BACKGROUND AND AIM OF THE STUDY: Quantitative Doppler echocardiography and proximal flow convergence methods facilitate quantification of regurgitant volume (RV), regurgitant fraction (RF) and the measurement of effective regurgitant orifice (ERO) to define mitral regurgitation (MR) severity. Vena contracta width (VCW) has been proposed as a simple, accurate marker of MR, and is instrumental in predicting the angiographic severity of valvular regurgitation. The study aim was to compare VCW with quantitative Doppler methods and angiography for assessing MR. METHODS: Sixty-four patients with MR (50 males; mean age 54 +/- 8 years; range: 34-84 years) were included. The etiology of MR was coronary artery disease, infective endocarditis, rheumatic disease, dilated cardiomyopathy or mitral valve prolapse. Exclusion criteria included aortic stenosis and/or aortic insufficiency, mitral stenosis, mechanical prostheses and atrial fibrillation. RV and ERO estimated by the proximal isovelocity surface area method (PISA), and RF calculated by Doppler, were compared with VCW measured by color Doppler. The angiographic severity of MR was classified on a four-point scale, in compliance with Sellers' criteria. RESULTS: A good correlation was found between VCW and ERO (r2 = 0.70, p <0.001), RV (r2 = 0.73, p <0.001), RF (r2 = 0.71, p <0.001) and angiographic grade (r2 = 0.72, p <0.001). CONCLUSION: VCW measured by color Doppler correlates well with MR severity. In addition, VCW is a simple, reproducible quantitative measurement of MR, and is recommended for use in the non-invasive assessment of the condition.

Adult↗

PubMed2004

[Left ventricle TEI index--assessment of clinical role in patients with aortic valve stenosis].

AIM: The study aimed to assess the clinical efficacy of the TEI index in patients with aortic valve stenosis (AVS). METHODS: The study group comprised 30 consecutive patients (12 F; 18 M; mean age: 60.1 +/- 9.2; range: 48-70 years) with aortic valve stenosis. Their clinical status was evaluated according to the NYHA criteria. A complete 2-dimensional, Doppler and color flow Doppler examination was performed. To assess systolic and diastolic left ventricle function we used ejection fraction--EF (%) and transmitral inflow velocity E/A ratio, respectively. The TEI index was calculated as (a - b)/b, were a is the interval between the cessation and onset of mitral inflow, and b is the ejection time. We also determined: maximal transaortic gradient--Ao max gr (mmHg), aortic valve area--AVA (cm2) and left ventricular mass index--LV mass index (g/m2). Based on clinical symptoms we divided patients into two groups: Group 1 (NYHA I/II) and Group 2 (NYHA III and IV). RESULTS: There were no significant differences in age, Ao max gr, AVA, EF and ejection time (b) between groups. But we found significantly prolonged time interval (a) and consequently significantly higher TEI index (p<0.001) in the group with severe symptoms. LV mass index and E/A ratio were also related to the patient's clinical status (p<0.05) but the TEI index seems to be more sensitive in distinguishing severely limited patients. CONCLUSION: The TEI index revealed to be closely related to symptoms in patients with aortic valve stenosis. The patient's clinical status seems to depend more on the TEI than on the conventional measured parameters like aortic valve area and transaortic gradient.

Aged↗

PubMed2004

[Use of cardiovascular magnetic resonance (CMR) in preoperative assessment of aortic stenosis--case report].

