Search PubMed⌕ Search

Biomedical subjects

A Sagie

Publications and source records attributed to A Sagie.

At least 73 records · Page 4Linked to original sources
PubMed1998

Colchicine treatment for recurrent pericarditis. A decade of experience.

BACKGROUND: The most troublesome complication of acute pericarditis is recurrent episodes of pericardial inflammation, occurring in 15% to 32% of cases. The cause of the recurrence is usually unknown, although in some cases it may be traced to viral infection or may be a consequence of coronary artery bypass grafting. The optimal method for prevention has not been fully established; accepted modalities include nonsteroidal anti-inflammatory drugs, corticosteroids, immunosuppressive agents, and pericardiectomy. METHODS AND RESULTS: Based on the proven efficacy of colchicine therapy for familial Mediterranean fever (recurrent polyserositis), several small studies have used colchicine successfully to prevent recurrence of acute pericarditis after failure of conventional treatment. Recently, we reported the results from the largest multicenter international study on 51 patients who were treated with colchicine to prevent further relapses and who were followed up for < or = 10 years. CONCLUSIONS: In light of new trial data that have accumulated in the past decade, we review the evidence for the efficacy and safety of colchicine for the prevention of recurrent episodes of pericarditis. Clinical and personal experience shows that colchicine may be an extremely promising adjunct to conventional treatment and may ultimately serve as the initial mode of treatment, especially in idiopathic cases.

Adult↗
PubMed1998

Acute anterior wall myocardial infarction entailing ST-segment elevation in lead V1: electrocardiographic and angiographic correlations.

BACKGROUND: The correlation between ST elevation in lead V1 during anterior wall acute myocardial infarction (AMI) and the culprit lesion site in the left anterior descending (LAD) coronary artery is poor. HYPOTHESIS: The study was undertaken to assess the electrocardiographic (ECG) characteristics and angiographic significance of ST-segment elevation in lead V1 during anterior wall acute myocardial infarction (AMI). METHODS: Data from 115 patients with anterior wall AMI, who underwent coronary angiography within 14 days of hospitalization, were studied. The admission 12-lead ECG was examined and the coronary angiogram was evaluated for the nature of the conal branch of the right coronary artery (RCA) and for the culprit lesion site in the left anterior descending (LAD) coronary artery. RESULTS: Mean ST-segment deviation and the frequency of patients with ST-segment elevation > 0.1 mV were significantly lower in lead V1 than in lead V2 (0.136 +/- 0.111 mV vs. 0.421 +/- 0.260 mV, and 37 vs. 96%, for leads V1 and V2, respectively). A small conal branch not reaching the interventricular septum (IVS) was more prevalent among patients with ST-segment elevation > 0.1 mV in lead V1 (67%), whereas a large conal branch was more prevalent in patients with ST-segment deviation (1 mV in that lead (83%, p < 0.001). No relation was found between ST-segment deviation in lead V1 during anterior wall AMI and the culprit lesion site in the LAD. CONCLUSION: ST-segment elevation in lead V1 during first anterior wall AMI was found in one third of the patients, and its magnitude was lower than that in the other precordial leads. ST-segment elevation in lead V1 favors the presence of a small conal branch of the RCA that does not reach the IVS.

Aged↗
PubMed1998

Value of T-wave direction with lead III ST-segment depression in acute anterior wall myocardial infarction: electrocardiographic prediction of a "wrapped" left anterior descending artery.

