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Patrizio Lancellotti - One of the best experts on this subject based on the ideXlab platform.
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recommendations for the echocardiographic assessment of native valvular Regurgitation an executive summary from the european association of cardiovascular imaging
European Journal of Echocardiography, 2013Co-Authors: Patrizio Lancellotti, Bogdan A. Popescu, Christophe Tribouilloy, Andreas Hagendorff, Thor Edvardsen, Luc Pierard, Luigi P Badano, Jose Luis ZamoranoAbstract:Valvular Regurgitation represents an important cause of cardiovascular morbidity and mortality. Echocardiography has become the primary non-invasive imaging method for the evaluation of valvular Regurgitation. The echocardiographic assessment of valvular Regurgitation should integrate the quantification of the Regurgitation, assessment of the valve anatomy and function, as well as the consequences of valvular disease on cardiac chambers. In clinical practice, the management of patients with valvular Regurgitation thus largely integrates the results of echocardiography. It is crucial to provide standards that aim at establishing a baseline list of measurements to be performed when assessing Regurgitation.
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impact of prosthesis patient mismatch on mitral Regurgitation after aortic valve replacement
Heart, 2010Co-Authors: Philippe Unger, Julien Magne, F Vanden Eynden, Daniele Plein, G Van Camp, Agnes Pasquet, Bernard Cosyns, Chantal Dedobbeleer, Patrizio LancellottiAbstract:Background Mitral Regurgitation is frequently observed in patients undergoing aortic valve replacement (AVR) for aortic stenosis and often improves postoperatively, mainly due to left ventricular remodelling and changes in loading conditions. Aortic prosthesis-patient mismatch (PPM) is associated with poor outcome and lesser left ventricular remodelling. This study tested the hypothesis that aortic PPM affects mitral Regurgitation. Methods and results Echocardiography was performed preoperatively and before discharge in 42 patients with aortic stenosis undergoing isolated AVR and presenting mitral Regurgitation with an effective regurgitant orifice (ERO) of 10 mm(2) or greater, as assessed by the proximal isovelocity surface area method. Postoperatively, mitral ERO and the regurgitant volume decreased from 16 +/- 5 mm(2) to 12 +/- 6 mm(2) (p<0.001) and from 28 +/- 8 ml to 16 +/- 9 ml (p<0.0001), respectively. PPM (indexed effective prosthetic valve area (EOAi) <= 0.85 cm(2)/m(2)), present in 23 patients (55%), was associated with a smaller decrease in regurgitant volume (p=0.0025) and ERO (p=0.02). A functional aetiology of mitral Regurgitation was associated with a larger improvement in mitral Regurgitation. In the whole cohort, EOAi correlated with the changes in mitral Regurgitation severity (ERO r=0.44, p-0.01; regurgitant volume r-0.47, p-0.003). However, these relationships were no longer significant in the subset of patients with functional mitral Regurgitation in whom mitral Regurgitation changes were mainly related to postoperative changes in mitral valve deformation. Conclusions The presence of PPM after AVR attenuates postoperative mitral Regurgitation changes, mainly in patients with organic mitral Regurgitation.
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european association of echocardiography recommendations for the assessment of valvular Regurgitation part 2 mitral and tricuspid Regurgitation native valve disease
European Journal of Echocardiography, 2010Co-Authors: Patrizio Lancellotti, Bogdan A. Popescu, Christophe Tribouilloy, Andreas Hagendorff, Luc Pierard, Uis L Moura, Eustachio Agricola, Jeanluc Monin, Rosa Sicari, Alec VahanianAbstract:Valvular Regurgitation represents an important cause of cardiovascular morbidity and mortality. Echocardiography has become the primary non-invasive imaging method for the evaluation of valvular Regurgitation. The echocardiographic assessment of valvular Regurgitation should integrate quantification of the Regurgitation, assessment of the valve anatomy, and function as well as the consequences of valvular disease on cardiac chambers. In clinical practice, the management of patients with valvular Regurgitation thus largely integrates the results of echocardiography. It is crucial to provide standards that aim at establishing a baseline list of measurements to be performed when assessing Regurgitation.
