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Abstract
BACKGROUND Acute rheumatic carditis is still an important cause of cardiac failure in developing countries. B-type natriuretic peptides, especially N-terminal segment of its prohormone are now recognised as essential parts of cardiologic evaluation. Increased plasma concentrations of B-type natriuretic peptide and its prohormone are markers of cardiac failure and hypoxia in adults. AIM To measure the prohormone levels in children with acute rheumatic carditis and to determine whether its concentrations correlate with clinical and laboratory findings. METHODS A total of 24 children with acute rheumatic carditis and 23 age and sex-matched healthy subjects were entered in the study. Transthoracic echocardiography was performed in all patients to assess the severity of the valve insufficiency and cardiac dysfunction. The prohormone plasma levels were tested for correlation with cardiac dysfunction and other biochemical markers, such as C-reactive protein, erythrocyte sedimentation rate, and anti-streptolysin-O titter. RESULTS The prohormone plasma concentrations were significantly higher in children with acute rheumatic carditis than in control subjects at the time of diagnosis. A significant decrease of the plasma level was detected among patients after treatments (6-8 weeks). CONCLUSION We found increased plasma prohormone levels in children with acute rheumatic carditis in the acute stage of illness compared with healthy subjects. Another result is increased plasma prohormone levels as acute rheumatic carditis are reversible.
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Fischer GW, Anyanwu AC, Adams DH. Intraoperative Classification of Mitral Valve Dysfunction: The Role of the Anesthesiologist in Mitral Valve Reconstruction. J Cardiothorac Vasc Anesth 2009; 23:531-43. [DOI: 10.1053/j.jvca.2009.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Indexed: 11/11/2022]
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Alkadhi H, Wildermuth S, Bettex DA, Plass A, Baumert B, Leschka S, Desbiolles LM, Marincek B, Boehm T. Mitral Regurgitation: Quantification with 16–Detector Row CT—Initial Experience. Radiology 2006; 238:454-63. [PMID: 16371578 DOI: 10.1148/radiol.2381042216] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively determine if retrospectively electrocardiographic (ECG)-gated multi-detector row computed tomography (CT) with a 16-detector row CT scanner can depict mitral regurgitation and enable quantification of the severity of the disease. MATERIALS AND METHODS The study had institutional review board approval, and patients gave informed consent. Nineteen patients with mitral regurgitation (10 men, nine women; mean age, 66 years +/- 9 [standard deviation]; range, 41-83 years) and 25 patients without mitral regurgitation (14 men, 11 women; mean age, 68 years +/- 9; range, 43-83 years) as determined with transesophageal color Doppler echocardiography and ventriculography underwent retrospectively ECG-gated 16-detector row CT. Twenty CT data sets covering the entire mitral valve apparatus were reconstructed in 5% steps of the R-R interval for each patient, and data analysis was performed with four-dimensional software. Using planimetry, two readers measured in consensus the area of the regurgitant orifice during systole. These measurements were compared with semiquantitative data from transesophageal echocardiography and ventriculography by using Spearman rank order correlation coefficients. RESULTS In the 25 patients without mitral regurgitation, no regurgitant orifice during systole could be detected with multi-detector row CT. In the 19 patients with mitral regurgitation, a regurgitant orifice could be visualized in all cases. The mean regurgitant orifice area at CT-45 mm(2) +/- 34 (range, 10-148 mm(2))-correlated significantly with the results at transesophageal echocardiography (r = 0.807, P < .001) and ventriculography (r = 0.922, P < .001). CONCLUSION Planimetric measurements of the regurgitant orifice area at retrospectively ECG-gated 16-detector row CT enable quantification of mitral regurgitation.
