Biomedical subjects

M Enriquez-Sarano

Publications and source records attributed to M Enriquez-Sarano.

At least 73 records · Page 4Linked to original sources

PubMed1994

Effective regurgitant orifice area: a noninvasive Doppler development of an old hemodynamic concept.

OBJECTIVES: The purpose of this study was to determine the feasibility, relation to other methods and significance of the effective regurgitant orifice area measurement. BACKGROUND: Assessment of the severity of valvular regurgitation (effective regurgitant orifice area) has not been implemented in clinical practice but can be made by Doppler echocardiography. METHODS: Effective regurgitant orifice area was calculated by Doppler echocardiography as the ratio of regurgitant volume/regurgitant jet time-velocity integral and compared with color flow Doppler mapping, angiography, surgical classification, regurgitant fraction and variables of volume overload. RESULTS: In 210 consecutive patients examined prospectively, feasibility improved from the early to the late experience (65% to 95%). Effective regurgitant orifice area was 28 +/- 23 mm2 (mean +/- SD) for aortic regurgitation (32 patients), 22 +/- 13 mm2 for ischemic/functional mitral regurgitation (50 patients) and 41 +/- 32 mm2 for organic mitral regurgitation (82 patients). Significant correlations were found between effective regurgitant orifice and mitral jet area by color flow Doppler mapping (r = 0.68 and r = 0.63, p < 0.0001, respectively) and angiographic grade (r = 0.77, p = 0.0004). Effective regurgitant orifice area in surgically determined moderate and severe lesions was markedly different in mitral regurgitation (35 +/- 12 and 75 +/- 33 mm2, respectively, p = 0.009) and in aortic regurgitation (21 +/- 8 and 38 +/- 5 mm2, respectively, p = 0.08). Strong correlations were found between effective regurgitant orifice area and variables reflecting volume overload. A logarithmic regression was found between effective regurgitant orifice area and regurgitant fraction, underlining the complementarity of these indexes. CONCLUSIONS: Calculation of effective regurgitant orifice area is a noninvasive Doppler development of an old hemodynamic concept, allowing assessment of the lesion severity of valvular regurgitation. Feasibility is excellent with experience. Effective regurgitant orifice area is an important and clinically significant index of regurgitation severity. It brings additive information to other quantitative indexes and its measurement should be implemented in the comprehensive assessment of valvular regurgitation.

Aged↗

PubMed1994

Echocardiographic prediction of survival after surgical correction of organic mitral regurgitation.

BACKGROUND: Left ventricular dysfunction is a frequent cause of death after successful surgical repair of mitral regurgitation. The role of preoperative echocardiographic left ventricular variables in the prediction of postoperative survival and thus their clinical implications remain uncertain. METHODS AND RESULTS: The survival of 409 patients operated on between 1980 and 1989 for pure, isolated, organic mitral regurgitation and with a preoperative echocardiogram (within 6 months of operation) was analyzed. The overall survival was 75% at 5 years (90% of expected), 58% at 10 years (88% of expected), and 44% at 12 years (73% of expected). Operative mortality was 6.6% and markedly improved from 1980 to 1984 (10.7%) to 1985 to 1989 (3.7%). Multivariate analysis showed that age (P = .0003), date of operation (P = .003), and functional class (P = .016) but not left ventricular function were predictors of operative mortality. In the most recent period (1985 to 1989), operative mortality was 12.3% in patients age 75 years or older and 1.1% in patients younger than 75 years. Late survival was analyzed in the operative survivors. Multivariate analysis showed that the most powerful predictor was echocardiographic ejection fraction (EF) (P = .0004), followed by age (P = .0031), creatinine level (P = .0062), systolic blood pressure (P = .0164), and presence of coronary artery disease (P = .0237). The late survival at 10 years was 32 +/- 12% for patients with EF < 50%, 53 +/- 9% for EF 50% to 60%, and 72 +/- 4% for EF > or = 60%. The hazard ratio compared with EF > or = 60% was 2.79 (95% confidence interval, 1.65 to 4.72) for EF < 50% and 1.81 (95% confidence interval, 1.11 to 2.95) for EF 50% to 60%. Echocardiographic EF remained the best predictor of late survival, even when combined with left ventricular angiographic variables. The survival of patients with EF > or = 60% was 100% of expected at 10 years but was better in patients in class I or II than in those in class III or IV (82 +/- 6% versus 59 +/- 6%, respectively, at 10 years; P = .0021). The preoperative predictors of operative and late mortality remained significant independent of the type of surgical correction performed in combined multivariate analyses. CONCLUSIONS: In organic mitral regurgitation, (1) operative mortality has markedly decreased recently, being at a low 1.1% in patients younger than 75 years, and is predicted by age and symptoms and not by left ventricular function, and (2) left ventricular EF measured by echocardiography is the most powerful predictor of late survival. These results suggest that surgical treatment should be considered early, even in the absence of severe symptoms, in patients with severe mitral regurgitation, before left ventricular dysfunction occurs.

