Long-term mortality associated with left ventricular dysfunction in mitral regurgitation due to flail leaflets: a multicenter analysis.

Background: Ejection fraction (EF) as a marker of left ventricular (LV) dysfunction and the appropriate thresholds for diagnosing severe or mild/moderate LV dysfunction in mitral regurgitation are doubted and poorly followed in clinical practice. We aimed at assessing the role of EF in a large registry of organic mitral regurgitation to objectively establish thresholds for various degrees of LV dysfunction and to analyze whether mitral surgery remains beneficial in those subsets of patients.

Methods And Results: We investigated the relation between EF and mortality in 1875 patients with mitral regurgitation due to flail leaflets in sinus rhythm (65±13 years; median EF, 66% [60%-71%]) enrolled in the Mitral Regurgitation International Database (MIDA) registry.

Improved Shear Wave Motion Detection Using Pulse-Inversion Harmonic Imaging With a Phased Array Transducer.

Ultrasound tissue harmonic imaging is widely used to improve ultrasound B-mode imaging quality thanks to its effectiveness in suppressing imaging artifacts associated with ultrasound reverberation, phase aberration, and clutter noise. In ultrasound shear wave elastography (SWE), because the shear wave motion signal is extracted from the ultrasound signal, these noise sources can significantly deteriorate the shear wave motion tracking process and consequently result in noisy and biased shear wave motion detection. This situation is exacerbated in in vivo SWE applications such as heart, liver, and kidney.

Real-time 3-dimensional dynamics of functional mitral regurgitation: a prospective quantitative and mechanistic study.

Background: Three-dimensional transthoracic echocardiography (3D-TTE) with dedicated software permits quantification of mitral annulus dynamics and papillary muscle motion throughout the cardiac cycle.

Methods And Results: Mitral apparatus 3D-TTE was acquired in controls (n=42), patients with left ventricle dysfunction and functional mitral regurgitation (LVD-FMR; n=43) or without FMR (LVD-noMR, n=35). Annulus in both normal and LVD-noMR subjects displayed saddle shape accentuation in early-systole (ratio of height to intercommissural diameter, 10.

Transvenous, antegrade Melody valve-in-valve implantation for bioprosthetic mitral and tricuspid valve dysfunction: a case series in children and adults.

Objectives: The purpose of this study was to report the results of percutaneous valve-in-valve therapy using the Melody valve (Medtronic, Minneapolis, Minnesota) for patients with degenerated mitral and tricuspid bioprosthetic valves.

Background: Open surgery for replacement of degenerated bioprosthetic valves is associated with morbidity and mortality.

Methods: Nineteen patients (median age 65 years, range 10 to 88 years; 7 males) with degenerated mitral (n = 9) or tricuspid (n = 10) bioprosthetic valves underwent transvenous valve-in-valve implantation of the Melody valve.

Robot-assisted repair of tricuspid leaflet prolapse using standard valvuloplasty techniques.

While minimally invasive approaches are used routinely to correct severe mitral regurgitation due to leaflet prolapse, isolated tricuspid valve prolapse is less frequent and usually addressed via sternotomy. A 34-year-old female presented with exertional dyspnea and severe tricuspid regurgitation due to an unsupported anterior leaflet causing prolapse, a tethered septal leaflet, and dilated annulus. Herein, the technique is described of a robot-assisted tricuspid valve repair using established open valvuloplasty principles.

Left atrial dissection after mitral valve replacement can mimic periprosthetic regurgitation.

Left atrial dissection is defined as a gap from the mitral or tricuspid annular area into the interatrial septum. It is most commonly occurs as a complication of mitral valve surgery. Herein, a patient is described who developed a left atrial dissection subsequent to multiple mitral valve procedures.

Accuracy of echocardiographic assessment of pulmonary hypertension severity and right ventricular dysfunction in patients with chronic thromboembolic pulmonary hypertension.

Aim: Chronic thromboembolic pulmonary hypertension (CTEPH) results from chronic thrombotic occlusion of the pulmonary arterial circulation and may be potentially cured by pulmonary thromboendarterectomy. Echocardiography is the most practical modality for the assessment of right ventricular function and right heart pressures before and after surgery. However, there is scant data on how these estimates compare with the "gold standards" of invasive right heart catheterization and CT and MR scanning.

Comparison of semiquantitative and quantitative assessment of severity of aortic regurgitation: clinical implications.

