Percutaneous transvenous mitral commissurotomy: significance of echocardiographic assessment in prediction of immediate result

The current study aims to identify demographic, clinical characteristics, echocardiographic and/or mitral valve morphological parameters that may predict the successful result of percutaneous transvenous mitral commissurotomy [PTMC]. The medical records of 196 patients [48 males, mean age: 42.7 +/- 11.5 years] who underwent PTMC were reviewed. Prior to PTMC, a combination of transthoracic and transesophageal echocardiography were used to investigate substantial mitral valve morphological subcomponents [thickening, mobility, calcification, and subvalvular thickness] and suitability for PTMC. The second transthoracic echocardiographic assessment was performed within six weeks after PTMC. Patients were divided into two categories of successful or unsuccessful according to PTMC results. Successful PTMC was defined as: final mitral valve area [MVA] >/= 1.5 cm[2] without a post-procedure mitral regurgitation [MR] grade >2. The significant predictor of the result was identified by comparing demographic data, initial echocardiographic assessment and mitral valve morphological scores within both groups. The mean MVA increased from 1.0 +/- 0.2 cm[2] to 1.7 +/- 0.4 cm[2], and mitral valve mean gradient [MVMG] decreased from 11.5 +/- 5.2 to 5.2 +/- 3.3 mmHg [P < 0.001 for both]. Successful results were obtained in 139 [70.9%] patients compared to unsuccessful results in 57 [29.1%]. Unsuccessful results were due to suboptimal secondary MVA < 1.5 cm[2] in 50 [25.5%] patients and post-procedure MR grade >2 in 7 [3.6%]. Multiple logistic regression analysis indicated that young age, lower size of the left atrium [LA], and smaller degree of mitral valve thickness were the predictors of successful result. Pre-procedure echocardiographic assessment appears to be helpful in predicting PTMC results. Successful PTMC is influenced by the patients' age, LA size, and mitral valve thickness

Late diagnosis of large left ventricular pseudoaneurysm after mitral valve replacement and coronary artery bypass surgery by real-time three-dimensional echocardiography

One of the most serious complications of mitral valve replacement is left ventricular rupture and pseudoaneurysm formation, which is rare but potentially lethal. We herein present a late type of post mitral valve replacement and coronary artery bypass surgery pseudoaneurysm in a 74-year-old female, who was admitted to our hospital with a recent history of exertional dyspnea. She had the above-mentioned operation 10 months before. The diagnosis was made via two-dimensional and real-time three-dimensional transthoracic echocardiography. The prosthetic mitral valve was removed, and the large orifice of the pseudoaneurysm was closed by surgery. At one year's follow-up, the patient was in good condition

Assessment of left ventricular dyssynchrony in heart failure patients regarding underlying etiology and QRS duration

Left ventricular [LV] dyssynchrony is a prevalent feature in heart failure [HF] patients. The current study aimed to evaluate the prevalence of inter and intraventricular dyssynchrony in HF patients with regard to the QRS duration and etiology. The available data on the tissue Doppler imaging [TDI] of 230 patients with refractory HF were analyzed. The patients were divided into three groups according to the QRS duration: QRS duration < 120 ms; 120-150 ms; and >/= 150 ms and the patients were re-categorized into two subgroups depending on the underlying etiology: ischemic cardiomyopathy [ICM] or dilated cardiomyopathy [DCM]. The time-to-peak myocardial sustained systolic velocity [Ts] in six basal and six middle segments of the LV was measured manually using the velocity curves from TDI. LV dyssynchrony was defined as interventricular mechanical delay >/= 40 ms and tissue Doppler velocity all segments delay >/= 105 ms; standard deviation [SD] of all segments >/= 34.4 ms; basal segments delay >/= 78 ms; SD of basal segments >/= 34.5 ms; and opposing wall delay >/= 65 ms. After adjustment for the possible confounders, interventricular dyssynchrony was more prevalent in the patients with QRS duration >/= 150 ms than in those with QRS duration 120-150 ms and < 120 ms. The patients with DCM also had a higher percentage of interventricular dyssynchrony than those with ICM in the wide QRS groups. Turning to the intraventricular dyssynchrony indices, the patients with QRS duration >/= 150 ms and 120-150 ms revealed a significantly greater delay between Ts at the basal and all segments than did those with QRS duration < 120 ms, while etiology did not influence the frequency of these indices in each QRS group. The prevalence of both inter and intraventricular dyssynchrony indices was greater in the patients with wide QRS than in those with narrow QRS duration. The underlying etiology may affect the frequency of interventricular but not intraventricular dyssynchrony indices