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Affiliation(s)
- Hatem Alkadhi
- Institute of Diagnostic Radiology, Institute of Anesthesia, Division of Cardiovascular Anesthesia, and Clinic for Cardiovascular Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
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Sampaio RO, Grinberg M, Leite JJ, Tarasoutchi F, Chalela WA, Izaki M, Spina GS, Rossi EG, Mady C. Effect of enalapril on left ventricular diameters and exercise capacity in asymptomatic or mildly symptomatic patients with regurgitation secondary to mitral valve prolapse or rheumatic heart disease. Am J Cardiol 2005; 96:117-21. [PMID: 15979448 DOI: 10.1016/j.amjcard.2005.02.056] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Revised: 02/23/2005] [Accepted: 02/23/2005] [Indexed: 11/29/2022]
Abstract
The effects of 12 months of therapy were evaluated in 47 mildly symptomatic patients with moderate to severe mitral valve regurgitation; 26 patients received enalapril and 21 received a placebo. Enalapril was associated with a significant reduction in left ventricular diameter and mitral regurgitation volume, with no evidence of change in systolic function indexes. However, enalapril did not hinder progressive aerobic impairment to effort.
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Affiliation(s)
- Roney O Sampaio
- Department of Valvular Heart Disease, University of São Paulo Medical School, São Paulo, Brazil.
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Kabukçu M, Arslantas E, Ates I, Demircioglu F, Ersel F. Clinical, echocardiographic, and hemodynamic characteristics of rheumatic mitral valve stenosis and atrial fibrillation. Angiology 2005; 56:159-63. [PMID: 15793605 DOI: 10.1177/000331970505600206] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic atrial fibrillation (AF) is associated with an increased frequency of embolic events and negative impact on cardiac function, and therefore, an increased morbidity and mortality risk in patients with rheumatic mitral valve stenosis (RMS). In the present study, the clinical, 2-D and Doppler echocardiographic, and left-and right-heart hemodynamic data were evaluated for 92 patients (68 women) with RMS and AF and compared with data from 118 patients (88 women) with RMS with sinus rhythm. The clinical, echocardiographic, and hemodynamic evaluations were performed within 1 to 7 days of each other. Patients with AF were older (45.7+/-13.4 vs 38.6+/-12.0 years, p < 0.01) and had a longer symptomatic period (108.2+/-117.9 vs 50.6+/-53.1 months, p < 0.01) compared with those with sinus rhythm. Most of the patients with AF were in NYHA functional capacity 3-4 (74% vs 19%), whereas most of the patients with sinus rhythm were in NYHA functional capacity 2. Patients with AF had a higher mitral valve score based on morphologic features ranging from 4 to 16 depending on the severity of disease (8.3+/-2.1 vs 6.5+/-1.9, p < 0.01) and greater left ventricular end-diastolic diameter (LVEDD) (52.3+/-8.7 vs 47.7+/-8.7 mm, p < 0.02), and end-systolic diameter (LVESD) (34.4+/-7.5 vs 30.9+/-7.5 mm, p < 0.01). Organic tricuspid valve involvement was diagnosed more frequently in patients with AF (61% vs 32%, p < 0.01). Mild mitral regurgitation was also more frequent in patients with AF (71%vs 51%, p < 0.03). The mitral valve area was similar in patients with and without AF (1.30+/-0.39 vs 1.39+/-0.41 cm2, p > 0.05). Mean diastolic mitral valve gradient and pulmonary artery pressure did not differ in patients with and without AF. Right atrial pressures were higher in patients with AF (7.6+/-3.3 vs 6.3+/-1.9 mm Hg, p < 0.02). The authors suggest that (1) AF occurred in older patients, who had a longer disease process and more serious symptoms; (2) hemodynamic derangements (mitral valve gradient, pulmonary artery pressure) did not differ in patients with and without AF; (3) greater mitral valve score, more tricuspid valve involvement, higher LVEDD, which are suggestive of greater rheumatic activity process were more frequently seen in patients with AF than in those without AF. These findings support the opinion that AF is a marker of widespread rheumatic damage in patients with RMS.
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Affiliation(s)
- Mehmet Kabukçu
- Department of Cardiology, Akdeniz University, Medical Faculty, Antalya, Turkey
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6
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Abstract
One of the first reports of cardiac ultrasound imaging occurred in 1954 by Elder and Hertz. They described the use of ultrasound imaging for displaying continuous recording of movement of heart walls. This was displayed by the use of A-mode and B-mode methods. In the late 1950s, continuous-wave Doppler was used in cardiac imaging. By the late 1960s, two-dimensional real-time B-mode imaging was performed using mechanical head transducers. In the mid-1970s, phased array transducers were being utilized. Also in the late 1970s, transesophageal echo was being tested. The 1980s have seen advances in computer technology that have made color flow Doppler imaging possible, along with better image quality through scan conversion and image processing. In the 1990s developing techniques included stress echocardiography, intravascular ultrasound, contrast echocardiography, digital acquisition, second harmonic imaging, ultrasonic tissue characterization, and three-dimensional echocardiography. More recently, echocardiography has seen advances in real-time 3D imaging, handheld echocardiography, and myocardial perfusion. Advances in technology, along with improved understanding of the equipment, have made the availability and demand of echocardiography invaluable.
