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[2-dimensional echocardiography].

In the mid-seventies, echocardiographic devices for clinical use have been developed to generate real-time cross-sectional images of the heart with a rate of about 30 frames per second. This technique improved the diagnostic power of M-mode echocardiography by visualizing the chambers, valves and walls of the heart in a variety of planes. Cross-sectional echocardiography provides important information for example in the evaluation of left ventricular function, diagnosis of congenital heart diseases, endocarditis, hypertrophic cardiomyopathies, cardiac tumors and others, that cannot be determined adequately by M-mode echocardiography alone.

Cardiomyopathy, Hypertrophic↗

[Coronary disease in patients operated on for valvulopathy].

In order to evaluate the influence of a significant coronary artery disease in patients with valvular heart disease or with prosthetic valves, we reviewed literature and our own experience. The incidence of coronary artery disease in valvulopathies has been diffusely studied and reported and, in a consecutive series of our hemodynamic studies, resulted 11%. The influence of a coronary artery disease on early and late results of a surgical procedure is different whether the coronary artery disease is operated or not. In particular, the combined surgery shows a higher early mortality, but a much better long-term prognosis. In addition, sometimes surgery introduces rare causes of coronary artery disease. Finally, it seems that coronary artery disease arises very rarely in patients undergone valvular surgery or, at least, patients rarely complain anginal symptoms in the post-surgical follow-up. In our experience on 529 patients only 6 complained typical angina and only 2 showed a coronary artery disease not present at the time of operation.

Aortic Valve↗

Midterm experience with the Sorin Bicarbon heart valve prosthesis for rheumatic disease.

BACKGROUND: In this study, we present a single center experience with Bicarbon bileaflet valve in 307 patients with rheumatic heart disease. METHODS: Between August 1998 and September 2000, 307 patients underwent heart valve replacement using the Bicarbon bileaflet valve (Sorin Biomedica, Saluggia, Italy) with an average age of 47.19+/-13.21 years (range 14 to 80 years), consisting of 147 males and 160 females at Alkan Hospital, Cardiovascular Surgery Department. Aortic valve replacement (AVR) was performed in 77 patients, mitral valve replacement (MVR) in 156 patients and double valve replacement (DVR) in 74 patients. RESULTS: The early mortality rate was 3.3% (10/307) and there was no late mortality. The actuarial survival rate, including hospital mortality, was 96.74+/-1.01% for the whole group, 96.5+/-1.5% for the MVR group, 97.4+/-1.8% for the AVR group and 97.3+/-1.9% for the DVR group at 35 months. One patient had obstructive valve thrombosis with MVR. The 35 months actuarial freedom from valve thrombosis was 99.58+/-0.4% for the whole group. Four patients were reoperated and the 35 months actuarial freedom from reoperation was 98.53+/-0.7% for the whole group, 98.65+/-0.9% for the MVR group, 96.73+/-02% for the DVR group and 100% for the AVR group. No instances of perivalvular leak, hemolysis, endocarditis or embolism were observed during the entire follow-up period. Mean follow-up duration was 16.5+/-7.9 months (ranged 4 to 35 months). CONCLUSION: We have presented our mid-term results with the Sorin Bicarbon bileaflet valve in patients with rheumatic heart disease, which provided good clinical performance combined with meticulous patient care and advanced surgical techniques.

Adolescent↗

Valvular heart disease and pregnancy: part II: prosthetic valves.

A large number of prosthetic heart valves (PHV) are being implanted in patients with both congenital and acquired valvular disease. Many of the recipients of such valves are women of childbearing age who desire to have children. The main issues involved with pregnancy in a patient with PHV include the selection of PHV in women during their childbearing age, risks to both the mother and the fetus associated with pregnancy and the management of the patients with PHV during gestation.

Bioprosthesis↗

[Value of the exercise test in the functional evaluation of non-coronary cardiac patients].

72 cardiac patients underwent an exercise test on the bicycle ergometer, with direct measurement of the oxygen consumption (VO2). These results are compared with those of 55 healthy subjects undergoing the same test. The amount of handicap varied with the nature of the cardiac lesion, being 39% for the mitral and cardiomyopathy groups, 31% for those with both mitral and aortic valve disease, 27% for the aortic valve group, and 25% for those with congenital abnormalities. The linear relationship between Watts and VO2 was reproduced both in the healthy and cardiac subjects, which allows us to calculate the value of VO2 under conditions of load for more than 3 minutes during a standardized exercise test.

