Motion Of Mitral Valve Research Articles

The frequency and functional impact of overlapping hypertension on hypertrophic cardiomyopathy: a single-center experience.

Between 1995 and 2005, 196 adults with hypertrophic cardiomyopathy (HCM) were evaluated. Among these, 122 (62%, group 1) patients also had systemic hypertension. The clinical presentation, management, outcome, and echocardiographic findings of these patients were compared with 74 (38%, group 2) patients without systemic hypertension. Patients in group 1 were older at the time of HCM diagnosis and had a higher prevalence of diabetes (28% vs 9%; P=.02) and coronary artery disease (40% vs 25%; P=.03). In addition, echocardiography showed a significantly higher prevalence of systolic anterior motion of the anterior mitral valve in association with dynamic left ventricular outflow obstruction (52% vs 19%; P=.02) and mitral annular calcification (27% vs 13%; P=.03) in group 1 patients. Left ventricular wall thickness (17 mm vs 19 mm), end-diastolic diameter (42 mm vs 42 mm), resting outflow tract gradient >30 mm Hg (17% vs 16%), and ejection fraction (65% vs 64%) were similar in the two groups. HCM frequently coexists with systemic hypertension in the adult population. Presence of systemic hypertension in HCM patients is associated with older age and higher risk of diabetes, coronary artery disease, and noncardiac death.

Tako-tsubo, hypertrophic obstructive cardiomyopathy & muscle bridging — Separate disease entities or a single condition?

We report a case of an apical ballooning syndrome using classical and high quality imagery. Co-existing features of asymmetrical septal hypertrophy, outflow tract obstruction, systolic anterior mitral valve motion and LAD myocardial bridging make the underlying patho-physiology difficult to ascertain. In conclusion we believe that this single case will promote discussion and add to an expanding literature base of the tako-tsubo cardiomyopathy syndrome.

Cardiac Magnetic Resonance Imaging Findings Are Useful for Differentiating Between Hypertrophic Obstructive Cardiomyopathy and Aortic Valve Stenosis in Elderly Patients

The objective of this study was to assess whether cardiac magnetic resonance (MR) imaging is useful for differentiating between hypertrophic obstructive cardiomyopathy (HOCM) and aortic valve stenosis (AS) in 21 elderly patients (>75 years old). Cine and delayed contrast-enhanced cardiac MR imaging was performed and used to assess the regional wall thickness, myocardial mass, mitral valve motion, and myocardial hyperenhancement in elderly patients with HOCM and AS. The basal anterior septal and midventricular inferior septal walls were significantly thicker, the ejection fraction was higher, and the ratio between the basal and midventricular inferior wall thicknesses was lower in patients with HOCM than those in patients with AS. Apical wall thinning and abnormal mitral valve motion were detected in patients with HOCM. Structural and functional parameters that are characteristic of HOCM can be assessed in cardiac MR imaging, and these parameters may be useful for differentiating between HOCM and AS in elderly patients.

P-109 Mitral Valve Motion and Mitral Inflow Dynamics in Aortic Regurgitation, with Reference to the Relation with Regurgitant Jet Direction

(2.6±0.9 vs. 3.4±0.9 cm/s, P= 0.028) and longer interatrial time delay (33±25 vs. 12±19ms, P= 0.022). However, there were no differences in Va of RA and intra-atrial synchronicity between two groups. The lower mitral A velocity and prolonged inter-atrial time delay (OR, 95%CI: 1.12, 1.01 1.24 p = 0.025; 1.08, 1.01 1.16 p = 0.020 resp.) were the strongest predictors on presence of PAF. Conclusion: Compared to these without AF, pts with SND and PAF had worsening of LA mechanical function. The occurrence of inter-atrial dyssychrony may have implications to the mechanical benefit of alternative atrial pacing.

