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At least 145 records · Page 8Linked to original sources
PubMed1989

Three-dimensional echocardiographic reconstruction of the mitral valve, with implications for the diagnosis of mitral valve prolapse.

Mitral valve prolapse has been diagnosed by two-dimensional echocardiographic criteria with surprising frequency in the general population, even when preselected normal subjects are examined. In most of these individuals, however, prolapse appears in the apical four-chamber view and is absent in roughly orthogonal long-axis views. Previous studies of in vitro models with nonplanar rings have shown that systolic mitral annular nonplanarity can potentially produce this discrepancy. However, to prove directly that apparent leaflet displacement in a two-dimensional view does not constitute true displacement above the three-dimensional annulus requires reconstruction of the entire mitral valve, including leaflets and annulus. Such reconstruction would also be necessary to explore the complex geometry of the valve and to derive volumetric measures of superior leaflet displacement. A technique was therefore developed and validated in vitro for three-dimensional reconstruction of the entire mitral valve. In this technique, simultaneous real-time acquisition of images and their spatial locations permits reconstruction of a localized structure by minimizing the effects of patient motion and respiration. By applying this method to 15 normal subjects, a coherent mitral valve surface could be reconstructed from intersecting scans. The results confirm mitral annular nonplanarity in systole, with a maximum deviation of 1.4 +/- 0.3 cm from planarity. They directly show that leaflets can appear to ascend above the mitral annulus in the apical four-chamber view, as they did in at least one view in all subjects, without actual leaflet displacement above the entire mitral valve in three dimensions, thereby challenging the diagnosis of prolapse by isolated four-chamber view displacement in otherwise normal individuals. This technique allows us to address a uniquely three-dimensional problem with high resolution and provide new information previously unavailable from the two-dimensional images. This new appreciation should enhance our ability to ask appropriate clinical questions relating mitral valve shape and leaflet displacement to clinical and pathologic consequences.

Algorithms↗
PubMed1989

Doppler echocardiographic assessment of transmitral gradients and mitral valve area before and after mitral valve balloon dilatation.

This is a comparative study of 60 sets of observations of mitral valve end-diastolic gradient, mean diastolic gradient, and mitral valve area obtained by Doppler echocardiography and cardiac catheterization. The studies were performed in 28 patients, 16 of whom underwent mitral valve balloon valvuloplasty. These 16 patients had studies performed before, immediately after valvuloplasty, and one week later. Thus 28 studies were performed before or without valvuloplasty (Group I) and 32 after valvuloplasty (Group II). The time interval between Doppler echocardiography and cardiac catheterization was less than 24 hours in 44 studies and 24 to 72 hours in 16 studies. In Doppler echocardiography the gradients were obtained by simplified Bernoulli's equation and the mitral valve area by pressure half-time method. There was excellent correlation between end-diastolic gradients (r = 0.96, p less than 0.001) and mean diastolic gradients (r = 0.92, p less than 0.001) measured by the two techniques. A statistically significant correlation also existed in the mitral valve area values (r = 0.53, p less than 0.005). On separate analysis Group I showed excellent correlation for all three variables (r values of 0.90, 0.87, and 0.82 for end-diastolic gradients, mean-diastolic gradients, and mitral valve area, respectively). Group II also showed excellent correlation of end-diastolic gradients (r = 0.80) and mean diastolic gradients (r = 0.87), but poor correlation of the mitral valve areas (r = 0.17; p = NS) by the two techniques. Doppler echocardiography can accurately measure transmitral gradients both before and after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Valve reconstruction for mitral regurgitation secondary to mitral valve prolapse].

