Aortic valve-sparing operation versus Bentall and mechanical aortic valve replacement--midterm results.

OBJECTIVES: The primary aim of this retrospective study was to evaluate short-term (one-to-six months) and mid-term (six-to-forty-eight months) results of aortic valve-sparing procedures. The second endpoint was to compare the results with the group of patients undergoing mechanical aortic valve replacement during the same period. METHODS: Between April 2008 and May 2012 at our institution, we treated 76 patients either with ascending aorta/root aneurysm/dissection or with isolated aortic regurgitation. A total of seventy-six patients undergoing aortic valve surgery. RESULTS: Analyzed parameters were divided into two parts as function of time. In the first part, i.e. during hospitalization, the mortality, duration of hospitalization, duration of extra corporeal circulation (ECC), and duration of cardiac arrest (CA) were compared and assessed. In the second part, i.e. during monitoring of the patients after their discharge from hospital (one-to-six months, and six-to-forty-eight months), the grade of postoperative AR aimed mainly at the group of aortic valve-sparing operations (subgroups A1, A2, A3), postoperative peak gradient, presence of thromboembolic and bleeding complications, postoperative endocarditis and need for reoperation or hospitalization due to cardiac reasons were analyzed. CONCLUSION: Based on our first experience, we believe that in spite of higher technical difficulty, the aortic valve-sparing operations can be possibly performed with the same or respectively lower rate of postoperative morbidity and mortality. Presented results show that compared with the aortic valve replacement, the aortic valve-sparing operation is a promising method, and an interesting therapeutic alternative for patients. After proper indications, we consider it to be a method of choice (Tab. 6, Fig. 7, Ref. 28).

[Clinical implications of enlargement of left atrium]. / Klinické dôsledky zväcsenia lavej predsiene.

Enlargement of left atrium (LA) has been shown to be a barometer of diastolic burden and a predictor of common cardiovascular outcomes such as atrial fibrillation, stroke, congestive heart failure, and cardiovascular death. Different methods exist for the assessment of LA size. The American Society of Echocardiography recommended LA volume and its indexed value assessed by 2-dimensional echocardiography, to measure LA size. Current findings suggest that echocardiographically determined LA size may become an important clinical risk identifier in preclinical cardiovascular disease and should be assessed as a part of routine echocardiographic evaluation.

[The importance of contractile reserve in patients with resynchronization therapy]. / Význam globálnej kontraktilnej rezervy u pacientov s resynchronizacnou liecbou.

INTRODUCTION: Contractile reserve of the myocardium is a strong prognostic factor in patients with heart failure. The presence of a significant amount of myocardial fibrosis might lead to insufficient response to resynchronization therapy We assumed that pre-implantation examination of global contractile reserve will allow prediction of the response to resynchronization treatment. METHODS: 25 symptomatic patients (NYHA III) with severe systolic dysfunction [ejection fraction (EF) 28.9 ± 6.9%] with signs of electric asynchrony (QRS 120 ms) went through dobutamine echocardiography prior to resynchronization treatment. The global contractile reserve was determined from the change to EF at rest and at the peak of pharmacological burden (40 µg/kg/min). Patients with a rise in EF of more than 5% and/or endsystolic volume reduction of more than 15% after three months of resynchronization treatment were considered responders. RESULTS: Compared to non-responders, responders had higher increase in EF during dobutamine stress echocardiography (Δ 12.8 ± 7.4 % vs. Δ 3.4 ± 7.1 %, p = 0.0042). Three months from the initiation of resynchronization therapy, the global myocardial contractile reserve also significantly correlated with EF increase (r = 0.67, p = 0.007). The 6% increase in EF during dobutamin stress echocardiography predicted responders to resynchronization therapy with 83% sensitivity and 75% specificity. CONCLUSION: The global contractile reserve may play an important role in prediction of a response to resynchronization therapy.

[Resynchronization therapy for heart failure--still many question marks]. / Resynchronizacná liecba srdcového zlyhávania-- stále vel'a otáznikov.

At present, the potential benefit of resynchronization therapy, i.e. an improved quality of life and prolonged survival in patients with heart failure, is not achieved in every patient. The 30% non-response has prompted a search for new criteria predicting patient response to resynchronization treatment. An absence of mechanical dyssynchrony, viability of the myocardium and an inadequate positioning of the intracardiac left ventricular lead probably limit the response to resynchronization therapy. ECG remains essential for the selection of suitable patients.

Obesity paradox and chronic kidney disease.