Mitral Valve Prolapse in Marfan Syndrome: An Old Topic Revisited

The echocardiographic features of mitral valve prolapse (MVP) in Marfan syndrome have been well described, and the incidence of MVP in Marfan syndrome is reported to be 40-80%. However, most of the original research was performed in the late 1980s and early 1990s, when the diagnostic criteria for MVP were less specific. Our goal was to investigate the characteristics of MVP associated with Marfan syndrome using currently accepted diagnostic criteria for MVP. Between January 1990 and March 2004, 90 patients with definitive diagnosis of Marfan syndrome (based on standardized criteria with or without genetic testing) were referred to Massachusetts General Hospital for transthoracic echocardiography. Patients' gender, age, weight, height, and body surface area at initial examination were recorded. Mitral valve thickness and motion, the degree of mitral regurgitation and aortic regurgitation, and aortic dimensions were quantified blinded to patients' clinical information. There were 25 patients (28%) with MVP, among whom 80% had symmetrical bileaflet MVP. Patients with MVP had thicker mitral leaflets (5.0 +/- 1.0 mm vs. 1.8 +/- 0.5 mm, P < 0.001), more mitral regurgitation (using a scale of 1-4, 2.2 +/- 1.0 vs. 0.90 +/- 0.60, P < 0.0001), larger LVEDD, and larger dimensions of sinus of Valsalva, sinotubular junction, aortic arch, and descending aorta indexed to square root body surface area, when compared with those without MVP. When echocardiographic features of patients younger than 18 years of age and those of patients older than 18 were compared, adult Marfan patients had larger LA dimension (indexed to square root body surface area), larger sinotubular junction (indexed to square root body surface area), and more mitral regurgitation and aortic regurgitation. The prevalence of MVP in Marfan syndrome is lower than previously reported. The large majority of patients with MVP have bileaflet involvement, and those with MVP have significantly larger aortic root diameters, suggesting a diffuse disease process.

1092 Automatic tracking of mitral valve motion by non-rigid image registration

1092 Automatic tracking of mitral valve motion by non-rigid image registration

Mitral valve motion after performing an edge-to-edge repair in an isolated swine heart

Mitral valve motion after performing an edge-to-edge repair is a major concern, but it has not yet been observed directly. Mitral valve motion was assessed by using a high-speed digital video camera and microsonometric analysis in an isolated swine heart, and any changes in the mitral valve area or the development of mitral stenosis symptoms were evaluated. A temporary edge-to-edge repair model was created. The mitral valve motion was assessed by using a high-speed digital video camera, and the motion of the mitral annulus was measured by means of sonomicrometric analysis with or without performing edge-to-edge repair (n = 5). The left ventricular volumetric measurements were also measured with a conductance catheter. One cardiac cycle was divided into 4 phases: the mitral valve open phase, the isovolumic contraction phase, the aortic valve open phase, and the isovolumic relaxation phase. The mitral valve was divided into 2 orifices by using the edge-to-edge technique, and the mitral valve area decreased by approximately 30%. The ratio of mitral valve open phase significantly decreased (31.9% +/- 3.4% vs 41.4% +/- 3.7%, P = .04). There were no significant differences in the diameter and the changes of anteroposterior dimensions of the mitral annulus. The stroke volume and the peak positive and negative dp/dt values showed no obvious change, but dv/dt values increased slightly without significance after removing the edge-to-edge suture (118 +/- 25 vs 130 +/- 17 mL/s, P = .14). The mitral valve area decreased slightly; however, edge-to-edge repair did not create symptomatic mitral stenosis and showed no adverse affects on cardiac function.

