possible to obtain results with good reproducibility, which only requires minimal user intervention.

  12. Tricuspid regurgitation after successful mitral valve surgery.

    PubMed

    Katsi, Vasiliki; Raftopoulos, Leonidas; Aggeli, Constantina; Vlasseros, Ioannis; Felekos, Ioannis; Tousoulis, Dimitrios; Stefanadis, Christodoulos; Kallikazaros, Ioannis

    2012-07-01

    The tricuspid valve (TV) is inseparably connected with the mitral valve (MV) in terms of function. Any pathophysiological condition concerning the MV is potentially a threat for the normal function of the TV as well. One of the most challenging cases is functional tricuspid regurgitation (TR) after surgical MV correction. In the past, TR was considered to progressively revert with time after left-sided valve restoration. Nevertheless, more recent studies showed that TR could develop and evolve postoperatively over time, as well as being closely associated with a poorer prognosis in terms of morbidity and mortality. Pressure and volume overload are usually the underlying pathophysiological mechanisms; structural alterations, like tricuspid annulus dilatation, increased leaflet tethering and right ventricular remodelling are almost always present when regurgitation develops. The most important risk factors associated with a higher probability of late TR development involve the elderly, female gender, larger left atrial size, atrial fibrillation, right chamber dilatation, higher pulmonary artery systolic pressures, longer times from the onset of MV disease to surgery, history of rheumatic heart disease, ischaemic heart disease and prosthetic valve malfunction. The time of TR manifestation can be up to 10 years or more after an MV surgery. Echocardiography, including the novel 3D Echo techniques, is crucial in the early diagnosis and prognosis of future TV disease development. Appropriate surgical technique and timing still need to be clarified.

  13. Cost effectiveness of robotic mitral valve surgery

    PubMed Central

    2017-01-01

    Significant technological advances have led to an impressive evolution in mitral valve surgery over the last two decades, allowing surgeons to safely perform less invasive operations through the right chest. Most new technology comes with an increased upfront cost that must be measured against postoperative savings and other advantages such as decreased perioperative complications, faster recovery, and earlier return to preoperative level of functioning. The Da Vinci robot is an example of such a technology, combining the significant benefits of minimally invasive surgery with a “gold standard” valve repair. Although some have reported that robotic surgery is associated with increased overall costs, there is literature suggesting that efficient perioperative care and shorter lengths of stay can offset the increased capital and intraoperative expenses. While data on current cost is important to consider, one must also take into account future potential value resulting from technological advancement when evaluating cost-effectiveness. Future refinements that will facilitate more effective surgery, coupled with declining cost of technology will further increase the value of robotic surgery compared to traditional approaches. PMID:28203539

  14. Patient-specific mitral leaflet segmentation from 4D ultrasound.

    PubMed

    Schneider, Robert J; Tenenholtz, Neil A; Perrin, Douglas P; Marx, Gerald R; del Nido, Pedro J; Howe, Robert D

    2011-01-01

    Segmenting the mitral valve during closure and throughout a cardiac cycle from four dimensional ultrasound (4DUS) is important for creation and validation of mechanical models and for improved visualization and understanding of mitral valve behavior. Current methods of segmenting the valve from 4DUS either require extensive user interaction and initialization, do not maintain the valve geometry across a cardiac cycle, or are incapable of producing a detailed coaptation line and surface. We present a method of segmenting the mitral valve annulus and leaflets from 4DUS such that a detailed, patient-specific annulus and leaflets are tracked throughout mitral valve closure, resulting in a detailed coaptation region. The method requires only the selection of two frames from a sequence indicating the start and end of valve closure and a single point near a closed valve. The annulus and leaflets are first found through direct segmentation in the appropriate frames and then by tracking the known geometry to the remaining frames. We compared the automatically segmented meshes to expert manual tracings for both a normal and diseased mitral valve, and found an average difference of 0.59 +/- 0.49 mm, which is on the order of the spatial resolution of the ultrasound volumes (0.5-1.0 mm/voxel).

  15. Usefulness of radionuclide angiocardiography in predicting stenotic mitral orifice area

    SciTech Connect

    Burns, R.J.; Armitage, D.L.; Fountas, P.N.; Tremblay, P.C.; Druck, M.N.

    1986-12-01

    Fifteen patients with pure mitral stenosis (MS) underwent high-temporal-resolution radionuclide angiocardiography for calculation of the ratio of peak left ventricular (LV) filling rate divided by mean LV filling rate (filling ratio). Whereas LV filling normally occurs in 3 phases, in MS it is more uniform. Thus, in 13 patients the filling ratio was below the normal range of 2.21 to 2.88 (p less than 0.001). In 11 patients in atrial fibrillation, filling ratio divided by mean cardiac cycle length and by LV ejection fraction provided good correlation (r = 0.85) with modified Gorlin formula derived mitral area and excellent correlation with echocardiographic mitral area (r = 0.95). Significant MS can be detected using radionuclide angiocardiography to calculate filling ratio. In the absence of the confounding influence of atrial systole calculation of 0.14 (filling ratio divided by cardiac cycle length divided by LV ejection fraction) + 0.40 cm2 enables accurate prediction of mitral area (+/- 4%). Our data support the contention that the modified Gorlin formula, based on steady-state hemodynamics, provides less certain estimates of mitral area for patients with MS and atrial fibrillation, in whom echocardiography and radionuclide angiocardiography may be more accurate.

  16. Genetic association analyses highlight biological pathways underlying mitral valve prolapse

    PubMed Central

    Dina, Christian; Bouatia-Naji, Nabila; Tucker, Nathan; Delling, Francesca N.; Toomer, Katelynn; Durst, Ronen; Perrocheau, Maelle; Fernandez-Friera, Leticia; Solis, Jorge; Le Tourneau, Thierry; Chen, Ming-Huei; Probst, Vincent; Bosse, Yohan; Pibarot, Philippe; Zelenika, Diana; Lathrop, Mark; Hercberg, Serge; Roussel, Ronan; Benjamin, Emelia J.; Bonnet, Fabrice; Su Hao, LO; Dolmatova, Elena; Simonet, Floriane; Lecointe, Simon; Kyndt, Florence; Redon, Richard; Le Marec, Hervé; Froguel, Philippe; Ellinor, Patrick T.; Vasan, Ramachandran S.; Bruneval, Patrick; Norris, Russell A.; Milan, David J.; Slaugenhaupt, Susan A.; Levine, Robert A.; Schott, Jean-Jacques; Hagege, Albert A.; Jeunemaitre, Xavier

    2016-01-01

    Non-syndromic mitral valve prolapse (MVP) is a common degenerative cardiac valvulopathy of unknown aetiology that predisposes to mitral regurgitation, heart failure and sudden death1. Previous family and pathophysiological studies suggest a complex pattern of inheritance2–5. We performed a meta-analysis of two genome-wide association studies in 1,442 cases and 2,439 controls. We identified and replicated in 1,422 cases and 6,779 controls six loci and provide functional evidence for candidate genes. We highlight LMCD1 encoding a transcription factor6, for which morpholino knockdown in zebrafish results in atrioventricular (AV) valve regurgitation. A similar zebrafish phenotype was obtained for tensin1 (TNS1), a focal adhesion protein involved in cytoskeleton organization. We also show the expression of tensin1 during valve morphogenesis and describe enlarged posterior mitral leaflets in Tns1−/− mice. This study identifies the first risk loci for MVP and suggests new mechanisms involved in mitral valve regurgitation, the most common indication for mitral valve repair7. PMID:26301497

  17. Mitral valve repair: an echocardiographic review: Part 2.

    PubMed

    Maslow, Andrew

    2015-04-01

    Echocardiographic imaging of the mitral valve before and immediately after repair is crucial to the immediate and long-term outcome. Prior to mitral valve repair, echocardiographic imaging helps determine the feasibility and method of repair. After the repair, echocardiographic imaging displays the new baseline anatomy, assesses function, and determines whether or not further management is necessary. Three-dimensional imaging has improved the assessment of the mitral valve and facilitates communication with the surgeon by providing the surgeon with an image that he/she might see upon opening up the atrium. Further advancements in imaging will continue to improve the understanding of the function and dysfunction of the mitral valve both before and after repair. This information will improve treatment options, timing of invasive therapies, and advancements of repair techniques to yield better short- and long-term patient outcomes. The purpose of this review was to connect the echocardiographic evaluation with the surgical procedure. Bridging the pre- and post-CPB imaging with the surgical procedure allows a greater understanding of mitral valve repair.

  18. Minimally invasive mitral valve surgery via right minithoracotomy.

    PubMed

    Glauber, Mattia; Karimov, Jamshid H; Farneti, Pier Andrea; Cerillo, Alfredo Giuseppe; Santarelli, Filippo; Ferrarini, Matteo; Del Sarto, Paolo; Murzi, Michele; Solinas, Marco

    2009-01-01

    From early experience in cardiac surgery on the mitral valve, access was gained in different ways: through left and right antero-lateral extended thoracotomy for closed and correspondingly for open mitral commissurotomy, from right parasternal access with rib resection, and via median sternotomy. Median sternotomy remains the most common approach for mitral valve procedures, such as replacement or repair, allowing good visualisation, exposure and working field. Applying the largely spread access as median sternotomy, surgeons always wanted to overcome the necessity of large incisions, get a better surgical view, to dissect with better respect to structural integrity and have better aesthetic results. Enhanced understanding of surgical bases and technological development sourced a breakthrough in minimally-invasive approach for mitral valve surgery, offering several advantages such as less postoperative pain, lower morbidity and mortality, faster recovery and shorter hospital stay. In an effort to share the institutional experience in less invasive surgery, this article demonstrates our approach in mitral valve repair through a right minithoracotomy in the 3rd or 4th intercostal space.

  19. What forces act on a flat rigid mitral annuloplasty ring?

    PubMed

    Jensen, Morten Ø; Jensen, Henrik; Nielsen, Sten L; Smerup, Morten; Johansen, Peter; Yoganathan, Ajit P; Nygaard, Hans; Hasenkam, J Michael

    2008-05-01

    Increasing mitral valve repair durability requires successful restoration and support with annuloplasty rings. The stress distribution in these devices indirectly determines the success of the repair. It is hypothesized that changes in annular geometry throughout the cardiac cycle result in adverse strain distribution in stiff, flat annuloplasty rings, and hence non-physiological loading of the myocardium. The study aim was to identify the three-dimensional (3-D) force distribution in mitral annuloplasty rings. Eight animals were included in an acute porcine study. The mitral annulus 3-D dynamic geometry was assessed with sonomicrometry prior to ring insertion. Strain gauges mounted on dedicated D-shaped rigid flat annuloplasty rings enabled dynamic force measurements to be made perpendicular to the annulus plane. The average systolic annular height to commissural width ratio before ring implantation was 13.7 +/- 1.4%. Following ring implantation, the annulus was fixed in the diastolic flat configuration (p <0.01). Force accumulation was seen from the anterior (0.7 +/- 0.4 N) and commissural (1.4 +/- 1.0 N) annular segments; both forces were acting in opposite directions and were statistically significantly larger than zero (p <0.01; n = 8). These data demonstrate highest strains at the anterior and commissural areas of flat mitral annuloplasty rings, and support the hypothesis that the mitral valve annulus and its attached valvular and subvalvular structures apply systolic torque onto the flat annuloplasty ring in an attempt to conform it into the saddle-shaped configuration.

  20. Percutaneous transluminal balloon dilatation of the mitral valve in pregnancy.

    PubMed Central

    Smith, R; Brender, D; McCredie, M

    1989-01-01

    Pregnancy can cause life threatening complications in women with mitral stenosis, and there is a substantial risk of fetal death if valvotomy under cardiopulmonary bypass is required. A patient is described in whom pulmonary oedema developed after delivery of her first child by caesarean section 13 months previously. Subsequent cardiac catheterisation showed severe mitral stenosis (valve area 0.96 cm2, valve gradient 12 mm Hg, pulmonary artery pressure 30/16 mm Hg). Before valvotomy could be performed the patient again became pregnant and presented in pulmonary oedema at twenty two weeks' gestation. Medical treatment was unsuccessful and she underwent percutaneous transluminal balloon dilatation of the mitral valve. This increased the valve area to 1.78 cm2 and reduced the transmitral gradient to 6 mm Hg. The procedure was uncomplicated, and she remained symptom free on no medication. She delivered vaginally at 37 weeks' gestation. Percutaneous transluminal balloon dilatation of the mitral valve is a safe and effective alternative to mitral valvotomy in pregnancy. PMID:2757867

  1. Genetic association analyses highlight biological pathways underlying mitral valve prolapse.

    PubMed

    Dina, Christian; Bouatia-Naji, Nabila; Tucker, Nathan; Delling, Francesca N; Toomer, Katelynn; Durst, Ronen; Perrocheau, Maelle; Fernandez-Friera, Leticia; Solis, Jorge; Le Tourneau, Thierry; Chen, Ming-Huei; Probst, Vincent; Bosse, Yohan; Pibarot, Philippe; Zelenika, Diana; Lathrop, Mark; Hercberg, Serge; Roussel, Ronan; Benjamin, Emelia J; Bonnet, Fabrice; Lo, Su Hao; Dolmatova, Elena; Simonet, Floriane; Lecointe, Simon; Kyndt, Florence; Redon, Richard; Le Marec, Hervé; Froguel, Philippe; Ellinor, Patrick T; Vasan, Ramachandran S; Bruneval, Patrick; Markwald, Roger R; Norris, Russell A; Milan, David J; Slaugenhaupt, Susan A; Levine, Robert A; Schott, Jean-Jacques; Hagege, Albert A; Jeunemaitre, Xavier

    2015-10-01

    Nonsyndromic mitral valve prolapse (MVP) is a common degenerative cardiac valvulopathy of unknown etiology that predisposes to mitral regurgitation, heart failure and sudden death. Previous family and pathophysiological studies suggest a complex pattern of inheritance. We performed a meta-analysis of 2 genome-wide association studies in 1,412 MVP cases and 2,439 controls. We identified 6 loci, which we replicated in 1,422 cases and 6,779 controls, and provide functional evidence for candidate genes. We highlight LMCD1 (LIM and cysteine-rich domains 1), which encodes a transcription factor and for which morpholino knockdown of the ortholog in zebrafish resulted in atrioventricular valve regurgitation. A similar zebrafish phenotype was obtained with knockdown of the ortholog of TNS1, which encodes tensin 1, a focal adhesion protein involved in cytoskeleton organization. We also showed expression of tensin 1 during valve morphogenesis and describe enlarged posterior mitral leaflets in Tns1(-/-) mice. This study identifies the first risk loci for MVP and suggests new mechanisms involved in mitral valve regurgitation, the most common indication for mitral valve repair.

  2. Three-dimensional echocardiography for assessment of mitral valve stenosis.

    PubMed

    Zamorano, Jose; de Agustín, Jose Alberto

    2009-09-01

    Since the last few years, three-dimensional echocardiography (3DE) has become an accurate tool for mitral stenosis assessment. We will review the latest developments of 3DE in this matter. Accuracy of 3DE planimetry is superior to the accuracy of the invasive Gorlin's method for mitral valve area (MVA) measurements when a median value obtained from two-dimensional planimetry, pressure half-time, and proximal isovelocity surface area method is used as the gold standard. 3DE improves MVA measurement particularly in less experienced operators compared with experienced operators. 3DE also improves the measurement of MVA in patients with calcific mitral stenosis by means of colour planimetry of the flow stream. Comparison of mitral valve volumes measured by 3DE in patients with critical and without critical stenosis has shown significantly larger volumes in patients with critical stenosis. Currently, there is sufficient evidence that 3DE is superior to two-dimensional echocardiography and may be routinely used in the quantification of the MVA in mitral stenosis. In the coming years, 3DE might replace Gorlin's method as the gold standard for MVA quantification and may eventually make cardiac catheterization unnecessary.

  3. Microwave Ablation in Mitral Valve Surgery for Atrial Fibrillation (MAMA).

    PubMed

    Jönsson, Anders; Lehto, Mika; Ahn, Henrik; Hermansson, Ulf; Linde, Peter; Ahlsson, Anders; Koistinen, Juhani; Savola, Jukka; Raatikainen, Pekka; Lepojärvi, Martti; Sahlman, Antero; Werkkala, Kalervo; Toivonen, Lauri; Walfridsson, Håkan

    2012-01-01

    Objective: Microwave ablation in conjunction with open heart surgery is effective in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). In patients assigned for isolated mitral valve surgery no prospective randomized trial has reported its efficacy. Methods: 70 patients with longlasting AF where included from 5 different centres. They were randomly assigned to mitral valve surgery and atrial microwave ablation or mitral valve surgery alone. Results: Out of 70 randomized, 66 and 64 patients were available for evaluation at 6 and 12 months. At 12 months SR was restored and preserved in 71.0 % in the ablation group vs 36.4 % in the control group (P=0.006), corresponding figures at 6 months was 62.5 % vs 26.5 % (P=0.003). The 30-day mortality rate was 1.4 %, with one death in the ablation group vs zero deaths in the control group. At 12 months the mortality rate was 7,1 % (Ablation n=3 vs Control n=2). No significant differences existed between the groups with regard to the overall rate of serious adverse events (SAE) during the perioperative period or at the end of the study. 16 % of patients randomized to ablation were on antiarrhytmic drugs compared to 6 % in the control group after 1 year (p=0.22). Conclusion: Microwave ablation of left and right atrium in conjunction with mitral valve surgery is safe and effectively restores sinus rhythm in patients with longlasting AF as compared to mitral valve surgery alone.