Echocardiography↗

PubMed1993

Amplitude-weighted mean velocity: clinical utilization for quantitation of mitral regurgitation.

OBJECTIVES: The purpose of this study was to determine the clinical usefulness of the amplitude-weighted mean velocity method for quantitation of mitral regurgitation. BACKGROUND: Amplitude-weighted mean velocity is a nonvolumetric method for calculating the mitral regurgitant fraction. Its previous validation at one center mandated an independent assessment of its usefulness and limitations. METHODS: In 56 patients with and 16 patients without mitral regurgitation, the regurgitant fraction was measured simultaneously by amplitude-weighted mean velocity, quantitative Doppler study and quantitative two-dimensional echocardiography. In 16 patients, multiple gain settings were used to determine the influence of this variable on amplitude-weighted mean velocity. RESULTS: In patients without regurgitation, amplitude-weighted mean velocity showed more scattering of regurgitant fraction (-18% to 23%) than Doppler (p = 0.016) or two-dimensional echocardiography (p = 0.022). The absolute value of regurgitant fraction was (mean +/- SD) 8 +/- 6%, 4 +/- 2% and 4 +/- 3%, respectively (p = NS). With increasing gain, the amplitude-weighted mean velocity mitral and aortic integrals increased, but the calculated regurgitant fraction remained unchanged. In patients with mitral regurgitation, significant correlation was found between amplitude-weighted mean velocity and Doppler study (r = 0.79, p = 0.0001) and between amplitude-weighted mean velocity and two-dimensional echocardiography (r = 0.76, p = 0.0001) for calculated regurgitant fraction, but the standard error of the estimate (12%) was large. CONCLUSIONS: The amplitude-weighted mean velocity-calculated regurgitant fraction is gain independent, whereas the aortic and mitral integrals are gain dependent. Compared with Doppler and two-dimensional echocardiography, it shows more scattering of values in patients without regurgitation, but the methods correlate significantly in patients with mitral regurgitation. Amplitude-weighted mean velocity can be used as a simple adjunctive tool for comprehensive, noninvasive quantitation of mitral regurgitation.

Adult↗

PubMed1993

Color flow imaging compared with quantitative Doppler assessment of severity of mitral regurgitation: influence of eccentricity of jet and mechanism of regurgitation.

OBJECTIVES: To determine the influence of jet eccentricity and mechanism of mitral regurgitation, we examined 1) the relation between jet extent and severity of mitral regurgitation, and 2) the use of Doppler color flow imaging for quantitation of mitral regurgitation. BACKGROUND: Doppler color flow imaging is widely used to assess mitral regurgitation. However, whether, how and in which subgroups it can quantify regurgitation remain controversial. METHODS: In 80 patients with mitral regurgitation, results of color flow Doppler studies obtained in two orthogonal apical views were prospectively compared with quantitative Doppler measurement of the regurgitant volume and the regurgitant fraction. Comparisons were made according to the eccentricity of the jet (group 1 eccentric jets, n = 29; group 2 central jets, n = 51); group 2 was subdivided according to the mechanism of mitral regurgitation (group 2a organic, n = 27; group 2b ischemic or functional, n = 24). RESULTS: Globally, weak correlations were found between regurgitant volume and jet area (r = 0.57) and regurgitant fraction and jet area/left atrial area ratio (r = 0.65). Groups 1 and 2 showed a correlation between regurgitant volume and jet area (r = 0.68 and r = 0.65, respectively, p < 0.0001), but the slope was steeper in group 2 than in group 1 (0.22 vs. 0.06, p < 0.0001). The same jet area corresponded to more severe regurgitation in group 1 than in group 2 (jet > or = 8 cm2, regurgitant volume 113 +/- 55 vs. 43 +/- 21 ml, p < 0.0001). Similarly, for comparable regurgitant volumes (24 +/- 22 vs. 29 +/- 11 ml, p = NS), group 2a had a smaller jet area than did group 2b (5.3 +/- 6 vs. 9.6 +/- 6 cm2, p < 0.02). Quantitation of regurgitation by Doppler color flow imaging was unreliable in group 1; in group 2b, the regression line between regurgitant fraction and jet area/left atrial area ratio was close to the identity line. CONCLUSIONS: Mitral regurgitant jet eccentricity and mechanism influence jet extent. The same regurgitant volume produces smaller jet areas for eccentric compared with central jets and for central organic compared with ischemic or functional regurgitation. Quantitation of regurgitation using Doppler color flow imaging is possible in ischemic or functional regurgitation but inappropriate in eccentric jets, where quantitative Doppler study should be recommended.

