Valvular heart disease, Part 2. Mitral valve disease in older adults.

Mitral valve disease is a common cause of morbidity and mortality in patients over age 65. The etiology, physical findings, and natural history of rheumatic mitral stenosis, rheumatic mitral regurgitation, chronic non-rheumatic mitral regurgitation, and acute mitral regurgitation may differ in older and younger patients. In addition, symptoms of mitral valve disease may be masked or exacerbated by coexistent coronary artery disease, pulmonary disease, hypertension, and other systemic disorders that commonly occur in older adults. The clinical evaluation, along with various non-invasive cardiac procedures, is important for identifying mitral valve disease as the cause of abnormal signs and symptoms in older patients. Recognition of mitral valve abnormalities has important implications, because mitral valve repair or replacement is usually associated with favorable short- and long-term results, even in patients over age 65.

Valvular heart disease, Part 1. Diagnosis and surgical management of aortic valve disease in older adults.

Aortic valve disease is a common cause of morbidity and mortality in older patients. The etiology, physical findings, and natural history of aortic stenosis and aortic regurgitation may differ in older patients compared with younger patients. In addition, symptoms of aortic valve disease may be masked or exacerbated by co-existent coronary artery disease, hypertension, pulmonary diseases, and other systemic disorders that commonly occur in the geriatric population. Clinical assessment, along with various non-invasive cardiac techniques including ECG, chest x-ray, and echocardiogram are important in identifying aortic valve disease as the cause of abnormal signs and symptoms in these patients. Recognition of aortic valve abnormalities has important therapeutic implications because aortic valve replacement is usually associated with favorable short- and long-term results, even in patients over age 65.

Multiplane Transesophageal and Intracardiac Echocardiography in Large Swine: Imaging Technique, Normal Values, and Research Applications.

Transthoracic echocardiographic imaging has been difficult to attain in the swine model. This study: (1) compares multiplane transesophageal echocardiography (TEE) with single plane TEE and intracardiac catheter echocardiography (ICE) for imaging of the swine cardiovascular system; and (2) defines normal values using these techniques in a closed chest large swine model (n = 24, body weight 50-114 kg). Multiplane TEE increased success rate over the single plane (the variable plane array only at 0 degrees ) TEE (P < 0.01) for imaging the left ventricular (LV) long-axis view (100% vs 50%), LV outflow tract (100% vs 33%), right atrium and its appendage (79% vs 33%), ascending aorta (100% vs 58%), and aortic arch (100% vs 17%). TEE-derived normal values at end-diastole (ED) and end-systole (ES) were: LV internal diameter (ID) = 49 +/- 3 mm (ED) and 33 +/- 4 mm (ES); LV wall thickness = 7 +/- 1 mm (ED); right ventricular (RV) ID = 24 +/- 4 mm (ED); RV wall thickness = 4 +/- 2 mm (ED); left atrial ID = 48 +/- 6 mm (ES); aortic root ID = 26 +/- 3 mm (ES); LV volume = 157 +/- 49 ml (ED) and 57 +/- 22 ml (ES). Baseline LV ejection fraction (64% +/- 6%), Doppler-derived stroke volume (86 +/- 14 ml), and cardiac index (107 ml/min per kg) were determined. Basal normal values, except for an elevated cardiac index in swine, are comparable to those reported for human adults. Multiplane TEE provided better overall cardiac imaging than did single plane TEE. ICE provided higher resolution imaging of individual cardiac chambers and structures when the ultrasound catheter was introduced into the right or left heart, but whole heart imaging was limited by ultrasound penetration at 12.5 MHz. Normal indices of chamber size and function provide a reference for the physiological significance of induced pathological states in this relevant animal model.