  4. Intraoperative assessment of mitral valve area after mitral valve repair: comparison of different methods.

    PubMed

    Maslow, Andrew; Gemignani, Anthony; Singh, Arun; Mahmood, Feroze; Poppas, Athena

    2011-04-01

    In the present study, 3 different methods to measure the mitral valve area (MVA) after mitral valve repair (MVRep) were studied. Data obtained immediately after repair were compared with postoperative data. The objective was to determine the feasibility and correlation between intraoperative and postoperative MVA data. A prospective study. A tertiary care medical center. Twenty-five elective adult surgical patients scheduled for MVRep. Echocardiographic data included MVAs obtained using the pressure half-time (PHT), 2-dimensional planimetry (2D-PLAN), and the continuity equation (CE). These data were obtained immediately after cardiopulmonary bypass and were compared with data obtained before hospital discharge (transthoracic echocardiogram 1) and 6 to 12 months after surgery (transthoracic echocardiogram 2). Intraoperative care was guided by hemodynamic goals designed to optimize cardiac function. The data show good agreement and correlation between MVA obtained with PHT and 2D-PLAN within and between each time period. MVA data obtained with the CE in the postoperative period were lower than and did not correlate or agree as well with other MVA data. The MVA recorded immediately after valve repair, using PHT, correlated and agreed with MVA data obtained in the postoperative period. These results contrast with previously published data and could highlight the impact of hemodynamic function during the assessment of MVA. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Anatomical features of acute mitral valve repair dysfunction: Additional value of three-dimensional echocardiography.

    PubMed

    Derkx, Salomé; Nguyen, Virginia; Cimadevilla, Claire; Verdonk, Constance; Lepage, Laurent; Raffoul, Richard; Nataf, Patrick; Vahanian, Alec; Messika-Zeitoun, David

    2017-03-01

    Recurrence of mitral regurgitation after mitral valve repair is correlated with unfavourable left ventricular remodelling and poor outcome. This pictorial review describes the echocardiographic features of three types of acute mitral valve repair dysfunction, and the additional value of three-dimensional echocardiography.

  6. Caseous Calcification of Mitral Annulus: A Rare Monster Leading to Cerebrovascular Accident.

    PubMed

    Memon, Sarfaraz; Chhabra, Lovely; Krainski, Felix; Parker, Matthew W; Swales, Heather

    2015-10-01

    Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification that maybe easily misdiagnosed or confused with an abscess, a tumor, or infective vegetation. The main pathophysiological mechanism leading to CCMA involves degeneration and calcium deposition on the mitral valve. We present a case of CCMA to help understand this clinical entity.

  7. Doppler Beats or Interference Fringes?

    ERIC Educational Resources Information Center

    Kelly, Paul S.

    1979-01-01

    Discusses the following: another version of Doppler beats; alternate proof of spin-1 sin-1/2 problems; some mechanisms related to Dirac's strings; Doppler redshift in oblique approach of source and observer; undergraduate experiment on noise thermometry; use of the time evolution operator; resolution of an entropy maximization controversy;…

  8. Doppler Beats or Interference Fringes?

    ERIC Educational Resources Information Center

    Kelly, Paul S.

    1979-01-01

    Discusses the following: another version of Doppler beats; alternate proof of spin-1 sin-1/2 problems; some mechanisms related to Dirac's strings; Doppler redshift in oblique approach of source and observer; undergraduate experiment on noise thermometry; use of the time evolution operator; resolution of an entropy maximization controversy;…

  9. Chronic mitral regurgitation: a pilot study to assess preoperative left ventricular contractile function using speckle-tracking echocardiography.

    PubMed

    de Isla, Leopoldo Perez; de Agustin, Alberto; Rodrigo, Jose Luis; Almeria, Carlos; del Carmen Manzano, Maria; Rodríguez, Enrique; García, Ana; Macaya, Carlos; Zamorano, José

    2009-07-01

    The development of postoperative left ventricular (LV) dysfunction is a frequent complication in patients with chronic severe mitral regurgitation (MR) and implies a poor prognosis. The aim of this study was to evaluate the predictive value of preoperative regional LV contractile function assessment using two-dimensional echocardiography-based speckle-tracking analysis in patients with chronic severe MR. Thirty-eight consecutive patients with chronic severe MR scheduled for mitral valve replacement were prospectively enrolled. Preoperative two-dimensional echocardiography-based speckle-tracking analysis at the level of the interventricular septum (IVS) was carried out, and strain and strain rate values were obtained. LV dP/dt and Doppler tissue imaging-derived strain and strain rate measurements were also obtained. LV volumes and LV ejection fraction (LVEF) were defined using three-dimensional echocardiography. Preoperative speckle tracking-derived longitudinal strain and strain rate values at the level of the IVS strongly predicted a postoperative LVEF decrease of >10%. Their predictive values were greater than those obtained for preoperative LV volumes and LVEF, LV dP/dt, and Doppler tissue imaging-derived strain and strain rate. The best discriminant parameter to detect a postoperative LVEF reduction of >10% with speckle tracking was a longitudinal strain rate at the level of the mid IVS < -0.80 s(-1) (area under the receiver operating characteristic curve, 0.88; sensitivity, 60%; specificity, 96.5%; positive predictive value, 90%; negative predictive value, 82.35%). IVS longitudinal speckle tracking-derived strain rate allows the accurate detection of early abnormalities in LV contractile function. It is a powerful predictor of early postoperative LVEF decreases in patients with chronic severe MR. Furthermore, speckle-tracking technology is more accurate than other methods. This new tool might assist clinicians in the optimal timing of surgery in patients with

  10. Effect of scanline orientation on ventricular flow propagation: assessment using high frame-rate color Doppler echocardiography

    NASA Technical Reports Server (NTRS)

    Greenberg, N. L.; Castro, P. L.; Drinko, J.; Garcia, M. J.; Thomas, J. D.

    2000-01-01

    Color M-mode echocardiography has recently been utilized to describe diastolic flow propagation velocity (Vp) in the left ventricle. While increasing temporal resolution from 15 to 200 Hz, this M-mode technique requires the user to select a single scanline, potentially limiting quantification of Vp due to the complex three-dimensional inflow pattern. We previously performed computational fluid dynamics simulations to demonstrate the insignificance of the scanline orientation, however geometric complexity was limited. The purpose of this study was to utilize high frame-rate 2D color Doppler images to investigate the importance of scanline selection in patients for the quantification of Vp. 2D color Doppler images were digitally acquired at 50 frames/s in 6 subjects from the apical 4-chamber window (System 5, GE/Vingmed, Milwaukee, WI). Vp was determined for a set of scanlines positioned through 5 locations across the mitral annulus (from the anterior to posterior mitral annulus). An analysis of variance was performed to examine the differences in Vp as a function of scanline position. Vp was not effected by scanline position in sampled locations from the center of the mitral valve towards the posterior annulus. Although not statistically significant, there was a trend to slower propagation velocities on the anterior side of the valve (60.8 +/- 16.7 vs. 54.4 +/- 13.6 cm/s). This study clinically validates our previous numerical experiment showing that Vp is insensitive to small perturbations of the scanline through the mitral valve. However, further investigation is necessary to examine the impact of ventricular geometry in pathologies including dilated cardiomyopathy.

  11. Effect of scanline orientation on ventricular flow propagation: assessment using high frame-rate color Doppler echocardiography

    NASA Technical Reports Server (NTRS)

    Greenberg, N. L.; Castro, P. L.; Drinko, J.; Garcia, M. J.; Thomas, J. D.

    2000-01-01

    Color M-mode echocardiography has recently been utilized to describe diastolic flow propagation velocity (Vp) in the left ventricle. While increasing temporal resolution from 15 to 200 Hz, this M-mode technique requires the user to select a single scanline, potentially limiting quantification of Vp due to the complex three-dimensional inflow pattern. We previously performed computational fluid dynamics simulations to demonstrate the insignificance of the scanline orientation, however geometric complexity was limited. The purpose of this study was to utilize high frame-rate 2D color Doppler images to investigate the importance of scanline selection in patients for the quantification of Vp. 2D color Doppler images were digitally acquired at 50 frames/s in 6 subjects from the apical 4-chamber window (System 5, GE/Vingmed, Milwaukee, WI). Vp was determined for a set of scanlines positioned through 5 locations across the mitral annulus (from the anterior to posterior mitral annulus). An analysis of variance was performed to examine the differences in Vp as a function of scanline position. Vp was not effected by scanline position in sampled locations from the center of the mitral valve towards the posterior annulus. Although not statistically significant, there was a trend to slower propagation velocities on the anterior side of the valve (60.8 +/- 16.7 vs. 54.4 +/- 13.6 cm/s). This study clinically validates our previous numerical experiment showing that Vp is insensitive to small perturbations of the scanline through the mitral valve. However, further investigation is necessary to examine the impact of ventricular geometry in pathologies including dilated cardiomyopathy.

  12. Percutaneous Mitral Valvotomy in a Case of Situs Inversus Totalis and Juvenile Rheumatic Critical Mitral Stenosis: Case Report

    PubMed Central

    Sinha, Santosh Kumar; Thakur, Ramesh; Jha, Mukesh Jitendra; Sayal, Karandeep Singh; Sachan, Mohit; Krishna, Vinay; Kumar, Ashutosh; Mishra, Vikas; Varma, Chandra Mohan

    2016-01-01

    Situs inversus totalis is a rare congenital disorder where the heart being a mirror image is situated on the right side of the body. Distorted cardiac anatomy makes fluoroscopy-guided percutaneous mitral valvotomy (PMV) technically challenging and there are only few reports of PMV in situs inversus totalis. Here we report a case where PMV was successfully done for situs inversus totalis with rare coincidence of juvenile rheumatic severe mitral stenosis in a 12-year-old boy with a few modifications of standard Inoue technique. He had exertional dyspnea of NYHA class III with initial mitral valve area (MVA) of 0.6 cm2 and severe pulmonary arterial hypertension with features suitable for PMV. Femoral vein was accessed from the left side to align the septal puncture needle and balloon to facilitate left ventricular entry. Septal descent and puncture by Brockenbrough needle was performed in the right anterior oblique view with the needle facing 5 o’clock position. Accura balloon was negotiated across mitral valve in left anterior oblique and procedure was successfully executed. Echocardiography showed a well-divided anterior commissure with an MVA of 2.0 cm2 and mild mitral regurgitation. In summary, PMV is safe and feasible in the rare patient with situs inversus totalis with few modifications of the Inoue technique. PMID:26985259

  13. The role of papillary muscle approximation in mitral valve repair for the treatment of secondary mitral regurgitation.

    PubMed

    Mihos, Christos G; Yucel, Evin; Santana, Orlando

    2016-12-30

    SummarySecondary mitral regurgitation (MR) is present in up to half of patients with dilated cardiomyopathy, and is associated with a poor prognosis. It primarily results from progressive left ventricular remodelling, papillary muscle displacement and tethering of the mitral valve leaflets. Mitral valve repair with an undersized ring annuloplasty is the reparative procedure of choice in the treatment of secondary MR. However, this technique is associated with a 30-60% incidence of recurrent moderate or greater MR at mid-term follow-up, which results in progressive deterioration of left ventricular function and increased morbidity. Combined mitral valve repair and papillary muscle approximation has been applied in order to address both the annular and subvalvular dysfunction that coexist in secondary MR, which include graft and suture-based techniques. Herein, we provide a systematic review of the published literature regarding the technical aspects, clinical application, and outcomes of mitral valve repair with combined ring annuloplasty and papillary muscle approximation for the treatment of secondary MR.

  14. [Does mitral valve annuloplasty improve long-term survival in patients having moderate ischemic mitral regurgitation undergoing CABG?].

    PubMed

    Silberman, Shuli; Merin, Ofer; Fink, Daniel; Alshousha, Atia; Shachar, Sigal; Tauber, Rachel; Butnaro, Adi; Bitran, Daniel

    2014-12-01

    The best surgical approach for patients with moderate ischemic mitral regurgitation (IMR) is still undetermined. We examined long term outcomes in patients with moderate IMR undergoing coronary bypass (CABG), and compared outcomes between those undergoing isolated CABG to those undergoing concomitant restrictive annuloplasty. Between the years 1993-2011, 231 patients with moderate IMR underwent CABG: group 1 (n = 186) underwent isolated CABG, group 2 (n = 15) underwent CABG with concomitant mitral valve annuloplasty. Univariate analysis was used to compare baseline parameters. Kaplan-Meier estimates were used to compare survival. Cox multivariate regression was used to determine predictors for late survival. Survival data up to 20 years is 97% complete. The groups were similar with respect to age, prior MI, LV function, and incidence of atrial fibrillation. Patients undergoing mitral repair had a higher incidence of congestive heart failure (CHF) (p < 0.0001). After surgery more repair patients required use of inotropes (p = 0.0005). Overall operative mortality was 7% and similar between groups. Ten year survival was 55% and 52% for groups 1 and 2 respectively (p = 0.2). Predictors of late mortality included age, CHF, LV dimensions and LV dysfunction. Neither the addition of a mitral procedure and type of ring implanted nor residual MR after surgery, emerged as predictors of survival. In patients with moderate ischemic MR, neither operative mortality nor long term survival are affected by the performance of a restrictive annuloplasty. For patients with CHF, mitral repair may be beneficial in terms of survival.

  15. The Ross II procedure: pulmonary autograft in the mitral position.

    PubMed

    Athanasiou, Thanos; Cherian, Ashok; Ross, Donald

    2004-10-01

    The surgical management of mitral valve disease in women of childbearing age, young patients, and children with congenital mitral valve defects is made difficult by the prospect of lifelong anticoagulation. We suggest the use of a pulmonary autograft in the mitral position (Ross II procedure) as an alternative surgical technique. We present a review of the literature, historical perspectives, indications, selection criteria, and surgical technique for the Ross II procedure. Our literature search identified 14 studies that reported results from the Ross II operation. Performed in 103 patients, the overall in-hospital mortality was 7 (6.7%), with a late mortality of 10 (9%). Although further research is needed, current evidence suggests the Ross II operation is a valuable alternative in low-risk young patients where valve durability and the complication rate from other procedures is unsatisfactory and anticoagulation not ideal.

  16. [Longterm results of mitral valve replacement (author's transl)].

    PubMed

    Erhard, W; Reichmann, M; Delius, W; Sebening, H; Herrmann, G

    1977-04-22

    210 patients were followed up by the actuary method for over 5 years after isolated mitral valve replacement or a double valve replacement. After isolated valve replacement the one month survival including the operative mortality was 92+/-2%. The survival after one year was 83+/-3% and after 5 years 66+/-7%. The five year survival of patients in preoperative class III (according to the NYHA) was 73+/-8% and of class IV 57+/-8% (P less than or equal to 0.1). A comparison of valve replacements for pure mitral stenosis or mitral insufficiency showed no statistically significant differences. In the 37 patients who had a double valve replacement the survival risk was not increased in comparison with those patients who had had a single valve replacement. Age above 45 years and a preoperative markedly raised pulmonary arteriolar resistance reduced the chances of survival.

  17. Review of mitral valve insufficiency: repair or replacement

    PubMed Central

    Madesis, Athanasios; Tsakiridis, Kosmas; Katsikogiannis, Nikolaos; Machairiotis, Nikolaos; Kougioumtzi, Ioanna; Kesisis, George; Tsiouda, Theodora; Beleveslis, Thomas; Koletas, Alexander; Zarogoulidis, Konstantinos

    2014-01-01

    Mitral valve (MV) dysfunction is the second-most common clinically significant form of valvular defect in adults. MV regurgitation occurs with the increasing frequency of degenerative changes of the aging process. Moreover, other causes of clinically significant MV regurgitation include cardiac ischemia, infective endocarditis and rhematic disease more frequently in less developed countries. Recent evidence suggests that the best outcomes after repair of severe degenerative mitral regurgitation (MR) are achieved in asymptomatic or minimally symptomatic patients, who are selected for surgery soon after diagnosis on the basis of echocardiography. This review will focus on the surgical management of mitral insufficiency according to its aetiology today and will give insight to some of the perspectives that lay in the future. PMID:24672698

  18. Percutaneous coronary intervention for acute myocardial infarction with mitral regurgitation

    PubMed Central

    Tu, Yan; Zeng, Qing-Chun; Huang, Ying; Li, Jian-Yong

    2016-01-01

    Ischemic mitral regurgitation (IMR) is a common complication of acute myocardial infarction (AMI). Current evidences suggest that revascularization of the culprit vessels with percutaneous coronary artery intervention (PCI) or coronary artery bypass grafting can be beneficial for relieving IMR. A 2.5-year follow-up data of a 61-year-old male patient with ST-segment elevation AMI complicated with IMR showed that mitral regurgitation area increased five days after PCI, and decreased to lower steady level three months after PCI. This finding suggest that three months after PCI might be a suitable time point for evaluating the possibility of IMR recovery and the necessity of surgical intervention of the mitral valve for AMI patient. PMID:27582769

  19. Surgical phantom for off-pump mitral valve replacement

    NASA Astrophysics Data System (ADS)

    McLeod, A. Jonathan; Moore, John; Guiraudon, Gerard M.; Jones, Doug L.; Campbell, Gordon; Peters, Terry M.