This study was performed to evaluate the late results of mitral valve replacement for isolated mitral regurgitation and the early results of mitral valve reconstruction for mitral regurgitation secondary to mitral valve prolapse. Between January 1974 and March 1989, 106 patients underwent isolated mitral valve replacement for mitral regurgitation. There were 54 male and 52 female patients ranging in age at operation from 22 to 76 years (average: 50.2 years). Mitral valve replacement with the Carpentier-Edwards bioprosthesis was performed in 55 patients and with the Björk-Shiley disc valve in 51 patients. The follow-up period ranged from four to 182 months with a mean of 64 months. There were three hospital deaths (2.8%). The actuarial survival including hospital deaths were 94.0% at five years and 89.3% at 10 years. The event-free rate was 75.5% at five years and 51.8% at 10 years. There was no significant differences in these results between two prosthetic valve groups. Because of high incidence of prosthetic valve-related events, mitral valve reconstruction for mitral regurgitation was performed in recent two years. Twenty patients had mitral reconstructive surgery. There were 11 male and nine female patients ranging in age at operation from 22 to 70 years (average: 54.4 years). Two had elongated chordae and 18 had torn chordae (anterior leaflet; four cases, posterior leaflet; 14 cases). There was no hospital and late death. One had reoperation because of severe hemolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Biplane transesophageal color Doppler echocardiography for assessment of mitral valve area with mitral inflow jet widths.

Biplane transesophageal color Doppler echocardiography can image the mitral valve orifice in two orthogonal views. If the maximal stenotic jet width through the mitral valve obtained with the vertical transducer represents the major axis, the stenotic jet width dissected by the horizontal transducer should be the minor axis of the mitral orifice. Thus the mitral valve area can be calculated assuming an oval shape of mitral orifice. Nineteen patients with mitral stenosis were investigated. Maximal mitral stenotic jet width (JW1) was searched on a vertical plane and the jet width from the orthogonal view (JW2) was obtained on a horizontal plane. Mitral valve areas from the color Doppler jet widths were calculated by pi.JW1/2.JW2/2 and compared with those derived from Gorlin's formula. Adequate quality of echocardiographic images could be obtained in all patients for transesophageal color Doppler jet width measurements or Doppler pressure half-time determinations and in 16 of 19 patients for transthoracic planimetery of the mitral orifice at the parasternal short axis. Mitral valve areas derived from biplane transesophageal color Doppler imaging (1.31 +/- 0.53 cm2) were not different from those calculated according to Gorlin's formula from the catheterization data (1.25 +/- 0.50 cm2), those determined by transthoracic echocardiographic planimetery (1.38 +/- 0.5 cm2), or those calculated from the Doppler pressure half-time method (1.32 +/- 0.41 cm2) (difference not significant by analysis of variance). There was a very strong correlation between transesophageal echocardiographic mitral valve areas and those derived from catheterization data (r = 0.94; standard error of the estimate = 0.13 cm2). A similar correlation was obtained for the planimetric echocardiographic method (r = 0.94; standard error of the estimate = 0.14 cm2). A slightly less strong correlation was found between mitral valve areas derived from the Doppler pressure half-time method and those derived from Gorlin's formula (r = 0.83; standard error of the estimate = 0.24 cm2). The pressure half-time method accurately predicted the mitral valve area in most (15/19) patients, but it significantly (> 0.4 cm2) overestimated mitral valve area in two patients with aortic regurgitation and underestimated (< 0.4 cm2) mitral valve area in two patients with left ventricular hypertrophy. Determination of mitral valve area by color Doppler biplane transesophageal echocardiography is an alternative for accurate estimation of mitral valve area and may be most useful in intraoperative monitoring during surgical or balloon mitral commissurotomy or in the case of inadequate imaging quality of transthoracic echocardiography.

Adult↗
PubMed1979

Echocardiographic pattern of posterior mitral valve leaflet movement after mitral valve repair.

The pattern of movement of the posterior leaflet at the time of opening of the stenosed mitral valve has been described as either anterior or posterior in direction. In 32 patients who underwent mitral annuloplasty, the anatomical features of the mitral apparatus were correlated with the postoperative echocardiographic pattern of movements of the posterior leaflet. Anterior movement of the posterior leaflet was associated with extensive disease of this leaflet, and posterior movement with minimal disease. No relation was found between valve orifice or anterior leaflet mobility and the pattern of movement of the posterior leaflet.

