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Toma M, Bloodworth CH, Pierce EL, Einstein DR, Cochran RP, Yoganathan AP, Kunzelman KS. Fluid-Structure Interaction Analysis of Ruptured Mitral Chordae Tendineae. Ann Biomed Eng 2017; 45:619-631. [PMID: 27624659 PMCID: PMC5332285 DOI: 10.1007/s10439-016-1727-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/02/2016] [Indexed: 10/21/2022]
Abstract
The chordal structure is a part of mitral valve geometry that has been commonly neglected or simplified in computational modeling due to its complexity. However, these simplifications cannot be used when investigating the roles of individual chordae tendineae in mitral valve closure. For the first time, advancements in imaging, computational techniques, and hardware technology make it possible to create models of the mitral valve without simplifications to its complex geometry, and to quickly run validated computer simulations that more realistically capture its function. Such simulations can then be used for a detailed analysis of chordae-related diseases. In this work, a comprehensive model of a subject-specific mitral valve with detailed chordal structure is used to analyze the distinct role played by individual chordae in closure of the mitral valve leaflets. Mitral closure was simulated for 51 possible chordal rupture points. Resultant regurgitant orifice area and strain change in the chordae at the papillary muscle tips were then calculated to examine the role of each ruptured chorda in the mitral valve closure. For certain subclassifications of chordae, regurgitant orifice area was found to trend positively with ruptured chordal diameter, and strain changes correlated negatively with regurgitant orifice area. Further advancements in clinical imaging modalities, coupled with the next generation of computational techniques will enable more physiologically realistic simulations.
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Affiliation(s)
- Milan Toma
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Charles H Bloodworth
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Eric L Pierce
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Daniel R Einstein
- Department of Mechanical Engineering, St. Martin's University, 5000 Abbey Way SE, Lacey, WA, 98503, USA
| | - Richard P Cochran
- Department of Mechanical Engineering, University of Maine, 219 Boardman Hall, Orono, ME, 04469-5711, USA
| | - Ajit P Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA.
| | - Karyn S Kunzelman
- Department of Mechanical Engineering, University of Maine, 219 Boardman Hall, Orono, ME, 04469-5711, USA
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Sinning JM. Trying to square the circle? Integration of computed tomography data for the evaluation of mitral regurgitation. Eur Heart J 2017; 38:2227-2229. [DOI: 10.1093/eurheartj/ehw685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Controversies in quantification of mitral valve regurgitation: role of cardiac magnetic resonance imaging. Curr Opin Cardiol 2016; 32:152-160. [PMID: 27861188 DOI: 10.1097/hco.0000000000000363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Mitral regurgitation remains a common problem, and when severe, is associated with significant morbidity and mortality. At present, echocardiography remains the primary modality for assessing both mechanism and severity of mitral regurgitation. However, recent studies demonstrate that the echocardiographic assessment of mitral regurgitation severity may be subject to variability as a result of semiquantitative parameters, dependence upon loading conditions and significant interobserver variability. RECENT FINDINGS Cardiac magnetic resonance (CMR) imaging is the gold standard in the assessment of cardiac function and structure, and offers an alternative method to estimate mitral regurgitation severity. Herein, we discuss the pitfalls of echocardiography in the assessment of mitral regurgitation and describe recent data demonstrating improved accuracy of CMR in the assessment of mitral regurgitation severity. Further, CMR derived regurgitant volume of ≤55 ml is associated with freedom from surgical intervention, in contrast to traditional volumetric measures, which fail to predict the need for surgical intervention. SUMMARY The CMR assessment of mitral regurgitation severity is easily performed and appears to be more accurate and predictive of the need for surgery than traditional echocardiography. These promising findings require further confirmation in larger outcome trials.