PURPOSE: CMR is a helpful additional diagnostic method in cardiac imaging. Thanks to high spatial and temporal resolution and high quality of obtained images this method is used in patients with poor echocardiographic acoustic window. We present a case of a patient, in whom CMR was conclusive as a non-invasive method of aortic valve stenosis assessment before qualification to cardiosurgery. METHODS: CMR was performed in a 70-year-old female A. C. who was under cardiological control due to symptomatic aortic stenosis. Because of difficulties in echocardiographic examinations (TTE) the aortic valve area was impossible to evaluate and aortic gradient value was difficult to assess and it differed in consecutive TTE performed over a short period (maximal gradient: 66-91 mmHg; mean gradient: 37-50 mmHg). The patient underwent CMR (Magnetom Vision Plus 1.5 T, Siemens) with the use of cine gradient echo sequences which made possible morphological and functional assessment of the valve and left ventricle. LV mass indices, IVS thickness, EF, aortic valve area, maximal aortic valve gradient were measured. RESULTS: CMR revealed: left ventricle muscle hypertrophy (IVS--1.8 cm; LV mass index--210 g/m2), EF--70%, no regional contractility disturbances and aortic valve area less than 1 cm2. In aortic valve and anulus extensive calcifications were visualised as low intensity signal area. Turbulent flow through aortic valve was found, maximal gradient about 64 mmHg. On the basis of all clinical symptoms and measurements based on imaging methods, the patient was qualified for cardiosurgery which was held in the Department of Cardiovascular Surgery and Transplantology. Coronary angiography revealed no significant stenosis. The operation was performed in extracorporeal circulation, general hypothermia and cardioplegia. Calcified aortic valve leaflets were excised and replaced by artificial valve (St. Jude Medical 21A Masters). The patient is in good health and was discharged. CONCLUSIONS: CMR is a valuable non invasive imaging method complementary to TTE in morphological and functional assessment of aortic valve and left ventricle, especially in patients with poor acoustic window in TTE.

Aged↗

PubMed2004

[Calcific and degenerative aortic stenosis--pathogenesis and new possibilities of treatment].

Currently, degenerative changes are the most important cause of valvular aortic stenosis. Epidemiological as well as experimental studies suggest that inflammatory process induced and intensified by common atherosclerosis risk factors as age, hyperlipidemia, diabetes, hypertension, male sex and smoking, is responsible for these changes. Microscopic examination of the affected valves reveals: endothelium derangement, thickening of the subendothelial layer, intra- and extracellular lipid, lipoprotein and protein deposits, inflammatory infiltrate composed of macrophages, T lymphocytes, foam cells and intensive calcification in the zones of lipid accumulation. The method of choice in the assessment of aortic valve stenosis is echocardiography. New, more sensitive, quantitative radiological methods like Electron Beam Computed Tomography and Multislice Computed Tomography may be useful in a detection of early lesions and monitoring of their progress. As the process of aortic valve degeneration is long and progressive in nature, early introduction of effective prevention would decrease the number of patients operated on for aortic stenosis. A number of studies indicate the role of statins in slowing the progression of aortic valve degeneration. Nevertheless, no large randomized prospective study has emerged in this field and there is no strong enough evidence for the efficacy of statins in degenerative aortic valve disease.

Aortic Valve↗

PubMed2004

[Evaluation of the correlation between calcifications in the aortic valve and in the coronary arteries using MSCT].

INTRODUCTION: Calcium score is the subject of wide research in evaluating atherosclerotic progression. The study aimed to determine whether an association exists between the presence of aortic valve calcium (a-CS) and coronary calcium (ca-CS) in patients with aortic valve stenosis as detected by multislice computed tomography (MSCT). METHOD: We examined 45 patients (27M; 18F); aged 67 (SD 9.5) with the aortic valve stenosis mean grad. 47.8 mmHg; max. grad. 75.3 mmHg; mean aortic valve area 1.02 cm2. The quantitative evaluation of calcifications on the aortic valve (a-CS) and in the coronary arteries (ca-CS) was performed in all patients with the use of MSCT and conventional coronary angiography (CCA). Aortic valve and total coronary artery calcium score were analysed. U-Mann-Whitney test and Pearson's correlation were used in the statistical analysis. The correlation coefficients between a-CS and ca-CS and between the lesions in coronarography and ca-CS were calculated. RESULTS: There was a weak correlation between aortic valve calcifications and coronary artery calcifications p=0.05, r=0.1. In 18 patients no coronary calcifications were found, none of the patients had lesions in CCA. In all patients with ca-CS > 400 there were significant stenoses in coronary arteries. A correlation between significant stenoses in CCA and ca-CS was established (p<0.01). CONCLUSIONS: Aortic valve calcium score (a-CS) may indicate the advancement of coronary artery calcifications in the patients with aortic valve stenosis. In this particular group ca-CS correlates well with stenoses in coronary arteries, as identified by CCA. Patients with the ca-CS > 400 are at high risk of coronary arteries stenoses, which is significant information in operation procedure qualification and time to surgery.