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Affiliation(s)
- Karen L. Strub
- Society for Diagnostic Medical Sonography, c/o Dawn Sanchez, 2745 N. Dallas Parkway, Suite 350, Plano, TX 75093,
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Gölbaşý Z, Uçar O, Yüksel AG, Gülel O, Aydoğdu S, Ulusoy V. Plasma brain natriuretic peptide levels in patients with rheumatic heart disease. Eur J Heart Fail 2005; 6:757-60. [PMID: 15542413 DOI: 10.1016/j.ejheart.2004.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2003] [Revised: 02/10/2004] [Accepted: 04/22/2004] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Brain natriuretic peptide (BNP) is a cardiac hormone secreted from the ventricular myocardium as a response to ventricular volume expansion and pressure overload. Rheumatic heart disease (RHD) is still an important cause of heart failure in developing countries. AIMS To measure BNP levels in patients with RHD and to determine whether BNP concentrations correlate with clinical and echocardiographic findings. METHODS Eighty-eight patients with rheumatic valve disease and 24 age- and sex-matched healthy subjects were entered in the study. BNP was measured using the Triage B-Type Natriuretic Peptide test (Biosite Diagnostics, San Diego, CA). Transthoracic echocardiography was performed in all patients to assess the severity of the valve disease and for the measurement of pulmonary artery pressure. RESULTS The plasma concentrations of BNP were significantly higher in patients with rheumatic heart disease than in control subjects (232+/-294 vs. 14+/-12 pg/ml, p<0.0001). The plasma BNP level was significantly higher in NYHA class III+IV than in class II (463+/-399 vs. 192+/-243 pg/ml, p<0.0001) and in NYHA class II than in class I (192+/-243 vs. 112+/-135 pg/ml, p<0.001). The independent determinants of higher BNP levels were NYHA functional class and systolic pulmonary artery pressure in multivariate analysis. CONCLUSION We found increased plasma BNP levels in patients with rheumatic heart disease compared with healthy subjects.
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Affiliation(s)
- Zehra Gölbaşý
- Department of Cardiology, Ankara Türkiye Yüksek Ihtisas Hospital, Attar sok. No: 14/3, GOP, 06700, Ankara, Turkey.
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Southworth R, Blackburn SC, Davey KAB, Sharland GK, Garlick PB. The low oxygen-carrying capacity of Krebs buffer causes a doubling in ventricular wall thickness in the isolated heart. Can J Physiol Pharmacol 2005; 83:174-82. [PMID: 15791291 DOI: 10.1139/y04-138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The buffer-perfused Langendorff heart is significantly vasodilated compared with the in vivo heart. In this study, we employed ultrasound to determine if this vasodilation translated into changes in left ventricular wall thickness (LVWT), and if this effect persisted when these hearts were switched to the "working" mode. To investigate the effects of perfusion pressure, vascular tone, and oxygen availability on cardiac dimensions, we perfused hearts (from male Wistar rats) in the Langendorff mode at 80, 60, and 40 cm H2O pressure, and infused further groups of hearts with either the vasoconstrictor endothelin-1 (ET-1) or the blood substitute FC-43. Buffer perfusion induced a doubling in diastolic LVWT compared with the same hearts in vivo (5.4 ± 0.2 mm vs. 2.6 ± 0.2 mm, p < 0.05) that was not reversed by switching hearts to "working" mode. Perfusion pressures of 60 and 40 cm H2O resulted in an increase in diastolic LVWT. ET-1 infusion caused a dose-dependent decrease in diastolic LVWT (6.6 ± 0.4 to 4.8 ± 0.4 mm at a concentration of 10–9 mol/L, p < 0.05), with a concurrent decrease in coronary flow. FC-43 decreased diastolic LVWT from 6.7 ± 0.5 to 3.8 ± 0.7 mm (p < 0.05), with coronary flow falling from 16.1 ± 0.4 to 8.1 ± 0.4 mL/min (p < 0.05). We conclude that the increased diastolic LVWT observed in buffer-perfused hearts is due to vasodilation induced by the low oxygen-carrying capacity of buffer compared with blood in vivo, and that the inotropic effect of ET-1 in the Langendorff heart may be the result of a reversal of this wall thickening. The implications of these findings are discussed.Key words: ultrasound, endothelin, ventricular wall thickness, vasodilation.