Resolution of a Heart Abnormality? - Basketball

Part I HISTROTY: This report is a follow-up to a case presented at the 1991 ACSM meeting. A previously healthy 18-year old African-Americ an Division I basketball player presented for PPE in 1990. History was negative for cardiac related symptoms and family history of sudden death. Following diagnosis, he was barred from playing collegiate basketball. PHYSICAL EXAMINATION: 1990, September. Height 6'7“, Weight 220 lbs., Pulse 90 bpm, BP 138/60. Physical exam normal except for cardiovascular exam. Auscultation: normal S1, physiologically split S2 and prominent S3 gallop over heart's apex. No murmurs or rubs. Resting ECG showed left ventricular hypertrophy with secondary repolarization changes. Loud S3 gallop prompted an echocardiogram (Echo). DIFFERENTIAL DIAGNOSIS: Athletic Heart Cardiomyopathy TESTS AND RESULTS: 1990, September: Initial Echo: Septum 16 mm, posterior free-wall (PFW) 11mm; Diastolic Ventricular Diameter (DVD) 51 mm. Septal to free wall ratio (SFWR) 1.45. No systolic anterior motion of mitral valve. Outflow tract flow velocity normal. Repeat Echo showed similar findings. 1990, December: Echo after 4 month deconditioning period: No septal thickness change, free wall regressed to 10 mm. SFWR 1.6. DVD reduced to 42–45 mm. Final Working Diagnosis: Hypertrophic Cardiomyopathy (HCM) TREATMENT AND OUTCOMES: Athlete barred from playing collegiate basketball following HCM diagnosis. Part II HISTROTY: Two years later this player was extensively evaluated at the National Institutes of Health. Previous diagnosis confirmed. However, NIH consultants believed his risk of sudden death was minimal. PHYSICAL EXAMINATION: PE unremarkable; gallop rhythm not heard after initial exam. DIFFERENTIAL DIAGNOSIS: HCM Athletic Heart Variant TESTS AND RESULTS: 1992, July: NIH Comprehensive Cardiac Evaluation. Tests were either normal or revealed no life-threatening abnormalities. FINAL WORKING DIAGNOSIS: HCM TESTS AND RESULTS: Athlete played Division I basketball and 9 yrs in the NBA with no cardiac related symptoms. Yearly cardiac evaluations demonstrated similar abnormal septal wall thickness and DVD dimensions. 2006, JUNE: ECHO: Normal Septum 8 mm, PFW 8 mm, SFWR 1.0, DVD 48 Impression: Athletic Heart variant with regression of myocardial septal hypertrophy?

Epidural Anesthesia for a Cesarean Section in a Parturient Patient with Congestive Heart Failure and Respiratory Insufficiency - A case report -

We report a case in which epidural anesthesia was successfully administered during a cesarean section of a 35 years old parturient patient with severe congestive heart failure and respiratory in sufficiency at 33 weeks of gestation. The patient had a past history of mitral regurgitation and mitral valve prolapse treated by mitral valve replacement ten years prior. When limited motion of the prosthetic mitral valve developed, congestive heart failure recurred and was aggravated by the pregnancy. In addition, the patient presented with symptoms of respiratory insufficiency including NYHA III dyspnea, orthopnea, severe pulmonary hypertension (systolic pulmonary arterial pressure: 112 mmHg) due to severe aortic regurgitation, pleural effusion and pulmonary edema on admission. Four-days after admission, with premature labor pain and fetal distress, the patient underwent an emergency cesarean section. Due to the orthopnea, the patient could not breathe in the supine position, and we chose to give epidural anesthesia at a sitting position for preserving self-respiration and to prevent a ventilation-perfusion mismatch that would possibly develop during general anesthesia. Moreover, we could control postoperative pain and maintain a minimal, gradual hemodynamic change throughout the epidural anesthesia. During surgery, the hemodynamic instabilities were controlled by the use of dopamine, dobutamine, ephedrine and milrinone. We safely finished the cesarean section under epidural anesthesia and the patient was sent to the intensive care unit postoperatively to manage congestive heart failure and respiratory insufficiency. (Korean J Anesthesiol 2007; 53: 656～9)

Kinking of the Atrioventricular Plane during the Cardiac Cycle

Systolic descent of the atrioventricular plane toward the relatively stationary left ventricular apex is well described. As the atrioventricular plane includes two separate valvular units, systolic atrioventricular plane displacement should not be homogenous. In 6 sheep, sonomicrometric crystals were implanted at the base of the right coronary sinus, anterolateral and posteromedial fibrous trigones, posterior mitral annulus, left ventricular apex, and the tips of the anterior and posterior mitral leaflets. The aortomitral angle was calculated and related to simultaneous left ventricular and aortic pressures and mitral valve movement. The aortomitral angle was largest at end diastole (150.73 degrees +/- 15.48 degrees ). During isovolumic contraction, it narrowed rapidly to 144.90 degrees +/- 16.64 degrees , followed by a slower narrowing during ejection until it reached its smallest angle at end systole (139.66 degrees +/- 16.78 degrees ). During isovolumic relaxation, the aortomitral angle increased to 143.66 degrees +/- 16.02 degrees at the beginning of diastole. During the first third of diastole, it narrowed again to 141 degrees +/- 16.24 degrees before re-expanding to maximum at end diastole. During systole, the atrioventricular plane descended non-homogeneously toward the apex, with kinking at the hinge between the aortic and mitral annulus plane. This deformation of the atrioventricular plane has relevance in valve surgery.