    2011-03-01

    Off-pump, intracardiac, beating heart surgery has the potential to improve patient outcomes by eliminating the need for cardiopulmonary bypass and aortic cross clamping but it requires extensive image guidance as well as the development of specialized instrumentation. Previously, developments in image guidance and instrumentation were validated on either a static phantom or in vivo through porcine models. This paper describes the design and development of a surgical phantom for simulating off-pump mitral valve replacement inside the closed beating heart. The phantom allows surgical access to the mitral annulus while mimicking the pressure inside the beating heart. An image guidance system using tracked ultrasound, magnetic instrument tracking and preoperative models previously developed for off-pump mitral valve replacement is applied to the phantom. Pressure measurements and ultrasound images confirm the phantom closely mimics conditions inside the beating heart.

  20. Effect of Ivabradine on Heart Rate and Duration of Exercise in Patients With Mild-to-Moderate Mitral Stenosis: A Randomized Comparison With Metoprolol.

    PubMed

    Saggu, Daljeet K; Narain, Varun S; Dwivedi, Sudhanshu K; Sethi, Rishi; Chandra, Sharad; Puri, Aniket; Saran, Ram K

    2015-06-01

    Symptoms in mitral stenosis (MS) are heart rate (HR) dependent. Increase in HR reduces diastolic filling period with rise in transmitral gradient. By reducing HR, beta-blockers improve hemodynamics and relieve symptoms, but the use may be limited by side effects. The present randomized crossover study looked at comparative efficacy of ivabradine and metoprolol on symptoms, hemodynamics, and exercise parameters in patients with mild-to-moderate MS (mitral valve area, 1-2 cm) in normal sinus rhythm. Baseline clinical assessment, treadmill stress testing, and an echocardiographic Doppler evaluation were performed to determine resting HR, total exercise duration, mean gradient across mitral valve, and mean pulmonary artery systolic pressure (PASP). Patients were then allocated to either metoprolol or ivabradine to maximal tolerated doses over 6 weeks (metoprolol: 100 mg twice a day, ivabradine: 10 mg twice a day). Reevaluation was done at the end of this period, and all drugs stopped for washout over 2 weeks. Thereafter, the 2 groups were crossed over to the other drug that was continued for another 6 weeks. Assessment was again performed at the end of this period. Thirty-three patients of 34 completed the protocol. Fifteen were male, mean age was 28.9 ± 6.6 years, all were in New York Heart Association class 2, and mean resting HR was 103.5 ± 7.2/min. Mean mitral valve area was 1.56 ± 0.16 cm, mean PASP was 38.1 ± 5.1 mm Hg, and mean gradient across mitral valve was 10.6 ± 1.6 mm Hg. Significant decrease in baseline and peak exercise HR was observed at the end of follow-up with both drugs. Reduction in mitral valve gradient after ivabradine (42%) and metoprolol (37%) and reduction in PASP after both ivabradine (23%) and metoprolol (27%) were to a similar extent. Significant reduction in total exercise duration after both ivabradine and metoprolol therapy was observed. One patient developed blurring of vision with ivabradine therapy but did not require

  1. Assessment of trans-aortic pressure gradient using a coronary pressure wire in patients with mechanical aortic and mitral valve prostheses.

    PubMed

    Kherada, Nisharahmed; Brenes, Juan Carlos; Kini, Annapoorna S; Dangas, George D

    2017-03-15

    Accurate evaluation of trans-aortic valvular pressure gradients is challenging in cases where dual mechanical aortic and mitral valve prostheses are present. Non-invasive Doppler echocardiographic imaging has its limitations due to multiple geometric assumptions. Invasive measurement of trans-valvular gradients with cardiac catheterization can provide further information in patients with two mechanical valves, where simultaneous pressure measurements in the left ventricle and ascending aorta must be obtained. Obtaining access to the left ventricle via the mitral valve after a trans-septal puncture is not feasible in the case of a concomitant mechanical mitral valve, whereas left ventricular apical puncture technique is associated with high procedural risks. Retrograde crossing of a bileaflet mechanical aortic prosthesis with standard catheters is associated with the risk of catheter entrapment and acute valvular regurgitation. In these cases, the assessment of trans-valvular gradients using a 0.014˝ diameter coronary pressure wire technique has been described in a few case reports. We present the case of a 76-year-old female with rheumatic valvular heart disease who underwent mechanical aortic and mitral valve replacement in the past. She presented with decompensated heart failure and echocardiographic findings suggestive of elevated pressure gradient across the mechanical aortic valve prosthesis. The use of a high-fidelity 0.014˝ diameter coronary pressure guidewire resulted in the detection of a normal trans-valvular pressure gradient across the mechanical aortic valve. This avoided a high-risk third redo valve surgery in our patient. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  2. Modeling the Myxomatous Mitral Valve With Three-Dimensional Echocardiography.

    PubMed

    Pouch, Alison M; Jackson, Benjamin M; Lai, Eric; Takebe, Manabu; Tian, Sijie; Cheung, Albert T; Woo, Y Joseph; Patel, Prakash A; Wang, Hongzhi; Yushkevich, Paul A; Gorman, Robert C; Gorman, Joseph H

    2016-09-01

    Degenerative mitral valve disease is associated with variable and complex defects in valve morphology. Three-dimensional echocardiography (3DE) has shown promise in aiding preoperative planning for patients with this disease but to date has not been as transformative as initially predicted. The clinical usefulness of 3DE has been limited by the laborious methods currently required to extract quantitative data from the images. To maximize the utility of 3DE for preoperative valve evaluation, this work describes an automated 3DE image analysis method for generating models of the mitral valve that are well suited for both qualitative and quantitative assessment. The method is unique in that it captures detailed alterations in mitral leaflet and annular morphology and produces image-derived models with locally varying leaflet thickness. The method is evaluated on midsystolic transesophageal 3DE images acquired from 22 subjects with myxomatous degeneration and from 22 subjects with normal mitral valve morphology. Relative to manual image analysis, the automated method accurately represents both normal and complex leaflet geometries with a mean boundary displacement error on the order of one image voxel. A detailed quantitative analysis of the valves is presented and reveals statistically significant differences between normal and myxomatous valves with respect to numerous aspects of annular and leaflet geometry. This work demonstrates a successful methodology for the relatively rapid quantitative description of the complex mitral valve distortions associated with myxomatous degeneration. The methodology has the potential to significantly improve surgical planning for patients with complex mitral valve disease. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Modeling the Myxomatous Mitral Valve With Three-Dimensional Echocardiography

    PubMed Central

    Pouch, Alison M.; Jackson, Benjamin M.; Lai, Eric; Takebe, Manabu; Tian, Sijie; Cheung, Albert T.; Woo, Y. Joseph; Patel, Prakash A.; Wang, Hongzhi; Yushkevich, Paul A.; Gorman, Robert C.; Gorman, Joseph H.

    2017-01-01

    Background Degenerative mitral valve disease is associated with variable and complex defects in valve morphology. Three-dimensional echocardiography (3DE) has shown promise in aiding preoperative planning for patients with this disease but to date has not been as transformative as initially predicted. The clinical usefulness of 3DE has been limited by the laborious methods currently required to extract quantitative data from the images. Methods To maximize the utility of 3DE for preoperative valve evaluation, this work describes an automated 3DE image analysis method for generating models of the mitral valve that are well suited for both qualitative and quantitative assessment. The method is unique in that it captures detailed alterations in mitral leaflet and annular morphology and produces image-derived models with locally varying leaflet thickness. The method is evaluated on midsystolic transesophageal 3DE images acquired from 22 subjects with myxomatous degeneration and from 22 subjects with normal mitral valve morphology. Results Relative to manual image analysis, the automated method accurately represents both normal and complex leaflet geometries with a mean boundary displacement error on the order of one image voxel. A detailed quantitative analysis of the valves is presented and reveals statistically significant differences between normal and myxomatous valves with respect to numerous aspects of annular and leaflet geometry. Conclusions This work demonstrates a successful methodology for the relatively rapid quantitative description of the complex mitral valve distortions associated with myxomatous degeneration. The methodology has the potential to significantly improve surgical planning for patients with complex mitral valve disease. PMID:27492671

  4. Mitral valve prolapse in Marfan syndrome: an old topic revisited.

    PubMed

    Taub, Cynthia C; Stoler, Joan M; Perez-Sanz, Teresa; Chu, John; Isselbacher, Eric M; Picard, Michael H; Weyman, Arthur E

    2009-04-01

    The echocardiographic features of mitral valve prolapse (MVP) in Marfan syndrome have been well described, and the incidence of MVP in Marfan syndrome is reported to be 40-80%. However, most of the original research was performed in the late 1980s and early 1990s, when the diagnostic criteria for MVP were less specific. Our goal was to investigate the characteristics of MVP associated with Marfan syndrome using currently accepted diagnostic criteria for MVP. Between January 1990 and March 2004, 90 patients with definitive diagnosis of Marfan syndrome (based on standardized criteria with or without genetic testing) were referred to Massachusetts General Hospital for transthoracic echocardiography. Patients' gender, age, weight, height, and body surface area at initial examination were recorded. Mitral valve thickness and motion, the degree of mitral regurgitation and aortic regurgitation, and aortic dimensions were quantified blinded to patients' clinical information. There were 25 patients (28%) with MVP, among whom 80% had symmetrical bileaflet MVP. Patients with MVP had thicker mitral leaflets (5.0 +/- 1.0 mm vs. 1.8 +/- 0.5 mm, P < 0.001), more mitral regurgitation (using a scale of 1-4, 2.2 +/- 1.0 vs. 0.90 +/- 0.60, P < 0.0001), larger LVEDD, and larger dimensions of sinus of Valsalva, sinotubular junction, aortic arch, and descending aorta indexed to square root body surface area, when compared with those without MVP. When echocardiographic features of patients younger than 18 years of age and those of patients older than 18 were compared, adult Marfan patients had larger LA dimension (indexed to square root body surface area), larger sinotubular junction (indexed to square root body surface area), and more mitral regurgitation and aortic regurgitation. The prevalence of MVP in Marfan syndrome is lower than previously reported. The large majority of patients with MVP have bileaflet involvement, and those with MVP have significantly larger aortic root

  5. Optimization of Doppler velocity echocardiographic measurements using an automatic contour detection method.

    PubMed

    Gaillard, E; Kadem, L; Pibarot, P; Durand, L-G

    2009-01-01

    Intra- and inter-observer variability in Doppler velocity echocardiographic measurements (DVEM) is a significant issue. Indeed, imprecisions of DVEM can lead to diagnostic errors, particularly in the quantification of the severity of heart valve dysfunction. To minimize the variability and rapidity of DVEM, we have developed an automatic method of Doppler velocity wave contour detection, based on active contour models. To validate our new method, results obtained with this method were compared to those obtained manually by an experienced echocardiographer on Doppler echocardiographic images of left ventricular outflow tract and transvalvular flow velocity signals recorded in 30 patients, 15 with aortic stenosis and 15 with mitral stenosis. We focused on three essential variables that are measured routinely by Doppler echocardiography in the clinical setting: the maximum velocity, the mean velocity and the velocity-time integral. Comparison between the two methods has shown a very good agreement (linear correlation coefficient R(2) = 0.99 between the automatically and the manually extracted variables). Moreover, the computation time was really short, about 5s. This new method applied to DVEM could, therefore, provide a useful tool to eliminate the intra- and inter-observer variabilities associated with DVEM and thereby to improve the diagnosis of cardiovascular disease. This automatic method could also allow the echocardiographer to realize these measurements within a much shorter period of time compared to standard manual tracing method. From a practical point of view, the model developed can be easily implanted in a standard echocardiographic system.

  6. Energy dynamics of the intraventricular vortex after mitral valve surgery.

    PubMed

    Nakashima, Kouki; Itatani, Keiichi; Kitamura, Tadashi; Oka, Norihiko; Horai, Tetsuya; Miyazaki, Shohei; Nie, Masaki; Miyaji, Kagami

    2017-04-07

    Mitral valve morphology after mitral valve surgery affects postoperative intraventricular flow patterns and long-term cardiac performance. We visualized ventricular flow by echocardiography vector flow mapping (VFM) to reveal the impact of different mitral valve procedures. Eleven cases of mechanical mitral valve replacement (nine in the anti-anatomical and two in the anatomical position), three bioprosthetic mitral valve replacements, and four mitral valve repairs were evaluated. The mean age at the procedure was 57.4 ± 17.8 year, and the echocardiography VFM in the apical long-axis view was performed 119.9 ± 126.7 months later. Flow energy loss (EL), kinetic pressure (KP), and the flow energy efficiency ratio (EL/KP) were measured. The cases with MVR in the anatomical position and with valve repair had normal vortex directionality ("Clockwise"; N = 6), whereas those with MVR in the anti-anatomical position and with a bioprosthetic mitral valve had the vortex in the opposite direction ("Counterclockwise"; N = 12). During diastole, vortex direction had no effect on EL ("Clockwise": 0.080 ± 0.025 W/m; "Counterclockwise": 0.083 ± 0.048 W/m; P = 0.31) or KP ("Clockwise": 0.117 ± 0.021 N; "Counterclockwise": 0.099 ± 0.057 N; P = 0.023). However, during systole, the EL/KP ratio was significantly higher in the "Counterclockwise" vortex than that in the "Clockwise" vortex (1.056 ± 0.463 vs. 0.617 ± 0.158; P = 0.009). MVP and MVR with a mechanical valve in the anatomical position preserve the physiological vortex, whereas MVR with a mechanical valve in the anti-anatomical position and a bioprosthetic mitral valve generate inefficient vortex flow patterns, resulting in a potential increase in excessive cardiac workload.

  7. Septic Cerebral Embolisation in Fulminant Mitral Valve Infective Endocarditis

    PubMed Central

    Doolub, Gemina

    2015-01-01

    A 37-year-old male with known intravenous drug use was admitted with an acute onset of worsening confusion and speech impairment. His vitals and biochemical profile demonstrated severe sepsis, with a brain CT showing several lesions suspicious for cerebral emboli. He then went on to have a bedside transthoracic echocardiogram that was positive for vegetation on the mitral valve, with associated severe mitral regurgitation. Unfortunately, before he was stable enough to be transferred for valve surgery, he suffered an episode of acute pulmonary oedema requiring intubation and ventilation on intensive care unit. PMID:26120312

  8. Artificial Intelligence in Mitral Valve Analysis

    PubMed Central

    Jeganathan, Jelliffe; Knio, Ziyad; Amador, Yannis; Hai, Ting; Khamooshian, Arash; Matyal, Robina; Khabbaz, Kamal R; Mahmood, Feroze

    2017-01-01

    Background: Echocardiographic analysis of mitral valve (MV) has become essential for diagnosis and management of patients with MV disease. Currently, the various software used for MV analysis require manual input and are prone to interobserver variability in the measurements. Aim: The aim of this study is to determine the interobserver variability in an automated software that uses artificial intelligence for MV analysis. Settings and Design: Retrospective analysis of intraoperative three-dimensional transesophageal echocardiography data acquired from four patients with normal MV undergoing coronary artery bypass graft surgery in a tertiary hospital. Materials and Methods: Echocardiographic data were analyzed using the eSie Valve Software (Siemens Healthcare, Mountain View, CA, USA). Three examiners analyzed three end-systolic (ES) frames from each of the four patients. A total of 36 ES frames were analyzed and included in the study. Statistical Analysis: A multiple mixed-effects ANOVA model was constructed to determine if the examiner, the patient, and the loop had a significant effect on the average value of each parameter. A Bonferroni correction was used to correct for multiple comparisons, and P = 0.0083 was considered to be significant. Results: Examiners did not have an effect on any of the six parameters tested. Patient and loop had an effect on the average parameter value for each of the six parameters as expected (P < 0.0083 for both). Conclusion: We were able to conclude that using automated analysis, it is possible to obtain results with good reproducibility, which only requires minimal user intervention. PMID:28393769

  9. Mathematical multi-scale model of the cardiovascular system including mitral valve dynamics. Application to ischemic mitral insufficiency

    PubMed Central

    2011-01-01

    Background Valve dysfunction is a common cardiovascular pathology. Despite significant clinical research, there is little formal study of how valve dysfunction affects overall circulatory dynamics. Validated models would offer the ability to better understand these dynamics and thus optimize diagnosis, as well as surgical and other interventions. Methods A cardiovascular and circulatory system (CVS) model has already been validated in silico, and in several animal model studies. It accounts for valve dynamics using Heaviside functions to simulate a physiologically accurate "open on pressure, close on flow" law. However, it does not consider real-time valve opening dynamics and therefore does not fully capture valve dysfunction, particularly where the dysfunction involves partial closure. This research describes an updated version of this previous closed-loop CVS model that includes the progressive opening of the mitral valve, and is defined over the full cardiac cycle. Results Simulations of the cardiovascular system with healthy mitral valve are performed, and, the global hemodynamic behaviour is studied compared with previously validated results. The error between resulting pressure-volume (PV) loops of already validated CVS model and the new CVS model that includes the progressive opening of the mitral valve is assessed and remains within typical measurement error and variability. Simulations of ischemic mitral insufficiency are also performed. Pressure-Volume loops, transmitral flow evolution and mitral valve aperture area evolution follow reported measurements in shape, amplitude and trends. Conclusions The resulting cardiovascular system model including mitral valve dynamics provides a foundation for clinical validation and the study of valvular dysfunction in vivo. The overall models and results could readily be generalised to other cardiac valves. PMID:21942971

  10. The challenges of managing rheumatic disease of the mitral valve in Jamaica.

    PubMed

    Little, Sherard G

    2014-12-01

    Between January, 2009 and December, 2013, 84 patients were identified who underwent isolated mitral valve surgery in Jamaica at The University Hospital of the West Indies and The Bustamante Hospital for Children. The most common pathology requiring surgery was rheumatic heart disease, accounting for 84% of the procedures performed. The majority of patients had regurgitation of the mitral valve (67%), stenosis of the mitral valve (22%), and mixed mitral valve disease (11%). The most common procedure performed was replacement of the mitral valve (69%), followed by mitral valve repair (29%). Among the patients, one underwent closed mitral commissurotomy. The choice of procedure differed between age groups. In the paediatric population (<18 years of age), the majority of patients underwent repair of the mitral valve (89%). In the adult population (18 years and above), the majority of patients underwent mitral valve replacement (93%). Overall, of all the patients undergoing replacement of the mitral valve, 89% received a mechanical valve prosthesis, whereas 11% received a bioprosthetic valve prosthesis. Of the group of patients who underwent mitral valve repair for rheumatic heart disease, 19% required re-operation. The average time between initial surgery and re-operation was 1.2 years. Rheumatic fever and rheumatic heart disease remain significant public health challenges in Jamaica and other developing countries. Focus must remain on primary and secondary prevention strategies in order to limit the burden of rheumatic valvulopathies. Attention should also be directed towards improving access to surgical treatment for young adults.

