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Thanaraj S, Balodi A, Anand R, Rawat A. Automatic boundary detection and severity assessment of mitral regurgitation. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Renker M, Fischer-Rasokat U, Walther C, Kim WK, Rixe J, Dörr O, Nef H, Rolf A, Möllmann H, Hamm CW. Evaluation of Patients for Percutaneous Edge-to-edge Mitral Valve Repair: Comparison of Cardiac Computed Tomography Angiography With Transesophageal Echocardiography. J Thorac Imaging 2022; 37:187-193. [PMID: 34232143 DOI: 10.1097/rti.0000000000000602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We sought to compare parameters derived from cardiac computed tomography angiography (CCTA) with those from transesophageal echocardiography (TEE) for the evaluation of patients with severe mitral regurgitation (MR) before percutaneous edge-to-edge mitral valve repair (PE2E). TEE is the mainstay for PE2E, although it has specific limitations. CCTA enables measurements in any arbitrary plane with high spatial resolution and offers good calcium visibility. MATERIALS AND METHODS Patients who underwent TEE and CCTA before scheduled PE2E at 2 medical centers were included in this retrospective analysis. Quantitative parameters relevant for PE2E were obtained from TEE and CCTA in a blinded manner and the intrareviewer variability was assessed. RESULTS All 30 patients (15 female, 76±10 y) had secondary MR attributable to ischemic (60%) or nonischemic cardiomyopathy (40%). On comparing parameters from TEE and CCTA, left ventricular end-diastolic diameter was 60±11 versus 64±11 mm (r=0.90), intercommissural mitral annulus was 35±5 versus 35±5 mm (r=0.88), long-axis annulus was 33±5 versus 33±5 mm (r=0.74), the distance between the fossa ovalis and the leaflet coaptation was 42±5 versus 41±5 mm (r=0.81), the anterior mitral leaflet was 21±6 versus 20±7 mm (r=0.81), the posterior mitral leaflet was 13±2 versus 13±2 mm (r=0.91), and the median mitral calcification was 1 (interquartile range: 0 to 2) versus 0 (interquartile range: 0 to 1; r=0.53), respectively. Intrareviewer agreement was good and excellent for continuous and categorical variables, respectively. CONCLUSIONS Our data suggest that evaluation of the mitral valve apparatus with CCTA in patients considered for PE2E is feasible, correlates well with TEE, and offers improved calcium visibility. In selected cases, additional information from CCTA may be helpful for achieving optimal interventional results.
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Affiliation(s)
- Matthias Renker
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main
| | - Ulrich Fischer-Rasokat
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main
| | - Claudia Walther
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main
- Department of Cardiology, University Hospital Frankfurt/Main, Frankfurt/Main
| | - Won-Keun Kim
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main
| | - Johannes Rixe
- Department of Cardiology and Angiology, University Hospital of Giessen and Marburg, Giessen
| | - Oliver Dörr
- Department of Cardiology and Angiology, University Hospital of Giessen and Marburg, Giessen
| | - Holger Nef
- Department of Cardiology and Angiology, University Hospital of Giessen and Marburg, Giessen
| | - Andreas Rolf
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main
| | - Helge Möllmann
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main
- Department of Internal Medicine I, St.-Johannes-Hospital, Dortmund, Germany
| | - Christian W Hamm
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main
- Department of Cardiology and Angiology, University Hospital of Giessen and Marburg, Giessen
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Buck T, Kortmann K, Plicht B, Kamler M, Tsagakis K, Thielmann M, Jakob HG, Erbel R. Critical importance of unsuspected findings detected by intraoperative transesophageal echocardiography for decision making during cardiac surgery. Clin Res Cardiol 2013; 102:351-9. [PMID: 23392530 DOI: 10.1007/s00392-013-0544-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 01/23/2013] [Indexed: 11/25/2022]
Abstract
AIMS To report the frequency of unsuspected pathologies detected by presurgical and/or postsurgical intraoperative transesophageal echocardiography (IOTEE) and its impact on the extent of cardiac surgery and the number of pathologies remaining unoperated. METHODS AND RESULTS In a 2-year study period, 469 patients (male/female = 273/196; age 68.0 ± 11.9 years) with presurgical and/or postsurgical IOTEE out of 2,035 patients submitted for cardiac surgery were analyzed retrospectively. Presurgical IOTEE was performed in all patients referred to valve surgery or suspicious valve disease or valve diseases with open surgical decision. Postsurgical IOTEE was performed in all patients after valve surgery. Pathologies relevant for surgery were defined as valve disease of moderate degree or higher or structural disease like shunt lesions. In 464 patients (98.9 %), a total number of 757 IOTEEs were successfully performed including 351 presurgical and 