1.Usefulness of Pressure Half Time by Pulse Doppler Ultrasound in Evaluation of the Severity of Mitral Stenosis.
Korean Circulation Journal 1987;17(3):419-425
Twenty-seven patients with moderate or severe mitral stenosis (MS) were studied by cardiac catheterization and angiography, 2-dimensional (2-D) echocardiography and Doppler echocardiography to assess the ability of Doppler ultrasound to accurately measure mitral valve orifice area and to assess whether mitral regurgitation (MR) affected the calculation. Mitral valve area by Doppler was determined by the pressure half time method. There were good correlation between 2-D & Doppler echocardiography (r=0.84) and between cardiac catheterization & Doppler echocardiography (r=0.83) regardless of the presence of MR. It is concluded that the Doppler echocardiography provides a simple, accurate, useful noninvasive method for the estimation of mitral valve area in patients with MS even in the presence of complicating MR.
Angiography
;
Cardiac Catheterization
;
Cardiac Catheters
;
Echocardiography
;
Echocardiography, Doppler
;
Humans
;
Mitral Valve
;
Mitral Valve Insufficiency
;
Mitral Valve Stenosis*
;
Ultrasonography*
2.Echocardiographic Follow-up Assessment of Mitral Valve Structure and Function in Patients Followed for 3 Months after Percutaneous Balloon Mitral Valvuloplasty.
Seung Jung PARK ; Seung Yun CHO ; Won Heum SHIM ; Woong Ku LEE ; Sung Soon KIM ; Seung Jea TAHK ; Kyung Kwon BAIK
Korean Circulation Journal 1989;19(2):255-263
Two-dimensional and Doppler echocardiographic examination were obtained in 31 patients both immediately and 2 to 5 months(mean3.1+/-1.8) after balloon dilation. Mitral valve area by planimetry immediately after valvuloplasty measured 1.8+/-0.3cm2 and 1.7+/-0.3cm2 at 2-5 months follow-up, but the difference was satistically insignificant. More than 15% decrease of the mitral valve area at follow-up was noticed in 10 patients(32%), but the valve area at follow-up was >1.5cm2 in all patients. Left atrial size(antero-posterior diameter) and volume by 2-dimensional echocardiography decreased more remarkably from 4.4+/-0.7cm, 82+/-42cm3 immediatly after vavuloplasty to 4.2+/-0.7cm, 68+/-26cm2 at follow-up respectively but there was no statistical significance. Mitral regurgitation graded by pulsed Doppler ultrasound decreased from 1.6+/-0.7 immediatly after valvuloplasty to 1.3+/-0.5(p<0.09) at follow-up, but there was no significant change in peak E velocity, EF slope, fractional shortening and ejection fraction. Symptomatic improvement at follow-up occured in all but one patient. Thus, 2 to 5 months after balloon mitral valvuloplasty there was no significantly after valvuloplasty decreased slightly at follow-up.
Echocardiography*
;
Follow-Up Studies*
;
Humans
;
Mitral Valve Insufficiency
;
Mitral Valve*
;
Ultrasonography
3.Congenital Double-Orifice Mitral Valve with Mitral Regurgitation due to Flail Leaflet in an Elderly Patient.
Shin Jae KIM ; Eun Seok SHIN ; Sang Gon LEE
The Korean Journal of Internal Medicine 2005;20(3):251-254
We report here on a case of double-orifice mitral valve with mitral regurgitation in a 75-year-old female who had complaints of mild dyspnea. Transthoracic and transesophageal echocardiography showed two orifices that were supplied by their own chordae from a different papillary muscle. Color Doppler echocardiography revealed moderate to severe mitral regurgitation due to the flail posterior leaflet of the anterolateral orifice. Except for the persistent left superior vena cava, no other congenital anomaly was demonstrated. The patient became asymptomatic with the administration of angiotensin-converting enzyme inhibitor and diuretics, and she has been scheduled for long term follow-up.
