The Effect of Depth of Anesthesia on the Severity of Mitral Regurgitation as Measured by Transesophageal Echocardiography

Chin, Ji-Hyun; Lee, Eun‐Ho; Choi, Dae Ki; Choi, In‐Cheol

doi:10.1053/j.jvca.2012.05.012

Cited by 19 publications

(10 citation statements)

References 22 publications

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“…19,29 Clinical echocardiographic studies of the mitral valve have demonstrated that general anesthesia may significantly influence functional valvular insufficiency. [30][31][32] Because of reduced preload, filling of the LV in functional mitral regurgitation is reduced, resulting in less leaflet tethering and improved coaptation observed on transesophageal echocardiography. [30][31][32] Similar mechanisms may be assumed to influence the tricuspid valvular complex under general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…[30][31][32] Because of reduced preload, filling of the LV in functional mitral regurgitation is reduced, resulting in less leaflet tethering and improved coaptation observed on transesophageal echocardiography. [30][31][32] Similar mechanisms may be assumed to influence the tricuspid valvular complex under general anesthesia. Dreyfus and colleagues 2 proposed that in nonanesthetized patients with mild TR and annular diameter of more than 40 mm, any additional changes in preload, afterload, or right ventricular function may lead to increased valvular insufficiency.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Tricuspid valvular dynamics and 3-dimensional geometry in awake and anesthetized sheep

Jaźwiec

Malinowski

Proudfoot

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tricuspid valvular dynamics and 3-dimensional geometry in awake and anesthetized sheep

Jaźwiec

Malinowski

Proudfoot

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…Intraoperative TEE was excluded by the study protocol because general anesthesia dramatically reduces the severity of MR by TEE. 21 …”

Section: Methodsmentioning

confidence: 99%

Mechanisms of Functional Mitral Regurgitation in Ischemic Cardiomyopathy Determined by Transesophageal Echocardiography (from the Surgical Treatment for Ischemic Heart Failure Trial)

Gołba¹,

Mokrzycki²,

Drożdż³

et al. 2013

The American Journal of Cardiology

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The mechanisms underlying functional mitral regurgitation (MR), and the relation between mechanism and severity of MR have not been evaluated in a large multicenter randomized controlled trial. Transesophageal echocardiography (TEE) was performed in 215 patients at 17 centers in the Surgical Treatment of Ischemic Heart Failure (STICH) trial. Both two-dimensional (2D, n=215) and three-dimensional (3D, n=81) TEE were used to assess multiple quantitative measures of the mechanism and severity of MR. By 2D TEE, leaflet tenting area, anterior and posterior leaflet angles, mitral annulus diameter, left ventricular (LV) end-systolic volume index, LV ejection fraction (LVEF), and sphericity index (p<0.05 for all) were significantly different across MR grades. By 3D TEE, mitral annulus area, leaflet tenting area, LV end-systolic volume index, LVEF, and sphericity index (p<0.05 for all) were significantly different across MR grades. A multivariable analysis showed a trend for annulus area (p=0.069) and LV end-systolic volume index (p=0.071) to predict effective regurgitant orifice area (EROA) and for annulus area (p=0.018) and LV end-systolic volume index (p=0.073) to predict vena contracta area. In the STICH trial, multiple quantitative parameters of the mechanism of functional MR are related to MR severity. The mechanism of functional MR in ischemic cardiomyopathy is heterogeneous but no single variable stands out as a strong predictor of quantitative severity of MR.

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“…Novel 3D methods including vena contracta area and 3D proximal isovelocity surface area have the potential to overcome these limitations regarding orifice shape (58,59). Transesophageal echocardiography has superior image quality and enables a more detailed morphological assessment of mitral valve apparatus; however, mild anesthesia is often required because of discomfort, which may modify the severity of functional MR (60,61).…”

Section: Clinical Implications Of Atrial Functional Mrmentioning

confidence: 99%

Augmentation of Tissue Perfusion in Patients With Peripheral Artery Disease Using Microbubble Cavitation

Mason¹,

Davidson²,

Sheeran³

et al. 2020

JACC: Cardiovascular Imaging

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OBJECTIVES The authors investigated ideal acoustic conditions on a clinical scanner custom-programmed for ultrasound (US) cavitation-mediated flow augmentation in preclinical models. We then applied these conditions in a first-inhuman study to test the hypothesis that contrast US can increase limb perfusion in normal subjects and patients with peripheral artery disease (PAD).BACKGROUND US-induced cavitation of microbubble contrast agents augments tissue perfusion by convective shear and secondary purinergic signaling that mediates release of endogenous vasodilators.METHODS In mice, unilateral exposure of the proximal hindlimb to therapeutic US (1.3 MHz, mechanical index 1.3) was performed for 10 min after intravenous injection of lipid microbubbles. US varied according to line density (17, 37, 65 lines) and pulse duration. Microvascular perfusion was evaluated by US perfusion imaging, and in vivo adenosine triphosphate (ATP) release was assessed using in vivo optical imaging. Optimal parameters were then used in healthy volunteers and patients with PAD where calf US alone or in combination with intravenous microbubble contrast infusion was performed for 10 min. RESULTSIn mice, flow was augmented in the US-exposed limb for all acoustic conditions. Only at the lowest line density was there a stepwise increase in perfusion for longer (40-cycle) versus shorter (5-cycle) pulse duration. For higher line densities, blood flow consistently increased by 3-fold to 4-fold in the US-exposed limb irrespective of pulse duration. High line density and long pulse duration resulted in the greatest release of ATP in the cavitation zone.Application of these optimized conditions in humans together with intravenous contrast increased calf muscle blood flow by >2-fold in both healthy subjects and patients with PAD, whereas US alone had no effect.CONCLUSIONS US of microbubbles when using optimized acoustic environments can increase perfusion in limb skeletal muscle, raising the possibility of a therapy for patients with PAD.

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The Effect of Depth of Anesthesia on the Severity of Mitral Regurgitation as Measured by Transesophageal Echocardiography

Cited by 19 publications

References 22 publications

Tricuspid valvular dynamics and 3-dimensional geometry in awake and anesthetized sheep

Tricuspid valvular dynamics and 3-dimensional geometry in awake and anesthetized sheep

Mechanisms of Functional Mitral Regurgitation in Ischemic Cardiomyopathy Determined by Transesophageal Echocardiography (from the Surgical Treatment for Ischemic Heart Failure Trial)

Augmentation of Tissue Perfusion in Patients With Peripheral Artery Disease Using Microbubble Cavitation

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