Journal of cardiology. Supplement最新文献

{"title":"[The prevalence and clinical features of pathologically abnormal mitral valve leaflets (myxomatous mitral valve) in the mitral valve prolapse syndrome: an echocardiographic and pathological comparative study].","authors":"T Takamoto,&nbsp;M Nitta,&nbsp;T Tsujibayashi,&nbsp;K Taniguchi,&nbsp;F Marumo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We studied the prevalence and clinical features of pathologically abnormal mitral valve leaflets (myxomatous mitral valve: MMV) in consecutive 142 patients with the mitral valve prolapse syndrome (MVP). Our echocardiographic criteria for MMV were 1) thick leaflets 3 mm or greater, 2) redundant leaflet-motion, and 3) echo-density lower than that of the aortic walls. The echocardiographic measurements of left ventricular diastolic dimensions (LVDd), percent fractional shortening (%FS), mitral annular diameter (MAD), and LV mass were compared between MMV and non-MMV groups. Twelve patients (8%) were referred for surgery because of congestive heart failure, and two patients died during the observation periods. Gross morphology of the MMV was characterized by increased surface area, dome formation of the leaflet-body, and non-uniform leaflets in thickness, and histologic findings of the MMV were the infiltration of spongiosa layer into the fibrosa layer. The diagnostic accuracy of echocardiography for the MMV was examined in 14 patients underwent either surgery or autopsy, and it was high (78% in sensitivity and 80% in specificity). The progression of mitral regurgitation (MR) from mild to moderate grade or mild to severe grade was found in five of 26 patients during follow-up studies over 12 months (mean = 36 months). All of the five patients were aged 50 years and older. While, MR completely disappeared in a 17-year-old boy with marked physical development within three years of the observation period. Mitral annular diameter significantly increased in MMV with MR when compared to non-MMV with MR (4.1 +/- 0.7 vs 3.5 +/- 0.4). But no significant changes were noted in LVDd and LV mass between non-MMV with MR and MMV with MR. Of the 142 patients with MVP, 96 patients were non-MMV and 46 patients were MMV. Ruptured chordae tendineae were associated in 5/96 patients (5%) with non-MMV and 22/46 patients (48%) with MMV. Intracardiac vegetations were seen in four of the 96 patients (4%) with non-MMV. The prevalence of MMV in MVP was greater in older patients, and it reached nearly as high as 50% of MVP patients aged 60 years and older. In conclusion, the echocardiographic diagnostic criteria for MMV are reliable with high sensitivity and specificity, and are useful to predict the high risk patients in the MVP syndrome. MMV may be a potential etiology causing aggravation of mitral regurgitation and/or ruptured chordae tendineae.</p>","PeriodicalId":77193,"journal":{"name":"Journal of cardiology. Supplement","volume":"25 ","pages":"75-86"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13049719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Efficacy of transesophageal echocardiography immediately after open heart surgery: diagnosis of coagula tamponade].","authors":"N Tanaka,&nbsp;S Beppu,&nbsp;K Ikegami,&nbsp;K Kumon,&nbsp;S Izumi,&nbsp;S Nakajima,&nbsp;S Nakatani,&nbsp;K Miyatake,&nbsp;Y Nimura","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Massive pericardial coagula were detected by transesophageal echocardiography in some patients with low cardiac output failure immediately after open heart surgery. Characteristically, the coagula were localized anterior to the right atrium and right ventricle in all patients. The coagula could not be detected by transthoracic echocardiography. Despite of low output, absence of wall motion abnormality of the left ventricle, tachycardia, elevated atrial pressure and small left ventricular cavity lead to diagnose cardiac tamponade by pericardial coagula. Neither the right atrial nor the right ventricular wall showed collapsing motion except the area with pericardial effusion. Massive coagula in the anterior mediastinum produced similar clinical manifestation, but could be differentiated from pericardial coagula by echographic identification of the anterior pericardium. Pericardial coagula were also observed in patients with superior vena cava syndrome, but low right atrial pressure differentiated it from coagula tamponade. In all of the present patients, usual transthoracic echocardiography did not offer any sufficient images for diagnosing pericardial coagula. Transesophageal echocardiography was indispensable for detecting pericardial coagula soon after open heart surgery.