Adult↗
PubMed1992

Factors affecting mitral valve reoperation in 317 survivors after mitral valve reconstruction.

From a very heterogeneous group of 340 patients undergoing mitral valve reconstruction from 1969 through 1988, 313 hospital survivors were analyzed for factors affecting the occurrence of reoperative mitral valve procedures related to native mitral valve dysfunction. Follow-up was 100% and extended from 1 year to 20 years (mean follow-up, 7.2 years). Sixty-three patients (18.5% of the 340) required mitral valve reoperation at a mean postoperative interval of 6 years (range, 1 to 15 years). Incremental risk factors analyzed for the event late mitral valve failure included age, sex, preoperative New York Heart Association class, cause of valvular disease, pathophysiology of the mitral valve, previous mitral valve operation, mitral valve pathology, and estimation of mitral valve function at operation after repair. Mitral valve pathophysiology affected the actuarial freedom from mitral valve replacement (p = 0.023 [log-rank]). Actuarial freedom from mitral valve reoperation was 90% at 5 years and 80% at 8 years in patients who had either pure mitral regurgitation or isolated mitral stenosis compared with 80% and 72% at 5 and 10 years, respectively, in patients who had mixed mitral stenosis and regurgitation (p = 0.023). Patients undergoing late reoperation were younger (51.7 +/- 1.56 years [+/- the standard error of the mean]) than those not having reoperation (p less than 0.0003). Durability of the repair was less in patients with rheumatic heart disease (p less than 0.025) and greater in patients with ischemic heart disease (p less than 0.004). Seventy-three percent of patients undergoing reoperation had concomitant operations compared with 68% of those not having reoperation (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Measurement of the end-diastolic pressure gradient and mitral valve area in mitral stenosis by Doppler ultrasound.

The pressure gradient across the mitral valve in mitral stenosis was determined by measurement of the maximum recorded velocity of the mitral jet at end-diastole using non-invasive Doppler ultrasound. The accuracy of the Doppler ultrasound technique was evaluated in 25 adult patients with mitral stenosis. In 10 patients, simultaneous ultrasound recordings and manometric recordings were made during cardiac catheterization. In seventeen patients with pure mitral stenosis, the mitral valve area was calculated from the manometric data using the Gorlin formula and from the ultrasound data. Good correlation was found between the Doppler ultrasound and the manometric method for the determination of both the end-diastolic pressure gradient and the mitral valve area. Results confirm that the non-invasive Doppler ultrasound technique is of diagnostic value in the assessment of mitral stenosis.

Adult↗
PubMed1990

[Value and limitations of the pressure halftime method for quantitating the mitral valve area in mitral stenosis].

To evaluate the accuracy of the pressure half-time (PHT) method in predicting the anatomical mitral valve area (Aa) in mitral stenosis, Doppler echocardiography was performed in 42 cases with mitral stenosis within 48 hours before mitral valve replacement. The diastolic mitral flow velocities were recorded by the continuous wave Doppler technique, and PHT and the derived mitral valve area (Ad) were measured by a computer system from the Doppler spectrum. Aa was measured from a photograph of the mitral valve excited en bloc at surgery. The comparison between Aa and Ad yielded a good correlation (r = 0.85). However, Ad significantly underestimated Aa (P less than 0.001) in cases with combined mitral stenosis and regurgitation, and significantly overestimated Aa in cases with combined mitral and aortic lesions. There was also a large scatter of data obtained by the two measurements (SEE = 0.41 cm2). It is concluded that the PHT method can predict Aa in isolated mitral stenosis with an acceptable accuracy but is of only limited value in combined mitral stenosis and regurgitation or combined mitral and aortic valve lesions.

