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Regurgitation
Kinds of Regurgitation Selected AbstractsEFFECT OF PARAPROSTHETIC MODERETE TO SEVERE MITRAL REGURGITATION ON EMBOLIC EVENTS IN PATIENTS WITH PROSTHETIC MITRAL VALVESECHOCARDIOGRAPHY, Issue 5 2004C. Cevik Thromboembolism is the major chronic risk for patients with mechanical prosthetic heart valves. Although optimal oral anticoagulantion is the key determinant for embolic events (EE) in these patients; other factors also contribute to this complication. We studied the prevalence and determinants of embolic events in patients with mitral prosthetic heart valves undergoing transesophageal echocardiography (TEE). 210 patients (86 male and 124 female, mean age 45.1 +/, 9.6 years) underwent a TEE study for evaluation of prosthetic valve functions. Clinical and TEE findings of the patients were as follows: Atrial fibrillation in 132 (%62) patients, prosthetic valve thrombus in 55 (%26) suboptimal INR (INR < 1.8) in 61 (%29) pts, left atrial spontenous echocardiographic contrast (SEC) in 31 (%14) patients, paraprosthetic moderete-severe mitral regurgitation (MR) in 28 (%13), left atrial (LA) and/or left atrial appendix (LAA) thrombus in 41 (%19), LA and/or LAA outflow velocities <0.25 m/sn in 21 patiens (%10), left atrial diameter >6 cm in 47 (%22). 72 patients had a history of EE in the previous 6 months (%34). In no patients were there any EE in the presence of paraprosthetic moderate to severe MR. Both with univariate and multivariate analysis presence of prosthetic valve and LA and/or LAA thrombus, absence of paraprosthetic moderete-severe MR, suboptimal INR, atrial fibrillation were found to be independent predictors for embolic events. Conclusions: Although the presence of prosthetic valve and LA and/or LAA thrombus, suboptimal INR, and AF predict EE, clinical and echocardiographic data support the protective effect of paraprosthetic moderate to severe MR against EE in pts with mitral prosthetic valves. [source] 3 ISCHEMIC MITRAL VALVE REPAIR: THE IMPACT OF THE MECHANISM OF MITRAL REGURGITATION ON LATE POSTOPERATIVE RESULTSECHOCARDIOGRAPHY, Issue 1 2004E. Ereminien Aim: The aim of our study was to establish the anatomical-functional mechanisms of ischemic mitral regurgitation (MR) and to analyse its impact on late results after mitral valve (MV) reconstructive surgery. Methods: The study included 53 patients with ischemic MR, who underwent CABG and MV repair. MV surgery consisted of subvalvular apparatus repair and/or annuloplasty. 2D Doppler investigations performed pre-, 10,14 days, and 12 months after surgery included evaluation of MV and left ventricular (LV) geometry and function. Results: Analysis of the mechanisms of ischemic MR permitted dividing patients into two groups: group 1,29 patients with inferobasal scar and posterior papillary muscle (PM) displacement, including 22 patients with PM infarction and 7 patients without it, and group 2,24 patients with isolated mitral annulus (MA) dilation. In the case of PM infarction two different mechanisms of MR were stated: (a) P3 restriction and A3 prolapse due to chordal tethering, (b) A3 P3 (commissural) prolapse due to chordal papillary elongation. Preoperatively LV geometry and function were better preserved in group 1 and late MV repair results were better versus (vs.) group 2: LV end-systolic diameter index decreased from 22.9 ± 3.1 mm/m2 to 20.9 ± 3.6 mm/m2 at 1 year, p < 0.05, LV ejection fraction increased from 34.9 ± 8.4 to 41.8 ± 8.1%, respectively, p < 0.05. No significant changes in LV geometry and function were noted in group 2. Conclusions: The underlying mechanism of ischemic MR has an impact on MV repair results. In patients with MR due to posterobasal infarction MV repair resulted in more favorable postoperative effect-marked improvement in LV geometry and function late after surgery versus MR due to isolated MA dilation. [source] Pulmonary Regurgitation after Tetralogy of Fallot Repair: Clinical Features, Sequelae, and Timing of Pulmonary Valve ReplacementCONGENITAL HEART DISEASE, Issue 6 2007Naser M. Ammash MD ABSTRACT Pulmonary regurgitation following repair of tetralogy of Fallot is a common postoperative sequela associated with progressive right ventricular enlargement, dysfunction, and is an important determinant of late morbidity and mortality. Although pulmonary regurgitation may be well tolerated for many years following surgery, it can be associated with progressive exercise intolerance, heart failure, tachyarrhythmia, and late sudden death. It also often necessitates re-intervention. Identifying the appropriate timing of such intervention could be very challenging given the risk of prosthetic valve degeneration and the increased risk of reoperation. Comprehensive informed and regular assessment of the postoperative patient with tetralogy of Fallot, including evaluation of pulmonary regurgitation, right heart structure and function, is crucial to the optimal care of these patients. Pulmonary valve replacement performed in an experienced tertiary referral center is associated with low operative morbidity and mortality and very good long-term results. Early results of percutaneous pulmonary valve replacement are also promising. [source] Vascular endothelial growth factor receptor signaling is required for cardiac valve formation in zebrafishDEVELOPMENTAL DYNAMICS, Issue 1 2006You Mie Lee Abstract Vascular endothelial growth factor-receptors (VEGF-Rs) are pivotal regulators of vascular