[Association between echocardiography derived right ventricular function parameters with cardiac magnetic resonance derived right ventricular ejection fraction and 6-minute walk distance in pulmonary hypertension patients].

OBJECTIVE: To explore the association between transthoracic echocardiography (TTE) derived right ventricular (RV) function parameters with cardiovascular magnetic resonance imaging (CMR) derived RV ejection fraction (RVEF) and 6 minute walk distance (6MWD) in pulmonary hypertension (PH) patients. METHODS: A total of 40 PH patients (37 pulmonary artery hypertension (PAH) and 3 chronic thromboembolic pulmonary hypertension (CTEPH)) hospitalized in our department between March 2011 and March 2013 were enrolled in this study. PH diagnosis was established by right heart catheterization and TTE, CMR and 6MWT were performed within one week post TTE examination. TTE parameters included: tricuspid annular peak systolic excursion (TAPSE), isovolumic contraction acceleration (IVA), peak systolic velocity (S') at the lateral tricuspid annulus derived from tissue Doppler imaging, RV myocardial performance index (MPI) and RV fractional area change (FAC). RVEF was obtained from CMR. RESULTS: S' (r = 0.69, P < 0.001), TAPSE (r = 0.65, P < 0.001), FAC (r = 0.62, P < 0.001), IVA (r = 0.43, P = 0.006), MPI (r = -0.38, P < 0.05) correlated significantly with RVEF obtained from CMR. The best parameter to detect RVEF ≤ 20% was S' < 8.79 cm/s (area under the ROC curve was 0.92 (95% CI: 0.72-0.84), sensitivity 0.91, and specificity 0.80) . No correlation was found between TTE parameters and 6MWD and between RVEF obtained from CMR and 6MWD. CONCLUSION: S', derived from tissue Doppler imaging correlates best with RVEF obtained from CMR and may facilitate simple and quantitative assessment of RV function. The best parameter to detect RVEF ≤ 20% is S' < 8.79 cm/s.

A case report of percutaneous successful closure of multiple atrial septal defect.

A 50-year-old male patient with a secundum-type atrial septal defect (ASD) suffering from respiratory distress for 7 days was referred to our hospital. Transthoracic echocardiography demonstrated the defects of 9 mm and 4 mm in the middle atrial septum in the parasternal four-chamber view. However, we found not 2, but 6 atrial defects by using real time 3-dimensional transesophageal echocardiography. Open heart surgery was not indicated, because his pulmonary function was poor. After fully informed consent, we decided to treat ASD with Amplatzer septal occluders.

Successful mitral valve repair for severe mitral regurgitation caused by isolated cleft of the posterior leaflet.

Cleft of the post mitral valve leaflet is extremely rare congenital cause of mitral regurgitation. Only six cases have being reported in literature. We report the case of a 34-year-old man with isolated cleft in the posterior mitral valve leaflet causing severe mitral regurgitation. The patient had been experiencing limitation of his exercise capacity becoming more easily tried. Therefore, he was referred for mitral valve surgery. The posterior mitral valve leaflet was successfully repaired using quadrangular resection technique. Intra-operative transesophageal echocardiography showed trivial mitral regurgitation after repair. Satisfactory clinical results were achieved at 2 years post-operatively.