Role of modern 3D echocardiography in valvular heart disease

Three-dimensional (3D) echocardiography has been conceived as one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an integral clinical tool thanks to the development of high quality real-time transesophageal echocardiography (TEE). In particular, for mitral valve diseases, this new approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the mitral valve and its dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks. In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. For aortic and tricuspid valve diseases, this method may not be quite as valuable as for the mitral valve. However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation. It is now clear that this method, especially with the continued development of real-time 3D TEE technology, will enhance the diagnosis and management of patients with these valvular heart diseases.

Pulmonary function assessment in children and teenagers before and after surgical treatment for rheumatic valve disease

OBJECTIVE: To assess pulmonary function in children and adolescents subjected to correction of rheumatic valve disease in order to quantify changes caused by factors inherent to surgery and rheumatic heart diseaseMETHODS: This was a longitudinal and quantitative intervention study, undertaken at a children's hospital that is a center of excellence for the state of Pernambuco (Instituto Materno Infantil de Pernambuco), between December 2004 and May 2005. Eighteen children suffering from rheumatic fever and indicated for surgery to repair or replace the mitral valve were assessed preoperatively and again on the first and fifth postoperative days. The parameters recorded were minute volume, rapid shallow breathing index, peak expiratory flow, forced vital capacity and inspiratory capacityRESULTS: All patients were aged 8 to 17 years (mean 12.4±2.1), they had a mean body mass index of 16.1±2.2, and were weaned off invasive mechanical ventilation during the first 10 postoperative hours. All parameters had undergone significant deterioration on the first day (statistically significant, p < 0.01), demonstrating gradual improvement up to the last day of assessment, although, with the exception of minute volume which was no longer significantly different from the fourth day onwards (p > 0.01), without returning to baseline levels.CONCLUSION: We observed that the pulmonary dysfunction that results from this type of heart surgery is maintained until at least the fifth postoperative day. It appears that this dysfunction is influenced by the pain and mechanical alterations caused by sternotomy and reduced pulmonary compliance post surgery.

Endocardite marântica no contexto das endocardites / Marantic endocarditis in endocarditis context

A endocardite marântica é um tema que na prática médica atual deve ser cogitado no diagnóstico diferencial das valvopatias cardíacas sem definição etiológica e(ou) cursando com doença sistêmica com complicações evolutivas tromboembólicas

Válvula de Eustaquio que simula un mixoma atrial / Eustachian valve that simulates atrial myxoma

Se presenta un caso de válvula de Eustaquio que simula ecocardiográficamente un mixioma atrial derecho, en un paciente con sospecha clínica de tromboembolismo pulmonar. La válvula de Eustaquio es un remanente embrionario de la porción derecha del seno venoso, cuya función consiste en permitir el paso de sangre oxigenada desde la vena cava inferior, a la circulación sistémica. Su presencia constituye parte del diagnóstico diferencial de otras masas intracavitarias cardíacas, como los mixiomas, trombos, metástasis tumorales, o tumores primarios del corazón. Descriptores: Válvula Eustaquio, mixoma, exocardiografía.

Importancia y fisiopatología de las calcificiones vasculares / Importance and pathophysiology of vascular calcifications

The objective of this study was to examine the importance and the pathophysiology of vascular calcifications. Pathophysiologic mechanisms of vascular calcification are scantly known. Anomalies of mineral metabolisms were classically attributed (with special reference to phosphorus) to the probability of developing the disease. The most important types of cardiovascular calcifications are: atherosclerotic, from the cardiac valves, medial arterial (Monckeberg's arteriosclerosis, arterial sclerosis involving the medial coat), infantile idiopathic arterial calcifications and vascular calciphylaxis. All these considerations are describe and detailed in the article

Hallazgos ecocardiográficos en el síndrome de Sjögren primario / Echocardiographic findings in primary Sjögren's syndrome