development, but a specific role for these receptors in the formation of heart valves has not been identified. We took advantage of small molecule inhibitors of VEGF-R signaling and showed that blocking VEGF-R signaling with receptor selective tyrosine kinase inhibitors, PTK 787 and AAC 787, from 17,21 hr post-fertilization (hpf) in zebrafish embryos resulted in a functional and structural defect in cardiac valve development. Regurgitation of blood between the two chambers of the heart, as well as a loss of cell-restricted expression of the valve differentiation markers notch 1b and bone morphogenetic protein-4 (bmp - 4), was readily apparent in treated embryos. In addition, microangiography revealed a loss of a definitive atrioventricular constriction in treated embryos. Taken together, these data demonstrate a novel function for VEGF-Rs in the endocardial endothelium of the developing cardiac valve. Developmental Dynamics 235:29,37, 2006. © 2005 Wiley-Liss, Inc. [source] CASE REPORTS: Trepopnea Associated with Paroxysmal Severe Tricuspid Regurgitation Triggered at Left Lateral Decubitus PositionECHOCARDIOGRAPHY, Issue 8 2010David Wolf M.D. A 78-year-old male patient was referred cardiovascular risk evaluation before elective resection of a bronchial carcinoma. A myocardial infarction with a subsequent coronary artery bypass revascularization and a mitral prosthetic valve surgery were known. Left lateral decubitus (LLD) was permanently avoided because of significant trepopnea since several years. No signs of heart failure were found in the physical examination. A mitral valve prosthesis presented normal characteristics at examination. Left ventricular dimensions and function were normal. A severe tricuspid regurgitation could be documented during examination in the LLD, with changing characteristics in dorsal decubitus, when it could be graded as moderate. Trepopnea associated with severe paroxysmal tricuspid regurgitation was never described before in the literature. Sympathetic/parasympathetic modulation of papillary muscles of the tricuspid valve can be proposed as a probable cause of this dynamic valvular dysfunction. (Echocardiography 2010;27:E77-E79) [source] Grading Functional Mitral Regurgitation by Tissue Doppler,Derived Isovolumic Acceleration Parameters in Patients with Nonischemic Dilated CardiomyopathyECHOCARDIOGRAPHY, Issue 7 2010Tansu Karaahmet M.D. Functional mitral regurgitation (FMR) is relatively common in heart failure and it is associated with adverse prognosis. The severity of FMR is usually assessed by echocardiography. Tissue Doppler echocardiography is used to acquire signals to determine the myocardial systolic functional parameters, including systolic ejection velocity and the systolic isovolumic acceleration (IVAs) rate. We investigated the utility of isovolumic acceleration parameters to grade the severity of FMR in nonischemic dilated cardiomyopathy (DC) patients. We analyzed the left ventricular systolic IVA rate, systolic isovolumic contraction (IVCs) velocity, and IVA duration (IVAd) values in 73 patients with DC. Patients were subgrouped according to FMR grade (Group I = mitral regurgitation mild and moderate; Group II = mitral regurgitation severe). IVAs was similar between two groups; however IVCs and IVAd were significantly higher in Group II than Group I. The IVCs cutoff value to predict severe FMR was 1.2 cm/sec (sensitivity 75% and specificity 70%). The IVAd cutoff value to predict severe FMR was 33 ms (sensitivity 77% and specificity 77%). Patients with IVCs , 1.2 cm/sec and IVAd , 33 ms had significantly higher FMR volume than the other subgroups. IVCs and IVAd values are useful to determine FMR severity in patients with DC. (Echocardiography 2010;27:815-822) [source] Tricuspid Regurgitation after Orthotopic Heart TransplantationECHOCARDIOGRAPHY, Issue 1 2010Nishant Kalra M.D. Background: Tricuspid regurgitation (TR) is a relatively common abnormality in normal adults as well as after orthotopic heart transplantation (OHT). A few studies have shown reduction in the incidence of TR after OHT by total bicaval surgical anastomosis technique. Other studies reported no significant difference in the rates of TR between the standard and bicaval techniques. Objective: Evaluate and compare the degree of TR after OHT by standard and bicaval anastomosis techniques. Method: Echocardiograms from the first 56 consecutive patients that had the total bicaval surgical technique performed were retrospectively reviewed and compared with the last 57 consecutive patients who had the standard biatrial technique performed. Patients with adequate two-dimensional and Doppler echocardiograms were included. Results: No statistical difference was observed for each grade of TR at both early and late time points. No significant difference was observed between the TR velocities of both biatrial and bicaval anastomosis patients at different periods. Conclusion: There appears to be no difference between the TR severity and TR velocity at early and late time points regardless of anastomotic technique. (Echocardiography 2010;27:1-4) [source] Mitral Regurgitation Associated with Mitral Annular Dilation in Patients with Lone Atrial Fibrillation: An Echocardiographic StudyECHOCARDIOGRAPHY, Issue 8 2009Takashi Kihara M.D. Background: Whether and how lone atrial fibrillation (AF) is associated with functional mitral regurgitation (MR) remain unclear. Method: We studied 12 lone AF patients without left ventricular (LV) dysfunction