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Argulian E, Borer JS, Messerli FH. Misconceptions and Facts About Mitral Regurgitation. Am J Med 2016; 129:919-23. [PMID: 27059381 DOI: 10.1016/j.amjmed.2016.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
Mitral regurgitation is a common heart valve disease. It is defined to be primary when it results from the pathology of the mitral valve apparatus itself and secondary when it is caused by distortion of the architecture or function of the left ventricle. Although the diagnosis and management of mitral regurgitation rely heavily on echocardiography, one should bear in mind the caveats and shortcomings of such an approach. Clinical decision making commonly focuses on the indications for surgery, but it is complex and mandates precise assessment of the mitral pathology, symptom status of the patient, and ventricular performance (right and left) among other descriptors. It is important for healthcare providers at all levels to be familiar with the clinical picture, diagnosis, disease course, and management of mitral regurgitation.
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Affiliation(s)
- Edgar Argulian
- Division of Cardiology, Icahn School of Medicine, Mt Sinai St Luke's Hospital, New York, NY.
| | | | - Franz H Messerli
- Division of Cardiology, Icahn School of Medicine, Mt Sinai St Luke's Hospital, New York, NY
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El Haddad M, De Backer T, De Buyzere M, Devos D, Swillens A, Segers P, Timmermans F. Grading of mitral regurgitation based on intensity analysis of the continuous wave Doppler signal. Heart 2016; 103:190-197. [DOI: 10.1136/heartjnl-2016-309510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 12/24/2022] Open
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Hammiri AE, Drighil A, Benhaourech S. Spectrum of cardiac lesions associated with Isolated Cleft Mitral Valve and their impact on therapeutic choices. Arq Bras Cardiol 2016; 106:367-72. [PMID: 27096525 PMCID: PMC4915223 DOI: 10.5935/abc.20160053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/26/2015] [Indexed: 01/25/2023] Open
Abstract
Background Isolated cleft mitral valve (ICMV) may occur alone or in association with
other congenital heart lesions. The aim of this study was to describe the
profile of cardiac lesions associated with ICMV and their potential impact
on therapeutic management. Methods We conducted a descriptive study with data retrieved from the Congenital
Heart Disease (CHD) single-center registry of our institution, including
patients with ICMV registered between December 2008 and November 2014. Results Among 2177 patients retrieved from the CHD registry, 22 (1%) had ICMV. Median
age at diagnosis was 5 years (6 days to 36 years). Nine patients (40.9%) had
Down syndrome. Seventeen patients (77.3%) had associated lesions, including
11 (64.7%) with accessory chordae in the left ventricular outflow tract
(LVOT) with no obstruction, 15 (88.2%) had ventricular septal defect (VSD),
three had secundum atrial septal defect, and four had patent ductus
arteriosus. Thirteen patients (59.1%) required surgical repair. The decision
to proceed with surgery was mainly based on the severity of the associated
lesion in eight patients (61.5%) and on the severity of the mitral
regurgitation in four patients (30.8%). In one patient, surgery was decided
based on the severity of both the associated lesion and mitral
regurgitation. Conclusion Our study shows that ICMV is rare and strongly associated with Down syndrome.
The most common associated cardiac abnormalities were VSD and accessory
chordae in the LVOT. We conclude that cardiac lesions associated with ICMV
are of major interest, since in this study patients with cardiac lesions
were diagnosed earlier. The decision to operate on these patients must take
into account the severity of both mitral regurgitation and associated
cardiac lesions.