</p>","PeriodicalId":77193,"journal":{"name":"Journal of cardiology. Supplement","volume":"26 ","pages":"111-7, discussion 118-20"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13090106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Imaging of coronary arteries and measurement of coronary flow using transesophageal Doppler echocardiography: a comparison with transthoracic Doppler echocardiography].","authors":"K Hirabayashi,&nbsp;H Morita,&nbsp;K Mizushige,&nbsp;S Yamada,&nbsp;K Ohmori,&nbsp;T Tanimoto,&nbsp;H Matsuo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Recent advances in Doppler echocardiographic techniques, especially using transesophageal approach, enable us to observe coronary arteries and their blood flow. However, the advantages of transesophageal approach in the evaluation of coronary artery are indistinct. The aim of this study was to examine the ability of transesophageal Doppler echocardiography (TED) and transthoracic Doppler echocardiography (TTD) to visualize coronary artery and measure its flow. The study population consisted of 17 healthy subjects and 41 patients with heart diseases (arrhythmia in 2, valvular disease in 10, ischemic heart disease without complete or subtotal obstruction of coronary artery in 22, congenital heart disease in two, cardiomyopathy in four, and infective endocarditis in one). Thirty subjects were examined by TED, and 44 subjects were examined by TTD. Two patients with complete obstruction of the proximal right coronary artery (RCA), who were not included in the above-mentioned subjects, were examined by TED. The results were as follows: 1) The detection rate of coronary arteries by TED and TTD were: left main trunk (LMT); 96.7/86.4%, left anterior descending artery (LAD) and left circumflex artery (LCx); 83.3/56.8%, and RCA; 63.3/38.6%, respectively. 2) Visible length from the orifice: LMT to LAD; 22.2/30.8 mm, RCA; 20.4/22.3 mm. 3) The detection rate of coronary flow by pulsed Doppler of the two methods: LMT; 66.8/0%, LAD; 70.0/31.8%, LCx; 6.6/0%. RCA; 26.7/0%. 4) Coronary flow was detected by transesophageal two-dimensional Doppler in 73.3% of LMT, 76.6% of LAD, 6.6% LCx and 43.3% of RCA. 5) RCA flow was not detected by transesophageal two-dimensional Doppler in two patients who had complete obstruction of the proximal RCA although RCA near the orifice was obviously imaged by two-dimensional echocardiography. In conclusion, TED had an advantage over TTD in detecting coronary arteries and their blood flow, but TTD had an advantage over TED as to the visible length of coronary artery. When RCA near the orifice was clearly visualized, the absence of RCA flow by TED implied complete obstruction of the proximal RCA.</p>","PeriodicalId":77193,"journal":{"name":"Journal of cardiology. Supplement","volume":"26 ","pages":"15-24"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13090107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Pulmonary venous flow patterns in normal subjects and cardiac patients: a transesophageal echocardiographic study].","authors":"C Tei,&nbsp;T Yutsudo,&nbsp;K Shibata,&nbsp;P Shah,&nbsp;J C Park,&nbsp;Y Horikiri,&nbsp;N Minakami,&nbsp;Y Sotoyama,&nbsp;N Tanaka","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The aim of this study is, first, to analyze pulmonary venous flow velocity (PVFV) pattern in normal subjects and second, to compare it with the various diseased state. PVFV was recorded in eleven normal volunteers, five patients with lone atrial fibrillation, twenty eight patients with valvular heart diseases and six patients with cardiomyopathy using transesophageal color Doppler echocardiography by placing the sample volume at the junction of the left superior pulmonary vein and left atrium. PVFV in normal subjects demonstrated distinct four waveforms: due to atrial systole (AS wave) and diastole (AD wave), and due to ventricular systole (VS wave) and diastole (VD wave). PVFV changed with respiration in normal subjects. The peak velocity of VD wave was increased with inspiration (p less than 0.001). The ratio of velocity VS/VD was increased during expiration (p less than 0.01). The ratio of area AD + VS/VD was significantly decreased with inspiration (p less than 0.01). We feel that this is the normal variation in pulmonary venous return during respiration , influenced by changes in the venous return on the right side of the heart. In all patients with atrial fibrillation, AS and AD waves were disappeared. The negative deflection occasionally observed was due to mitral valve closure. In patients with mitral stenosis, the peak velocity of VD wave was significantly decreased compared to that of normal subjects, but it was not significantly different between the patients with mitral valve replacement and normal subjects. The peak velocity of VD wave was also correlated with pressure half time among the patients with mitral stenosis, mitral valve replacement and mitral commissurotomy. On the other hand, it was significantly increased in patients with mitral regurgitation and returned to normal level after the operation. The peak velocity of VS wave was correlated with the left atrial dimension among the patients with mitral valve diseases except these with mitral regurgitation. In patients with mitral regurgitation, the peak velocity was decreased compared to that of normal subjects and reversed flow was seen in half of the patients. Also, it was decreased in patients with dilated cardiomyopathy and increased in patients with hypertrophic cardiomyopathy. In conclusion, PVFV is influenced not only by changes of venous return with respiration but also by the left atrial size, presence or absence of MS or MR, left atrial or left ventricular systolic and diastolic function in the various diseased states.