1
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Ota M, Kitai T. Echocardiographic Evaluation of Successful Mitral Valve Repair or Need for a Second Pump Run in the Operating Room. Interv Cardiol Clin 2024; 13:71-80. [PMID: 37980068 DOI: 10.1016/j.iccl.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Detailed preoperative and intraoperative echocardiographic assessment of the mitral valve apparatus is critical for a successful repair. The recent advent of 3-dimensional transesophageal echocardiography has added an extra pivotal role to transesophageal echocardiography in the assessment of mitral apparatus and mitral regurgitation. Because surgeons must rapidly decide whether cardiopulmonary bypass should be continued to be weaned off or a second pump run should be selected, the echocardiographer conducting intraoperative transesophageal echocardiography is required to be trained according to a certain algorithm. This review summarizes the current clinical role of intraoperative transesophageal echocardiography in mitral valve repair in the operating room.
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Affiliation(s)
- Mitsuhiko Ota
- Department of Cardiovascular Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan.
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe 650-0047, Japan
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2
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Kim DH. Multimodality Imaging for the Assessment of Mitral Valve Disease. Interv Cardiol Clin 2024; 13:115-125. [PMID: 37980062 DOI: 10.1016/j.iccl.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Mitral valve disease is the most common valvular heart disease. Imaging determines the etiology (anatomic assessment), valve function and severity of valvular heart disease (hemodynamic assessment), remodeling of the left ventricle and right ventricle, and preplanning and guidance of percutaneous intervention. Although roles of computed tomography and magnetic resonance are increasing, echocardiography serves as the first-line imaging modality for the diagnosis and serial follow-up in most cases. This review summarizes the roles of multimodality imaging currently available from research fields to daily clinical practice.
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Affiliation(s)
- Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1, Poongnap-dong, Songpa-ku, Seoul 138-736, Korea.
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3
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Bulbul Z, El Rassi I, Hamade R, Tamim H, Bitar F. Three-dimensional printing of mitral valve models using echocardiographic data improves the knowledge of cardiology fellow physicians in training. Front Cardiovasc Med 2023; 10:1307994. [PMID: 38124899 PMCID: PMC10731368 DOI: 10.3389/fcvm.2023.1307994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Background High fidelity three-dimensional Mitral valve models (3D MVM) printed from echocardiography are currently being used in preparation for surgical repair. Aim We hypothesize that printed 3DMVM could have relevance to cardiologists in training by improving their understanding of normal anatomy and pathology. Methods Sixteen fellow physicians in pediatric and adult cardiology training were recruited. 3D echocardiography (3DE) video clips of six mitral valves (one normal and five pathological) were displayed and the fellows were asked to name the prolapsing segments in each. Following that, three still images of 3D MVMs in different projections: enface, profile and tilted corresponding to the same MVs seen in the clip were presented on a screen. Participating physicians were presented with a comprehensive questionnaire aimed at assessing whether the 3D MVM has improved their understanding of valvular anatomy. Finally, a printed 3D MVM of each of the valves was handed out, and the same questionnaire was re-administered to identify any further improvement in the participants' perception of the anatomy. Results The correct diagnosis using the echocardiography video clip of the Mitral valve was attained by 45% of the study participants. Both pediatric and adult trainees, regardless of the year of training demonstrated improved understanding of the anatomy of MV after observing the corresponding model image. Significant improvement in their understanding was noted after participants had seen and physically examined the printed model. Conclusion Printed 3D MVM has a beneficial impact on the cardiology trainees' understanding of MV anatomy and pathology compared to 3DE images.
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Affiliation(s)
- Ziad Bulbul
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Issam El Rassi
- Pediatric Cardiac Surgery, Al Jalila Hospital, Dubai, United Arab Emirates
| | - Ramsey Hamade
- Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Biostatistics, American University of Beirut, Beirut, Lebanon
| | - Fadi Bitar
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
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4
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Baessato F, Fusini L, Muratori M, Tamborini G, Ghulam Ali S, Mantegazza V, Baggiano A, Mushtaq S, Pepi M, Patti G, Pontone G. Echocardiography vs. CMR in the Quantification of Chronic Mitral Regurgitation: A Happy Marriage or Stormy Divorce? J Cardiovasc Dev Dis 2023; 10:jcdd10040150. [PMID: 37103029 PMCID: PMC10145831 DOI: 10.3390/jcdd10040150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Quantification of chronic mitral regurgitation (MR) is essential to guide patients’ clinical management and define the need and appropriate timing for mitral valve surgery. Echocardiography represents the first-line imaging modality to assess MR and requires an integrative approach based on qualitative, semiquantitative, and quantitative parameters. Of note, quantitative parameters, such as the echocardiographic effective regurgitant orifice area, regurgitant volume (RegV), and regurgitant fraction (RegF), are considered the most reliable indicators of MR severity. In contrast, cardiac magnetic resonance (CMR) has demonstrated high accuracy and good reproducibility in quantifying MR, especially in cases with secondary MR; nonholosystolic, eccentric, and multiple jets; or noncircular regurgitant orifices, where quantification with echocardiography is an issue. No gold standard for MR quantification by noninvasive cardiac imaging has been defined so far. Only a moderate agreement has been shown between echocardiography, either with transthoracic or transesophageal approaches, and CMR in MR quantification, as supported by numerous comparative studies. A higher agreement is evidenced when echocardiographic 3D techniques are used. CMR is superior to echocardiography in the calculation of the RegV, RegF, and ventricular volumes and can provide myocardial tissue characterization. However, echocardiography remains fundamental in the pre-operative anatomical evaluation of the mitral valve and of the subvalvular apparatus. The aim of this review is to explore the accuracy of MR quantification provided by echocardiography and CMR in a head-to-head comparison between the two techniques, with insight into the technical aspects of each imaging modality.
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Affiliation(s)
- Francesca Baessato
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, 80636 Munich, Germany
- Department of Cardiology, Regional Hospital S. Maurizio, 39100 Bolzano, Italy
| | - Laura Fusini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, 20133 Milan, Italy
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
- Correspondence:
| | - Manuela Muratori
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Gloria Tamborini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Sarah Ghulam Ali
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Valentina Mantegazza
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Mauro Pepi
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
- Division of Cardiology, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 2012 Milan, Italy
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5
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Pino PG, Madeo A, Lucà F, Ceravolo R, di Fusco SA, Benedetto FA, Bisignani G, Oliva F, Colivicchi F, Gulizia MM, Gelsomino S. Clinical Utility of Three-Dimensional Echocardiography in the Evaluation of Mitral Valve Disease: Tips and Tricks. J Clin Med 2023; 12:2522. [PMID: 37048605 PMCID: PMC10094963 DOI: 10.3390/jcm12072522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
Although real-time 3D echocardiography (RT3DE) has only been introduced in the last decades, its use still needs to be improved since it is a time-consuming and operator-dependent technique and acquiring a good quality data can be difficult. Moreover, the additive value of this important diagnostic tool still needs to be wholly appreciated in clinical practice. This review aims at explaining how, why, and when performing RT3DE is useful in clinical practice.