BACKGROUND: Lead III ST-segment depression during acute anterior wall myocardial infarction (AMI) has been attributed to reciprocal changes. However, the value of the T-wave direction (positive or negative) in predicting the site of obstruction and type of the left anterior descending (LAD) artery is not clear and has not been studied before. HYPOTHESIS: The aim of the study was to assess retrospectively the correlation between two patterns of lead III ST-segment depression, and type of LAD artery and its level of obstruction during first AMI. METHODS: The study group consisted of 48 consecutive patients, admitted to the coronary care unit for first AMI, who showed ST-segment elevation in lead a VL and ST-segment depression in lead III on admission 12-lead electrocardiogram. The patients were divided by T-wave direction into Group 1 (n = 31), negative T wave, and Group 2 (n = 17), positive T wave. The coronary angiogram was evaluated for type of LAD ("wrapped", i.e., surrounding the apex or not), site of obstruction (pre- or postdiagonal branch), and other significant coronary artery obstructions. RESULTS: Mean lead III ST-segment depression was 1.99 +/- 1.32 mm in Group 1 and 1.13 +/- 0.74 mm in Group 2 (p = 0.004); mean ST-segment elevation in a VL was 1.35 +/- 0.84 mm and 1.23 +/- 0.5 mm, respectively (p = 0.5). A wrapped LAD was found in 12 patients (38.7%) in Group 1 and in 13 in Group 2 (76.4%) (p = 0.02). The sensitivity of lead III ST-segment depression with positive T wave to predict a wrapped LAD was 52%, and the specificity was 82% with a positive predictive value of 76%. On angiography, 25 patients (80%) in Group 1 and 13 (76%) in Group 2 had prediagonal occlusion of the LAD (p = 0.77). No significant difference between groups was found for right and circumflex coronary artery involvement or incidence of multivessel disease. CONCLUSIONS: The presence of lead III ST-segment depression with positive T wave associated with ST-segment elevation in a VL in the early course of AMI can serve as an early electrocardiographic marker of prediagonal occlusion of a "wrapped" LAD.

Case-Control Studies↗
PubMed1998

Intravenous leiomyomatosis with cardiac involvement in a pregnant woman.

Intravenous leiomyomatosis is a rare benign neoplasm that commonly grows into the pelvic veins and the inferior vena cava and, rarely, the right side of the heart. We report the first case of intravenous leiomyomatosis with cardiac involvement in a pregnant woman. The treatment of choice is surgical resection in two steps.

Adult↗
PubMed1998

Evaluation of tricuspid regurgitation severity: echocardiographic and clinical correlation.

The correlation between 19 echocardiographic markers of tricuspid regurgitation (TR) severity and findings on physical examination was studied in 66 consecutive patients (age 63 +/- 12 years) with moderate or severe TR. Clinical TR was defined by two or more of the following: prominent jugular venous pulse V waves, pulsating liver, and sea-saw parasternal movement. Thirty-eight patients (57.6%) had clinical TR, whereas 28 patients (42.4%) did not. In a univariate analysis, the most powerful predictors of clinical TR (p < 0.01) were jet area > or =9 cm2, right atrial area > or =30 cm2, jet width at origin > or =0.8 cm, systolic flow reversal in the hepatic veins, paradoxical septal movement, diastolic septal flattening, inferior vena cava diameter > or =2.1 cm, and lack of inferior vena cava respiratory variation. Regurgitant index was a weaker predictor. Multivariate analysis showed that the only independent echocardiographic predictor of clinical TR was systolic flow reversal (positive and negative predictive values 91.2% and 78.1%, respectively). Significant echocardiographic TR can be subclinical in a substantial number of patients.

Adult↗
PubMed1998

Association between mitral annulus calcification and carotid atherosclerotic disease.

BACKGROUND AND PURPOSE: It has been established that mitral annulus calcification (MAC) is an independent predictor of stroke, though a causative relationship was not proved, and that carotid artery atherosclerotic disease is also associated with stroke. The aim of this study was to determine whether there is an association between the presence of MAC and carotid artery atherosclerotic disease. METHODS: Of the 805 patients in whom the diagnosis of MAC was made by transthoracic echocardiography between 1995 and 1997, 133 patients (60 men and 73 women; mean age, 74.3+/-8 years; range, 47 to 89 years) underwent carotid artery duplex ultrasound for various indications; the study group comprised these patients. They were compared with 129 age- and sex-matched patients without MAC (57 men and 72 women; mean age, 73.6+/-7 years; range, 61 to 96 years) who underwent carotid artery duplex ultrasound during the same period for the same indications. MAC was defined as a dense, localized, highly reflective area at the base of the posterior mitral leaflet. MAC was considered severe when the thickness of the localized, highly reflective area was > or =5 mm on 2-dimensional echocardiography in the 4-chamber view. Carotid artery stenosis was graded as follows: 0%, 20%, 40%, 60%, 80%, and 100%. RESULTS: Compared with the control group, the MAC group showed a significantly higher prevalence of carotid stenosis of > or =40% (45% versus 29%, P=0.006), which was associated with > or =2-vessel disease (23% versus 10%, P=0.006) and bilateral carotid artery atherosclerotic disease (21% versus 10%, P=0.011). Severe MAC was found in 48 patients. More significant differences were found for the severe MAC subgroup (for carotid stenosis of > or =40%) in rates of carotid artery atherosclerotic disease (58% versus 29%, P=0.001), and > or =2-vessel disease (31% versus 10%, P=0.001), in addition to bilateral carotid artery stenosis (27% versus 10%, P=0.004) and even bilateral proximal internal carotid artery stenosis (21% versus 8%, P=0.015). Furthermore, significant carotid artery atherosclerotic disease (stenosis of > or =60%) was significantly more common in the severe MAC subgroup than in the controls (42% versus 26%, P<0.05) and was associated with higher rates of > or =2-vessel disease (19% versus 7%, P=0.02) and bilateral carotid artery stenosis (17% versus 7%, P=0.05). On multivariate analysis, MAC and age but not traditional risk factors were the only independent predictors of carotid atherosclerotic disease (P=0.007 and P=0.04, respectively). CONCLUSIONS: There is a significant association between the presence of MAC and carotid artery atherosclerotic disease. MAC may be an important marker for atherosclerotic disease of the carotid arteries. This association may explain the high prevalence of stroke in patients with MAC.

