Biomedical subjects
Publications and source records attributed to J Azevedo.
In this article, we will attempt to review basic requirements for three-dimensional reconstruction, methods of cavity reconstruction, approaches to gray scale tissue-depiction displays, and current clinical experience, and also present some directions for future development.
Advances in ultrasound instrumentation and computer technology provide us an opportunity to develop methods to perform three-dimensional echocardiography in patients. Optimal methods of displaying three-dimensional images are critical for the perception of depth and distances. We examined the utility of various shading techniques in volume-rendered three-dimensional images in 22 patients with a variety of cardiac defects. Distance coding, gray level gradient shading, texture shading, and mixtures of these shading techniques were used. Our observations suggest that the mixture of shading techniques portray the dynamic three-dimensional anatomy better than a single type of shading. Appropriate mix of shadings could provide dynamic three-dimensional echocardiograms of clinical utility.
We report a clinical case of a 60 year old male patient with a orthotopic cardiac transplant, submitted to a transesophageal echocardiographic study. This semi-invasive study showed a mobile multi-lobulated mass of the left atria, related with the hyperplastic process of the surgical suture area and directly associated with the cardiac transplant procedure. We discuss the rarity of this benign case, the different forms of two-dimensional echocardiographic presentation of this type of lesions, the problems of non invasive diagnostic techniques, the risk and the prognostic value of these structures. We conclude that a longitudinal study in a larger number of cardiac transplant patients will be needed, in order to define better the clinical implications of these echocardiographic findings.
OBJECTIVE: Comparative analysis of left atrial and left ventricle Doppler inflow patterns in patients with essential systemic mild to moderate hypertension and normal global left ventricular systolic function. PATIENTS: A group of out patients with the diagnosis of hypertension referred to the Echocardiographic Laboratory of Egas Moniz Hospital in Lisbon. SETTING: Echocardiographic Doppler prospective study. MATERIAL AND METHODS: We studied a group of 50 patients with the diagnosis of mild to moderate arterial hypertension (Group H), which was compared with a population of 50 normal subjects (Group N). In each case we analysed the pulsed Doppler flow of the right upper pulmonary vein and the diastolic inflow of the left ventricular cavity. We calculated the peak velocities and time velocity integrals of the systolic, diastolic and atrial contraction waves of the pulmonary venous flow and also the systo-diastolic velocity and time velocity integral ratios. In the transmitral Doppler flow analysis we evaluated the peak velocities and time velocity integrals of the early (E wave) and late (A wave) waves, and their time velocity and velocity ratio. We assessed also the isovolumic relaxation time and left ventricular mass index. RESULTS: In groups N and H the peak velocity of the pulmonary venous flow systolic wave was 0.53 +/- 0.15 cm/sec and 0.75 +/- 0.10 cm/sec (p = 0.01), diastolic wave was 0.50 +/- 0.10 cm/sec and 0.41 +/- 0.09 cm/sec (p = 0.03) and atrial contraction wave was 0.18 +/- 0.03 cm/sec and 0.35 +/- 0.08 (p = 0.001), with a systo-diastolic ratio of 1.06 +/- 0.10 and 1.83 +/- 0.10 (p < 0.001), respectively. In these two groups the time velocity integral of the pulmonary venous flow systolic wave was 14.4 +/- 2.6 cm and 17.8 +/- 1.8 cm (p = 0.001), the diastolic wave was 12.5 +/- 3.2 cm and 9.3 +/- 1.3 cm (p = 0.05) and the atrial contraction wave was 4.4 +/- 0.07 cm (p = 0.001), with a systo-diastolic ratio of 1.1 +/- 0.16 and 1.9 +/- 0.12 (p < 0.001), respectively. For the group H and considering the three subgroups, hypertensive patients without anatomical or functional alterations, with isolated diastolic dysfunction and with left ventricular hypertrophy associated to diastolic dysfunction, the velocity systo-diastolic ratio was 1.08 +/- 0.12, 1.57 +/- 0.08 (p < 0.01) and 2.4 +/- 0.08 (p < 0.01) and 2.4 +/- 0.08 (p < 0.001), the systo-diastolic time velocity integral ratio was 1.22 +/- 0.17, 1.72 +/- 0.13 (p < 0.01) and 2.4 +/- 0.15 (p < 0.001), the peak velocity of the atrial contraction wave was 0.28 +/- 0.07, 0.3 +/- 0.08 (p < 0.01) and 0.43 +/- 0.07 (p < 0.001) and its time velocity integral was 4.6 +/- 0.06 cm, 5.6 +/- 0.07 cm (p < 0.01) and 7.0 +/- 0.08 cm (p < 0.001). CONCLUSIONS: Pulsed Doppler study of pulmonary venous flow is significantly abnormal in patients with arterial hypertension. This abnormal pulmonary venous flow pattern has a close relationship with structural and functional alterations of the left ventricle. Combined analysis of the pulsed Doppler inflow at these two cardiac anatomical levels is fundamental to understand the pathophysiology of hypertensive heart disease.
