Interobserver Variation in Echocardiographic Measurements and Grading of Tricuspid Regurgitation Based on a Novel Web-Based Assessment Environment.

Objectives: The primary aim of this study was to assess interobserver variability in grading tricuspid regurgitation (TR) severity. The authors' secondary goals were to delineate which transesophageal echocardiographic (TEE) parameters best correlate with severity and how consistent the participants were at grading severity.

Design: This was a prospective cohort study of how clinicians evaluated previously acquired TEE images and videos.

A Tale of Two Valves: Bioprosthetic Aortic Valve Obstruction in Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome.

Patients with systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APLAS) are at risk for cardiac manifestations, specifically valvular heart disease requiring valve replacement. Bioprosthetic valve endocarditis is an important cause of valve failure, and it is important to keep a wide differential, especially in patients with preexisting SLE and APLAS. In this E-challenge, 2 cases of bioprosthetic aortic valve endocarditis are presented; 1 case describes infective bacterial endocarditis on an aortic prosthesis and the second describes a patient with SLE and APLAS who developed bioprosthetic valve obstruction secondary to vegetations, consistent with nonbacterial endocarditis and thrombus.

Inverted Aortic Prosthesis in the Mitral Position: Is Upside Down Always the Right Side Up?

Evaluation of prosthetic valve function is a challenging task. The clinician has to employ multiple parameters to quantify dysfunction (if present), the results of which can be mutually discrepant. This results from heterogeneity in the design of the valves themselves, implantation techniques, and both intra- and interpatient hemodynamic variability.

Three-dimensional versus two-dimensional echocardiographic assessment of functional mitral regurgitation proximal isovelocity surface area.

Background: The geometric shape of the mitral regurgitation (MR) proximal isovelocity surface area (PISA) is conventionally assumed to be a hemisphere (HS). However, in functional MR, PISA is frequently neither an HS nor a hemiellipse (HE) but is often asymmetric and crescent shaped. We used 3-dimensional transesophageal echocardiographic (3D TEE), full-volume data sets to directly measure the PISA and subsequently compared calculated values of effective regurgitant orifice area (EROA) with conventional 2D TEE techniques.

Complete regression of Barrett's esophagus after Roux-en-Y gastric bypass.

Regression of Barrett's esophagus may occur after effective anti-reflux surgery. Roux-en-Y gastric bypass (RYGBP) is an effective operation to treat morbid obesity. In addition, it provides complete relief of gastroesophageal reflux disease (GERD).