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Affiliation(s)
- Ayoub El Hammiri
- Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Abdenasser Drighil
- Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Sanaa Benhaourech
- Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
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Rehfeldt KH, Lambert AS. Assessment of Mitral Regurgitation. Anesth Analg 2016; 122:299-301. [DOI: 10.1213/ane.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Cobey FC, Ashihkmina E, Edrich T, Fox J, Shook D, Bollen B, Breeze JL, Sanouri Ursprung WW, Shernan SK. The Mechanism of Mitral Regurgitation Influences the Temporal Dynamics of the Vena Contracta Area as Measured with Color Flow Doppler. Anesth Analg 2016; 122:321-9. [DOI: 10.1213/ane.0000000000001056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Emerging from Two-Dimensional Shadows, the Value of Added Dimensions in the Accurate Assessment of Mitral Regurgitation. J Am Soc Echocardiogr 2016; 29:A26-7. [DOI: 10.1016/j.echo.2015.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sargent J, Connolly DJ, Watts V, Mõtsküla P, Volk HA, Lamb CR, Luis Fuentes V. Assessment of mitral regurgitation in dogs: comparison of results of echocardiography with magnetic resonance imaging. J Small Anim Pract 2015; 56:641-50. [DOI: 10.1111/jsap.12410] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 07/29/2015] [Accepted: 09/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J. Sargent
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - D. J. Connolly
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - V. Watts
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - P. Mõtsküla
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - H. A. Volk
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - C. R. Lamb
- The Royal Veterinary College; University of London; Herts AL9 7TA
| | - V. Luis Fuentes
- The Royal Veterinary College; University of London; Herts AL9 7TA
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Scarsoglio S, Camporeale C, Guala A, Ridolfi L. Fluid dynamics of heart valves during atrial fibrillation: a lumped parameter-based approach. Comput Methods Biomech Biomed Engin 2015; 19:1060-8. [DOI: 10.1080/10255842.2015.1094800] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Over the past decade, new echocardiographic techniques such as three-dimensional echocardiography and the imaging of myocardial deformation (strain) have been developed, and are increasingly used in clinical practice. In this article, we describe the rationale and methodology, review available guidelines for practice, and discuss the advantages and limitations of each of these modalities. When available, we have also summarised the scientific evidence for the clinical application of these techniques to detect heart failure in children.
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Ashikhmina E, Shook D, Cobey F, Bollen B, Fox J, Liu X, Worthington A, Song P, Shernan S. Three-dimensional versus two-dimensional echocardiographic assessment of functional mitral regurgitation proximal isovelocity surface area. Anesth Analg 2015; 120:534-542. [PMID: 25166465 DOI: 10.1213/ane.0000000000000409] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The geometric shape of the mitral regurgitation (MR) proximal isovelocity surface area (PISA) is conventionally assumed to be a hemisphere (HS). However, in functional MR, PISA is frequently neither an HS nor a hemiellipse (HE) but is often asymmetric and crescent shaped. We used 3-dimensional transesophageal echocardiographic (3D TEE), full-volume data sets to directly measure the PISA and subsequently compared calculated values of effective regurgitant orifice area (EROA) with conventional 2D TEE techniques. EROA calculations from all PISA measurements were finally compared with the cross-sectional area at the vena contracta, a well-validated reference measure of the functional MR orifice area. METHODS Twenty-four cardiac surgical patients with functional MR, who underwent routine intraoperative TEE examinations with a 3D matrix array probe (X7-2t; IE33; Philips Healthcare, Inc., Andover, MA) were retrospectively evaluated for MR severity using quantitative 2D and 3D TEE-derived techniques. Conventional 2D TEE methods were used to estimate PISA assuming an HS shape and an HE shape. In addition, direct measurement of the 3D PISA was obtained (QLab, Philips Healthcare, Inc.) from corresponding full-volume, color-flow Doppler data sets. EROAs calculated from HS- and HE-PISA techniques were compared with the same values obtained from 3D TEE PISAs. EROAs obtained from all 3 PISA techniques were subsequently compared with vena contracta area. RESULTS Three-dimensional PISA was significantly larger than both HS-PISA and HE-PISA (mean ± SD: 4.65 ± 2.03 cm² vs 2.10 ± 1.58 cm² and 2.75 ± 1.42 cm²; both P < 0.0001), respectively. HE-PISA was also larger than HS-PISA (P = 0.042). In addition, 3D EROA was larger than both HS- and HE-acquired EROAs (mean ± SD: 0.44 ± 0.21 vs 0.19 ± 0.12 cm² and 0.26 ± 0.14; both P < 0.0001), respectively, while HE-EROA was larger than HS-EROA (P = 0.024). Vena contracta area correlated well with 3D EROA (Spearman r = 0.865), HS-EROA (Spearman r = 0.820; P < 0.001) and HE-EROA (Spearman r = 0.819). However, the difference between vena contracta area and 3D EROA was significantly less than the differences between vena contracta area and either 2D HS- or 2D HE-EROA (P < 0.0001). CONCLUSIONS Quantitative assessment of functional MR severity by 3D TEE may be superior to 2D methods by permitting more direct measures of PISA. Two-dimensional TEE techniques for assessing functional MR severity that rely on an HS- or HE-PISA shape may underestimate the EROA due to geometric assumptions that do not account for asymmetry.