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Affiliation(s)
- R Southworth
- NMR Laboratory, Division of Imaging Sciences, Guy's, King's and St Thomas' School of Medicine, Guy's Hospital, St. Thomas, London, UK.
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Kaymaz C, Ozdemir N, Kirma C, Ozkan M. Spontaneous echo contrast in the descending aorta in patients without aortic dissection: associated clinical and echocardiographic characteristics. Int J Cardiol 2003; 90:147-52. [PMID: 12957745 DOI: 10.1016/s0167-5273(02)00150-x] [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: 11/20/2022]
Abstract
The objective of the study was to evaluate the frequency, clinical and echocardiographic correlates of spontaneous echo contrast in the descending aorta in the absence of dissection. Prevalence of spontaneous echo contrast in the descending aorta in the absence of dissection, and its clinical and echocardiographic correlates were investigated in 1199 consecutive patients who underwent transesophageal echocardiography. Spontaneous echo contrast in the descending aorta was detected in 54 (4.5%) patients. Patients with spontaneous echo contrast in the descending aorta had an older age (60.6+/-8 vs. 40.6+/-14.2 years, P=0.0001), an increased prevalence of male gender (66.7 vs. 43.9%, P=0.001), an increased diameter of ascending aorta (4.2+/-1.0 vs. 3.3+/-1.1 cm, P=0.0001), an increased diameter of descending aorta (3.1+/-0.9 vs. 2.1+/-0.4 cm, P=0.0001), a higher prevalence of aortic wall calcification (9.3 vs. 0.5%, P=0.00001), complex plaque in the descending aorta (13 vs. 0.7%, P=0.0001), left ventricular dysfunction (7.4 vs. 2.1%, P<0.05), a lower incidence of severe aortic regurgitation (0 vs. 3.5%, P<0.05), a lower peak flow velocity in the descending aorta (28+/-9 vs. 51+/-21 cm/s, P<0.00001), and a lower maximal shear rate in the descending aorta (51+/-29 vs. 105+/-47 s(-1), P<0.00001) compared with patients without spontaneous echo contrast in the descending aorta. However, prevalence of atrial fibrillation, mitral valve disease, intracardiac spontaneous echo contrast and/or thrombus and embolic event were not different between patients with and without spontaneous echo contrast in the descending aorta (P>0.05). Shear rate, diameter of the descending aorta, aortic wall calcification, complex plaque in the descending aorta, absence of severe aortic regurgitation and male gender were independent variables of spontaneous echo contrast in the descending aorta. Spontaneous echo contrast in the descending aorta is a local and flow-dependent phenomenon related to aortic dilation, atherosclerosis, and decreased shear rates in the descending aorta. However, in this study, spontaneous echo contrast in the descending aorta was not found to be associated with embolic events.
