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Mitral regurgitation quantification

Gülay Gök, Tufan Çınar, Nurten Sayar
INTRODUCTION: Rheumatic mitral stenosis (MS) is an important health issue in developing countries. Assessment of the correct mitral valve area (MVA) is essential for the timing of intervention. Most of the parameters for the assessment of rheumatic MS are derived from Two-dimensional (2D) echocardiography. Three-dimensional (3D) echocardiography is commonly used in our daily practice at the present time. The aim of this study was to assess the value of 3D echocardiography mitral valve vena contracta area (VCA) in predicting the severity of Rheumatic MS by comparing 3D planimetry...
December 11, 2018: Echocardiography
Toshiyuki Kimura, Véronique L Roger, Nozomi Watanabe, Sergio Barros-Gomes, Yan Topilsky, Shun Nishino, Yoshisato Shibata, Maurice Enriquez-Sarano
Aims: Mechanisms of chronic ischaemic mitral regurgitation (IMR) are well-characterized by apically tethered leaflet caused by papillary muscles (PMs) displacement and adynamic mitral apparatus. We investigated the unique geometry and dynamics of the mitral apparatus in first acute myocardial infarction (MI) by using quantified 3D echocardiography. Methods and results: We prospectively performed 3D echocardiography 2.3 ± 1.8 days after first MI, in 174 matched patients with (n = 87) and without IMR (n = 87)...
December 4, 2018: European Heart Journal Cardiovascular Imaging
Vivian P Kamphuis, Arno A W Roest, Nina Ajmone Marsan, Pieter J van den Boogaard, Lucia J M Kroft, Jean-Paul Aben, Jeroen J Bax, Albert de Roos, Hildo J Lamb, Jos J M Westenberg
Purpose To compare four-dimensional flow MRI with automated valve tracking to manual valve tracking in patients with acquired or congenital heart disease and healthy volunteers. Materials and Methods In this retrospective study, data were collected from 114 patients and 46 volunteers who underwent four-dimensional flow MRI at 1.5 T or 3.0 T from 2006 through 2017. Among the 114 patients, 33 had acquired and 81 had congenital heart disease (median age, 17 years; interquartile range [IQR], 13-49 years), 51 (45%) were women, and 63 (55%) were men...
October 30, 2018: Radiology
Eric L Pierce, Vahid Sadri, Beatrice Ncho, Keshav Kohli, Siddhi Shah, Ajit P Yoganathan
While transcatheter mitral valve (TMV) replacement technology has great clinical potential for surgically inoperable patients suffering from mitral regurgitation, no TMV has yet achieved regulatory approval. The diversity of devices currently under development reflects a lack of consensus regarding optimal design approaches. In Part I of this two-part study, a test system was developed for the quantification of paravalvular leakage (PVL) following deployment of a TMV or TMV-like device in pressurized, explanted porcine hearts (N = 7)...
October 17, 2018: Annals of Biomedical Engineering
Patrizia Aruta, Denisa Muraru, Andrada Camelia Guta, Sorina Mihaila, Niccolò Ruozi, Chiara Palermo, Basma Elnagar, Sabino Iliceto, Luigi P Badano
BACKGROUND: Transcatheter mitral valve replacement (TMVR) is a new therapeutic option for high surgical risk patients with mitral regurgitation (MR). Mitral valve (MV) geometry quantification is of paramount importance for success of the procedure and transthoracic 3D echocardiography represents a useful screening tool. Accordingly, we sought to asses MV geometry in patients with functional MR (FMR) that would potentially benefit of TMVR, focusing on the comparison of mitral annulus (MA) geometry between patients with ischemic (IMR) and non ischemic mitral regurgitation (nIMR)...
October 12, 2018: Cardiovascular Ultrasound
Carmen P S Blanken, Emile S Farag, S Matthijs Boekholdt, Tim Leiner, Jolanda Kluin, Aart J Nederveen, Pim van Ooij, R Nils Planken
The most common types of left-sided valvular heart disease (VHD) in the Western world are aortic valve stenosis, aortic valve regurgitation, and mitral valve regurgitation. Comprehensive clinical evaluation entails both hemodynamic analysis and structural as well as functional characterization of the left ventricle. Cardiac magnetic resonance imaging (MRI) is an established diagnostic modality for assessment of left-sided VHD and is progressively gaining ground in modern-day clinical practice. Detailed flow visualization and quantification of flow-related biomarkers in VHD can be obtained using 4D flow MRI, an imaging technique capable of measuring blood flow in three orthogonal directions over time...