Mitral valve motion assessed by high-speed video camera in isolated swine heart

We have recently reported our isolated and working swine heart model that examines the valve motion precisely by a high-speed digital video camera system. Using this modality, the present study aimed (1) to delineate the motion of the mitral leaflets, chords and annulus throughout the cardiac cycle, and (2) to elucidate the influence of alterations in loading conditions on leaflet excursion. The valve motion of five isolated and working swine hearts was observed by an endoscope recording the images at 250 frames per second. Modified Krebs-Ringer solution was used as the sole perfusate. The images were obtained in hearts 30 min after reperfusion, changing the left atrial pressure as 4, 8, and 12 mmHg. The motion of the mitral valve in the vicinity of diastole was considered to be well understood by dividing the entire sequence into five stages: 'decoaptation,' 'E excursion,' 'diastasis,' 'A excursion,' and 'coaptation.' Initial separation occurred at both sides of the central tips of the leaflets. The leading edges always followed the mid-portion of the rough zone during opening and closing. The 'strut' second-order chords retained their tension throughout the cardiac cycle and played the role as rotary shafts of the other branching chords. The first-order chords lost their tension during opening, suggesting they mainly are involved in valve competence. Annular constriction occurred coincident with atrial contraction. An increase in preload made the isovolumic relaxation and contraction times shorter. The leaflets opened faster in the rapid-filling phase, whereas they required more time for opening and closing in the atrial-filling phase. The present study revealed the integrated movement of the mitral leaflets, chords and annulus, as well as the impact of altered preload.

Mitral Valve Replacement to Control Recurrent Systolic Anterior Motion of Mitral Valve and Left Ventricular Outflow Tract Obstruction after Alcohol Septal Ablation

Mitral Valve Replacement to Control Recurrent Systolic Anterior Motion of Mitral Valve and Left Ventricular Outflow Tract Obstruction after Alcohol Septal Ablation

Apport de l'échocardiographie pour le bilan lésionnel des insuffisances mitrales

Echocardiographic assessment of mitral regurgitation allows the diagnosis of its mechanism and cause which are major determinants in the feasibility of mitral valve repair. This assessment is based on a systematic analysis of the different structures of the mitral valve apparatus: mitral annulus (enlargement, calcification), mitral valve morphology (thickening, calcification, floppy valve, vegetations, perforation), mitral valve motion (restriction, identification of the prolapsed leaflets and scallops in patients with mitral valve prolapse or flail leaflets), subvalvular apparatus (ruptured chordae, thickening), papillary muscles, and left ventricular wall. This analysis can diagnose the mechanism of mitral regurgitation according to the Carpentier classification, and can clarify its cause: degenerative lesions (prolapse or flail leaflet with or without ruptured chordae), rheumatic lesions (thickened valves with restricted motion), endocarditis (vegetations, perforation, ruptured chordae), ischemic mitral regurgitation (restricted valve motion with inferior or posterior left ventricular wall asynergy), or functional mitral regurgitation (annular dilatation, displacement of papillary muscles with restricted leaflet motion). Transthoracic echocardiography with harmonic imaging usually allows a comprehensive assessment of functional anatomy of mitral regurgitation. Transesophageal echocardiography is indicated if transthoracic echocardiography is inadequate. It is also indicated just before surgery and as an intraoperative procedure. Real time 3D echocardiography should probably complete the evaluation of mitral regurgitation in the near future.

Silent pericardial effusion in a sample of anorexic patients.