OBJECTIVE: Transesophageal echocardiographic analysis of the degree of severity of mitral regurgitation eccentric wall jets by color Doppler and pulsed Doppler interrogation of the pulmonary venous flow. DESIGN: Transesophageal echocardiographic prospective study. SETTING: consecutive out and in patients referred to the Echocardiographic Laboratory of Gregorio Marañon General Hospital, Madrid, Spain. MATERIAL AND METHODS: We studied 90 consecutive patients with the clinical and echocardiographic diagnosis of valvular mitral regurgitation. In each patient through pulsed Doppler transesophageal echocardiographic technique, we measured the peak velocities and areas of systolic forward flow and systolic reversed flow of the left superior pulmonary vein. By pulsed color Doppler transesophageal echocardiographic technique, we calculated total area, severity and spatial direction of the mitral regurgitant jet. MAIN RESULTS: There were 80% (72/90) of patients included in the JC group and 20% (18/90) in the JP group. The color Doppler maximal area in the JC group was 484 +/- 118 mm2 and 445 +/- 79 mm2 (p = NS) in the JP group. Mild mitral regurgitation was present in 32% (23/72) and 55% (10/18) of the patients in the JC and JP groups (p < 0.01) respectively. Severe mitral regurgitation was present in 29% (21/72) and 0% (0/18) of the same groups (p < 0.0001). Peak velocity of pulsed Doppler pulmonary venous systolic forward flow in JC and JP groups was 47 +/- 7 cm/sec and 29 +/- 8 cm/sec respectively (p < 0.01). Maximal area of pulmonary venous flow wave in JC and JP groups was 1215 +/- 140 mm2 and 568 +/- 176 mm2 (p < 0.001) respectively. Peak velocity of reversed systolic pulmonary venous flow in JC and JP groups was 28 +/- 10 cm/sec and 46 +/- 8 cm/sec (p < 0.01) respectively. Maximal area of reversed pulmonary venous flow of JC and JP groups was 124 +/- 30 mm2 and 389 +/- 40 mm2 (p < 0.001) respectively. CONCLUSIONS: Color Doppler echocardiographic evaluation of mitral regurgitation wall jets, is not an exact method to quantify their degree of severity. In the assessment of extreme eccentric mitral regurgitation jets that interact with the atrial wall, the color Doppler quantification criteria is not sufficient. In these cases of mitral regurgitation wall jets, pulmonary venous pulsed Doppler flow criteria can be useful.