INTRODUCTION AND OBJECTIVES: In general population, obesity is associated with increased risk of adverse outcomes. However, the studies carried out in the past years have offered a new insight into obesity when associated with chronic disease states such as chronic heart disease, heart failure, chronic kidney disease, end-stage renal disease, etc. Studies of patients with these chronic diseases suggest that the outcomes of overweight and obese patients may be paradoxically better than in lean patients. The aim of our study was to identify how BMI can influence the renal and cardiac functions. METHODS: We carried out a retrospective study on 93 patients (51 males and 42 females; mean age 60.83 +/- 12.32 years) with chronic kidney disease in different stages of chronic renal failure according to K/DOQI. RESULTS: We found significantly higher GFR and lower creatinine levels in obese patients when compared to normal subjects (p = 0.0009, and p = 0.05, respectively). When comparing the group of obese patients (BMI >30) with normal subjects, we found significantly higher values of EF (p = 0.05) and S vel (global radial myocardial velocity of the left ventricle in systole; p = 0.04) in obese patients. There were no significant differences between these three groups of patients in other parameters such as B-type of natriuretic peptide, C-reactive protein, and fibrinogen (p = 0.2, p = 0.4, and 0.9, respectively). CONCLUSION: In our group of 93 patients with chronic kidney disease in different stages of chronic renal failure, we have proved no adverse effect of obesity on cardiac or renal function (Tab. 4, Fig. 3, Ref. 27).

[BNP and echocardiographic parameters in patients with chronic kidney disease and dialyzed patients]. / BNP a echokardiografické parametre u pacientov s chronickými chorobami obliciek a dialyzovaných chorých.

We assessed the relation between BNP levels and some echocardiographic parameters of systolic and diastolic function of the left ventricle in 49 patients (mean age 69.39 +/- 8.47 years) with chronic kidney disease in different stages of chronic renal failure according to K/DOQI and in 45 subjects (mean age 52.6 +/- 14.85 years) on dialysis. Median for BNP in the group of patients with chronic renal failure was 132 pg/ml, and in dialysis subjects 320 pg/ml. None of our patients had clinical signs of heart failure during the last six months. Using a method of correlation matrix we found the left ventricular mass and its indexed value as a common indicator of increased BNP level in both groups of patients (dialysis patients, p = 0.0003, and p = 0.0005, respectively; patients with chronic renal failure, p = 0.03, and p = 0.04, respectively). Further analysis proved that in the group of dialysis patients the main determinants of increased BNP level were volumes of the left heart side: left ventricular end diastolic volume (p = 0.004), endsystolic volume (p = 0.01), and left atrial volumes (maximal, minimal, and total atrial stroke volume; p = 0.004, p = 0.009 and p = 0.04, respectively). In the group of patients with chronic renal failure the major contributors to increased BNP level were echocardiographic parameters of diastolic filling assessed from transmitral and pulmonary venous flow: E wave (p = 0.001), A wave (p = 0.01), E/A (p < 0.001), IVRT (p = 0.004), E/EDT (p < 0.0001), S wave (p = 0.01), D wave (p = 0.0003), S/D (p = 0.001), Ar duration (p = 0.02), and E/Vp (p = 0.003). No significant relation to left ventricular ejection fraction was found in both groups of patients. Our results suggest that the main determinant of increased BNP level in patients with different stages of chronic renal failure is diastolic dysfunction, whereas in dialysis patients high left heart volumes due to volume overload. The common denominator of high BNP level in both groups of patients is especially the left ventricular mass.

Left atrial volume as a predictor of heart function.

OBJECTIVES: This study was designed to identify an association between left atrial volume and systolic and diastolic functions of the left ventricle. BACKGROUND: Several studies have shown a relationship between the left atrial volume and different cardiovascular risk factors. METHODS: Transthoracic echocardiographic results of 268 patients (136 women and 132 men, mean age 60.2+/-17.3 years) were studied retrospectively. Key echocardiographic variables of systolic and diastolic function were related to the left atrial volume and its indexed value. RESULTS: The mean indexed left atrial volume in a subgroup of patients with normal echocardiography, was 25.3+/-6.7 ml/m2. Left atrial volume significantly (p<0.0001) increased in deteriorating diastolic function (impaired relaxation, pseudonormalized pattern, and restrictive physiology): 33.6+/-11.6, 48.7+/-21.8 and 84.5+/-60.5 ml/m2, respectively. There were also significant (p=0.0001) differences in cases with normal systolic function (EF>50 %) and systolic dysfunction (EF<50%): 37.9+/-24.1 vs 54.9+/-34.7 ml/m2. There were no significant differences in the left atrial volumes (33.1+/-10.9 ml/m2 and 38.3+/-15.4 ml/m2, p=0.13) in patients with normal systolic function and impaired relaxation compared to patients with systolic dysfunction. However, in both cases these values were different from those with normal echocardiography (p<0.0001). In multiple regression analysis the best predictor of enlarged left atrial volume was the left ventricular mass. CONCLUSION: We found a strong association between left atrial volume and left ventricular systolic and diastolic dysfunction. The strongest association appeared between increasing left atrial volume and left ventricular mass (Tab. 2, Fig. 4, Ref. 26). Full Text (Free, PDF) www.bmj.sk.