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Affiliation(s)
- Paolo G. Pino
- Former Cardiology Department, San Camillo Forlanini Hospital, 00151 Roma, Italy
| | - Andrea Madeo
- Cardiology Department, Ferrari Hospital, 87012 Castrovillari, Italy
| | - Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | - Roberto Ceravolo
- Cardiology Unit, Giovanni Paolo II Hospital, 88046 Lamezia, Italy
| | | | - Francesco Antonio Benedetto
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | | | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
| | - Furio Colivicchi
- Cardiology Department, San Filippo Neri Hospital, 00135 Rome, Italy
| | | | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University, 6211 LK Maastrich, The Netherlands
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6
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Mantegazza V, Gripari P, Tamborini G, Muratori M, Fusini L, Ghulam Ali S, Garlaschè A, Pepi M. 3D echocardiography in mitral valve prolapse. Front Cardiovasc Med 2023; 9:1050476. [PMID: 36704460 PMCID: PMC9871497 DOI: 10.3389/fcvm.2022.1050476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Mitral valve prolapse (MVP) is the leading cause of mitral valve surgery. Echocardiography is the principal imaging modality used to diagnose MVP, assess the mitral valve morphology and mitral annulus dynamics, and quantify mitral regurgitation. Three-dimensional (3D) echocardiographic (3DE) imaging represents a consistent innovation in cardiovascular ultrasound in the last decades, and it has been implemented in routine clinical practice for the evaluation of mitral valve diseases. The focus of this review is the role and the advantages of 3DE in the comprehensive evaluation of MVP, intraoperative and intraprocedural monitoring.
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Affiliation(s)
- Valentina Mantegazza
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy,*Correspondence: Valentina Mantegazza ✉
| | - Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Anna Garlaschè
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
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7
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Adabifirouzjaei F, Hsiao A, DeMaria AN. Mitral Valve Prolapse-The Role of Cardiac Imaging Modalities. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100024. [PMID: 37273735 PMCID: PMC10236887 DOI: 10.1016/j.shj.2022.100024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 06/06/2023]
Abstract
Mitral valve prolapse (MVP) is the most common nonischemic mitral regurgitation etiology and mitral abnormality requiring surgery in the Western world. There is an increasing awareness that pathological findings in MVP are not confined to the valve tissue; rather, it is a complex disease, involving the mitral valve apparatus, cardiac hemodynamics, and cardiac structure. Imaging has played a fundamental role in the understanding of the diagnosis, prevalence, and consequences of MVP. The diagnosis of MVP by imaging is based upon demonstrating valve leaflets ascending into the left atrium through the saddle-shaped annulus. Transthoracic and transesophageal echocardiography are the primary modalities in the diagnosis and assessment of MVP patients and must include careful assessment of the leaflets, annulus, chords, and papillary muscles. High-spatial-resolution imaging modalities such as cardiac magnetic resonance images and cardiac computed tomography play a secondary role in this regard and can demonstrate the anatomical relation between the mitral valve annulus and leaflet excursion for appropriate diagnosis. Ongoing development of new methods of cardiac imaging can help us to accurately understand the mechanism, diagnose the disease, develop an appropriate treatment plan, and estimate the risk for sudden death. Recently, several new observations with respect to prolapse have been derived from cardiac imaging including three-dimensional echocardiography and tissue-Doppler imaging. The aim of this article is to present these new imaging-derived insights for the diagnosis, risk assessment, treatment, and follow-up of patients with MVP.
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Affiliation(s)
- Fatemeh Adabifirouzjaei
- Department of Cardiology, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
| | - Albert Hsiao
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Anthony N. DeMaria
- Department of Cardiology, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
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8
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Meucci MC, Delgado V. Preoperative assessment of mitral valve regurgitation with two- and three-dimensional transesophageal echocardiography. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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9
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Carvalho JL, Ashikhmina E, Abel MD, Viehman JK, Lahr BD, Geske JB, Schaff HV. Hypertrophic Obstructive Cardiomyopathy: Discrepancy Between Hemodynamic Measurements in the Cardiac Laboratory and Operating Room Is to Be Expected. J Cardiothorac Vasc Anesth 2021; 36:422-428. [PMID: 34172363 DOI: 10.1053/j.jvca.2021.05.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES It is not uncommon to observe some discrepancy in hemodynamic values characterizing left ventricular outflow tract (LVOT) obstruction preoperatively and in the operating room in patients with hypertrophic obstructive cardiomyopathy. Interpretation of this discrepancy can be challenging. To clarify the extent of the discrepancy, the authors compared hemodynamic variables in patients undergoing septal myectomy at the time of preoperative and intraoperative evaluation. DESIGN Retrospective study. SETTING Single academic medical center. INTERVENTIONS Medical records review, study group-173 patients. MEASUREMENTS AND MAIN RESULTS While there was no statistically significant difference in resting peak LVOT gradients by preoperative transthoracic echocardiography (TTE) compared to intraoperative transesophageal echocardiography (46 mmHg [19-87 mmHg] v 36 mmHg [16-71 mmHg], p = 0.231), the former were higher compared to direct needle-resting LVOT gradient measurements before myectomy (49 mmHg [19-88 mmHg] v 32 mmHg [14-67 mmHg], p = 0.0022). The prevalence of systolic anterior motion was high (94.6% v 91.6%, P = 1.000) both on pre- and intraoperative evaluation. The incidence of moderate/severe mitral was higher intraoperatively (p < 0.0001). Pulmonary artery systolic pressures measured by pulmonary artery catheter provided higher values compared to preoperative TTE estimate (39 mmHg [34-45 mmHg] v 34 mmHg [28-41 mmHg], p < 0.0001). CONCLUSIONS Discrepancy between hemodynamic measurements in the cardiac laboratory and operating room is common and generally should not affect planned patients' care. These changes in hemodynamics might be explained by preoperative fasting, anesthetic agents, volume shifts while supine, and positive-pressure ventilation, as well as the difference in measurement techniques.
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Affiliation(s)
| | - Elena Ashikhmina
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| | - Martin D Abel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Jason K Viehman
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Brian D Lahr
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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10
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Körber MI, Friedrichs KP, Aydin F, Pfister R, Mauri V, Baldus S, Rudolph V, Huntgeburth M. Impact of cleft-like indentations on procedural outcome of percutaneous edge-to-edge mitral valve repair. Catheter Cardiovasc Interv 2021; 97:1236-1243. [PMID: 33002279 DOI: 10.1002/ccd.29286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/07/2020] [Accepted: 09/13/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES AND BACKGROUND Percutaneous edge-to-edge mitral valve (MV) repair (PMVR) is broadly applied in high-risk patients with relevant mitral regurgitation (MR). We investigated the incidence of cleft-like indentations (CLI) and their impact on PMVR. METHODS AND RESULTS In a retrospective single center analysis including 263 patients undergoing PMVR with the MitraClip®-system between 11/2012 and 7/2016, MV anatomy was assessed by 3-dimensional transesophageal echocardiography. CLI were present in 37/263 patients (14.1%). Of these, 62.2% had 1 CLI, 27% had 2 CLI, and 10.8% had 3 CLI, mostly concerning segment P2 or P2/3 of the MV. Baseline characteristics were similarly distributed. Interestingly, most patients with CLI suffered from secondary MR (n = 29, 78%). The number of deployed MitraClips was higher in patients with CLI (2 [1.25-2] vs. 2 [1, 2], p = .035), whereas procedural as well as clinical success was similar: MR grade (1.2 vs. 1.5, p = .061), vena contracta width (4.2 vs. 4.5 mm, p = .293), dPmean (4.2 vs. 4.0 mmHg, p = .618) at discharge and NYHA class at 30 days did not differ between groups. Periprocedural complications were rare and equally distributed between groups. At 30 days, MR reduction persisted in patients with CLI (95.8% of these selected patients had a MR grade ≤ 2). CONCLUSIONS CLI of the MV are common in patients undergoing PMVR, also when presenting mainly with secondary MR. While the number of clips needed to address MR is slightly higher in patients with CLI, procedural success rates appear not to be affected. PMVR seems to be a safe treatment option for patients with CLI.