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European Association of Echocardiography recommendations for the assessment of valvular Regurgitation. Part 1: aortic and pulmonary Regurgitation (native valve disease).
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2010Co-Authors: Patrizio Lancellotti, Bogdan A. Popescu, Christophe Tribouilloy, Andreas Hagendorff, Luc Pierard, Luigi P Badano, Eustachio Agricola, Jeanluc Monin, Luis Moura, Jose Luis ZamoranoAbstract:Valvular Regurgitation represents an important cause of cardiovascular morbidity and mortality. Echocardiography has become the primary non-invasive imaging method for the evaluation of valvular Regurgitation. The echocardiographic assessment of valvular Regurgitation should integrate quantification of the Regurgitation, assessment of the valve anatomy, and function as well as the consequences of valvular disease on cardiac chambers. In clinical practice, the management of patients with valvular Regurgitation thus largely integrates the results of echocardiography. It is crucial to provide standards that aim at establishing a baseline list of measurements to be performed when assessing Regurgitation.
Mubashir Mumtaz - One of the best experts on this subject based on the ideXlab platform.
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transcatheter aortic valve replacement in patients with severe mitral or tricuspid Regurgitation at extreme risk for surgery
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Stephen H Little, Jeffrey J Popma, Neal S Kleiman, Michael G Deeb, Thomas G Gleason, Steven J Yakubov, Stan Checuti, Daniel Ohair, Tanvir Bajwa, Mubashir MumtazAbstract:Abstract Objectives Patients with symptomatic severe aortic stenosis and severe mitral Regurgitation or severe tricuspid Regurgitation were excluded from the major transcatheter aortic valve replacement trials. We studied these 2 subgroups in patients at extreme risk for surgery in the prospective, nonrandomized, single-arm CoreValve US Expanded Use Study. Methods The primary end point was all-cause mortality or major stroke at 1 year. A favorable medical benefit was defined as a Kansas City Cardiomyopathy Questionnaire overall summary score greater than 45 at 6 months and greater than 60 at 1 year and with a less than 10-point decrease from baseline. Results There were 53 patients in each group. Baseline characteristics for the severe mitral Regurgitation and severe tricuspid Regurgitation cohorts were age 84.2 ± 6.4 years and 84.9 ± 6.5 years; male, 29 (54.7%) and 22 (41.5%), and mean Society of Thoracic Surgeons score 9.9% ± 5.0% and 9.2% ± 4.0%, respectively. Improvement in valve Regurgitation from baseline to 1 year occurred in 72.7% of the patients with severe mitral Regurgitation and in 61.8% of patients with severe tricuspid Regurgitation. A favorable medical benefit occurred in 31 of 47 patients (66.0%) with severe mitral Regurgitation and 33 of 47 patients (70.2%) with severe tricuspid Regurgitation at 6 months, and in 25 of 44 patients (56.8%) with severe mitral Regurgitation and 24 of 45 patients (53.3%) with severe tricuspid Regurgitation at 1 year. All-cause mortality or major stroke for the severe mitral Regurgitation and severe tricuspid Regurgitation cohorts were 11.3% and 3.8% at 30 days and 21.0% and 19.2% at 1 year, respectively. There were no major strokes in either group at 1 year. Conclusions Transcatheter aortic valve replacement in patients with severe mitral Regurgitation or severe tricuspid Regurgitation is reasonable and safe and leads to improvement in atrioventricular valve Regurgitation.
Hartzell V. Schaff - One of the best experts on this subject based on the ideXlab platform.
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Functional tricuspid Regurgitation at the time of mitral valve repair for degenerative leaflet prolapse: the case for a selective approach.
The Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: Oguz Yilmaz, Richard C. Daly, Joseph A. Dearani, Harold M. Burkhart, Thoralf M. Sundt, Rakesh M. Suri, Maurice Enriquez-sarano, Hartzell V. SchaffAbstract:Objectives It is not clear whether clinically silent tricuspid valve Regurgitation should be addressed at the time of mitral valve repair for severe mitral Regurgitation due to leaflet prolapse. We examined the clinical and echocardiographic outcomes of patients with tricuspid Regurgitation who underwent only mitral valve repair. Methods We retrospectively analyzed records of patients undergoing mitral valve repair for isolated mitral valve prolapse who had coexistent tricuspid valve Regurgitation during an 11-year period at our institution. Echocardiographic data were compared preoperatively, intraoperatively, and postoperatively at less than 1, 1 to 3, 3 to 5, and more than 5 years. Results In 699 patients who underwent mitral valve repair for severe mitral Regurgitation, mean age was 60.4 years and 459 (66%) were male. At the time of mitral valve repair, tricuspid valve Regurgitation was grade 3 or more in 115 (16%) patients and less than grade 3 in 584 (84%) patients. After mitral valve repair, overall grade of tricuspid valve Regurgitation decreased significantly within the first year (P = .01). In patients with grade 3 Regurgitation or more, the grade decreased at dismissal and until the third year (P Conclusions Clinically silent nonsevere tricuspid valve Regurgitation in patients with degenerative mitral valve disease is unlikely to progress after mitral valve repair. Tricuspid valve surgery is rarely necessary for most patients undergoing repair of isolated mitral valve prolapse.
David H Adams - One of the best experts on this subject based on the ideXlab platform.
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tricuspid valve repair for treatment and prevention of secondary tricuspid Regurgitation in patients undergoing mitral valve surgery
Current Cardiology Reports, 2008Co-Authors: Ani C Anyanwu, Joanna Chikwe, David H AdamsAbstract:Secondary or functional tricuspid Regurgitation occurring late after mitral valve surgery is associated with high morbidity and mortality. In this article, we review the pathophysiology of secondary tricuspid Regurgitation and the evidence supporting the use of tricuspid valve annuloplasty for preventing and treating secondary tricuspid Regurgitation. Liberal application of tricuspid valve annuloplasty is recommended to prevent progression of secondary Regurgitation, as contrary to widely held opinion, fixing the left-sided valve dysfunction often does not resolve secondary tricuspid valve dysfunction. Based on existing literature, assessing the tricuspid valve annular dimensions can be recommended as part of all mitral valve operations, and annuloplasty strongly considered in patients with tricuspid annular dilatation or moderate to severe tricuspid Regurgitation.
J. Smrcek - One of the best experts on this subject based on the ideXlab platform.
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Longitudinal observations in normally grown fetuses with tricuspid valve Regurgitation: report of 22 cases.
Prenatal Diagnosis, 1999Co-Authors: J. Smrcek, Ulrich GembruchAbstract:Longitudinal observations of tricuspid valve Regurgitation were prospectively performed in 22 singleton fetuses with normal anatomy, normal biometry and normal Doppler to determine the characteristics of functional tricuspid valve Regurgitation. Tricuspid valve Regurgitation was semi-quantified by spatial and temporal Doppler-derived parameters. In 18 cases tricuspid valve Regurgitation was part-systolic (early and mid-systolic) and showed little spatial expansion of the jet as examined by colour Doppler flow imaging. In 16 of these 18 cases the maximum velocity of these regurgitant jets was below 2.00 m/s. Four fetuses demonstrated holosystolic regurgitant jets and in addition to the longer duration of these jets, the spatial expansion was also greater and the maximum velocity was slightly higher compared with the part-systolic tricuspid valve Regurgitations. Re-examination of the 22 normally grown fetuses showed that tricuspid valve Regurgitation was a transient phenomenon. Within a period of one to seven weeks after the diagnosis of tricuspid valvc Regurgitation, the Regurgitation could no longer be demonstrated in any of these cases, including the four fetuses with holosystolic regurgitant jets. Tricuspid valve Regurgitation was the only detected abnormality in all of these cases. The fetal outcome of the 22 normally grown fetuses with tricuspid valve Regurgitation was unremarkable concerning the evaluated parameters. Although fetal tricuspid valve Regurgitation may be a sign of increased preload, afterload or cardiac dysfunction, in most cases tricuspid valve Regurgitation is an isolated transient phenomenon with little temporal and spatial expansion: nevertheless in some cases holosystolic tricuspid valve Regurgitation may also be an isolated transient finding, and it may be a functional phenomenon.