We investigated the possible ameliorating and preventive effect of swimming on prednisolone-induced osteoporosis in elderly rats. A total of 48 female Sabra strain rats were randomly assigned to the following groups and treatments: (1) control (C), (2) swimming (S), (3) prednisolone-treated (CP), and (4) swimming + prednisolone (SP). An additional 8 rats were sacrificed and examined at the onset of the study. Groups C and S were sham injected; groups CP and SP were injected with prednisolone (Ultracorten), 80 mg/kg three times per week for 10 weeks. Groups S and SP swam 1 h daily, 5 days per week for 10 weeks. SP rats swam simultaneously with prednisolone administration. At the end of the swimming period, in vivo bone mineral content (BMC) measurements were performed on rat vertebrae L4-5 by single-photon absorptiometry. Later, the humerus and femur were removed for the following measurements: morphometric, bone density (BD) by Compton scattering technique, bone ion content by atomic absorption, and hydration fraction by proton magnetic resonance (PMR). We found that the humeral BD of S rats was greater by 14% for group S over C and 3% greater for group SP over CP (P less than 0.05). Vertebral BMC was higher by 15% in group S over C and 11% higher for group SP over CP (P less than 0.05). Femoral calcium (mg/g dry bone) ion content was higher by 5% in group S over C and 8% in group SP over CP group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
The characteristics and clinical implications of left atrial appendage (LAA) flow have not been clearly analyzed. Thirty-nine consecutive patients underwent a transesophageal echocardiographic (TEE) color Doppler study to correlate the LAA pulsed Doppler flow pattern with echocardiographic variables and the cardiac rhythm of each patient. Three different LAA flow patterns were identified. Type I flow, characterized by a biphasic pattern (waves of filling and emptying), was found in 17 patients, all in sinus rhythm; it was not associated with LAA spontaneous contrast or thrombus. Mean peak velocities of the filling and emptying waves were, respectively: 28 +/- 12 cm/sec and 31 +/- 9 cm/sec. Type II sawtooth active flow (eight patients) (mean peak velocity: 49 +/- 12 cm/sec) was only detected in atrial fibrillation (AF) and dilated LAA (LAA area: 421 +/- 40 mm2) but without thrombus or significant LAA spontaneous echocardiographic contrast. Type III flow pattern was noted in 14 patients with AF and a very dilated LAA (LAA area: 619 +/- 96 mm2). This flow pattern was characterized by the absence of identifiable flow waves and was associated with the presence of LAA spontaneous contrast; the majority (six of seven) had evidence of thrombus. We concluded that the LAA is a dynamic structure in which TEE study identified three flow patterns with different implications. AF is associated with two LAA flow types (II and III) with a larger LAA size as well as a higher incidence of LAA clots in type III flow.
OBJECTIVE: The aim of this study was to analyze, through transesophageal echocardiography, different factors related to left atrial spontaneous echocardiographic formation. DESIGN: Transthoracic and transesophageal comparative study of left atrial thrombotic phenomena. SETTING: Ambulatory and in hospital patients referred to Gregorio Marañon General Hospital Echocardiographic Laboratory. PATIENTS: 120 consecutive patients with mitral valve disease or prosthesis were included in this transesophageal echocardiographic prospective study. All patients were divided in two groups, according with left atrial spontaneous contrast. In each patient we measured total left atrial area, rhythm abnormalities, mitral valve area, left atrial cavity thrombus and maximal mitral regurgitation area. MEASUREMENTS AND RESULTS: Transthoracic echocardiography did not detect any patient with left atrial spontaneous contrast, compared to 57.5% diagnosed through the transesophageal technique. Transesophageal echocardiography diagnosed left atrial thrombosis in 19% (n = 23) of patients compared to 1% (n = 2) through the transthoracic technique. In the group with left atrial contrast, 59% of patients had mitral regurgitation less than 600 mm2, 64% were in atrial fibrillation and left atrial total area was 28 +/- 10.8 mm2. CONCLUSIONS: Transesophageal echocardiography is the technique of choice to diagnose, with greater security, left atrial cavity thrombosis, and establish the relationship of echocardiographic variables and left atrial thrombotic phenomena. Among these echocardiographic factors, left atrial dynamic spontaneous echocontrast is fundamental.
OBJECTIVE: Transthoracic and transesophageal comparative analysis of functional and morphological abnormalities associated to idiopathic mitral valve prolapse (MVP). DESIGN: Prospective study. SETTING: Outpatients with MVP diagnosis referred to echocardiographic laboratory of Cardiology Institute in Madrid, Spain. MATERIAL AND METHODS: In each case we analyzed by TTE and TEE, anterior, posterior and double localization of MVP, number of prolapsed mitral leaflets/patient, total area of MVP to mitral valve plane, mitral annulus diameter, total area and spatial distribution of mitral regurgitation. RESULTS: TEE diagnosed a greater number of prolapsed mitral leaflets and a greater percentage of double (80%) MVP. MPV area by TEE (50 +/- 31 mm2) was considerably larger (96 +/- 30 mm2) than TTE MVP area (50 +/- 31 mm3. Associated mitral valve regurgitation area calculated through TEE was larger (558 +/- 502 mm2) than the same parameter evaluated by TTE (450 +/- 515 mm2). CONCLUSIONS: TEE is an efficient technique in MVP non invasive diagnosis and particularly sensitive to posterior MVP. Our data could be helpful in MVP cases scheduled for mitral valve repairment.