Aged↗

PubMed2004

[Effect of the dispersion of calcium deposits on allogenic aortic valves durability. Mineralization phases].

This investigation was aimed at comparison of calcium content and calcium dispersion in allogenic aortic valve leaflets removed due to dysfunction, to establish the influence of both parameters on graft durability. Calcification was assessed histochemically (von Kossa) as well as physicochemically using atomic absorption spectroscopy (AAS). The morpho-metric data (leaflet area involved in the calcification process) were obtained by computer-assisted image analysis system. The dry weight content of leaflet calcium and phosphorus were assessed by atomic absorptive spectroscopy (AAS) and Ca/P ratio was calculated. Calcium dispersion coefficient (Dc) was established according to the formula: Dc = 1/Ca(c)/Ap, where Ca(c) = calcium dry weight concentration; Ap = percent of leaflet area involved in calcification. We found biphasic correlation between calcium concentration and area involved in calcification. The first one was characterized by rising dispersion of calcium deposits while for the second one saturation with hydroxyapatite of formerly calcified areas was predominant, negatively influencing graft durability. Allograft durability was correlated with calcium dispersion (Dc) (p<0.001), while no significant correlation was found with calcium concentration. Decreased Dc was characteristic for 93.8% of low durability grafts (<11.6 years). Our results suggest that lowered calcium dispersion decreasing allograft lifetime and is a better predictor of allograft durability than the total calcium content.

Adolescent↗

PubMed2004

[Mineralization of homograft aortic valves stored in a nutrient solution].

BACKGROUND AND AIM OF THE STUDY: Mineralization of the homograft aortic valve cusps is a complex process leading to their degeneration and decreasing durability. Factors that play a decisive role in regulation of mineralization, growth of hydroxyapatite crystals are still open questions. We studied development of mineralization in the homograft aortic valves prepared for transplantation stored in the Parker's solution with antibiotics. METHOD: The aortic valves were explanted from 12 donors <18 hours after death. All the cusps were divided into halves. One half of each cusp was stored in the Parker's solution with antibiotics for 28 days at 4 degrees C. Concentrations of several elements (P, S, Cl, K, Ca, Mn, Fe, Ni, Cu, Zn i Sr) in incubated and control samples were determined using energy dispersive X-ray fluorescence (ED-XRF). RESULTS: The study showed that the concentration of Ca and Ca/P increased during incubation that may indicate development of mineralization. CONCLUSIONS: The homograft aortic valve cusps underwent mineralization during in vitro incubation. This may aggravate mineralization in the aortic valve recipients and decrease valve durability which indicate a need for modification of storing condition.

Adult↗

PubMed2004

[Quality of life after homograft aortic valve replacement and reoperation].