Cardiac biomarkers and chronic renal diseases.

Accelerated atherosclerosis can lead to an increased prevalence of coronary artery disease, heart failure, brain stroke and peripheral arterial disease. Thus, subjects with chronic renal failure are exposed to increased morbidity and mortality from cardiovascular events. A strong and pervasive link exists between kidney failure and cardiac disease. A variety of individual biomarkers have been evaluated and several have been found to successfully predict the outcome in patients with kidney disease. These include markers of myocardial necrosis, such as cardiac troponin T and I, markers of heart failure, such as B-type of natriuretic peptide and its associated inactive N-terminal fragment, markers of systemic inflammation--C-reactive protein, and an endogenous inhibitor of nitric oxide synthase-asymmetric dimethyl arginin. Increased concentrations of C-reactive protein, B-type of natriuretic peptide, asymmetric dimethyl arginine, and troponin predict a high risk of cardiovascular mortality as well as a mortality due to other causes in patients with chronic renal failure or end stage renal disease (Tab. 1, Ref. 33). Full Text (Free, PDF) www.bmj.sk.

Quality of life and psychological well-being in patients with various pacing modes.

AIM: of the study was to assess the influence of different pacing modes on the quality of life (QOL), anxiety and depression. METHODS: QOL was assessed in 101 patients (58 men, mean age 69.39 +/- 14.64 years) with implanted pacemaker (35 patients received VVI pacemaker, 17 patients VVIR, 21 patients DDD, 28 patients DDDR). QOL was measured by the SF-36 and Aquarel questionnaires, anxiety by Beck scale and depression by Zung scale. RESULTS: No differences in QOL were observed between patients with single chamber and dual chamber pacing. Patients with rate-adaptive pacing had higher scores in SF 36 scales (physical component summary, mental component summary, vitality and bodily pain), Aquarel (chest pain and dyspnea) and they exhibited lower degree of anxiety and depression compared to non-rate-adaptive pacing. Differences were shown only in a group of dual chamber pacemakers, not in the group of single chamber pacemakers. There was a strong correlation between the degree of anxiety and depression and the QOL in pacemaker patients. CONCLUSION: Dual chamber rate-adaptive pacing offered better QOL and psychological profile compared to dual chamber non-rate-adaptive pacing. No differences were observed between single chamber and dual chamber pacing (Tab. 3, Fig. 3, Ref. 24).

Relation of various degrees of body mass index to systolic and diastolic dysfunctions.

OBJECTIVES: This study was designed to identify any associations between left ventricular function and obesity using clinical two-dimensional echocardiographic and Doppler studies. METHODS: We retrospectively evaluated 260 consecutive clinical echocardiographic findings. Key echocardiographic variables of systolic and diastolic function were related to various degrees of body mass index. RESULTS: In multiple regression analysis in the whole group of patients there was significant relation of body mass index to left ventricular mass and its indexed value (p < 0.0001). Multiple regression analyses in subgroups of patients according to systolic and diastolic function or dysfunction revealed similarly the strongest association of body mass index to mainly left ventricular mass. In subgroups of patients classified on the basis of their body mass indices significant differences were found also in case of left ventricular mass as well as left atrial volume (p = 0.0001, and p = 0.003, respectively). There was no association between body mass index and systolic or diastolic dysfunction. CONCLUSION: We found strong association between obesity and left ventricular mass. Obesity was not related to systolic and diastolic function or dysfunction.

Diagnostic yield of adenosine and nitroglycerine stimulated tilt test in patients with unexplained syncope.