OBJECTIVE: to evaluate the statistical significance of the haemodynamic examination making use of the Swan-Ganz catheter (S-G) on the hospitalary mortality of patients (pts) with acute myocardial infarction (AMI). CONCEPTION: Not randomized, not controlled and retrospective study. SETTING: Intensive coronary care unit (CCU). PATIENTS: 2562 pts with AMI sequentially admitted to a CCU were studied. METHODS: The 2562 pts were divided in two groups: Group A--involving 2117 pts not submitted to haemodynamic examination; Group B-constituted by 445 pts (17% of all pts) submitted to haemodynamic examination. All pts admitted to the study were distributed according to the four classes of Killip. The pts included in each Killip class were distributed by the groups A (not catheterized) and B (catheterized). Hospitalary mortalities of the pts included in the global A and B groups, and the mortalities of the patients included in the particular A and B groups in each Killip class were determined. To evaluate the statistical significance of the differences in distributions of the number of pts who survived and who died in each set of A and B groups square chi test was used. Values of p less than 0.05 were considered as statistical significant. RESULTS: The distributions of the pts who died and who survived during the stay in the hospital by the A and B groups, be it in the total group of patients be it in each Killip class, were not significant different (p greater than 0.05). CONCLUSIONS: The mortalities of pts with AMI submitted or not to haemodynamic examination with S-G catheter did not significantly differ even in each Killip class, which means that it was not demonstrated a benefit with the S-G catheter use in the pts with AMI. In the presence of this conclusion and considering that retrospective studies must be interpreted with circumspection, it seems necessary to accomplish a prospective randomized and controlled study for evaluation the risk/benefit relation of the haemodynamic examination with the S-G catheter in pts with AMI.
The aim of this parallel controlled-placebo study was to assess the antihypertensive effect of diltiazem in a slow release formulation in monotherapy by the ambulatory blood pressure monitoring (ABPM). Twenty patients with moderate essential hypertension entered the trial. Whole day ambulatory blood pressure (BP) monitoring, with a COLIN ABPM 630, was done after a wash-out period, after placebo administration and 60 days of therapy with diltiazem in a 120 or 180 mg once or twice daily administration. We verified by ABPM that placebo administration did not have an antihypertensive effect (146 +/- 10 mmHg/87 +/- 7 mmHg at base line to 145 +/- 8 mmHg/84 +/- 6 mmHg with placebo p = ns). Eithy four percent of the patients showed a significant systolic and diastolic BP decrease after 60 days of therapy (from 146 +/- 10 mmHg/87 +/- 7 mmHg at base line to 132 +/- 7/77 +/- 6 mmHg - p less than 0.025). In 56% of the patients this was achieved with 180 mg/day and this effect was sustained throughout the 24 hours. We did not find a significant decrease on heart rate. The ABPM is a valuable technique to assess the effect of antihypertensive drugs and demonstrated that diltiazem in a slow release formulation was effective in decreasing systolic and diastolic BP, throughout the day even in patients with low doses, once daily.
The aim of this study was to analyse the meaning of unexpected hypertensive response during treadmill stress test in resting normotensive individuals without any evidence of cardiovascular pathology. The study group of 52 persons who fulfil the inclusion criteria was compared with a homogenous control population composed by 200 individuals with a suitable blood pressure response to stress. The adopted criteria for hypertensive response were the presence of blood pressure greater than or equal to 180/100 mmHg after 6 stress, in maximal stress greater than or equal to 210/110 mmHg and after 5' recovering greater than or equal to 150/90 mmHg. 74% of patients with hypertensive response appeared to be hypertensive according to the criteria of ambulatory blood pressure monitoring--day blood pressure greater than or equal to 140/90 mmHg and night blood pressure greater than or equal to 120/80 mmHg. After echocardiographic study to define the index of left ventricular mass, 68% of individuals with hypertensive stress response showed left ventricular hypertrophy with a medium index of 145 + 17 g/m2 (P less than or equal to 0.01) in most cases with a concentrical hypertrophy type. The appearance of tensional response of hypertensive type ascertains the probability of hypertensive disease. The analysis of tensional response to stress is an integrant part of a methodology of approaching patients suspect of high blood pressure.
