Left retrograde cardioangiography in acquired cardiac disease

Sellers, Robert D.; Levy, Morris J.; Amplatz, Kurt; Lillehei, C. Walton

doi:10.1016/0002-9149(64)90027-x

Cited by 760 publications

(64 citation statements)

References 5 publications

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“…The longitudinal extent of asynergy was classified as follows: In the presence of anterior infarction, left ventricular asynergy limited to the apical region under the papillary muscle level was designated as narrow infarction, and asynergy extending to the basal level as broad; in patients with inferior infarction, asynergy limited to the basal level was designated as narrow infarction, and asynergy extending to the attaching wall of the papillary muscle as broad; and in the presence of anterior and inferior infarction, when either anterior and/or inferior walls had broad infarction, the extent of asynergy was designated as broad. The results indicated broad infarction in 54 patients and narrow infarction in 27 (figure 5).…”

Section: Severitymentioning

confidence: 91%

Mechanism of mitral regurgitation in patients with myocardial infarction: a study using real-time two-dimensional Doppler flow imaging and echocardiography.

Izumi¹,

Miyatake²,

Beppu³

et al. 1987

Circulation

147

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The aim of the present study was to elucidate the mechanisms of mitral regurgitation accompanying myocardial infarction. Severity and site of mitral regurgitation was evaluated by the real-time two-dimensional Doppler flow imaging technique in 81 patients with old myocardial infarction. The incidence of mitral regurgitation did not depend on the region of infarction. There was, however, a close relationship between the site of regurgitation and the region of infarction. In patients with mitral regurgitation spurting from the posteromedial area of the valve, the inferior wall was involved in infarction without exception and in some of these patients, the posteromedial papillary muscle was also found to be affected by myocardial infarction; in those with regurgitation spurting from the anterolateral area, the anterior wall showed asynergy. On the other hand in patients with mitral regurgitation spurting from the central area, the region of infarction varied. In these patients, however, the larger the diameter of the mitral anulus, the more severe the grade of regurgitation. The extent of asynergy was another factor related to the severity of mitral regurgitation. Both longitudinally and transversely, broad infarction leads to the enlargement of the mitral anulus. However, even if the mitral anulus is not so dilated, severe involvement of either commissural area results in severe mitral regurgitation from the same commissural side. Thus, there are two major causative factors of mitral regurgitation: (1) asynergy of the papillary muscle or the ventricle that results in mitral regurgitation located in the commissural area of the same side as asynergy, and (2) enlargement of mitral anulus, which results in regurgitation from the central area of the orifice. The mechanisms of mitral regurgitation unveiled in the present study will contribute much to the clarification of the concept of so-called papillary muscle dysfunction." Circulation 76, No. 4, 777-785, 1987. MITRAL REGURGITATION is frequently observed in patients with myocardial infarction. Since it develops in the absence of any lesions in the mitral valve leaflet, its pathogenesis has been explained by the concept of "papillary muscle dysfunction" proposed by Burch et al. 1 At present, papillary muscle dysfunction is thought to be a sequence of unsuccessful coordination of the whole mitral apparatus (which is composed of the anulus, leaflets, chordae tendineae, papillary muscles, and the left ventricular wall), rather than a mere disorder of the papillary muscle. However, the concept of papillary muscle dysfunction is a rather theoretical one and its existence has not been proven from the point of view of functional anatomy. The purpose of this present study was to elucidate the pathogenesis of mitral regurgitation observed in patients with old myocardial infarction by assessment of the topographic features of regurgitation with a realtime two-dimensional Doppler flow imaging technique as well as two-dimensional echocardiography. Materials and methods...

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Section: Severitymentioning

confidence: 91%

Mechanism of mitral regurgitation in patients with myocardial infarction: a study using real-time two-dimensional Doppler flow imaging and echocardiography.