Adolescent↗
PubMed1991

Early experience with mitral valve reconstruction for mitral insufficiency.

Mitral valve repair for mitral regurgitation has been reported to have more favorable early and late results than mitral valve replacement. From July 1985 through July 1990, 63 patients have undergone valve repair at Good Samaritan Hospital. Twenty-two men and 41 women whose ages ranged from 34 to 81 years (mean 67.9 years) were treated. Twenty-eight patients were in New York Heart Association functional class III or IV. Twelve (19%) had undergone prior cardiac surgery. Isolated valve repair was performed in 18 patients. Valve repair was combined with coronary artery bypass grafting, other valve procedures, or aneurysm resection in the remainder (71%). Two patients (3%) died while in the hospital, and four deaths (one valve-related) occurred after discharge. Leaflet resection for ruptured chordae was done in 24 patients (38%), chordal shortening in 5 patients (8%), and leaflet transposition in 2 patients. Rigid ring annuloplasty (Carpentier) was performed in 62 patients. Eight patients required mitral valve replacement at the same operation because of unsatisfactory valve repair. Results of valve repair evaluated by echocardiography at discharge show that 48 patients (88%) are free of significant regurgitation. Follow-up to date reveals that all surviving patients who underwent valve repair have clinically improved and are stable. Four of five patients with moderate mitral regurgitation are currently asymptomatic. There have been two valve-related late failures requiring reoperation. Based on this early experience, we conclude that valve repair compared with mitral valve replacement has a low operative mortality with good early results. Continued efforts to preserve native mitral valve function in the presence of mitral regurgitation appear justified.

Adult↗
PubMed1980

Pseudo-mitral-valve echogram following prosthetic mitral valve replacement.

Echocardiographic recordings from a patient with a prosthetic mitral valve revealed echoes within the left ventricular cavity that mimicked the motion pattern of a "normal" anterior mitral leaflet. The echo pattern was continuous, recorded from multiple views, and by two-dimensional images it was localized to the level of the papillary muscles. Although thrombus and vegetation are possibilities, this echo probably originates from a pliable chordal structure severed but not removed at the time of surgery. The apparent responsiveness to hemodynamic influences was striking, and we suggest that the prevalence and pathophysiologic implications of such findings are of potential import.

Aged↗
PubMed1984

[Mitral commissurotomy or mitral valve replacement. Comparison of results of closed and open operative procedures in acquired mitral valve stenoses and combined mitral valve defects, predominantly stenosis].

1012 closed operations for mitral stenoses, mitral restenoses and combined mitral and aortic stenoses were performed from 1963 to 1981. Moreover 888 operations were performed at the mitral valve from 1973 to October 1983 as open heart procedures: 676 cases of mitral valve replacement (MVR) including 7 cases of coronary artery operations; 4 cases both of mitral, aortic and tricuspidal valve replacement or mitral and tricuspidal valve replacement; 9 cases of valve reinsertion; 20 cases of open commissurotomy and 4 cases of annular plastic according to Wooler. The functional results after open operation are quite better than those after closed procedures. The rate of reoperations after MVR is only 3% but after closed operations more than 25%. In this way we believe the open operation to be the better way of treating acquired mitral stenosis. In our opinion the closed method may be used in cases of late pregnancy and in those centres having an insufficient capacity for open heart surgery to be performed.

Aortic Valve↗
PubMed1994

Prediction of change in mitral valve area after mitral balloon commissurotomy using cine computed tomography.