Aged↗

PubMed1993

Multiplane transesophageal echocardiography: image orientation, examination technique, anatomic correlations, and clinical applications.

Multiplane transesophageal echocardiography (TEE) consists of a single ultrasound array or imaging sector that can be rotated around the long axis of the ultrasound beam typically in a 180 degrees arc. This capability produces a circular (conical) continuum of tomographic two-dimensional images. The principal advantage of multiple TEE is that the transducer can be rotated to an image-specific orientation and critically optimized. Thus, manipulation of the transducer is less complex than with the biplane technique, and user adaptation is considerably enhanced. The logical image notation (that is, degrees of rotation) and orientation are described in this report. A step-by-step approach to the multiplane TEE examination, which evolved from our initial experience with 400 consecutive patients, is correlated with accompanying tomographic anatomic corroboration. The unique clinical applications are discussed and related to the amplification of diagnostic information. Although the multiplanar TEE transducer is relatively large, all adult patients who weigh 40 kg or more can be examined. No major complications occurred in our initial experience with this promising new technology.

Adolescent↗

PubMed1993

Quantitative Doppler assessment of valvular regurgitation.

BACKGROUND: Quantitation of valvular regurgitation remains a challenge. The accuracy of quantitative Doppler is controversial, and its ability to measure regurgitant volume is unknown; therefore, it is not widely used. METHODS AND RESULTS: In 120 patients (20 without regurgitation, 19 with aortic regurgitation, and 81 with mitral regurgitation), the stroke volume through the mitral annulus and left ventricular outflow tract were measured using pulsed-wave Doppler concurrently with left ventricular stroke volume calculated using left ventricular volumes measured by two-dimensional echocardiography Simpson's biapical method. Regurgitant volume and fraction were thus computed using Doppler or ventricular methods. In normal patients there were good correlations between Doppler and left ventricular measurements of stroke volume. Doppler regurgitant volume and fraction were 4.4 +/- 4.4 mL and 5.3 +/- 4.5%, respectively. In patients with aortic regurgitation, there were good correlations between Doppler and left ventricular measurements of stroke volume, regurgitant volume, and regurgitant fraction (r = 0.97, r = 0.95, and r = 0.93, respectively; p < 0.0001). In patients with mitral regurgitation, despite good correlations between Doppler and ventricular methods for stroke volume, regurgitant volume, and regurgitant fraction (r = 0.94, r = 0.93, and r = 0.94, respectively; p < 0.001), these variables were overestimated by Doppler. However, in the last 54 patients compared with the first 27, overestimation decreased significantly for regurgitant volume (5 +/- 10 mL versus 18 +/- 27 mL, p < 0.05) and regurgitant fraction (3.3 +/- 6.7% versus 6.2 +/- 6.8%, p = 0.05). CONCLUSIONS: Quantitative Doppler can be performed in large numbers of patients in a clinical laboratory. Its potential limitation was identified as overestimation of mitral regurgitation, which is overcome with increased experience. Its achieved accuracy in mitral and aortic regurgitation allows measurement not only of regurgitant fraction but most importantly of regurgitant volume.

Adult↗

PubMed1990

[Value of transesophageal echocardiography. From a preliminary experience of 532 cases].