384 postsurgical studies, 1-s presurgical IOTEE, 20-s postsurgical, and one-third postsurgical IOTEE. Surgically relevant unsuspected findings were detected in 33.0 % of presurgical IOTEE leading to alteration of surgery in 27.6 %. Relevant pathologies detected by postsurgical IOTEE were found in 7.8 % as remnant valvular dysfunction of the operated valve and in 12.3 % related to other structures. Relevant pathologies detected by postsurgical IOTEE finally remained unoperated in 21.2 % of patients with only postsurgical IOTEE versus only 10.7 % (p < 0.05) of patients with both presurgical and postsurgical IOTEE. CONCLUSION We found an alarming high number of unsuspected pathologies by IOTEE causing substantial alterations of surgery. Beyond this, whether patients received presurgical IOTEE or not made a significant difference on the number of pathologies left unoperated.
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Affiliation(s)
- Thomas Buck
- Department of Cardiology, West German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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Bharucha T, Honjo O, Seller N, Atlin C, Redington A, Caldarone CA, van Arsdell G, Mertens L. Mechanisms of tricuspid valve regurgitation in hypoplastic left heart syndrome: a case-matched echocardiographic–surgical comparison study. ACTA ACUST UNITED AC 2012; 14:135-41. [DOI: 10.1093/ehjci/jes123] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Minami T, Kawano H, Yamachika S, Tsuneto A, Kaneko M, Kawano Y, Minami S, Eishi K, Maemura K. Comparison of the Diagnostic Power of Transthoracic and Transesophageal Echocardiography to Detect Ruptured Chordae Tendineae. Int Heart J 2012; 53:225-9. [DOI: 10.1536/ihj.53.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takako Minami
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Akira Tsuneto
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Masayuki Kaneko
- Department of Cardiology, Cardiovascular Center, Oita Oka Hospital
| | - Yasuko Kawano
- Cardiology Division, Shunkaikai Nagasaki Kita Hospital
| | - Shigeki Minami
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kiyoyuki Eishi
- Department of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
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Chaudhry FA, Upadya SPY, Singh VP, Cusik DA, Izrailtyan I, Sanders J, Hargrove C. Identifying patients with degenerative mitral regurgitation for mitral valve repair and replacement: A transesophageal echocardiographic study. J Am Soc Echocardiogr 2004; 17:988-94. [PMID: 15337965 DOI: 10.1016/j.echo.2004.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to preoperatively identify the suitability of patients with degenerative mitral valve (MV) regurgitation for MV repair (MVR) and MV replacement. BACKGROUND MVR is the preferred method of treatment over MV replacement, if surgically feasible. MVR preserves left ventricular function and decreases risk of hemolysis, thromboembolism, and-in the absence of anticoagulation-hemorrhage. However, the ability to identify patients suitable for MVR preoperatively is somewhat limited. METHODS In all, 76 patients underwent MV operation for severe symptomatic mitral regurgitation. The decision to operate was at the discretion of the referring physician in consultation with respective cardiothoracic surgeons at two separate, nonrelated institutions. All patients underwent preoperative and/or intraoperative transesophageal echocardiographic studies. RESULTS In all, 35 patients (46%) underwent MVR and 41 (54%) underwent MV replacement. There was no difference in the percentage of MVRs between the two institutions: 17 cases (41%) at Hahnemann University Hospital, Philadelphia, Pa, versus 18 cases (53%) at Northwestern University Memorial Hospital, Chicago, Ill (P = not significant). Age was found to be a significant univariate predictor with older age favoring MV replacement. On average, patients who underwent MVR were 11 years younger then those who underwent MV replacement. Heart failure was also found to be a significant univariate predictor: as New York Heart Association functional class worsened, MV replacement was more likely. Echocardiographic variables favoring MVR included chordal length (>29 mm, P <.001), length of posterior mitral leaflet (>17 mm, P <.008), and length of anterior leaflet (>25 mm, P <.01). The only echocardiographic parameter favoring replacement was the presence of anterior mitral annular calcification. Using multivariate analysis, older age (>63 years) was again a significant predictor favoring MV replacement (P <.002; odds ratio [OR] 20). Longer chordal length (>29 mm) was the strongest predictor favoring MVR (P <.001; OR 11.2). Longer length of the posterior leaflet (>17 mm; OR 5.07) and mitral annulus size > 35 mm (OR 7.75) were also significant multivariate predictors favoring MVR. The presence of anterior mitral annular calcification favored MV replacement using multivariate analysis (OR 25). CONCLUSIONS Patients suitable for MVR can be identified preoperatively using a combination of clinical and echocardiographic parameters.