  11. A quantitative approach to the intraoperative echocardiographic assessment of the mitral valve for repair.

    PubMed

    Mahmood, Feroze; Matyal, Robina

    2015-07-01

    Intraoperative echocardiography of the mitral valve has evolved from a qualitative assessment of flow-dependent variables to quantitative geometric analyses before and after repair. In addition, 3-dimensional echocardiographic data now allow for a precise assessment of mitral valve apparatus. Complex structures, such as the mitral annulus, can be interrogated comprehensively without geometric assumptions. Quantitative analyses of mitral valve apparatus are particularly valuable for identifying indices of left ventricular and mitral remodeling to establish the chronicity and severity of mitral regurgitation. This can help identify patients who may be unsuitable candidates for repair as the result of irreversible remodeling of the mitral valve apparatus. Principles of geometric analyses also have been extended to the assessment of repaired mitral valves. Changes in mitral annular shape and size determine the stress exerted on the mitral leaflets and, therefore, the durability of repair. Given this context, echocardiographers may be expected to diagnose and quantify valvular dysfunction, assess suitability for repair, assist in annuloplasty ring sizing, and determine the success and failure of the repair procedure. As a result, anesthesiologists have progressed from being mere service providers to participants in the decision-making process. It is therefore prudent for them to acquaint themselves with the principles of intraoperative quantitative mitral valve analysis to assist in rational and objective decision making.

  12. A retrospective analysis of mitral valve pathology in the setting of bicuspid aortic valves

    PubMed Central

    van Rensburg, Annari; Doubell, Anton

    2017-01-01

    The therapeutic implications of bicuspid aortic valve associations have come under scrutiny in the transcatheter aortic valve implantation era. We evaluate the spectrum of mitral valve disease in patients with bicuspid aortic valves to determine the need for closer echocardiographic scrutiny/follow-up of the mitral valve. A retrospective analysis of echocardiograms done at a referral hospital over five years was conducted in patients with bicuspid aortic valves with special attention to congenital abnormalities of the mitral valve. One hundred and forty patients with a bicuspid aortic valve were included. A congenital mitral valve abnormality was present in eight (5.7%, P = 0.01) with a parachute mitral valve in four (2.8%), an accessory mitral valve leaflet in one (0.7%), mitral valve prolapse in one, a cleft in one and the novel finding of a trileaflet mitral valve in one. Minor abnormalities included an elongated anterior mitral valve leaflet (P < 0.001), the increased incidence of physiological mitral regurgitation (P < 0.001), abnormal papillary muscles (P = 0.002) and an additional chord or tendon in the left ventricle cavity (P = 0.007). Mitral valve abnormalities occur more commonly in patients with bicuspid aortic valves than matched healthy individuals. The study confirms that abnormalities in these patients extend beyond the aorta. These abnormalities did not have a significant functional effect. PMID:28515127

  13. The age-related advancement of arterial disease measured by Doppler ultrasound diastolic flow analysis.

    PubMed

    Terenzi, T; Gallagher, D; DeMeersman, R; Beadle, E; Muller, D

    1993-10-01

    To quantify by A-mode Doppler sonography the age-related progression of arterial disease so that age dependent normal values may be established for the screening Doppler peripheral arterial exam. Arterial distensibility was assessed by A-mode Doppler diastolic flow analysis as a measure of atherogenesis. These values will increase the sensitivity and decrease the incidence of false-positive results when the Doppler exam is utilized to differentially diagnosis vascular and sciatic neurogenic claudication. The relationship between age and results from the standard ankle/arm index ultrasound pneumatic cuff examination was also analyzed. A two by three analysis of variance with orthogonal Helmert contrast codes and simple linear regression analysis was utilized for this cross-sectionally designed investigation. The dependent measures of diastolic flow analysis and ankle/arm pressure index were obtained within three nested successively increasing age groups. Chiropractic office. Studied were a total of 90 sedentary nonsmoking subjects, aged 23-79 yr, all of whom had normally accepted levels of serum glucose, cholesterol and blood pressure. Subjects were screened for evidence of aortic coarctation, myocardial infarction, tachyarrhythmia, aortic valve stenosis, mitral prolapse, hypertension, hypercholesterolemia, diabetes and peripheral occlusive arterial disease. Anthropometric measurements and percent body fat were obtained. A predictive oxygen consumption bike ergometer test was performed to obtain aerobic capacity. The commonly utilized standard ankle/arm index ultrasound pneumatic cuff examination and arterial diastolic flow analysis were performed with A-mode Doppler ultrasound on all subjects. These results demonstrate that a significant inverse linear relationship exists between aging and arterial compliance (p < .0001) in our population. Diastolic flow analysis had a greater sensitivity to arterial disease than the standard ankle/arm index ultrasound pneumatic

  14. How safe is it to train residents to perform mitral valve surgery?

    PubMed

    Gabriel, Joseph; Göbölös, László; Miskolczi, Szabolcs; Barlow, Clifford

    2016-11-01

    A best evidence topic was constructed according to a structured protocol. The enquiry: In [patients undergoing mitral valve surgery] are [postoperative morbidity and mortality outcomes] acceptable when patients are operated on by [residents]? Four hundred and twenty-three were identified from the search strategy. Six articles selected as best evidence were tabulated. All current published evidence, encompassing open and minimally invasive mitral valve repair in addition to mitral valve replacement, supports the involvement of trainees in mitral procedures. Although trainees may experience longer aortic cross-clamp and cardiopulmonary bypass times than specialist surgeons, they are not associated with significantly worse perioperative or postoperative outcomes in comparable mitral procedures. Important factors in the viability of mitral valve training and its quality include the volume of cases per institution and the expertise of the supervising surgeon, and these remain largely unexplored. Overall, mitral valve surgery remains a valuable potential training opportunity, one which is perhaps underexploited.

  15. [Functional mitral regurgitation. Physiopathology and impact of medical therapy and surgical techniques for left ventricle reduction].

    PubMed

    Comín, J; Manito, N; Roca, J; Castells, E; Esplugas, E

    1999-07-01

    Functional mitral regurgitation is frequently observed in the setting of left ventricular dyfunction. This finding is a marker of poor outcome in patients with either ischemic or dilated cardiomyopathy. The mechanism accounting for this phenomenon is an altered balance of tethering versus coapting forces acting on the mitral valves in the failing heart. Tethering forces represent an anomalous tension on the mitral valves due to displacement of mitral valve attachments secondary to increased left ventricular chamber sphericity associated with systolic ventricular dysfunction. On the other hand, coapting forces are weak and unable to counteract the abnormal tension acting on the mitral valve, which restricts closure and leads to regurgitation. Vasodilators and inotropic drugs are effective in the management of functional mitral regurgitation. Although partial left ventriculectomy or Batista's procedure is still investigational, this new technique seems to provide an optimal control of functional mitral regurgitation and improve functional capacity and survival of some patients with heart failure.

  16. Digital Doppler measurement with spacecraft

    NASA Technical Reports Server (NTRS)

    Kinman, Peter W.; Hinedi, Sami M.; Labelle, Remi C.; Bevan, Roland P.; Del Castillo, Hector M.; Chong, Dwayne C.

    1991-01-01

    Digital and analog phase-locked loop (PLL) receivers were operated in parallel, each tracking the residual carrier from a spacecraft. The PLL tracked the downlink carrier and measured its instantaneous phase. This information, combined with a knowledge of the uplink carrier and the transponder ratio, permitted the computation of a Doppler observable. In this way, two separate Doppler measurements were obtained for one observation window. The two receivers agreed on the magnitude of the Doppler effect to within 1 mHz. There was less jitter on the data from the digital receiver. This was due to its smaller noise bandwidth. The demonstration and its results are described.

  17. GEOS-3 Doppler difference tracking

    NASA Technical Reports Server (NTRS)

    Rosenbaum, B.

    1977-01-01

    The Doppler difference method as applied to track the GEOS 3 spacecraft is discussed. In this method a pair of 2 GHz ground tracking stations simultaneously track a spacecraft beacon to generate an observable signal in which bias and instability of the carrier frequency cancel. The baselines are formed by the tracking sites at Bermuda, Rosman, and Merritt Island. Measurements were made to evaluate the effectiveness of the Doppler differencing procedure in tracking a beacon target with the high dynamic rate of the GEOS 3 orbit. Results indicate the precision of the differenced data to be at a level comparable to the conventional precise two way Doppler tracking.

  18. Digital Doppler measurement with spacecraft

    NASA Technical Reports Server (NTRS)

    Kinman, Peter W.; Hinedi, Sami M.; Labelle, Remi C.; Bevan, Roland P.; Del Castillo, Hector M.; Chong, Dwayne C.

    1991-01-01

    Digital and analog phase-locked loop (PLL) receivers were operated in parallel, each tracking the residual carrier from a spacecraft. The PLL tracked the downlink carrier and measured its instantaneous phase. This information, combined with a knowledge of the uplink carrier and the transponder ratio, permitted the computation of a Doppler observable. In this way, two separate Doppler measurements were obtained for one observation window. The two receivers agreed on the magnitude of the Doppler effect to within 1 mHz. There was less jitter on the data from the digital receiver. This was due to its smaller noise bandwidth. The demonstration and its results are described.

  19. Percutaneous mitral balloon valvotomy in a case of situs inversus dextrocardia with severe rheumatic mitral stenosis.

    PubMed

    Kulkarni, Prashanth; Halkati, Prabhu; Patted, Suresh; Ambar, Sameer; Yavagal, Suresh

    2012-01-01

    The efficacy, safety and applicability of Inoue balloon technique for BMV are clearly established worldwide in selected subset of patients with rheumatic mitral stenosis (MS). However, in altered cardiac anatomy it offers technical challenges. Distorted cardiac anatomy and cardiac malpositions considerably increase the complications involved in interatrial septal puncture and left ventricular entry during BMV. There are only a few reports worldwide on successful BMV in altered cardiac anatomy using the standard Inoue technique. Here we describe a case of a 27-year-old female with situs inversus and dextrocardia, where BMV was successfully performed with a few modifications of the standard Inoue technique previously described in similar patients. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Diastolic Mitral Regurgitation in a Patient With Complex Native Mitral and Aortic Valve Endocarditis: A Rare Phenomenon With Potential Catastrophic Consequences.

    PubMed

    Pulido, Juan N; Lynch, James J; Mauermann, William J; Michelena, Hector I; Rehfeldt, Kent H

    2016-03-01

    Diastolic mitral valve regurgitation is a rare phenomenon described in patients with atrioventricular conduction abnormalities, severe left ventricular systolic or diastolic dysfunction with regional wall motion dyssynchrony, or severe acute aortic valve regurgitation. The presence of diastolic mitral valve regurgitation in acute aortic regurgitation due to endocarditis suggests critical severity requiring urgent surgical valve replacement. We describe a case of diastolic mitral regurgitation in the setting of complex native mitral-aortic valve endocarditis in a patient in normal sinus rhythm and review the etiologic mechanisms of this phenomenon, echocardiographic assessment, and therapeutic implications for hemodynamic management.

  1. Percutaneous Mitral Valve Repair in Mitral Regurgitation Reduces Cell-Free Hemoglobin and Improves Endothelial Function

    PubMed Central

    Rammos, Christos; Zeus, Tobias; Balzer, Jan; Kubatz, Laura; Hendgen-Cotta, Ulrike B.; Veulemans, Verena; Hellhammer, Katharina; Totzeck, Matthias; Luedike, Peter; Kelm, Malte; Rassaf, Tienush

    2016-01-01

    Background and Objective Endothelial dysfunction is predictive for cardiovascular events and may be caused by decreased bioavailability of nitric oxide (NO). NO is scavenged by cell-free hemoglobin with reduction of bioavailable NO up to 70% subsequently deteriorating vascular function. While patients with mitral regurgitation (MR) suffer from an impaired prognosis, mechanisms relating to coexistent vascular dysfunctions have not been described yet. Therapy of MR using a percutaneous mitral valve repair (PMVR) approach has been shown to lead to significant clinical benefits. We here sought to investigate the role of endothelial function in MR and the potential impact of PMVR. Methods and Results Twenty-seven patients with moderate-to-severe MR treated with the MitraClip® device were enrolled in an open-label single-center observational study. Patients underwent clinical assessment, conventional echocardiography, and determination of endothelial function by measuring flow-mediated dilation (FMD) of the brachial artery using high-resolution ultrasound at baseline and at 3-month follow-up. Patients with MR demonstrated decompartmentalized hemoglobin and reduced endothelial function (cell-free plasma hemoglobin in heme 28.9±3.8 μM, FMD 3.9±0.9%). Three months post-procedure, PMVR improved ejection fraction (from 41±3% to 46±3%, p = 0.03) and NYHA functional class (from 3.0±0.1 to 1.9±1.7, p<0.001). PMVR was associated with a decrease in cell free plasma hemoglobin (22.3±2.4 μM, p = 0.02) and improved endothelial functions (FMD 4.8±1.0%, p<0.0001). Conclusion We demonstrate here that plasma from patients with MR contains significant amounts of cell-free hemoglobin, which is accompanied by endothelial dysfunction. PMVR therapy is associated with an improved hemoglobin decompartmentalization and vascular function. PMID:26986059

  2. Predictive model for the detection of pulmonary hypertension in dogs with myxomatous mitral valve disease

    PubMed Central

    MIKAWA, Shoma; MIYAGAWA, Yuichi; TODA, Noriko; TOMINAGA, Yoshinori; TAKEMURA, Naoyuki

    2014-01-01

    Pulmonary hypertension (PH) often occurs due to a left heart disease, such as myxomatous mitral valve disease (MMVD), in dogs and is diagnosed using Doppler echocardiography and estimated pulmonary arterial pressure. Diagnosis of PH in dogs requires expertise in echocardiography: however, the examination for PH is difficult to perform in a clinical setting. Thus, simple and reliable methods are required for the diagnosis of PH in dogs. The purpose of this study was to develop models using multiple logistic regression analysis to detect PH due to left heart disease in dogs with MMVD without echocardiography. The medical records of dogs with MMVD were retrospectively reviewed, and 81 dogs were included in this study and classified into PH and non-PH groups. Bivariate analysis was performed to compare all parameters between the groups, and variables with P values of <0.25 in bivariate analysis were included in multiple logistic regression analysis to develop models for the detection of PH. In multiple logistic regression analysis, the model included a vertebral heart scale short axis of >5.2 v, and a length of sternal contact of >3.3 v was considered suitable for the detection of PH. The predictive accuracy of this model (85.9%) was judged statistically adequate, and therefore, this model may be useful to screen for PH due to left heart disease in dogs with MMVD without echocardiography. PMID:25319513

  3. Parachute mitral valve accompanied by bicuspid aortic valve on three-dimensional transesophageal echocardiography.

    PubMed

    Feng, Tian-Ying; Li, Zhi-An; He, Yi-Hua; Han, Jian-Cheng; Luan, Shu-Rong; Wang, Lin-Lin

    2012-09-01

    We report the findings of three-dimensional (3D) transesophageal echocardiography (TEE) in a patient with a parachute mitral valve (MV) accompanied by aortic valve (AV) malformation. The results indicated an enhanced echo in MV anterior leaves, incrassate, and shortened subvalvular chordae tendineae, and posteromedial papillary muscle that had echo reinforcement, calcification, retroposition, and a significant decrease compared with anterolateral papillary muscle. In addition, the anterolateral papillary muscle was huge, with the bilateral papillary muscles fused partly, and the posterior subvalvular chordae tendineae incrassate, shortened, and attached parachute-like to the anterolateral papillary muscle. The MV appeared dome-shaped for the open limit in diastole with an MV area of 1.6 cm. Moreover, the left ventricle increased in size and the bicuspid AV was malformed. Continuous wave Doppler angiograph showed that the flow rate increased to 398 cm/seconds at the AV orifice area. A 3D form of the MV structure was observed from the left ventricle using 3D-TEE inspection. The anterolateral papillary muscle was fused with its posteromedial homologue. The chordae tendineae was attached to the anterolateral papillary with the parachute-like structure, indicating dome movement. Copyright © 2012. Published by Elsevier B.V.