and/or dilatation, who underwent mitral valve annuloplasty for functional mitral regurgitation (MR). Ten lone AF patients without MR served as controls. Results: Lone AF Patients with MR had a greater mitral valve annular area and left atrial area than those without MR. There were no differences in LV volumes or LV ejection fraction. Conclusions: Therefore, we concluded that left atrial dilation and corresponding mitral annular dilation may cause MR in lone AF patients without LV dysfunction and/or dilatation. [source] Worsening of Left Ventricular End-Systolic Volume and Mitral Regurgitation without Increase in Left Ventricular Dyssynchrony on Acute Interruption of Cardiac Resynchronization TherapyECHOCARDIOGRAPHY, Issue 7 2009Suman S. Kuppahally M.D. Background: Responders to cardiac resynchronization therapy (CRT) have greater left ventricular (LV) dyssynchrony than nonresponders prior to CRT. Aim: We conducted this study to see whether the long term responders have more worsening of LV dyssynchrony and LV function on acute interruption of CRT. Materials and Methods: We identified 22 responders and 13 nonresponders who received CRT as per standard criteria for 23.73 ± 7.9 months (median 24.5 months). We assessed the acute change in LV function, mitral regurgitation (MR) and compared LV dyssynchrony in CRT on and off modes. Results: On turning off CRT, there was no significant worsening of LV dyssynchrony in both responders and nonresponders. The dyssynchrony measurements by SPWMD, TDI and 3D echocardiography did not correlate significantly. LVESV increased (p = 0.02) and MR (p = 0.01) worsened in CRT-off mode in responders only without significant change in LVEF or LV dimensions. Discussion and Conclusion: In long-term responders to CRT, there is alteration in the function of remodeled LV with acute interruption of CRT, without significant worsening of LV dyssynchrony. The role of different echocardiographic parameters in the assessment of LV dyssynchrony remains controversial. Even after long-term CRT reversely remodels the LV, the therapy needs to be continued uninterrupted for sustained benefits. [source] Prosthetic Valve Dysfunction Presenting as Intermittent Acute Aortic RegurgitationECHOCARDIOGRAPHY, Issue 8 2008Dali Fan M.D., Ph.D. We describe the case of a 43 year old man with a history of aortic stenosis, for which he had undergone aortic valve replacement in 1991 with a 25-mm Medtronic Hall prosthesis. He presented with several acute episodes of dyspnea and flash pulmonary edema. Transthoracic and transesophageal echocardiography performed to evaluate prosthetic valve function revealed evidence of "intermittent" episodes of AI, documented on color M-mode flow mapping to have a variable duration of diastolic flow (early vs. pandiastolic) across the left ventricular outflow tract and the pulse wave Doppler in the descending thoracic aorta showed similar variability in the duration of diastolic flow reversal. [source] Relationship between Left Ventricular Geometry and Left Ventricular Systolic and Diastolic Functions in Patients with Chronic Severe Aortic RegurgitationECHOCARDIOGRAPHY, Issue 6 2008Murat Çayli M.D. Background: Chronic aortic regurgitation (AR) is a form of volume overload inducing left ventricle (LV) dilatation. Myocardial fibrosis, apoptosis, progressive LV dilatation, and eventually LV dysfunction are seen with the progression of disease. The aim of the study was to assess the relation between LV geometry and LV systolic and diastolic functions in patients with chronic severe AR. Methods: The study population consisted of 88 patients with chronic severe AR and 42 healthy controls. The LV ejection fraction (LVEF) was calculated. Subjects were divided as Group I (controls, n = 42), Group II (LVEF > 50%, n = 47), and Group III (LVEF < 50%, n = 41). Transmitral early and late diastolic velocities and deceleration time were measured. The annular systolic (Sa) and diastolic (Ea and Aa) velocities were recorded. Diastolic function was classified as normal, impaired relaxation (IR), pseudonormalization (PN), and restrictive pattern (RP). Results: The LVEF was similar in Group I and II, while significantly lower in Group III. Sa velocity was progressively decreasing, but LV long- and short-axis diameters were increasing from Group I to Group III. Forty-six, 31 and 11 patients had IR, PN, and RP, respectively. LV long-axis systolic and diastolic diameters were significantly increasing, while LVEF and Sa velocity were significantly decreasing from patients with IR to patients with RP. The LV long-axis diastolic diameter is independently associated with LV systolic and diastolic functions. Conclusions: The LV long-axis diastolic diameter is closely related with LV systolic and diastolic functions in patients with chronic severe AR. [source] Local Dysfunction and Asymmetrical Deformation of Mitral Annular Geometry in Ischemic Mitral Regurgitation: A Novel Computerized 3D Echocardiographic AnalysisECHOCARDIOGRAPHY, Issue 4 2008Masao Daimon M.D. Objective: Most studies of the pathogenesis of functional mitral regurgitation (MR) have focused on alterations in ventricular function and geometry. We used a novel 3D echocardiographic method to assess abnormalities in mitral annular (MA) geometry and motion in patients with ischemic MR (IMR) and compared these data to those obtained from normal subjects and from patients with MR caused by dilated cardiomyopathy (DMR). Methods: Real time 3D echo was performed in 12 normal subjects, 