The mitral complex

Silverman, Michael E.; Hurst, J. Willis

doi:10.1016/0002-8703(68)90237-8

Cited by 118 publications

(9 citation statements)

References 179 publications

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“…Evidence of this suggestion was presented by Strunk et al The excursion of the AR could also be explained by its attachment to the cardiac skeleton, which would suggest that its movements follow those of the base of the heart . The sequence of movements of the base of the heart during systole and diastole could also account for the AR motion . Therefore, whether the DAR is related to left atrial volume changes, the excursion of the base of the heart, or both of these mechanisms, this study demonstrated that a decreased DAR was observed in conditions causing diminished stroke volume and LVEF.…”

Section: Discussionsupporting

confidence: 63%

An Alternative Approach to the Bedside Assessment of Left Ventricular Systolic Function in the Emergency Department: Displacement of the Aortic Root

Ünlüer

Karagöz

Bayata

et al. 2013

Academic Emergency Medicine

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Objectives: Left ventricular ejection fraction (LVEF) is a crucial parameter in the management of patients with dyspnea in the emergency department (ED). The use of techniques other than echocardiography such as nuclear or magnetic resonance imaging to measure LVEF is unsuitable in the ED because of time constraints. This study aimed to compare echocardiographic aortic root (AR) excursion and LVEF measurement using the modified Simpson's method (biplane method of disks) as recommended by the American Society of Echocardiography. Methods: After 2 hours of theoretical video and hands-on training with 20 patients by an experienced echocardiographer, two emergency physicians prospectively evaluated patients with dyspnea. Two-dimensional echocardiograms of the parasternal long-axis view were obtained, and the displacement of the aortic root (DAR) was studied. M-mode DAR recordings were obtained, and distances were measured as the maximized anterior displacement of the AR from the horizontal axis at end-systole by using the leading-edge methodology. LVEF was measured by an experienced cardiologist using the modified Simpson's rule. The sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-), and positive and negative predictive values (PPV, NPV) were analyzed. A new formula for the prediction of the ejection fraction (EF) with the aid of DAR was then created. Results: The mean (AESD) age with of the 70 study patients was 69.7 (AE11.91) years. In these patients, DAR was highly correlated with EF (point biserial correlation coefficient = 0.79, p < 0.001) and one-way analysis of variance (ANOVA) results were significant (F = 115.9; p < 0.001). The sensitivity was 94.4; specificity, 94.1; LR+, 16.6; LR-, 0.059; PPV, 94.4; and NPV, 94.1. Conclusions: The results indicate that DAR is a sensitive index of left ventricular systolic function (SF) and can be used to reliably predict EF values using the rough formula of EF = 20 + 44 (DAR). ACADEMIC EMERGENCY MEDICINE 2013; 20:367-373 O ptimizing cardiac performance is an important goal in the management of critical illnesses. Physical examination has proven unreliable for differentiating between cardiogenic and noncardiogenic causes of hypotension, 1,2 and rapid determination of left ventricular ejection fraction (LVEF) may have important implications for patient diagnosis and treatment. 3,4 Studies in intensive care units have shown that echocar-diography may supplement or replace invasive measures of volume status and have provided information about short-and long-term prognosis. 5-11 The use of focused cardiac ultrasound (FOCUS) within the emergency department (ED) has historically provided both prognostic information for patients with suspected cardiac ischemia and diagnostic clues about diastolic heart failure. 12-15 Studies have also demonstrated that experienced emergency physicians (EPs) with additional FOCUS training can accurately assess LVEF in ED patients with acute dyspnea. 16-18 Because of the limited time available for ED patient evaluation, t...