  4. Mitral valve prolapse associated with celiac artery stenosis: a new ultrasonographic syndrome?

    PubMed Central

    Arcari, Luciano

    2004-01-01

    Background Celiac artery stenosis (CAS) may be caused by atherosclerotic degeneration or compression exerted by the arched ligament of the diaphragm. Mitral valve prolapse (MVP) is the most common valvular disorder. There are no reports on an association between CAS and MVP. Methods 1560 (41%) out of 3780 consecutive patients undergoing echocardiographic assessment of MVP, had Doppler sonography of the celiac tract to detect CAS. Results CAS was found in 57 (3.7%) subjects (23 males and 34 females) none of whom complained of symptoms related to visceral ischemia. MVP was observed in 47 (82.4%) subjects with and 118 (7.9%) without CAS (p < 0.001). The agreement between MVP and CAS was 39% (95% CI 32–49%). PSV (Peak Systolic Velocity) was the only predictor of CAS in MPV patients (OR 0.24, 95% CI 0.08–0.69) as selected in a multivariate logistic model. Conclusion CAS and MVP seem to be significantly associated in patients undergoing consecutive ultrasonographic screening. PMID:15588321

  5. Evaluation of meteorological airborne Doppler radar

    NASA Technical Reports Server (NTRS)

    Hildebrand, P. H.; Mueller, C. K.

    1984-01-01

    This paper will discuss the capabilities of airborne Doppler radar for atmospheric sciences research. The evaluation is based on airborne and ground based Doppler radar observations of convective storms. The capability of airborne Doppler radar to measure horizontal and vertical air motions is evaluated. Airborne Doppler radar is shown to be a viable tool for atmospheric sciences research.

  6. Doppler characteristics of sea clutter.

    SciTech Connect

    Raynal, Ann Marie; Doerry, Armin Walter

    2010-06-01

    Doppler radars can distinguish targets from clutter if the target's velocity along the radar line of sight is beyond that of the clutter. Some targets of interest may have a Doppler shift similar to that of clutter. The nature of sea clutter is different in the clutter and exo-clutter regions. This behavior requires special consideration regarding where a radar can expect to find sea-clutter returns in Doppler space and what detection algorithms are most appropriate to help mitigate false alarms and increase probability of detection of a target. This paper studies the existing state-of-the-art in the understanding of Doppler characteristics of sea clutter and scattering from the ocean to better understand the design and performance choices of a radar in differentiating targets from clutter under prevailing sea conditions.

  7. Doppler tracking of planetary spacecraft

    NASA Technical Reports Server (NTRS)

    Kinman, Peter W.

    1992-01-01

    This article concerns the measurement of Doppler shift on microwave links that connect planetary spacecraft with the Deep Space Network. Such measurements are made by tracking the Doppler effect with phase-locked loop receivers. A description of equipment and techniques as well as a summary of the appropriate mathematical models are given. The two-way Doppler shift is measured by transmitting a highly-stable microwave (uplink) carrier from a ground station, having the spacecraft coherently transpond this carrier, and using a phase-locked loop receiver at the ground station to track the returned (downlink) carrier. The largest sources of measurement error are usually plasma noise and thermal noise. The plasma noise, which may originate in the ionosphere or the solar corona, is discussed; and a technique to partially calibrate its effect, involving the use of two simultaneous downlink carriers that are coherently related, is described. Range measurements employing Doppler rate-aiding are also described.

  8. Dual-Doppler Feasibility Study

    NASA Technical Reports Server (NTRS)

    Huddleston, Lisa L.

    2012-01-01

    When two or more Doppler weather radar systems are monitoring the same region, the Doppler velocities can be combined to form a three-dimensional (3-D) wind vector field thus providing for a more intuitive analysis of the wind field. A real-time display of the 3-D winds can assist forecasters in predicting the onset of convection and severe weather. The data can also be used to initialize local numerical weather prediction models. Two operational Doppler Radar systems are in the vicinity of Kennedy Space Center (KSC) and Cape Canaveral Air Force Station (CCAFS); these systems are operated by the 45th Space Wing (45 SW) and the National Weather Service Melbourne, Fla. (NWS MLB). Dual-Doppler applications were considered by the 45 SW in choosing the site for the new radar. Accordingly, the 45th Weather Squadron (45 WS), NWS MLB and the National Aeronautics and Space Administration tasked the Applied Meteorology Unit (AMU) to investigate the feasibility of establishing dual-Doppler capability using the two existing systems. This study investigated technical, hardware, and software requirements necessary to enable the establishment of a dual-Doppler capability. Review of the available literature pertaining to the dual-Doppler technique and consultation with experts revealed that the physical locations and resulting beam crossing angles of the 45 SW and NWS MLB radars make them ideally suited for a dual-Doppler capability. The dual-Doppler equations were derived to facilitate complete understanding of dual-Doppler synthesis; to determine the technical information requirements; and to determine the components of wind velocity from the equation of continuity and radial velocity data collected by the two Doppler radars. Analysis confirmed the suitability of the existing systems to provide the desired capability. In addition, it is possible that both 45 SW radar data and Terminal Doppler Weather Radar data from Orlando International Airport could be used to alleviate any

  9. Three-dimensional echocardiographic assessment of the repaired mitral valve.

    PubMed

    Maslow, Andrew; Mahmood, Feroze; Poppas, Athena; Singh, Arun

    2014-02-01

    This study examined the geometric changes of the mitral valve (MV) after repair using conventional and three-dimensional echocardiography. Prospective evaluation of consecutive patients undergoing mitral valve repair. Tertiary care university hospital. Fifty consecutive patients scheduled for elective repair of the mitral valve for regurgitant disease. Intraoperative transesophageal echocardiography. Assessments of valve area (MVA) were performed using two-dimensional planimetry (2D-Plan), pressure half-time (PHT), and three-dimensional planimetry (3D-Plan). In addition, the direction of ventricular inflow was assessed from the three-dimensional imaging. Good correlations (r = 0.83) and agreement (-0.08 +/- 0.43 cm(2)) were seen between the MVA measured with 3D-Plan and PHT, and were better than either compared to 2D-Plan. MVAs were smaller after repair of functional disease repaired with an annuloplasty ring. After repair, ventricular inflow was directed toward the lateral ventricular wall. Subgroup analysis showed that the change in inflow angle was not different after repair of functional disease (168 to 171 degrees) as compared to those presenting with degenerative disease (168 to 148 degrees; p<0.0001). Three-dimensional imaging provides caregivers with a unique ability to assess changes in valve function after mitral valve repair. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Custodiol HTK cardioplegia use in robotic mitral valve.

    PubMed

    Patel, Nirav; DeLaney, Ed; Turi, Gerard; Stapleton, Thomas

    2013-06-01

    Robotic surgery is a growing subspecialty in cardiac surgery. Custodiol HTK cardioplegia offers long-term myocardial protection, decreased metabolism, and eliminates multiple cardioplegia dosing. This article reviews the technique, strategy, and considerations for use of Custodiol HTK for myocardial protection in robotic mitral valve surgery.

  11. Takotsubo syndrome after mitral valve replacement for acute endocarditis.

    PubMed

    Gariboldi, Vlad; Jop, Bertrand; Grisoli, Dominique; Jaussaud, Nicolas; Kerbaul, François; Collart, Frédéric

    2011-03-01

    Takotsubo syndrome is characterized by transient and acute left ventricular dysfunction and apical ballooning, with electrocardiographic abnormalities, but without coronary disease. We report a case of Takotsubo syndrome occurring after emergent mitral valve replacement for acute infective endocarditis. The patient is a 66-year-old woman who regained complete recovery of left ventricular function.

  12. Novel pathogenetic mechanisms and structural adaptations in ischemic mitral regurgitation.

    PubMed

    Silbiger, Jeffrey J

    2013-10-01

    Ischemic mitral regurgitation (MR) is a common complication of myocardial infarction thought to result from leaflet tethering caused by displacement of the papillary muscles that occurs as the left ventricle remodels. The author explores the possibility that left atrial remodeling may also play a role in the pathogenesis of ischemic MR, through a novel mechanism: atriogenic leaflet tethering. When ischemic MR is hemodynamically significant, the left ventricle compensates by dilating to preserve forward output using the Starling mechanism. Left ventricular dilatation, however, worsens MR by increasing the mitral valve regurgitant orifice, leading to a vicious cycle in which MR begets more MR. The author proposes that several structural adaptations play a role in reducing ischemic MR. In contrast to the compensatory effects of left ventricular enlargement, these may reduce, rather than increase, its severity. The suggested adaptations involve the mitral valve leaflets, the papillary muscles, the mitral annulus, and the left ventricular false tendons. This review describes the potential role each may play in reducing ischemic MR. Therapies that exploit these adaptations are also discussed.

  13. Mathematical Models for Doppler Measurements

    NASA Technical Reports Server (NTRS)

    Lear, William M.

    1987-01-01

    Error analysis increases precision of navigation. Report presents improved mathematical models of analysis of Doppler measurements and measurement errors of spacecraft navigation. To take advantage of potential navigational accuracy of Doppler measurements, precise equations relate measured cycle count to position and velocity. Drifts and random variations in transmitter and receiver oscillator frequencies taken into account. Mathematical models also adapted to aircraft navigation, radar, sonar, lidar, and interferometry.

  14. Novel instantaneous laser Doppler velocimeter.

    PubMed

    Avidor, J M

    1974-02-01

    A laser Doppler velocimeter capable of directly measuring instantaneous velocities is described. The new LDV uses a novel detection technique based on the utilization of a static slightly defocused spherical Fabry-Perot interferometer used in conjunction with a special mask for the detection of instantaneous Doppler frequency shifts. The essential characteristics of this LDV are discussed, and such a system recently developed is described. Results of turbulent flow measurements show good agreement with data obtained using hot wire anemometry.

  15. High Resolution Doppler Lidar

    NASA Technical Reports Server (NTRS)

    1996-01-01

    This Grant supported the development of an incoherent lidar system to measure winds and aerosols in the lower atmosphere. During this period the following activities occurred: (1) an active feedback system was developed to improve the laser frequency stability; (2) a detailed forward model of the instrument was developed to take into account many subtle effects, such as detector non-linearity; (3) a non-linear least squares inversion method was developed to recover the Doppler shift and aerosol backscatter without requiring assumptions about the molecular component of the signal; (4) a study was done of the effects of systematic errors due to multiple etalon misalignment. It was discovered that even for small offsets and high aerosol loadings, the wind determination can be biased by as much as 1 m/s. The forward model and inversion process were modified to account for this effect; and (5) the lidar measurements were validated using rawinsonde balloon measurements. The measurements were found to be in agreement within 1-2 m/s.

  16. Adaptive spectral doppler estimation.

    PubMed

    Gran, Fredrik; Jakobsson, Andreas; Jensen, Jørgen Arendt

    2009-04-01

    In this paper, 2 adaptive spectral estimation techniques are analyzed for spectral Doppler ultrasound. The purpose is to minimize the observation window needed to estimate the spectrogram to provide a better temporal resolution and gain more flexibility when designing the data acquisition sequence. The methods can also provide better quality of the estimated power spectral density (PSD) of the blood signal. Adaptive spectral estimation techniques are known to provide good spectral resolution and contrast even when the observation window is very short. The 2 adaptive techniques are tested and compared with the averaged periodogram (Welch's method). The blood power spectral capon (BPC) method is based on a standard minimum variance technique adapted to account for both averaging over slow-time and depth. The blood amplitude and phase estimation technique (BAPES) is based on finding a set of matched filters (one for each velocity component of interest) and filtering the blood process over slow-time and averaging over depth to find the PSD. The methods are tested using various experiments and simulations. First, controlled flow-rig experiments with steady laminar flow are carried out. Simulations in Field II for pulsating flow resembling the femoral artery are also analyzed. The simulations are followed by in vivo measurement on the common carotid artery. In all simulations and experiments it was concluded that the adaptive methods display superior performance for short observation windows compared with the averaged periodogram. Computational costs and implementation details are also discussed.

  17. High Resolution Doppler Imager

    NASA Technical Reports Server (NTRS)

    Hays, Paul B.

    1999-01-01

    This report summarizes the accomplishments of the High Resolution Doppler Imager (HRDI) on UARS spacecraft during the period 4/l/96 - 3/31/99. During this period, HRDI operation, data processing, and data analysis continued, and there was a high level of vitality in the HRDI project. The HRDI has been collecting data from the stratosphere, mesosphere, and lower thermosphere since instrument activation on October 1, 1991. The HRDI team has stressed three areas since operations commenced: 1) operation of the instrument in a manner which maximizes the quality and versatility of the collected data; 2) algorithm development and validation to produce a high-quality data product; and 3) scientific studies, primarily of the dynamics of the middle atmosphere. There has been no significant degradation in the HRDI instrument since operations began nearly 8 years ago. HRDI operations are fairly routine, although we have continued to look for ways to improve the quality of the scientific product, either by improving existing modes, or by designing new ones. The HRDI instrument has been programmed to collect data for new scientific studies, such as measurements of fluorescence from plants, measuring cloud top heights, and lower atmosphere H2O.

  18. Thrombotic valvular dysfunction with transcatheter mitral interventions for postsurgical failures.

    PubMed

    Eng, Marvin H; Greenbaum, Adam; Wang, Dee Dee; Wyman, Janet; Dnp; Arjomand, Heider; Yadav, Pradeep; Nemeh, Hassan; Paone, Gaetano; Guerrero, Mayra; O'Neill, William

    2017-08-01

    Degenerated surgical mitral valve repairs or surgical prostheses are currently being treated with transcatheter mitral valve replacement (TMVR). We report the procedural and mid-term assessment of thirteen cases. From 12/2013 to 12/2015, 13 consecutive patients with degenerated mitral valve repair or valve replacement were treated. Patients were assessed for mitral valve academic valve consortium (MVARC) defined outcomes. Immediate procedural MVARC defined technical success was 92%. At 30 days MVARC device and procedure success were 61% and 84%, respectively. Mean follow-up was 150 days [IQR 40-123 days]. There were 2 late major adverse outcomes, a noncardiac related death (628 days) and a stroke (382 days). The mean mitral gradient decreased from 9.5 ± 3.4 to 5.5 ± 2.6 mm Hg (P < 0.01). Three patients were found to have high gradients, two presented with heart failure while another patient was found to have reduced leaflet motion and abnormal thickening postprocedure. The two patients with heart failure were treated with enoxaparin, which caused subsequent resolution of increased valve gradients in one patient. The other patient could not tolerate prolonged treatment from anticoagulation due to gastrointestinal bleeding. Three of 13 patients were treated with dual-antiplatelet therapy and were suspected to have valve thrombosis. Thrombotic related dysfunction post-TMVR occurred in 15% (2/13) of patients and one patient had abnormal leaflet thickening that may have been thrombus related. Dual-antiplatelet therapy was used in all 3 cases suggesting the possible need for oral anticoagulation postmitral valve-in-valve therapy. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  19. Prevention of Unilateral Pulmonary Edema Complicating Robotic Mitral Valve Operations.

    PubMed

    Moss, Emmanuel; Halkos, Michael E; Binongo, Jose N; Murphy, Douglas A

    2017-01-01

    Unilateral pulmonary edema (UPE) has been reported after mitral operations performed through the right side of the chest. The clinical presentation is compatible with an ischemia-reperfusion injury. This report describes modifications to robotic mitral valve operations that were designed to reduce UPE. We reviewed 15 patients with UPE after robotic mitral valve operations from 2006 through 2012. Technique modifications to reduce right lung ischemia were used from 2013 through June 2015. Modifications included alterations in patient position, ventilation, and perfusion factors. The incidence of UPE before and after modifications was determined, as was perfusion factors and outcomes in a higher-risk patient subgroup with pulmonary hypertension and prolonged bypass procedures. The incidence of UPE was 1.4% (n = 15) in 1,059 consecutive robotic mitral valve procedures using the standard technique and 0.0% in 435 consecutive procedures using the modified technique (p < 0.02). All patients with UPE had pulmonary hypertension and bypass times of greater than 120 minutes. Patients in the higher-risk subgroup had significantly lower systemic temperature (31°C [range, 30°-32°C] versus 34°C [range, 33°-34°C]; p < 0.01) and higher mean perfusion pressure (67mm Hg [range 62-72 mm Hg] versus 54 mm Hg [range, 52-57 mm Hg]; p < 0.01) on bypass using the modified technique. The incidence of UPE in higher-risk patients was significantly reduced using the modified technique (0% versus 5.6%; p < 0.01) without any increase in overall morbidity or mortality. The incidence of UPE in patients undergoing robotic mitral valve operations has been significantly reduced using a modified technique, without increasing the perioperative complication rate. Further work is necessary to validate this protocol and understand the pathophysiology of postoperative UPE. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Exercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation.

    PubMed

    Magne, Julien; Lancellotti, Patrizio; Piérard, Luc A

    2010-07-06

    Current guidelines recommend mitral valve surgery for asymptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular systolic function when exercise pulmonary hypertension (PHT) is present. However, the determinants of exercise PHT have not been evaluated. The aim of this study was to identify the echocardiographic predictors of exercise PHT and the impact on symptoms. Comprehensive resting and exercise transthoracic echocardiography was performed in 78 consecutive patients (age, 61+/-13 years; 56% men) with at least moderate degenerative mitral regurgitation (effective regurgitant orifice area =43+/-20 mm(2); regurgitant volume =71+/-27 mL). Exercise PHT was defined as a systolic pulmonary arterial pressure (SPAP) >60 mm Hg. Exercise PHT was present in 46% patients. In multivariable analysis, exercise effective regurgitant orifice was an independent determinant of exercise SPAP (P<0.0001) and exercise PHT (P=0.002). Resting PHT and exercise PHT were associated with markedly reduced 2-year symptom-free survival (36+/-14% versus 59+/-7%, P=0.04; 35+/-8% versus 75+/-7%, P<0.0001). After adjustment, although the impact of resting PHT was no longer significant, exercise PHT was identified as an independent predictor of the occurrence of symptoms (hazard ratio=3.4; P=0.002). Receiver-operating characteristics curves revealed that exercise PHT (SPAP >56 mm Hg) was more accurate than resting PHT (SPAP >36 mm Hg) in predicting the occurrence of symptoms during follow-up (P=0.032). Exercise PHT is frequent in patients with asymptomatic degenerative mitral regurgitation. Exercise mitral regurgitation severity is a strong independent predictor of both exercise SPAP and exercise PHT. Exercise PHT is associated with markedly low 2-year symptom-free survival, emphasizing the use of exercise echocardiography. An exercise SPAP >56 mm Hg accurately predicts the occurrence of symptoms.

