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Anterior Leaflet (anterior + leaflet)

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Medical Sciences	100%

Selected Abstracts

Reference Values Describing the Normal Mitral Valve and the Position of the Papillary Muscles

ECHOCARDIOGRAPHY, Issue 7 2007
Petrus Nordblom M.Sc.
In patients with functional mitral regurgitation (MR), the principal mechanisms are insufficient coaptation due to dilatation of the mitral annulus (MA), global ventricular dysfunction with tethering of leaflets, or restricted leaflet motion with incorrect apposition due to regional ventricular dysfunction and displacement of the papillary muscles (PMs). These different entities often coexist and for this reason, knowledge of the normal reference values describing the shape and size of the MA and the position of the PMs is essential. In the present study, we describe the MA dimensions and the position of the PMs in a group of normal individuals (n = 38, 60% women, age [mean ± SD] 51 ± 9 years and BSA 1.83 ± 0.16 m2) investigated with transthoracic echocardiography. The anteroposterior dimension (AP) of the ellipse-shaped MA was measured in a parasternal long axis, while the distance from the posteromedial (PoM) to the anterolateral (AL) commissure was measured in a parasternal short axis (CC). The annular area was calculated assuming elliptic geometry. The MA shape was described by the ratios AP/CC and AP/length of the anterior leaflet. The PMs' position was described by the following distances: (a) from the MA to the tip of the PoM and AL, PMs measured in a modified two-chamber view where both PMs could be identified, (b) the interpapillary distance, and (c) the tethering distance from the tip of the PM to the contralateral MA. These data on the normal mitral valve morphology should provide useful information when assessing the underlying mechanism of functional MR. [source]

Posttraumatic Tricuspid Insufficiency Successfully Repaired by Conventional Technique

JOURNAL OF CARDIAC SURGERY, Issue 4 2005
Ph.D., Shoh Tatebe M.D.
Preoperative echocardiography showed severe tricuspid insufficiency (TI) caused by chordal rupture and prolapse of the anterior leaflet. A novel repair technique, the "clover technique," was applied, but was unsuccessful in this case. The valve was then repaired successfully using conventional techniques, that is, insertion of an artificial chordae, plication of the prolapsing leaflet, and DeVega's annuloplasty. We present here a brief review of posttraumatic TI, and discuss effective and less expensive techniques for repair. [source]

Echocardiographic Evaluation of a TASER-X26 Application in the Ideal Human Cardiac Axis

ACADEMIC EMERGENCY MEDICINE, Issue 9 2008
Jeffrey D. Ho MD
Abstract Objectives:, TASER electronic control devices (ECDs) are used by law enforcement to subdue aggressive persons. Some deaths temporally proximate to their use have occurred. There is speculation that these devices can cause dangerous cardiac rhythms. Swine research supports this hypothesis and has reported significant tachyarrhythmias. It is not known if this occurs in humans. The objective of this study was to determine the occurrence of tachyarrhythmias in human subjects subjected to an ECD application. Methods:, This was a prospective, nonblinded study. Human volunteers underwent limited echocardiography before, during, and after a 10-second TASER X26 ECD application with preplaced thoracic electrodes positioned in the upper right sternal border and the cardiac apex. Images were analyzed using M-mode through the anterior leaflet of the mitral valve for evidence of arrhythmia. Heart rate (HR) and the presence of sinus rhythm were determined. Data were analyzed using descriptive statistics. Results:, A total of 34 subjects were enrolled. There were no adverse events reported. The mean HR prior to starting the event was 108.7 beats/min (range 65 to 146 beats/min, 95% CI = 101.0 to 116.4 beats/min). During the ECD exposure, the mean HR was 120.1 beats/min (range 70 to 158 beats/min, 95% CI = 112.2 to 128.0 beats/min) and a mean of 94.1 beats/min (range 55 to 121 beats/min, 95% CI = 88.4 to 99.7 beats/min) at 1 minute after ECD exposure. Sinus rhythm was clearly demonstrated in 21 (61.7%) subjects during ECD exposure (mean HR 121.4 beats/min; range 75 to 158 beats/min, 95% CI = 111.5 to 131.4). Sinus rhythm was not clearly demonstrated in 12 subjects due to movement artifact (mean HR 117.8 beats/min, range 70 to 152 beats/min, 95% CI = 102.8 to 132.8 beats/min). Conclusions:, A 10-second ECD exposure in an ideal cardiac axis application did not demonstrate concerning tachyarrhythmias using human models. The swine model may have limitations when evaluating ECD technology. [source]

Repair of Flail Leaflet of the Tricuspid Valve by a Simple Cusp Remodeling Technique

JOURNAL OF CARDIAC SURGERY, Issue 4 2007
Xiubin Yang M.D.
We try to present an alternative method and midterm results. Methods: Between April 1997 and December 2004, eight patients (5 males, 3 females; mean age 23.9 ± 5.8 years; range: 8 to 57 years) with severe tricuspid regurgitation (congenital lack of chordae in 5 cases and traumatic rupture of chordae in 3 cases) underwent surgical repair at Fu Wai Hospital. Four patients were in NYHA (New York Heart Association) class III, and 4 in class IV. Eight flail anterior leaflets and one flail septal leaflet of the tricuspid valve with massive tricuspid regurgitation were identified by echocardiography and the spaces of the free edges of the flail leaflets ranged from 20 to 30 mm. Tricuspid repair was performed under hypothermic cardiopulmonary bypass. The free edge of the affected cusp segment was sutured in folio, the segment of annulus devoid of leaflet was plicated, and the neo-annulus was fixed with a flexible annuloplasty ring. Results: All patients survived and recovered after the operation. Echocardiography showed good coaptation with no regurgitation of the tricuspid valve in five patients and a mild residual tricuspid regurgitation in three patients. A remarkable decrease in the diameter of the right ventricle was observed, from a mean of 42.6 ± 12.5 mm to a mean of 23.6 ± 5.3mm (p < 0.01). Mean follow up was 50 ± 42.9 months. Six patients were in NYHA class I, and two in class II and III. Except for one patient who had a mild-to-moderate increase in tricuspid regurgitation a year later, all the other patients were doing well. Conclusion: The procedure provided a simple and valuable option for repair of flail leaflet of tricuspid valve caused by congenital lack of chordae or traumatic rupture of chordae. [source]