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Section: Discussionsupporting

confidence: 63%

An Alternative Approach to the Bedside Assessment of Left Ventricular Systolic Function in the Emergency Department: Displacement of the Aortic Root

Ünlüer

Karagöz

Bayata

et al. 2013

Academic Emergency Medicine

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“…Additional components of the mature chordal system are bands of tissue that extend between chordae tendineae (Silverman and Hurst, 1968;Tucker, 1974). Tucker (1974) terms these interchordal ligaments and assigns them major significance for dissipation and equalization of forces being transmitted to the valve.…”

Section: Discussionmentioning

confidence: 99%

Morphogenesis of chordae tendineae. I: Scanning electron microscopy

1984

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The formation of the chordae tendineae of the left atrioventricular valve in the chick embryo is described using scanning electron microscopy. These supportive structures for the valve cusps develop between days 6 and 13 of incubation. Elevations which represent the primitive papillary muscles form on the ventricular wall. These elevations bifurcate into thin, web-like folds which are attached to the primitive valve cusps. The folds are the primordia of the chordae tendineae. Linear ridges develop on the web between the cusp and papillary muscle. These ridges alternate with depressions. The depressions become perforate to create the individual chorda from the linear ridges. Multiple perforations form initially but they typically consolidate to create one large aperture between two chordae. Some interchordal connections of tissue do persist throughout the period studied. During the period of perforation, prominent rounded cells are typical of the endocardium between the chordae. These cells are similar at the scanning electron microscope level to those present in the formation of the foramina secunda of the atrial septum. Primary, secondary, and tertiary chordae tendineae appear to develop in the same manner. First order chordae (those attached at the free margin of a cusp) are not found in the chick embryo. The majority of the chordae are second order, which insert into the ventricular surface of the cusp a short distance from the free edge. These chordae typically have a horizontal banding or grooving along their length. Third order chordae which extend from the papillary muscle to the ventricular wall are also present. It is suggested that chordal development is a programmed cellular and hemodynamic event.

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“…The excursion of the aortic root could also be explained by its attachment to the cardiac skeleton which would necessitate that its movements follow those of the base of the heart. Left ventriculographic studies demonstrate that during the ejection phase the base of the heart descends in a leftward, anterior, and inferior direction with an opposite retracting motion of the left ventricular apex (7). During diastole the base of the heart ascends, moves to the right and posteriorly, and makes abrupt posterior movements during rapid filling and with atrial systole.…”

Section: Discussionmentioning

confidence: 99%

Aortic root motion determined by ultrasound: Relation to cardiac performance in man

Burggraf

Mathew

Parker

1978

Cathet. Cardiovasc. Diagn.

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The purpose of this study was to determine if aortic root systolic anteroposterior excursion measured ultrasonically is related to cardiac performance. Aortic motion was 9 +/- 1.5 mm (mean +/- SD) in 30 normal subjects (range 7-12 mm). Ten patients with coronary artery disease and congestive failure and 10 with congestive cardiomyopathy had significantly smaller values of 4 +/- 1.2 and 5 +/- 1.7 mm, respectively (P less than 0.001). In 28 subjects undergoing cardiac catheterization, aortic root motion correlated positively with stroke volume (r = 0.59), but did not correlate significantly with ejection fraction. By increasing heart rate in 14 subjects from 75 to 174 beats/min with atrial pacing, stroke volume decreased from 81 +/- 22 to 34 +/- 14 ml/beat and aortic excursion from 10 +/- 1.6 to 5 +/- 1.5 mm (P less than 0.001). This study has shown: 1) Aortic root motion less than or equal to 6 mm indicates left ventricular dysfunction; 2) stroke volume correlates positively with, but cannot be accurately predicted from, root motion.

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The mitral complex

Cited by 118 publications

References 179 publications

An Alternative Approach to the Bedside Assessment of Left Ventricular Systolic Function in the Emergency Department: Displacement of the Aortic Root

An Alternative Approach to the Bedside Assessment of Left Ventricular Systolic Function in the Emergency Department: Displacement of the Aortic Root

Morphogenesis of chordae tendineae. I: Scanning electron microscopy

Aortic root motion determined by ultrasound: Relation to cardiac performance in man

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