ABSTRACT
BACKGROUND: Echocardiographic quantification of mitral regurgitation (MR) can be challenging if the valve geometry is significantly altered. Our aim was to compare the quantification of MR by the recently developed real time three-dimensional (3D) volume color flow Doppler (RT-VCFD) method to the conventional two-dimensional (2D) echocardiographic methods during the MitraClip procedure. METHODS: Twenty-seven patients (mean age 76 ± 8 years, 56% male) were prospectively enrolled and severity of MR was assessed before and after the MitraClip procedure in the operating room by 3 different methods: (1) by integrative visual approach by transesophageal echocardiography, (2) by transthoracic 2D pulsed-wave Doppler-based calculation of aortic stroke volumes (SV) and mitral inflow allowing calculation of regurgitant volume, and (3) by transthoracic 3D RT-VCFD-based calculation of regurgitant volume. RESULTS: We found moderate agreement between the integrative visual approach and the 3D RT-VCFD method for assessment of MR severity before (κ = 0.4, P < 0.05) and after MitraClip (κ = 0.5, P < 0.05). Relevant MR (3+ and 4+) was detected by visual approach in 27/27 and by 3D-VCFD method in 24/27 patients before and in 1 patient by both methods after the MitraClip procedure. In contrast, MR quantification by 2D SV method did not agree with the integrative visual approach or with the 3D RT-VCFD method. CONCLUSIONS: Quantification of MR before and after percutaneous MV repair by 3D RT-VCFD is comparable to the integrative visual assessment and more reliable than the 2D SV method in this small study population. Further automation of 3D RT-VCFD is needed to improve the accuracy of peri-interventional MR quantification.
Subject(s)
Echocardiography, Doppler, Color , Echocardiography, Three-Dimensional , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/physiopathology , Postoperative Care , Preoperative Care , Aged , Aged, 80 and over , Female , Humans , Image Interpretation, Computer-Assisted , Male , Middle Aged , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , Mitral Valve/surgery , Mitral Valve Insufficiency/surgery , Prospective Studies , Reproducibility of Results , Severity of Illness Index , Stroke VolumeABSTRACT
We report the case of a 58 year old man with unspecific lower abdominal pain, respiratory failure and shock. An acute aortic syndrome and a massive pulmonary embolism were excluded, and a coronary angiography for suspected acute myocardial infarction was performed, with detection of a high-grade stenosis of the left main coronary artery. A percutaneous coronary intervention was needed. We discuss the difficulty to distinguish an acute aortic syndrome, an acute coronary syndrome, and a massive pulmonary embolism in the emergency situation. In addition we discuss the difficulty of detecting a left main coronary artery stenosis in the ECG.
Subject(s)
Abdominal Pain/etiology , Dyspnea/etiology , Myocardial Infarction/diagnosis , Respiratory Insufficiency/etiology , Shock, Cardiogenic/diagnosis , Angioplasty, Balloon, Coronary , Coronary Angiography , Diagnosis, Differential , Humans , Male , Middle Aged , Myocardial Infarction/therapy , Shock, Cardiogenic/therapy , StentsABSTRACT
We admitted a 42 year old woman with clinical signs of shock, coma, and ecg changes consistent with a ST elevation myocardial infarction to percutaneous coronary intervention. Normal coronary arteries were found. Due to the comatose state a cranial computed tomography scan was performed, where a subarachnoid hemorrhage was detected. We discuss the difficulty of diagnosing a subarachnoid hemorrhage, the pathophysiological cause of cardiac damage and ecg changes in acute neurological disease, and the differential diagnosis of ST elevation in the ecg.