AIM: To evaluate quality of life (QoL) in patients after aortic homograft implantation for aortic valve disease and in those who had undergone reoperation due to homograft dysfunction. METHODS: QoL was assessed in 354 patients (72 women and 282 men, mean age 55.1 +/- 11.5 years, range 13-69) after aortic homograft implantation. Patients were divided into two groups: I--patients after aortic homograft implantation without reoperation (291 patients) and II--patients after reoperation (68 patients). We used two questionnaires: SF 36 (Short Formulation 36) and a self-developed questionnaire for patients after cardiac operation (SDQ). SF 36 has three levels: a) 36 items; b) eight scales: physical activity, social activity, limitations in every day activity, body pain, mental health, emotional problems, vitality and health perception; c) two summary measures that aggregate scales; general physical health which constitutes of physical activity, limitations in every day activities, body pain, health perception and general mental health which constitutes the rest of four scales: social activity, mental health, emotional problems, vitality. Each scale is standardized from 1 to 100 with > 50 indicating better than general population average. SDQ is focused on social and demographic factors, clinical symptoms before and after operation, risk factors and physical and occupational activity. RESULTS: By SF 36, only health perception was below general population average. We found a statistically positive relationship between QoL and high physical and occupational activity in both groups (p<0.05). The presence of dyspnea, chest pain, palpitations, edema, faints, fear/anxiety and hypertension were related to decreased general physical and mental health in both groups (p<0.05). CONCLUSIONS: Patients after aortic homograft implantation have high QoL. This holds also for those after reoperation for homograft dysfunction. Symptomatic patients have lower QoL. Higher QoL is associated with physical and occupational activity. There is no difference in general physical health in both groups. General mental health is decreased in reoperated patients. Since reoperated patients more often suffer from emotional problems, they may particularly benefit from the psychological support.

Adolescent↗

PubMed2004

[Atrial septal defect associated with mitral valve prolapse--prevalence and clinical significance].

AIM: High incidence of mitral valve prolapse (MVP) associated with atrial septal defect (ASD) has been reported. The study aimed to evaluate the prevalence, etiology and clinical significance of MVP in patients with ASD. METHODS: Forty-seven consecutive patients with secundum type ASD (30 F; 17 M; mean age: 37.9 +/- 14.0; range: 16-62 years) were enrolled into the study. All patients underwent M-mode and two dimensional echocardiography to check for MVP, defined as the superior systolic displacement of mitral leaflets > or = 2 mm above annulus with coaptation point at, or superior to the annular plane. Pulmonary to systemic flow ratio (Qp/Qs), diastolic right ventricle dimension (RV), left ventricle dimension (LV) and left to right ventricle ratio (LV/RV) were measured. Furthermore, mitral and tricuspid valve insufficiency and right ventricle systolic pressure (RVSP) were evaluated. A symptom-limited, incremental exercise test (CPX)--modo Bruce on Marquette 2000 Treadmill was performed in every patient. We determined: time of exercise--Time (min), peak oxygen uptake--VO2peak (ml/kg/min), VO2peak expressed as % of predicted value--VO2% and anaerobic threshold--AT (expressed as % VO2 max). The study population was divided into two groups: Group I--patients with ASD and MVP and Group II--patients with ASD without MVP. RESULTS: MVP was recognized in 17 patients (36%); anterior MVP was found in 14, two cases revealed posterior MVP and one was diagnosed with both anterior and posterior MVP. MVP was not associated with significant mitral regurgitation. Echocardiographic and CPX data are summarized in table I. There were no significant differences in age, RVSP, RV and LV diastolic dimensions between groups, although Qp/Qs was significantly higher (p=0.01) and LV/RV significantly lower (p=0.02) in the MVP group. Moreover, there was a significant negative correlation between Qp/Qs and LV/RV ratio (r=-0.70; p<0.001) in a study group. No significant difference in time of exercise, VO2peak, VO2%, and AT was observed between respective groups. CONCLUSIONS: Our data support the thesis that MVP associated with secundum ASD is a functional disorder due to the atrial shunt and leftward shift of interventricular septum. MVP does not affect cardiopulmonary capacity in ASD patients.

Adolescent↗

PubMed2004

[Early haemodynamic changes after transcatheter closure of atrial septal defect].