El síndrome de Sjögren primario es una enfermedad autoinmune con sustrato inmunopatológico caracterizado por aumento en la actividad de la inmunidad celular y humoral, que determina el depósito de complejos inmunes a nivel multisistémico. Las principales alteraciones morfológicas y funcionales, que se asocian con este síndrome a nivel cardiovascular, sólo se han descrito en casos aislados. En el presente trabajo, se estudiaron mediante ecocardiografía transtorácica las alteraciones cardiovasculares que presentaron 23 pacientes con diagnóstico de síndrome de Sjögren primario. El análisis consistió en relacionar el tiempo de evolución de la enfermedad, el sexo y la edad, con el tipo de alteraciones encontradas, para determinar si existía algún vínculo entre estas variables. Todos los pacientes fueron mujeres, con edad promedio de 58 años (límites de 39 y 76 años), el tiempo de evolución máximo del síndrome de Sjögren fue de 20 años y el menor de 2. Las principales alteraciones observadas se localizaron a nivel valvular y estaban representadas por dos patrones de engrosamiento: 1) el que abarcó toda la extensión de una o más valvas y; 2) el nodular, que se encontró en el vértice o en el borde libre de una o más valvas. Las válvulas alteradas incluyeron a la mitral, aórtica y tricúspide, pero en ninguna de ellas se determinó compromiso funcional significativo. No se logró establecer asociación del tipo de alteración valvular con la edad o el tiempo de evolución del síndrome de Sjögren primario. Se concluye, que la gama de alteraciones morfológicas a nivel valvular tuvieron relación con los factores degenerativos asociados con la edad en varios casos, pero en otros, no se descarta que su desarrollo pudiera estar relacionado con el sustrato inmunopatológico del síndrome de Sjögren primario. Lo anterior debe comprobarse en futuros estudios en donde el tejido afectado pueda ser susceptible de análisis mediante pruebas inmunohistoquímicas

Studies on prosthetic valve function--a transesophageal echocardiographic assessment.

Haemodynamic assessment was done by colour flow mapping and Doppler interrogation by both Transthoracic (TTE) and Transesophageal echocardiography (TEE) in 40 consecutive patients (mean age 36.6 +/- 12.35 years) with prosthetic valves. There were 30 cases of mitral (MVR) and 12 aortic (AVR) valve replacement. Major purpose of the study was to detect the sensitivity of TEE in detecting prosthetic valve malfunction particularly in comparison to TTE. Pannus was detected in 3 and 8 cases of MVR (p < 0.01) by TTE and TEE respectively; however, TEE was found to be of equal status in detecting pannus over AV (2 cases). Physiological regurgitation in MVR and AVR was detected in 13% and 25% by TTE and 20% and 33% by TEE respectively. Paravalvular leak was detected in 3 cases of MVR by TEE compared to only case by TTE. Though it is difficult to deduce any specific conclusion from this small number of patients, there is definite trend to higher sensitivity in detecting disorders with TEE specially for mitral prostheses.

Valvular heart disease in end-stage renal failure patients on maintenance hemodialysis.

To determine the presence of, and factors associated with, valvular heart disease in end-stage renal failure patients by M-mode, two-dimensional and Doppler echocardiography. Case series of an unselected group of patients on maintenance haemodialysis. Haemodialysis unit and echocardiography laboratory of the King Fahd Central Hospital, Gizan, Saudi Arabia Sixty patients on haemodialysis for at least 6 months. Main outcome measures: Detection of functional and structural valve abnormalities and their relation to putative aetiological factors. The mean age was 34.4 [SD13.0], range 14-66 years; 31 [51.7%] were men and 29 women. The duratior of dialysis was 37 [SD 29] months with a range of 6-106 months. Mitral regurgitation was found in 20 [33.3%], mitral annular calcification in 3 [5.0%], aortic valve calcification in 5 [8.3%] and tricuspid regurgitation in 8 [13.3%] patients At least one of these lesions was present in 22 [36.7%] patients. No patient had mitral or aortic stenosis. There were significant associations found between left ventricular mass and mitral regurgitation; calcium-phosphate product and aortic valvular calcification; and right ventricular enlargement and tricuspid regurgitation. Mitral and tricuspid regurgitation were common in our dialysis patients. The calcium and phosphate product was found to be an important determinant of aortic valvular calcification. Further studies are needed to determine whether early control of calcium and phosphate levels would prevent the development of this complication

Patologias do endocardio valvar: bases para uma classificacao dos disturbios funcionais das valvas cardiacas / Pathologies of the valvar endocardium: bases to a classification of functional disturbances of the cardiac valves

O autor descreve e ilustra, com figuras apropriadas, as principais lesoes anatomo-patologicas adquiridas das valvas cardiacas, excluindo as anomalias congenitas. Refere-se aos aspectos qualitativos e quantitativos das lesoes, pelo que representam como fatores determinantes dos defeitos funcionais das valvas, bem como pelas alteracoes hemodinamicas que acarretam. Para dar um cunho de aplicacao pratica ao trabalho, apresenta a classificacao anatomo-funcional que utiliza, com base em criterios fisiopatologicos, considerando os seguintes aspectos anatomo-funcionais: a) estenose valvares puras; b) insuficiencias valvares puras; C) disfuncoes valvares completas. Menciona ainda os subtipos conforme a interferencia do acometimento prevalente dos varios componentes do aparelho valvar: ostio, cuspide, comissuras, cordoalhas tendinosas e musculos papilares

