A Common Color Flow Doppler Finding in the Mitral Regurgitation of Acute Rheumatic Fever

Between October 1986 and May 1991, 19 patients with acute rheumatic fever who were hospitalized in the Department of Pediatrics at Soroka Medical Center underwent echocardiographic color flow Doppler examination. Five patients had an echocardiographic picture of mitral valve prolapse, with or without leaflet thickening, and one had a flail anterior leaflet. Six had mitral valve thickening without prolapse, and seven patients had an echocardiographically normal appearing mitral valve. All 19 patients had a posterolaterally directed jet of mitral regurgitation demonstrated on color flow Doppler. All patients had echocardiographically normal aortic valves. However, mild aortic regurgitation was noted in eight of them. The posterolateral jet of mitral insufficiency in acute rheumatic fever may be the most common echo-Doppler finding in this condition. (ECHOCARDIOGRAPHY, Volume 8, November 1991)
Summary and Conclusions     

Unusual Pulmonic Regurgitant Jet on Color Flow Doppler

We describe the color flow Doppler appearances of an unusually directed jet of pulmonic valve regurgitation in a patient who has had surgery for aortic root dissection. This jet was bluish on color flow Doppler (away from transducer) and diastolic in timing, with peak velocity 1.8 m/sec; it originated at the point of apposition of the pulmonic cusps. These features served to distinguish the jet from that due to an iatrogenic aortic root-right ventricular fistula. We speculate that the pulmonary trunk was so distorted during surgery on the ascending aorta as to alter alignment of the pulmonic valve cusps, resulting in the unusual direction of the regurgitant jet.     

Anomalous Mitral Arcade: Echocardiographic and Color Flow Findings

A patient with surgically confirmed anomalous mitral valve arcade was noninvasively studied. Two-dimensional echocardiography clearly visualized the "arcade" shape and Doppler color flow mapping was useful in assessing hemodynamics. (ECHOCARDIOGRAPHY, Volume 8, November 1991)     

High Occurrence of Mitral Valve Prolapse in Cardiac Catheterization Patients with Pure Isolated Mitral Regurgitation

ABSTRACT. Danielsen R, Nordrehaug JE, Vik-Mo H (Department of Clinical Physiology, Haukeland Hospital, University of Bergen, Bergen, Norway). High occurrence of mitral valve prolapse in cardiac catheterization patients with pure isolated mitral regurgitation. Acta Med Scand 1987; 221:33–8. The aetiological spectrum of angiographically verified pure isolated mitral regurgitation (MR) was studied in 48 consecutive adult patients (35 males). Severe MR was found in 35 patients (73%) and moderate MR in 13 patients (27%). Mitral valve prolapse (MVP) syndrome was found in 21 patients (44%). These were younger than the rest of the study population (55±13 vs. 62±6 years, p<0.05) and 15 (71%) of them were men. Endocarditis and chordal rupture occurred in 19% and 43% of the MVP patients. Sixteen patients (33%) had MR secondary to myocardial infarction while only three patients (6%) had MR of rheumatic aetiology. Bacterial endocarditis, hypertensive heart disease, hypertrophic obstructive car-diomyopathy and mitral annulus calcification were less frequently found. Mitral valve replacement was done in 20 (57%) of the patients with severe MR and MVP was the underlying disease in 15 (75%) of these patients. In conclusion, MVP is a frequent cause of pure isolated MR and of mitral valve replacement. In contrast to the preponderance of young females amongst MVP patients in population surveys, most of the MVP patients with MR in this study are middle-aged and elderly men.     

Patterns of Flow Within the Dilated Cardiomyopathy Left Ventricle: Color Flow Doppler Observations

Study of the pathways of intraventricular flow by pulsed Doppler and color flow Doppler has shown that, in normal individuals, a broad strong stream flows into the left ventricular chamber from the mitral annulus to the apex during early rapid and late (atrial) ventricular filling phases; in systole, a broad rapid stream from the apex to the aortic orifice is dominant. In dilated cardiomyopathy, flow velocities are slower, and the typical pattern is a circular type of diastolic flow along the lateral left ventricular wall toward the apex and then from the apex to the aortic orifice along the septum. The systolic flow pattern is also different in dilated cardiomyopathy; in addition to the flow along the septum toward the aortic orifice, some blood flows in a circular manner back to the apex along the lateral wall. An important aspect of abnormal flow patterns in dilated dysfunctional left ventricular chambers is their association with a tendency to thrombus formation. Thus, the pathophysiology of abnormal intraventricular flow patterns may have academic but also therapeutic implications. (ECHOCARDIOGRAPHY, Volume 8, March 1991)     

Three-Dimensional Echocardiography: Advancements in Qualitative and Quantitative Analyses of Mitral Valve Morphology in Mitral Valve Prolapse

Degenerative mitral valve disease (MVD) is the leading cause of organic mitral regurgitation (MR), one of the most common valvular heart disease in western countries. Substantial progresses in the surgical treatment of degenerative MVD have improved life expectancy of patients with significant MR. However, prognosis, surgical decision and timing of surgery strongly depend on the accurate characterization of mitral valve (MV) anatomy and pathology and on the precise quantification of MR. Three-dimensional (3D) echocardiography, a major technological breakthrough in the field of cardiovascular imaging, provides several advantages over two-dimensional (2D) imaging in the qualitative and quantitative evaluations of MV apparatus. In this review, we focus on the contribution of this new modality to the diagnosis of degenerative MVD, the quantitative assessment of MR severity, the selection and monitoring of surgical and percutaneous procedures, the evaluation of procedural outcomes. The results of a systematic and exhaustive search of the existing literature, restricted to real-time 3D echocardiography in adults, are here reported.     