August 2018: Journal of Magnetic Resonance Imaging: JMRI
Tao Cong, Jinping Gu, Alex Pui-Wai Lee, Zhijuan Shang, Yinghui Sun, Qiaobing Sun, Hong Wei, Na Chen, Siyao Sun, Tingting Fu
BACKGROUND: Atrial fibrillation (AF) can result in atrial functional mitral regurgitation (MR), but the mechanism remains controversial. Few data about the relationship between the 3-dimensional morphology of the MV and the degree of MR in AF exist. METHODS: Real-time 3-dimensional transesophageal echocardiography (3D-TEE) of the MV was acquired in 168 patients with AF (57.7% persistent AF), including 25 (14.9%) patients with moderate to severe MR (the MR+ group) and 25 patients without AF as controls...
August 21, 2018: Cardiovascular Ultrasound
Matthew A Jolley, Peter E Hammer, Sunil J Ghelani, Adi Adar, Lynn A Sleeper, Ronald V Lacro, Gerald R Marx, Meena Nathan, David M Harrild
BACKGROUND: Mitral valve (MV) prolapse is common in children with Marfan syndrome (MFS) and is associated with varying degrees of mitral regurgitation (MR). However, the three-dimensional (3D) morphology of the MV in children with MFS and its relation to the degree of MR are not known. The goals of this study were to describe the 3D morphology of the MV in children with MFS and to compare it to that in normal children. METHODS: Three-dimensional transthoracic echocardiography was performed in 27 patients (3-21 years of age) meeting the revised Ghent criteria for MFS and 27 normal children matched by age (±1 year)...
November 2018: Journal of the American Society of Echocardiography
Sandra L Gonzalez Navarrete, José Alberto de Agustín Loeches, Eduardo Pozo Osinalde, Keyla de Jesús, Adahir Madrigal, Silvana L López, Eduardo Ortiz, Adriana Saltijeral, Eduardo Enriquez-Rodriguez, José J Gómez de Diego, Patricia Mahía, Pedro Marcos Alberca, Miguel A García Fernández, Carlos Macaya, Leopoldo Pérez de Isla
INTRODUCTION: Mitral regurgitation severity assessment is usually carried out using qualitative, semiquantitative, and quantitative parameters. The mitral valve navigation (MVN) tool allows to measure the mitral effective regurgitant orifice (MERO) from 3D echo datasets. Our aim was to validate the MVN as a new tool to quantify MERO. A secondary aim was to assess the intra- and interobserver variability. METHODS: This is a retrospective study in which consecutive subjects undergoing a transoesophageal echocardiogram for more than mild mitral regurgitation evaluation were included...
August 5, 2018: Echocardiography
Tiffany Chen, Victor A Ferrari, Frank E Silvestry
Chronic mitral regurgitation (MR), whether due to valve degeneration or secondary to myocardial disease, affects an increasing proportion of the aging population. Percutaneous mitral valve interventions, including edge-to-edge repair, are emerging as feasible and effective therapy for patients with severe MR at high or prohibitive surgical risk. Imaging with echocardiography is crucial for patient selection by evaluating mitral anatomy, the mechanism of dysfunction, and MR severity. In this article, the authors review the imaging characteristics for identifying and quantifying degenerative and functional MR for transcatheter mitral valve repair...
July 2018: Interventional cardiology clinics
Ramji Iyer, Aaron Chalekian, Randy Lane, Mike Evans, Seung Yi, John Morris
Transcatheter Mitral Valve Replacement (TMVR) is currently under clinical investigation as a viable treatment option for mitral regurgitation (MR). Therefore, it is important to outline the key functional requirements of a TMVR prosthesis in order to provide an overall approach to assessing mitral valve replacement devices utilizing a combination of in vitro and preclinical methods. This article provides a review of the mitral valve disease as well as general considerations and guidance for developing a TMVR device based on International Industry Standards...
September 2018: Cardiovascular Engineering and Technology
Mirian M Pardi, Pablo M A Pomerantzeff, Roney Orismar Sampaio, Maria C Abduch, Carlos M A Brandão, Wilson Mathias, Max Grinberg, Flavio Tarasoutchi, Marcelo L C Vieira
BACKGROUND: The identification of predictors of mitral valve (MV) repair results is important for quality improvement in cardiac surgery. The aim of this study was to evaluate the relationship between MV morphological quantification by three-dimensional (3D) transesophageal echocardiography and mitral repair results. METHODS: Fifty-four patients with MV prolapse who were submitted to surgical repair were divided into 2 groups according to their postoperative mitral regurgitation (MR) degree (group 1, grade 0-I MR; group 2, ≥grade II MR)...
September 2018: Echocardiography
Donato Mele, Gabriele Pestelli, Andrea Luisi, Vittorio Smarrazzo, Filippo Trevisan, Roberto Ferrari
Echocardiography is the most commonly used technique for evaluating patients with mitral regurgitation (MR) and estimating MR severity. However, in clinical practice, echocardiographic assessment of MR severity remains challenging in many cases, particularly in patients with forms of intermediate or borderline severity. The main causes are the improper application of the echocardiographic methods for assessment of MR severity and the lack of a validated standardized approach for quantification of various types of MR, including organic and functional MR...