  1. A complexity scoring system for degenerative mitral valve repair.

    PubMed

    Anyanwu, Anelechi C; Itagaki, Shinobu; Chikwe, Joanna; El-Eshmawi, Ahmed; Adams, David H

    2016-06-01

    To develop a score to allow stratification of complexity in degenerative mitral valve repair. Retrospective modeling of data from 668 consecutive patients who underwent surgery for mitral valve prolapse. A complexity scoring scale was developed using a consensus approach, assigning a score to each valve, based on the following: prolapsing segments (weight 1 for each posterior segment; weight 2 for each anterior or commissural segment); presence of valve restriction (weight 2); presence of calcification (weight 3 if annulus involved, otherwise weight 2); and prior mitral valve repair (weight 3). Valve repairs were categorized into 3 groups based on the complexity score: 1: Simple (n = 244); 2-4: Intermediate (n = 260); ≥5: Complex (n = 164). Mitral valve repair was successfully performed in 667 patients (repair rate: 99.9%). The complexity score was directly correlated with surrogates of technical complexity. The mean cardiopulmonary bypass time increased with lesion complexity ([in minutes] simple: 152; intermediate: 167; complex 195; P < .001). The median number of repair techniques utilized was related to lesion complexity (simple: 3; intermediate: 4; complex: 5; P < .001). Barlow's type etiology was more prevalent in complex cases (63%), compared with simple (9%) and intermediate (35%) cases (P < .001). Advanced repair techniques were required to complete repair in 51% of complex cases, compared with 14% of intermediate and 0% of simple cases (P < .001). Early and late outcomes were similar. Our scoring system may allow effective stratification of complexity of mitral valve repair. Future studies are required to evaluate the use of our score in a prospective setting. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  2. Immediate and long-term results of mitral valve replacement with University of Cape Town mitral valve prosthesis

    PubMed Central

    Schrire, Velva; Barnard, Christiaan N.

    1970-01-01

    We describe seven years' experience with the University of Cape Town lenticular mitral valve prosthesis in 122 patients. All the patients had severe mitral valve disease. In 98 severe mitral stenosis was present with or without incompetence and in 24 the dominant or sole lesion was mitral incompetence. Other valves, particularly the tricuspid, were also frequently affected. The disability was severe or total in almost every patient. One hundred and five patients were discharged from hospital, and in 90 per cent of these the clinical improvement was most gratifying, with the disappearance of pulmonary oedema, paroxysmal dyspnoea, angina pectoris, and congestive cardiac failure. Return to full normal activity including physical work was the rule. The hospital mortality was 14 per cent and a further 38 per cent died during the follow-up period. The major post-operative complication was systemic embolism which could occur at any time after operation. The most important factor influencing the frequency of this complication was the nature of the valve seat. A bare steel seat was associated with a 100 per cent embolism, and a significant reduction occurred when a cloth-covered seat of Dacron-velour was introduced. Anticoagulant therapy appeared to prevent large or fresh clots but had no effect on the deposition of fibrin or platelet thrombi. The only other factor of importance was the age of the patient: after the age of 50 life expectancy and trouble-free long-term survival was reduced. Images PMID:5440520

  3. Hospital-based health technology assessment on the use of mitral clips in the treatment of mitral regurgitation.

    PubMed

    Miniati, Roberto; Cecconi, Giulio; Dori, Fabrizio; Marchetti, Matteo; Gentili, Guido Biffi; Porchia, Barbara; Presicce, Giorgio; Franchi, Sara; Gusinu, Roberto

    2013-01-01

    This study, carried out at the Florence Teaching Hospital Careggi (AOUC), reports the technological evaluation, through the use of Health Technology Assessment (HTA), on the application of mitral clips in the treatment of mitral insufficiency. The assessment, carried out by analyzing the clinical, technological, social, procedural, safety and economic elements, sought to answer the following research questions: Evaluation of the general technological status of the mitral clips in the treatment process of mitral regurgitation, with particular reference to traditional methods; and contextualisation of the analyses within the hospital structure, by identifying criticality issues and improvements. The methodology was based on the following steps: technological description; areas of evaluation and the selection of Key Performance Indicators; research of scientific facts and the collection of expert opinions; evaluation and reporting of findings. The results are based on an analysis which included a total of 50 indicators, effectively evaluating 86.5% of them, from the least from the clinical sector (80%) to the most in the areas of procedure, safety and social (100%). Traditional surgery (repair or valve replacement) still represents the gold standard for the treatment of mitral regurgitation due to its maturity both on a technological and clinical level. The minimally invasive procedures which use the mitral clips present interesting opportunities both on a social level (minimum stay in hospital and no post-operative rehabilitation) and clinical level, especially as an alternative to medication, even if they are still at an emergent level (the long-term results are unknown) and complex to use. From the clinical point of view they show some interesting findings related to immediate and post-operative mortality (none during the operation and a minor and equal amount 30 days and 12 months later in comparison to traditional methods) whilst economically, despite the fact

  4. Is an adjunctive subvalvular repair during mitral annuloplasty for secondary mitral regurgitation effective in preventing recurrent regurgitation?

    PubMed

    Mihos, Christos G; Santana, Orlando

    2016-02-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Is an adjunctive subvalvular repair during mitral annuloplasty for secondary mitral regurgitation effective in preventing recurrent regurgitation? Altogether, 353 studies were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. The best evidence regarding adjunctive subvalvular repair during mitral annuloplasty for secondary mitral regurgitation was from retrospective analyses. The studies reported outcomes of mitral valve repair (MVr) with annuloplasty alone (ring MVr) versus adjunctive papillary muscle approximation (PMA; n = 3), papillary muscle relocation (PMR; n = 3), secondary chordal cutting (n = 2) and PMA + PMR (n = 1). All but one study included concomitant coronary artery bypass grafting, whereas additional ventriculoplasty was performed in three studies. Follow-up ranged from 1 month to 5 years. The performance of PMA was associated with a lower mitral regurgitation (MR) grade when combined with ventriculoplasty in one study, whereas a greater improvement in left ventricular end-diastolic diameter and left ventricular ejection fraction at follow-up was observed with PMA alone in a separate study. Three studies of ring + PMR reported a reduction in ≥ 2+ recurrent MR, whereas two studies also observed a greater reduction in left ventricular end-diastolic diameter. The two studies on secondary chordal cutting reported a lower MR grade, lower recurrence of ≥ 2+ MR and a greater left ventricular ejection fraction at follow-up. Combining PMA + PMR + ventriculoplasty significantly reduced left ventricular end-systolic volume index at short-term follow-up in one study. Finally, none of the studies reported a significant difference in

  5. A mitral annulus tracking approach for navigation of off-pump beating heart mitral valve repair.

    PubMed

    Li, Feng P; Rajchl, Martin; Moore, John; Peters, Terry M

    2015-01-01

    To develop and validate a real-time mitral valve annulus (MVA) tracking approach based on biplane transesophageal echocardiogram (TEE) data and magnetic tracking systems (MTS) to be used in minimally invasive off-pump beating heart mitral valve repair (MVR). The authors' guidance system consists of three major components: TEE, magnetic tracking system, and an image guidance software platform. TEE provides real-time intraoperative images to show the cardiac motion and intracardiac surgical tools. The magnetic tracking system tracks the TEE probe and the surgical tools. The software platform integrates the TEE image planes and the virtual model of the tools and the MVA model on the screen. The authors' MVA tracking approach, which aims to update the MVA model in near real-time, comprises of three steps: image based gating, predictive reinitialization, and registration based MVA tracking. The image based gating step uses a small patch centered at each MVA point in the TEE images to identify images at optimal cardiac phases for updating the position of the MVA. The predictive reinitialization step uses the position and orientation of the TEE probe provided by the magnetic tracking system to predict the position of the MVA points in the TEE images and uses them for the initialization of the registration component. The registration based MVA tracking step aims to locate the MVA points in the images selected by the image based gating component by performing image based registration. The validation of the MVA tracking approach was performed in a phantom study and a retrospective study on porcine data. In the phantom study, controlled translations were applied to the phantom and the tracked MVA was compared to its "true" position estimated based on a magnetic sensor attached to the phantom. The MVA tracking accuracy was 1.29 ± 0.58 mm when the translation distance is about 1 cm, and increased to 2.85 ± 1.19 mm when the translation distance is about 3 cm. In the study on

  6. One-year outcome of percutaneous mitral valve repair in patients with severe symptomatic mitral valve regurgitation

    PubMed Central

    Gotzmann, Michael; Sprenger, Isabell; Ewers, Aydan; Mügge, Andreas; Bösche, Leif

    2017-01-01

    AIM To investigate one-year outcomes after percutaneous mitral valve repair with MitraClip® in patients with severe mitral regurgitation (MR). METHODS Our study investigated consecutive patients with symptomatic severe MR who underwent MitraClip® implantation at the University Hospital Bergmannsheil from 2012 to 2014. The primary study end-point was all-cause mortality. Secondary end-points were degree of MR and functional status after percutaneous mitral valve repair. RESULTS The study population consisted of 46 consecutive patients (mean logistic EuroSCORE 32% ± 21%). The degree of MR decreased significantly (severe MR before MitraClip® 100% vs after MitraClip® 13%; P < 0.001), and the NYHA functional classes improved (NYHA III/IV before MitraClip® 98% vs after MitraClip® 35%; P < 0.001). The mortality rates 30 d and one year after percutaneous mitral valve repair were 4.3% and 19.5%, respectively. During the follow-up of 473 ± 274 d, 11 patients died (90% due to cardiovascular death). A pre-procedural plasma B-type natriuretic peptide level > 817 pg/mL was associated with all-cause mortality (hazard ratio, 6.074; 95%CI: 1.257-29.239; P = 0.012). CONCLUSION Percutaneous mitral valve repair with MitraClip® has positive effects on hemodynamics and symptoms. Despite the study patients’ multiple comorbidities and extremely high operative risk, one-year outcomes after MitraClip® are favorable. Elevated B-type natriuretic peptide levels indicate poorer mid-term survival. PMID:28163835

  7. A pig model of ischemic mitral regurgitation induced by mitral chordae tendinae rupture and implantation of an ameroid constrictor.

    PubMed

    Cui, Yong-Chun; Li, Kai; Tian, Yi; Yuan, Wei-Min; Peng, Peng; Yang, Jian-Zhong; Zhang, Bao-Jie; Zhang, Hui-Dong; Wu, Ai-Li; Tang, Yue

    2014-01-01

    A miniature pig model of ischemic mitral regurgitation (IMR) was developed by posterior mitral chordae tendinae rupture and implantation of an ameroid constrictor. A 2.5-mm ameroid constrictor was placed around the left circumflex coronary artery (LCX) of male Tibetan miniature pigs to induce ischemia, while the posterior mitral chordae tendinae was also ruptured. X-ray coronary angiography, ECG analysis, echocardiography, and magnetic resonance imaging (MRI) were used to evaluate heart structure and function in pigs at baseline and one, two, four and eight weeks after the operation. Blood velocity of the mitral regurgitation was found to be between medium and high levels. Angiographic analyses revealed that the LCX closure was 10-20% at one week, 30-40% at two weeks and 90-100% at four weeks subsequent ameroid constrictor implantation. ECG analysis highlighted an increase in the diameter of the left atria (LA) at two weeks post-operation as well as ischemic changes in the left ventricle (LV) and LA wall at four weeks post-operation. Echocardiography and MRI further detected a gradual increase in LA and LV volumes from two weeks post-operation. LV end diastolic and systolic volumes as well as LA end diastolic and systolic volume were also significantly higher in pig hearts post-operation when compared to baseline. Pathological changes were observed in the heart, which included scar tissue in the ischemic central area of the LV. Transmission electron microscopy highlighted the presence of contraction bands and edema surrounding the ischemia area, including inflammatory cell infiltration within the ischemic area. We have developed a pig model of IMR using the posterior mitral chordae tendineae rupture technique and implantation of an ameroid constrictor. The pathological features of this pig IMR model were found to mimic the natural history and progression of IMR in patients.

  8. Influence of the echocardiographic score and not of the previous surgical mitral commissurotomy on the outcome of percutaneous mitral balloon valvuloplasty.

    PubMed

    Peixoto, E C; Peixoto, R T; Borges, I P; Oliveira, P S; Labrunie, M; Salles Netto, M; Villela, R A; Labrunie, P; Brito, G A; Peixoto, R T

    2001-06-01

    To evaluate prior mitral surgical commissurotomy and echocardiographic score influence on the outcomes and complications of percutaneous mitral balloon valvuloplasty. We performed 459 complete mitral valvuloplasty procedures. Four hundred thirteen were primary valvuloplasty and 46 were in patients who had undergone prior surgical commissurotomy. The prior commissurotomy group was older, had higher echo scores, and a tendency toward a higher percentage of atrial fibrillation. When the groups were compared with each other, no differences were found in pre- and postprocedure mean pulmonary artery pressure, mean mitral gradient, mitral valve area, and mitral regurgitation. Because we found no significant differences, we subdivided the entire group based on echo scores, those with echo scores < or =8 and those with echo scores >8 the mitral valve area being higher in the < or =8 echo score group 2.06+/-0.42 versus 1.90+/-0.40 cm2 (p=0.0090) in the >8 echo score group. Dividing the groups based on echo score revealed that the higher echo score group had smaller mitral valve areas postvalvuloplasty.

  9. Determination of correlation between backflow volume and mitral valve leaflet young modulus from two dimensional echocardiogram images

    NASA Astrophysics Data System (ADS)

    Jong, Rudiyanto P.; Osman, Kahar; Adib, M. Azrul Hisham M.

    2012-06-01

    Mitral valve prolapse without proper monitoring might lead to a severe mitral valve failure which eventually leads to a sudden death. Additional information on the mitral valve leaflet condition against the backflow volume would be an added advantage to the medical practitioner for their decision on the patients' treatment. A study on two dimensional echocardiography images has been conducted and the correlations between the backflow volume of the mitral regurgitation and mitral valve leaflet Young modulus have been obtained. Echocardiogram images were analyzed on the aspect of backflow volume percentage and mitral valve leaflet dimensions on different rates of backflow volume. Young modulus values for the mitral valve leaflet were obtained by using the principle of elastic deflection and deformation on the mitral valve leaflet. The results show that the backflow volume increased with the decrease of the mitral valve leaflet Young modulus which also indicate the condition of the mitral valve leaflet approaching failure at high backflow volumes. Mitral valve leaflet Young modulus values obtained in this study agreed with the healthy mitral valve leaflet Young modulus from the literature. This is an initial overview of the trend on the prediction of the behaviour between the fluid and the structure of the blood and the mitral valve which is extendable to a larger system of prediction on the mitral valve leaflet condition based on the available echocardiogram images.

  10. Preoperative Three-Dimensional Valve Analysis Predicts Recurrent Ischemic Mitral Regurgitation after Mitral Annuloplasty

    PubMed Central

    Bouma, Wobbe; Lai, Eric K.; Levack, Melissa M.; Shang, Eric K.; Pouch, Alison M.; Eperjesi, Thomas J.; Plappert, Theodore J.; Yushkevich, Paul A.; Mariani, Massimo A.; Khabbaz, Kamal R.; Gleason, Thomas G.; Mahmood, Feroze; Acker, Michael A.; Woo, Y. Joseph; Cheung, Albert T.; Jackson, Benjamin M.; Gorman, Joseph H.; Gorman, Robert C.