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Affiliation(s)
- Maria Isabel Körber
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Kai Peter Friedrichs
- General and Interventional Cardiology, Heart & Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Fatma Aydin
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Roman Pfister
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Victor Mauri
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Stephan Baldus
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Volker Rudolph
- General and Interventional Cardiology, Heart & Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michael Huntgeburth
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
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11
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Echocardiographic Evaluation of Successful Mitral Valve Repair or Need for a Second Pump Run in the Operating Room. Cardiol Clin 2021; 39:233-242. [PMID: 33894937 DOI: 10.1016/j.ccl.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Detailed preoperative and intraoperative echocardiographic assessment of the mitral valve apparatus is critical for a successful repair. The recent advent of 3-dimensional transesophageal echocardiography has added an extra pivotal role to transesophageal echocardiography in the assessment of mitral apparatus and mitral regurgitation. Because surgeons must rapidly decide whether cardiopulmonary bypass should be continued to be weaned off or a second pump run should be selected, the echocardiographer conducting intraoperative transesophageal echocardiography is required to be trained according to a certain algorithm. This review summarizes the current clinical role of intraoperative transesophageal echocardiography in mitral valve repair in the operating room.
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12
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Kim DH. Multimodality Imaging for the Assessment of Mitral Valve Disease. Cardiol Clin 2021; 39:243-253. [PMID: 33894938 DOI: 10.1016/j.ccl.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mitral valve disease is the most common valvular heart disease. Imaging determines the etiology (anatomic assessment), valve function and severity of valvular heart disease (hemodynamic assessment), remodeling of the left ventricle and right ventricle, and preplanning and guidance of percutaneous intervention. Although roles of computed tomography and magnetic resonance are increasing, echocardiography serves as the first-line imaging modality for the diagnosis and serial follow-up in most cases. This review summarizes the roles of multimodality imaging currently available from research fields to daily clinical practice.
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Affiliation(s)
- Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1, Poongnap-dong, Songpa-ku, Seoul 138-736, Korea.
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13
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Gavazzoni M, Taramasso M, Zuber M, Russo G, Pozzoli A, Miura M, Maisano F. Conceiving MitraClip as a tool: percutaneous edge-to-edge repair in complex mitral valve anatomies. Eur Heart J Cardiovasc Imaging 2020; 21:1059-1067. [PMID: 32408344 DOI: 10.1093/ehjci/jeaa062] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/25/2020] [Accepted: 03/23/2020] [Indexed: 11/13/2022] Open
Abstract
Improvements in procedural technique and intra-procedural imaging have progressively expanded the indications of percutaneous edge-to-edge technique. To date in higher volume centres and by experienced operators MitraClip is used for the treatment of complex anatomies and challenging cases in high risk-inoperable patients. This progressive step is superimposable to what observed in surgery for edge-to-edge surgery (Alfieri's technique). Moreover, the results of clinical studies on the treatment of patients with high surgical risk and functional mitral insufficiency have confirmed that the main goal to be achieved for improving clinical outcomes of patients with severe mitral regurgitation (MR) is the reduction of MR itself. The MitraClip should therefore be considered as a tool to achieve this goal in addition to medical therapy. Nowadays, evaluation of patient's candidacy to MitraClip procedure, discussed in local Heart Team, must take into account not only the clinical features of patients but even the experience of the operators and the volume of the centre, which are mostly related to the probability to achieve good procedural results. This 'relative feasibility' of challenges cases by experienced operators should always been taken into account in selecting patients for MitraClip. Here, we present a review of the literature available on the treatment of complex and challenging lesions.
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Affiliation(s)
- Mara Gavazzoni
- Heart and Valve Center, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Maurizio Taramasso
- Heart and Valve Center, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Michel Zuber
- Heart and Valve Center, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Giulio Russo
- Heart and Valve Center, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland.,Cardiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Alberto Pozzoli
- Heart and Valve Center, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Mizuki Miura
- Heart and Valve Center, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Francesco Maisano
- Heart and Valve Center, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland
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14
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Zaidi SJ, Penk J, Schweig L, Cui VW, Cossor W, Roberson DA. Added Value of Live 3-Dimensional Transesophageal Echocardiography During Procedures in Fontan Patients. Pediatr Cardiol 2020; 41:1370-1375. [PMID: 32488509 DOI: 10.1007/s00246-020-02388-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/27/2020] [Indexed: 11/26/2022]
Abstract
3D transesophageal echocardiography (3D-TEE) has proven useful and accurate during some operating room (OR), interventional cardiac catheterization (Cath), and electrophysiologic (EP) procedures. The use of 3D-TEE during similar procedures in patients who have undergone Fontan surgery and its additional value have not been previously reported. To determine if live 3D-TEE during procedures post Fontan has added value, 3D-TEEs in 58 post-Fontan patients over a 5-year study period were reviewed. Additional information provided by 3D-TEE (over 2D-TEE) was classified into the following: A: new information which changed/refined the plan and 0: no new important information. Pre- and post-bypass OR 3D-TEEs were counted as one study. A total of 67 3D-TEEs (41 Cath, 13 OR, and 13 EP procedures) were performed. Median age was 14 years (6-39 years). Median weight was 47 kg (21-109 kg). In Cath procedures, only 2/41 (5%) were graded A (R to L atrial level shunt [Fontan leak], n = 1; thrombus in pulmonary artery stump, n = 1). In the OR, 6/13 (46%) were graded A (atrioventricular valvuloplasty, n = 1; neo-aortic valvuloplasty, n = 1; relief of systemic and pulmonary venous outflow obstruction, n = 2 and n = 2; respectively). In EP procedures, 4/13 (31%) were graded A (thrombus, n = 3; mapping for lead placement to assist in multisite pacing for dyssynchrony, n = 1). 3D-TEE of Fontan improved visualization and frequently added value in the OR/EP lab and may be helpful in select catheterization cases. Future studies with a larger sample could build on this data to identify when 3D-TEE will be most useful.
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Affiliation(s)
- S Javed Zaidi
- Department of Pediatric Cardiology, Advocate Children's Hospital, Chicago, IL, USA.