OBJECTIVE: Brief description of a clinical information system and its application to 2334 cases of acute myocardial infarction. DESIGN: To evaluate the influence on intra-hospital prognosis of 22 clinical characteristics observed in patients on the acute phase of myocardial infarction admitted to a coronary care unit. SETTING: Coronary care unit. PATIENTS: 2334 cases of myocardial infarction admitted sequentially to a coronary care unit. MATERIAL AND METHODS: A locally developed computerized information system was used. Software was organized in a modular way in order to turn available simplicity, flexibility and expandibility which are requisites of an automatic information system operating in a coronary unit. Following characteristics were evaluated: age and sex; previous myocardial infarction, angina, hypertension, diabetes, tabagism and hyperlipidemia; electrocardiographic localization of the infarction; ventricular dysfunction as evaluated by Killip classes; supraventricular and ventricular dysrhythmias; auriculo ventricular and intraventricular blocks; epistenocardic pericarditis; intra-hospital extension of the infarction; transient episode of hypertension and post-infarction angina. Statistical association between these characteristics and intra-hospital mortality was evaluated. Statistical significance was considered with a p less than 0.05. RESULTS: Statistical significant differences were found between surviving and non-surviving patients in the following characteristics: age and sex; previous history of myocardial infarction, angina and diabetes; Killip classes distribution; electrocardiographic localization of the infarction; intra-hospital extension of the infarction; auriculoventricular block, left and right bundle branch block; supraventricular and ventricular dysrhythmias. Patients with a previous history of tabagism and hyperlipidemia had a lesser mortality and were younger than the patients without these characteristics. Patients with transient episodes of hypertension and epistenocardic pericarditis had a lesser hospital mortality. CONCLUSIONS: Local development of a computerized information system turned available clinical information of 2334 patients sequentially admitted to a coronary care unit. A worse intra-hospital prognosis was present in the following groups of patients: older patients and females; patients with a previous history of infarction, angina and diabetes; anterior myocardial infarction, left ventricular dysfunction as evaluated by Killip classes, ventricular and supraventricular dysrhythmias, auriculoventricular and intraventricular blocks, transient episodes of hypertension and extension of the infarction. Patients with a previous history of tabagism and hyperlipidemia had a lesser mortality; however, there patients were younger than other. Patients with transient episodes of hypertension on first hours of infarction and those who had epistenocardic pericarditis had a lesser mortality.
It has been shown that coagulation factor VII (FVII) has an increased coagulant activity (FVIIc) in cardiovascular high risk patients and that it is a important risk factor for the development of ischaemic heart disease (IHD) and cardiovascular death. In this study, we measured FVII coagulant (FVIIc) and immunological (FVIIag) activities during the acute phase of unstable angina (UA) and acute uncomplicated and complicated myocardial infarction (AMI). We have also studied its changes in relation to thrombin formation and coagulation activation, as assessed by determination of thrombin-antithrombin circulating complexes (T-AT) at the same time. Our results show a marked increase in FVIIc in all patients, with highest significant levels in complicated AMI. In fact, this increase was also different between groups, complicated AMI showing a significant degree of increase in FVIIc in relation to UA and uncomplicated AMI. FVIIag did not vary between groups and controls, implicating a progressive activation of FVII. As expected, we found comparable levels of T-AT in UA and in AMI patients, suggesting that a common thrombotic process is involved in both situations. FVIIc was strongly correlated to T-AT in all patients (r = 0. 750; p less than 0.001) and also within groups. This study underlines the important positive contribution of FVIIc to IHD and to the prognosis of its thrombotic acute events, and shows that the increase in FVII activity is associated with an increase of a thrombotic marker (thrombin-antithrombin). Further studies are needed to evaluate if FVII activation is the cause or the consequence of the thrombotic processes.
Two hundred patients (90 men and 110 women), mean age 36.2 years, admitted to a Department of Medicine, between 1961 and 1979 with subacute infective endocarditis (SIE) were studied. Rheumatic heart valve disease was the predisposing lesion in 94% and the mitral valve was involved in about 80% of the cases. Diagnosis of SIE was confirmed by blood cultures in 66 patients and at autopsy on another 57 patients. The rheumatic symptoms and signs (RSS) considered were: arthralgia, rachialgia, arthritis, myalgia and Osler's nodes. RSS showed up in 50 (25%) of the subjects and arthralgias were the most frequent (12.5%). There were no significant differences between the 50 RSS patients and the other patients, regarding bacteriological and other laboratory data, including immunoglobulins. RSS patients were significantly younger (P less than 0.001). Out of the 200 patients, 71 (35.5%) died. Eight (16%) of these were in RSS subgroup of 50 patients. Presence of RSS did not worsen prognosis in our patients. Septic bone metastasis was not identified.