Aged↗
PubMed1997

Doppler echocardiographic assessment of progression of aortic regurgitation.

The rate of progression of the degree of chronic aortic regurgitation (AR) is unknown. Furthermore, although left ventricular (LV) dilation has been studied in patients with severe AR, its rate and determining factors, and specifically, its relation to the degree of regurgitation remain to be established and have not previously been studied for mild and moderate AR. The purpose of this study was to explore the progression of chronic AR by 2-dimensional and Doppler echocardiography, and the relation of LV dilation to the fundamental regurgitant lesion and its progression in patients with a full spectrum of initial AR severity. We studied 127 patients with AR by 2-dimensional and Doppler echocardiography (69 men; 59 +/- 21 years; 67 with mild, 45 with moderate, 15 with severe AR). AR increased in 38 patients (30%) (25% of mild, 44% of moderate, and 50% of moderate to severe lesions; p <0.006). The ratio of proximal AR jet height to LV outflow tract height also increased (30.3 +/- 17.5% vs 35.2 +/- 19.7%; p <0.0001). Initial LV volumes and mass were larger in patients with more severe AR and increased significantly during follow-up (138 +/- 53 to 164 +/- 70 ml; 59 +/- 32 to 71.7 +/- 42 ml; 203 +/- 89 to 241 +/- 114 g; p <0.0001). LV volumes and mass increased faster in patients with more severe AR, and in those in whom the degree of AR progressed more rapidly. Finally, patients with bicuspid aortic valve (n = 21) had a higher prevalence of severe AR than patients with tricuspid aortic valves (52% vs 4%; p <0.001). In conclusion, AR is a progressive disease not only in patients with severe AR but also in those with mild and moderate regurgitation. Patients with more severe AR have larger left ventricles that also dilate more rapidly.

Adolescent↗
PubMed1997

Importance of the conal branch of the right coronary artery in patients with acute anterior wall myocardial infarction: electrocardiographic and angiographic correlation.

OBJECTIVES: This study assessed prospectively the correlation between the conal branch of the right coronary artery and the pattern of ST segment elevation in leads V1 and V3R during anterior wall acute myocardial infarction (AMI). BACKGROUND: The traditional electrocardiographic (ECG) definition of anteroseptal AMI-ST segment elevation in leads V1 to V3-has recently been challenged. The significance of ST segment elevation in lead V1 during anterior wall AMI is unclear. METHODS: The admission 12-lead ECG with additional lead V3R and the coronary angiograms performed within 10 days of hospital admission were evaluated in 28 consecutive patients (mean age +/- SD 62 +/- 9 years) admitted to the coronary care unit with anterior wall AMI. Patients were classified into two groups according to the magnitude of ST segment elevation in lead V1: group A (elevation > or = 1.5 mm, n = 12) and group B (elevation < 1.5 mm, n = 16). Two types of conal branch were identified: small (not reaching the interventricular septum [IVS]) and large (reaching the IVS). RESULTS: ST segment elevation in lead V3R was found in 11 (92%) and 6 (37%) patients from group A and group B, respectively (p < 0.001); a small conal branch was seen in 10 (83%) and 3 (19%) patients, respectively (p < 0.001). Ten patients (all from group B) had a large conal branch. CONCLUSIONS: ST segment elevation in lead V1 in the admission ECG of patients with anterior wall AMI is strongly related to ST segment elevation in lead V3R and is associated with a small conal branch. Our findings suggest that lead V1 reflects the right paraseptal area supplied by the septal branches of the left anterior descending coronary artery (LAD), alone or together with the conal branch. The absence of ST segment elevation in lead V1 during anterior AMI suggests that the IVS is protected by a large conal branch in addition to the septal branches of the LAD (double circulation).