全胸腔镜下二尖瓣置换术的临床经验总结

目的 总结全胸腔镜下二尖瓣置换术的临床经验.方法 2004年10月～2006年8月,共完成右侧胸壁3孔、全胸腔镜下二尖瓣置换术56例,手术采用股动脉、静脉插管建立体外循环,阻闭升主动脉,冷血心脏停跳液顺行灌注保护心肌,全胸腔镜下行二尖瓣置换手术.结果 本组无死亡,手术成功54例,成功率96%;体外循环时间86～156(99±26)min;升主动脉阻闭时间45～73(53±13)min;术后呼吸机辅助时间9～16(12±4)h;术后胸液引流量20～330(78±28)ml;用血量0～1200(350±70)ml,9例患者未输血;术后住院时间7～12(9±4)d.术后并发症4例,发生率7%.结论 全胸腔镜下二尖瓣置换术安全、可行.     

Color Doppler of Diastolic Flow Converging Into Coronary Ostia by Transthoracic Ultrasound

The flow convergence method is a recently described color Doppler method for determination of flow rate across orifices in patients with valve leaks and ventricular septal defects. For a given geometry, the flow net of the flow convergence region is predictable, which allows one to derive flow rate from the local velocity at given points within the field of convective acceleration proximal to the orifice. This underlying fluid dynamic principle should also apply to coronary ostia. Therefore, we looked to see if the flow convergence region proximal to the coronary ostia can be imaged by color Doppler. In 16 healthy adults we imaged the aortic root by transthoracic color Doppler echocardiography in the parasternal short axis. A low velocity setup was used (PRF 450–2000 Hz, wall filter 50–200 Hz). Eighty-four percent of the coronary ostia was seen (left 15/16; right 12/16). A color signal of the coronary flow convergence region was displayed in 88% of coronary ostia (left 15/16; right 13/16). By quantitative analysis of these color maps the velocity profile across the flow convergence was determined. This always resulted in a steady increase in velocity when approaching the ostium. Within 2 to 18 mm proximal to the orifice, the absolute velocities ranged from 1.2 to 16 cm I sec. The coronary flow convergence region can be imaged by color Doppler. However, the potential estimation of instantaneous diastolic coronary flow rate from these images needs further evaluation.     

二尖瓣反流经导管介入微创治疗新进展

随着微创及介入治疗技术在心脏瓣膜病的治疗中不断发展,心脏瓣膜病治疗的适应证逐渐扩大,尤其在二尖瓣反流的介入治疗领域,各项实验技术成果在动物及临床实验当中取得显著效果。现介绍二尖瓣反流经导管介入治疗的新进展,并针对当前研究热点,重点对有关技术的临床研究进展做一综述。     

Combined Femoral Pseudoaneurysm and Arteriovenous Fistula: Diagnosis by Doppler Color Flow Mapping

This case report is the first to describe a combined femoral pseudoaneurysm and arteriovenous fistula resulting from a cardiac catheterization, diagnosed by color Doppler.     

The Role of Intraoperative Transesophageal Echocardiography in Robotic Mitral Valve Repair

Background: Robotic mitral valve (MV) repair is a new surgical technique that uses small incisions. Previous studies have demonstrated the importance of intraoperative transesophageal echocardiography (TEE) for conventional MV surgery with the use of a median sternotomy incision. The aim of the present study was to delineate the utility of intraoperative TEE in robotic MV repair. Methods: Intraoperative TEE was performed in 22 consecutive patients undergoing robotic MV repair for severe degenerative mitral regurgitation (MR) over a period of 2 years. Before cardiopulmonary bypass (CPB), TEE was used to define the lesions of degenerative MR and the localization of the prolapsed leaflets, and to evaluate the severity of MR. During establishment of peripheral CPB, TEE was used to guide placement of the cannulae in the inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). After weaning from CPB, TEE was used to assess immediately the competency of the surgical repair. Results: Agreement between TEE and surgical findings was excellent: 92.3% (kappa, 0.873) for the lesions of degenerative MR, and 98.5% (kappa, 0.943) for the localization of the prolapsed leaflets. Under TEE guidance, all the cannulae (100%) in the SVC, IVC, and AAO were placed correctly. TEE demonstrated all the patients (100%) had successful robotic MV repairs. Conclusions: Intraoperative TEE is a valuable adjunct in the assessment of robotic MV repair. (Echocardiography 2011;28:85‐91)     

The spectrum of mitral regurgitation in idiopathic mitral valve prolapse: a Color Doppler study

To characterize the spectrum of mitral regurgitation in mitral valve prolapse, one hundred patients were studied by color Doppler flow mapping. The findings were correlated with the clinical presentation and with the possible complications. Mitral regurgitation was absent in 46 patients, mild in 26 patients, moderate in 18 patients and severe in 10 patients. The jet orientation was central in 15 patients, antero-medial in 13 patients and postero-lateral in 26 patients. The regurgitation was early systolic in 7 patients, late systolic in 20 patients and holosystolic in 27 patients. A good agreement was observed between the color flow patterns and the presence, timing and radiation of a murmur. Systolic clicks were not predictors of the presence or the severity of regurgitation. The grade of mitral regurgitation was positively correlated with age, left heart enlargement and valvular redundancy. No sex difference was observed. The prevalence of serious arrhythmias or cerebral ischemic events was not significantly increased when a regurgitation was present.