An integrated approach to the quantification of aortic regurgitation by Doppler echocardiography.

BACKGROUND: Although different Doppler methods have been proposed for the quantification of aortic regurgitation, no study has prospectively compared these methods with each other and their correlation with angiography. The aim of this study was to prospectively analyze the usefulness of different Doppler echocardiography parameters by testing all such parameters in each patient. METHODS: Fifty-one patients with aortic regurgitation underwent 2-dimensional and Doppler echocardiographic studies and catheterization. The following Doppler indexes were analyzed and compared with aortography. Color Doppler: (1) jet color height/left ventricular outflow tract height in parasternal long-axis view, and (2) jet color area/left ventricular outflow tract area in short-axis view. Continuous Doppler: (3) regurgitant flow pressure half-time, (4) regurgitant flow time velocity integral (in centimeters), and (5) regurgitant flow time velocity integral (in centimeters)/diastolic period (in milliseconds). Pulsed Doppler in thoracic and abdominal aorta: (6) time velocity integral of diastolic reverse flow (in centimeters), (7) time velocity integral of systolic anterograde flow/integral of diastolic reverse flow, (8) (time velocity integral of diastolic reverse flow/diastolic period) x 100, and (9) diastolic reverse flow duration/diastolic period (as a percentage). We compared these parameters with severity of regurgitation measured by angiography and classified as mild, moderate, or severe. RESULTS: The most useful parameters were (1) jet color height/left ventricular outflow tract height (correctly classified 42 of 49 patients), (2) (time velocity integral of diastolic reverse flow/diastolic period) x 100 in the thoracic aorta (correctly classified 41 of 46 patients), and (3) (time velocity integral of diastolic reverse flow/diastolic period) x 100 in the abdominal aorta (correctly classified 42 of 49 patients). Sequential integration of these 3 parameters correctly classified 96% of patients (44 of 46 patients) and was achieved in 90% of cases. CONCLUSION: An integrated combination of several Doppler parameters can quickly and accurately classify the degree of aortic regurgitation as determined by angiography.

[A false aneurysm with a double entry orifice]. / Falso aneurisma con doble orificio de entrada.

A case of a 64-year-old man is described, who was diagnosed as having a false aneurysm of the left ventricle, or pseudoaneurysm, a year following an inferior wall myocardial infarction. The echocardiogram demonstrated the presence of two ways of entry which communicated the inferior wall of the left ventricle to the false aneurysm. The patient was taken to surgery, where the diagnosis was confirmed. Aspects related to the diagnosis, treatment and prognosis of this case are discussed.

Tricuspid valve replacement in rheumatic disease: preoperative predictors of hospital mortality.

BACKGROUND AND AIM OF THE STUDY: The study analyzes the possible predictive power of different clinical and hemodynamic parameters with regard to hospital mortality after the first tricuspid valve replacement. METHODS: A retrospective study of 62 consecutive patients undergoing tricuspid valve replacement from 1974 to 1994 (7.2% of all tricuspid surgery performed at our institution in this period) was completed. Hospital mortality was 37%. Twenty-three patients died in hospital after the first tricuspid valve replacement (group I) and 39 patients (group II) survived this procedure. Tricuspid insufficiency was organic in 87% of group I and 84.6% of group II. RESULTS: The parameters showing significant differences between the two groups were NYHA class IV (p = 0.05), severe congestive heart failure (p = 0.02), mean right atrial pressure (p = 0.05), pulmonary arterial resistance (p = 0.006) and mean pulmonary arterial pressure (p = 0.0001). Cardiopulmonary bypass time (p = 0.005) and aortic cross-clamp time (p = 0.05) were longer in group I. Multiple regression analysis showed that the variables with greatest predictive power for hospital death were preoperative functional class, congestive heart failure and mean pulmonary artery pressure. The model gave a p < 0.001, with r = 0.58. CONCLUSIONS: The high hospital mortality rate after tricuspid valve replacement seems to be related to clinical functional class, severe congestive heart failure, and to chronic hemodynamic changes in the right atrium and pulmonary circulation.

Balloon mitral commissurotomy in patients with previous annuloplasty. Our experience.

Balloon mitral commissurotomy is an alternative to surgical commissurotomy in the treatment of mitral stenosis and different studies have shown its usefulness for restenosis following surgical commissurotomy. We describe our experience in balloon mitral commissurotomy in five patients with previous commissurotomy and annuloplasty. Among 360 balloon commissurotomies performed in our hospital up to December 1993, 29 procedures were performed on patients with restenosis after surgical commissurotomy, five of whom also had an annuloplasty (flexible ring in four and rigid in one). The balloon commissurotomy was performed without complications using the Inoue single balloon technique. Mitral valve area increased from 0.9 +/- 0.1 cm2 to 1.0 +/- 0.1 cm2 by pressure half-time, and from 1.0 +/- 0.2 cm2 to 1.3 +/- 0.1 cm2 by Gorlin formula. Two patients in functional class III underwent mitral valve replacement, 32 and 11 months later; the other three patients were in class II 38, 10 and 7 months later. The presence of a mitral ring should not constitute a contraindication to balloon commissurotomy. However, the haemodynamic results are not favourable in our patients, probably due to the practical absence of commissural fusion and the ring's restrictive effect on valvular stretching.

[Anomalous origin of the circumflex artery from the pulmonary artery in a patient with rheumatic mitral stenosis]. / Origen anómalo de la arteria circunfleja en la arteria pulmonar en un paciente con estenosis mitral reumática.

Left circumflex coronary artery arising from the pulmonary artery is an infrequent congenital anomaly, only described once in an adult patient. We present one patient with rheumatic mitral stenosis in whom this anomaly was noticed when an angiography was performed prior to a percutaneous mitral valvuloplasty.

[Lipomatous hypertrophy of the interatrial septum simulating an atrial mass in a patient with a pulmonary embolism: its diagnosis by transesophageal echocardiography and percutaneous biopsy]. / Hipertrofia lipomatosa de septo interauricular simulando masa auricular en paciente con embolismo pulmonar: diagnóstico mediante ecocardiografía transesofágica y biopsia percutánea.

A case of lipomatous hypertrophy of the interatrial septum in a patient with a history of repeated pulmonary embolism is presented. Thickening of the interatrial septum mimicking the presence of a right atrial mass was evidenced by transthoracic and transesophageal echocardiography. Lipomatous hypertrophy was suspected. The diagnostic was confirmed by echo guided (transesophageal) percutaneous transvenous biopsy. To our knowledge, there is no relationship between lipomatous hypertrophy and pulmonary embolism and in this case, it could be associated with smoking habit and oral contraceptives.