    2015-01-01

    Background Valve repair for ischemic mitral regurgitation (IMR) with undersized annuloplasty rings is characterized by high IMR recurrence rates. Patient-specific preoperative imaging-based risk stratification for recurrent IMR would optimize results. We sought to determine if pre-repair three-dimensional (3D) echocardiography combined with a novel valve modeling algorithm would be predictive of IMR recurrence 6 months after repair. Methods Intraoperative transesophageal real-time 3D echocardiography was performed in 50 patients undergoing undersized ring annuloplasty for IMR (and in 21 patients with normal mitral valves). A customized image analysis protocol was used to assess 3D annular geometry and regional leaflet tethering. IMR recurrence (≥grade 2) was assessed with two-dimensional transthoracic echocardiography 6 months after repair. Results Preoperative annular geometry was similar in all IMR patients; and preoperative leaflet tethering was significantly higher in patients with recurrent IMR (n=13) as compared with patients in whom IMR did not recur IMR (n=37) (tethering index 3.91±1.01 vs. 2.90±1.17, P=0.008; tethering angles of A3 (23.5±8.9° vs. 14.4± 11.4°, P=0.012), P2 (44.4±8.8° vs. 28.2±17.0°, P=0.002), and P3 (35.2±6.0° vs. 18.6±12.7°, P<0.001)). Multivariate logistic regression analysis revealed preoperative P3 tethering angle as an independent predictor of IMR recurrence with an optimal cut-off value of 29.9° (AUC 0.92, 95%CI 0.84–1.00, P<0.001). Conclusions 3D echocardiography combined with valve modeling is predictive of recurrent IMR. Preoperative regional leaflet tethering of segment P3 is a strong independent predictor of IMR recurrence after undersized ring annuloplasty. In patients with a preoperative P3 tethering angle ≥29.9° chordal-sparing valve replacement rather than valve repair should be strongly considered. PMID:26688087

  11. Usefulness of three-dimensionally guided assessment of mitral stenosis using matrix-array ultrasound.

    PubMed

    Sebag, Igal A; Morgan, John G; Handschumacher, Mark D; Marshall, Jane E; Nesta, Francesca; Hung, Judy; Picard, Michael H; Levine, Robert A

    2005-10-15

    Two-dimensional (2-D) planimetry is limited by the technical demands, time, and observer variability required to locate the minimal orifice area, limiting the confident clinical reporting of mitral valve area (MVA). In 27 consecutive patients, MVA was determined independently by 2 observers using the conventional 2-D method and a new 3-D-guided method. Using a matrix-array probe, the valve was visualized in a long-axis view and a cursor steered to intersect the leaflet tips and provide a perpendicular short-axis plane viewed side-by-side. Two-dimensional and 3-D-guided methods allowed planimetry in 24 patients. Consistent with better orifice localization, 3-D guidance eliminated the overestimation of internal orifice diameters in the planimetered short-axis view relative to the limiting diameter defined by the long-axis view (for 3-D guidance, 0.73 +/- 0.20 vs 0.73 +/- 0.21 cm, p = 0.98, vs 0.90 +/- 0.27 cm in the 2-D short-axis view, p <0.01). Accordingly, mean values for the smallest orifice area by 3-D guidance were less than by 2-D imaging (1.4 +/- 0.5 vs 1.5 +/- 0.5 cm(2), p <0.01), changing the clinical severity classification in 11 of 24 patients (46%). The 2-D method also overestimated MVA relative to 3-D guidance compared with Doppler pressure halftime and (n = 6) Gorlin areas. Phantom studies verified no differences in resolution for the 2 acquisition modes. Three-dimensional guidance reduced intraobserver variability from 9.8% to 3.8% (SEE 0.14 to 0.06 cm(2), p <0.01) and interobserver variability from 10.6% to 6.1% (SEE 0.15 to 0.09 cm(2), p <0.02). In conclusion, matrix-array technology provides a feasible and highly reproducible direct 3-D-guided method for measuring the limiting mitral orifice area.

  12. Minimally invasive approach for redo mitral valve surgery

    PubMed Central

    Cannata, Aldo; Bruschi, Giuseppe; Fratto, Pasquale; Taglieri, Corrado; Russo, Claudio Francesco; Martinelli, Luigi

    2013-01-01

    Redo cardiac surgery represents a clinical challenge due to a higher rate of peri-operative morbidity and mortality. Mitral valve re-operations can be particularly demanding in patients with patent coronary artery bypass grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, perivalvular leaks, or thrombosis). Risk of graft injuries, hemorrhage, the presence of dense adhesions and complex valve exposure can make redo valve operations challenging through a median sternotomy. In this review article we provide an overview of minimally invasive approaches for redo mitral valve surgery discussing indications, techniques, outcomes, concerns and controversies. Scientific literature about minimally invasive approach for redo mitral surgery was reviewed with a MEDLINE search strategy combining “mitral valve” with the following terms: ‘minimally invasive’, ‘reoperation’, and ‘alternative approach’. The search was limited to the last ten years. A total of 168 papers were found using the reported search. From these, ten papers were identified to provide the best evidence on the subject. Mitral valve reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space termed “mini” thoracotomy or “port access”. The greatest potential benefit of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, avoiding the risk of injury to cardiac structures or patent grafts. Good percentages of valve repair can be achieved. Mortality is low as well as major complications. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of minimally invasive access and continuous myocardial perfusion. Less invasive trans-catheter techniques could be considered as the natural future evolution for management of structural heart disease and mitral reoperations. The safety and

  13. Minimally invasive approach for redo mitral valve surgery.

    PubMed

    Botta, Luca; Cannata, Aldo; Bruschi, Giuseppe; Fratto, Pasquale; Taglieri, Corrado; Russo, Claudio Francesco; Martinelli, Luigi

    2013-11-01

    Redo cardiac surgery represents a clinical challenge due to a higher rate of peri-operative morbidity and mortality. Mitral valve re-operations can be particularly demanding in patients with patent coronary artery bypass grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, perivalvular leaks, or thrombosis). Risk of graft injuries, hemorrhage, the presence of dense adhesions and complex valve exposure can make redo valve operations challenging through a median sternotomy. In this review article we provide an overview of minimally invasive approaches for redo mitral valve surgery discussing indications, techniques, outcomes, concerns and controversies. Scientific literature about minimally invasive approach for redo mitral surgery was reviewed with a MEDLINE search strategy combining "mitral valve" with the following terms: 'minimally invasive', 'reoperation', and 'alternative approach'. The search was limited to the last ten years. A total of 168 papers were found using the reported search. From these, ten papers were identified to provide the best evidence on the subject. Mitral valve reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space termed "mini" thoracotomy or "port access". The greatest potential benefit of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, avoiding the risk of injury to cardiac structures or patent grafts. Good percentages of valve repair can be achieved. Mortality is low as well as major complications. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of minimally invasive access and continuous myocardial perfusion. Less invasive trans-catheter techniques could be considered as the natural future evolution for management of structural heart disease and mitral reoperations. The safety and efficacy of these

  14. The mitral valve prolapse epidemic: fact or fiction.

    PubMed Central

    Lewis, R. P.; Wooley, C. F.; Kolibash, A. J.; Boudoulas, H.

    1987-01-01

    In spite of two decades of research, the precise relationship of anatomic mitral valve prolapse (floppy valve) to the neuroendocrine disorder (MVP syndrome) remains unclear. In all likelihood they are two separate genetic disorders which travel together in some fashion. Mitral valve prolapse is a common disorder but progressive mitral regurgitation usually occurs late in life and in only a few patients. Other complications such as bacterial endocarditis, stroke, and sudden death are far less common but can occur at younger ages. The neuroendocrine syndrome in civilian life is mainly seen in young females (interestingly the peak incidence years correspond to peak female sex hormone output) but can be seen in males when subjected to unusual stress such as military service. More recent echocardiographic studies have questioned whether all prolapsing valves are truly abnormal. It has been shown that echographic prolapse can be produced in normal subjects by reducing venous return and impaired venous return may be present in some patients with the MVP syndrome. However, clicks and murmurs are apparently not heard when normal valves prolapse. It is our opinion that the presence of a click or typical murmur requires some anatomic abnormality of the mitral valve. One wonders if minimal valve abnormality (noted and dismissed by Davies) is the valve abnormality present in many young females with MVP syndrome, and that it may remain a mild abnormality throughout life. Recent psychiatric studies suggest that MVP is present in 30% of patients with Panic Disorder. It is not clear that this psychiatric syndrome is the same thing as the MVP syndrome. In Devereux's study, anxiety proneness was no different in the MVP cohort than in relatives without MVP. It is possible that diagnostic mixing of two similar but separate disorders has occurred, as has been the case since World War I. Perhaps the most important question is whether young patients with MVP syndrome and no

  15. Percutaneous closure of perivalvular mitral regurgitation: how should the interventionalists and the echocardiographers communicate?

    PubMed

    Quader, Nishath; Davidson, Charles J; Rigolin, Vera H

    2015-05-01

    There is considerable interest in percutaneous closure of perivalvular leaks without the need for repeat surgery. Successful percutaneous closure of these defects requires extensive planning and coordination before and during the procedure. However, there is no standardized description of valve pathology in the presence of a prosthetic valve, which adds to the challenge of communication. Transesophageal echocardiography is ideally suited to guide percutaneous mitral valve procedures, because of the proximity of the mitral valve to the esophagus. Successful percutaneous procedures of the mitral valve require teamwork. Both the interventionalist and the echocardiographer must have great familiarity with mitral valve anatomy, structure, and function, and they must know how to effectively communicate with each other. The authors review the relevant periprocedural mapping of the mitral valve and provide guidance to echocardiographers and interventionalists on effective ways to communicate during percutaneous perivalvular mitral leak closures to accomplish a successful outcome. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  16. Degenerative mitral valve disease-contemporary surgical approaches and repair techniques.

    PubMed

    Koprivanac, Marijan; Kelava, Marta; Alansari, Shehab; Javadikasgari, Hoda; Tappuni, Bassman; Mick, Stephanie; Marc, Gillinov A; Suri, Rakesh; Mihaljevic, Tomislav

    2017-01-01

    Given the increasing age of the US population and the accompanying rise in cardiovascular disease, we expect to see an increasing number of patients affected by degenerative mitral valve disease in a more complex patient population. Therefore, increasing the overall rate of mitral valve repair will become even more important than it is today, and the capability to provide a universally and uniformly accepted quality of repair will have important medical, economic, and societal implications. This article will describe preoperative and intraoperative considerations and the currently practiced mitral valve repair approaches and techniques. The aim of the article is to present our contemporary approach to mitral valve repair in the hope that it can be adopted at other institutions that may have low repair rates. Adoption of simple and reproducible mitral valve repair techniques is of paramount importance if we as a profession are to accomplish overall higher rates of mitral valve repair with optimal outcomes.

  17. Degenerative mitral valve disease-contemporary surgical approaches and repair techniques

    PubMed Central

    Kelava, Marta; Alansari, Shehab; Javadikasgari, Hoda; Tappuni, Bassman; Mick, Stephanie; Marc, Gillinov A.; Suri, Rakesh; Mihaljevic, Tomislav

    2017-01-01

    Given the increasing age of the US population and the accompanying rise in cardiovascular disease, we expect to see an increasing number of patients affected by degenerative mitral valve disease in a more complex patient population. Therefore, increasing the overall rate of mitral valve repair will become even more important than it is today, and the capability to provide a universally and uniformly accepted quality of repair will have important medical, economic, and societal implications. This article will describe preoperative and intraoperative considerations and the currently practiced mitral valve repair approaches and techniques. The aim of the article is to present our contemporary approach to mitral valve repair in the hope that it can be adopted at other institutions that may have low repair rates. Adoption of simple and reproducible mitral valve repair techniques is of paramount importance if we as a profession are to accomplish overall higher rates of mitral valve repair with optimal outcomes. PMID:28203540

  18. Noninvasive assessment of the stenotic mitral valve orifice by two-dimensional echocardiography

    PubMed Central

    Jain, Surendra K.; Pechacek, Leonard W.; Decastro, Carlos M.; Garcia, Efrain; Hall, Robert J.

    1981-01-01

    Two-dimensional echocardiographic imaging of the mitral valve orifice was attempted in 26 patients with isolated mitral stenosis. The intention was to examine further the clinical usefulness and limitations of this technique for estimating the severity of mitral stenosis. Technically adequate recordings of the mitral orifice were obtained in 20 patients (77%). Mitral valve area calculated from echocardiography compared favorably to the valve area derived from cardiac catheterization with the use of the Gorlin formula (r = 0.95). The average difference between the two methods was 0.109 cm2. Two-dimensional echocardiography does provide clinically useful data for predicting the degree of mitral stenosis in the majority of patients provided that critical technical limitations are recognized. Images PMID:15216223

  19. Planetary Doppler Imaging

    NASA Astrophysics Data System (ADS)

    Murphy, N.; Jefferies, S.; Hart, M.; Hubbard, W. B.; Showman, A. P.; Hernandez, G.; Rudd, L.

    2014-12-01

    Determining the internal structure of the solar system's gas and ice giant planets is key to understanding their formation and evolution (Hubbard et al., 1999, 2002, Guillot 2005), and in turn the formation and evolution of the solar system. While internal structure can be constrained theoretically, measurements of internal density distributions are needed to uncover the details of the deep interior where significant ambiguities exist. To date the interiors of giant planets have been probed by measuring gravitational moments using spacecraft passing close to, or in orbit around the planet. Gravity measurements are effective in determining structure in the outer envelope of a planet, and also probing dynamics (e.g. the Cassini and Juno missions), but are less effective in probing deep structure or the presence of discrete boundaries. A promising technique for overcoming this limitation is planetary seismology (analogous to helioseismology in the solar case), postulated by Vorontsov, 1976. Using trapped pressure waves to probe giant planet interiors allows insight into the density and temperature distribution (via the sound speed) down to the planetary core, and is also sensitive to sharp boundaries, for example at the molecular to metallic hydrogen transition or at the core-envelope interface. Detecting such boundaries is not only important in understanding the overall structure of the planet, but also has implications for our understanding of the basic properties of matter at extreme pressures. Recent Doppler measurements of Jupiter by Gaulme et al (2011) claimed a promising detection of trapped oscillations, while Hedman and Nicholson (2013) have shown that trapped waves in Saturn cause detectable perturbations in Saturn's C ring. Both these papers have fueled interest in using seismology as a tool for studying the solar system's giant planets. To fully exploit planetary seismology as a tool for understanding giant planet structure, measurements need to be made

  20. The Mitral Valve Prolapsus : Quantification of the Regurgitation Flow Rate by Experimental Time-Dependant PIV

    DTIC Science & Technology

    2007-11-02

    The Mitral Valve Prolapsus : Quantification of the Regurgitation Flow Rate by Experimental Time-Dependant PIV. F. Billy1, D. Coisne1,2, L. Sanchez1... mitral valve insufficiency), assumes that the velocity field in the convergent region have hemispheric shapes and introduce miscalculation specially...upstream a prolaps model of regurgitant orifice based on 2D time dependent PIV reconstruction. Keywords- Mitral Valve , Prolapsus, Regurgitation Flow

  1. Safety and feasibility of a novel adjustable mitral annuloplasty ring: a multicentre European experience†

    PubMed Central

    Andreas, Martin; Doll, Nicolas; Livesey, Steve; Castella, Manuel; Kocher, Alfred; Casselman, Filip; Voth, Vladimir; Bannister, Christina; Encalada Palacios, Juan F.; Pereda, Daniel; Laufer, Guenther; Czesla, Markus

    2016-01-01

    OBJECTIVES Recurrent mitral regurgitation is a significant problem after mitral valve repair in patients with functional valve disease. We report the safety and feasibility of a novel adjustable mitral annuloplasty device that permits downsizing of the anterior–posterior diameter late after initial surgery. METHODS In this multicentre, non-randomized, observational register, patients with moderate or severe mitral regurgitation undergoing surgical mitral valve repair with the MiCardia EnCorSQ™ Mitral Valve Repair system were evaluated. Patient characteristics, operative specifications and results as well as postoperative follow-up were collected for all five centres. RESULTS Ninety-four patients with a median age of 71 (64–75) years (EuroSCORE II 6.7 ± 6.3; 66% male, 48% ischaemic MR, 37% dilated cardiomyopathy and 15% degenerative disease) were included. Operative mortality was 1% and the 1-year survival was 93%. Ring adjustment was attempted in 12 patients at a mean interval of 9 ± 6 months after surgery. In three of these attempts, a technical failure occurred. In 1 patient, mitral regurgitation was reduced two grades, in 2 patients mitral regurgitation was reduced one grade and in 6 patients, mitral regurgitation did not change significantly. The mean grade of mitral regurgitation changed from 2.9 ± 0.9 to 2.1 ± 0.7 (P = 0.02). Five patients were reoperated after 11 ± 9 months (Ring dehiscence: 2; failed adjustment: 3). CONCLUSION We conclude that this device may provide an additional treatment option in patients with functional mitral regurgitation, who are at risk for reoperation due to recurrent mitral regurgitation. Clinical results in this complex disease were ambiguous and patient selection seems to be a crucial step for this device. Further trials are required to estimate the clinical value of this therapeutic concept. PMID:25694471

  2. Assessment of mitral regurgitation in dogs: comparison of results of echocardiography with magnetic resonance imaging.

    PubMed

    Sargent, J; Connolly, D J; Watts, V; Mõtsküla, P; Volk, H A; Lamb, C R; Fuentes, V Luis

    2015-11-01

    Echocardiography is used routinely to assess mitral regurgitation severity, but echocardiographic measures of mitral regurgitation in dogs have not been compared with other quantitative methods. The study aim was to compare echocardiographic measures of mitral regurgitation with cardiac magnetic resonance imaging-derived mitral regurgitant fraction in small-breed dogs. Dogs with myxomatous mitral valve disease scheduled for magnetic resonance imaging assessment of neurological disease were recruited. Correlations were tested between cardiac magnetic resonance imaging-derived mitral regurgitant fraction and the following echocardiographic measures: vena contracta/aortic diameter, transmitral E-wave velocity, amplitude of mitral prolapse/aortic diameter, diastolic left ventricular diameter:aortic diameter, left atrium:aortic diameter, mitral regurgitation jet area ratio and regurgitant fraction calculated using the proximal isovelocity surface area method. Measurement of cardiac magnetic resonance imaging-derived mitral regurgitant fraction was attempted in 21 dogs. Twelve consecutive, complete studies were obtained and 10 dogs were included in the final analysis: vena contracta/aortic diameter (r = 0 · 89, p = 0 · 001) and E-wave velocity (r = 0 · 86, p = 0 · 001) had the strongest correlations with cardiac magnetic resonance imaging-derived mitral regurgitant fraction. E velocity had superior repeatability and could be measured in all dogs. The presence of multiple jets precluded vena contracta/aortic diameter measurement in one dog. Measurement of cardiac magnetic resonance imaging-derived mitral regurgitant fraction is feasible but technically demanding. The echocardiographic measures that correlated most closely with cardiac magnetic resonance imaging-derived mitral regurgitant fraction were vena contracta/aortic diameter and E-wave velocity. © 2015 British Small Animal Veterinary Association.