- Department of Pediatric Cardiology, Advocate BroMenn Medical Center, Normal, IL, 61761, USA.
| | - Jamie Penk
- Department of Pediatric Cardiology, Advocate Children's Hospital, Chicago, IL, USA
| | - Lorene Schweig
- Department of Pediatric Cardiology, Advocate Children's Hospital, Chicago, IL, USA
| | - Vivian W Cui
- Department of Pediatric Cardiology, Advocate Children's Hospital, Chicago, IL, USA
| | - Waseem Cossor
- Department of Pediatric Cardiology, Advocate Children's Hospital, Chicago, IL, USA
| | - David A Roberson
- Department of Pediatric Cardiology, Advocate Children's Hospital, Chicago, IL, USA
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15
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Posada-Martinez EL, Ortiz-Leon XA, Ivey-Miranda JB, Trejo-Paredes MC, Chen W, McNamara RL, Lin BA, Lombo B, Arias-Godinez JA, Sugeng L. Understanding Non-P2 Mitral Regurgitation Using Real-Time Three-Dimensional Transesophageal Echocardiography: Characterization and Factors Leading to Underestimation. J Am Soc Echocardiogr 2020; 33:826-837. [PMID: 32387034 DOI: 10.1016/j.echo.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/02/2020] [Accepted: 03/15/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND P2 prolapse is a common cause of degenerative mitral regurgitation (MR); echocardiographic characteristics of non-P2 prolapse are less known. Because of the eccentric nature of degenerative MR jets, the evaluation of MR severity is challenging. The aim of this study was to test the hypotheses that (1) the percentage of severe MR determined by transthoracic echocardiography (TTE) would be lower compared with that determined by transesophageal echocardiography (TEE) in patients with non-P2 prolapse and also in a subgroup with "horizontal MR" (a horizontal jet seen on TTE that hugs the leaflets without reaching the atrial wall, particularly found in non-P2 prolapse) and (2) the directions of MR jets between TTE and real-time (RT) three-dimensional (3D) TEE would be discordant. METHODS One hundred eighteen patients with moderate to severe and severe degenerative MR defined by TEE were studied. The percentage of severe MR between TTE and TEE was compared in P2 and non-P2 prolapse groups and in horizontal and nonhorizontal MR groups. Additionally, differences in the directions of the MR jets between TTE and RT 3D TEE were assessed. RESULTS Eighty-six percent of patients had severe MR according to TEE. TTE underestimated severe MR in the non-P2 group (severe MR on TTE, 57%; severe MR on TEE, 85%; P < .001) but not in the P2 group (severe MR on TTE, 79%; severe MR on TEE, 91%; P = .157). Most "horizontal" MR jets were found in the non-P2 group (85%), and this subgroup showed even more underestimation of severe MR on TTE (TTE, 22%; TEE, 89%; P < .001). There was discordance in MR jet direction between two-dimensional TTE and RT 3D TEE in 41% of patients. CONCLUSIONS Non-P2 and "horizontal" MR are significantly underestimated on TTE compared with TEE. There is substantial discordance in the direction of the MR jet between RT 3D TEE and TTE. Therefore, TEE should be considered when these subgroups of MR are observed on TTE.
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Affiliation(s)
- Edith L Posada-Martinez
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut; Laboratory of Echocardiography, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Xochitl A Ortiz-Leon
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut; Laboratory of Echocardiography, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Juan B Ivey-Miranda
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut; Department of Cardiology, Hospital de Cardiologia Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Maria C Trejo-Paredes
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut
| | - Wanwen Chen
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut
| | - Robert L McNamara
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut
| | - Ben A Lin
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Bernardo Lombo
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut
| | - Jose A Arias-Godinez
- Laboratory of Echocardiography, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Lissa Sugeng
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale University, New Haven, Connecticut.
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16
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Forteleoni A, Montereggi F, Sanna GD, Portoghese M, Parodi G. Traumatic mitral valve regurgitation. J Cardiovasc Med (Hagerstown) 2019; 20:709-717. [DOI: 10.2459/jcm.0000000000000809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Mantovani F, Bursi F, Di Giannuario G, Barbieri A. Echocardiographic prediction of surgical reparability in degenerative mitral regurgitation due to leaflet prolapse: a review. Expert Rev Cardiovasc Ther 2019; 17:653-662. [PMID: 31483165 DOI: 10.1080/14779072.2019.1664289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Despite current guidelines provide recommendations for the optimal management of degenerative mitral regurgitation (MR), this condition remains often undertreated with delay in surgical referral and dismal effect on outcomes. Areas covered: This review focuses on the role of echocardiography in guiding mitral valve (MV) surgical repair in degenerative MR due to leaflet prolapse. Expert opinion: A stepwise protocol-driven echocardiography shared by referring physician and surgeon may help to guide referral to surgical repair in degenerative MR. This protocol particularly is useful to identify the ideal patho-anatomy for a successful and durable repair especially when early surgery is proposed and to refer the patient to centers of excellence in case of complex anatomy. Nearly 100% repair rate can be achieved when the surgical technique is adapted to the lesions seen in each valve. Three-dimensional echocardiography predicts repair complexity may be useful and should therefore be implemented. However, the current literature is far from comprehensive deriving from small, single-center studies. Therefore, reproducibility and external validation, especially with newly developed quantitative automated software, are still needed.
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Affiliation(s)
- Francesca Mantovani
- Department of Cardiology, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia , Reggio Emilia , Italy
| | - Francesca Bursi
- Department of Cardiology, Azienda Socio Sanitaria Territoriale (A.S.S.T.) SANTI PAOLO E CARLO - Presidio Ospedale San Paolo , Milano , Italy
| | | | - Andrea Barbieri
- Department of Cardiology, Azienda Ospedaliera-Universitaria di Modena , Modena , Italy
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18
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19
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MitraClip for radiotherapy-related mitral valve regurgitation. Hellenic J Cardiol 2019; 60:232-238. [DOI: 10.1016/j.hjc.2018.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/15/2018] [Accepted: 07/20/2018] [Indexed: 01/09/2023] Open
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20
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Kam D, Patel PA, Steinberg T, Feinman JW, MacKay EJ, Patel S, Mickus GJ, Fabbro M, Augoustides JGT. Percutaneous Edge-to-Edge Mitral Valve Repair: Navigating the Challenges of Multiple Mechanisms for Mitral Regurgitation. J Cardiothorac Vasc Anesth 2019; 33:2327-2333. [PMID: 31079894 DOI: 10.1053/j.jvca.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/07/2019] [Indexed: 12/14/2022]
Affiliation(s)
- David Kam
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Toby Steinberg
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily J MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Saumil Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gregory J Mickus
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Michael Fabbro
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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21
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Three-Dimensional Echocardiographic Assessment of Mitral Annular Physiology in Patients With Degenerative Mitral Valve Regurgitation Undergoing Surgical Repair: Comparison between Early- and Late-Stage Severe Mitral Regurgitation. J Am Soc Echocardiogr 2018; 31:1178-1189. [DOI: 10.1016/j.echo.2018.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Indexed: 11/19/2022]
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22
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Quien MM, Vainrib AF, Freedberg RS, Bamira DG, Benenstein RJ, Williams MR, Saric M. Advanced Imaging Techniques for Mitral Regurgitation. Prog Cardiovasc Dis 2018; 61:390-396. [PMID: 30321560 DOI: 10.1016/j.pcad.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/16/2022]
Abstract
Mitral regurgitation (MR) is one of the most commonly encountered valvular lesions in clinical practice. MR can be either primary (degenerative) or secondary (functional) depending on the etiology of MR and the pathology of the mitral valve (MV). Echocardiography is the primary diagnostic tool for MR and is key in determining this etiology as well as MR severity. While clinicians usually turn to 2 Dimensional echocardiography as first-line imaging, 3 Dimensional echocardiography (3DE) has continually shown to be superior in terms of describing MV anatomy and pathology. This review article elaborates on 3DE techniques, modalities, and advances in software. Furthermore, the article demonstrates how 3DE has reformed MR evaluation and has played a vital role in determining patient management.
