In order to define baseline descriptive criteria for the diagnosis of mitral valve prolapse with cross-sectional echocardiography, 49 patients undergoing catheterization were examined by a real-time, two-dimensional phased array echocardiographic imaging system. Angiography was used to separate patients into two distinct groups: 15 with normal mitral valve function and 34 with definite mitral valve prolapse. Systolic mitral leaflet and annulus motion were then observed in each patient and similarities and differences were noted between the two groups of patients. Correlative M-mode echocardiographic data were available in 37 patients. Certain two-dimensional echocardiographic findings restricted to the angiographically proven mitral valve prolapse group were defined: 1) posteriorly displaced coaptation of the leaflets, 2) systolic superior movement of one or both mitral leaflets above the level of the mitral ring, and 3) a systolic curling motion of the posterior mitral ring on its adjacent myocardium. One or more of these abnormalities were found in all 34 patients with angiographic mitral valve prolapse. When mitral valve prolapse does occur, the results of two-dimensional echocardiography would suggest that both leaflets are usually involved.

A real-time, phased-array, two-dimensional echocardiography system was used to assess mitral valve motion in 30 catheterized patients with pure mitral stenosis. Suitable images for analysis of mitral valve motion were obtained in 25 patients. The valve leaflets were most thickened and immobile at the leaflet tips while maximum mobility was at the leaflet body. Diastolic movement of anterior mitral leaflet toward the septum pulled the posterior mitral leaflet mid-portion inferiorly. Systolic bulging of the mid-portion of the anterior mitral leaflet into the left atrium was seen in 40% (10 of 25). Movement of the anterior mitral leaflet in diastole is primarily due to movement of the whole mitral apparatus in patients with mitral stenosis. The anterior mitral leaflet E to F slopes did not correlate (r=0.38) with the mitral valve area determined at catheterization. Planimetry of the mitral valve area directly from the videotape images compared favorably to the valve area determined at catheterization (r=0.95). Thus, mitral valve area determined by this technique is an accurate noninvasive method for assessing the severity of mitral stenosis.¿

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Objectives: To evaluate the effects of diffused lavender on the frequency of behavioral issues [BIs], defined as a composite of restlessness/wandering [RW], agitation [AGT], anger [ANG], and anxiety [ANX] in an adult day care center. Secondary objectives evaluate systematic differences on the frequency of BIs between age cohorts, gender, and individual behaviors. Design: Pre-post quasi-experimental study. Setting: Private nonprofit adult day care center for patients with dementia. Participants: Elderly patients older than 65 years of age with a clinical diagnosis of dementia, who require daytime monitoring. Intervention: Lavender aromatherapy twice a day for 20 min during a two-month period during active clinic days. Measurements: Behavioral issues were recorded using the behavior/intervention monthly flow record during the pre- and post-intervention periods. Results: There was no significant difference on frequency of BIs between pre-intervention and post-intervention periods (p = .06). There was a significant difference between pre-intervention and post-intervention total number of AGT occurrences (129 vs. 25; p value < .01). There was no significant difference between age cohorts for computed difference of RW, ANG, and ANX issues. There was a significant difference between age cohorts for computed difference of AGT (p value = .04) as the 70–85 age cohort showed less agitation compared to the 85–100 age cohort. Conclusion: The use of diffused lavender twice daily has shown to reduce the frequency of agitation in elderly patients with dementia, especially in the 70–85 age cohort. Though diffused lavender did not show statistical differences in the frequency of other behaviors (restlessness/wander, anger, anxiety), the study population may have been too small to find a difference.