</p>","PeriodicalId":77193,"journal":{"name":"Journal of cardiology. Supplement","volume":"26 ","pages":"91-102"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13090729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Diagnosis of prosthetic mitral valve regurgitation by Doppler color flow imaging using right parasternal approach: a comparative study with transesophageal method].","authors":"T Mikami,&nbsp;M Hashimoto,&nbsp;H Onozuka,&nbsp;R Koizumi,&nbsp;S Sakamoto,&nbsp;H Yasuda","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Doppler color flow imaging is a useful tool in evaluating mitral regurgitation (MR). However, it is frequently difficult to assess prosthetic valve MR by the conventional transthoracic approach using left parasternal or apical echo-windows, because of the interception of ultrasound by the prosthesis or artifacts produced by its motion. The purpose of this study is to determine the usefulness of the \"right\" parasternal approach (RPA) in the echo diagnosis of prosthetic MR. Six patients with pathological prosthetic MR determined by transesophageal approach (TEA) were studied. Transthoracic echo was performed using both the RPA and the conventional approach, and the presence or absence and the extent of MR signals by these transthoracic approaches were compared with those by TEA. Prosthetic MR was detected in five of six patients by the RPA and the extent of MR signals by the RPA was very similar to that by TEE in each of the five patients. MR could not be detected by the RPA only in one patient, whose MR was estimated to be very mild by TEE. By the conventional approach, MR could not be detected in three patients and the degree of MR was significantly underestimated in two of the remaining three patients. Thus, the transthoracic RPA is often as useful as TEA in diagnosing prosthetic MR, which is often undetectable or underestimated by the conventional approach. Because the RPA is less invasive than TEA, the RPA should be encouraged in patients with suspected prosthetic mitral valve dysfunction.</p>","PeriodicalId":77193,"journal":{"name":"Journal of cardiology. Supplement","volume":"25 ","pages":"131-6; discussion 137-8"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13049094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Development of severe mitral regurgitation following percutaneous transvenous mitral valve commissurotomy].","authors":"S Okamoto,&nbsp;M Inden,&nbsp;M Setsuda,&nbsp;T Konishi,&nbsp;T Nakano,&nbsp;N Ono,&nbsp;H Nishikawa,&nbsp;Y Kakuta,&nbsp;H Okano,&nbsp;R Kouji","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The purpose of this study was to analyze the risk factors of unexpected occurrence of mitral regurgitation (MR) following percutaneous transvenous mitral valve commissurotomy (PTMC) in patients with mitral stenosis. The analyzed factors were clinical pictures, hemodynamic findings, echocardiographic findings and balloon inflation techniques during PTMC. Among 24 patients undergoing successful PTMC using an Inoue's balloon, severe MR developed in five patients (21%). No significant correlation in the occurrence of MR was observed in clinical findings, hemodynamic data and balloon inflation techniques including the times and size of ballooning. Echocardiographic findings of the mitral valve including the pliability of the mitral leaflet and localized calcification of the mitral orifice were the most contributory factors to the occurrence of severe MR. The localized alternation of valve stiffness produced localized tear or excessive dilatation of the mitral leaflet during PTMC, resulting in severe MR. Hemodynamic results and calculated mitral valve areas after PTMC showed significant improvement in both groups with and without MR. However, symptomatic improvement in patients with severe MR was less prominent when compared to the patients without MR. Thus, the complete echocardiographic evaluation of the mitral valve apparatus before PTMC is important to prevent severe MR.</p>","PeriodicalId":77193,"journal":{"name":"Journal of cardiology. Supplement","volume":"25 ","pages":"139-45; discussion 146-7"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13049095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The first conference on transesophageal echocardiography].","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77193,"journal":{"name":"Journal of cardiology. Supplement","volume":"26 ","pages":"1-120"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12847421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Physiology of the heart valves].","authors":"Y Nakamura","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The function of healthy heart valves has been understood as the \"on-off switch\", which initiates and terminates blood flow in the cardiac cycle. It is believed that an impedance of the valves against blood flow is minimal