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Affiliation(s)
- Cihangir Kaymaz
- Department of Cardiology, Koşuyolu Heart and Research Hospital, Kadiköy, 81020 Istanbul, Turkey
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Kaymaz C, Ozdemir N, Cevik C, Izgi C, Ozveren O, Kaynak E, Incedere O, Ozkan M. Effect of paravalvular mitral regurgitation on left atrial thrombus formation in patients with mechanical mitral valves. Am J Cardiol 2003; 92:102-5. [PMID: 12842262 DOI: 10.1016/s0002-9149(03)00481-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Cihangir Kaymaz
- Department of Cardiology, Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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11
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Kaymaz C, Ozdemir N, Erentuğ V, Sişmanoğlu M, Yakut C, Ozkan M. Location, size, and morphologic characteristics of left atrial thrombi as assessed by transesophageal echocardiography in relation to systemic embolism in patients with rheumatic mitral valve disease. Am J Cardiol 2003; 91:765-9. [PMID: 12633822 DOI: 10.1016/s0002-9149(02)03428-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Cihangir Kaymaz
- Department of Cardiology, Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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12
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Gill EA, Pittenger B, Otto CM. Evaluación de la severidad y decisiones quirúrgicas en las valvulopatías. Rev Esp Cardiol 2003; 56:900-14. [PMID: 14519278 DOI: 10.1016/s0300-8932(03)76979-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A better knowledge of the natural history of valvular disease and the advances in surgical techniques are allowing to improve the prognosis of patients with valvular heart disease. At present, imaging techniques, particularly Doppler-echocardiography, is the main tool to determine the diagnosis and prognosis of patients with valvular heart disease. Consequently, decision making in valvular heart disease is now days based on a combination of symptomatic status and echocardiographic findings. The main applications of Doppler-echocardiography with this purpose are summarized in this article. Therapeutic algorithms for patients with valvular heart disease are proposed, as well as the potential application of new imaging modalities appeared in the last years. The state of the art of clinical practice guidelines are also reviewed.
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Affiliation(s)
- Edward A Gill
- Division of Cardiology. Department of Medicine. University of Washington. Seattle, Washington 98104-2499, USA.
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Kaymaz C, Ozdemir N, Kýrma C, Ozkan M. Spontaneous echo contrast in the descending aorta in patients without aortic dissection: associated clinical and echocardiographic characteristics. Int J Cardiol 2002; 85:271-6. [PMID: 12208594 DOI: 10.1016/s0167-5273(02)00185-7] [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: 11/24/2022]
Abstract
OBJECTIVE To evaluate the frequency, clinical and echocardiographic correlates of spontaneous echo contrast in the descending aorta in the absence of dissection. METHODS Prevalence of spontaneous echo contrast in the descending aorta in the absence of dissection, and its clinical and echocardiographic correlates were investigated in 1,199 consecutive patients who underwent transesophageal echocardiography. RESULTS Spontaneous echo contrast in the descending aorta was detected in 54 (4.5%) patients. Patients with spontaneous echo contrast in the descending aorta had an older age (60.6+/-8 vs. 40.6+/-14.2 years, p=0.0001), an increased prevalence of male gender (66.7 vs. 43.9%, p=0.001), an increased diameter of ascending aorta (4.2+/-1.0 vs. 3.3+/-1.1 cm, p=0.0001), an increased diameter of descending aorta (3.1+/-0.9 vs. 2.1+/-0.4 cm, p=0.0001), a higher prevalence of aortic wall calcification (9.3 vs. 0.5%, p=0.00001), complex plaque in the descending aorta (13 vs. 0.7%, p=0.0001), left ventricular dysfunction (7.4 vs. 2.1%, p<0.05), a lower incidence of severe aortic regurgitation (0 vs. 3.5%, p<0.05), a lower peak flow velocity in the descending aorta (28+/-9 vs. 51+/-21 cm/s, p<0.00001), and a lower maximal shear rate in the descending aorta (51+/-29 vs. 105+/-47 s(-1), p<0.00001) compared with patients without spontaneous echo contrast in the descending aorta. However, prevalence of atrial fibrillation, mitral valve disease, intracardiac spontaneous echo contrast and/or thrombus and embolic event were not different between patients with and without spontaneous echo contrast in the descending aorta (p>0.05). Shear rate, diameter of the descending aorta, aortic wall calcification, complex plaque in the descending aorta, absence of severe aortic regurgitation and male gender were independent variables of spontaneous echo contrast in the descending aorta. CONCLUSIONS Spontaneous echo contrast in the descending aorta is a local and flow dependent phenomenon relates to aortic dilation, atherosclerosis, and decreased shear rates in the descending aorta. However, in this study, spontaneous echo contrast in the descending aorta was not found to be associated with embolic events.