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Affiliation(s)
- Elena Ashikhmina
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts; and International Heart Institute of Montana, Missoula, Montana
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Fadel BM, Bakarman H, Dahdouh Z, Di Salvo G, Mohty D. Spectral Doppler interrogation of mitral regurgitation -spot diagnosis. Echocardiography 2015; 32:1179-83. [PMID: 25611451 DOI: 10.1111/echo.12891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Mitral regurgitation (MR) is one of the most common valvular lesions that are readily identified by transthoracic echocardiography. Color Doppler imaging is the modality of choice for the recognition of MR, and it plays an important role in the assessment of regurgitation severity. Continuous wave (CW) Doppler is commonly used to interrogate the MR signal, and this modality can provide highly useful data regarding several physiological and pathological parameters. In this manuscript, we present a series of cases that illustrate the various hemodynamic parameters that can be derived from analysis of the CW Doppler signal of MR.
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Affiliation(s)
- Bahaa M Fadel
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Hatem Bakarman
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ziad Dahdouh
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Giovanni Di Salvo
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Ng A, Swanevelder J. The third ultrasound dimension in anaesthesia and intensive care. Br J Anaesth 2014; 114:366-9. [PMID: 25315145 DOI: 10.1093/bja/aeu341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Ng
- Heart and Lung Centre, Royal Wolverhampton Hospital NHS Trust, Wolverhampton, West Midlands WV10 0QP, UK
| | - J Swanevelder
- Department of Anaesthesia, Groote Schuur and Red Cross War Memorial Children's Hospitals, University of Cape Town Medical School, Anzio Road, Observatory 7925 Cape Town, South Africa
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Lancellotti P, Zamorano JL, Vannan MA. Imaging challenges in secondary mitral regurgitation: unsolved issues and perspectives. Circ Cardiovasc Imaging 2014; 7:735-46. [PMID: 25027455 DOI: 10.1161/circimaging.114.000992] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Patrizio Lancellotti
- From the Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, Liège, Belgium (P.L.); University Hospital Ramón y Cajal, Madrid, Spain (J.-L.Z.); and Piedmont Heart Institute, Atlanta, GA (M.A.V.).
| | - Jose-Luis Zamorano
- From the Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, Liège, Belgium (P.L.); University Hospital Ramón y Cajal, Madrid, Spain (J.-L.Z.); and Piedmont Heart Institute, Atlanta, GA (M.A.V.)
| | - Mani A Vannan
- From the Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, Liège, Belgium (P.L.); University Hospital Ramón y Cajal, Madrid, Spain (J.-L.Z.); and Piedmont Heart Institute, Atlanta, GA (M.A.V.)
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Kung E, Perry JC, Davis C, Migliavacca F, Pennati G, Giardini A, Hsia TY, Marsden A. Computational modeling of pathophysiologic responses to exercise in Fontan patients. Ann Biomed Eng 2014; 43:1335-47. [PMID: 25260878 DOI: 10.1007/s10439-014-1131-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/19/2014] [Indexed: 11/29/2022]
Abstract
Reduced exercise capacity is nearly universal among Fontan patients. Although many factors have emerged as possible contributors, the degree to which each impacts the overall hemodynamics is largely unknown. Computational modeling provides a means to test hypotheses of causes of exercise intolerance via precisely controlled virtual experiments and measurements. We quantified the physiological impacts of commonly encountered, clinically relevant dysfunctions introduced to the exercising Fontan system via a previously developed lumped-parameter model of Fontan exercise. Elevated pulmonary arterial pressure was observed in all cases of dysfunction, correlated with lowered cardiac output (CO), and often mediated by elevated atrial pressure. Pulmonary vascular resistance was not the most significant factor affecting exercise performance as measured by CO. In the absence of other dysfunctions, atrioventricular valve insufficiency alone had significant physiological impact, especially under exercise demands. The impact of isolated dysfunctions can be linearly summed to approximate the combined impact of several dysfunctions occurring in the same system. A single dominant cause of exercise intolerance was not identified, though several hypothesized dysfunctions each led to variable decreases in performance. Computational predictions of performance improvement associated with various interventions should be weighed against procedural risks and potential complications, contributing to improvements in routine patient management protocol.