Mortality in anorexic patients is mainly due to suicide or cardiac failure. The aim of this study was to investigate structural and functional cardiovascular alterations further by means of echocardiography in a sample of 15 medication-free patients with DSM-IV anorexia nervosa (AN) (BMI < 17.5 kg/m2) and without any known cardiovascular disease and/or a family history of deafness or sudden death, and correlate the findings with clinical variables. The controls consisted of a sample of 10 constitutionally thin women (BMI < 19 kg/m2), of comparable age, height and degree of physical activity. All of the subjects underwent Doppler echocardiography (ECHO), and the patients were also administered the Diagnostic Schedule for Eating Disorders (DSED) in order to assess the features and course of the eating disorder. ECHO revealed silent pericardial effusion in 71.4% of the patients vs. 10% of the controls (p < 0.05); among the patients, the separation of pericardial leaflets was more frequent in those with a shorter duration of illness (p < 0.05). Mitral valve motion abnormalities were more frequent among the patients than the controls (69.2% vs. 10%, p < 0.005), and the left ventricular mass/body surface area was lower (54.8% vs. 59%, p < 0.001). Isovolumetric relaxation time was longer in the patients (98.4 vs. 65 msec, p < 0.01), but there were no significant differences in left ventricular ejection fraction (53.8% vs. 59%) or early diastolic deceleration time (146 vs. 155 msec). The results of this study support the association between AN and demonstrable anatomic and functional cardiac abnormalities, such as a reduced ventricular mass and mitral valve abnormalities. The ECHO findings provide evidence for clinically silent pericardial effusion in AN, which may be an early sign of cardiovascular involvement.

Une expérience de lˈéchocardiographie transthoracique après chirurgie cardiaque

Objective: In order to determine if routine use of transthoracic echocardiography (TTE) shortly after heart surgery could have a role in postoperative management, we carried out TTE in postoperative patients operated on for CABG or valvular repair. Patients and methods: For a 3 months period, we prospectively enrolled 51 patients for TTE. We performed a TTE using a Hewlett Packard Sonos 1500 and a 2.5 MHz probe. Feasibility, left ventricular kinesis, valve function, intracardiac thrombi, and pericardial effusion were noted for each patient. Patients have been divided into 2 groups : patients with or, without haemodynamic disturbance (HD, mean arterial blood pressure ≤ 80 mmHg). Results: Nine TTE were impossible for bad acoustic images. Feasibility was about 82% (42 TTE/ 51 patients). Two ETT views were easily obtained: the apical 4-chambers (75%) and the subcostal (30%) views. TTE examination induced treatment change in 12 patients for hypovolaemia (ten patients), left ventricular dysfunction (one patient), and systolic anterior motion of mitral valve (one patient). In patients without HD (41 patients) only hypovolaemia was found (three patients) and TTE returned to normal with fluid challenge. In patients with HD (ten patients), one patient returned to the operating room for valvular replacement, one patient was treated with dobutamine for left ventricular dysfunction, seven patients with hypovolaemia recovered with fluid challenge. Conclusion: TTE can guide postoperative management of patients operated on for heart surgery especially in patients with haemodynamic disturbance. Because of its safety and easiness, TTE may be the first-line examination in these patients before any invasive evaluation.

Motion correction for the quantification of mitral regurgitation using the control volume method.

Quantifying mitral regurgitation is difficult because of the complexity of the flow, geometry and motion of the mitral valve. In this paper a MRI compatible phantom was built incorporating a left ventricle and mitral valve motion. Valve motion was obtained using a pneumatic piston. The mitral valve was made regurgitant and the regurgitant volume quantified using a modified control volume method. The modification to the method was the addition of mitral motion correction. This was attained by moving the control volume in unison with the mitral valve and by correcting for this motion in the integration of velocity. This correction was found to be simple, in that it represented the volume swept out by the moving control surface. The measured regurgitant volume was compared to a second MR measurement using a single slice technique, made possible by the tubular construction of the phantom's left atrium. Regression analysis between these two methods produced a regression line of y = 0 + 1.02 x; R = 0.97; standard error of the estimate = 3.47 ml.

Motion correction for the quantification of mitral regurgitation using the control volume method

Quantifying mitral regurgitation is difficult because of the complexity of the flow, geometry and motion of the mitral valve. In this paper a MRI compatible phantom was built incorporating a left ventricle and mitral valve motion. Valve motion was obtained using a pneumatic piston. The mitral valve was made regurgitant and the regurgitant volume quantified using a modified control volume method. The modification to the method was the addition of mitral motion correction. This was attained by moving the control volume in unison with the mitral valve and by correcting for this motion in the integration of velocity. This correction was found to be simple, in that it represented the volume swept out by the moving control surface. The measured regurgitant volume was compared to a second MR measurement using a single slice technique, made possible by the tubular construction of the phantom's left atrium. Regression analysis between these two methods produced a regression line of y = 0 + 1.02 x; R = 0.97; standard error of the estimate = 3.47 ml.