Adult↗
PubMed1997

Echocardiography can detect cloth cover tears in fully covered Starr-Edwards valves: a long-term clinical and echocardiographic study.

The incidence of cloth cover tears in fully covered Starr-Edwards valves, as assessed by autopsy or repeat surgery, is approximately 1% per patient-year. However, no echocardiographic study has explored this phenomenon. This study was designed as a one-time observational study and aimed to explore the ability of two-dimensional transthoracic echocardiography to identify cloth cover tears in 35 late survivors with 38 fully covered Starr-Edwards valves who had been operated on 20 to 24 years earlier. The hemodynamic profile, clinical status, and valve-related complications in this highly selected group of late survivors were also studied. Five patients also underwent transesophageal echocardiography. An elongated echogenic mass attached to the prosthetic valve cage and floating downstream was considered indicative of cloth tear. There were 16 patients with aortic valve prostheses, 16 with mitral valve prostheses, and three with double prosthetic valves. In six (17.1%) patients (four with aortic valve prostheses, two with mitral valve prostheses), an echogenic mass suggestive of cloth cover tear was detected, which was confirmed by transesophageal echocardiography in three patients. In two patients the echocardiographic finding was confirmed at surgery. The initial presentation of these six patients was endocarditis, possible embolism, unexplained dyspnea, and weakness in one patient each. Two patients were asymptomatic. There was no evidence of significant prosthetic valve malfunction in any patient. The transvalvular gradients were similar in patients with and without cloth cover tears. Echocardiographic findings highly suggestive of cloth cover tears are not uncommon and can be detected in the third postoperative decade in patients with fully covered Starr-Edwards valves. A prospective study to evaluate the clinical significance of an incidental echocardiographic finding suggestive of cloth cover tears in asymptomatic patients with these valve models is warranted.

Adult↗
PubMed1997

Two-dimensional echocardiographic assessment of the progression of aortic root size in 127 patients with chronic aortic regurgitation: role of the supraaortic ridge and relation to the progression of the lesion.

Although aortic root dilation has etiologic and prognostic significance in patients with chronic aortic regurgitation (AR), no information is available regarding changes over time in aortic root size in patients with the entire spectrum of AR severity or how such changes relate to progression of the AR or to left ventricular (LV) overload. To analyze this, a total of 127 patients with chronic AR who had more than 6 months of follow-up by two-dimensional and Doppler echocardiography were included in the study (69 men and 58 women; mean age 59.3 +/- 21.2 years [range 14 to 94 years]; 67 cases of mild, 45 moderate, 15 severe, and 21 bicuspid aortic valve disease). The aortic anulus, sinuses of Valsalva, supraaortic ridge, and ascending aorta were measured in the parasternal long-axis view, LV volumes were calculated (biplane Simpson's approach), and the severity of AR was quantified based on proximal jet size and graded according to an algorithm that takes into account major color Doppler criteria. At entry to the study, significant differences between patients with mild, moderate, and severe AR were noted only in supraaortic ridge size (1.46 +/- 0.29 cm/m2 vs 1.63 +/- 0.33 cm/m2 [p < 0.006]; vs 1.67 +/- 0.43 cm/m2 [p < 0.03]). A significant increase in aortic root size at all levels was observed during the follow-up period in all three groups of severity of AR. The rate of change of the supraaortic ridge, the upper support structure of the anulus and cusps, was faster in patients with more severe degrees of AR (p = 0.013); this was not the case at the other aortic levels. No differences were observed in aortic root size or rate of progression between patients with bicuspid or tricuspid aortic valves. Patients were considered "progressive" if they lay on the steepest positive segment of the curve representing the rank order in the rate of aortic root progression. Compared with "nonprogressive" patients, patients who were progressive in supraaortic ridge size (rate >0.12 cm/yr; n = 23) had a faster rate of progression in the degree of regurgitation as assessed by the regurgitant jet area/LV outflow tract area ratio measured in the parasternal short-axis view (0.48 +/- 0.45 vs 0.24 +/- 0.5/yr; p < 0.03) and a foster rate of progression of LV end-diastolic volume (30 +/- 22.8 vs 14.4 +/- 15.6 ml/yr; p < 0.0002) and LV mass (70.8 +/- 74.4 vs 16.8 +/- 19.2 gm/yr; p < 0.0004). In conclusion, there is progressive dilation of the aortic root at all levels, even in patients with mild AR. More rapid progression in aortic root size is associated with more rapid progression of the underlying aortic insufficiency, as well as more rapid increases in LV volume and mass.