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Affiliation(s)
- Ethan Kung
- Mechanical Engineering Department, Clemson University, Clemson, SC, 29634, USA
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69
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Maréchaux S, Le Goffic C, Ennezat PV, Semichon M, Castel AL, Delelis F, Lemahieu JM, Menet A, Graux P, Tribouilloy C. Quantitative assessment of primary mitral regurgitation using left ventricular volumes: a three-dimensional transthoracic echocardiographic pilot study. Eur Heart J Cardiovasc Imaging 2014; 15:1133-9. [PMID: 24855214 DOI: 10.1093/ehjci/jeu091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To investigate the value of assessment of mitral regurgitant fraction (RF) using left ventricular (LV) volumes obtained by three-dimensional echocardiography (3DE) to quantify primary mitral regurgitation (MR). METHODS AND RESULTS Sixty patients with primary MR in sinus rhythm were prospectively enrolled. RF was calculated using either 2DE or 3DE LV volumes obtained as follows: (LV total stroke volume - LV forward stroke volume by Doppler)/LV total stroke volume. Severity of MR was graded independently by two cardiologists blinded to LV volumetric data using an integrative approach, as recommended by current guidelines. Sixty patients with LV ejection fraction >50% and no MR were also studied. In patients without MR, 3D total LV stroke volume was more strongly correlated with LV forward stroke volume than 2D total LV stroke volume (r = 0.75, P < 0.0001 vs. r = 0.62, P < 0.0001, respectively). The 3D method had a feasibility of 90% in patients with MR. Inter-reader concordance for MR grading (four grades) was excellent with a Kappa-value of 0.90, P < 0.0001. A significant correlation was observed between grade of MR severity and 3D RF (r = 0.83, P < 0.0001) and 2D RF (r = 0.74, P < 0.0001). Comparisons between individual grades for 3D RF were significant (P < 0.05) except for 3+ vs. 4+ MR (P = 0.213). All patients with 3D RF ≥40% had ≥3+ or 4+ MR and those with 3D RF ≤30% had 1+ or 2+ MR with a 'grey' overlap zone between 30 and 40%. CONCLUSIONS RF can be routinely determined using 3D LV volumes with a high feasibility in patients with primary MR and is reliable for identification of Grade 3+ or Grade 4+ MR. The incorporation of this parameter into the currently recommended multiparametric integrative approach might be helpful to discriminate significant MR.
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Affiliation(s)
- Sylvestre Maréchaux
- Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France INSERM U 1088 Université de Picardie, Amiens, France
| | - Caroline Le Goffic
- Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France
| | | | - Marc Semichon
- Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France
| | - Anne-Laure Castel
- Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France
| | - François Delelis
- Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France
| | - Jean Michel Lemahieu
- Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France
| | - Aymeric Menet
- Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France
| | - Pierre Graux
- Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France
| | - Christophe Tribouilloy
- INSERM U 1088 Université de Picardie, Amiens, France Centre Hospitalier Universitaire d'Amiens, Amiens, France
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Wang W, Lin Q, Wu W, Jiang Y, Lan T, Wang H. Quantification of Mitral Regurgitation by General Imaging Three-Dimensional Quantification: Feasibility and Accuracy. J Am Soc Echocardiogr 2014; 27:268-76. [DOI: 10.1016/j.echo.2013.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Indexed: 11/25/2022]
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Francone M. Role of cardiac magnetic resonance in the evaluation of dilated cardiomyopathy: diagnostic contribution and prognostic significance. ISRN RADIOLOGY 2014; 2014:365404. [PMID: 24967294 PMCID: PMC4045555 DOI: 10.1155/2014/365404] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/05/2013] [Indexed: 01/07/2023]
Abstract
Dilated cardiomyopathy (DCM) represents the final common morphofunctional pathway of various pathological conditions in which a combination of myocyte injury and necrosis associated with tissue fibrosis results in impaired mechanical function. Recognition of the underlying aetiology of disease and accurate disease monitoring may be crucial to individually optimize therapeutic strategies and stratify patient's prognosis. In this regard, CMR has emerged as a new reference gold standard providing important information for differential diagnosis and new insight about individual risk stratification. The present review article will focus on the role of CMR in the evaluation of present condition, analysing respective strengths and limitations in the light of current literature and technological developments.