RATIONALE AND OBJECTIVES: Mitral balloon commissurotomy (MBC) can successfully increase the mitral valve area (MVA) in mitral stenosis, but the outcome is variable. In multicenter studies, qualitative echocardiographic scores obtained before MBC are only weakly predictive of the increase in MVA after MBC. METHODS: To evaluate whether the change in MVA after MBC can be predicted by evaluating mitral valve morphology using cine computed tomography (CT), we studied 12 women with mitral stenosis and 11 female control subjects. RESULTS: In the patients with mitral stenosis, MVA increased from 1.13 +/- 0.24 to 1.93 +/- 0.56 cm2 (P < .0001) after MBC. A standard echocardiographic score assessment of mitral valve morphology before MBC was not associated with the change in MVA after MBC in these patients (P > .20). However, the total mitral valve morphology score evaluated by cine computed tomography was strongly associated with the change in MVA after MBC (r = -.87; P < .0005). In addition, the individual morphologic characteristics of mitral valve mobility (P < .0025), leaflet thickness (P < .05), and subvalvular disease (P < .05) were significant predictors of the change in MVA after MBC. CONCLUSION: Cine computed tomography may be useful for predicting immediate increases in MVA in patients after MBC and may be helpful for preoperative assessment of these patients.

Catheterization↗
PubMed1985

Complex arrhythmias in mitral regurgitation with and without mitral valve prolapse: contrast to arrhythmias in mitral valve prolapse without mitral regurgitation.

Atrial and ventricular arrhythmias were characterized by ambulatory electrocardiography in 31 patients with nonischemic mitral regurgitation (MR), 17 of whom had echocardiographic evidence of mitral valve prolapse (MVP) and 14 of whom had other causes of MR. Frequent and complex arrhythmias were common and equally prevalent in each MR subgroup, whether or not MVP was present. Multiform ventricular ectopy was found in 77% (24 of 31), ventricular couplets in 61% (19 of 31), and ventricular salvos or ventricular tachycardia in 35% (11 of 31) of patients with MR. Arrhythmias in patients with MR were significantly more prevalent than in 63 patients with MVP who had no evidence of MR. Among patients with MVP, excess arrhythmias associated with MR were most striking with respect to frequent ventricular premature complexes (41% with MR vs 3% without MR), multiform ventricular ectopic activity (88% vs 43%), ventricular couplets (65% vs 6%), and ventricular salvos or ventricular tachycardia (35% vs 5%) (p less than 0.005 for each comparison). These data demonstrate that complex arrhythmias are common in patients with nonischemic MR irrespective of etiology, and that these arrhythmias are more strongly associated with hemodynamically important MR than with MVP alone.

Adult↗
PubMed1985

The results of valve replacement for mitral valve prolapse.

Between January, 1975, and December, 1982, 33 patients underwent mitral valve replacement for mitral valve prolapse secondary to myxomatous degeneration. The majority were in the seventh decade of life (median age, 62 years), and all were seen with symptoms of mitral regurgitation. Echocardiography was more accurate in making the diagnosis of mitral valve prolapse more often (75%) than angiography (66%). Thirty-eight percent of the patients who underwent cineangiography had concomitant coronary artery disease and had coronary artery bypass grafting as well as mitral valve replacement. There was 1 operative death, an operative mortality of 3%. There were 6 late deaths, a late mortality of 18%. Of the 26 long-term survivors, 23 (88%) were in New York Heart Association Functional Class I and 3 (12%) were in Class II. The average length of follow-up was 33.25 months, and the 5-year actuarial survival was 76%. There was only one incident of thromboembolism (3%). Short-term and long-term survival were not related to the severity of mitral regurgitation but to the status of the left ventricle and the overall condition of the patient. These data suggest that older patients with severe mitral regurgitation secondary to mitral valve prolapse can undergo valve replacement with low operative mortality and gratifying long-term results.

Actuarial Analysis↗
PubMed1993

[Mitral valve replacement with preservation of mitral valve device].

40 patients underwent mitral valve replacement with preservation of the posterior leaflet, chordae tendineae and papillary muscles. Twelve of the patients had double valve replacement and 10 tricuspid annuloplasty in combination with valve replacement. The incidence of postoperative low cardiac output syndrome was low. LADD was significantly decreased and EF was slightly lowered postoperatively. A new surgical technique and its indications were concisely described.

Adolescent↗