Quantitation of mitral regurgitation by Doppler echocardiography.

Blumlein, Steven; Bouchard, Amelie; Schiller, Nelson B.; Dae, M.; Byrd, Benjamin F.; Ports, Thomas A.; Botvinick, E H

doi:10.1161/01.cir.74.2.306

Cited by 126 publications

(44 citation statements)

References 20 publications

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“…MR was quantified by 3 methods: quantitative Doppler with mitral and aortic stroke volumes, 15,16 quantitative 2D echocardiography with LV stroke volumes, 15,17 and the proximal isovelocity surface area method. 2 These methods were averaged, which allowed calculation of regurgitant volume, regurgitation fraction (RF), and effective regurgitant orifice.…”

Section: Doppler Echocardiographymentioning

confidence: 99%

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B-Type Natriuretic Peptide in Organic Mitral Regurgitation

et al. 2005

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Section: Doppler Echocardiographymentioning

confidence: 99%

“…The value of quantitative Doppler echocardiographic methods has been debated; however, LV volumes are reliable with high-resolution imaging, LA volume has been measured to describe LA remodeling, 20,46 and MR has been quantified by 3 validated methods. [15][16][17] …”

Section: Study Limitationsmentioning

confidence: 99%

B-Type Natriuretic Peptide in Organic Mitral Regurgitation

et al. 2005

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“…9 3D LV volumes were obtained using endocardial borders from 9 views. 21 MR stroke volume was calculated as LV ejection volume minus aortic outflow volume directly measured by flowmeter, 22 and MR orifice area was calculated from regurgitant stroke volume and LV-LA pressure gradient (Yellin-modified Gorlin equation). 9 Regurgitant fraction was calculated as (MR stroke volume)/(Forward aorticϩMR stroke volumes).…”

Section: D Echocardiographymentioning

confidence: 99%

Chordal Cutting

et al. 2001

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Background-Mitral regurgitation (MR) conveys adverse prognosis in ischemic heart disease. Because such MR is related to increased leaflet tethering by displaced attachments to the papillary muscles (PMs), it is incompletely treated by annular reduction. We therefore addressed the hypothesis that such MR can be reduced by cutting a limited number of critically positioned chordae to the leaflet base that most restrict closure but are not required to prevent prolapse. This was tested in 8 mitral valves: a porcine in vitro pilot with PM displacement and 7 sheep with acute inferobasal infarcts studied in vivo with three-dimensional (3D) echo to quantify MR in relation to 3D valve geometry. Methods and Results-In all 8 valves, PM displacement restricted leaflet closure, with anterior leaflet angulation at the basal chord insertion, and mild-to-moderate MR. Cutting the 2 central basal chordae reversed this without prolapse. In vivo, MR increased from 0.8Ϯ0.2 to 7.1Ϯ0.5 mL/beat after infarction and then decreased to 0.9Ϯ0.1 mL/beat with chordal cutting (PϽ0.0001); this paralleled changes in the 3D leaflet area required to cover the orifice as dictated by chordal tethering (r 2 ϭ0.76). Conclusions-Cutting a minimum number of basal chordae can improve coaptation and reduce ischemic MR. Such an approach also suggests the potential for future minimally invasive implementation.

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“…17 Threedimensional LV volumes were obtained through endocardial borders from 9 views. 21 MR stroke volume was calculated as LV ejection volume minus aortic outflow volume directly measured by flowmeter, 22 and MR orifice area was calculated from regurgitant stroke volume and LV-LA pressure gradient (Yellin-modified Gorlin equation). 17 The least-squares plane of the mitral annular hinge points (confirmed by cineloop review) was established as the reference frame 23 ; projecting the annulus onto this plane gave annular area.…”

Section: Three-dimensional Echocardiographymentioning

confidence: 99%

Paradoxic Decrease in Ischemic Mitral Regurgitation With Papillary Muscle Dysfunction

et al. 2001

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Background-Ischemic mitral regurgitation (MR) was first ascribed to papillary muscle (PM) contractile dysfunction.Current theories include apical leaflet tethering caused by left ventricular (LV) distortion, but PM dysfunction is still postulated and commonly diagnosed. PM contraction, however, parallels apical tethering, suggesting the hypothesis that PM contractile dysfunction can actually diminish MR due to ischemic distortion of the inferior base alone. Methods and Results-We therefore occluded the proximal circumflex circulation in 7 sheep while maintaining PM perfusion, confirmed by contrast echocardiography. By 3D echocardiography, we measured the tethering distance between the ischemic medial PM tip and anterior annulus and LV ejection volume to give MR (by subtracting flowmeter LV outflow). In 6 sheep without initial MR, inferior ischemia alone produced PM tip retraction with restricted leaflet closure and mild-to-moderate MR (regurgitant fraction, 25.2Ϯ2.8%). Adding PM ischemia consistently decreased MR and tethering distance (5.2Ϯ0.3 to 1.4Ϯ0.3 mL; ϩ3.8Ϯ0.5 mm to Ϫ2.2Ϯ0.7 mm axially relative to baseline; PϽ0.001) as PM strain rate decreased from ϩ0.78Ϯ0.07 per second (contraction) to Ϫ0.42Ϯ0.06 per second (elongation, PϽ0.001) and leaflet tenting decreased. In one sheep, prolapse and MR resolved with inferior ischemia and recurred with PM ischemia. Conclusions-PM contractile dysfunction can paradoxically decrease MR from inferobasal ischemia by reducing leaflet tethering to improve coaptation. This emphasizes the role of geometric factors in ischemic MR mechanism and potential therapy.

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Quantitation of mitral regurgitation by Doppler echocardiography.

Cited by 126 publications

References 20 publications

B-Type Natriuretic Peptide in Organic Mitral Regurgitation

B-Type Natriuretic Peptide in Organic Mitral Regurgitation

Chordal Cutting

Paradoxic Decrease in Ischemic Mitral Regurgitation With Papillary Muscle Dysfunction

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