25 with IMR, and 14 with DMR. Eight points along the saddle-shaped MA were identified using our software at systole and diastole. From these eight points, four annular diameters at each cardiac phase were determined. Annular motion was assessed by measuring local displacement (LD) of a given point between systole and diastole. Results: Annular motion was different between groups: IMR had smaller LD in posterior MA segments than did normals (2.6 ± 1.1 vs 4.8 ± 1.9 mm, P < 0.01), while DMR had globally reduced LD. In IMR systolic MA dilatation was striking in the anterior,posterior (diameter; IMR vs controls, 28.3 ± 3.5 vs 22.5 ± 2.2 mm, P< 0.05) and anterolateral,posteromedial (31.7 ± 3.5 vs 25.1 ± 2.2 mm, P < 0.05) directions; in IMR, systolic MA diameters in these two directions correlated with MR severity(P = 0.02). MA dilatation occurred globally in DMR. Conclusion: This novel 3D echo method demonstrated that MA motion and dilatation were asymmetric in IMR and symmetric in DMR. These differences in MA geometry and motion may aid in the development of distinct new therapies for IMR and DMR. [source] A Larger Aortic Annulus Causes Aortic Regurgitation and a Smaller Aortic Annulus Causes Aortic Stenosis in Bicuspid Aortic ValveECHOCARDIOGRAPHY, Issue 3 2008Makoto Sonoda M.D. A bicuspid aortic valve (BAV) often causes aortic stenosis (AS) or regurgitation (AR). In 54 patients with a BAV (48 ± 16 years), transthoracic and transesophageal echo were performed to measure aortic annulus diameter (AAD), to evaluate the severity of aortic valve disease (AVD) and to calculate the area eccentricity index (AEI) of a BAV defined as a ratio of the larger aortic cusp area to a smaller aortic cusp area. By multiple linear regression analysis, the severity of AR correlated significantly with the AAD (r = 0.38) and AEI (r = 0.35) (P < 0.05) and that of AS correlated significantly with the AAD (r =,0.40) and AEI (r = 0.34) (P < 0.05). Thirty-six patients showed anteroposteriorly (A-P) located BAVs and 18 patients showed right-left (R-L) located BAVs. The AAD was larger in A-P type than in R-L type (15 ± 3 vs 13 ± 2 mm/BSA, P < 0.05) and there was no difference in the age and AEI between the two groups. AR was more severe in A-P type than in R-L type while AS was more severe in R-L type than in A-P type (P < 0.05). Twenty-nine patients showed raphes. The AEI was larger in raphe (+) type than in raphe (,) type (1.83 ± 0.53 vs 1.51 ± 0.47, P < 0.05) and there was no difference in the AAD and severity of AVD between the two groups. In conclusion, a BAV with larger aortic annulus or A-P located will tend to cause AR while a BAV with smaller aortic annulus or R-L located will tend to cause AS. [source] A New Echocardiographic Index for Assessing Left Ventricular Function and Mechanism of Mitral Regurgitation and Its Relation to Other Echocardiographic IndicesECHOCARDIOGRAPHY, Issue 6 2007Cemal Sag M.D. Objective: Mitral regurgitation (MR) is a progressive disease of the mitral valve, which can be primary or functional. The assessment of left ventricular function in MR is still troublesome. In this study, we evaluated the validity of a new parameter, total dt, in patients with MR. Methods: Forty patients with severe MR constituted the study group. According to the transesophageal echocardiographic evaluation, the patients were dichotomized into two groups: (1) Primary MR; n = 21, (2) Functional MR; n = 19. The total dt was defined as the sum of time intervals from 1 msto 3 ms (positive dt) and from 3 ms to 1 ms (negative dt) on the CW Doppler recording of MR jet. It was compared to other indices of left ventricular function and left ventricular geometry, including ejection fraction, fractional shortening, myocardial performance index, coaptation distance, left ventricular volume and diameter, sphericity index, and parameters of diastolic function. Result: The total dt correlated with myocardial performance index, coaptation distance, and sphericity index. It could differentiate between primary and functional MR with an area under curve of 0.878, followed by myocardial performance index with 0.860. The total dt > 104 ms was 79% sensitive and 81% specific for discrimination. Conclusion: The total dt is useful for assessing left ventricular function and also for differentiating primary MR from functional MR. [source] Color M-Mode Regurgitant Flow Propagation Velocity: A New Echocardiographic Method for Grading of Mitral RegurgitationECHOCARDIOGRAPHY, Issue 9 2005Ramazan Akdemir M.D. Purpose: The aim of this study was to evaluate the reliability of mitral regurgitation color M-mode regurgitant flow propagation velocity (RFPV) in grading mitral regurgitation (MR).Methods: We prospectively examined 52 consecutive patients with grades of MR mild in 10 patients, moderate in 19 patients, and severe in 23 patients with quantitative pulse Doppler echocardiography. MR was evaluated by vena contracta diameter (VCD), regurgitant jet area (RJA), and RFPV. These qualitative and quantitative methods were compared with the pulsed Doppler quantitative flow measurements and concordance of these three methods was determined.Results: The mean RFPV for mild, moderate, and severe MR were 26.4 ± 7 cm/sec, 43.3 ± 7 cm/sec, and 60.3 ± 7.3 respectively (P < 0.001). RFPV is highly sensitive and moderately specific in differentiating mild and severe MR from other subgroups. Sensitivity and specificity were 92.1%,64.3% for mild and 100%,68.5% for severe MR, respectively. Significant