Papillary Muscles/abnormalities/ultrasonography
;
Mitral Valve Insufficiency/*etiology/ultrasonography
;
Mitral Valve/*abnormalities/ultrasonography
;
Humans
;
Female
;
Echocardiography, Doppler, Color
;
Chordae Tendineae/abnormalities/ultrasonography
;
Aged
4.Tearing of the Mitral Valve during Vent Removal after a Successful Mitral Valve Repair: a Beneficial Role of Transesophageal Echocardiography.
Ji Young KIM ; Young Jun OH ; Yong Kyung LEE ; Young Lan KWAK
Yonsei Medical Journal 2006;47(3):440-442
In this case, a successful mitral valve repair was confirmed by transesophageal echocardiography (TEE) at the end of a cardiopulmonary bypass. The left ventricular vent was placed through the mitral valve to remove the air after the TEE examination, and on its way out, the left ventricular vent damaged the anterior mitral leaflet (AML). Re-examination of the valve with TEE detected the new mitral valve insufficiency. The CPB was reinstituted, and tearing of the lateral third part of the anterior mitral leaflet was found. This case emphasizes the importance of TEE in the operating room as a continuous monitor, not only to evaluate the result of the cardiac surgery, but also to detect any unpredictable events during the surgery.
Mitral Valve Insufficiency/*surgery/*ultrasonography
;
Mitral Valve/*injuries/surgery
;
Middle Aged
;
Intraoperative Complications/surgery
;
Humans
;
Female
;
*Echocardiography, Transesophageal
;
Cardiopulmonary Bypass/*adverse effects
5.Prompt diagnosis of ST-elevation myocardial infarction with papillary muscle rupture by point-of-care ultrasound in the emergency department.
Koon Ho CHEUNG ; Colin Graham ALEXANDER
Clinical and Experimental Emergency Medicine 2017;4(3):178-181
A previously healthy 61-year-old man presented to the emergency department with chest pain and dyspnoea for 6 hours. Examination revealed distress with an apical pansystolic murmur. Initial electrocardiogram showed sinus tachycardia and ST elevation in leads II, III, and aVF compatible with an inferior ST-elevation myocardial infarction. Point-of-care echocardiography in the emergency department showed a flail anterior mitral leaflet and severe mitral regurgitation, leading to a provisional diagnosis of papillary muscle rupture. Emergency cardiac catheterization showed 100%, 80%, and 70% occlusion of the middle right coronary, left anterior descending, and left circumflex arteries, respectively. An emergency triple vessel coronary artery bypass grafting and mitral valve replacement was performed. Posteromedial papillary muscle rupture resulting in mitral regurgitation was confirmed intraoperatively. The patient recovered uneventfully. In the absence of primary percutaneous coronary intervention, thrombolysis decisions should be made with extreme caution if mechanical complications of ST-elevation myocardial infarction are suspected.
Arteries
;
Cardiac Catheterization
;
Cardiac Catheters
;
Chest Pain
;
Coronary Artery Bypass
;
Diagnosis*
;
Echocardiography
;
Electrocardiography
;
Emergencies*
;
Emergency Service, Hospital*
;
Humans
;
Middle Aged
;
Mitral Valve
;
Mitral Valve Insufficiency
;
Myocardial Infarction*
;
Papillary Muscles*
;
Percutaneous Coronary Intervention
;
Point-of-Care Systems*
;
Rupture*
;
Tachycardia, Sinus
;
Ultrasonography*
6.Percutaneous mitral valve repair with MitraClip for severe functional mitral regurgitation.
Khung Keong YEO ; Zee Pin DING ; Yeow Leng CHUA ; Soo Teik LIM ; Kenny Yoong Kong SIN ; Jack Wei Chieh TAN ; Paul Toon Lim CHIAM ; Nian Chih HWANG ; Tian Hai KOH
Singapore medical journal 2013;54(1):e9-e12
A 67-year-old Chinese woman with comorbidities of chronic obstructive lung disease, hypertension and prior coronary artery bypass surgery presented with severe functional mitral regurgitation (MR) and severely depressed left ventricular function. She was in New York Heart Association (NYHA) Class II-III. Due to high surgical risk, she was referred for percutaneous treatment with the MitraClip valve repair system. This procedure is typically performed via the femoral venous system and involves a transseptal puncture. A clip is delivered to grasp the regurgitant mitral valve leaflets and reduce MR. This was performed uneventfully in our patient, with reduction of MR from 4+ to 1+. She was discharged on post-procedure Day 2 and her NYHA class improved to Class I. This was the first successful MitraClip procedure performed in Asia and represents a valuable treatment option in patients with severe MR, especially those with functional MR or those at high surgical risk.