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Affiliation(s)
- Mary M Quien
- Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016
| | - Alan F Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016
| | - Robin S Freedberg
- Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016
| | - Daniel G Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016
| | - Ricardo J Benenstein
- Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016
| | - Mathew R Williams
- Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016.
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23
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Weir-McCall JR, Blanke P, Naoum C, Delgado V, Bax JJ, Leipsic J. Mitral Valve Imaging with CT: Relationship with Transcatheter Mitral Valve Interventions. Radiology 2018; 288:638-655. [DOI: 10.1148/radiol.2018172758] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan R. Weir-McCall
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Philipp Blanke
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Christopher Naoum
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Victoria Delgado
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Jeroen J. Bax
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Jonathon Leipsic
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
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24
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Wunderlich NC, Beigel R, Ho SY, Nietlispach F, Cheng R, Agricola E, Siegel RJ. Imaging for Mitral Interventions. JACC Cardiovasc Imaging 2018; 11:872-901. [DOI: 10.1016/j.jcmg.2018.02.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/12/2018] [Accepted: 02/22/2018] [Indexed: 10/14/2022]
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25
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Fernando RJ, Johnson SD, Patel PA, Gutsche JT, Lauter D, Feinman JW, Guelaff E, Weiss SJ, Richardson KM, Boisen ML, Gelzinis TA, Augoustides JG. Unexpected Mitral Regurgitation During Coronary Artery Bypass Graft Surgery: The Multidisciplinary Management of a Mitral Valve Cleft. J Cardiothorac Vasc Anesth 2018; 32:1480-1486. [DOI: 10.1053/j.jvca.2017.09.008] [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] [Received: 09/03/2017] [Indexed: 12/23/2022]
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26
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Chew PG, Bounford K, Plein S, Schlosshan D, Greenwood JP. Multimodality imaging for the quantitative assessment of mitral regurgitation. Quant Imaging Med Surg 2018; 8:342-359. [PMID: 29774187 DOI: 10.21037/qims.2018.04.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The natural history of mitral regurgitation (MR) results in significant morbidity and mortality. Innovations in non-invasive imaging have provided new insights into the pathophysiology and quantification of MR, in addition to early detection of left ventricular (LV) dysfunction and prognostic assessment in asymptomatic patients. Transthoracic (TTE) and transesophageal (TOE) echocardiography are the mainstay for diagnosis, assessment and serial surveillance. However, the advance from 2D to 3D imaging leads to improved assessment and characterization of mitral valve (MV) disease. Cardiovascular magnetic resonance (CMR) is increasingly used for MR quantitation and can provide an alternative imaging method if echocardiography is suboptimal or inconclusive. Other techniques such as exercise echocardiography, tissue Doppler imaging and speckle-tracking echocardiography can further offer complementary information on prognosis. This review summarises the current evidence for state-of-the-art cardiovascular imaging for the investigation of MR. Whilst advanced echocardiographic techniques are superior in the evaluation of complex MV anatomy, CMR appears the most accurate technique for the quantification of MR severity. Integration of multimodality imaging for the assessment of MR utilises the advantages of each imaging technique and offers the most comprehensive assessment of MR.
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Affiliation(s)
- Pei G Chew
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | | | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
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27
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La Canna G, Scarfo' I, Caso I. How to differentiate functional from degenerative mitral regurgitation. J Cardiovasc Med (Hagerstown) 2018. [PMID: 29538148 DOI: 10.2459/jcm.0000000000000579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Giovanni La Canna
- Echocardiography Service, Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy
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28
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Gripari P, Mapelli M, Bellacosa I, Piazzese C, Milo M, Fusini L, Muratori M, Ali SG, Tamborini G, Pepi M. Transthoracic echocardiography in patients undergoing mitral valve repair: comparison of new transthoracic 3D techniques to 2D transoesophageal echocardiography in the localization of mitral valve prolapse. Int J Cardiovasc Imaging 2018; 34:1099-1107. [PMID: 29484557 DOI: 10.1007/s10554-018-1324-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/22/2018] [Indexed: 11/27/2022]
Abstract
Successful mitral valve (MV) repair for degenerative mitral regurgitation (DMR) is mainly related to surgical expertise and MV anatomy. Although 2D echocardiography, specifically transoesophageal (TOE), provides precise information regarding MV anatomy, recent advancements in matrix technology meant a decisive step forward to the point where segmental MV analysis can be accurately performed from a noninvasive 3D transthoracic (TTE) approach. The aims of this study were: (a) to evaluate the feasibility and time required for real-time 3D TTE in a large consecutive cohort of patients with severe DMR in the assessment of MV anatomy; (b) to compare the accuracy of 3D TTE and 2D TOE versus surgical inspection in the recognition and localization of all components of the MV leaflets; (c) to establish the added diagnostic value of 3D colourDoppler examination to pure 3D morphologic evaluation. 149 consecutive patients with severe DMR underwent complete 3D TTE before surgery and 2D TOE in the operating room. Echocardiographic data obtained by the different techniques were compared with surgical inspection. 3D TTE was feasible in a relatively short time (8 ± 4 min), with good (49%) and optimal (33%) imaging quality in the majority of cases. 3D TTE had significant better overall accuracy compared to 2D TOE (93 and 91%, p < 0.05, respectively). 2D TOE was significantly more specific than 3D TTE in the identification of A3 prolapse (99 vs. 96%). The colourDoppler mode did not improve significantly the accuracy of 3D TTE, albeit it determined a better sensitivity in the detection of A2 prolapse if compared to 2D TOE (95 vs. 85%). 3D TTE with or without colourDoppler is a feasible and useful method in the analysis of MV prolapse; it allows a preoperative and noninvasive description of the pathology as accurate as the 2D TOE.
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Affiliation(s)
- Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy.
| | - Massimo Mapelli
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Ilaria Bellacosa
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Concetta Piazzese
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Maria Milo
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Parea 4, 20138, Milan, Italy
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29
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Antoine C, Mantovani F, Benfari G, Mankad SV, Maalouf JF, Michelena HI, Enriquez-Sarano M. Pathophysiology of Degenerative Mitral Regurgitation. Circ Cardiovasc Imaging 2018; 11:e005971. [DOI: 10.1161/circimaging.116.005971] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Clemence Antoine
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Francesca Mantovani
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Giovanni Benfari
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Sunil V. Mankad
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Joseph F. Maalouf
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Hector I. Michelena
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Maurice Enriquez-Sarano
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
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30
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Kim DH, Kang DH. Early Surgery in Valvular Heart Disease. Korean Circ J 2018; 48:964-973. [PMID: 30334383 PMCID: PMC6196155 DOI: 10.4070/kcj.2018.0308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/27/2018] [Indexed: 01/14/2023] Open
Abstract
The burden of valvular heart disease (VHD) is increasing with age, and the elderly patients with moderate or severe VHD are notably common. When to operate in asymptomatic patients with VHD remains controversial. The controversy is whether early surgical intervention should be preferred, or a watchful waiting approach should be followed. The beneficial effects of early surgery should be balanced against operative mortality and long-term results. Indications of early surgery in each of the VHD will be discussed in this review on the basis of the latest American and European guidelines.