correlation was observed between pulse Doppler quantitative grades, RFPV, VC, and RJA (P < 0.0001, r = 0.87; P < 0.0001, r =,0.84; P < 0.0001, r = 0.76, respectively).Conclusion: This results show that RFPV is a reliable and simple semiquantitative new method that can be used for determining severity of MR. [source] Elongation Index as a New Index Determining the Severity of Left Ventricular Systolic Dysfunction and Mitral Regurgitation in Patients with Congestive Heart FailureECHOCARDIOGRAPHY, Issue 7 2005Mehmet Yokusoglu M.D. The shape of the left ventricle is an important echocardiographic feature of left ventricular dysfunction. Progression of the mitral regurgitation and consequent left ventricular remodeling is unpredictable in heart failure. Elongation index is an index of left ventricular sphericity. The surface area of the elongated ventricle is larger than that of a spherical one. The objective of this study was to assess the relation between elongation index and the degree of mitral regurgitation along with noninvasive indices of left ventricular function. Thirty-two patients (21 male, 11 female, mean age: 57 ± 6 yrs) with congestive heart failure and mitral regurgitation were included. Patients were stratified into three groups according to vena contracta width as having mild (n = 11), moderate (n = 11) and severe mitral regurgitation (n = 10). The elongation index (EI) was considered as equal to {[(left ventricular internal area-measured) , (theoretical area of the sphere with measured left ventricular volume)]/(theoretical area of the sphere with measured left ventricular volume)}. Ejection fractions by the modified Simpson rule, dP/dt and sphericity index (SI) were also recorded. The relationship between (EI), ejection fraction, dP/dt and SI reached modest statistical significance (p < 0.05). When the EI and SI were compared, the correlation was also significant (p < 0.01). The areas under the receiver operator curve of EI and SI for discriminating dP/dt < 1000 mm Hg/s were 0.833 and 0.733, respectively. In conclusion, the elongation, which defines the shape of the left ventricle, might be related to the systolic function of the left ventricle and the degree of the mitral regurgitation. Further studies are needed to demonstrate its use in other clinical entities. [source] Quantification of Annular Dilatation and Papillary Muscle Separation in Functional Mitral Regurgitation: Role of Anterior Mitral Leaflet Length as ReferenceECHOCARDIOGRAPHY, Issue 6 2005Vinod Jorapur M.D. Background: We hypothesized that anterior mitral leaflet length (ALL) does not differ significantly between normal subjects and patients with functional mitral regurgitation (FMR) and hence may be used as a reference measurement to quantify annular dilatation and papillary muscle separation. Methods and Results: We prospectively studied 50 controls, 15 patients with systolic left ventricular dysfunction (LVD) with significant FMR, and 15 patients with LVD without significant FMR. Significant MR was defined as an effective regurgitant orifice area , 0.2 cm2 as measured by the flow convergence method. Annular diameter, interpapillary distance, and ALL were measured, and the following ratios were derived: annular diameter indexed to ALL (ADI) and interpapillary distance indexed to ALL (IPDI). There was no significant difference in ALL among the three groups. The mean ADI was 1.26 times controls in patients with LVD without significant FMR compared to 1.33 times controls in patients with LVD with significant FMR (P = 0.06, no significant difference between groups). The mean IPDI was 1.42 times controls in patients with LVD without significant FMR compared to 2.1 times controls in patients with LVD with significant FMR (P < 0.0001, significant difference between groups). Conclusion: There was no significant difference in ALL between controls and patients with LVD. ALL can be used as a reference measurement to quantify annular dilatation and papillary muscle separation in patients with FMR. Interpapillary distance but not annular diameter indexed to ALL correlates with severity of FMR. [source] Role of Echocardiography in Assessing the Mechanism and Effect of Ramipril on Functional Mitral Regurgitation in Dilated CardiomyopathyECHOCARDIOGRAPHY, Issue 4 2005D.M. (Card), F.I.A.E., F.I.A.M.S., F.I.C.C., F.I.C.P., I.B. Vijayalakshmi M.D. The objectives of this article are to determine the possible mechanism of functional mitral regurgitation in patients with dilated cardiomyopathy (DCM) and to know the effect of ramipril on left ventricle (LV) and mitral regurgitation by ECHO. Several postulates are put forth for functional mitral regurgitation in DCM, and mitral annular dilatation is said to be the primary mechanism in the past, but the exact mechanism is not clear. Though angiotensin converting enzyme (ACE) inhibitors are known to remodel the LV, their beneficial effect in patients with DCM with functional mitral regurgitation is not known. Various cardiac dimensions and degree of mitral regurgitation were measured by echocardiography in 30 normal control group and in 30 patients with DCM of various etiologies except ischemic, before and after ramipril therapy. There was a significant difference in all parameters especially sphericity of left ventricle and position of papillary muscles (P < 0.0003) in DCM patients, but mitral valve annulus did not show significant change (P < 0.3) compared to control group. In 50% of the patients, the functional mitral