Transesophageal echocardiography (TEE) was introduced recently in France. The aim of this study was to review the diagnostic value of this technique after 8 months' use in our cardiology department. A total of 532 TEE studies were carried out between April and December 1988 in 396 patients (average age 54 years, range 17 to 89 years) at Tenon Hospital. The failure rate was 1.8 per cent (N = 10), over half of which occurred at the beginning of the operator's experience. TEE was particularly valuable compared with the standard transthoracic approach in the following instances: the investigation of mitral stenosis, especially before percutaneous valvuloplasty (N = 75). A left atrial thrombus was demonstrated in 5 cases by TEE vs none by standard echocardiography. There was also a much higher diagnostic sensitivity for small interatrial shunts (40 vs 6) resulting from transseptal catheterisation. In the preoperative investigation of severe mitral regurgitation (N = 29). The etiology was accurately diagnosed in 29 vs 26 cases, and the mechanism of the regurgitation was correctly classified especially in cases of ruptured chordae (15 vs 6 cases). In endocarditis (N = 26) by the visualisation of abscess of the aortic ring (7 vs 1) and vegetations (19 vs 8). In prosthetic valve dysfunction (N = 65) by the demonstration of primary degeneration of bioprostheses (7 vs 4), perivalvular leaks (10 vs 4) and non-occlusive thrombi of mechanical prostheses (3 vs 0). In cases of intracardiac tumours, dissection of the thoracic aorta and atrial septal defects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

[Factors influencing survival after surgery of pure non-ischemic mitral insufficiency].

Uni and multifactorial (Cox) statistical analysis of the results of surgery in a series of 247 patients operated between 1969 and 1988 for pure, non-ischaemic mitral regurgitation was undertaken to determine the factors influencing operative and late mortality. All but 3 cases were adults, average age 51 years, and very symptomatic (75 per cent Class III et IV of NYHA Classification). Dystrophic or degenerative lesions were responsible for 53 per cent of cases of regurgitation whilst rheumatic valvular disease was only observed in 30 per cent of cases. Mitral valve replacement was performed in 137 patients (96 mechanical and 41 bioprostheses) and conservative surgery was possible in 110 cases. There were 12 operative deaths (4.9%); the operative risk increased with age and with the practice of valve replacement. Eleven of the 235 survivors (4.7%) were lost to follow-up. During the follow-up period (average 58 months) there were 37 late deaths of which nearly a half were due to left ventricular dysfunction. Multifactorial analysis identified cardiothoracic ratio and atrial fibrillation as predictive factors of late mortality whilst left ventricular ejection fraction and the type of surgery were related to the development of left ventricular dysfunction. The postoperative left ventricular ejection fraction was significantly lower after valve replacement than after valvuloplasty (11 +/- 13% vs 3 +/- 13%; p less than 0.01). These results are therefore in favour of early correction of severe mitral regurgitation by conservative surgery whenever possible.

Adolescent↗

PubMed1990

[Echography in surgical mitral insufficiency. Pathologic diagnosis and provision of the surgical procedure].

The aim of this study was to determine the reliability of preoperative transthoracic and transesophageal echocardiography compared with the surgical findings in pure or dominant severe mitral regurgitation with respect to: the evaluation of the lesions, mechanism and etiology; the provision of the type of surgery (valve replacement or reconstruction); One hundred and fifty patients were divided into two groups: Group I (N = 120) in which preoperative assessment included transthoracic echo-Doppler coupled with color Doppler in the last 32 patients; Group II (N = 30) operated recently who underwent both transesophageal and transthoracic echo-Doppler examination. In Group I, the sensitivity of transthoracic echo in the evaluation of the etiological was 86% overall [100% in rheumatic valve disease (N = 28), 86% in degenerative or dystrophic valves (N = 72), 44% in endocarditis (N = 9), 87% in ischaemic dysfunction (N = 8)]. The echo evaluation of the mechanism of the regurgitation was also reliable with the exception of ruptured chordae in which direct visualisation of the rupture was only possible in 19 of the 64 cases (30%). The type of surgery predicted by echo was practiced in 87% of cases.

Adolescent↗

PubMed1987

[Traumatic tricuspid insufficiency. Apropos of a case treated by conservative surgery].

Traumatic tricuspid insufficiency is a rare condition which raises the problem of when and how should its surgical correction be performed. Its diagnosis has been considerably facilitated by echocardiography. We report a case of traumatic tricuspid insufficiency with extensive lesions of the tricuspid valve system, which was diagnosed after a 15-year period without functional signs. Echocardiography and Doppler ultrasounds provided very accurate information on the lesions. Optimal correction was obtained by conservative surgery. The excellent results observed at short and medium term suggest that surgical indications should be extended.

