Quantitative Doppler-Echocardiographic Determination of Regurgitant Volume in Patients with Aortic Insufficiency

Background: The severity of aortic regurgitation (AR) can be determined by invasive or echocardiographic methods. We systematically compared quantitative invasive and echocardiographic data with semiquantitative invasive grades in a prospective series of patients. Methods: Using Doppler-echocardiography we determined the cardiac output over the aortic, pulmonary and mitral valve in 27 patients (20 with, 7 without AR). Aortic regurgitant volume was calculated as the difference between the cardiac output over aortic and pulmonary valve/ mitral valve. During angiography the severity of AR was assessed semiquantitatively by aortography and the regurgitant volume was calculated invasively as the difference between the left- and right ventricular cardiac output. Results: The echocardiographically and invasively determined regurgitant blood volume correlated closely (R≈0.8). The regurgitant volume increased with higher angiographic grade but there was significant overlap between adjoining qualitative grades. Conclusion: In patients with AR, quantitative echocardiographic and angiographic measurements of the regurgitant volume correlate closely.

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Quantification of aortic regurgitation by real-time 3-dimensional echocardiography in a chronic animal model: Computation of aortic regurgitant volume as the difference between left and right ventricular stroke volumes

Journal of the American Society of Echocardiography ◽

10.1067/mje.2001.115660 ◽

2001 ◽

Vol 14 (11) ◽

pp. 1112-1118 ◽

Cited By ~ 14

Author(s):

Timothy Irvine ◽

George D. Stetten ◽

Vandana Sachdev ◽

Arthur D. Zetts ◽

Michael Jones ◽

...

Keyword(s):

Animal Model ◽

Right Ventricular ◽

Real Time ◽

Aortic Regurgitation ◽

Model Computation ◽

Regurgitant Volume ◽

3 Dimensional ◽

Left And Right ◽

The Difference ◽

Dimensional Echocardiography

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Severe pulmonic valve regurgitation due to histoplasma endocarditis

Echo Research and Practice ◽

10.1530/erp-14-0103 ◽

2015 ◽

Vol 2 (1) ◽

pp. K21-K24 ◽

Cited By ~ 2

Author(s):

Ewa A Konik ◽

Merri Bremer ◽

Peter T Lin ◽

Sorin V Pislaru

Keyword(s):

Mitral Valve ◽

Right Ventricular ◽

Transesophageal Echocardiography ◽

Doppler Echocardiography ◽

Pulmonary Valve ◽

High Index ◽

Valve Regurgitation ◽

Pulmonic Valve ◽

High Index Of Suspicion

SummaryA 67-year-old man with myelodysplastic syndrome, disseminated histoplasmosis, and mitral valve replacement presented with dyspnea and peripheral edema. Transthoracic echocardiography demonstrated abnormal pulmonic valve with possible vegetation. Color flow imaging showed laminar flow from main pulmonary artery into right ventricular outflow tract (RVOT) in diastole. The continuous wave Doppler signal showed dense diastolic envelope with steep deceleration slope. These findings were consistent with severe pulmonic valve regurgitation, possibly due to endocarditis. Transesophageal echocardiography demonstrated an echodense mass attached to the pulmonic valve. The mitral valve bioprosthesis appeared intact. Bacterial and fungal blood cultures were negative; however, serum histoplasma antigen was positive. At surgery, the valve appeared destroyed by vegetations. Gomori methenamine silver-stains showed invasive fungal hyphae and yeast consistent with a dimorphic fungus. Valve cultures grew one colony of filamentous fungus. Itraconazole was continued based on expert infectious diseases diagnosis. After surgery, dyspnea and ankle edema resolved. To the best of our knowledge, histoplasma endocarditis of pulmonic valve has not been previously reported. Isolated pulmonic valve endocarditis is rare, accounting for about 2% of infectious endocarditis (IE) cases. Fungi account for about 3% of cases of native valve endocarditis. Characterization of pulmonary valve requires thorough interrogation with 2D and Doppler echocardiography techniques. Parasternal RVOT view allowed visualization of the pulmonary valve and assessment of regurgitation severity. As an anterior structure, it may be difficult to image with transesophageal echocardiography. Mid-esophageal right ventricular inflow–outflow view clearly showed the pulmonary valve and vegetation.Learning pointsIdentification and characterization of pulmonary valve abnormalities require thorough interrogation with 2D and Doppler echocardiography techniques.Isolated pulmonary valve IE is rare and requires high index of suspicion.Histoplasma capsulatum IE is rare and requires high index of suspicion.

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Main Systolic Blood Flow Patterns in the Left and Right Ventricular Outflow Tracts Determined by Doppler Echocardiography

Angiology ◽

10.1177/000331978503600302 ◽

1985 ◽

Vol 36 (3) ◽

pp. 143-153 ◽

Cited By ~ 2

Author(s):

Kouichi Itoh

Keyword(s):

Blood Flow ◽

Right Ventricular ◽

Doppler Echocardiography ◽

Flow Patterns ◽

Left And Right ◽

Blood Flow Patterns

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Abstract 2611: Transcatheter Valve Insertion A Model Of Enlarged Right Ventricular Outflow Tracts

Circulation ◽

10.1161/circ.118.suppl_18.s_753 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Adeline Basquin ◽

Younes Boudjemline

Keyword(s):

Right Ventricular ◽

Pulmonary Valve ◽

Main Pulmonary Artery ◽

Pulmonary Regurgitation ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

The Difference ◽

Group 2 ◽

Transcatheter Valve ◽

Group B

Background: Transcatheter pulmonary valve insertion has recently emerged as an alternative to surgery. To extend the indications to patients with large right ventricular outflow tract (RVOT), we previously developed an intravascular device that reduces the diameter of the main pulmonary artery (MPA) allowing the insertion of available valved stents. We report its use in a model of animals with enlarged RVOT and pulmonary valve incompetence (PVI). Methods and Results: 33 sheep were included. They first underwent surgical MPA enlargement. We then intended to implant percutaneously a reducer followed by the insertion of a valve. Three animals died during interstage. The remaining were sacrificed acutely (group 1, n=6), after a mean follow-up of 1 (group 2, n=12) and 2 months (group 3, n=12). Animals from chronic groups were equally divided into 2 subgroups according to the difference between diameters of the device inserted and MPA (A: < 5-mm, B: ≥ 5-mm). Reducers were inserted successfully (n=30). One embolized after its insertion (Group 3A). A valved stent could be implanted in all animals but one which experienced a balloon ruptured during its inflation leading to incomplete expansion and death of the animal. Six animals had pulmonary regurgitation after valve insertion. Five of them (Group A, n=5; Group B, n=1) had downsizing of the reducer. Conclusion: Pulmonary valve insertion is possible through a transcatheter technique using a PA reducer. Oversizing of this device reduces the risk of embolisation and paraprosthetic leak.

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