June 2018: Giornale Italiano di Cardiologia
Pei G Chew, Katrina Bounford, Sven Plein, Dominik Schlosshan, John P Greenwood
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...
April 2018: Quantitative Imaging in Medicine and Surgery
Tom Banks, Orod Razeghi, Ioannis Ntalas, Waqar Aziz, Jonathan M Behar, Rebecca Preston, Brian Campbell, Simon Redwood, Bernard Prendergast, Steven Niederer, Ronak Rajani
OBJECTIVES: The primary aim of this study was to quantify the dimensions and geometry of the mitral valve complex in patients with dilated cardiomyopathy and significant mitral regurgitation. The secondary aim was to evaluate the validity of an automated segmentation algorithm for assessment of the mitral valve compared to manual assessment on computed tomography. BACKGROUND: Transcatheter mitral valve replacement (TMVR) is an evolving technique which relies heavily on the lengthy evaluation of cardiac computed tomography (CT) datasets...
July 2018: Journal of Cardiovascular Computed Tomography
Daniel Lavall, Andreas Hagendorff, Stephan H Schirmer, Michael Böhm, Michael A Borger, Ulrich Laufs
Secondary mitral regurgitation (MR) results from left ventricular dilatation and dysfunction. Quantification of secondary MR is challenging because of the underlying myocardial disease. Clinical and echocardiographic evaluation requires a multi-parametric approach. Severe secondary MR occurs in up to one-fourth of patients with heart failure with reduced ejection fraction, which is associated with a mortality rate of 40% to 50% in 3 years. Percutaneous edge-to-edge mitral valve repair (MitraClip) has emerged as an alternative to surgical valve repair to improve symptoms, functional capacity, heart failure hospitalizations, and cardiac haemodynamics...
August 2018: ESC Heart Failure
Franck Levy, Sylvestre Marechaux, Laura Iacuzio, Elie Dan Schouver, Anne Laure Castel, Manuel Toledano, Stephane Rusek, Vincent Dor, Christophe Tribouilloy, Gilles Dreyfus
BACKGROUND: Quantitative assessment of primary mitral regurgitation (MR) using left ventricular (LV) volumes obtained with three-dimensional transthoracic echocardiography (3D TTE) recently showed encouraging results. Nevertheless, 3D TTE is not incorporated into everyday practice, as current LV chamber quantification software products are time consuming. AIMS: To investigate the accuracy and reproducibility of new automated fast 3D TTE software (HeartModelA.I. ; Philips Healthcare, Andover, MA, USA) for the quantification of LV volumes and MR severity in patients with isolated degenerative primary MR; and to compare regurgitant volume (RV) obtained with 3D TTE with a cardiac magnetic resonance (CMR) reference...
August 2018: Archives of Cardiovascular Diseases
Seth Uretsky, Edgar Argulian, Jagat Narula, Steven D Wolff
Accurate quantification of regurgitant volume is a central component to the management of mitral regurgitation. Cardiac magnetic resonance imaging (CMR) accurately quantifies mitral regurgitation as the difference between left ventricular stroke volume and forward stroke volume using steady state free precession and phase contrast imaging. The CMR measurement of mitral regurgitant volume is reproducible and can quantify mitral regurgitation in patients without regard to regurgitant jet morphology, such as patients with multiple and eccentric jets...
February 6, 2018: Journal of the American College of Cardiology
Giovanni Benfari, Stefano Nistri, Pompilio Faggiano, Marie-Annick Clavel, Caterina Maffeis, Maurice Enriquez-Sarano, Corrado Vassanelli, Andrea Rossi
BACKGROUND: Mitral regurgitation (MR) and elevated pulmonary artery pressure are common findings in patients with aortic valve stenosis (AS). The pathophysiologic role of quantitatively defined MR as a determinant of pulmonary hypertension (PH) is incompletely characterized across the whole spectrum of AS degrees. The purpose of the study was to investigate whether the quantification of MR reveals a link to PH in patients with AS. METHODS: Consecutive patients undergoing comprehensive echocardiography and presenting peak aortic velocity ≥ 2...
May 2018: Journal of the American Society of Echocardiography
Alexander Dietl, Christine Prieschenk, Franziska Eckert, Christoph Birner, Andreas Luchner, Lars S Maier, Stefan Buchner
BACKGROUND: Percutaneous mitral valve repair (PMVR) is increasingly performed in patients with severe mitral regurgitation (MR). Post-procedural MR grading is challenging and an unsettled issue. We hypothesised that the direct planimetry of vena contracta area (VCA) by 3D-transoesophageal echocardiography allows quantifying post-procedural MR and implies further prognostic relevance missed by the usual ordinal scale (grade I-IV). METHODS: Based on a single-centre PMVR registry containing 102 patients, the association of VCA reduction and patients' functional capacity measured as six-minute walk distance (6 MW) was evaluated...
January 9, 2018: Cardiovascular Ultrasound
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