Assessment of tricuspid annulus: anatomic and echocardiographic correlation.

Tricuspid regurgitation is associated with a poor outcome and its quantification remains a challenge. Tricuspid annulus dilatation is one of the parameters that influences clinical decision-making. The aim of this study was to compare the use of 2D transoesophageal echocardiography with surgical assessment for the measurement of the tricuspid annulus. Sixty-one cardiac patients (median age 64 years) were included in the study. Echocardiographic tricuspid annulus measurements were obtained from four chamber and transgastric short axis views and compared with the surgical measurements of this valve. The study was approved by the Ethics Committee of our institution. The tricuspid annulus measurements were obtained from the four chamber and the short axis views in 57 and 49 patients, respectively, while surgical measurement was performed in all 61 patients. Bland-Altman analysis of 49 tricuspid annulus-matched dimensions of the short axis view and surgical values showed a mean bias of 0.223 mm/m2, with limits of agreement of -5.86 to 6.31 mm/m2. Echocardiographic measurements of the tricuspid annulus dimension were accurate (90% sensitivity and 90% specificity for a four chamber view cut-off value ≥ 24.5 mm/m2, and 89% sensitivity and 97% specificity for a short axis view cut-off value ≥ 37.6 mm/m2, P < 0.0001; both cases) for detecting directly assessed annular dilatation by the surgeon in the operative field. Echocardiographic values of tricuspid annulus dimension have a good predictive value to detect surgically assessed annular dilatation and may help identify patients who require surgical tricuspid intervention.

Systematic echocardiographic assessment of aortic regurgitation-what should the surgeon know for aortic valve repair?

Aortic valve (AV) repair is the preferred surgical treatment in young patients with aortic regurgitation (AR) and/or proximal aorta aneurysm, as noted in the recent European Society of Cardiology (ESC) guidelines. However, this surgical option is still underused in clinical practice. This emphasizes the need to build a heart team dedicated to AV repair with expert surgeons and echocardiographers. Surgical techniques are now standardized in their approaches to enhance the reproducibility and expansion of AV repair. The objective of this keynote is to also demonstrate the need for a standardized pre-pump intra-operative echocardiography protocol to fulfill surgeon's needs in providing a road map and predicting techniques to be used for an effective and durable repair.

3D transesophageal echocardiography: A new imaging tool for assessment of mitral regurgitation and for guiding percutaneous edge-to-edge mitral valve repair.

Real time three dimensional transesophageal echocardiography (3D TEE) is probably the most powerful and convincing imaging method for understanding the complicated multiform morphology and for evaluating geometry, dynamics and function of degenerative and functional mitral valve (MV) regurgitation. Moreover, color Doppler 3D TEE has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. 3D TEE has been shown to be of enormous value in helping surgeons to perform MV repair. In addition, due to its ability to show a "panoramic" view of the "theater" where the procedure takes place, it has become an indispensable companion of 2D TEE during percutaneous edge-to-edge repair. A novel hybrid imaging modality where echocardiography is merged with fluoroscopy, may in the future further improve guidance of this and other complex percutaneous transcatheter interventions.

Pivotal role of bedside Doppler echocardiography in the assessment of patients with acute heart failure and mitral regurgitation.

Patients presenting with mitral regurgitation and acute heart failure remain a challenge for the clinicians. Bedside echocardiography ascertains the functional or primary nature of mitral regurgitation, thereby allowing to focus therapy on the left ventricle and mitral valve apparatus in patients with functional mitral regurgitation and to hasten mitral valve repair or replacement when acute heart failure results from primary mitral regurgitation. This short article reviews the evaluation by bedside echocardiography to guide management of these patients.

Exposure assessment of French women and their newborn to brominated flame retardants: determination of tri- to deca- polybromodiphenylethers (PBDE) in maternal adipose tissue, serum, breast milk and cord serum.

In the frame of a French monitoring program, tri- to deca- polybromodiphenylethers (PBDE) have been measured in maternal and cord serum, adipose tissue, and breast milk samples, collected from 93 volunteer women during caesarean deliveries. The seven major tri- to heptaBDE (BDE-28, 47, 99, 100, 153, 154, and 183) were detected in adipose tissue and breast milk with cumulated median values of 2.59 and 2.51 ng g(-1) l w. Nine highly brominated octa- to decaBDE (BDE-196, 197, 201, 202, 203, 206, 207, 208 and 209) was performed in the same samples, with cumulated median values of 2.73 and 3.39 ng g(-1) l w in adipose tissue and breast milk, respectively. At this opposite, median levels of octa- to decaBDE in maternal and cord serum appeared significantly higher than the levels of tri- to heptaBDE in the same matrices, i.e. 8.85 and 12.34 versus 0.98 and 0.69 ng g(-1) l w, respectively.

Exposure assessment of French women and their newborns to tetrabromobisphenol-A: occurrence measurements in maternal adipose tissue, serum, breast milk and cord serum.

A French monitoring study was initiated to evaluate the exposure of fetus and newborn to brominated flame retardants (BFR). A previously developed multi-residue analytical method was used for measuring the main classes of BFR (tetrabromobisphenol-A, and tri- to decabomodiphenyl ethers) in various human biological matrices. Analyzed samples (maternal and cord serum, adipose tissue and breast milk) were collected from 93 volunteer women during caesarean deliveries. TBBPA was detected in 44% of the analyzed breast milk samples, at levels varying from 0.06 to 37.34 ng g(-1) lipid weight, but was not detected in adipose tissue. This compound was also detected in 30% of the analyzed serum samples, with similar average values in maternal and cord serum (154 pg g(-1) fresh weight versus 199 pg g(-1) fresh weight, respectively). The interpretation of the collected data permitted the demonstration of (1) a significant exposure to TBBPA both for mothers and fetuses and (2) a possible risk of overexposure of newborns through breastfeeding.

Exposure assessment of fetus and newborn to brominated flame retardants in France: preliminary data.

Brominated flame retardants (BFR) are chemicals extensively used in many manufactured products to reduce the risk of fire, but also environmental pollutants. In order to assess the potential risk linked to these compounds in human, a French monitoring study was initiated to evaluate the exposure of fetus and newborn. A previously described multi-residue analytical method was used, for measuring the main classes of BFR (hexabromocyclododecane, tetrabromobisphenol-A, and tri- to deca-polybromodiphenylethers) in various biological matrices. These analyzed samples (maternal and umbilical serum, adipose tissue and breast milk) were collected on volunteer women during caesarean deliveries. Preliminary results obtained on 26 individuals (mother/newborn pairs) mainly demonstrated the presence of polybromodiphenylethers (PBDE) and tetrabromobisphenol A both in maternal and fetal matrices, and a possible risk of overexposure of newborns through breastfeeding. Contaminations levels were found globally in the ng/g lipid weight range, consistent with other published European data. Exposure results regarding highly brominated PBDE congeners (octa- to deca-BDE) appeared particularly informative and non-commonly reported, these compounds accounting for around 50% of the total PBDE load. Additional data collection and metabolism investigations are now on-going. A more complete statistical analysis related to this BFR exposition study will be provided in a next future.