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Affiliation(s)
- Dae Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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31
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Faletra FF, Berrebi A, Pedrazzini G, Leo LA, Paiocchi VL, Cautilli G, Casso G, Cassina T, Moccetti T, Malouf JF. 3D transesophageal echocardiography: A new imaging tool for assessment of mitral regurgitation and for guiding percutaneous edge-to-edge mitral valve repair. Prog Cardiovasc Dis 2017; 60:305-321. [DOI: 10.1016/j.pcad.2017.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 10/15/2017] [Indexed: 12/17/2022]
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Hunter LD, Monaghan M, Lloyd G, Pecoraro AJK, Doubell AF, Herbst PG. Screening for rheumatic heart disease: is a paradigm shift required? Echo Res Pract 2017; 4:R43-R52. [PMID: 28864463 PMCID: PMC5633059 DOI: 10.1530/erp-17-0037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 12/02/2022] Open
Abstract
This focused review presents a critical appraisal of the World Heart Federation criteria for the echocardiographic diagnosis of rheumatic heart disease (RHD) and its performance in African RHD screening programmes. It identifies various logistical and methodological problems that negatively influence the current guideline’s performance. The authors explore novel RHD screening methodology that could address some of these shortcomings and if proven to be of merit, would require a paradigm shift in the approach to the echocardiographic diagnosis of subclinical RHD.
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Affiliation(s)
- L D Hunter
- Division of Cardiology, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa
| | - M Monaghan
- King's College Hospital NHS Trust, London, UK
| | - G Lloyd
- Department of Echocardiography, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - A J K Pecoraro
- Division of Cardiology, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa
| | - A F Doubell
- Division of Cardiology, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa
| | - P G Herbst
- Division of Cardiology, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa
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33
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Cho EJ, Park SJ, Lee GY, Kim EK, Chang SA, Choi JO, Lee SC, Park SW, Park PW. Effects of Decreased Annular Height and Annular Saddle-Shaped Non-Planarity in Degenerative Severe Mitral Regurgitation with Normal Left Ventricular Ejection Fraction: Real-Time 3D Transesophageal Echocardiography. J Cardiovasc Ultrasound 2017; 25:47-56. [PMID: 28770032 PMCID: PMC5526885 DOI: 10.4250/jcu.2017.25.2.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/09/2017] [Accepted: 05/23/2017] [Indexed: 11/22/2022] Open
Abstract
Background The extent of mitral annular (MA) remodeling and dysfunction is correlated with the severity of mitral regurgitation (MR) as well as left atrial (LA) and left ventricular (LV) dilation. MA dysfunction may be a useful prognostic factor for operative timing and MR recurrence after successful mitral valve (MV) repair. The aim of this study was to evaluate additive prognostic factors of MA non-planarity using real-time 3D transesophageal echocardiography (RT3D-TEE) analysis in patients with chronic severe MR and preserved LV systolic function. Methods Forty-seven patients with chronic severe MR and preserved LV systolic function scheduled for MV repair were prospectively enrolled. Echocardiographic studies were performed before surgery and postoperatively within 2 weeks and at least 6 months after surgery. RT3D-TEE was performed before the operation and immediately post-operative. Results Mean age was 55.4 ± 15.1 years and 24 were male. Annulus height/body surface area (BSA) obtained via RT3D-TEE was correlated with the degree of postoperative LA remodeling. Patients were divided into two groups by average baseline annulus height/BSA. Patients with normal annular height had a smaller postoperative LV end-diastolic dimension, LV end-systolic dimension and LA volume index than patients with decreased annular height. Preoperative annulus height/BSA values strongly predicted postoperative LA remodeling. Conclusion MA height may be a useful prognostic factor for determining the timing of surgery in patients with chronic primary MR. Annulus height/BSA assessed via RT3D-TEE may provide additional information predictive of postoperative LA remodeling after successful MV repair.
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Affiliation(s)
- Eun Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division of Cardiology, Department of Internal Medicine, National Cancer Center, Goyang, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga Yeon Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of Thoracic Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Huenges K, Pokorny S, Berndt R, Cremer J, Lutter G. Transesophageal Echocardiography in Swine: Establishment of a Baseline. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:974-980. [PMID: 28214035 DOI: 10.1016/j.ultrasmedbio.2016.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 11/21/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023]
Abstract
The porcine model is a commonly used animal model in cardiovascular research. Along with new innovative operative techniques, choice of the optimal imaging technique is crucial. Transesophageal echocardiography (TEE) is a reliable imaging tool is highly important in a large number of experimental evaluations. But so far, TEE data for swine are limited, and few standard values have been established for the porcine model. The experience and baseline results for TEE in 45 swine are presented in this study. A full TEE examination was conducted in 45 German landrace or German large white swine, with an average body weight of 49 ± 3 kg, before experimental off-pump mitral valved stent implantation. Additionally hemodynamic measurements were evaluated. The valve implantation procedure was guided solely by real-time 3-D TEE. Baseline values of standard echocardiographic parameters are provided and, where appropriate, compared with human reference values. TEE proved to be an adequate imaging technique in this experimental porcine animal model. The baseline TEE and hemodynamic parameters established for the widely used porcine model can serve as a reference in future studies.
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Affiliation(s)
- Katharina Huenges
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Saskia Pokorny
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Rouven Berndt
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Georg Lutter
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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35
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Paulsen JM, Smith TW. Echocardiographic Imaging of the Mitral Valve for Transcatheter Edge-to-Edge Repair. Interv Cardiol Clin 2016; 5:17-31. [PMID: 27852479 DOI: 10.1016/j.iccl.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Echocardiography continues to be the most effective imaging tool for the diagnosis and follow-up of mitral valve disease. This review addresses the use of transthoracic echocardiography and transesophageal echocardiography in the planning and guidance of transcatheter mitral valve therapies. Many of the echo-imaging guidance techniques are applicable to transcatheter intervention as a whole. However, given that the MitraClip is the only device approved for mitral regurgitation at present, specific attention is paid to this procedure, with additional focus on the guidance of noncentral repair. The imaging techniques discussed will be applicable to future devices.
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Affiliation(s)
- Jeffrey M Paulsen
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis Health System, Sacramento, CA 95817, USA
| | - Thomas W Smith
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis Health System, Sacramento, CA 95817, USA.
