Discrimination between fibroelastic deficiency and Barlow disease using parameters of mitral annulus derived from real-time three-dimensional echocardiography.

BACKGROUND: Discrimination between fibroelastic deficiency (FED) and Barlow disease (BD) is crucial for decision making in mitral valve surgery as BD is a more complex lesion demanding high surgical skill and experience. In our study we focused on the differentiation of FED from BD using three-dimensional (3D) echocardiographic parameters of the mitral annulus assessed by the mitral valve quantification (MVQ) program. METHODS: We examined 90 patients (30 women) with FED and BD aged 37-76 years. The following parameters of the mitral annulus were assessed using the MVQ program: bicommissural and anteroposterior diameter of the mitral annulus, 3D annulus circumference, minimal surface spanning the annulus, and mitral annulus height. The study group was subdivided into 2 subgroups according to the intraoperative findings: the first subgroup comprised 60 individuals (19 women) with FED and the second subgroup comprised 30 patients (11 women) with BD. The discrimination between patients with BD and FED was carried out by univariate as well as multivariate statistical methods. RESULTS: BD and FED patients differed highly significantly in all parameters of the mitral annulus (t test), values of all parameters in BD being higher. In the classification tree modeling, the diagnoses were completely separated by a single parameter-mitral annulus height-with a cutoff value of 6.55 mm. This value and higher stands for BD. Multivariate analysis treating all the variables showed similar results, so the use of a single indicator variable is preferable. CONCLUSION: The only parameter-mitral annulus height-can be used for discrimination between Barlow disease and fibroelastic deficiency.

RT 3D TEE: Characteristics of Mitral Valve in Ischemic Mitral Regurgitation Evaluated by MVQ Program.

AIM: To assess the changes of mitral valve (MV) in ischemic mitral regurgitation (IMR) using Mitral Valve Quantification (MVQ) program. METHODS: We examined 46 patients (18 women) with IMR aged 45-86 and a control group of 33 healthy individuals (14 women) aged 18-88. Following parameters were assessed: Area of minimal surface spanning annulus (A3), annulus height (h), tenting height (Th), exposed area of anterior (AL), posterior (PL) and both leaflets (BL), ejection fraction of the left ventricle (LV EF), regurgitation volume (RV) and BL/A3, AL/A3, PL/A3 ratios. The normal range of BL/A3 ratio was defined as the average ± 2SD of control group. The study group was separated into subgroup 1 with BL/A3 ratio within normal values and subgroup 2 with pathological BL/A3 ratio. Corresponding parameters of IMR group were compared to the controls and both subgroups were compared to each other using Student t-test. RESULTS: In IMR group, as compared to the controls, A3, AL, PL, BL as well as BL/A3, AL/A3, PL/A3 ratios and Th were significantly increased, conversely, h and LV EF was significantly decreased. In the subgroup 2 as compared to the subgroup 1 there was significant increase of Th, BL, AL and PL, while EF LV was significantly decreased. There was no significant difference between these subgroups in A3, h and RV. CONCLUSION: In ischemic MV remodeling two stages were identified without relation to the severity of IMR. The first stage was mainly influenced by the LV dilatation while LV remodeling was more important in the second stage.

RT-3D TEE: characteristics of mitral annulus using mitral valve quantification (MVQ) program.

AIM: To evaluate the mitral annulus characteristics in significant mitral regurgitant lesions using mitral valve quantification (MVQ) program. METHODS: We examined 117 patients (39 women), aged 18-86. Patients were separated into four subgroups: 35 patients with ischemic mitral regurgitation, 42 patients with isolated prolapse of the mitral valve, 12 patients with Barlow disease, and 28 healthy controls. Mitral annulus was examined in end-systole. The following parameters were assessed: anteroposterior and intercommissural diameter, perimeter of annulus, area of minimal surface spanning annulus and height of the mitral annulus. A new parameter--mitral annulus height index (height/circumference × 100) was introduced. Values of these parameters in subgroups with mitral pathology were compared with corresponding parameters of control group using Student t-test. RESULTS: In subgroups with mitral pathology all parameters except mitral annulus height and mitral annulus height index were significantly higher than those in the control group. Mitral annulus height was significantly higher in Barlow disease, significantly lower in mitral prolapse group and comparable to normal controls in the ischemic regurgitation group. Mitral annulus height index was significantly higher in Barlow disease and significantly lower in patients with prolapse and ischemic regurgitation. CONCLUSIONS: Barlow disease is characterized by dilation and vertical deformation of the mitral annulus (annulus height and height index increase). Prolapse of the mitral valve and ischemic regurgitation of mitral annulus involve dilation and flattening of the annulus (annulus height decreases in prolapse group significantly, in ischemic regurgitation nonsignificantly, while annulus height index decreases significantly in both subgroups).

What is a "normal" right ventricle?

AIMS: The aim of this project was to define normal values of right ventricular (RV) volumes and ejection fraction (EF) in healthy population using 2D echocardiography. METHODS AND RESULTS: The "patient" group comprised 91 healthy volunteers aged 17-62 years. RV volumetry was based on ellipsoidal shell model method. Left ventricular (LV) volumes were assessed by Teichholz formula. All volumes were indexed per m(2) of BSA and the rate distribution of measured and calculated values were evaluated. The normal range of individual parameters was expressed as mean value+/-2 standard deviations (delta). A pair test was used to compare corresponding results of the RV and LV measurements. The regression analysis was used to test the relationship between LV and RV volumes and age. Indexed enddiastolic and endsystolic RV volumes were 79.1+/-29.9ml and 32.6+/-19.7ml, respectively, EF being 50+/-9.7% in men and 58+/-13.6% in women. No correlation with patient's age was observed. CONCLUSION: Enddiastolic and endsystolic volumes of RV were significantly higher than those of LV. EF of RV was lower as compare to LV. Right ventricular EF in men was lower than that in women. There was no correlation between EF and patient's age.

Echo-guided endomyocardial biopsy in heart transplant recipients.

After heart transplantation the effect of immunosuppression is monitored by histopathology of endomyocardial biopsy (EMB). EMB is usually carried out under X-ray guidance. Between January 1998 and March 2003, 1,262 biopsies were collected under echo-guidance in 156 patients. The biopsy access was gained through the internal jugular vein, by the standard catheterization technique. The average time of the procedure was 17 min. Four or five specimens were obtained from each patient, with a success rate of 96%. Complications involved two episodes of partial pneumothorax in one patient, atrial flutter in another and ventricular fibrillation in three patients. Conversion from echo to X-ray guidance was indicated in 11 patients. No case of significant tricuspid regurgitation related to the EMB procedure was recorded. The echo-guided endomyocardial biopsy appears to be a prospective alternative to the conventional approach under X-ray guidance. Its duration is comparable, it eliminates X-ray exposure, enables continuous echocardiographic monitoring and can be performed at the bedside.