Journal ArticleDOI
Quantitative determinants of the outcome of asymptomatic mitral regurgitation
Maurice Enriquez-Sarano,Jean François Avierinos,David Messika-Zeitoun,Delphine Detaint,Maryann Capps,Vuyisile T. Nkomo,Christopher G. Scott,Hartzell V. Schaff,A. Jamil Tajik +8 more
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TLDR
Quantitative grading of mitral Regurgitation is a powerful predictor of the clinical outcome of asymptomatic mitral regurgitation and patients with an effective regurgitant orifice of at least 40 mm2 should promptly be considered for cardiac surgery.Abstract:
background The clinical outcome of asymptomatic mitral regurgitation is poorly defined, and the treatment is uncertain. We studied the effect on the outcome of quantifying mitral regurgitation according to recent guidelines. methods We prospectively enrolled 456 patients (mean [±SD] age, 63±14 years; 63 percent men; ejection fraction, 70±8 percent) with asymptomatic organic mitral regurgitation, quantified according to current recommendations (regurgitant volume, 66±40 ml per beat; effective regurgitant orifice, 40±27 mm 2 ). results The estimated five-year rates (±SE) of death from any cause, death from cardiac causes, and cardiac events (death from cardiac causes, heart failure, or new atrial fibrillation) with medical management were 22±3 percent, 14±3 percent, and 33±3 percent, respectively. Independent determinants of survival were increasing age, the presence of diabetes, and increasing effective regurgitant orifice (adjusted risk ratio per 10-mm 2 increment, 1.18; 95 percent confidence interval, 1.06 to 1.30; P<0.01), the predictive power of which superseded all other qualitative and quantitative measures of regurgitation. Patients with an effective regurgitant orifice of at least 40 mm 2 had a five-year survival rate that was lower than expected on the basis of U.S. Census data (58±9 percent vs. 78 percent, P=0.03). As compared with patients with a regurgitant orifice of less than 20 mm 2 , those with an orifice of at least 40 mm 2 had an increased risk of death from any cause (adjusted risk ratio, 2.90; 95 percent confidence interval, 1.33 to 6.32; P<0.01), death from cardiac causes (adjusted risk ratio, 5.21; 95 percent confidence interval, 1.98 to 14.40; P<0.01), and cardiac events (adjusted risk ratio, 5.66; 95 percent confidence interval, 3.07 to 10.56; P<0.01). Cardiac surgery was ultimately performed in 232 patients and was independently associated with improved survival (adjusted risk ratio, 0.28; 95 percent confidence interval, 0.14 to 0.55; P<0.01). conclusions Quantitative grading of mitral regurgitation is a powerful predictor of the clinical outcome of asymptomatic mitral regurgitation. Patients with an effective regurgitant orifice of at least 40 mm 2 should promptly be considered for cardiac surgery.read more
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Journal ArticleDOI
The Evaluation of Real-time 3-Dimensional Transthoracic Echocardiography for the Preoperative Functional Assessment of Patients with Mitral Valve Prolapse : A Comparison with 2-Dimensional Transesophageal Echocardiography
TL;DR: RT-3DE is feasible with comparative accuracy to TEE for precise anatomic localization of prolapsing mitral valve segments, however, the technique is limited by poor image quality in 11% of patients.
Journal ArticleDOI
The Effect of Routine Intraoperative Transesophageal Echocardiography on Surgical Management
Mohammed M. Minhaj,Komal Patel,David Muzic,Avery Tung,Valluvan Jeevanandam,Jai Raman,Mark A. Chaney +6 more
TL;DR: Routine use of TEE during cardiac surgery revealed new cardiac pathology in one of every 3 patients and led to altered surgical management in 1 of every 4 patients, suggesting that intraoperative TEE should be used routinely in all patients undergoing cardiac surgery.
Journal ArticleDOI
Predictors of Long-Term Outcomes in Patients With Significant Myxomatous Mitral Regurgitation Undergoing Exercise Echocardiography
Peyman Naji,Brian P. Griffin,Fadi Asfahan,Tyler Barr,L. Leonardo Rodriguez,Richard A. Grimm,Shikhar Agarwal,William J. Stewart,Tomislav Mihaljevic,A. Marc Gillinov,Milind Y. Desai +10 more
TL;DR: In patients with grade III+ or greater myxomatous mitral regurgitation undergoing exercise echocardiography, lower percent of age/sex-predicted metabolic equivalents, lower heart rate recovery, atrial fibrillation, lower LV ejection fraction, and high resting right ventricular systolic pressure predicted worse outcomes.
Journal ArticleDOI
Small-incision mitral valve repair: safe, durable, and approaching perfection.
TL;DR: Direct visualization of the mitral valve through a right chest small-incision enables safe and effective performance of complex MV repair, with repair rates in excess of 95%.
Journal ArticleDOI
Direct measurement of multiple vena contracta areas for assessing the severity of mitral regurgitation using 3D TEE.
Eiichi Hyodo,Shinichi Iwata,Aylin Tugcu,Kotaro Arai,Kenei Shimada,Takashi Muro,Junichi Yoshikawa,Minoru Yoshiyama,Linda D. Gillam,Rebecca T. Hahn,Marco R. Di Tullio,Shunichi Homma +11 more
TL;DR: Direct measurement of multiple VC areas using 3D transesophageal echocardiography allows for assessing MR severity in patients with multiple jets, particularly for MR degrees greater than mild and in cases of more than 2 jets, for which geometric assumptions may be challenging.
References
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Journal ArticleDOI
Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography
William A. Zoghbi,Maurice Enriquez-Sarano,Elyse Foster,Paul A. Grayburn,Carol D. Kraft,Robert A. Levine,Petros Nihoyannopoulos,Catherine M Otto,Miguel A. Quinones,Harry Rakowski,William J. Stewart,Alan D. Waggoner,Neil J. Weissman +12 more
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