Accidents, Traffic↗

PubMed1987

[Doppler measurement of transvalvular gradients. Simultaneous Doppler-catheterization recordings on 78 patients].

Several studies have demonstrated the value of Doppler ultrasound as a means of measuring gradients across cardiac valves. However, in view of sudden variations in cardiac output gradients should be measured simultaneously by Doppler and catheterization in order to validate the former method and determine its accuracy. We conducted a prospective study with simultaneous recordings in 78 patients with aortic valve stenosis (33) or mitral valve stenosis (19) or cardiac valve prosthesis (26). Mean age of the patients was 55 +/- 14 years, and 50% of them were male. Subjects with pure or predominant regurgitation were excluded from the study. In the whole of the population studied, correlation between Doppler ultrasound and haemodynamics was very good with r = 0.98, p less than 0.001 for maximum gradient and r = 0.96, p less than 0.001 for mean gradient. The perfect simultaneity of the haemodynamic and ultrasonic recordings was confirmed by comparing the duration of gradients measured by the two methods (r = 0.996, p less than 0.001). There also was very close correlation between ultrasounds and catheter in patients with mitral stenosis (maximum gradient r = 0.98, p less than 0.001; mean gradient r = 0.97, p less than 0.001). Mean Doppler-catheter differences were not significant, and no underestimation by Doppler reached or exceeded 5 mmHg. Correlations were also satisfactory in patients with aortic stenosis (maximum gradient r = 0.97, p less than 0.01; mean gradient r = 0.90, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve Stenosis↗

PubMed1986

[Traumatic aorto-right ventricular fistula. Apropos of a case].

The authors report the case of a 19 year old young man with an aorto-right ventricular fistula caused by a stab wound. The diagnosis was not made initially during surgery to control haemorrhage (left hemothorax due to a damaged internal mammary artery). However, three weeks later, a continuous murmur was detected and the diagnosis established by echocardiography and cardiac catheterisation. The lesions were repaired by open heart surgery under cardiopulmonary bypass. The authors describe the main features of this condition based on their own experience and a review of the literature.

Adult↗

PubMed1985

[Hemodynamic evaluation of Ionescu-Shiley pericardial bioprostheses].

36 patients with a total of 39 pericardial Ionescu-Shiley bioprostheses (20 aortic, 13 mitral and 3 double valve replacements) were studied. The population consisted if 12 women and 24 men with an average age of 33 +/- 11 years. The control was performed on average 7 +/- 4 months after surgery. At the time of investigation all patients were in functional classes I or II of the NYHA. The average cardio-thoracic ratio was 0.51 +/- 0.05. The catheter data showed a mean pulmonary capillary pressure of 10 +/- 2.7 mmHg, a mean cardiac index of 3.2 +/- 0.9 l/min/m2, a mean end diastolic volume of 132 +/- 33 ml/m2 and a mean ejection fraction of 0.53 +/- 0.12. Haemodynamic data was obtained under basal conditions and during intravenous infusion of isoproterenol. The average transvalvular pressure gradient was measured by transseptal catheterisation. The cardiac output was measured by dye dilution and the functional surface area calculated using the Gorlin formula (k = 44.5 for the aortic valve and k = 31 for the mitral valve). Perivalvular leaks were excluded by selective left ventriculography or aortography. The average transvalvular pressure gradients for the aortic valve prostheses (no 19 = 1, no 21 = 4, no 23 = 3, no 25 = 7, no 27 = 8) were 17 +/- 7 mmHg for no 19 and 21, 12 +/- 5 mmHg for no 23 and 25, and 9.7 +/- 2.7 mmHg for no 27.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1985

[Results and indications of coronarography in mitral valvulopathies].