  3. Mitral valve prolapse with mid-late systolic mitral regurgitation: pitfalls of evaluation and clinical outcome compared with holosystolic regurgitation.

    PubMed

    Topilsky, Yan; Michelena, Hector; Bichara, Valentina; Maalouf, Joseph; Mahoney, Douglas W; Enriquez-Sarano, Maurice

    2012-04-03

    Mitral regurgitation (MR) of mitral valve prolapse predominates in late systole but may be holosystolic or purely mid-late systolic, but the impact of MR timing on MR left ventricular and left atrial consequences and outcome is unknown. Whether effective regurgitant orifice (ERO) by the flow convergence method is similarly linked to outcome in mid-late systolic MR and holosystolic MR is uncertain. We comprehensively and prospectively quantified MR in 111 patients with mitral valve prolapse and mid-late systolic MR and matched them to 90 patients with mitral valve prolapse and holosystolic MR for age, gender, atrial fibrillation, ejection fraction, and ERO (flow convergence). Mid-late systolic MR versus holosystolic MR groups were well matched, including for comorbidity, blood pressure, and heart rate (all P>0.10). Mid-late systolic MR versus holosystolic MR caused similar color jet area, midsystolic regurgitant flow, and peak velocity (P>0.40). Despite identical ERO (0.25±0.15 versus 0.25±0.15 cm(2); P=0.53), the shorter duration of mid-late systolic MR (233±56 versus 426±50 ms; P<0.0001) yielded lower regurgitant volume (24.8±13.4 versus 48.6±25.6 mL; P<0.0001). MR consequences, systolic pulmonary pressure, and left ventricular and left atrial volume index (all P<0.001) were more benign in mid-late systolic MR versus holosystolic MR. Under medical management, fewer cardiac events (5 years: 15.8±4.6% versus 40.4±6.1%; P<0.0001) occurred in mid-late systolic MR versus holosystolic MR, requiring less mitral surgery. Multivariable analysis confirmed the independent association of mid-late systolic MR with benign consequences and outcomes (all P<0.01). Absolute ERO was not linked to outcome, in contrast to regurgitant volume. MR of mitral valve prolapse that is purely mid-late systolic causes more benign consequences and outcomes than holosystolic MR. Assessment may be misleading because jet area and ERO by flow convergence appear similar to those of

  4. The implication of tissue Doppler echocardiography and cardiopulmonary exercise in early detection of cardiac dysfunction in systemic lupus erythematosus patients

    PubMed Central

    Elnady, Basant M.; Abdelghafar, Ayman Saeed Mohamed; Khalik, El Shazly Abdul; Algethami, Mohammed Mesfer; Basiony, A.S.; Al-otaibi, Mona Dhaif Allah; Al-otaibi, Maram Eidhah

    2016-01-01

    Objective Systemic lupus erythematosus (SLE) can present limitations to exercise capacity and quality of life (QoL) because of various clinical conditions, such as pulmonary disease or heart disease. Tissue Doppler echocardiography (TDE) offers the promise of an objective measurement to quantify regional and global ventricular function through the assessment of myocardial velocity data. This study aimed to assess the intensity of left ventricular (LV) and right ventricular (RV) systolic and diastolic dysfunction in SLE patients by means of TDE and cardiopulmonary exercise (CPX) testing to determine their impact on QoL. Material and Methods Overall, 56 SLE patients within two tertiary healthcare centers as well as 50 healthy controls were examined with TDE after the exclusion of cardiovascular risk factors. TDE was performed for maximal systolic (S), early diastolic (E′), and late diastolic (A′) velocities of the mitral and tricuspid annulus. Pulsed wave (PW) Doppler of mitral and tricuspid valve inflow was performed in addition to the estimation of the left ventricle ejection fraction and assessment of right ventricle systolic function by tricuspid annular plane systolic excursion (TAPSE). Disease activity was assessed by the Systemic Lupus Activity Measure (SLAM), and the damage index was assessed by the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). CPX tests according to the modified Bruce protocol were performed. Results SLE patients in both subgroups had more or less similar laboratory data and statistically higher values of ESR, CRP, and anticardiolipin (aCL) antibodies compared to the control group. LV function showed statistically insignificant EF compared to the control group, being lower in the patient group. Tissue Doppler image revealed that E′ and A′ of the mitral annulus were lower in the patient group than in the control group. Concerning RV, TAPSE in the patient group was

  5. The implication of tissue Doppler echocardiography and cardiopulmonary exercise in early detection of cardiac dysfunction in systemic lupus erythematosus patients.

    PubMed

    Elnady, Basant M; Abdelghafar, Ayman Saeed Mohamed; Khalik, El Shazly Abdul; Algethami, Mohammed Mesfer; Basiony, A S; Al-Otaibi, Mona Dhaif Allah; Al-Otaibi, Maram Eidhah

    2016-09-01

    Systemic lupus erythematosus (SLE) can present limitations to exercise capacity and quality of life (QoL) because of various clinical conditions, such as pulmonary disease or heart disease. Tissue Doppler echocardiography (TDE) offers the promise of an objective measurement to quantify regional and global ventricular function through the assessment of myocardial velocity data. This study aimed to assess the intensity of left ventricular (LV) and right ventricular (RV) systolic and diastolic dysfunction in SLE patients by means of TDE and cardiopulmonary exercise (CPX) testing to determine their impact on QoL. Overall, 56 SLE patients within two tertiary healthcare centers as well as 50 healthy controls were examined with TDE after the exclusion of cardiovascular risk factors. TDE was performed for maximal systolic (S), early diastolic (E'), and late diastolic (A') velocities of the mitral and tricuspid annulus. Pulsed wave (PW) Doppler of mitral and tricuspid valve inflow was performed in addition to the estimation of the left ventricle ejection fraction and assessment of right ventricle systolic function by tricuspid annular plane systolic excursion (TAPSE). Disease activity was assessed by the Systemic Lupus Activity Measure (SLAM), and the damage index was assessed by the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). CPX tests according to the modified Bruce protocol were performed. SLE patients in both subgroups had more or less similar laboratory data and statistically higher values of ESR, CRP, and anticardiolipin (aCL) antibodies compared to the control group. LV function showed statistically insignificant EF compared to the control group, being lower in the patient group. Tissue Doppler image revealed that E' and A' of the mitral annulus were lower in the patient group than in the control group. Concerning RV, TAPSE in the patient group was statistically lower than in the control group

  6. Mitral prolapse. A heart anomaly in a clinical neuroendocrine context.

    PubMed

    Parlapiano, C; Paoletti, V; Alessandri, N; Campana, E; Giovanniello, T; Pantone, P; Califano, F; Borgia, M C

    2000-06-01

    Mitral valve prolapse was identified as a separate nosological entity by Barlow in 1963. A characteristic of this cardiac anomaly is blood reflux into the left atrium during the systole owing to the lack of adhesion between valve flaps. The presence of symptoms linked to neuroendocrine dysfunctions or to the autonomic nervous system lead to the onset of the pathology known as mitral valve prolapse syndrome (MVPs). It is usually diagnosed by chance in asymptomatic patients during routine tests. MVPs includes complex alterations to the neurovegetative system and a high clinical incidence of neuropsychiatric symptoms, like anxiety and panic attacks. A neuroendocrine mechanism thought to underlie panic attacks was recently proposed based on a biological model. In general, the cardiovascular anomaly manifested by patients with MVPs could be defined in neuroendocrine-constitutional terms.

  7. Amplatzer Amulet left atrial appendage occluder entrapment through mitral valve.

    PubMed

    González-Santos, Jose María; Arnáiz-García, María Elena; Arribas-Jiménez, Antonio; López-Rodríguez, Javier; Rodríguez-Collado, Javier; Vargas-Fajardo, María del Carmen; Dalmau-Sorlí, María José; Bueno-Codoñer, María Encarnación; Arévalo-Abascal, R Adolfo

    2013-11-01

    We report on a 77-year-old woman in whom percutaneous left atrial appendage (LAA) closure was performed. The patient had a left atrial myxoma resection 3 years previously, and 2 years later, she suffered a transient ischemic attack. Atrial fibrillation was detected and anticoagulation therapy was established. An episode of intracranial bleeding forced interruption of anticoagulation. Thus, percutaneous LAA closure with an Amplatzer Amulet LAA Occluder (St Jude Medical) was proposed. During the procedure, the LAA occluder migrated and became trapped in the mitral valve. Secondary massive mitral regurgitation and hemodynamic instability forced emergent cardiac surgery. Successful removal of the Amplatzer Amulet LAA Occluder was achieved. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  8. Asymptomatic and isolated accessory mitral valve tissue in an adult.

    PubMed

    Hisatomi, Kazuki; Hashizume, Koji; Tanigawa, Kazuyoshi; Miura, Takashi; Matsukuma, Seiji; Yokose, Shogo; Sumi, Mizuki; Eishi, Kiyoyuki

    2016-02-01

    Accessory mitral valve (AMV) tissue is a congenital anomaly that occurs in association with other congenital anomalies, and is an uncommon cause of left ventricular outflow tract obstruction. It is usually detected in early childhood when accompanied by symptoms of obstruction of the left ventricular outflow tract, and is rarely diagnosed in adults. We present a case of a 53-year-old man who was referred to our institution for evaluation of a systolic heart murmur. Echocardiography disclosed a diagnosis of AMV tissue. This case was uncommon because of the lack of severe obstruction of left ventricular outflow, cardiac symptoms, or other cardiac anomalies. We were able to carry out surgical resection of AMV tissue to avert possible progression of aortic insufficiency and the risk of a cerebrovascular embolization. The patient's postoperative course was uneventful, and postoperative echocardiography showed no residual accessory mitral tissue.

  9. The effect of panic attack on mitral valve prolapse.

    PubMed

    Yang, S; Tsai, T H; Hou, Z Y; Chen, C Y; Sim, C B

    1997-12-01

    It has been reported that panic attacks might cause mitral valve prolapse (MVP) via haemodynamic or indirect effects. Such prolapse can be classified as being physiological (benign course) or pathological (poor course). It is therefore important to consider whether panic attacks, as a risk factor for MVP, are associated with its physiological or pathological type. Our study sample consisted of two groups of patients with panic disorder (PD), one having onset within 1 year (n=24) and the other with a history of more than 10 years (n=21). Demographic data, symptom presentations, auscultatory and echocardiographic findings of both groups were compared, but no significant difference was found except with regard to anticipatory anxiety. It is concluded that panic attack exerts no significant effect on mitral valve prolapse.

  10. [Left Ventricular Rupture during Both Mitral and Aortic Valve Replacements].

    PubMed

    Kurumisawa, Soki; Aizawa, Kei; Takazawa, Ippei; Sato, Hirotaka; Muraoka, Arata; Ohki, Shinnichi; Saito, Tsutomu; Kawahito, Koji; Misawa, Yoshio

    2015-05-01

    A 73-year-old woman on hemodialysis was transferred to our hospital for surgical treatment of heart valve disease. She required both mitral and aortic valve replacement with mechanical valves, associated with tricuspid annuloplasty. After aortic de-clamping, a massive hemorrhage from the posterior atrioventricular groove was observed. Under repeated cardiac arrest, the left atrium was reopened, the implanted mitral prosthetic valve was removed and a type I left ventricular rupture (Treasure classification) was diagnosed. The lesion was directly repaired with mattress stitches and running sutures, using reinforcement materials such as a glutaraldehyde-treated bovine pericardium. To avoid mechanical stress by the prosthetic valve on the repaired site, a mechanical valve was implanted using a translocation method. The patient suffered from aspiration pneumonia and disuse atrophy for 3 months. However, she was doing well at 1 year post-operation.

  11. Beating heart mitral valve repair with integrated ultrasound imaging

    NASA Astrophysics Data System (ADS)

    McLeod, A. Jonathan; Moore, John T.; Peters, Terry M.

    2015-03-01

    Beating heart valve therapies rely extensively on image guidance to treat patients who would be considered inoperable with conventional surgery. Mitral valve repair techniques including the MitrClip, NeoChord, and emerging transcatheter mitral valve replacement techniques rely on transesophageal echocardiography for guidance. These images are often difficult to interpret as the tool will cause shadowing artifacts that occlude tissue near the target site. Here, we integrate ultrasound imaging directly into the NeoChord device. This provides an unobstructed imaging plane that can visualize the valve lea ets as they are engaged by the device and can aid in achieving both a proper bite and spacing between the neochordae implants. A proof of concept user study in a phantom environment is performed to provide a proof of concept for this device.

  12. [Mitral valve replacement in a patient with Sheehan's syndrome].

    PubMed

    Morokuma, H; Nakayama, Y; Minematsu, N

    2008-09-01

    Sheehan' syndrome is caused by pituitary apoplexy occurring during parturition and results in hypopituitarism, adrenal insufficiency and hypothyroidism. A 66-year-old woman with Sheehan's syndrome had received corticosteroids and thyroid hormones for about 18 years. The patient underwent mitral valve replacement for mitral regurgitation. Intraoperatively, just after the initiation of cardiopulmonary bypass, hypotension and severe edema suddenly occurred. Crystalloid fluid was rapidly administered to increase intravascular volumes. Postoperatively the body weight increased by 9.4 kg. The patient was intubated for 64 hours, stayed in the intensive care unit (ICU) for 7 days and was discharged from hospital on the postoperative day 36. Careful perioperative hormone supplementation is necessary for patients with Sheehan's syndrome.

  13. Effects of increasing flow rate on aortic stenotic indices: evidence from percutaneous transvenous balloon dilatation of the mitral valve in patients with combined aortic and mitral stenosis.

    PubMed Central

    Lee, T. M.; Su, S. F.; Chen, M. F.; Liau, C. S.; Lee, Y. T.

    1996-01-01

    OBJECTIVES: To investigate the effects of transvalvar flow rate on aortic valve resistance and valve area after percutaneous transvenous balloon dilatation of the mitral valve in a homogeneous group of patients with rheumatic heart disease. DESIGN: Retrospective analysis of 12 patients with combined aortic and mitral stenosis who had undergone balloon dilatation of the mitral valve over a period of 9 years. SETTING: Tertiary referral centre. PATIENTS: Twelve (8 women, 4 men; mean (SD) age 37 (9) of 227 consecutive patients with critical mitral stenosis undergoing transvenous balloon dilation of the mitral valve in the centre also had aortic stenosis, defined as a transaortic pressure gradient of more than 25 mm Hg measured at a catheterisation study before valvuloplasty. INTERVENTIONS: Echocardiographic variables (mitral valve area measured by the pressure half-time method and planimetry, and the aortic valve area derived from the continuity equation) and haemodynamic measurements (cardiac output, left ventricular mean systolic pressure, aortic mean pressure, transaortic valve pressure gradient, mitral valve and aortic valve areas derived from the Gorlin formula, and aortic valve resistance) were assessed before and after transvenous balloon dilatation of the mitral valve. Follow up catheterisation to measure haemodynamic variables was performed one week after mitral valvuloplasty. RESULTS: Mean transaortic flow rate increased 33% after mitral valvuloplasty (from 198 (68) to 254 (41) ml/s, P = 0.002). Aortic valve areas derived from the Gorlin formula were significantly increased from 0.57 (0.12) to 0.73 (0.14) cm2 (P = 0.006) after mitral valvuloplasty. However, aortic valve area and valve resistance derived from the continuity equation were independent of the increase in flow rate after mitral valvuloplasty (from 1.29 (0.35) to 1.30 (0.29) cm2 and from 317 (65) to 259 (75) dyn.s.cm-5, both P = NS). CONCLUSION: The Gorlin-derived aortic valve area tends to be flow

  14. Differential Doppler as a diagnostic

    SciTech Connect

    Dzieciuch, M.; Munk, W. )

    1994-10-01

    Differential Doppler compression and travel time of individual peaks in the arrival sequence (relative to an overall average) are measured for the 5500-km acoustic transmissions from a moving source at Heard Island to Christmas (Crab) Island. The differentials cannot be explained by simple adiabatic propagation models. A hybrid theory, coupling polar and temperate models at the Antarctic Front can account for some of the qualitative features. Differential Doppler could be a useful tool for identifying ray arrivals. 10 refs., 11 figs., 3 tabs.

  15. Continuous wave ultrasonic Doppler tomography

    PubMed Central

    Liang, Haidong-Dong; Tsui, Chun Sing Louis; Halliwell, Michael; Wells, Peter N. T.

    2011-01-01

    In continuous wave ultrasonic Doppler tomography (DT), the ultrasonic beam moves relative to the scanned object to acquire Doppler-shifted frequency spectra which correspond to cross-range projections of the scattering and reflecting structures within the object. The relative motion can be circular or linear. These data are then backprojected to reconstruct the two-dimensional image of the object cross section. By using coherent processing, the spatial resolution of ultrasonic DT is close to an order of magnitude better than that of traditional pulse-echo imaging at the same ultrasound frequency. PMID:22866236

  16. Disc erosion in Models 103 and 104 of Beall mitral valve prostheses

    PubMed Central

    Gómez, Ricardo; Verduras, María José; Lopez-Quintana, Alfonso; Riera, Luis; Zerolo, Ignacio; Martinez-Bordiu, Cristóbal

    1981-01-01

    T