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Affiliation(s)
- Farooq A Chaudhry
- St Luke's-Roosevelt Hospital, Columbia University, College of Physicians and Surgeons, New York, New York 10025, USA.
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Bech-Hanssen O, Rydén T, Lepore V, Wandt B, Jeppsson A. Echocardiographic assessment of anatomic lesions predicts surgical strategy in mitral regurgitation. SCAND CARDIOVASC J 2003; 37:229-34. [PMID: 12944212 DOI: 10.1080/14017430310001717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE In the present study, we evaluate our ability to predict surgical procedure repair or replacement using preoperative echocardiography. DESIGN The reports from transthoracic echocardiographic examinations of 298 patients were analyzed and the gross anatomic lesions and the mechanisms involved were classified into one of three main groups (functional with normal valves, organic degenerated with hypermobile valve or organic degenerated without hypermobility). RESULTS It was possible to assess the likelihood of repair in 226 patients (76%). The criteria used were institution based and reflect the surgical procedures during the study period (1995-1999). The proportion of patients undergoing repair was 58%. In patients with a high likelihood, repair was performed in 86%. The corresponding figures in the intermediate- and low-likelihood groups were 63 and 23%, respectively. Hypermobility in the posterior leaflet and functional mitral regurgitation led to repair in the majority of patients, while patients with hypermobility in the anterior or both valves more frequently underwent replacement. CONCLUSION We conclude that it is possible to identify patients with a high likelihood of repair using transthoracic echocardiography.
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Affiliation(s)
- Odd Bech-Hanssen
- Clinical Psychology, Sahlgrenska University Hospital, Götegorg, Sweden.
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Gallet B. [Use of echocardiography in mitral regurgitation for the assessment of its mechanism and etiology for the morphological analysis of the mitral valve]. Ann Cardiol Angeiol (Paris) 2003; 52:70-7. [PMID: 12754963 DOI: 10.1016/s0003-3928(03)00007-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Echocardiographic assessment of mitral regurgitation allows the diagnosis of its mechanism and cause which are major determinants in the feasibility of mitral valve repair. This assessment is based on a systematic analysis of the different structures of the mitral valve apparatus: mitral annulus (enlargement, calcification), mitral valve morphology (thickening, calcification, floppy valve, vegetations, perforation), mitral valve motion (restriction, identification of the prolapsed leaflets and scallops in patients with mitral valve prolapse or flail leaflets), subvalvular apparatus (ruptured chordae, thickening), papillary muscles, and left ventricular wall. This analysis can diagnose the mechanism of mitral regurgitation according to the Carpentier classification, and can clarify its cause: degenerative lesions (prolapse or flail leaflet with or without ruptured chordae), rheumatic lesions (thickened valves with restricted motion), endocarditis (vegetations, perforation, ruptured chordae), ischemic mitral regurgitation (restricted valve motion with inferior or posterior left ventricular wall asynergy), or functional mitral regurgitation (annular dilatation, displacement of papillary muscles with restricted leaflet motion). Transthoracic echocardiography with harmonic imaging usually allows a comprehensive assessment of functional anatomy of mitral regurgitation. Transesophageal echocardiography is indicated if transthoracic echocardiography is inadequate. It is also indicated just before surgery and as an intraoperative procedure. Real time 3D echocardiography should probably complete the evaluation of mitral regurgitation in the near future.
