Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
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J Am Soc Echocardiogr · Sep 1990
Case ReportsSevere tricuspid regurgitation after mitral valve repair: diagnosis by intraoperative transesophageal echocardiography.
Transesophageal echocardiography facilitates the evaluation of valvular repair in the operating room. The functional valvular morphology and degree of valvular regurgitation can be assessed before and after repair. This technique can also identify unsuspected findings--in this case, severe tricuspid regurgitation complicating cardiopulmonary bypass. We report a previously undescribed cause of traumatic tricuspid regurgitation.
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J Am Soc Echocardiogr · Jan 1990
Flow velocity acceleration in the left ventricle: a useful Doppler echocardiographic sign of hemodynamically significant mitral regurgitation.
Doppler echocardiography is a sensitive method to detect mitral regurgitation in patients with both native and prosthetic valves. However, estimates of the amount of mitral regurgitation remain semiquantitative, and even severe mitral regurgitation may be underestimated in the presence of markedly eccentric regurgitant jets or acoustic shadowing of the left atrium by mitral or aortic prostheses. This report describes the Doppler findings in 10 patients with severe native valve mitral regurgitation (angiographic grade III or IV) and in 15 patients with severe bioprosthetic mitral regurgitation that required valve replacement. ⋯ A similar flow signal was not recorded in the left ventricle of any individual in a control group of 30 patients who had no mitral regurgitation or who had angiographic grade I or II mitral regurgitation. These findings suggest that acceleration of left ventricle flow toward the mitral valve in systole is only recorded when there is hemodynamically significant mitral regurgitation that is approximately equal to angiographic grade III or IV. Recognition of this Doppler finding may help in the estimation of mitral regurgitation severity, especially in difficult diagnostic situations.
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J Am Soc Echocardiogr · Sep 1989
Left atrial systolic antegrade flow in patients with mitral regurgitation: a pulsed Doppler sign displayed by color flow imaging.
Twenty-two patients with severe mitral regurgitation were observed to have turbulent systolic antegrade flow on pulsed Doppler mapping of the left atrium. All were studied by color flow imaging to delineate the mechanism of this peculiar flow. Pulsed Doppler findings of an eccentric regurgitant flow in one side, an antegrade systolic flow with slightly delayed onset in the other side, and a low velocity flow near the posterior wall, were consistant with the theory of a large eccentric regurgitant jet swirling in the left atrium. ⋯ The other three patients had deformed rheumatic mitral valve. The severity of mitral regurgitation was confirmed in all 16 patients studied by left ventricular cineangiography. We have shown that the antegrade systolic left atrial flow is the result of the swirling of a large regurgitant eccentric jet, is commonly observed with flail mitral valve, can occur in patients with deformed rheumatic mitral valve without flail leaflet, and most significantly indicates the presence of severe mitral regurgitation.
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J Am Soc Echocardiogr · May 1989
Comparative StudyComparison of several noninvasive methods for estimation of pulmonary artery pressure.
Noninvasive estimation of pulmonary artery pressure is an important component of cardiac ultrasound studies. A number of methods are available for estimation of pulmonary pressure, each with varying degrees of reported accuracy. To assess feasibility and accuracy, noninvasive pulmonary artery pressure estimates were performed in infants and children at the time of catheterization. ⋯ For diastolic pressure estimation, systolic time interval records were the most difficult to obtain and did not provide useful accuracy. In contrast, pulmonary regurgitation velocities were easily obtained and provided high accuracy results. This is a selected pediatric series, evaluating methods in nearly ideal circumstances.(ABSTRACT TRUNCATED AT 400 WORDS)
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J Am Soc Echocardiogr · Nov 1988
Reliability of M-mode, two-dimensional and Doppler echocardiography in diagnosing a flail mitral valve leaflet.
The purpose of this study was to evaluate the M-mode, two-dimensional, and Doppler echocardiographic signs for a flail mitral valve leaflet. This was a retrospective evaluation of 54 patients who had (1) significant mitral regurgitation, (2) a technically adequate echocardiographic study, and (3) description of valve anatomy done at surgery or necropsy. The following M-mode signs were examined for their ability to detect a flail valve: (1) systolic flutter of the mitral valve closure line, sensitivity 29%, specificity 76%; (2) abnormal diastolic posterior leaflet motion, sensitivity 73%, specificity 71%; (3) abnormal diastolic anterior leaflet motion, sensitivity 67%, specificity 86%; (4) systolic atrial echoes, sensitivity 28%, specificity 68%; (5) multiple independent systolic closure lines, sensitivity 71%, specificity 52%. ⋯ When all the two-dimensional signs except systolic whipping and the M-mode signs for abnormal diastolic leaflet motion were combined, the sensitivity for detecting a flail mitral valve was maximized at 97%, but specificity was reduced to 64%. In conclusion, two-dimensional echocardiographic signs are more sensitive and specific than either M-mode or Doppler signs for detecting a flail mitral valve. The various M-mode, two-dimensional, and Doppler echocardiographic signs, however, are complementary to each other, and sensitivity is maximized when they are combined.