Longitudinal right ventricular function as a predictor of functional capacity in patients with mitral stenosis: an exercise echocardiographic study.

BACKGROUND: The influence of right ventricular (RV) function on exercise capacity has been poorly explored in mitral stenosis (MS). The objective of this study was to assess the determinants of functional status with exercise echocardiography in MS. METHODS: Thirty-nine patients (55 +/- 12 years, 29 female) with MS (1.3 +/- 0.5 cm(2)) underwent an exercise echocardiography (14 patients had previous balloon valvuloplasty). RV function was assessed by tricuspid annulus S-wave velocity (Tric-S) and tricuspid annular plane systolic excursion (TAPSE). RESULTS: Tric-S correlated with TAPSE (P = .03), cardiac output (P = .006), and mitral valve area (P = .009). With exercise, Tric-S and TAPSE increased significantly (11.3 +/- 3.1 cm/s to 15.5 +/- 3.4 cm/s and 21.2 +/- 5.2 mm to 24.0 +/- 5.8 mm, respectively, both P < .05). TAPSE was lower in patients in New York Heart Association class 3 or 4. In multivariate analysis, Tric-S at rest (beta = 0.34, P = .006) and mitral Delta mean diastolic gradient (beta = 0.34, P = .006) were the independent determinants of maximum workload. CONCLUSION: Resting RV longitudinal function assessed through Tric-S is an important determinant of functional capacity in MS.

Assessment of papillary fibroelastomas with live three-dimensional transthoracic echocardiography.

Seven consecutive patients presenting with typical echocardiographic features of papillary fibroelastoma requiring surgery were studied. All patients underwent standard two-dimensional (2D) transthoracic echocardiography (TTE) followed by live three-dimensional (live 3D) echocardiography with data set storage allowing analysis with systematic cropping of the acquired 3D data and volume measurement of the lesions. Assessment of papillary fibroelastoma by 2D and live 3D TTE was compared to operative findings. The feasibility of live 3D echocardiography in this setting was 100%. The quality of images was considered as optimal in three patients, good in three patients, and poor in one patient. A typical speckled appearance of the tumor was observed in three patients presenting with large tumors. The location of the tumor attachment was precisely defined in all but one patient, with a clear improvement in spatial assessment with live 3D TTE in three patients. Live 3D TTE also improved the operative planning in three patients. Live 3D TTE appears to be useful in the assessment of intracardiac tumors as small as papillary fibroelastomas, leading to a comprehensive approach of the lesion and facilitating the operative planning.

Acute coronary syndromes associated with thrombus in the sinus of valsalva and normal coronary arteriography: the pivotal role of transesophageal echocardiography in the intensive care unit.

We describe 4 patients with thrombus in nonaneurysmal sinus of Valsalva. The diagnosis was made with transesophageal echocardiography performed in the Intensive care unit, in the setting of acute coronary syndromes. Coronary arterlography showed normal coronary arteries in each patient. In 3 patients, conservative medical therapy resulted in full recovery. Two patients had previously undergone aortic valve surgery.