regurgitation totally disappeared. In 30% of patients, it came down from grade II to I or became trivial. In 20% of patients, it remained unchanged. There was remarkable improvement in sphericity, LV dimension, volumes, and EF%, which increased from 31 ± 9.81 to 39.3 ± 8.3% (P < 0.0003). It is concluded that echocardiography clearly demonstrates the increased sphericity of LV in DCM. The lateral migration of papillary muscles possibly plays a major role in functional mitral regurgitation. Ramipril significantly reduces not only sphericity but also functional mitral regurgitation. [source] Transesophageal and Transpharyngeal Ultrasound Demonstration of Reversed Diastolic Flow in Aortic Arch Branches and Neck Vessels in Severe Aortic RegurgitationECHOCARDIOGRAPHY, Issue 4 2004Deepak Khanna M.D. In the current study, we describe an adult patient with torrential aortic regurgitation due to an aortic dissection flap interfering with aortic cusp motion, in whom a transesophageal echocardiogram with the probe positioned in the upper esophagus and transpharyngeal ultrasound examination demonstrated prominent reversed flow throughout diastole in the left subclavian, left vertebral, left common carotid, and left internal carotid arteries. Another unique finding was the demonstration of aortic valve leaflets held in the fully opened position in diastole by the dissection flap as it prolapsed into the left ventricular outflow tract, dramatically documenting the mechanism of torrential aortic regurgitation in this patient. (ECHOCARDIOGRAPHY, Volume 21, May 2004) [source] Echocardiographic Evaluation of Valvular Regurgitation and Management Strategies: Getting Better All the TimeECHOCARDIOGRAPHY, Issue 3 2000ARA SADANIANTZ M.D., F.A.C.C., F.E.S.C. No abstract is available for this article. [source] Utilization of the Edge-to-Edge Valve Plasty Technique to Correct Severe Tricuspid Regurgitation in Patients with Congenital Heart DiseaseJOURNAL OF CARDIAC SURGERY, Issue 6 2009Yong-chao Cui Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using the edge-to-edge valve plasty technique to correct severe tricuspid regurgitation in patients with congenital heart disease. Methods: From December 2002 to August 2007, severe tricuspid regurgitation was corrected with a flexible band annuloplasty and edge-to-edge valve plasty technique in nine patients with congenital heart disease. The age ranged from 7 to 62 years (average 24.4 years). Congenital cardiac anomalies included atrioventricular canal in five cases, secundum atrial septal defect in three cases, and cor triatriatum in one case. Results: No hospital death or postoperative morbidity occurred. No or trivial tricuspid regurgitation was present in six cases and mild tricuspid regurgitation in three cases at discharge. The follow-up ranged from 12 months to 70 months (average 39.3 months). No tricuspid stenosis was found. No to mild tricuspid regurgitation was present in eight cases, and moderate tricuspid regurgitation in one case at the latest follow-up. Conclusions: Edge-to-edge valve plasty is an easy, effective, and acceptable additional procedure to correct severe tricuspid regurgitation in patients with congenital heart disease. [source] Papillary Muscle Approximation for Ischemic Mitral Valve RegurgitationJOURNAL OF CARDIAC SURGERY, Issue 6 2008Akhtar Rama M.D. Several procedures were described to restore a more normal alignment between the mitral annulus and the laterally displaced papillary muscles. We report a new approach to relocate the displaced papillary toward the mitral annulus and to reduce tethering. This procedure is believed to be technically easy and beneficial in terms of mitral repair. [source] Chordal Cutting VIA Aortotomy in Ischemic Mitral Regurgitation: Surgical and Echocardiographic StudyJOURNAL OF CARDIAC SURGERY, Issue 1 2008Georges Fayad M.D. In addition, MR may exacerbate during exercise not only trough exercise-induced ischemia but also through an increase in tenting area. Accordingly, we aimed to perform chordal cutting through aortotomy in patients with exercise-induced ischemic worsening of MR. Methods: Five patients with ischemic MR, due to anterior leaflet tenting, whichworsened during exercise echocardiography were enrolled. All patients underwent cutting of the 2 basal chordae attached to the anterior mitral leaflet associated with myocardial revascularization. Three patients had additional mitral valve annuloplasty. Postoperative MR was evaluated using exercise echocardiography. Results: Age ranged from 63 to 78 years and 4 patients were male. Preoperative LV ejection fraction averaged 39 ± 3%. Chordal cutting was performed through aortotomy allowing comfortable access to the anterior mitral valve. Mitral effective regurgitant orifice at rest and at peak exercise was reduced by surgery (10 ± 3 to 0.6 ± 0.5 mm2 at rest and from 20 ± 3 to 6 ± 2 mm2 at peak exercise; p = 0.03). Mitral tenting area at rest and at peak exercise was concomitantly reduced by surgery (1.83 ± 0.21 cm2 to 0.50 ± 0.4 cm2 at rest and from 3.11 ± 0.58 to 1.7 ± 0.5 cm2 at peak exercise; p = 0.03). Left ventricular size and function remained unchanged after surgery. Conclusions: Chordal cutting through aortotomy may be an effective option to treat ischemic MR due to anterior leaflet tenting. Associated with myocardial revascularization, it resulted in a decrease of MR at rest and during exercise through a decrease in tenting area without impairment of LV function. [source] Combined DOR