Aged
;
Cardiac Surgical Procedures
;
methods
;
Cardiology
;
instrumentation
;
methods
;
Catheters
;
Echocardiography
;
methods
;
Equipment and Supplies
;
Female
;
Heart Ventricles
;
physiopathology
;
Humans
;
Mitral Valve
;
surgery
;
Mitral Valve Insufficiency
;
surgery
;
Pulmonary Disease, Chronic Obstructive
;
complications
;
Risk
;
Ultrasonography, Doppler
;
methods
;
Ventricular Dysfunction, Left
;
surgery
7.Echocardiography in Transcatheter Aortic Valve Implantation and Mitral Valve Clip.
The Korean Journal of Internal Medicine 2012;27(3):245-261
Transcatheter aortic valve implantation and transcatheter mitral valve repair (MitraClip) procedures have been performed worldwide. In this paper, we review the use of two-dimensional and three-dimensional transesophageal echo for guiding transcatheter aortic valve replacement and mitral valve repair.
Aged
;
Aged, 80 and over
;
Aortic Valve Stenosis/*therapy/*ultrasonography
;
Balloon Valvuloplasty
;
Bioprosthesis
;
*Cardiac Catheterization/adverse effects/instrumentation
;
*Echocardiography
;
Echocardiography, Doppler, Color
;
Echocardiography, Three-Dimensional
;
Echocardiography, Transesophageal
;
Heart Valve Prosthesis
;
Heart Valve Prosthesis Implantation/adverse effects/instrumentation/*methods
;
Humans
;
Mitral Valve Insufficiency/*therapy/*ultrasonography
;
Predictive Value of Tests
;
Prosthesis Design
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Severity of Illness Index
;
Surgical Instruments
;
Ultrasonography, Interventional/*methods
8.Comparison of Clinical and Echocardiographic Outcomes After Valve Repair: Degenerative Versus Rheumatic Mitral Regurgitation.
Jae Kwan SONG ; Hyun Sook KIM ; Jong Min SONG ; Duk Hyun KANG ; Hyun SONG ; Suk Jung CHOO ; Meong Gun SONG ; Jae Won LEE
Journal of Korean Medical Science 2003;18(3):344-348
We compared clinical (30+/-24 months) and echocardiographic follow-up (22 +/- 20 months) data of 184 consecutive patients with myxomatous degenerative mitral regurgitation (Group A) and 85 consecutive patients with rheumatic mitral regurgitation (Group B) after repair. Selection criteria for rheumatic etiology was predominant mitral regurgitation with valve area >or= 2.0 cm2 and with no significant calcification in valvular apparatus. Repair was successful in 93% of group A and in 92% of group B (p>0.05). There was no difference of operative mortality (1% vs 0%) and of the incidence of the second-pump valve replacement (4% vs 5%). The 4-yr survival, 4-yr event-free survival, and 4-yr mitral regurgitation-free survival rates in group A were 96 +/- 2%, 89 +/- 4%, and 76 +/- 5%, respectively, which were not different from those in group B (97 +/-2 %, 93 +/- 4%, and 68 +/-7 %, p >0.05). Independent determinants of development of at least moderate regurgitation in group A were no use of ring annuloplasty (hazards ratio 6.6, 95% CI 2.0 to 21.5) and new chordae formation (hazards ratio 3.5, 95% CI 1.4 to 8.7). In group B, no use of ring annuloplasty (hazards ratio 15.3, 95% CI 3.5 to 66.7) also was independent predictor. Valve repair is highly feasible in selected patients with rheumatic mitral regurgitation, and clinical course is not significantly different from that of patients with degenerative mitral regurgitation.