Adolescent↗
PubMed1997

Candida tropicalis multifocal endophthalmitis as the only initial manifestation of pacemaker endocarditis.

PURPOSE: To document a case of Candida tropicalis endophthalmitis as the only manifestation of pacemaker endocarditis. METHODS: We examined a 75-year-old man with diabetes mellitus who was initially examined for bilateral multifocal endophthalmitis complicating endocarditis 2 years after a permanent pacemaker for sick sinus syndrome was implanted. RESULTS: Transesophageal echocardiography showed a large vegetation with a 3-cm diameter attached to the pacing electrode in the right ventricle. Six consecutive blood cultures grew C tropicalis. CONCLUSIONS: Ocular involvement, including multifocal endophthalmitis, may occur as the only manifestation of C tropicalis endocarditis, complicating an intravenous permanent pacemaker.

Aged↗
PubMed1997

Echocardiographic assessment of mitral stenosis and its associated valvular lesions in 205 patients and lack of association with mitral valve prolapse.

To date, the relation between mitral stenosis (MS) and other associated cardiac valvular lesions has been reported by angiography and surgical pathologic study in patients with more advanced disease but has not been studied systematically by two-dimensional echocardiography and Doppler color flow mapping in a large referral population with a broader spectrum of severity. In addition, prior reports have suggested that up to 40% of patients with MS have mitral valve prolapse (MVP); however, because of recent developments in two-dimensional echocardiographic imaging and the definition of MVP, this association must now be reconsidered. The purpose of this study was to explore the association of other valvular lesions with MS and their relation to its severity and in particular to test whether MS is in fact associated with MVP with the frequency reported previously. We reviewed the studies of 205 consecutive patients (aged 61 +/- 14 years; range 26 to 87 years) with MS who were studied from 1992 to 1994 by two-dimensional echocardiography and Doppler color flow mapping to assess valvular stenosis, regurgitation, and MVP in patients with a range of severity of MS (28% mild, 34% moderate, and 38% severe MS based on mitral valve area). MS was associated with at least mild mitral regurgitation in 78% of patients (160/205), and pure MS was correspondingly uncommon (22%). There was an inverse relationship between the severity of MS and the degree of mitral regurgitation (p < 0.001). MS was frequently associated (54% of patients) with significant lesions of other valves, including aortic stenosis (17%), at least moderate aortic regurgitation (8%) and tricuspid regurgitation (38%), and tricuspid stenosis (4%). Tricuspid stenosis was associated with more severe MS (p < 0.01), and tricuspid regurgitation was more common in patients with mixed MS and regurgitation than in those with pure stenosis (60% versus 26% for at least moderate tricuspid regurgitation; p < 0.001). Mitral valve prolapse was present in only one patient (0.5%). Superior systolic bulging of the midportion of the anterior mitral leaflet toward the left atrium (but not superior to the annular hinge points) was seen in 22 patients (11%). Patients with such superior bulging had significantly lower mitral valve scores but a similar degree of mitral regurgitation compared with those without bulging. The majority of patients with MS (78%) have associated mitral regurgitation and significant lesions of the other cardiac valves (54%). The frequency of true MVP associated with chronic MS is much lower than reported previously. This may provide insight into the underlying pathophysiologic process, tending to shorten the chordae tendineae and leaflets to produce stenosis rather than elongate them to produce prolapse.

Adult↗
PubMed1997

Acute stroke after coronary angiography associated with protruding mobile thoracic aortic atheromas.