Ventriculoplasty and Aortic Valve Replacement in the Treatment of Post Infarction Ventricular Aneurysm and Aortic RegurgitationJOURNAL OF CARDIAC SURGERY, Issue 5 2006Erik E. Suarez M.D. We present the unique case of a patient suffering from congestive heart failure due to both post-infarct aortic regurgitation and ventricular aneurysm along with his successful surgical treatment. [source] A Technique for Infusion of Cardioplegic Solution in Coronary Artery Bypass with Aortic RegurgitationJOURNAL OF CARDIAC SURGERY, Issue 6 2004Mizuho Imamaki M.D. A technique for administration of cardioplegic solution was carried out to avoid such complications. Methods and Results: Cardiopulmonary bypass was established. After aortic cross-clamping, cardioplegic solution was administered from aortic root. Because complete cardiac arrest was not rapidly achieved, the aortic root was incised. Three cusps of the aortic valve were sutured. The aorta was closed; cardioplegic solution was administered from the aortic root. Then, cardiac arrest was rapidly achieved. After distal anastomosis of quadruple bypass was completed, the suture of the cusps was removed. There was no exacerbation of AR due to this method compared to the preoperative state. Conclusion: When off-pump coronary artery bypass is impossible and retrograde cardioplegia cannot be performed for a certain reason, this method may be set to one of the choices. [source] Does Repair of Mitral Regurgitation Eliminate the Need for Left Ventricular Volume Reduction?JOURNAL OF CARDIAC SURGERY, Issue 2003Akira T. Kawaguchi M.D. Methods: Among patients undergoing PLV, 120 had paired pre- and postoperative (<1 week) Doppler echocardiograms. Effects of preoperative MR were studied by comparing 45 patients with no preoperative MR (MR,) and 75 patients with significant MR (MR+; MR = 1.51 when MR is enumerated as none = 0, mild = 1, moderate = 2). Results: MR, patients as compared with the MR+ group were older (53.8 vs. 49.2 years, P = 0.047), had less frequent dilated cardiomyopathy (33.3% vs 49.3%,P <0.01), similar ventricular dimension (72.3 mm vs 73.0 mm), septal thickness (9.5 mm vs 9.6 mm), posterior wall, fractional shortening (15.9% vs 16.8%) and ventricular mass (330 g vs 345 g), resulting in comparably reduced functional capacity (NYHA 3.40 vs 3.67). Although the MR, group required significantly less frequent mitral procedure (64.4% vs 84.0%, P < 0.01) and shorter cardiac arrest time, they had similar postoperative MR (0.22 vs 0.39), highly significant parallel reduction in ventricular dimension (P < 0.001 in either group), and improved %FS (P <0.001 in either group), resulting in similar hospital survival (87.1% vs 86.4%) and 90-day survival (71.1% vs 78.7%) with significantly comparable improvement in functional class (P = 0.011 in both groups). Histological severity of interstitial fibrosis (P = 0.80), weight (P = 0.93), and thickness (P = 0.76) of excised myocardium was comparable between the two groups. Conclusion: Patients with no preoperative MR were found to benefit from PLV as did patients with significant MR. Beneficial effects of PLV appeared to derive mainly from volume reduction rather than abolished MR in this study.(J CARD SURG 2003;18 (Suppl 2):S95-S100) [source] Mitral Regurgitation After Partial Left Ventriculectomy As the Cause of Ventricular RedilatationJOURNAL OF CARDIAC SURGERY, Issue 2 2001Akira T. Kawaguchi M.D. Background: It remains unclear whether ventricular redilatation after partial left ventriculectomy (PLV) is due to underlying pathology or to continued volume overload amenable to surgery. Methods: Among patients undergoing PLV, 32 had Doppler echocardiography preoperatively, immediately after surgery (> 1 week), early after surgery (1,3 months), and late after surgery (8,14 months). Patients were divided into groups with mitral regurgitation (MR; MR+, n = 16) and without postoperative MR (MR-, n = 16) and were compared for ventricular size, performance, and survival. Results: After initial surgical reduction, left ventricular dimension on average gradually increased back to the preoperative level in subgroups of patients with valvular disease and cardiomyopathy and in all patients combined. Most patients showed drastically reduced left ventricular dimension early after PLV. In MR+ patients, dimension increased back to the preoperative level within 3 months after surgery, whereas the MR- group maintained reduced dimension throughout the first year in all patients combined and in a subgroup of patients with cardiomyopathy. Occurrence of significant MR after PLV appeared to be related to severity of fibrosis in excised myocardium but not to severity of preexisting MR, etiology, or performance of mitral valvuloplasty. Conclusions: Early postoperative MR, residual or new, appeared to play an important role in dictating early hemodynamics and late outcome in patients undergoing PLV. Results suggest an aggressive simultaneous approach to abolish MR. Causative role of myocardial fibrosis remains unclear and needs further study. [source] Impact of Tricuspid Regurgitation and Prior Coronary Bypass Surgery on the Geometry of the Coronary Sinus: A Rotational Coronary Angiography StudyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2010DAN BLENDEA M.D., Ph.D. Coronary Venous Geometry in Patients Undergoing CRT.,Introduction: The coronary sinus (CS) is often distorted in patients with advanced cardiomyopathy, making CS cannulation difficult. The objective of this study was to