1,721,045 research outputs found
Quantitation of mitral regurgitation
No full textMitral regurgitation (MR) is the most frequent valve disease. Nevertheless, evaluation of MR severity is difficult because standard color flow imaging is plagued by considerable pitfalls. Modern surgical indications in asymptomatic patients require precise assessment of MR severity. MR severity assessment is always comprehensive, utilizing all views and methods. Determining trivial/mild MR is usually easy, based on small jet and flow convergence. Specific signs of severe MR (pulmonary venous flow systolic reversal or severe mitral lesion) are useful but insensitive. Quantitative methods, quantitative Doppler (measuring stroke volumes) and flow convergence (aka PISA method), measure the lesion severity as effective regurgitant orifice (ERO) and volume overload as regurgitant volume (RVol). Interpretation of these numbers should be performed in context of specific MR type. In organic MR (intrinsic valve lesions) ERO ≥ 0.40 cm2 and RVol ≥ 60 mL are associated with poor outcome, while in functional MR ERO ≥ 0.20 cm2 and RVol ≥ 30 mL mark reduced survival. While MR assessment should always be comprehensive, quantitative assessment of MR provides measures that are strongly predictive of outcome and should be the preferred approach. The ERO and RVol measured by these methods require interpretation in causal context to best predict outcome and determine MR management
Surgical treatment of degenerative mitral regurgitation: should we approach differently patients with flail leaflets of simple mitral valve prolapse?
No full textNot Availabl
Contribution of ischemic mitral regurgitation to congestive heart failure after myocardial infarction.
No full textPrognostic impact of pulmonary arterial hypertension in patients with severe mitral regurgitation due to flail leflets: a multicenter long-term international study
No full textAims
To determine the frequency, predictors, and outcome implications of pulmonary hypertension (PH) diagnosed by Doppler echocardiography in a large cohort of patients with the homogenous diagnosis of degenerative mitral regurgitation (MR) due to flail leaflets.
Methods and results
The Mitral Regurgitation International DAtabase (MIDA) is a registry including patients with MR due to flail leaflets consecutively referred at tertiary centres in Europe and the USA. Between 1987 and 2004, pulmonary artery systolic pressure (PASP) was measured at baseline by Doppler echocardiography in 437 patients (age 67 ± 11 years; 66% men). Pulmonary hypertension (PASP > 50 mmHg) was observed in 102 patients (23%). Independent predictors of PH were age and left atrial size (P < 0.0001). During a mean follow-up of 4.8 ± 2.8 years, PH was a strong independent predictor of death [adjusted HR 2.03 (1.30–3.18) P = 0.002], cardiovascular death [CVD; adjusted HR 2.21 (1.30–3.76) P = 0.003], and heart failure [adjusted HR 1.70 (1.10–2.62) P = 0.018]. Mitral valve surgery at any time during follow-up (performed in 325 patients, 75%) was beneficial [adjusted HR for death 0.22 (0.14–0.36) P < 0.001], but PH was associated with the increased risk of postoperative death and CVD (P = 0.01).
Conclusion
Pulmonary hypertension is a frequent complication of significant MR due to flail leaflet and is associated with major outcome implications, approximately doubling the risk of death and heart failure after diagnosis. Mitral valve surgery performed during follow-up is beneficial but does not completely abolish the adverse effects of PH once it is established and is particularly beneficial in patients without PH. These data support relieving PH secondary to MR due to flail leaflet, but also careful consideration for mitral surgery before PH is established
Clinical outcome after surgical correction of mitral regurgitation due to papillary muscle rupture.
No full textThromboembolic complications after surgical correction of mitral regurgitation incidence, predictors, and clinical implications.
No full textVisual assessment parameters for determining mitral regurgitation severity.
No full text<p>1. Grossman W, Dexter L. Profiles in valvular heart disease. In: Grossman W, ed. <i>Cardiac Catheterization and Angiography</i>. 2nd ed. Philadelphia, Pa: Lea & Febiger; 1980: 305–324.</p><p>2. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. <i>Recommendations for evaluation of the severity of native valvular regurgitation with two dimensional and Doppler echocardiography</i>. J Am Soc Echocardiogr. 2003;16: 777–802.</p><p>LA: Left Atrial.</p><p>LVESD = Left Ventricular End-Systolic Diameter.</p
Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy.
No full textBACKGROUND:
Functional mitral regurgitation (FMR) is a common finding in patients with heart failure (HF), but its effect on outcome is still uncertain, mainly because in previous studies sample sizes were relatively small and semiquantitative methods for FMR grading were used.
OBJECTIVE:
To evaluate the prognostic value of FMR in patients with HF.
METHODS AND RESULTS:
Patients with HF due to ischaemic and non-ischaemic dilated cardiomyopathy (DCM) were retrospectively recruited. The clinical end point was a composite of all-cause mortality and hospitalisation for worsening HF. FMR was quantitatively determined by measuring vena contracta (VC) or effective regurgitant orifice (ERO) or regurgitant volume (RV). Severe FMR was defined as ERO >0.2 cm(2) or RV >30 ml or VC >0.4 cm. Restrictive mitral filling pattern (RMP) was defined as E-wave deceleration time <140 ms. The study population comprised 1256 patients (mean age 67 ± 11; 78% male) with HF due to DCM: 27% had no FMR, 49% mild to moderate FMR and 24% severe FMR. There was a powerful association between severe FMR and prognosis (HR = 2.0, 95% CI 1.5 to 2.6; p<0.0001) after adjustment of left ventricular ejection fraction and RMP. The independent association of severe FMR with prognosis was confirmed in patients with ischaemic DCM (HR = 2.0, 95% CI 1.4 to 2.7; p<0.0001) and non-ischaemic DCM (HR = 1.9, 95% CI 1.3 to 2.9; p = 0.002).
CONCLUSION:
In a large patient population it was shown that a quantitatively defined FMR was strongly associated with the outcome of patients with HF, independently of LV function
- …