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Functional pulmonary valve Regurgitation in the fetus
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 1998Co-Authors: J. Smrcek, U. Germer, Ulrich GembruchAbstract:Objective The purpose of this study was to determine the prevalence and the characteristics of functional pulmonary valve Regurgitation in normally grown fetuses. Design A prospective cross-sectional study. Subjects A total of 1115 singleton fetuses between 18 and 41 weeks of gestation and who had normal heart anatomy, normal estimated weight for gestational age and normal flow velocity waveforms in the umbilical and middle cerebral arteries and umbilical vein were examined. Cases with agenesis, constriction or other abnormalities of the ductus arteriosus were excluded. Methods Examination of the pulmonary valve was performed by color Doppler echocardiography, pulsed wave Doppler and, if necessary, continuous wave Doppler in the short-axis view at the level of the origin of the great arteries and/or in a subcostal view of the right ventricular outflow tract and pulmonary trunk. If pulmonary valve Regurgitation was detected by color Doppler flow imaging and confirmed by pulsed wave Doppler echocardiography, the maximum velocity of the regurgitant jets as well as their maximum lengths were measured. Results The prevalence of functional pulmonary valve Regurgitation was 0.54% (n = 6). Pulmonary valve Regurgitation was part diastolic in four cases and holodiastolic in two cases, with maximum velocity of ≤ 2.05 m/s and maximum length of 3–8 mm. Prenatal re-examination of five of the six fetuses with pulmonary valve Regurgitation showed that pulmonary valve Regurgitation was a transient phenomenon in four cases. The fetal outcome in the presence of transient pulmonary valve Regurgitation was normal; pediatric echocardiographic examination in these six fetuses with transient pulmonary valve Regurgitation showed no Regurgitations or other cardiac anomalies. Conclusions Pulmonary valve Regurgitation was functional in all six fetuses. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
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The prevalence and clinical significance of tricuspid valve Regurgitation in normally grown fetuses and those with intrauterine growth retardation
Ultrasound in Obstetrics & Gynecology, 1997Co-Authors: Ulrich Gembruch, J. SmrcekAbstract:The aim of this study was to assess the prevalence and clinical significance of fetal tricuspid valve Regurgitation. In a cross-sectional study, 289 normally grown singleton fetuses with normal heart anatomy, normal estimated weight for gestational age, normal amniotic fluid volume and normal flow velocity waveforms in the umbilical and middle cerebral arteries and umbilical vein were examined. A further 31 singleton fetuses with intrauterine growth retardation (estimated fetal weight below the 3rd centile) were analyzed. Semiquantification of the tricuspid valve Regurgitation by spatial and temporal parameters was performed in the four-chamber view by color Doppler flow imaging and by color Doppler M-mode echocardiography (M-Q mode). The prevalence of fetal tricuspid valve Regurgitation among normally grown fetuses was 6.23% (n = 18). In all cases, the tricuspid Regurgitation was part-systolic (non-holosystolic, early and mid-systolic tricuspid Regurgitation) and showed little spatial expansion of the jet as examined by color Doppler flow imaging (no jet reached the opposite atrial wall, the area of tricuspid Regurgitation being less than 25% of the atrial area). The maximum velocity of the regurgitant jets was below 2 m/s with one exception. There was no statistically significant correlation between gestational age and occurrence of tricuspid Regurgitation (U test, p > 0.05). Re-examination of 14 of the 18 fetuses with tricuspid Regurgitation showed that tricuspid Regurgitation was a transient phenomenon in these instances. The fetal outcome in the presence of tricuspid valve Regurgitation was normal. Regurgitations of the mitral, pulmonary and aortic valves were excluded in all 289 fetuses. Only two of the 31 fetuses (6.45%) with intrauterine growth retardation showed tricuspid valve Regurgitation. In one fetus the tricuspid Regurgitation was only part-systolic. In the other severely compromised fetus with highly abnormal flow velocity waveforms in the arterial and venous side of the fetal circulation, cardiac dilatation with holosystolic tricuspid and holosystolic mitral Regurgitation occurred immediately before intrauterine death. Fetal tricuspid valve Regurgitation was a frequent finding during Doppler echocardiography. Although it may be a sign of increased preload, afterload or cardiac dysfunction, in most cases tricuspid valve Regurgitation is an isolated transient finding with little temporal and spatial expansion, and it may be physiological. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