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Affiliation(s)
- Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324 00161 Rome, Italy
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Gripari P, Muratori M, Fusini L, Tamborini G, Pepi M. Three-Dimensional Echocardiography: Advancements in Qualitative and Quantitative Analyses of Mitral Valve Morphology in Mitral Valve Prolapse. J Cardiovasc Echogr 2014; 24:1-9. [PMID: 28465897 PMCID: PMC5353406 DOI: 10.4103/2211-4122.131985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Degenerative mitral valve disease (MVD) is the leading cause of organic mitral regurgitation (MR), one of the most common valvular heart disease in western countries. Substantial progresses in the surgical treatment of degenerative MVD have improved life expectancy of patients with significant MR. However, prognosis, surgical decision and timing of surgery strongly depend on the accurate characterization of mitral valve (MV) anatomy and pathology and on the precise quantification of MR. Three-dimensional (3D) echocardiography, a major technological breakthrough in the field of cardiovascular imaging, provides several advantages over two-dimensional (2D) imaging in the qualitative and quantitative evaluations of MV apparatus. In this review, we focus on the contribution of this new modality to the diagnosis of degenerative MVD, the quantitative assessment of MR severity, the selection and monitoring of surgical and percutaneous procedures, the evaluation of procedural outcomes. The results of a systematic and exhaustive search of the existing literature, restricted to real-time 3D echocardiography in adults, are here reported.
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Affiliation(s)
- Paola Gripari
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
| | - Manuela Muratori
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
| | - Gloria Tamborini
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
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Iwashima S, Ishikawa T. Quantitative, Noninvasive Assessment of Patent Ductus Arteriosus Shunt Flow by Measuring Proximal Isovelocity Surface Area on Color Doppler Imaging. Circ J 2014; 78:2302-2308. [DOI: 10.1253/circj.cj-14-0229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Satoru Iwashima
- Department of Pediatrics, Hamamatsu University School of Medicine
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Maffessanti F, Mirea O, Tamborini G, Pepi M. Three-dimensional echocardiography of the mitral valve: lessons learned. Curr Cardiol Rep 2013; 15:377. [PMID: 23686753 DOI: 10.1007/s11886-013-0377-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Three-dimensional echocardiography has markedly improved our understanding of normal and pathologic mitral valve (MV) mechanics. Qualitative and quantitative analysis of three-dimensional (3D) data on the mitral valve could have a clinical impact on diagnosis, patient referral, surgical strategies, annuloplasty ring design and evaluation of the immediate and long-term surgical outcome. This review covers the contribution of 3D echocardiography in the diagnosis of MV disease, its role in selecting and monitoring surgical procedures, and in the assessment of surgical outcomes. Moreover, advantages of this technique versus the standard 2D modality, as well as future applications of advanced analysis techniques, will be reviewed.
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77
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Maragiannis D, Little SH. Quantification of Mitral Valve Regurgitation: New Solutions Provided by 3D Echocardiography. Curr Cardiol Rep 2013; 15:384. [DOI: 10.1007/s11886-013-0384-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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78
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Dixon SR, Safian RD. The Year in Interventional Cardiology. J Am Coll Cardiol 2013; 61:1637-52. [DOI: 10.1016/j.jacc.2013.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 01/16/2013] [Indexed: 02/07/2023]
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