We clearly demonstrated 3D geometric deformity of the mitral leaflets and annulus in ischemic MR using novel software for creating images by 3D echocardiography. This technique will be helpful in making a proper decision for the surgical strategy in each patient.

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Retrograde flow in the LAD by TTDE is a highly sensitive and specific finding that can be used to noninvasively diagnose total LAD occlusion.

To evaluate left-to-right shunts after percutaneous balloon mitral valvuloplasty, we studied 15 consecutive patients by using transesophageal color Doppler flow-imaging system. Transesophageal color Doppler examinations were performed five times in each patient (before valvuloplasty and 1 day, 1 week, 1 month, and 6 months after valvuloplasty). No shunt flow was observed before valvuloplasty. On 1 day after mitral valvuloplasty, transesophageal color Doppler echocardiography demonstrated left-to-right shunts in 13 (87%) of 15 patients. However, a significant oxygen step-up was present in the right heart in only one patient. The mean diameter of the interatrial septal defect detected by transesophageal two-dimensional echocardiography was 1.8± 1.0 mm. The mean velocity of left-to-right shunting flow measured by high-pulse repetition frequency Doppler technique was 0.83±0.38 m/sec. One week after the procedure, left-to-right shunt flow was detected in 11 (73%) patients. One month after valvuloplasty, left-to-right shunting flow was detected in seven (47%) of 15 patients. There was a significant decrease in the diameter of an interatrial septal defect between 1 day and 1 week (p<0.01), between 1 week and 1 month (p<0.01), and between 1 month and 6 months (p<0.05). Six months after valvuloplasty, left-to-right shunting flow remained in three (20%) patients. By using transthoracic color Doppler echocardiography, we detected left-to-right shunting flow in two patients on 1 day after the procedure. In these patients, no shunting flow was detected 1 month after mitral valvuloplasty from the transthoracic approach. Oximetry demonstrated left-to-right shunts of pulmonary-to-systemic flow ratio of 1.3:1 in one patient immediately after mitral valvuloplasty. Thus, transesophageal color Doppler echocardiography is useful in the detection of left-to-right shunts after percutaneous mitral valvuloplasty, and most of the patients undergoing percutaneous mitral valvuloplasty had small left-to-right shunts that were not detected by oximetry. (Circulation 1989;80:1521-1526

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