Adult
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Comparative Study
;
Disease-Free Survival
;
*Echocardiography
;
Female
;
Follow-Up Studies
;
Human
;
Male
;
Middle Aged
;
Mitral Valve Insufficiency/etiology/mortality/*surgery/*ultrasonography
;
Rheumatic Heart Disease/mortality/*surgery/*ultrasonography
;
Survival Analysis
;
Treatment Outcome
9.Unilateral Pulmonary Edema: A Rare Initial Presentation of Cardiogenic Shock due to Acute Myocardial Infarction.
Jeong Hun SHIN ; Seok Hwan KIM ; Jinkyu PARK ; Young Hyo LIM ; Hwan Cheol PARK ; Sung Il CHOI ; Jinho SHIN ; Kyung Soo KIM ; Soon Gil KIM ; Mun K HONG ; Jae Ung LEE
Journal of Korean Medical Science 2012;27(2):211-214
Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.
Acute Disease
;
Aged
;
Coronary Angiography
;
Diagnosis, Differential
;
Heart Atria/ultrasonography
;
Heart Failure/diagnosis/etiology
;
Humans
;
Male
;
Mitral Valve Insufficiency/ultrasonography
;
Myocardial Infarction/complications/*diagnosis/therapy
;
Pulmonary Edema/*diagnosis/etiology/therapy
;
Shock, Cardiogenic/*diagnosis/etiology/therapy
;
Tomography, X-Ray Computed
10.Tissue Doppler-derived E/e' ratio as a parameter for assessing diastolic heart failure and as a predictor of mortality in patients with chronic kidney disease.
Min Keun KIM ; Biro KIM ; Jun Young LEE ; Jae Seok KIM ; Byoung Geun HAN ; Seung Ok CHOI ; Jae Won YANG
The Korean Journal of Internal Medicine 2013;28(1):35-44
BACKGROUND/AIMS: Diastolic dysfunction occurs frequently in patients with chronic kidney disease (CKD) and is associated with heart failure (HF) or mortality. We investigated whether the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e' ratio), estimated using tissue Doppler imaging, has prognostic value for cardiovascular morbidity and all-cause mortality in patients with CKD. METHODS: For 186 patients with CKD of stages III to V, we obtained echocardiograms with tissue Doppler imaging. A 5-year follow-up of 136 patients was performed based on hospital records and telephone interviews. The enrolled patients (79 males and 57 females) were categorized into the following CKD subgroups: stage III (n = 25); stage IV (n = 22); and stage V (n = 89). RESULTS: The average follow-up period was 30.45 months and the mean age of the patients was 61.13 years. The mortality rate after 5 years was 60.0%. The causes of death were: sepsis, 21.9%; HF, 16.2%; and sudden death, 15.2%. Age (p = 0.000), increased C-reactive protein level (p = 0.018), and increased E/e' ratio (p = 0.048) were found to correlate with mortality. Age (p = 0.000), decreased ejection fraction (p = 0.003), and increased E/e' ratio (p = 0.045) correlated with cardiovascular event. CONCLUSIONS: The E/e' ratio can predict mortality and cardiovascular events in patients with CKD who have diastolic dysfunction.
Aged
;
Chi-Square Distribution
;
*Echocardiography, Doppler
;
Female
;
Glomerular Filtration Rate
;
Heart Failure, Diastolic/*mortality/physiopathology/*ultrasonography
;
Humans
;
Incidence
;
Kaplan-Meier Estimate
;
Kidney/physiopathology
;
Linear Models
;
Male
;
Middle Aged
;
Mitral Valve/physiopathology/ultrasonography
;
Predictive Value of Tests
;
Prognosis
;
Proportional Hazards Models
;
ROC Curve
;
Renal Insufficiency, Chronic/diagnosis/*mortality/physiopathology
;
Republic of Korea/epidemiology
;
Risk Assessment
;
Risk Factors
;
Stroke Volume
;
Time Factors
;
Ventricular Function, Left