Systolic Anterior Movement of Mitral Valve During Acute Apical Myocardial Infarction: An Unusual Mechanism of Acute Mitral Regurgitation

We describe a singular case of a 75-year-old woman affected by an anterior acute myocardial infarction in the subset of a very recent orthopaedic surgery. She had had severe mitral regurgitation on coronary angiography. A thorough cardiac echocardiographic examination revealed the particular mechanism of mitral incompetence, consisting of a dynamic anterior mitral leaflet displacement caused by a sustained compensatory left ventricle hypercontractility and favored by postsurgical moderate anemia and mild hypertensive hypertrophy. The use of β-blockers and the avoidance of pure vasodilators permitted complete reversal of such mechanisms during the clinical course. (J Am Soc Echocardiogr 1999;12:1117-21.)

Doppler echocardiographic method to determine early and late diastolic filling volume separately. Validation and relationship between filling velocity and volume.

We devised a pulsed Doppler echocardiographic method of separately calculating early diastolic filling volume (EDFV) and late diastolic filling volume during atrial contraction (LDFV) and observed a relationship between diastolic filling volume and velocity in thirty patients with coronary artery disease. By analysing the transmitral flow velocity curve and mitral valve motion, EDFV and LDFV were measured on the basis of the equality of left ventricular inflow and outflow volumes. The Doppler-determined EDFV and LDFV correlated well with those obtained from the left ventricular filling curve produced by left ventriculography. Angiographic EDFV and LDFV were measured from the time (t)-volume (V) curve, using the t-dV/dt curve to define early and late diastolic phases. A good correlation was found between Doppler and angiographic EDFV (y = -3.0 + 1.0 x, r = 0.98, p = 0.0001, n = 20), Doppler and angiographic LDFV (y = 1.6 + 1.0 x, r = 0.86, p = 0.0001), and also between Doppler and angiographic EDFV/LDFV (y = 0.05 + 0.9 x, r = 0.93, p = 0.0001). EDFV and the peak early diastolic filling velocity were significantly correlated (E velocity; y = 25 + 0.51 x, r = 0.48, p = 0.0068), while LDFV and the peak late diastolic filling velocity during atrial contraction (A velocity) were not. Our results validate the method of calculating EDFV and LDFV separately and suggest that early diastole in the left ventricle has flow volume dependency, but that the late diastole filling velocity during atrial contraction may be regulated by other factors such as increased left atrial contraction.

Marcapasos bicameral en la miocardiopatía hipertrófica obstructiva: variación del gradiente con ecocardiografía de estrés

Permanent cardiac pacing with a dual chamber pacemaker has become a valid alternative in treatment of patients with obstructive hypertrophic cardiomyopathy and refractory symptoms to pharmacological treatment, with a significant decrease of left ventricular outflow tract gradient. To assess any modification of the gradient with dobutamine stress echocardiography. We study 10 patients with obstructive hypertrophic cardiomyopathy and angina and/or dyspnea refractory to customary pharmacological treatment. A dual chamber pacemaker had been implanted 3-6 months previously. A dobutamine stress echocardiography was performed, beginning with a 10 microgram/kg/min infusion, with increases of 10 micrograms each 3 minutes until a maximum of 40. Modification of subaortic gradient, severity of systolic anterior motion of mitral valve (SAM, degree 0-3/3) and severity of mitral regurgitation (degree 0-4/4) were assessed. Subaortic gradient decreased in all patients after pacemaker implantation (90 +/- 15 vs 20 +/- 10 mmHg; p < 0.001). With stress echocardiography the gradient increased in all patients (20 +/- 10 to 101 +/- 13 mmHg; p < 0.001). After implant there were only two patients with a +1 SAM, while during stress echocardiography SAM developed in all patients in +2 or +3 degree. Three patients had +1 mitral regurgitation after pacemaker implantation but during stress echocardiography 2-4/4 mitral regurgitation developed in all patients. Permanent dual chamber pacing decreased left ventricular outflow tract gradient in patients with obstructive hypertrophic cardiomyopathy, but during dobutamine stress echocardiography obstruction echocardiographic signs appeared.