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Eccentric severe mitral regurgitation

Jeong Yoon Jang, Joon-Won Kang, Dong Hyun Yang, Sahmin Lee, Byung Joo Sun, Dae-Hee Kim, Jong-Min Song, Duk-Hyun Kang, Jae-Kwan Song
Background: Overestimation of the severity of mitral regurgitation (MR) by the proximal isovelocity surface area (PISA) method has been reported. We sought to test whether angle correction (AC) of the constrained flow field is helpful to eliminate overestimation in patients with eccentric MR. Methods: In a total of 33 patients with MR due to prolapse or flail mitral valve, both echocardiography and cardiac magnetic resonance image (CMR) were performed to calculate regurgitant volume (RV)...
March 2018: Journal of Cardiovascular Ultrasound
Tetsuro Sugiura, Toshika Okumiya, Mikio Kamioka, Toru Kubo, Yoko Hirakawa, Taisuke Hisahara, Yoshihisa Matsumura
BACKGROUND: Intravascular hemolysis has been reported in patients with cardiac valve prostheses, but intravascular hemolysis in patients with mitral regurgitation with native valve has not been evaluated in detail. We designed a study to elucidate the impact of regurgitation flow on intravascular hemolysis in patients with primary mitral regurgitation by measuring erythrocyte creatine. METHODS: Erythrocyte creatine was enzymatically assayed in 29 patients with moderate to severe primary mitral regurgitation and 12 age-matched healthy volunteers...
April 2018: Journal of Cardiology
Masahiro Kashiura, Kazuya Tateishi, Taro Yokoyama, Mioko Jujo, Takahiro Tanabe, Kazuhiro Sugiyama, Akiko Akashi, Yuichi Hamabe
Case: Two cases of cardiogenic unilateral pulmonary edema are reported. Both patients presented to the emergency department with dyspnea, and chest radiography revealed unilateral infiltration, which mimics pulmonary disease. However, the patients were diagnosed with cardiogenic pulmonary edema, because echocardiography showed severe mitral regurgitation with an eccentric jet. Outcome: The patients underwent mitral valve replacement and were discharged without complications...
January 2017: Acute Medicine & Surgery
Ayman Battisha, Ahmed Abdelhaleem, Swetha Srialluri, Mohammed J Arisha, Adel A Farhoud, Hassan Kamel, Mohamed S Mahmoud, Omar Tageldin, Ahmed Y Salama, Bashar Ibeche, Navin C Nanda
Assessing aortic regurgitation (AR) severity in patients with mitral valve prosthesis may pose an echocardiographic challenge. We present a case of mild AR in whom difficulty occurred in judging its severity due to eccentric mitral prosthetic inflow signals filling practically completely the proximal left ventricular outflow tract in diastole mimicking severe AR. Frame-by-frame analysis of two-dimensional transthoracic echocardiographic images using a small sector depth and width was helpful in clarifying the true severity of AR...
October 2017: Echocardiography
Mehmet Celik, Ahmet Güner, Alev Kılıçgedik, Sabahattin Gunduz, Abdulrahman Naser, Elif Eroglu Büyüköner, Muzaffer Kahyaoglu, Cagatay Onal, Gokhan Kahveci
A 28-year-old man was admitted to our emergency service with a shortness of breath and palpitation. On admission, his blood pressure was high and he was in hypertensive pulmonary edema. His physical examination showed rales in both lungs and pansystolic murmur at mitral focus. His medical history included aortic valve replacement (AVR) because of native aortic valve infective endocarditis. Transthoracic echocardiography (TTE) showed normal functional aortic valve. Color flow imaging demonstrated severe mitral regurgitation with posterior eccentric jet...
August 2017: Echocardiography
Yifan Wang, Annalisa Quaini, Sunčica Čanić, Marija Vukicevic, Stephen H Little
Mitral valve regurgitation (MR) is a disorder of the heart in which the mitral valve does not close properly. This causes an abnormal leaking of blood backwards from the left ventricle into the left atrium during the systolic contractions of the left ventricle. Noninvasive assessment of MR using echocardiography is an ongoing challenge. In particular, a major problem are eccentric or Coanda regurgitant jets which hug the walls of the left atrium and appear smaller in the color Doppler image of regurgitant flow...
December 2017: Cardiovascular Engineering and Technology
Sergiu Darabant, Shelby B Oberton, Luis P Roldan, Carlos A Roldan
Aortic valve infective endocarditis (IE) can be complicated with severe aortic regurgitation (AR) jet-related lesions such as vegetations, pseudoaneurysms, aneurysms or perforations on the anterior mitral leaflet. Herein is reported the case of a 69-year-old male with culture-negative aortic valve endocarditis complicated with aortic valve perforations resulting in severe and eccentric AR and an AR jet-related ventricular septal defect (VSD). Neither transthoracic echocardiography (TTE) nor two-dimensional transesophageal echocardiography (2D-TEE) were unable to clearly discriminate an aorto-right ventricular fistula from a VSD...