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OBJECTIVE: Analysis of different indices of blood pressure (BP) variability using the ambulatory blood pressure monitoring (ABPM) method in two populations of hypertensive patients (HTA Group) and normotensive volunteers (NOR Group). SETTING: Noninvasive prospective ambulatory study to assess the alterations of the circadian blood pressure profile through ABPM indices of blood pressure variability. PATIENTS: Patients with the diagnosis of essential arterial hypertension referred for clinical investigation to the Cardiology Department of Egas Moniz Hospital in Lisbon. MATERIAL AND METHODS: 40 hypertensive patients (HTA Group) and 30 normal subjects (NOR Group) were included in this study. We calculated the short and long term variability indices. The short term variability indices were the casual and mean immediate BP deviation, percentage of BP peaks and BP peak relative deviation and maximal range variation. Some clinical and general factors considered were namely age, gender, height, weight, body area and index, mean and casual systolic-diastolic blood pressure. RESULTS: Concerning systolic blood pressure in hypertension Vs normal groups respectively, the casual BP deviation was 15 +/- 4 mmHg and 7 +/- 4 mmHg (p 0.003), the mean immediate BP deviation was 18.5 +/- 4 mmHg and 7.5 +/- 3 mmHg (p 0.002), the percentage of BP peaks was 27 +/- 6% (p < 0.001), the percentage of BP peak area was 29 +/- 7% and 6 +/- 3% (p 0.001) and the percentage of relative deviation was 14 +/- 4% and 8 +/- 3% (p 0.03). For diastolic blood pressure all differences were not statistically significant between the two groups and the same happened for systolic blood pressure in relation to standard deviation and maximal range variation. Among these parameters and general and clinical characteristics, the systolic mean and casual blood pressure level showed an acceptable correlation with mean immediate deviation (R = 0.54/0.49), percentage of BP peaks (R = 0.56/0.49) and percentage of BP peak area (R = 0.60/0.53). CONCLUSIONS: Blood pressure variability can be adequately evaluated through the method of ambulatory blood pressure monitoring. Some variability indices can be extracted from the 24 hour curves of ambulatory blood pressure monitoring. Long-term variability indices are not related to the level of blood pressure. In the hypertension group we found a greater variability concerning short term indices, namely immediate deviation, percentage and are of peak curve.
OBJECTIVE: Transesophageal echocardiographic analysis of color Doppler characteristics of mitral valvular regurgitation jets. DESIGN: Transesophageal echocardiographic prospective study. SETTING: Ambulatory patients referred to Echocardiographic Laboratory of Gregorio Marañon General Hospital, Madrid, Spain. MATERIAL AND METHODS: We studied a group of 100 consecutive patients with mitral regurgitation diagnosis. In each patient we calculated the degree of severity, percentage of wall intersection, maximal traced area, axis direction, atrial depth, maximal transversal diameter, perimeter and angle of the mitral regurgitation jet. We divided the entire population in three different groups according to the jet direction in central (CJ), eccentric (EJ) and wall jets (WJ). MAIN RESULTS: The direction of the mitral regurgitation jet was central in 49%, eccentric in 33% and impinging the left atrial wall in 18%. The mitral regurgitation jet angle was in the CJ 80 +/- 11 degrees, EJ 33 +/- 10 degrees and WJ 6 +/- 7 degrees. Maximal mitral regurgitant traced area in CJ was 732 +/- 104 mm2, EJ was 593 +/- 110 mm2 and WJ was 267 +/- 80 mm2. Maximal regurgitant jet depth in CJ was 36 +/- 17 mm, EJ 30 +/- 15 mm and WJ 49 +/- 14 mm. The perimeter of the mitral regurgitation jet in the CJ was 87 +/- 22 mm, EJ was 68 +/- 22 mm and WJ was 92 +/- 30 mm. CONCLUSIONS: Color Doppler quantification criteria are not useful in all patients with mitral regurgitation jets. The presence of atrial walls close to the mitral regurgitation jet area is an important factor in the mitral regurgitation color Doppler evaluation.