OBJECTIVES: We aimed to compare diagnostic yield of adenosine tilt test (A-HUT) with nitroglycerine tilt test (NTG-HUT) in patients with unexplained syncope and to assess the use of adenosine tilt test as an alternative to routine tilt testing. BACKGROUND: Adenosine could provoke a vasovagal response in susceptible patients. Adenosine stimulated tilt testing is less time consuming than conventional tilt testing. METHODS: Forty-one consecutive patients with unexplained syncope were tested (29 females /12 males; mean age 44 +/- 20 years). As a part of standard diagnostic testing they undewent both adenosine and nitroglycerin stimulated tilt testing in random fashion. RESULTS: NTG-HUT was positive in 28 patients (68%). Six patients (14.6 %) developed a vasovagal response after adenosine stimulated head-up tilt test (A-HUT). All patiens with positive A-HUT showed also the positivity of NTG-HUT. No patient from with negative NTG-HUT developed a vasovagal response after adenosine induction. The diagnostic yield of NTG-HUT was significantly higher than yield of A-HUT (p < 0.001). The diagnostic yield of A-HUT was significantly affected by age. Subjects with a positive adenosine tilt test were younger than those with a negative tilt (29 +/- 10 vs. 46 +/- 20 years, p = 0.016). Five of six positive patients were <30 years of age. Diagnostic yield in those patients was 31%, whereas in patients >30 years of age was significantly lower (4%, p = 0.007). CONCLUSION: Diagnostic yield of the adenosine stimulated tilt testing is significantly lower than diagnostic yield of nitroglycerine stimulated tilt testing. Given the very short time needed for performing adenosine stimulated HUT, it may be useful in patiens <30 years of age. In this group of patiens positive adenosine-stimulated HUT may obviate need for the time consuming nitroglycerine-stimulated HUT (Tab. 1, Fig. 3, Ref. 17).

[Dobutamine exercise echocardiography versus SPECT in diagnosing ischemic heart disease]. / Dobutamínová zát'azová echokardiografia vs SPECT pri diagnostikovaní ischemickej choroby srdca.

UNLABELLED: The aim of the study was comparison of dobutamine stress echocardiography with SPECT in the assessment of ischemic heart disease. METHODS: It is a retrospective study analysing 119 patients (72 women and 47 men, mean age 56.9 +/- 10.68 years), who underwent dobutamine stress echocardiography and SPECT. Because of inconclusive findings (LBBB, decreased myocardial perfusion by SPECT depending on the position of the body), 23 patients were excluded. RESULTS: In the whole group of 96 patients the diagnostic validity of dobutamine stress echocardiography was as follows: sensitivity 78%, specificity 93%, positive predictive value 89%, negative predictive value 85%, and kappa value 0.71. In women the sensitivity was 69%, specificity 93%, positive predictive value 79%, negative predictive value 89%, and kappa value 0.64. In men the diagnostic validity was: sensitivity 83%, specificity 92%, positive predictive value 95%, negative predictive value 73%, and kappa value 0.70. CONCLUSION: In conclusion, dobutamine stress echocardiography is highly sensitive and specific method in the diagnosis of ischemic heart disease with good agreement when compared with SPECT. Because of availability and lower cost in comparison with SPECT, dobutamine stress echocardiography is an optimal method in the diagnosis and management of patients with ischemic heart disease in routine clinical practice.

[Diagnostic benefit of the use of implanted loop recorder (Reveal Plus) for patients with syncope with unclear aetiology]. / Diagnostický prínos pouzitia implantovaného sluckového rekordéra (Reveal Plus) u pacientov so synkopou nejasnej etiológie.

UNLABELLED: The objective of the study was to evaluate the diagnostic yield of a loop recorder (Reveal Plus, Medtronic) in the diagnosis of syncope conditions whose aetiology remains unclear despite the performance of a full diagnostic procedure. PATIENTS AND METHOD: Loop recorders were implanted in 25 patients with recurrent syncope (9 men, 16 women, average age 59 +/- 14 years), who reported 4 +/- 2.7 episodes of syncope (2-10 episodes). A complete diagnostic algorithm was performed for all patients before implantation including the head-up tilt test, an invasive electrophysiological examination and a neurological examination. The aetiology of the syncope was not established by these examinations. RESULTS: During an average monitoring period of 13 +/- 8 months (1-24 months) 10 patients experiences recidivating syncope, 7 patients experienced pre-syncope and 1 patient experienced palpitations. 7 were asymptomatic during monitoring. Symptomatic arrhythmia was detected in 10 patients (40%). The most frequent finding was bradyarrhythmia (6 patients--sinus arrest in 3 patients, serious bradycardia in 2 patients, AV block in 1 patient). Tachyarrhythmia was the cause of symptoms in 4 patients (supraventricular tachycardia in 3 patients, ventricular bigeminy in 1 patient). In the case of 5 patients (20%) syncope (pre-syncope) took place in the absence of a serious arrhythmia and was classified as vasovagal syncope. CONCLUSION: The implantable loop recorder established a diagnosis in 15 of 25 patients (60%) with syncope that was not diagnosed by conventional tests and it is a highly beneficial method for diagnosing syncope.