OBJECTIVE: To evaluate the outcomes of transcatheter closure of secundum atrial septal defect (ASD) using the Amplatzer Septal Occluder (ASO). METHODS: Between December 2000 and December 2002, 27 adult patients (20 females, 7 males) with a mean age of 41.1 +/- 13.3 (range 18-62) years were enrolled for an attempt at ASD closure with the ASO device. All patients had an isolated secundum ASD with a large left-to-right shunt (ratio of pulmonary to systemic blood flow or Qp:Qs >1.5:1). Transthoracic color Doppler echocardiographic examination was performed on all patients before procedure, 24 hours, 1 and 6 months after surgery. Clinical observation (NYHA class) was performed 1 and 6 months after surgery. RESULTS: The ASO device was successfully implanted in all patients (procedure time 19-63 minutes, median 43 minutes, fluoroscopy time 4-40 minutes, median 12.6 minutes), with only 3 patients with a trivial residual shunt. The defect echo diameter was 14.2 +/- 4.3 (7-24). At one month of follow-up transthoracic echocardiography showed that the device was correctly positioned in all cases and no predictors for a residual shunt were identified. Residual trivial shunt in one month follow-up was shaded in 3 patients. Paradoxical septal motion abnormalities normalized in all patients. The right ventricular dimension evaluated by 2D echocardiography decreased in 20 pts (74.1%), mean 5.0 +/- 3.4 mm (range 1.5-8), the right atrium dimension decreased in 21 pts (77.8%), mean 8.65 +/- 4.3 mm (range 2-20) and the left atrium dimension decreased in 15 pts (55.6%), mean 6.36 +/- 3 mm (range 2-21). We didn't find correlations between ratio of left-to-right shunt before ASD closure and the decrease of right heart dimension as well as the decrease of pulmonary artery systolic pressure. CONCLUSIONS: Transcatheter closure of secundum ASD using the ASO is a safe and effective procedure, with excellent short-term follow-up results. During one month observation it caused partial normalization of echocardiographic parameters.

Adult↗

PubMed2004

[Early results of atrial septal defect closure with the Amplatzer Septal Occluder are impacted by tricuspid insufficiency].

OBJECTIVE: Our study reports the results of a comparison of transcatheter closure of secundum atrial septal defect (ASD) using the Amplatzer Septal Occluder (ASO) in patients with and without tricuspid insufficiency. METHODS: Consecutive 27 adult patients (20 females, 7 males) with a mean age of 41.1 +/- 13.3 (range 18-62) years having an ASD II and a transcatheter closure between December 2000 and December 2002 were analyzed. All the patients had an isolated secundum ASD with a significant left-to-right shunt (ratio of pulmonary to systemic blood flow or Qp:Qs >1.5:1). Patients were divided in two groups: group I--without tricuspid abnormalities (8 patients, 29.6%), group II--patients with tricuspid insufficiency I-III stage, (19 patients, 70.4%). Transthoracic color Doppler echocardiographic study was performed in all patients before discharge and was repeated one month after discharge. RESULTS: The mean age, the diameter of defect, the degree of left-to-right shunt, the diameter of implanted device were comparable in both groups. Before implantation the dimension of right heart cavities differed between groups. The right ventricular dimension was larger in group II (mean 36.2 mm vs. 29.1 mm; p<0.009), the right atrium diameter was larger in group II (46.2 mm vs. 24.3 mm; p<0.007). Pulmonary artery systolic pressure before the procedure was higher in group II (36.6 mmHg vs. 20.43 mmHg; p<0.006). The ASO device was successfully implanted in all the patients. At one month follow-up septal motion abnormalities normalized in all patients in both groups. The mean decrease of right atrium diameter in group I was 6.2 mm (range 1.5-12 mm) compared to 9.6 mm (range 2-20) in group II, (p<0.001), the mean decrease of right ventricular diameter in group I was 5.8 mm (range 2-8 mm) compared to 3.1 mm (range 1-5.9) in group II, (p<0.006). CONCLUSIONS: Short-term follow-up demonstrated excellent results of ASD closure in both groups. In one month follow-up the decrease of right cavities dimensions was significantly higher in the patients without tricuspid abnormalities. The pulmonary artery systolic pressure before ASD closure was significantly higher in the patients with tricuspid abnormality.

Adult↗