Izumi¹,

Miyatake²,

Beppu³

et al. 1987

Circulation

147

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“…These 20 patients were excluded from further long-term result analysis. Successful results were defined as immediate postprocedure MVA ≥1.5 cm 2 and no MR grade >2/4 according to Sellers’ classification [19]. Eleven patients who originated from neighboring countries were lost to follow-up.…”

Section: Methodsmentioning

confidence: 99%

Long-Term (up to 18 Years) Clinical and Echocardiographic Results of Mitral Balloon Valvuloplasty in 531 Consecutive Patients and Predictors of Outcome

Fawzy¹,

Shoukri

Fadel³

et al. 2009

Cardiology

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Objectives: The study aim was to assess the long-term results (up to 18 years) of mitral balloon valvuloplasty (MBV) and to identify predictors of restenosis and event-free survival. Methods: The immediate and long-term results for 531 consecutive patients (mean age 31 ± 11 years) who underwent successful MBV and were followed up for a mean of 8.5 ± 4.8 years (range: 1.5–18 years) are reported. Results: The mitral valve area (MVA) increased from 0.92 ± 0.17 to 1.95 ± 0.29 cm² (p < 0.0001). Restenosis was 31 and 19% in patients with mitral echocardiographic score (MES) ≤8. Actuarial freedom from restenosis at 10, 15 and 18 years was 77 ± 2, 46 ± 3 and 18 ± 4% and 86 ± 2, 62 ± 4 and 31 ± 7% for MES ≤8, respectively (p < 0.001). Event-free survival (death, redo MBV, mitral valve replacement, NYHA class III or IV) at 10, 15 and 18 years was 88 ± 1, 53 ± 4, and 21 ± 5% and 93 ± 2, 65 ± 5 and 38 ± 8% for MES ≤8, respectively (p < 0.001). Multivariable Cox regression analysis identified MES >8 (p < 0.0001) and previous surgery (p = 0.043) as predictors of restenosis, and MES >8 (p < 0.0001) and baseline atrial fibrillation (p = 0.03) as predictors of combined events. Conclusion: MBV provides excellent long-term results. The baseline clinical and MES characteristics are predictors of outcome.

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“…The degree of AR (grade 3 or 4) was determined by composite analysis of either angiography 9 or color flow Doppler. 10 Echocardiographic measurements obtained during routine clinical studies within 1 month before surgery were prospectively collected and electronically transferred without alteration.…”

Section: Echocardiographic and Angiographic Methodsmentioning

confidence: 99%

Outcomes After Aortic Valve Replacement in Patients With Severe Aortic Regurgitation and Markedly Reduced Left Ventricular Function

et al. 2002

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Background— Left ventricular dysfunction is an indication for aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR). However, the postoperative outcome of patients with severe AR and a markedly low ejection fraction (EF) is not known. Methods and Results— The study group consisted of a total of 450 patients who had AVR for isolated AR between 1980 and 1995. Patients with markedly reduced left ventricular function (EF <35%, LoEF, n=43) were compared with those with moderate reduction in left ventricular function (EF 35% to 50%, MedEF, n=134) and those with normal left ventricular function (EF ≥50%, Nl EF, n=273). The operative mortality rate was higher with LoEF (14%) than with MedEF and Nl EF (6.7% and 3.7%, respectively, P =0.02). At 10 years, 41%±9% of LoEF patients had survived compared with 56%±5% and 70%±3% of MedEF and Nl EF patients, respectively ( P <0.0001). Congestive heart failure occurred at 10 years in 25%±9% with LoEF compared with 17%±4% and 9%±2% with MedEF and NL EF, respectively ( P <0.003). Postoperative EF improved by 4.9%±13.8% in the LoEF group and by 4%±11.9% in the MedEF group compared with −2.3%±10.9% in the Nl EF group ( P <0.002 and P <0.0001, respectively). Conclusions— Patients with severe AR and markedly low EF incur excess operative mortality rates, postoperative mortality rates, and congestive heart failure after AVR. However, postoperative EF improves markedly, and most patients enjoy a long postoperative survival without recurrence of heart failure after AVR; thus they should not be denied the benefits of AVR.

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Left retrograde cardioangiography in acquired cardiac disease

Cited by 760 publications

References 5 publications

Mechanism of mitral regurgitation in patients with myocardial infarction: a study using real-time two-dimensional Doppler flow imaging and echocardiography.

Mechanism of mitral regurgitation in patients with myocardial infarction: a study using real-time two-dimensional Doppler flow imaging and echocardiography.

Long-Term (up to 18 Years) Clinical and Echocardiographic Results of Mitral Balloon Valvuloplasty in 531 Consecutive Patients and Predictors of Outcome

Outcomes After Aortic Valve Replacement in Patients With Severe Aortic Regurgitation and Markedly Reduced Left Ventricular Function

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