Repeat cardiac operations for mitral restenosis

Twelve patients with mitral valve re-stenosis following previous closed mitral valvotomy, who had repeat cardiac operations, are discussed, with only one operative mortality

Avaliaçäo da endomiocardiofibrose pelo ecocardiograma bidimensional: análise da gravidade e correlaçäo com a angiocardiografia / Evaluation of endomyocardial fibrosis by two-dimensional echocardiogram: Analysis of the severity and correlation with angiocardiography

Objetivo Comparar o ecocardiograma bidimensional (Eco-2D) à angiocardiografa (Angio) na avaliação da gravidade de endomiocardiofibrose (EMF). Métodos Doze pacientes e idades entre 14 e 35 (média 24,6 ± 6,6) anos, sendo 8 mulheres. Para comparar a gravidade pelos 2 métodos, o processo obliterativo foi graduado em cruzes, de acordo com a sua extensão ao longo do eixo maior do ventrículo correspondente na diástole: 1. + ocupando apenas o ápice: 2 + < 50% e 3 + ³ 50% desde o ápice até o piano da valva atrioventricular (AV). Resultados Todos os pacientes tinham doença biventricular na Angio, com predomínio em ventrículo direito (VD) em 5 (42%), em ventrículo esquerdo (VE) em 1 (8%) e balanceado em 6 (50%). Pelo Eco-2D estes númerosforam 11 (92%), 5 (42%),1 (8%) e 5 (42%) respectivamente. Em apenas 1 caso o envolvimento do VE (1 +) não foi identificado pelo Eco 2D. O grau de concordância entre o Eco-2D e a Angio foi de 100% para o VD e 75% para o VE (p < 0,005). Insuficiência mitral (IM) foi detectada em 7 (58%) e tricúspide (IT) em 11 (92% ) pacientes pela Angio. Estes pacientes, exceto 1, tinham a área do átrio correspondente maior que 18 cm, pelo Eco-2D. Observou-se correlação estatisticamente significativa entre a área atrial e a gravidade da insuficiência valval (IM p < 0,005; IT p < 0,05). 0 movimento paradoxal do septo interventricular (SIV) foi obsevado em 6 (50%) pacientes, associando-se a doença predominante do VD, IT severa e IM ausente ou leve...

Purpose To evaluate the capacity of two dimensional echocardiogram (2D-Echo) to establish the severity of endomyocardial fibrosis (EMF) in comparison with angiography (Angio). Méthods Twelve patients with EMF were prospectively studied by both: 2D-Echo and Angio. The mean age was 24.6 ± 6.6 years (14 to 35), with 8 women and 4 men. To compare the severity by the 2 methods the obliterative process was graded according to its extension relative to the long exis of the respective, in diastole, as follows: 1 + only apical: 2 + < 50°% and 3 + ³ 50% from the apex to the atrioventricular valve level. Results All patients (100%) had biventricular disease by Angio, with right ventricle (RV) predominance in 5 (42%), left ventricle (LV) predominance in 1 (8%) and balanced in 6 (50%). By 2D-Echo the se numbers were: 11 (92%),5(42%), 1 (8%) and 5 (42%), respectively. The degree of concordance between 2D-Echo and Angio was 100% for the RV and 75% for the LV (p < 0.005). In only 1 patient the LV apical involvement (+) was not identified by 2D-Echo. Mitral insufficiency (MI) was detected in 7 (58%) and tricuspid (TI) in 11 (92%) patients by Angio. These patients, expect one, had the corresponding atrial area > 18 cm2 by 2D-Echo. It was observed a statistically significant correlation between the atrial area and the degree of AV valve insufficiency (MI p < 0.005; TI p < 0.05). Paradoxicalmovement of the interventricular septum (IVS) was noted in 6 (50%) patients, associated with predominant RV disease, severe TI and mild or abesent Mi...

Válvula de presión variable en el tratamiento de hidrocefalia con ventrículos chicos / Valve of variable pressure in the treatment of hydrocephalus with small ventricles

Se presenta una paciente de 13 años portadora de un síndrome de ventrículos chicos, tratada mediante la instalación de una válvula de presión variable. Partiéndose de una presión de 67 mm de H2O, que va subiendo en forma progresiva hasta 101 mm, observándose una respuesta ventricular, que va aumentando su tamaño en relación directa a la presión valvular. Se estima en definitiva los 84 mm de H2O, la presión más adecuada para tener una buena respuesta clínica con un tamaño ventricular aceptable. No es posible obtener conclusiones, pero se abre una nueva posibilidad terapéutica mediante el uso de las válvulas de presiones variables