examine the impact of the underlying cardiac pathology on the variability of the CS anatomy, using rotational coronary venous angiography (RCVA). Methods and Results: Seventy-nine patients undergoing RCVA for cardiac resynchronization therapy (CRT) were evaluated: age 63 ± 15 years, 43% with prior coronary artery bypass grafting (CABG). Aspects of the CS anatomy which could impact cannulation were examined: the CS ostial angle, the posterior displacement of the CS away from the atrioventricular groove, a measure of CS curvature, and the presence of stenoses and aneurysmal dilatations. The CS ostial angle was variable (65,151°, mean 119 ± 19°, <90° in 8 patients) and decreased significantly (P = 0.0022) with increasing severity of tricuspid regurgitation (TR), reaching 94 ± 18° in patients with severe TR. The posterior displacement of the CS was significantly more accentuated in patients with prior CABG when compared with the patients without CABG (7.1 ± 3.7 vs 4.5 ± 2.8 mm; P = 0.0246). The decrease in luminal diameter at the CS,great cardiac vein (GCV) junction was 2.0 ± 1.0 mm, being more pronounced in patients with prior CABG versus nonCABG (26 vs 20%; P = 0.042). Stenoses and aneurysmal dilatations of the CS,GCV were encountered in 4 (5%) and 6 (8%) of patients, respectively, all of them with prior CABG, representing 12% and 18% of the CABG group. Conclusion: The CS anatomy in patients undergoing CRT is variable, and is impacted by the severity of the underlying TR and history of a prior CABG. (J Cardiovasc Electrophysiol, Vol. 21, pp. 436,440, April 2010) [source] Percutaneous Treatment for Mitral Regurgitation: The QuantumCor SystemJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2008RICHARD R. HEUSER M.D. Aims:Percutaneous edge-to-edge techniques and annuloplasty have been used to treat mitral regurgitation (MR). However, neither intervention can be performed reliably a second time and, with annuloplasty, a foreign body is left behind. The mitral and tricuspid annuli are areas of dense collagen (Fig. 1); treatment with radiofrequency (RF) energy in sheep reduces their size, and can be repeated without affecting the coronary sinus. RF energy may also be used in leaflet procedures. Our aim was to improve mitral valve competence using techniques that can be incorporated into a minimally invasive approach. Figure 1. This trichrome stain slide shows the amount of collagen present in the mitral annulus (in green). Methods:In open-heart procedures in 16 healthy sheep (6 with naturally occurring MR), we used a malleable probe (QuantumCor, Inc., Lake Forest, CA) that conforms to the annular shape to deliver RF energy via a standard generator to replicate a surgical mitral annular ring. Four segments of the posterior mitral valve annulus were treated while on cardiopulmonary support via a left thoracotomy with access via the atrial appendage. Seven sheep were followed chronically. Results:All sheep underwent intracardiac echocardiography (ICE) or direct circumferential measurement of the mitral annulus before and after RF therapy. RF therapy was administered in less than 4 minutes in each case, and the mean anteroposterior (AP) annular distance was reduced by a mean of 5.75 ± 0.86 mm (23.8% reduction, P< 0.001). In the 6 sheep with nonischemic MR, regurgitation was eliminated. Acute histopathology (HP) demonstrated no damage to the leaflets, coronary sinuses, or coronary arteries. At 30 days, the AP distance continued to be reduced in the 7 surviving sheep (mean 5.0 ± .6 mm, 21.4% reduction, P< 0.001). Conclusions:In a sheep model, RF energy applied for less than 4 minutes per case at subablative temperatures in four quadrants of the posterior mitral valve annulus reduced the AP and circumferential annular distances significantly, and eliminated nonischemic MR. Results will need to be confirmed in follow-up studies to determine safety and efficacy. RF energy administered as a novel, percutaneous method of mitral valve annuloplasty may have the potential to reduce morbidity and mortality associated with current surgical techniques. [source] Transcatheter Mitral Valve Repair for Functional Mitral Regurgitation: Coronary Sinus ApproachJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2007NICOLO PIAZZA M.D. Mitral regurgitation has become recognized as an important health problem. More specifically, functional mitral regurgitation is associated with worse outcomes in heart failure, postmyocardial infarction, and perioperative coronary artery bypass surgery patients. Many patients with severe mitral regurgitation are denied or refused mitral valve surgery. A less invasive procedure with possibly fewer potential complications may thus be attractive for patients with severe mitral regurgitation. Devices used for coronary sinus (CS) mitral annuloplasty are directed toward patients with functional mitral regurgitation. Because of its easy accessibility and close relationship to the posterior mitral annulus (MA), alterations of the CS geometry with percutaneous devices may translate to displacement of the posterior annulus and correct mitral leaflet coaptation. This review will focus on the contemporary CS annuloplasty devices: (1) Edwards MONARC system; (2) Cardiac Dimensions CARILLON; and (3) Viacor Shape Changing Rods system. In addition, important information obtained from recent imaging studies describing the relationship between the CS, MA, and coronary arteries will be reviewed. [source] | ||||||||||||||||||||||||||||||||||||||||