patient it seemed to resolve post-op Day 2, responding only to surgery having been refractory medically prior to that.In summary, cardiogenic pulmonary oedema remains a possible and sufficient explanation for asymmetric right upper lobe pulmonary abnormalities in a patient with significant mitral valve regurgitation. Transthoracic and/or transoesophageal echocardiography with particular attention to mitral regurgitation jet direction and demonstration of regurgitant systolic reversal of flow into right pulmonary vein(s) would corroborate this diagnosis. Clinical judgment may mandate the need to exclude other coexisting pulmonary pathology, but indeed the sole underlying pathology may be cardiac. Such pulmonary oedema may persist despite aggressive medical measures and resolve only after surgical correction of the valve dysfunction.
S Heart, Lung and CirculationAbstracts S181 2011;20S:S156-S251 chronic elevation of LA pressure, with dilatation defined as a LA volume ≥34 mL/m 2 . Increased LA pressure was estimated using transmitral flow and tissue Doppler imaging at the lateral border of the mitral annulus; LA pressure elevation was defined as E/e ≥ 12. Pulmonary systolic pressure was estimated by standard criteria according to the ASE guidelines and PH was defined as a PA pressure ≥40 mm Hg.Results: There were 94 scleroderma subjects of age 32-82 years (14 males) who were in sinus rhythm and had no or mild valvular disease. Thirty-five (37%) subjects had LA dilatation, 12 (13%) had E/e ≥ 12, and 13 (14%) had PH. In subjects with PH, three had LA dilatation and two had increased E/e . In subjects with increased E/e , nine (75%) had LA dilatation. In subjects with LA dilatation, nine (26%) had increased E/e . Conclusion: In scleroderma, LA dilatation and elevation of LA pressure are common in subjects with and without PH. Therefore, LA pressure elevation may not only contribute to elevation of pulmonary pressure in PH but could also be a cause of dyspnoea in patients without PH.Aim: Left atrial (LA) enlargement occurs in mitral regurgitation (MR) with LA size increasing with MR severity. We sought to examine phasic LA volumes and atrial dysfunction with increasing severity of MR.Method: We recruited 100 patients (38 mild, 28 moderate and 34 severe MR) in sinus rhythm with varying grades of MR graded semi-quantitatively from the departmental database. Biplane LA volumes were measured and phasic volumes calculated. Atrial function was further assessed by measuring LA peak global strain during atrial systole using velocity vector imaging (VVI).Results: Maximum, minimum and pre-P volumes increased with increasing severity of MR. Passive and conduit volumes increased with no significant change in active emptying volume suggesting increased atrial emptying volume. However, peak LA strain was reduced indicating associated atrial dysfunction with worsening MR. Conclusion: With increasing severity of MR, the increase in LA volumes and altered phasic function is associated with LA dysfunction as demonstrated by reduction in atrial strain Mild MR (n = 38) Moderate MR (n = 28) Severe MR (n = 34)Max LA V (ml/m 2 ) 32.9 ± 10.1 48.1 ± 13.9 * 52.4 ± 19.2 *, § Min LA V (ml/m 2 ) 16.1 ± 6.8 27.5 ± 12.0 * 28.7 ± 14.0 * Pre-P V (ml/m 2 ) 22.5 ± 8.3 35.5 ± 12.5 * 36.9 ± 15.1 * Passive emptying volume (ml)18.8 ± 7.9 22.6 ± 10.7 28.0 ± 13.3 * Conduit volume (ml) 46.0 ± 19.5 46.8 ± 25.9 62.7 ± 28.9 *, § Active emptying volume (ml) 11.5 ± 5.8 14.4 ± 7.9 14.9 ± 7.2 * Peak strain (%) −7.2 ± 4.0 −3.8 ± 3.3 * −5.0 ± 3.4 * * p < 0.05 vs mild MR. § p < 0.05 vs moderate MR. Background: Cardiac MRI (CMR) is the gold standard for assessment of left ventricular (LV) mass. Global LV mass can be increased in conditions where the LV is dilated, or reduced in circumstances where the LV volume is small but the LV wall is thickened. We proposed that normalising the LV mass f...
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