We describe two patients who developed acute embolic stroke immediately after coronary catheterization for unstable angina. Transesophageal echocardiography (TEE) and spiral CT of the chest revealed protruding floating atheromas within the aortic arch. These cases of stroke immediately after coronary catheterization suggest that protruding floating atheromas of the thoracic aorta place patients at risk for stroke. TEE or CT might predict a risk of stroke in such patients.

Acute Disease↗
PubMed1997

[Prosthetic heart valve thrombosis: a 3-year experience].

A series of 12 patients with 16 episodes of prosthetic heart-valve thrombosis over 3 years is presented. Most episodes affected mitral or tricuspid bileaflet prostheses. All patients were inadequately anticoagulated at the time of thrombosis. The clinical presentation was acute and severe in 6 patients, and subacute or chronic in the rest. Physical examination was suggestive of stuck valves in most cases. Transthoracic echocardiography revealed increased transvalvular gradients in most. However, clearer evidence of valve thrombosis was obtained from transesophageal echocardiography or fluoroscopy. 9 patients eventually had their valves re-replaced successfully, and the preoperative diagnosis was confirmed in all. 5 patients were operated as soon as the diagnosis was established. and an additional 4 were operated after failure of anticoagulation. In 4 patients the valve leaflets became completely mobile after a course of thrombolysis. Prosthetic valve thrombosis is a severe and potentially fatal complication in patients with mechanical heart valves. Alertness of physicians at all levels- the general practitioner, the internist and the cardiologist- to the possibility of valve thrombosis and to its clinical presentation may lead to prompt and earlier diagnosis and to comprehensive therapy.

Adolescent↗
PubMed1996

New method for accurate calculation of regurgitant flow rate based on analysis of Doppler color flow maps of the proximal flow field. Validation in a canine model of mitral regurgitation with initial application in patients.

OBJECTIVES: The purpose of this study was to develop a rational and objective method for selecting a region in the proximal flow field where the hemispheric formula for calculating regurgitant flow rates by the flow convergence technique is most accurate. BACKGROUND: A major obstacle to clinical implementation of the proximal flow convergence method is that it assumes hemispheric isovelocity contours throughout the Doppler color flow map, whereas contour shape depends critically on location in the flow field. METHODS: Twenty mitral regurgitant flow rate stages were produced in six dogs by implanting grommet orifices into the anterior mitral leaflet and varying driving pressures so that actual peak flow rate could be determined from the known effective regurgitant orifice times the orifice velocity. Because plotting flow rate calculated by using a hemispheric formula versus alias velocities produces underestimation near the orifice and overestimation far from it, this plot was fitted to a polynomial function to allow identification of an inflection point within a relatively flat intermediate zone, where factors causing overestimation and underestimation are expected to be unimportant or balanced. The accuracy of flow rate calculation by the inflection point was compared with unselective and selective averaging techniques. Clinical relevance, initial feasibility and correlation with an independent measure were tested in 13 consecutive patients with mitral regurgitation who underwent cardiac catheterization. RESULTS: 1) The accuracy of single-point calculations was improved by selecting points in the flat portion of the curve (y = 1.15x - 3.34, r = 0.87, SEE = 22.1 ml/s vs. y = 1.34x - 1.99, r = 0.71, SEE = 45.6 ml/s, p < 0.01). 2) Selective averaging of points in the flat portion of the curve further improved accuracy and decreased scatter compared with unselective averaging (y = 1.08x + 4.8, r = 0.96, SEE = 11.6 ml/s vs. y = 1.30x + 0.6, r = 0.90, SEE = 20.9 ml/s, p < 0.01). 3) The proposed algorithm for mathematically identifying the inflection point provided the best results (y = 0.96x + 4.5, r = 0.96, SEE = 9.9 ml/s), with a mean error of 1.6 +/- 9.7 ml/s vs. 11.4 +/- 11.7 ml/s for selective averaging (p < 0.01). In patients, the proposed algorithm identified an inflection point at which calculated regurgitant volume agreed best with invasive measurements (y = 1.1x - 0.61, r = 0.93, SEE = 17 ml). CONCLUSIONS: The accuracy of the proximal flow convergence method can be significantly improved by analyzing the flow field mathematically to identify the optimal isovelocity zone before using the hemispheric formula to calculate regurgitant flow rates. Because the proposed algorithm is objective, operator independent and, thus, suitable for automatization, it could provide the clinician with a powerful quantitative tool to assess valvular regurgitation.

Adult↗