[Comparison of continuous wave Doppler and heart catheterization in the determination of the mean transvalvular gradient in mitral stenosis. A simultaneous beat to beat analysis]. / Confronto tra Doppler ad onda continua e cateterismo cardiaco nella determinazione del gradiente medio transvalvolare nella stenosi mitralica. Analisi contemporanea battito su battito.

Continuous wave Doppler echocardiography (CWD) is widely used in the assessment of pressure gradients in patients with valvular heart disease, utilizing the simplified Bernoulli equation. However determination of non-simultaneous mean pressure gradient (MG) in mitral stenosis (MS) from CWD recordings has often been described as being unsatisfactory. Therefore, the purpose of this study was to compare the estimates of trans-mitral MG derived from CWD with gradients measured simultaneously at cardiac catheterization (beat to beat analysis). We studied 3 patients (pts) with MS (1 man and 2 women, aged 55, 55 and 62 years respectively); one patient (pt) was in sinus rhythm and 2 were in atrial fibrillation. In each pt the trans-mitral flow velocity curve was obtained simultaneously with trans-mitral gradient measured directly at cardiac catheterization (cath). In this way it was possible to obtain a beat to beat correlation between Doppler and cath in 181 beats taken from the 3 pts. These beats were selected from a total number of 321 beats because of their excellent quality for analysis (74 beats were obtained from the first pt, 38 from the second pt and 69 from the third pt). Mean diastolic velocity, defined as the mean of maximal velocities throughout diastole, was obtained for each beat by planimetring the envelope of the spectral velocity profile. MG was calculated from mean velocity by applying the simplified Bernoulli equation (delta P = 4V2).(ABSTRACT TRUNCATED AT 250 WORDS)

Prolapse of atrioventricular valve leaflets in the setting of double orifice.

Prolapse of the valve leaflets is reported in 2 cases in the setting of double orifice atrioventricular valve. Diagnosis in the first case, an asymptomatic 8-year-old female, was achieved by echocardiography and consisted in prolapsing leaflets of a double orifice ("bridge type") mitral valve. The second patient, a 24-year-old male, died suddenly. Postmortem examination revealed prolapsing atrioventricular valves, with double orifice ("holy type") of the septal leaflet of the tricuspid valve. There was disruption of the penetrating atrioventricular bundle into multiple fragments with fasciculo-ventricular by-pass fibers.

[Normally functioning mitral prosthesis: visualization and characterization of the trans-valvular flow using color-coded Doppler]. / Protesi mitraliche normofunzionanti: visualizzazione e caratterizzazione del flusso transvalvolare mediante Doppler a codice di colori.

Color flow imaging (CFI) allows real time visualization of intracardiac and transvalvular blood flow, superimposed on two-dimensional echocardiographic images. Therefore it can be useful in the identification and characterization of spatial configuration of jets through valve prosthesis. The aim of this study was to define the transvalvular flow pattern of jet in 54 patients (pts) with mitral valve prosthesis which were functioning well. Thirty-six of these pts were females and 18 males; their ages ranged from 40 to 73 years, mean age: 58. Prosthetic mitral inflow was evaluated utilizing the parasternal long axis, apical long axis and apical 4 chamber views; in addition ("off axis") intermediate sections were used when needed. Adequate CFI for detailed frame by frame analysis was obtained in 50 pts (92%). Fourteen pts had biological prosthesis (9 Hancock, 4 Carpentier-Edwards, 1 Ionescu-Shiley). Thirty-six pts had mechanical prosthesis: 13 Björk-Shiley, 8 Starr-Edwards, 9 Sorin, 5 Lillehey-Kaster, 1 Smeloff-Cutter. Variable jet configurations were identified, which were related to the type of prosthetic valve. Bioprosthetic valve characteristically had a wide, homogeneous transvalvular flow, directed towards the interventricular septum. Björk-Shiley prosthesis presented typically a jet with two components. Trans-prosthetic flow was dependent on the spatial position of the prosthesis and on the orientation of the tilting disc. Thus, the main jet, coming from the major orifice, could be directed towards the apex, flowing parallel to the left ventricular postero-lateral wall while the jet coming from the minor orifice was thin and directed towards the interventricular septum.(ABSTRACT TRUNCATED AT 250 WORDS)

[Visualization and characterization of the transvalvular jet in mitral stenosis using color-coded Doppler]. / Visualizzazione e caratterizzazione del jet transvalvolare nella stenosi mitralica mediante Doppler a codice di colori.

Two-dimensional Color Doppler flow imaging is a new non-invasive technique which allows real-time visualization of intracardiac blood flow and provides informations about its direction, velocity and presence of turbulence. As a consequence the identification of jets configuration across stenotic valve orifices is now possible by Color flow imaging. This non invasive tool may be particularly helpful in patients with rheumatic mitral valve disease in whom distortion of mitral valve apparatus is often present, determining a non uniform and variable appearance of jets. Therefore the aim of this study was to describe our initial experience with color flow imaging in the visualization of transtenotic mitral jets in order to characterize different spatial configurations. We studied 45 patients with clinical and echocardiographic diagnosis of mitral stenosis. The mean age of these patients was 59 years (range from 36 to 72 years), 34 were women and 11 men. The different types of transmitral jets were characterized by real time and frame by frame analysis. The following characteristics of transmitral jets have been evaluated: A) appearance ("Candle flame", "Mushroom", "Scimitar"-shaped, "Double-jets"); B) direction (centrally directed or eccentric); C) extension into the left ventricle (basal, mid-ventricular and apical); D) persistence of turbulent flow during diastole (early-, mid-, late diastole). Mitral valve area was calculated from the velocity tracings obtained by continuous wave Doppler, applying the pressure half-time method. Color flow imaging of good quality for analysis was obtained in 41 of 45 patients (91%). In the other 4 patients the quality of color flow images was suboptimal however the direction and configuration of the jets could still be visualised.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value and limitations of 2-dimensional echocardiography in the identification of arrhythmogenic right ventricular dysplasia]. / Valore e limiti dell'ecocardiografia bidimensionale nell'identificazione della "displasia ventricolare destra aritmogena".

The aim of this study was to evaluate the value and limitations of Cross-sectional Echocardiography (CSE) in the diagnosis of Arrhythmogenic right ventricular dysplasia (ARVD). Diagnosis was based on accepted clinical, electrocardiographic, electrophysiologic and angiographic criteria. CSE criteria for the diagnosis are segmental right ventricular wall motion abnormalities of unknown cause, usually associated with localized or diffuse dilatation of right ventricular (RV) chamber and with the presence of localized anomalies consisting of sacculation or bulging of RV wall. Comparison of CSE and RV angiographic findings was performed in 8 patients with ARVD (6 men and 2 women, aged 10 to 37 years, mean 28 years). CSE and angiography compared closely when diffuse RV enlargement and wall motion abnormalities were identified by both techniques. Bulging and sacculation of the RV wall at CSE predicted the presence of similar lesions at angiography, but agreement for specific location was poor and, in addition, CSE showed low sensitivity in their detection. The inherent different information provided by the two methods added to the subjectivity of the qualitative analysis probably accounts for the inconsistencies. Therefore in patients with diagnosed ARVD RV enlargement, otherwise unexplained, associated with wall motion abnormalities and localized anomalies at CSE strongly supports the diagnosis and avoids the need for angiography. By other hand, in patients with high clinical suspicion of ARVD a negative CSE study can not exclude the diagnosis and angiography should be indicated.