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Sordelli C, Lancellotti P, Carlomagno G, Di Giannuario G, Alati E, De Bonis M, Alfieri O, La Canna G. Tricuspid Annular Size and Regurgitation Progression After Surgical Repair for Degenerative Mitral Regurgitation. Am J Cardiol 2016; 118:424-31. [PMID: 27287061 DOI: 10.1016/j.amjcard.2016.05.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/05/2016] [Accepted: 05/05/2016] [Indexed: 11/26/2022]
Abstract
The late worsening of nonsevere tricuspid regurgitation (TR) after mitral valve surgery is a relevant clinical problem that can lead to high-risk reoperation. Although tricuspid annulus (TA) dilatation has been proposed for prophylactic annuloplasty to prevent TR worsening, prospective data in degenerative mitral regurgitation (MR) are lacking. The aim of this prospective cohort study was to evaluate TA dimension to predict TR progression after valve repair for degenerative MR. Clinical and echocardiographic evaluation of 706 patients with degenerative MR and no significant TR was obtained preoperatively and at follow-up after isolated mitral valve repair. Together with standard cardiac chamber and valve analysis, 3-dimensional (3D) transesophageal echocardiography was performed to evaluate TA, including the anteroposterior and septolateral diameters. After a mean follow-up of 24 ± 15 months (range 6 to 60), 2 patients died while 14 developed severe MR. Compared with preoperative values, TR decreased (≤1 degree) in 227 patients, was unchanged in 437, and increased (≥1 degree) in 39 patients, with the development of significant TR (3 to 4 degree) in 3 patients. Receiver-operating characteristic curve analysis did not identify significant TA values predicting postoperative TR worsening. On multivariate regression analysis, recurrent MR and pulmonary hypertension at follow-up emerged as significant positive predictors of TR progression. Newly developed significant TR is a rare event after successful repair of degenerative MR. Although more accurate than conventional 2D measurement, 3D analysis of TA does not predict early to midterm subsequent TR progression.
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37
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Ghulam Ali S, Fusini L, Tamborini G, Muratori M, Gripari P, Mapelli M, Zanobini M, Alamanni F, Pepi M. Detailed Transthoracic and Transesophageal Echocardiographic Analysis of Mitral Leaflets in Patients Undergoing Mitral Valve Repair. Am J Cardiol 2016; 118:113-20. [PMID: 27184171 DOI: 10.1016/j.amjcard.2016.04.020] [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] [Received: 01/14/2016] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 11/24/2022]
Abstract
A recent histological study of resected scallop-P2 in mitral valve (MV) prolapse, showed that chordae tendinae may be missing or hidden in superimposed fibrous tissue of the leaflets, contributing to their thickening. This may have relevant clinical implication because detailed analysis of MV leaflets has a central role in the evaluation of patients undergoing repair. The aim of this study was to analyze MV leaflets focusing on thickness of prolapsing segments and the presence of chordal rupture (CR). We enrolled 246 patients (age 63 ± 13 years, 72 men) with isolated P2 prolapse and also 50 age-matched patients with normal MV anatomy as control group. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were retrospectively analyzed to quantify the length and the proximal and distal thickness of both anterior (A2) and posterior (P2) MV scallops. Measurements were performed at end diastole in the standard TTE and TEE views. TTE and TEE measurements were feasible in all cases. Echocardiographically 176 patients had CR (group A), 45 had no rupture (group B), and 25 had an uncertain diagnosis (group C). All pathological groups showed thickening and elongation of involved leaflets versus normal, whereas no differences in leaflets characteristics were found among MV groups. Most patients undergoing MV repair had CR with thickening of the prolapsed segment. These findings are in agreement with recent histological studies showing superimposed fibrous tissue on MV leaflets partially including ruptured chordae. This may also explain that in cases without ruptured chordae, thickness of the leaflets is markedly increased (hidden chordae?). In conclusion, detailed analysis of MV apparatus may further improve knowledge of these patients and may influence surgical timing.
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Wallenborn J, Herrmann S, Hansen M, Hu K, Voelker W, Störk S, Ertl G, Weidemann F. Systematic Echocardiographic Evaluation of Mitral Valve Regurgitation for Transcatheter Edge-to-Edge Repair. Echocardiography 2016; 33:1069-79. [DOI: 10.1111/echo.13251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Julia Wallenborn
- Department of Internal Medicine I; University Hospital Wuerzburg; Wuerzburg Germany
- Comprehensive Heart Failure Center; University of Wuerzburg; Wuerzburg Germany
| | - Sebastian Herrmann
- Department of Internal Medicine I; University Hospital Wuerzburg; Wuerzburg Germany
- Comprehensive Heart Failure Center; University of Wuerzburg; Wuerzburg Germany
| | - Marc Hansen
- Abbott Vascular Structural Heart; Abbott Vascular Germany GmbH; Wetzlar Germany
| | - Kai Hu
- Department of Internal Medicine I; University Hospital Wuerzburg; Wuerzburg Germany
- Comprehensive Heart Failure Center; University of Wuerzburg; Wuerzburg Germany
| | - Wolfram Voelker
- Department of Internal Medicine I; University Hospital Wuerzburg; Wuerzburg Germany
- Comprehensive Heart Failure Center; University of Wuerzburg; Wuerzburg Germany
| | - Stefan Störk
- Department of Internal Medicine I; University Hospital Wuerzburg; Wuerzburg Germany
- Comprehensive Heart Failure Center; University of Wuerzburg; Wuerzburg Germany
| | - Georg Ertl
- Department of Internal Medicine I; University Hospital Wuerzburg; Wuerzburg Germany
- Comprehensive Heart Failure Center; University of Wuerzburg; Wuerzburg Germany
| | - Frank Weidemann
- Department of Internal Medicine I; University Hospital Wuerzburg; Wuerzburg Germany
- Comprehensive Heart Failure Center; University of Wuerzburg; Wuerzburg Germany
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The role of experience in echocardiographic identification of location and extent of mitral valve prolapse with 2D and 3D echocardiography. Int J Cardiovasc Imaging 2016; 32:1171-7. [PMID: 27168076 DOI: 10.1007/s10554-016-0895-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/15/2016] [Indexed: 12/31/2022]
Abstract
Contradiction exists on the incremental value of two-dimensional (2D) and 3D transoesophageal echocardiography (TOE) over 2D transthoracic echocardiography (TTE) for the detection of mitral valve (MV) prolapse in readers with different echocardiographic experience. Twenty patients and five healthy persons were retrospectively identified who had undergone 2D-TTE, 2D-TOE and 3D-TOE. Fifteen (75 %) patients had surgical evidence of prolapse of the posterior MV leaflet and five patients (25 %) had a dilated MV annulus without prolapse. Three reader groups with different echocardiographic expertise (novice, trainees, cardiologists) scored thus in total 675 posterior scallops. Overall there was an improvement in agreement and Kappa values from novice to trainees to cardiologists. Diagnostic accuracies of 2D-TOE were higher than those of 2D-TTE mainly in novice readers. The incremental value of 3D-TOE over 2D-TOE was mainly seen in specificities. Time to diagnosis was dramatically reduced from 2D to 3D-TEE in all reader groups (all P < 0.001). 3D-TOE also improved the agreement (+12 to +16 %) and Kappa values (+0.14 to +0.21) in all reader groups for the exact description of P2 prolapse. Differences between readers with variable experience in determining the precise localization and extent of the prolapsing posterior MV scallops exist in particular in 2D-TTE analysis. 3D-TOE analysis was extremely fast compared to the 2D analysis methods and showed the best diagnostic accuracy (mainly driven by specificity) with identification of P1 and P3 prolapse still improving from novice to trainees to cardiologists and provided optimal description of P2 prolapse extent.
