Imaging modalities in valvular heart disease

Abstract

Evaluating valvular heart disease requires a multi-parametric analysis of valvular pathology, hemodynamic derangements, and impact on ventricular size and function. The capability to perform real-time three-dimensional (3-D) imaging has vastly strengthened the already established role of echocardiography. CT and MRI advances have led to their use as daily clinical tools. Two-dimensional and 3-D echocardiography and Doppler modalities allow for accurate assessment of valvular lesions, pressure gradients, stenotic valve orifice areas, pulmonary artery pressures, intracardiac pressures, and regurgitant volumes. Quantitation of chamber volumes has become more accurate and reproducible with 3-D echocardiography, CT, and cardiac MRI. Although ultrasound imaging is the primary tool, the other techniques provide adjuvant or alternate options to examine valvular heart disease. This array of imaging modalities is likely to provide greater insights into the pathophysiology of valvular heart disease, new pointers to prognosis, and also guide innovative treatment strategies.

Cardiac disease in patients with mucopolysaccharidosis: presentation, diagnosis and management

“…Because of its versatility, ease of performance and cost-effectiveness, transthoracic two-dimensional echocardiography is the primary imaging modality used to evaluate cardiac anatomy and function in patients with MPS (Aguilar et al 2008). Echocardiography provides reliable measurements of ventricular chamber dimensions (both systolic and diastolic) and left ventricular posterior and septal wall thicknesses, which can be normalized for body surface area.…”

“…Accurate measures of ventricular function (shortening fraction & ejection fraction) can be determined. Doppler interrogation of cardiac valves allows accurate grading of valve stenosis and regurgitation as well as estimation of cardiac output and right ventricular/pulmonary artery pressures (Aguilar et al 2008). Despite its benefits, echocardiography provides only limited information in the assessment of coronary artery anatomy and pathology.…”

“…Magnetic resonance imaging (MRI) and computed tomography (CT) are advanced techniques not routinely used for cardiac evaluation in children. Although MRI is a reliable tomographic technique for assessing cardiac anatomy and function (with quantification of volumetrics and regurgitation), its application is limited by heart rate constraints, slow acquisition times, and the need for sedation, and may be contraindicated in individuals with implanted devices (Aguilar et al 2008). Cardiac CT angiography, advantageous with respect to acquisition speed and resolution, is limited by relatively large radiation exposure and suboptimal assessment of valve morphology and hemodynamics (Aguilar et al 2008).…”

Mucopolysaccharidosis type II: Enzyme Replacement Therapy Efficiency

“…Уже опубликованы результаты научных исследований, посвященных изучению влияния ФЗТ идурсульфазой на функционирование различных органов и систем у пациентов с синдромом Хантера [17,18] 4; 38,4), без лечения -21,2 года (16,1; 31,5). Риск смерти (главным образом от сердечно-сосудистых и респираторных осложнений), согласно регрессионной модели Кокса, составил 0,46 (95% ДИ 0,29-0,72), т. е. был на 54% ниже у пациентов, получавших патогенетическую терапию, в сравнении с таковым у нелеченых больных [13].…”

“…Это говорит о том, что ФЗТ должна проводиться регулярно и длительно, и не прерываться без веских на то оснований. Патология сердечно-сосудистой системы при различных типах МПС и влияние ФЗТ на прогрессирование этой патологии изучались в нескольких исследованиях [14,18,19]. Вследствие отложения гликозаминогликанов в области клапанного аппарата, эндокарда, миокарда, стенок коронарных артерий уже к концу первого десятилетия жизни бо льшая часть пациентов с различными типами МПС имеет патологию клапанов сердца, особенно при быстропрогрессирующем течении заболевания с раннего возраста [14,19].…”