Mitral annular calcification predicts immediate results of percutaneous transvenous mitral commissurotomy

<p>Abstract</p> <p>Background</p> <p>Many previous studies have evaluated the impact of mitral valve (MV) deformity scores on the percutaneous transvenous mitral commissurotomy (PTMC) outcome in patients with mitral stenosis; however, the relationship between mitral annulus calcification (MAC) and the PTMC result has not yet been established. The current study aimed to investigate whether MAC could independently influence the immediate result of PTMC.</p> <p>Methods</p> <p>Of all patients undergoing PTMC in our institution between April 2005 and November 2009, we included 87 patients (28.7%male, mean ± SD age = 42.8 ± 12.6 years) with rheumatic mitral stenosis who had additional data on the echocardiographic evaluation of MAC along with MV leaflets morphology. Echocardiographic assessments were repeated up to six weeks after PTMC to evaluate the immediate PTMC outcome. The frequency of the optimal PTMC result (secondary MV area > = 1.5 cm²with > = 25% increase and without final mitral regurgitation grade > 2) was compared between two groups of patients with MAC (n = 17) and those without MAC (n = 70).</p> <p>Results</p> <p>The optimal result was obtained in 55 (63.2%) patients, whereas the result was suboptimal in 32 (36.8%) patients due to insufficient MV area increase in 31(96.9%) subjects and post-procedure mitral regurgitation grade > 2 in 1(3.1%). The rate of optimal PTMC results was less in patients with MAC in comparison to those without MAC (29.4% vs.71.4%). After adjustments for possible confounders such as age and leaflets morphological subcomponents (thickening, mobility, calcification, and subvalvular thickening), MAC remained a significant negative predictor of a suboptimal PTMC result (odds ratio = 0.154; 95%CI = 0.038-0.626, p value = 0.009) together with leaflet thickening (odds ratio = 0.214; 95%CI = 0.060-0.770, p value = 0.018).</p> <p>Conclusions</p> <p>MAC appeared to independently influence the immediate result of PTMC; therefore, mitral annulus evaluation may be considered in the echocardiographic assessment of the mitral apparatus prior to PTMC.</p

Late Diagnosis of Large Left Ventricular Pseudoaneurysm after Mitral Valve Replacement and Coronary Artery Bypass Surgery by Real-Time Three-Dimensional Echocardiography

One of the most serious complications of mitral valve replacement is left ventricular rupture and pseudoaneurysm formation, which is rare but potentially lethal. We herein present a late type of post mitral valve replacement and coronary artery bypass surgery pseudoaneurysm in a 74-year-old female, who was admitted to our hospital with a recent history of exertional dyspnea. She had the above-mentioned operation 10 months before. The diagnosis was made via two-dimensional and real-time three-dimensional transthoracic echocardiography. The prosthetic mitral valve was removed, and the large orifice of the pseudoaneurysm was closed by surgery. At one year's follow-up, the patient was in good condition

Assessment of Left Ventricular Dyssynchrony in Heart Failure Patients Regarding Underlying Etiology and QRS Duration

Background: Left ventricular (LV) dyssynchrony is a prevalent feature in heart failure (HF) patients. The current study aimed to evaluate the prevalence of inter and intraventricular dyssynchrony in HF patients with regard to the QRS duration and etiology. Methods: The available data on the tissue Doppler imaging (TDI) of 230 patients with refractory HF were analyzed. The patients were divided into three groups according to the QRS duration: QRS duration &amp;lt; 120 ms; 120-150 ms; and &amp;ge; 150 ms and the patients were re-categorized into two subgroups depending on the underlying etiology: ischemic cardiomyopathy (ICM) or dilated cardiomyopathy (DCM). The time-to-peak myocardial sustained systolic velocity (Ts) in six basal and six middle segments of the LV was measured manually using the velocity curves from TDI. LV dyssynchrony was defined as interventricular mechanical delay &amp;ge; 40 ms and tissue Doppler velocity all segments delay &amp;ge; 105 ms; standard deviation (SD) of all segments &amp;ge; 34.4 ms; basal segments delay &amp;ge; 78 ms; SD of basal segments &amp;ge; 34.5 ms; and opposing wall delay &amp;ge; 65 ms. Results: After adjustment for the possible confounders, interventricular dyssynchrony was more prevalent in the patients with QRS duration &amp;ge; 150 ms than in those with QRS duration 120-150 ms and &amp;lt; 120 ms. The patients with DCM also had a higher percentage of interventricular dyssynchrony than those with ICM in the wide QRS groups. Turning to the intraventricular dyssynchrony indices, the patients with QRS duration &amp;ge; 150 ms and 120-150 ms revealed a significantly greater delay between Ts at the basal and all segments than did those with QRS duration &amp;lt; 120 ms, while etiology did not influence the frequency of these indices in each QRS group. Conclusion: The prevalence of both inter and intraventricular dyssynchrony indices was greater in the patients with wide QRS than in those with narrow QRS duration. The underlying etiology may affect the frequency of interventricular but not intraventricular dyssynchrony indices