Color Doppler assessment of mitral regurgitation with orthogonal planes.

We evaluated 147 patients with adequate color Doppler and angiographic studies for mitral regurgitation. Sixty-five patients had no mitral regurgitation by both color Doppler and angiography and 82 patients had mitral regurgitation by both techniques. Thus the sensitivity and specificity of color Doppler for the detection of mitral regurgitation was 100%. Three two-dimensional echocardiographic planes (parasternal long and short axis, apical four-chamber view) were used to analyze variables of the mitral regurgitant jet signals in the left atrium. The best correlation with angiography was obtained when the regurgitant jet area (RJA) (maximum or average from three planes) expressed as a percentage of the left atrial area (LAA) obtained in the same plane as the maximum regurgitant area was considered. The maximum RJA/LAA was under 20% in 34 of 36 patients with angiographic grade I mitral regurgitation, between 20% and 40% in 17 of 18 patients with grade II mitral regurgitation, and over 40% in 26 of 28 patients with severe mitral regurgitation. Maximum RJA/LAA also correlated with angiographic regurgitant fractions (r = .78) obtained in 21 of 40 patients in normal sinus rhythm and with no evidence of associated aortic regurgitation. Other variables of the regurgitant jet such as maximal linear and transverse dimensions, maximal area, or maximal area expressed as a percentage of the LAA in one or two planes correlated less well with angiography. Color Doppler is a useful noninvasive technique that is not only highly sensitive and specific in the identification of mitral regurgitation but also provides accurate estimation of its severity.

Heterotopic heart transplantation: a radiographic review.

Heterotopic heart transplantation can be performed in the presence of high pulmonary vascular resistance. The authors call attention to a rare, but potentially life-saving procedure.

Congenital pulmonary vein stenosis: a radiographic study.

Seven patients with congenital pulmonary venous stenosis were retrospectively evaluated. Chest radiographs and pulmonary angiograms were interpreted without knowledge of anatomic findings, and results were correlated with autopsy data. Bilateral foci of stenosis of varying severity were found in all patients but occurred with greater frequency and severity in the left-sided pulmonary veins. Chest radiographic findings revealed asymmetric pulmonary vascularity in all patients. Shunt vascularity was seen in three right upper zones and three right lower zones but was not observed in any of the left lung zones. In seven patients angiograms revealed asymmetry in the size and number of pulmonary arterial branches. Arterial vascularity was increased in two right upper zones and four right lower zones but was not increased in any of the left lung zones. Pulmonary veins from 22 zones were visualized. Pulmonary venous opacification was delayed, asymmetric, and asynchronous in the majority. Venoatrial stenosis was seen in veins from 18 zones. Congenital pulmonary vein stenosis can be suspected based on chest radiographic findings of asymmetry of pulmonary vascularity between both lungs as well as regional discrepancies in the vascularity within each lung. Pulmonary angiography can support the diagnosis.