Relationship between plasma aldosterone and left ventricular structure and function in patients with essential hypertension.

Recent experimental studies demonstrated that elevation of plasma aldosterone is associated with an increased collagen accumulation resulting in myocardial fibrosis. The aim of this study was to evaluate the association of circulating aldosterone with cardiac structural and functional changes in patients with essential hypertension. The authors examined 39 patients (aged 51 +/- 14 years, 13 male, 26 female) with essential hypertension. M-mode and two-dimensional echocardiography was performed in each subject. Plasma renin activity (PRA) and plasma aldosterone (PA) at baseline and after 4 hours upright posture were measured. Mean levels of baseline and stimulated PRA were similar in hypertensives and control group of normotensives. Baseline and stimulated PA levels were mildly but not significantly higher compared to control group. Using Tukey Kramer multiple analysis we found a significant positive correlation of both baseline and stimulated PA with echocardiographic parameters of left ventricle in hypertensive subjects: IVSd (p<0.001), PWd (p<0.001), LVIDd (p<0.001) and E/A (p<0.001). However, no correlation between PRA and left ventricular structure and function was found in this group of patients. The authors conclude that plasma aldosterone levels are related to the structure and function of left ventricle. (Tab. 3, Ref. 20.).

Diastolic function of the left ventricle assessed by echocardiography.

The authors evaluated a value of diastolic indices of the left ventricle assessed by Doppler from transmitral flow in prediction of diastolic dysfunction. They were related to instantaneous pressure decline of the left ventricle, which was considered as a standard of left ventricular relaxation and was evaluated by Doppler. In a group of 38 patients the diastolic function was assessed by measuring the isovolumic relaxation time, peak velocity during the rapid filling phase of the left ventricle, its deceleration time, peak velocity during atrial contraction, its ratio and flow propagation velocity. Polynomial regression revealed significant association of the instantaneous pressure decline of the left ventricle to isovolumic relaxation time and a value of more than 100 ms identifying a high risk group of patients. There was no association to other echocardiographic indices of diastolic function. (Tab. 3, Fig. 2, Ref. 11)

[Effect of ACE gene polymorphism on left ventricular function in patients with type 2 diabetes]. / Vplyv polymorfizmu ACE génu na funkciu l'avej komory u chorých s diabetom 2. typu.

The authors evaluated the influence of the ACE gene polymorphism on left ventricular function in patients with diabetes type 2. In a group of 23 patients left ventricular mass, global and regional systolic function of the left ventricle as well as diastolic function was assessed from transmitral flow using two-dimensional echocardiography. In a subgroup of patients with DD (n = 7) and ID genotype (n = 16), no significant differences were found in age (p = 0.19), duration of diabetes (p = 0.46), level of HbA1c (p = 0.10), cholesterol level (p = 0.18), quantitative proteinuria (p = 0.39), systolic and diastolic blood pressure (p = 0.25, p = 0.40). No association was found between insertion-deletion polymorphism of the ACE gene and observed echocardiographic parameters [left ventricular mass index (p = 0.43), EF (p = 0.46), wall motion index (p = 0.25), E wave (p = 0.14), A wave (p = 0.07), deceleration time of the E wave (p = 0.06), E/A (p = 0.07), flow propagation velocity (Vp) (p = 0.14) and E/Vp (p = 0.38)]. The presence of myocardial infarction, ischemic heart disease and hypertension had no association with ACE gene polymorphism (p = 0.53, p = 0.61 and p = 0.64). In conclusion, there is no association between ACE gene polymorphism and systolic and diastolic function of the left ventricle in this group of patients with diabetes type 2.

Assessment of the left atrial appendage mechanical function by three-dimensional echocardiography.