Adult↗

Emergency mitral and aortic valve replacement during acute rheumatic fever in a 5-year-old child.

Emergency combined mitral and aortic valve replacement was performed during an attack of acute rheumatic fever in a 5-year-old boy. He made an uneventful recovery and has remained asymptomatic 1 year after the operation. From this and other authors' clinical experience, we believe that the decision to operate on these patients should be based on the severity of the disability and the hemodynamic disturbances rather than on the activity or inactivity of the rheumatic process.

Acute Disease↗

Advances in noninvasive assessment of valvular heart disease.

Echocardiography continues to be the noninvasive method of choice in the evaluation of valvular heart disease. Important recent developments include clinical validation of approaches used to quantify valvular regurgitation, in particular the proximal flow convergence zone method; use of transesophageal imaging to monitor and evaluate surgical or percutaneous interventions in valvular heart disease, in particular mitral valve repair; insight into flow-related stretch of the orifice area in aortic stenosis; and validation of nuclear magnetic resonance imaging in small series for quantification of left-sided valvular stenotic and regurgitant lesions.

Blood Flow Velocity↗

Long-term survival after counterpulsation for medically refractory heart failure complicating myocardial infarction and cardiac surgery.

Intra-aortic balloon counterpulsation (IABP) was performed in 225 patients over a 12-year period for the treatment of severe left ventricular failure following acute myocardial infarction and cardiac surgery, and which had failed to respond to conventional therapy. Of these patients, 97 (43%) were discharged alive from hospital. Patients were followed-up for a mean of 5.8 years (3 months to 11 years) and assessment of functional status was made. In patients with shock after myocardial infarction, the most favourable outcome was seen in patients who had mechanical cardiac defects which were corrected after institution of IABP and in those treated within 8 hours of the onset of shock; of those patients without shock, best results were seen in patients who had evidence of continuing ischaemia prior to IABP. In patients treated after cardiac surgery, long-term results were favourable in patients with good pre-operative left ventricular function and in those who underwent coronary artery bypass grafting or aortic valve replacement. Long-term results in patients treated with IABP for refractory cardiac failure are encouraging and suggest that IABP should have a continuing role in certain high risk patient groups.

Adult↗

[Transesophageal echocardiography in the study of intracardiac thrombosis, tumors and vegetations].

Of 200 consecutive patients, studied with transesophageal echocardiography the findings were analyzed with respect to the presence of thrombi, tumors or vegetations. Thrombus formation was detected in 18 patients; their location and associated pathology are described. Tumors were present in 9 cases and in 10 patients endocarditis in native or prosthetic valves. The information obtained by transesophageal echocardiography was compared with transthoracic echocardiographic data. Transoesophageal echocardiography was demonstrated to be more sensitive, especially in the detection of intracavitary masses in the posterior structures of the heart.

Adolescent↗

Diagnosing aortic valve stenosis by parameter extraction of heart sound signals.

The objective of this study was to develop an automatic signal analysis system for heart sound diagnosis. This should support the general practitioner in discovering aortic valve stenoses at an early stage to avoid or decrease the number of surgical interventions. The applied analysis method is based on classification of heart sound signals utilising parameter extraction. From the wavelet decomposition of a representative heart cycle as well as from the Short Time Fourier Transform (STFT) and the Wavelet Transform (WT) spectra new time series were derived. In several segments, parameters were extracted and analysed. In addition, features of the Fast Fourier Transform (FFT) of the raw signal were examined. In this study, 206 patients were enrolled, 159 with no heart valve disease or any other heart valve disease but aortic valve stenosis and 47 suffering from aortic valve stenosis in a mild, moderate or severe stage. To separate the groups, a linear discriminant function analysis was applied leading to a reduced parameter set. The introduced two classification stage (CS) system for automatic detection of aortic valve stenoses achieves a high sensitivity of 100% for moderate and severe aortic valve stenosis and a sensitivity of 75% for mild aortic valve stenosis. A specificity of 93.7% for patients without aortic valve stenosis is provided. The developed method is robust, cost effective and easy to use, and could, therefore, be a suitable method to diagnose aortic valve stenosis by general practitioners.

Aortic Valve Stenosis↗