Relation of mitral valve morphology and motion to mitral regurgitation severity in patients with mitral valve prolapse

<p>Abstract</p> <p>Background</p> <p>Mitral valve thickness is used as a criterion to distinguish the classical from the non-classical form of mitral valve prolapse (MVP). Classical form of MVP has been associated with higher risk of mitral regurgitation (MR) and concomitant complications. We sought to determine the relation of mitral valve morphology and motion to mitral regurgitation severity in patients with MVP.</p> <p>Methods</p> <p>We prospectively analyzed transthoracic echocardiograms of 38 consecutive patients with MVP and various degrees of MR. In the parasternal long-axis view, leaflets length, diastolic leaflet thickness, prolapsing depth, billowing area and non-coaptation distance between both leaflets were measured.</p> <p>Results</p> <p>Twenty patients (53%) and 18 patients (47%) were identified as having moderate to severe and mild MR respectively (ERO = 45 ± 27 mm²vs. 5 ± 7 mm², p < 0.001). Diastolic leaflet thickness was similar in both groups (5.5 ± 0.9 mm vs. 5.3 ± 1 mm, p = 0.57). On multivariate analysis, the non-coaptation distance (OR 7.9 per 1 mm increase; 95% CI 1.72-37.2) was associated with significant MR. Thick mitral valve leaflet as traditionally reported (≥ 5 mm) was not associated with significant MR (OR 0.9; 95% CI 0.2-3.4).</p> <p>Conclusions</p> <p>In patients with MVP, thick mitral leaflet is not associated with significant MR. Leaflet thickness is probably not as important in risk stratification as previously reported in patients with MVP. Other anatomical and geometrical features of the mitral valve apparatus area appear to be much more closely related to MR severity.</p

Surge models as providers of improved "Inverse Barometer Corrections" for coastal altimetry users

The observation ofrising mean sea levels over the Earth's oceans using satellite altimetry has helped infolID and shape the debate on global climate change that has emerged over the last 2 decades (Cazenave and Nerem 2004; Bindoff et al. 2007). The ongoing monitoring of secular changes in global mean sea level with accuracy tolerances of better than I nun/year remains a fundamental science goal within satellite altimetl), and represents one of the most challenging objectives in space geodesy. Central to this objective has been the recognition that calibration and validation (cal/val) are vital components of the altimeter measurement system technique. Cal/val defines a multidisciplinary problem in and of itself, which pushes the limits of available ten'estrial, oceanographic, and space-based observational techniques

Influence of non-linear effects upon surge elevations along the west coast of Britain

Abstract: A two-dimensional vertically integrated hydrodynamic finite-element model of the west coast of Britain is used to examine the response of the region to extreme meteorological forcing. The extent to which tide-surge interaction modifies the computed surge elevation and current distributions is examined in detail. The nature of the finite-element model with its ability to refine the mesh in nearshore regions is ideal for examining the influence of non-linear effects upon surges in these regions. Calculations using spatially uniform orthogonal wind stresses show that the surge elevation and current in shallow water are particularly sensitive to the method used to remove the tide as a result of the highly non-linear nature of the tide-surge interaction in these regions. The most accurate means of de-tiding the solution is by subtracting a tide derived by harmonic analysis of the tide and surge time series at the time of the surge. Subtracting a tide-only solution (the usual approach) leads to tidal energy leaking into the surge solution. Calculations show that this arises because the surge modifies the tidal amplitude and phase in shallow-water regions to such an extent that they are appreciably different to those found in the tide-only calculation. Results suggest that this problem becomes more important, as nearshore meshes are refined in an attempt to improve surge prediction. This suggests that in the future, highly accurate fine-mesh models will be required to compute total water levels without the present linear separation into tidal and surge signal used in operational surge prediction

Influence of sea surface wind wave turbulence upon wind-induced circulation, tide–surge interaction and bed stress

A three-dimensional finite volume unstructured mesh model of the west coast of Britain, with high resolution in the coastal regions, is used to investigate the role of wind wave turbulence and wind and tide forced currents in producing maximum bed stress in the eastern Irish Sea. The spatial distribution of the maximum bed stress, which is important in sediment transport problems, is determined, together with how it is modified by the direction of wind forced currents, tide–surge interaction and a surface source of wind wave turbulence associated with wave breaking. Initial calculations show that to first order the distribution of maximum bed stress is determined by the tide. However, since maximum sediment transport occurs at times of episodic events, such as storm surges, their effects upon maximum bed stresses are examined for the case of strong northerly, southerly and westerly wind forcing. Calculations show that due to tide–surge interaction both the tidal distribution and the surge are modified by non-linear effects. Consequently, the magnitude and spatial distribution of maximum bed stress during major wind events depends upon wind direction. In addition calculations show that a surface source of turbulence due to wind wave breaking in shallow water can influence the maximum bed stress. In turn, this influences the wind forced flow and hence the movement of suspended sediment. Calculations of the spatial variability of maximum bed stress indicate the level of measurements required for model validation