Background: Recent studies have emphasized the importance of quantitative assessment of the degree of aortic regurgitation (AR). However, semiquantitative methods have remained mainly used despite their unclear diagnostic value. The aim of this study was to define the sensitivity and specificity of semiquantitative methods compared with the proximal isovelocity surface area method as a reference for the diagnostic of severe AR.

Contribution of ventricular diastolic dysfunction to pulmonary hypertension complicating chronic systolic heart failure.

Objectives: The aim of the study is to clarify the clinical role of Doppler-echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) as determinants of pulmonary hypertension in patients experiencing left ventricular systolic dysfunction (LVSD) with and without the presence of functional mitral valve regurgitation (FMR).

Background: Pulmonary hypertension (pulmonary venous or mixed pulmonary venous-arterial hypertension) complicating LVSD is associated with poor outcomes beyond that of LVSD alone. The view of the contribution of LVDD as a determinant of pulmonary hypertension is controversial and not well defined as a tool in clinical practice.

Safety of same-day coronary angiography in patients undergoing elective aortic valve replacement.

Background: Coronary artery imaging is required for most adult patients undergoing aortic valve replacement (AVR).

Methods: Between January 1, 2000, and December 31, 2007, 1413 patients underwent elective AVR at Mayo Clinic. Two propensity-matched groups at low risk for acute kidney injury were created: 321 patients with coronary angiography on the same day as AVR (same day) and 321 patients with coronary angiography more than 1 day before AVR (non-same day).

Pathophysiology of tricuspid regurgitation: quantitative Doppler echocardiographic assessment of respiratory dependence.

Background: Respiratory dependence of tricuspid regurgitation (TR), a long-held concept suggested by murmur variation, remains unproven and of unclear mechanisms.

Methods And Results: In 41 patients with mild or greater TR (median age, 67 years), we performed triple Doppler echocardiographic quantification (TR severity, right ventricular, and right atrial quantification) with simultaneous respirometer recording of respiratory phases. Expiration to inspiration changes (median) affected TR peak velocity (-40 cm/s; 25th to 75th percentile, -60 to -30 cm/s), duration (-12 milliseconds; 25th to 75th percentile, -45 to 2 milliseconds), and time-velocity integral (-17 cm; 25th to 75th percentile, -23.

Acrocyanosis from phenazopyridine-induced sulfhemoglobinemia mistaken for Raynaud phenomenon.

Rheumatologists are often asked to evaluate patients with Raynaud phenomenon. Occasionally, an alternate explanation is revealed such as acrocyanosis. Methemoglobinemia and sulfhemoglobinemia are rare causes of cyanosis that can be medication-induced.

Endothelial progenitor cells restore renal function in chronic experimental renovascular disease.

Background: Endothelial progenitor cells (EPCs) promote neovascularization and endothelial repair. Renal artery stenosis (RAS) may impair renal function by inducing intrarenal microvascular injury and remodeling. We investigated whether replenishment with EPCs would protect the renal microcirculation in chronic experimental renovascular disease.

Magnetically targeted endothelial cell localization in stented vessels.

Objectives: A novel method to magnetically localize endothelial cells at the site of a stented vessel wall was developed. The application of this strategy in a large animal model is described.

Background: Local delivery of blood-derived endothelial cells has been shown to facilitate vascular healing in animal models.

Magnetic forces enable rapid endothelialization of synthetic vascular grafts.

Background: Synthetic vascular grafts cannot be used in small vessels because of graft failure caused by thrombosis and neointima formation. Rapid endothelialization may overcome this limitation. We hypothesized that a magnetic graft would be able to capture and retain endothelial cells labeled with paramagnetic particles.

Gene transfer for ischemic cardiovascular disease: is this the end of the beginning or the beginning of the end?

The past decade has represented a period of high expectations for cardiovascular gene transfer on the basis of the findings from preclinical experiments and promising early clinical results. Yet, randomized studies have not demonstrated similar results. Do these poor results mean that gene transfer for ischemic cardiovascular disease has failed in its promise, or do they merely signify the inherent challenges of a pioneering field? In this paper we briefly review the clinical experience of gene transfer for ischemic cardiovascular disease and propose future directions for research.

Optimization of ultrasound-mediated gene transfer: comparison of contrast agents and ultrasound modalities.

Aims: Ultrasound (US)-enhanced gene transfer for cardiovascular disease is an emerging technique with translational relevance. Prior to pre-clinical applications, optimization of gene transfer using various US contrast agents and parameters is required. In order to do so, two clinically relevant contrast agents (Optison and PESDA), and two US modalities (dedicated continuous wave system and diagnostic scanner) were tested in vitro and in vivo.