Echocardiographic assessment of degenerative mitral stenosis: a diagnostic challenge of an Eemerging cardiac disease

Degenerative mitral stenosis (DMS) is characterized by decreased mitral valve (MV) orifice area and increased transmitral pressure gradient due to chronic noninflammatory degeneration and subsequent calcification of the fibrous mitral annulus and the MV leaflets. The “true” prevalence of DMS in the general population is unknown. DMS predominantly affects elderly individuals, many of whom have multiple other comorbidities. Transcatheter MV replacement techniques, although their long-term outcomes are yet to be tested, have been gaining popularity and may emerge as more effective and relatively safer treatment option for patients with DMS. Echocardiography is the primary imaging modality for evaluation of DMS and related hemodynamic abnormalities such as increased transmitral pressure gradient and pulmonary arterial pressure. Classic echocardiographic techniques used for evaluation of mitral stenosis (pressure half time, proximal isovelocity surface area, continuity equation, and MV area planimetry) lack validation for DMS. Direct planimetry with 3-dimensional echocardiography and color flow Doppler is a reasonable technique for determining MV area in DMS. Cardiac computed tomography is an essential tool for planning potential interventions or surgeries for DMS. This article reviews the current concepts on mitral annular calcification and its role in DMS. We then discuss the epidemiology, natural history, differential diagnosis, mechanisms, and echocardiographic assessment of DMS

Use of a guiding catheter for contralateral femoral artery angioplasty

We describe a unique method employing a transseptal sheath as a “guiding catheter” that allows contralateral retrograde femoral artery access to perform balloon angioplasty of proximal superficial femoral artery lesions. This technique simplifies arterial access, provides support for crossing lesions, and allows angiographic visualization of target lesions during the procedure

Percutaneous coronary angioscopy in patients with restenosis after coronary angioplasty

Percutaneous transluminal coronary angioscopy with a flexible steerable microangioscope was performed in five patients undergoing repeat angioplasty. Recurrent lesions were assessed by angioscopy before and after the angioplasty procedure. The most common surface morphology observed in these restenosis lesians was that of white unpigmented lesions consistent with the proliferation of fibrous tissue. Also noted during angioscopy was the presence or absence of thrombus or dissection in association with the lesions either before or after angioplasty. Filmy wisps of tissue, presumably intimal flaps, were commonly visualized after angioplasty. There were no complications related to angioscopy or angioplasty in these patients. The surface morphology of restenosis lesions appears to be different from that of primary atherosclerotic lesions. The lesions in these five patients with restenosis were generally white and fibrotic in appearance, as opposed to the pigmented yellow to yellow-brown lesions commonly seen in undilated atherosclerotic lesions. It was also noted that the presence of intracoronary thrombus was strongly associated with the clinical syndrome of unstable angina. These findings support the hypothesis that restenosis lesions are the result of a reparative process consisting of smooth muscle cell proliferation and fibrosis

Morphologic comparison of atherosclerotic lesions in native coronary arteries and saphenous vein graphs with intracoronary angioscopy in patients with unstable angina

Coronary vein grafts develop accelerated atherosclerosis after aortocoronary bypass surgery. Previous pathologic studies have suggested that the morphologic appearance of atherosclerotic lesions in saphenous vein grafts may have subtle differences compared with those of native coronary arteries and may be more prone to disruption and thrombus formation. However, a comparative in vivo assessment of the angioscopic morphology differences between these two types of vessels has not been reported previously. We compared the angioscopic lesion morphology of native coronary arteries and saphenous vein grafts in patients with unstable angina