AIMS: We evaluated the feasibility of three-dimensional echocardiography, in the assessment of left atrial appendage (LAA) function. METHODS AND RESULTS: Forty-five patients underwent multiplane transoesophageal echocardiography. In addition to Doppler and two-dimensional echocardiography, data for three-dimensional echocardiography reconstruction were obtained during transoesophageal echocardiography. Left atrial appendage ejection fraction based on three-dimensional echocardiography volume measurements (EFv) and two-dimensional echocardiography area measurements (EFa), coupled with other echocardiographic data, were related to left atrial appendage late peak emptying velocity, a frequently used indicator of left atrial appendage function. Multiple regression analysis has revealed a significant association of peak emptying velocity with EFv (P<0.0001), spontaneous echocardiographic contrast (P=0.001), tricuspid regurgitation (P=0.03) and left ventricular hypertrophy (P=0.05). No significant relation was observed between peak emptying velocity and EFa, presence or absence of atrial fibrillation, left ventricular dysfunction, mitral stenosis and insufficiency, left atrial dilatation, pulmonary venous peak systolic, diastolic and peak reverse flow velocity at atrial contraction as well as left atrial appendage volumes derived from two-dimensional echocardiography and three-dimensional echocardiography. In a simple linear correlation, the degree of association between peak emptying velocity and EFv was higher as between peak emptying velocity and EFa (r=0.7 vs 0.4, both P<0.001). Observer variabilities for calculating EFv were considerably lower than for two-dimensional echocardiography derived EFa. Ejection fractions determined by two-dimensional echocardiography area measurements at 45 degrees, 90 degrees and 135 degrees cutplane angulations were related to EFv only at 135 degrees. CONCLUSIONS: Left atrial appendage ejection fraction calculation by three-dimensional echocardiography is feasible, more accurate than by two-dimensional echocardiography and has lower observer variability. Furthermore, an optimal cutplane angulation of the left atrial appendage view at 135 degrees has been demonstrated.

Quantitative assessment of mechanical prosthetic valve area by 3-dimensional transesophageal echocardiography.

OBJECTIVE: The goal of this study was to assess the geometric orifice area of mechanical valve prostheses by transesophageal 3-dimensional echocardiographic planimetry. METHODS AND RESULTS: Currently used Doppler methods for prosthetic assessment (orifice area-Doppler) were compared with 3D planimetry for orifice area (orifice area-3D) and with manufacturer's values (orifice area-manufacturer) for the corresponding prosthesis types and sizes and with historical controls provided by Doppler literature (orifice area-literature). Twenty-four mechanical valve prostheses (in 22 patients) were studied: 13 in mitral position and 11 in aortic position. Orifice area-manufacturer, orifice area-Doppler, orifice area-literature, and orifice area-3D were 3.6 +/- 1.1 cm(2), 2.3 +/- 0.9 cm(2), 2.4 +/- 0.9 cm(2), and 2.6 +/- 0.7 cm(2), respectively. Orifice area-manufacturer values were significantly larger. Correlation coefficients between orifice area-3D and orifice area-manufacturer, and between orifice area-3D and orifice area-Doppler and orifice area-literature were 0.83, 0.90, and 0.73, respectively (all P < .0001). CONCLUSION: Three-dimensional transesophageal echocardiography is feasible and has good correlation with orifice area-Doppler (in aortic position) and good correlation with orifice area-manufacturer (in aortic and mitral positions) methods.

[Mitral stenosis evaluated with three-dimensional echocardiography]. / Mitrálna stenóza hodnotená trojrozmernou echokardiografiou.

The authors evaluated the possibilities of three-dimensional echocardiography in the assessment of the severity of mitral valve stenosis. In 45 patients, the Doppler pressure half-time method was compared with two three-dimensional echocardiographic methods in the measurement of mitral valve orifice: anyplane echocardiography and surface rendering. There was significant relation between them: r = 0.74 and r = 0.70, both p < 0.0001. In addition, mitral valve stenosis was also quantified by two new indices, such as the doming volume of the mitral apparatus and mitral valve volume. Subgroup analysis revealed relation between atrial fibrillation and decreasing doming volume as well as significantly higher mitral valve volume in patients with critical stenosis. Associated valve abnormalities did not influence the mitral orifice measurement neither by Doppler method nor three-dimensional echocardiography. In conclusion, three-dimensional echocardiography allows reliable assessment of mitral stenosis and moreover provides new quantitative indices, which can be clinically important in the assessment of three-dimensional geometry of the mitral apparatus.

Anterior mitral valve aneurysm: evaluation by three-dimensional echocardiography.

Three-dimensional reconstruction of cardiac structures is becoming increasingly important. Complete spatial visualization of cardiac structures and their relation to each other enable better understanding of both morphologic and functional lesions.