Comparison between 2D and 3D Echocardiography in Efficient Detection of Commissural Calcification in Rheumatic Mitral Stenosis.

Rheumatic heart disease causes a substantial number of morbidity and mortality in Southeast Asia. In Bangladesh prevalence of Rheumatic Fever and Rheumatic heart disease is still high, 0.6 and 0.3 per thousand populations, respectively. Mitral valve mostly involved in the form of mitral stenosis in the rheumatic process. Treatment selections and its success largely depend upon the severity of disease especially the extent and distribution of calcification. Echocardiography has got the key role in determining the pattern, extent and severity of mitral stenosis. Two dimensional and Doppler echocardiography are conventionally used. With the increasing availability of 3D echocardiography, better cardiac imaging is possible now. The heart being a complex three-dimensional structure, the 3D evaluation would definitely offer better imaging for accurate assessment of the severity of mitral stenosis, especially details of commissural involvements. Many scoring systems are available for the assessment of the severity of rheumatic Mintral Stenosis (MS), mostly 2DE based; among them, Wilkins is mostly practiced. This cross-sectional observational study was conducted in University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from May 2012 to October 2012. Data were collected from 50 subjects who underwent transthoracic 2D and 3D Echocardiography for the assessment of rheumatic mitral stenosis especially detection of calcification also it's severity, extent, and distribution, furthermore the presence of commissural calcification. Precise measurement of Mitral valvular area is essential in the assessment of severity, which is found similar by both 2DE (0.98±0.24cm²) and 3DE (0.92±0.23cm²). But in identifying calcification and its extent especially commissural involvement is better detected by 3DE (p=0.002). This has paramount importance in therapeutic decision making of chronic rheumatic MS. To make a well-organized management plan and also for the confident prediction of complications, three-dimensional echocardiography has promising prospects in detecting commissural calcification and should be considered as an essential adjuvant to the conventional two-dimensional echocardiography.

3D Echocardiography Is More Efficient In Detail Assessment of Calcification in Chronic Rheumatic Mitral Stenosis.

Rheumatic heart disease is in the declining phase, with the increase of urbanization and increment of availability of healthcare facility. However still it causes a substantial number of morbidity and mortality in South Asia. The prevalence of Rheumatic Fever and Rheumatic heart disease in Bangladesh is still high, 0.6 and 0.3 per thousand populations respectively. In the rheumatic process mitral is the frequently involved valve, mostly in the form of mitral stenosis. Choice of a treatment modality and its success largely depend on the accurate assessment of severity of disease especially the extent and distribution of calcification. Echocardiography has a key role in the determination of the severity of mitral stenosis as well as assessment of details calcification. Conventionally 2 dimensional and Doppler echocardiography is used. Now a days, 3D echocardiography offers better cardiac imaging for detail evaluation. The heart being a complex structure, the 3D evaluation would certainly offer better imaging for the accurate assessment of the mitral stenosis, especially details of presence & distribution calcification. This cross-sectional observational study was done from May 2012 to October 2012 in University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Data were collected with informed written consent, from 50 subjects who underwent transthoracic 2D and 3D Echocardiography for the assessment of rheumatic mitral valve with special emphasis on accurate assessment of severity, extent and distribution of calcification. Precise measurement of MV area is essential in the assessment of severity, which is found comparable by both 2DE (0.98±0.24cm²) and 3DE (0.92±0.23cm²). But in identifying calcification and accurate assessment of severity, more importantly commissural involvement is better detected by 3DE (p=0.002). This has extreme importance in therapeutic decision making in the treatment of chronic rheumatic MS. So, to formulate an efficient management plan, three-dimensional echocardiography has promising prospects in detecting severity & extent of rheumatic calcification.

An Echocardiographic Study of the Right Ventricular Diastolic Function in Systemic Hypertension and Its Relation with the Left Ventricular Homologous Changes.

Diastolic dysfunction is a major predictor of mortality and morbidity in hypertensive patients. Not only LV, the RV is also expected to be affected in this overall procedure. To observe the Echocardiographic changes of diastolic function of the RV in systemic HTN and their relation with similar parameters of the LV was the objective. TDI was used in association with standard Doppler modality. In this cross-sectional study, 50 hypertensive subjects were studied who were devoid of any other conditions that may influence the diastolic function of the RV from 01 May 2012 to 31 October 2012 at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. In addition to 2D and M-mode evaluation, standard Doppler and pulsed tissue Doppler assessment of both ventricles were performed. Measurements were obtained for diastolic as well as systolic function of both ventricles. The RV diastolic parameters were impaired in both standard Doppler and tissue Doppler analysis in association with LV parameters. Systolic functions (LV FS and RV TAPSE) were preserved. Doppler-derived tricuspid peak E and E/A were related negatively to septal thickness, but tissue Doppler-derived RV Em/Am showed negative association with both RVAWT and septal thickness. RV RTm was related positively to RVAWT. The RV diastolic parameters showed positive relation with the LV similar parameters both in standard Doppler (E peak velocity, E/A ratio and EDT) and tissue Doppler (Em peak velocity, Em/Am and PCTm) assessment. So, in systemic HTN, LV diastolic dysfunction is also associated with diastolic disturbances of the RV. Pulsed tissue Doppler is a useful tool to detect the changes. RV diastolic parameters correlate well with those of the LV. Prolongation of the active relaxation (RTm) phase of RV is due to its increased wall thickness.