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40
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Mahmood F, Jeganathan J, Saraf R, Shahul S, Swaminathan M, Burkhard Mackensen G, Knio Z, Matyal R. A Practical Approach to an Intraoperative Three-Dimensional Transesophageal Echocardiography Examination. J Cardiothorac Vasc Anesth 2016; 30:470-90. [DOI: 10.1053/j.jvca.2015.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Indexed: 12/15/2022]
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Ahmed M, Roshdy A, Sharma R, Fletcher N. Sudden cardiac arrest and coexisting mitral valve prolapse: a case report and literature review. Echo Res Pract 2016; 3:D1-8. [PMID: 27249812 PMCID: PMC5402658 DOI: 10.1530/erp-15-0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/04/2016] [Indexed: 12/27/2022] Open
Abstract
The aetiology of sudden cardiac arrest can often be identified to underlying cardiac pathology. Mitral valve prolapse is a relatively common valvular pathology with symptoms manifesting with increasing severity of mitral regurgitation (MR). It is unusual for severe MR to be present without symptoms, and there is growing evidence that this subset of patients may be at increased risk of sudden cardiac arrest or death. The difficulty lies in identifying those patients at risk and applying measures that are appropriate to halting progression to cardiac arrest. This article examines the association of mitral valve prolapse with cardiac arrests, the underlying pathophysiological process and the strategies for identifying those at risk.
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Affiliation(s)
- Mohamed Ahmed
- Cardiothoracic Critical Care Department, St George's Hospital, London, UK
| | - Ashraf Roshdy
- Critical Care Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rajan Sharma
- Department of Cardiology, St George's Hospital, London, UK
| | - Nick Fletcher
- Cardiothoracic Critical Care Department, St George's Hospital, London, UK
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Mori M, Yoshimuta T, Ohira M, Yagi M, Sakata K, Konno T, Kawashiri MA, Tomita S, Watanabe G, Iino K, Takemura H, Yamagishi M, Hayashi K. Impact of real-time three-dimensional transesophageal echocardiography on procedural success for mitral valve repair. J Echocardiogr 2015. [DOI: 10.1007/s12574-015-0255-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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43
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A Quantitative Approach to the Intraoperative Echocardiographic Assessment of the Mitral Valve for Repair. Anesth Analg 2015; 121:34-58. [DOI: 10.1213/ane.0000000000000726] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Magunia H, Rosenberger P. [Application fields of intraoperative transesophageal 3D echocardiography]. Anaesthesist 2015; 63:662-72, 674-7. [PMID: 24994014 DOI: 10.1007/s00101-014-2346-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Intraoperative transesophageal echocardiography (TEE) is an established diagnostic tool and has to be regarded as the standard of care for intraoperative monitoring and cardiac surgical decision-making. Furthermore, intraoperative TEE is also used for monitoring and assessment of hemodynamic changes and the detection of previously unknown pathologies. In the past few years 3D-TEE has extended the spectrum of 2D-TEE by allowing pathomorphological features to be more easily and intuitively linked to the anatomy of the heart and the great vessels. Thus, a comprehensive 2D-TEE examination is favorably complemented by focused 3D-TEE. Especially during mitral valve surgery, 3D-TEE has proven its superiority in the diagnosis of the underlying pathology as demonstrated by a large number of studies in this field. This review presents the available data about the role of intraoperative 3D-TEE echocardiography and introduces practical fields of application.
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Affiliation(s)
- H Magunia
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Eberhard-Karls-Universität, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland,
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Mantovani F, Clavel MA, Vatury O, Suri RM, Mankad SV, Malouf J, Michelena HI, Jain S, Badano LP, Enriquez-Sarano M. Cleft-like indentations in myxomatous mitral valves by three-dimensional echocardiographic imaging. Heart 2015; 101:1111-7. [DOI: 10.1136/heartjnl-2014-307016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/27/2015] [Indexed: 11/03/2022] Open
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Al Amri I, van der Kley F, Schalij MJ, Ajmone Marsan N, Delgado V. Transcatheter mitral valve repair therapies for primary and secondary mitral regurgitation. Future Cardiol 2015; 11:153-69. [PMID: 25760875 DOI: 10.2217/fca.15.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Mitral regurgitation is one of the most prevalent valvular heart diseases and its prevalence is related to population aging. Elderly patients with age-associated co-morbidities have an increased risk for conventional mitral valve surgery. Transcatheter mitral valve repair has emerged as a feasible and safe alternative in patients with contraindications for surgery or high operative risk. Several transcatheter mitral repair technologies have been developed during the last decade. While the development of some devices was abandoned due to suboptimal results, others demonstrated to be safe and effective and have been included in current practice guidelines. Not all technologies are suitable for all mitral anatomies and regurgitation mechanisms. Therefore, accurate evaluation of mitral valve anatomy and function are pivotal to the success of these therapies. Cardiac imaging plays a central role in selecting patients, guiding the procedure and evaluating the durability of the repair at follow-up.
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Affiliation(s)
- Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Three-dimensional transesophageal echocardiography in degenerative mitral regurgitation. J Am Soc Echocardiogr 2015; 28:437-48. [PMID: 25684076 DOI: 10.1016/j.echo.2015.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Indexed: 12/19/2022]
Abstract
The morphology of mitral valve (MV) prolapse and flail may be extremely variable, with dominant and secondary dynamic lesions. Any pathologic valve appears unique and different from any other. Three-dimensional (3D) transesophageal echocardiography is a powerful tool to evaluate the geometry, dynamics, and function of the MV apparatus and may be of enormous value in helping surgeons perform valve repair procedures. Indeed, in contrast to the surgical view, 3D transesophageal echocardiography can visualize MV prolapse and flail in motion and from different perspectives. The purpose of this special article is not to provide a comprehensive review of degenerative MV disease but rather to illustrate different types of mitral prolapse and flail as they appear from multiple 3D transesophageal echocardiographic perspectives using a series of clinical scenarios. Because in everyday practice, 3D transesophageal echocardiographic images of MV prolapse and flail are usually observed in motion, each scenario is accompanied by several videos. Finally, the authors provide for each scenario a brief description of the surgical techniques that are usually performed at their institution.
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48
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49
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Abstract
Three-dimensional (3D) echocardiography has been conceived as one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an integral clinical tool thanks to the development of high quality real-time transesophageal echocardiography (TEE). In particular, for mitral valve diseases, this new approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the mitral valve and its dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks. In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. For aortic and tricuspid valve diseases, this method may not be quite as valuable as for the mitral valve. However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation. It is now clear that this method, especially with the continued development of real-time 3D TEE technology, will enhance the diagnosis and management of patients with these valvular heart diseases.
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Affiliation(s)
- Takahiro Shiota
- Department of Medicine, Heart Institute, Cedars-Sinai Medical Center and University of California, Los Angeles, Los Angeles, CA, USA
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50
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Abstract
Degenerative mitral regurgitation (MR), the leading cause of organic MR in western countries, is primarily characterized by mitral valve prolapse but encompasses a wide spectrum of anatomic lesions from fibroelastic deficiency (localized prolapse segment often associated with ruptured chordae) to diffuse myxomatous degeneration (Barlow's disease, diffuse excessive tissue with multiple valvular segments involved). Echocardiography is the method of choice to evaluate patients with degenerative MR and plays a crucial role in clinical management. It allows accurate assessment of MR severity, left ventricular and atrial consequences, etiology, mechanisms and anatomic lesions and consequently defines the probability of mitral valve repair.
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