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Affiliation(s)
- Cihangir Kaymaz
- Department of Cardiology, Koşuyolu Heart and Research Hospital, Kadiköy, 81020 Istanbul, Turkey
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Gölbaşi Z, Dinçer S, Bayol H, Uğurlu B, Ciçek D, Keleş T, Aydoğdu S, Erbaş D. Increased nitric oxide in exhaled air in patients with rheumatic heart disease. Eur J Heart Fail 2001; 3:27-32. [PMID: 11163732 DOI: 10.1016/s1388-9842(00)00116-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Endogenous production of nitric oxide and its presence in exhaled air was observed in humans. Prior studies have yielded contrasting information about the production of nitric oxide in patients with heart failure. AIMS The aim of this study was to measure nitric oxide in the exhaled air of patients with chronic rheumatic heart disease with and without pulmonary hypertension. METHODS Seventy-four patients (6 patients had isolated mitral stenosis; 13 patients had combined mitral stenosis and mitral regurgitation; 1 patient had isolated mitral regurgitation; 54 patients had combined mitral and aortic valve disease) and 27 healthy subjects were entered in the study. The nitric oxide concentration in exhaled air was determined with a chemiluminescence analyser. Echocardiography was performed in all patients to assess the severity of the valve disease and for the measurement of pulmonary artery pressure. RESULTS The level of exhaled nitric oxide was significantly greater in patients with rheumatic heart disease than in controls. The value of nitric oxide concentration in exhaled air was significantly increased in patients with pulmonary hypertension, as compared with patients who had normal pulmonary artery systolic pressure. CONCLUSION We found increased nitric oxide in the exhaled air in patients with rheumatic heart disease, especially in those with pulmonary hypertension, compared with healthy patients.
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Affiliation(s)
- Z Gölbaşi
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
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Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davidson TW, Davis JL, Douglas PS, Gillam LD. ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation 1997; 95:1686-744. [PMID: 9118558 DOI: 10.1161/01.cir.95.6.1686] [Citation(s) in RCA: 377] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Irani WN, Grayburn PA, Afridi I. A negative transthoracic echocardiogram obviates the need for transesophageal echocardiography in patients with suspected native valve active infective endocarditis. Am J Cardiol 1996; 78:101-3. [PMID: 8712097 DOI: 10.1016/s0002-9149(96)00236-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We studied 134 patients with suspected native valve infective endocarditis who underwent transthoracic and transesophageal echocardiography. Our data suggest that in patients without prosthetic valves who have a technically adequate negative transthoracic echocardiogram, transesophageal echocardiography is unlikely to be of incremental benefit in diagnosing endocarditis.
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Affiliation(s)
- W N Irani
- University of Texas Southwestern Medical Center, Dallas, USA
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Afridi I, Apostolidou MA, Saad RM, Zoghbi WA. Pseudoaneurysms of the mitral-aortic intervalvular fibrosa: dynamic characterization using transesophageal echocardiographic and Doppler techniques. J Am Coll Cardiol 1995; 25:137-45. [PMID: 7798491 DOI: 10.1016/0735-1097(94)00326-l] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of this study was to provide a detailed description of echocardiographic and Doppler features of pseudoaneurysms involving the mitral-aortic intervalvular fibrosa and to compare echocardiographic and aortographic findings. BACKGROUND Infection of the aortic valve may spread to the aortic annulus, resulting in ring abscesses or pseudoaneurysms, or both, of the intervalvular fibrosa, which can alter patient management and prognosis. METHODS The echocardiographic and Doppler findings of 20 patients with pseudoaneurysms or ring abscesses, or both, were reviewed and compared with surgical and aortographic results. RESULTS A total of 23 lesions were identified, of which 16 were intervalvular pseudoaneurysms, and 7 were ring abscesses. Transthoracic echocardiography detected 43% of the lesions, whereas transesophageal echocardiography identified 90% (p < 0.01). The most distinct feature of the pseudoaneurysms was marked pulsatility, with systolic expansion and diastolic collapse (mean systolic area [+/- SD] 4.1 +/- 3.4 cm2 vs. diastolic mean area 1.8 +/- 2.2 cm2, p < 0.05). Using color Doppler, two types were identified: unruptured pseudoaneurysms (n = 9), which communicated only with the left ventricular outflow tract and had a distinct flow pattern, and ruptured pseudoaneurysms (n = 7), which, in addition, communicated with the left atrium or aorta. Compared with pseudoaneurysms, ring abscesses were smaller and nonpulsatile and showed either no flow or continuous systolic and diastolic flow, the site of paravalvular aortic insufficiency. In 10 patients who underwent aortography, three lesions were identified, and findings were concordant with echocardiography. However, in seven patients aortographic findings were normal, whereas echocardiography identified intervalvular pseudoaneurysms, all of which were documented at operation. CONCLUSIONS Intervalvular pseudoaneurysms are more frequently detected by transesophageal echocardiography than by aortography or transthoracic examination and exhibit distinct dynamic features and Doppler patterns that can further help characterize cavitary lesions in the aortic root and guide appropriate surgical intervention.