March 2016: Journal of Heart Valve Disease
Jerry Fan, Alexa Timbrook, Sarmad Said, Kamran Babar, Mohamed Teleb, Debabrata Mukherjee, Aamer Abbas
BACKGROUND: Myxomatous mitral valve with prolapse are classically seen with abnormal leaflet apposition during contraction of the heart. Hemodynamic disorders can result from eccentric mitral regurgitation usually caused by chordae tendinae rupture or papillary muscle dysfunction. Echocardiography is the gold standard for evaluation of leaflet flail and prolapse due to high sensitivity and specificity. Though most mitral valve prolapse are asymptomatic those that cause severe regurgitation need emergent surgical intervention to prevent disease progression...
2016: Polish Journal of Radiology
Selin Bayburt, Sahin Senay, Ahmet Umit Gullu, Muharrem Kocyigit, Gultekin Karakus, Mustafa Kemal Batur, Cem Alhan
Combined therapeutic approach with performing mitral valve repair may be necessitated for the treatment of idiopathic hypertrophic subaortic stenosis (IHSS) with systolic anterior motion. This report includes operative technique for combined robotic septal myectomy and mitral valve repair. A 45-year-old man with IHSS was admitted to our center for surgical intervention. The transthoracic echocardiography showed typical asymmetric ventricular hypertrophy. Left ventricle posterior wall thickness was 11 mm, and interventricular septum thickness was 21 mm...
March 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Mehrnoush Toufan, Seyed Sajjad Mahmoudi
A 29-year old female patient was referred to our hospital for evaluation of dyspnea NYHA class I which begun from several months ago. The only abnormal sign found on physical examination was a grade 2/6 systolic murmur at the apex position without radiation. Echocardiography revealed normal left and right ventricular sizes and systolic function, and only one papillary muscle in left ventricular (LV) cavity which all chordae tendineae inserted into that muscle. The mitral valve orifice was eccentrically located at the lateral side with mild to moderate mitral regurgitation but without significant mitral stenosis...
2016: Journal of Cardiovascular and Thoracic Research
Christian Hamilton-Craig, Wendy Strugnell, Niranjan Gaikwad, Matthew Ischenko, Vicki Speranza, Jonathan Chan, Johanne Neill, David Platts, Gregory M Scalia, Darryl J Burstow, Darren L Walters
OBJECTIVE: Percutaneous valve intervention for severe mitral regurgitation (MR) using the MitraClip is a novel technology. Quantitative assessment of residual MR by transthoracic echocardiography (TTE) is challenging, with multiple eccentric jets and artifact from the clips. Cardiovascular magnetic resonance (CMR) is the reference standard for left and right ventricular volumetric assessment. CMR phase-contrast flow imaging has superior reproducibility for quantitation of MR compared to echocardiography...
July 2015: Annals of Cardiothoracic Surgery
Marie-Claude Drolet, Vincent Desbiens-Brassard, Elise Roussel, Veronique Tu, Jacques Couet, Marie Arsenault
BACKGROUND: Hypertrophy (H) is an adaptive response of the heart to a hemodynamic overload. Severe left ventricular (LV) volume overload (VO) from valve regurgitations (aortic (AR) or mitral regurgitation) leads to eccentric LVH. Increased protein turnover is a major event during development of LVH and the mechanistic target of rapamycin (mTOR) is a key molecule for its control. The role of mTOR inhibition in the development of LVH using rapamycin for relatively short periods of time (days to a few weeks) has been studied in the past in pressure overload models but not in VO models...
2015: SpringerPlus
Hirofumi Kurokawa, Ikuo Misumi, Tsuyoshi Honda, Hiroki Usuku, Hisayo Yasuda, Koichi Kaikita, Seiji Hokimoto, Hisao Ogawa, Daisuke Nakatsuka, Minoru Tabata
A 70-year-old man with a diastolic Levine V/VI musical murmur came to our department. Doppler color-flow imaging showed eccentric severe aortic regurgitation. M-mode echocardiography demonstrated fluttering of the anterior mitral leaflet and fine tremors at the aortic root. The curved M-mode representation of the myocardial strain rate showed that the basal septum was encoded in a mixture of blue and red spots during diastole, showing massive basal septal vibration. In the present case, the force of the regurgitant flow might have caused vibration of the basal septum, thereby possibly leading to distinct thrill...