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Affiliation(s)
- B Gallet
- Service de cardiologie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95100 Argenteuil, France.
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Foster GP, Isselbacher EM, Rose GA, Torchiana DF, Akins CW, Picard MH. Accurate localization of mitral regurgitant defects using multiplane transesophageal echocardiography. Ann Thorac Surg 1998; 65:1025-31. [PMID: 9564922 DOI: 10.1016/s0003-4975(98)00084-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Appropriate patient selection for surgical repair of the mitral valve depends on the specific location and mechanism of regurgitation, which, in turn, has necessitated a more detailed method to accurately describe mitral pathology. This study tests a strategy of using multiplane transesophageal echocardiography to systematically localize mitral regurgitant defects and compares these results with the surgical findings. METHODS Fifty patients with mitral regurgitation underwent intraoperative transesophageal echocardiography for the evaluation of mitral pathology and potential repair. Mitral regurgitant defects were localized using a systematic strategy and a simple nomenclature that divides each mitral valve into six sections (three sections per leaflet) and each prosthetic sewing ring into six sections (60 radial degrees = one section). RESULTS Thirty-nine patients with native mitral valves were studied, for a total of 234 sections evaluated. Eighty-seven of these sections contained regurgitant defects by transesophageal echocardiography (mean number of regurgitant defects per valve, 2.2; range, 1 through 6). There was agreement between the transesophageal echocardiographic and surgical localizations in 96% (224/234; p < 0.0001) of the sections. Eleven patients with prosthetic mitral valves were studied, for a total of 66 sections evaluated. Twenty-three of these sections contained paravalvular leaks by transesophageal echocardiography (mean number of leaks per prosthesis, 2.1; range, 1 through 6). There was agreement between the transesophageal echocardiographic and surgical localizations in 88% (58/66; p < 0.001) of the sections. CONCLUSIONS This transesophageal echocardiographic strategy provides a systematic method to accurately localize mitral regurgitant lesions and has the potential to improve the preoperative assessment of patients with significant mitral regurgitation.
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Affiliation(s)
- G P Foster
- Cardiac Unit, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Hellemans IM, Pieper EG, Ravelli AC, Hamer JP, Jaarsma W, Cheriex E, Peels CH, Bakker PF, Tijssen JG, Visser CA. Prediction of surgical strategy in mitral valve regurgitation based on echocardiography. Interuniversity Cardiology Institute of The Netherlands. Am J Cardiol 1997; 79:334-8. [PMID: 9036754 DOI: 10.1016/s0002-9149(96)00757-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this prospective multicenter study of 350 consecutive patients who were accepted for mitral valve surgery because of severe regurgitation, was to assess the value of preoperative transthoracic and transesophageal echocardiography in predicting the surgical strategy in severe mitral regurgitation: repair or replacement. The cardiologist predicted the surgical strategy on the basis of the echocardiographic examination, according to predefined guidelines for repair and replacement. The predicted strategy and motivation thereof were compared with the surgical findings and procedure that was performed. Agreement on the basis of transthoracic echocardiography was reached in 86% of the repair patients and on the basis of transesophageal echocardiography in 89%. Agreement on the basis of transthoracic echocardiography was reached in 74% of the replacement patients and on the basis of transesophageal echocardiography in 75%. This study underlines the potential role of echocardiography in predicting the surgical procedure to be applied, provided that both surgeon and cardiologist use the same nomenclature and that the guidelines for replacement/repair are adhered to. Both transthoracic and transesophageal echocardiography appear to be equally accurate in predicting the optimal surgical procedure in this respect.
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Affiliation(s)
- I M Hellemans
- Interuniversity Cardiology Institute of The Netherlands, Utrecht
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