The International Journal of Cardiovascular Imaging

Paul, Biswajit; Minocha, Anil

doi: 10.1007/s10554-009-9548-9pmid: 20012207

Rheumatic mitral valve disease being common in India, valve replacement and hence thrombosis of prosthetic heart valves (PHV) are not uncommon. The diagnosis is commonly established by increased gradients across PHV during transthoracic echo and restricted leaflet movement during transesophageal echo or fluoroscopy. We demonstrated both the leaflets of a thrombosed PHV,of which one was stuck in closed position by real-time three-dimensional transesophageal echocardiography.

Purvis, John; Kennedy, Vincent; McNeill, Albert

doi: 10.1007/s10554-009-9563-xpmid: 20039135

An asymptomatic 35-year-old woman with history of coarctation repair underwent routine echo. This showed a bicuspid aortic valve with a significant gradient in the left ventricular outflow tract (LVOT). The anterior mitral valve leaflet appeared redundant. Transoesophageal echo showed thickened chordae tendineae from both mitral valve leaflets inserted into a single postero-medial papillary muscle—a parachute mitral valve. During systole, there was anterior motion of redundant mitral chordae into the LVOT producing significant obstruction. A diagnosis of partial Shone complex was made. She was referred for mitral (and possibly aortic) valve surgery. The combination of aortic coarctation with bicuspid aortic valve should stimulate a search for other levels of systemic obstruction-don’t stop at two!

Ozdemir, Aydan; Kaya, Cansın; Ozcan, Ozgur; Ozdol, Cagdas; Candemir, Basar; Turhan, Sibel; Dıncer, Irem; Erol, Cetin

doi: 10.1007/s10554-009-9550-2pmid: 19967561

Longitudinal two-dimensional strain deformation is a novel technique which evaluates global and regional left ventricular (LV) function with high reproducibility. The aim of the study was to investigate the global and regional systolic function using this method in patients with pure mitral stenosis (MS). Conventional echocardiography and longitudinal two-dimensional strain analysis were performed in 60 patients (41 ± 5 years, 48 women) with mild to moderate MS (mitral valve area: 1.9 ± 0.5 cm²), and 52 healthy controls (40 ± 7 years, 37 women). For strain analysis standard apical views were obtained, and by using a software system peak systolic strain and strain rate were calculated off-line in each segment. In all, 88% of the segments could be optimally tracked by the software system. Despite normal LV systolic function as assessed by ejection fraction (66 ± 8%), mean global longitudinal strain (GLS) and global longitudinal strain rate (GLSR) were significantly reduced in patients with isolated MS (GLS −17 ± 3.3 vs. −19 ± 2.5%, P = 0.006 and GLSR −1.3 ± 0.3 vs. −1.5 ± 0.3 s−1, P < 0.0001). Regional analysis demonstrated that patients with MS had a significantly reduced longitudinal peak strain and strain rate in all basal, and some mid (inferior, anteroseptal, interventricular septum) segments of the left ventricle. For other segments longitudinal peak strain and strain rate values were similar among the groups. Evaluation of LV systolic function by longitudinal two-dimensional strain deformation identified early abnormalities in MS patients who had apparently normal standard systolic function.