June 2015: Journal of Echocardiography
Jaehuk Choi, Geu-Ru Hong, Minji Kim, In Jeong Cho, Chi Young Shim, Hyuk-Jae Chang, Joel Mancina, Jong-Won Ha, Namsik Chung
Recent advances in real-time three-dimensional (3D) echocardiography provide the automated measurement of mitral inflow and aortic stroke volume without the need to assume the geometry of the heart. The aim of this study is to explore the ability of 3D full volume color Doppler echocardiography (FVCDE) to quantify aortic regurgitation (AR). Thirty-two patients with more than a moderate degree of AR were enrolled. AR volume was measured by (1) two-dimensional-CDE, using the proximal isovelocity surface area (PISA) and (2) real-time 3D-FVCDE with (3) phase-contrast cardiac magnetic resonance imaging (PC-CMR) as the reference method...
October 2015: International Journal of Cardiovascular Imaging
Haïfa Mahjoub, Philippe Pibarot, Jean-Gaston Dumesnil
The specific flow pattern and imaging features of prosthetic heart valves poses major challenges for the Doppler echocardiographic assessment of prosthetic valve structure and function. A comprehensive approach that integrates several semi-quantitative and quantitative parameters obtained from multiple views is key to appropriately detect and quantitate prosthetic valve dysfunction and complications. In patients with prosthetic valves, and particularly in those with mitral prostheses, transesophageal echocardiography is often required to confirm and/or complement information obtained by transthoracic echocardiography...
June 2015: Current Cardiology Reports
Kevin G Friedman, Lindsay Freud, Maria Escobar-Diaz, Puja Banka, Sitaram Emani, Wayne Tworetzky
Fetal aortic valvuloplasty (FAV) has shown promise in averting the progression of fetal aortic stenosis to hypoplastic left-heart syndrome. Altered loading conditions due to valvar disease, intrinsic endomyocardial abnormalities, and procedures that alter endomyocardial mechanics may place patients with biventricular circulation (BiV) after FAV at risk of abnormal LV remodeling and function. Using the most recent echo data on BiV patients after technically successful FAV (n = 34), we evaluated LV remodeling pattern, risk factors for pathologic LV remodeling, and the association between LV remodeling pattern and LV function...
October 2015: Pediatric Cardiology
Olivia Weill, Marianne Peyre, Mathieu Vergnat, Alexandre Cazavet, Bertrand Stos, Emre Belli, Sébastien Hascoet, Philippe Acar
BACKGROUND: Severe haemolysis is a rare complication after mitral valve repair in congenital heart disease. AIM: We describe four children with severe mitral regurgitation who underwent valve repair and subsequently developed profound haemolytic anaemia. METHODS: Clinical, echocardiographic and surgical data were collected retrospectively from a surgical centre in France during a 5-year period. RESULTS: Two patients had atrioventricular septal defects, one patient had congenital mitral dysplasia and one had anomalous left coronary artery from the pulmonary artery with mitral regurgitation...
February 2015: Archives of Cardiovascular Diseases
Maryam Esmaeilzadeh, Mohammadtaghi Salehi-Omran, Saeid Hosseini, Mohammadali Sadr-Ameli
We present a very rare case of partially unroofed coronary sinus without persistent left superior vena cava in a 74 years old female with a history of hypertension, severe myxomatous bileaflet mitral valve prolapse with severe eccentric mitral regurgitation which was diagnosed during cardiac surgery.
November 2012: Research in Cardiovascular Medicine
Christian Frerker, Karl-Heinz Kuck, Tobias Schmidt, Felix Kreidel, Ralf Bader, Michael Schmoeckel, Stephan Geidel
AIMS: To report the first described case of a mitral valve infective endocarditis (IE) post MitraClip®. METHODS AND RESULTS: An 88-year-old patient at high surgical risk (log. EuroSCORE 30.4%) underwent a MitraClip procedure for severe eccentric organic mitral regurgitation (MR) due to prolapse with a flail leaflet of the P2 segment (flail gap 6 mm). After one month, the patient was readmitted to our department for fever and recurrence of shortness of breath. An echocardiogram demonstrated severe MR recurrence due to ulceration in the region of the posterior leaflet despite good insertion of both clips, and a large vegetation of 1513 mm within the clip region...
July 2015: EuroIntervention
Rajiv Bharat Kharwar, Abhisekh Mohanty, Akhil Sharma, Varun Shankar Narain, Rishi Sethi
Ruptured aneurysm of the anterior mitral leaflet is a rare but a devastating complication secondary to aortic valve infective endocarditis. We report a case of 30-year-old male with native aortic valve endocarditis who was referred to us for evaluation of worsening of heart failure after an initial period of responsiveness to antibiotics. Detailed evaluation with two-dimensional and three-dimensional transthoracic echocardiography revealed ruptured anterior mitral leaflet aneurysm with severe eccentric mitral regurgitation along with a large vegetation on the aortic valve...
March 2014: Echocardiography
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