and their closure is abrupt and complete. Clinically, an increase in impedance of the diseased valve is estimated by measuring pressure difference across that valve. However, the pressure gradient induced by acceleration of blood along the outflow tract of the ventricle or the artery during the early ejection phase, or along the inflow tract of the ventricle during the rapid filling phase can not be estimated separately from the pressure difference produced by valvular impedance in physiological state. Opening speed of the valve is related to the factors determining the velocity of blood flow. Mechanisms of a valve closure have been explained based on the Henderson and Johnson's concepts. Recent advances in ultrasonic technology can only confirm their concepts. Measurement of the pressure gradient across the semilunar valves in the late ejection phase has also several technical difficulties. Relationships among pressure, flow and valve motion have been extensively investigated, how-exact determination of the timing of the valve closure is not detected. The heart valves are considered to function as a passive organ throughout the cardiac cycle except for the atrioventricular valves including the subvalvular apparatus during systolic phase. The development of new methodology is necessary for the investigation of this field.</p>","PeriodicalId":77193,"journal":{"name":"Journal of cardiology. Supplement","volume":"25 ","pages":"45-50; discussion 51-2"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13049717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Morphological observation of the mitral annulus fibrosus (II)].","authors":"M Sugiura,&nbsp;C Watanabe,&nbsp;S Ohkawa,&nbsp;A Toku,&nbsp;T Imai,&nbsp;K Kuboki,&nbsp;H Shimada","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In 1986, Hutchins observed a high incidence of the disjunction of the mitral annulus fibrosus in mitral valve prolapse syndrome. However, we could not prove his view in our previous study using one section in each case. In this study, the types of mitral annulus fibrosus were analyzed in plural sections. Autopsy hearts of nine aged cases were used for examination of the mitral annulus fibrosus in five to eight longitudinal sections from the posterolateral wall. The types of the mitral annulus fibrosus were classified as; Type A (the mitral valve attaches to the left ventricle), Type B (the valve attaches to the left atrium), Type C (the atrialis layer of the valve continues to the left atrium, while the fibrosa layer continues to the left ventricle), and type D (mitral annulus calcification). A1-3 and B1-3 are subtypes. In the nine cases there were no consistent patterns in type distributions. All sections showed Type A1 (Case 2), Type A1 to A3 (Case 5), and Type B1 to B3 (Case 8). In other cases, a combination of Type A and B (Case 4, 6, 7, 9), and inclusion of Type C (Case 1) and Type D (Case 3) were found. The location of the middle scallop of the posterior mitral leaflet corresponded to the section of the previous study. Among three cases of Type A in the middle scallop, two showed Type A in every section. Among five cases of Type B in the middle scallop, only one case showed Type B in every section. Other four cases showed various combinations with the other types. A case of Type D in the middle scallop showed also Type B and Type C. The conclusion of this study was that in 1/3 of the cases, the type of the mitral annulus fibrosus was consistent, but in the other 2/3 they were not consistent. In other words, one section is not necessarily representative of the morphology of the mitral annulus fibrosus in each case.</p>","PeriodicalId":77193,"journal":{"name":"Journal of cardiology. Supplement","volume":"25 ","pages":"63-73; discussion 74"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13049718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mitral regurgitation due to redundant chordae].","authors":"T Ishimitsu,&nbsp;Y Hiranuma,&nbsp;H Kamiya,&nbsp;T Enomoto,&nbsp;Y Sugishita,&nbsp;K Okamoto,&nbsp;T Tsutsui,&nbsp;Y Sakakibara,&nbsp;T Mitsui,&nbsp;M Hori","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This paper reports the etiology and the findings of phonocardiograms and echocardiograms in four cases with mitral regurgitation caused by the redundant chordae. Redundancy of the chordae were determined by the surgeon during operation. The results were as follows: 1. The etiology of redundant chordae was either congenital, rheumatic, or mucoid degeneration. 2. Phonocardiographic findings of this condition are a holosystolic murmur accompanied by a diastolic rumble at the apex. 3. Two-dimensional echocardiogram shows holosystolic bulging of the mitral leaflet to which redundant chordae are attached. 4. The findings of the M-mode echocardiogram are multiple linear echoes and bowing of the mitral valve in systole.</p>","PeriodicalId":77193,"journal":{"name":"Journal of cardiology. Supplement","volume":"25 ","pages":"95-102; discussion 103-4"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13049721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}