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MESH Headings
- Adult
- Aged
- Analysis of Variance
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/surgery
- Aneurysm, Ruptured/diagnostic imaging
- Aneurysm, Ruptured/surgery
- Aortic Valve/diagnostic imaging
- Aortic Valve/surgery
- Aortography
- Cineradiography
- Echocardiography, Doppler, Color/instrumentation
- Echocardiography, Doppler, Color/methods
- Echocardiography, Doppler, Color/statistics & numerical data
- Echocardiography, Transesophageal/instrumentation
- Echocardiography, Transesophageal/methods
- Echocardiography, Transesophageal/statistics & numerical data
- Female
- Heart Rupture/diagnostic imaging
- Heart Rupture/surgery
- Heart Valve Diseases/diagnostic imaging
- Heart Valve Diseases/surgery
- Heart Valve Prosthesis
- Humans
- Male
- Middle Aged
- Mitral Valve/diagnostic imaging
- Mitral Valve/surgery
- Rupture, Spontaneous
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Affiliation(s)
- I Afridi
- Department of Medicine, Baylor College of Medicine, Methodist Hospital, Houston, Texas 77030
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19
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Grossmann G, Giesler M, Schmidt A, Kochs M, Wieshammer S, Eggeling T, Felder C, Hombach V. Quantification of mitral regurgitation by colour flow Doppler imaging--value of the 'proximal isovelocity surface area' method. Int J Cardiol 1993; 42:165-73. [PMID: 8112922 DOI: 10.1016/0167-5273(93)90087-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In this study 97 patients with mitral regurgitation (age 62 +/- 11 years, 55 men, 42 women) quantified by angiography were studied using colour flow Doppler imaging of isovelocity surface areas in the flow convergence region proximal to the regurgitant orifice. The radii of the proximal isovelocity surface areas for the flow velocities of 28 and 41 cm/s were measured. A flow convergence region was imaged in 100% (96%) of the patients with Grade I/II or more and in 92% (64%) of the patients with Grade I mitral regurgitation for a flow velocity of 28 (41) cm/s. The radii of the proximal isovelocity surface areas correlated significantly with the angiographic grade in patients with sinus rhythm as well as atrial fibrillation. A correct differentiation of Grade I to II from Grade III to IV mitral regurgitation was provided in more than 90% of all patients for both flow velocities investigated. Assuming hemispheric proximal isovelocity surface areas, in 11 patients the regurgitant volumes from echocardiography (range: 2.6-241 (0.9-198) ml for a flow velocity = 28 (41) cm/s) correlated with, but considerably overestimated the values from cardiac catheterization (range: 1.4-72.5 ml) with r = 0.79 (0.82) (P < 0.01) and SEE = 57.9 (42.4) ml for a flow velocity of 28 (41) cm/s. It was concluded that colour flow Doppler imaging of the flow convergence region enables the diagnosis of mitral regurgitation and the differentiation between Grade I to II and Grade III to IV mitral regurgitation, but may be of little value in estimating the regurgitant volume, assuming a hemispheric symmetry of the proximal flow convergence region.
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Affiliation(s)
- G Grossmann
- Department of Internal Medicine, University of Ulm, Germany
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20
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Abstract
Aortic regurgitation is a serious disorder that can challenge the best clinicians in terms of both diagnosis and management. The chronic form requires valve replacement when patients have symptoms or show evidence of left ventricular dysfunction. The acute form requires urgent aortic valve replacement. In all cases, medical management is only a temporizing procedure that can potentially mask the progression of left ventricular dysfunction. Endocarditis prophylaxis for indicated procedures is mandatory for all patients.
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Affiliation(s)
- D F Follman
- University of Chicago, Division of Biological Sciences, Pritzker School of Medicine
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