Selective coronary angiography was carried out in 110 patients (68 women, 42 men; average age 57 +/- 8 years) with significant, isolated, non-ischaemic mitral valve disease. The indication for coronary angiography was angina or myocardial infarction in 42 cases and the investigation was carried out routinely in the other 68 cases. Coronary stenosis greater than 50 p. 100 was demonstrated in 25 cases (22.7 p. 100), 18 single vessel, 5 double or triple vessel disease and 2 cases of stenosis of the left main stem. The incidence of coronary artery disease was higher in patients with cardiovascular risk factors (0 factors: 13 p. 100; 1 factor: 22 p. 100, 2 or 3 factors: 45 p. 100; p less than 0.01). The coronary patients had higher mean pulmonary artery pressures (33 +/- 16 mmHg vs 25 +/- 8 mmHg, p 0.001), higher left ventricular end diastolic pressures (12.5 +/- 7 mmHg vs 9 +/- 5 mmHg, p less than 0.01) and greater left ventricular end diastolic volumes (83 + 40 ml/m2 vd 59 +/- 29 ml/m2, p less than 0.01). There was no difference in segmental wall motion between coronary and non coronary patients. 89 patients were referred for surgery, 17 of whom had coronary artery disease. 5 patients underwent coronary bypass surgery. The incidence of peroperative cardiac complications (low output, ventricular arrhythmias, myocardial infarction) was higher in the coronary patients (53 p. 100 vs 18 p. 100, p less than 0.01). The 6 year survival rate was 75 +/- 8 p. 100.(ABSTRACT TRUNCATED AT 250 WORDS)

Constriction, Pathologic↗

PubMed1985

[Recurrent systemic arterial embolism in patients with valve prostheses].

The first 400 cases of 1,436 patients undergoing cardiac valve replacement were analysed to determine the clinical features of recurrent systemic embolism. The average follow-up period was 87 months. Three groups of patients were compared: A: 289 cases without embolic complications (72.5 p. 100) B: 78 cases with a single systemic thrombo-embolic event. (TEE) (19,5 p. 100) C: 33 cases with recurrent TEE (8.25 p. 100). The incidence of recurrence is high (30 p. 100 of cases, 8,1 p. 100 per patient year, compared to 3.8 p. 100 for the first TEE). The site of recurrent embolism was the same in 45 p. 100 of cases. The consequences were serious, 30 to 40 p. 100 of events being associated with death or invalidating sequellae. Four factors predisposed to TEE: mitral valve prosthesis, atrial fibrillation, left atrial dilatation and poor anticoagulant control. Fifty-four months after the first TEE, 60 p. 100 with inadequate anticoagulation had a recurrence compared to 20 p. 100 of patients with satisfactory control. Twenty-six patients (Groups B and C) had operative or autopsy examination of the prosthesis: thrombosis was found in 12 out of 18 cases in Group B, and in 7 out of 8 cases in Group C. Reoperation may be necessary to change the valve (27 out of 1,436 patients). Strict adherence to anticoagulant therapy remains the best prophylaxis against TEE and their recurrence.

Adolescent↗

PubMed1984

Recurrent systemic embolic events with valve prosthesis.

Among 1436 patients who underwent valve replacement, the 400 first cases were studied to assess the features of recurrent systemic embolic event. The mean follow-up was 87 months. Three groups of patients were compared: groups A-289 patients without any thromboembolic event (72.25%); group B-78 patients with only one embolic event (19.5%); group C-33 patients with several embolic events (8.25%). The frequency of recurrence was high: one patient out of three (linearized mean 8.9% in group C considering only one recurrence, vs 3.8% in group B). The recurrence have the same location in 45% of patients. The consequences of these embolisms are serious; each event has a 30 to 40% risk of death or major disability. Four variables seem statistically to promote the occurrence of embolic events: mitral prostheses, pre-operative fibrillation, left atrial enlargement, poor anticoagulant therapy. 54 months after the first embolic event, 60% of the patients with poor anticoagulant therapy experience a recurrent thromboembolism vs 20% with adequate therapy. Twenty-six patients of groups B and C had a pathological study of prostheses. Thrombosis of the prostheses was found in 12 out of 18 patients in group B and in 7 out of 8 patients; in group C. Strict observance of anticoagulant therapy is the better way to prevent thromboembolism and especially recurrences. A reoperation is sometimes necessary. Valve re-replacement was performed in 27 cases out of 1436 patients.

Actuarial Analysis↗

PubMed1984

Thromboembolic and haemorrhagic risk in mechanical and biological aortic prostheses.

Thromboembolism, valve thrombosis and haemorrhagic events have been compared in 356 Starr-Edwards (SE) 1260, 113 Björk-Shiley (BS), and 178 aortic bioprostheses operated upon between 1968 and 1982, and reviewed by the same group with less than 2% of patients lost of follow-up. Expressed in actuarial rate at 7 years the percentage of patients free of thromboembolism event is 87% for SE, 86% for BS, 94% for bioprostheses; the linearized rate is 2.9%/patient/year for SE, 2.2 for BS, 1.9 for bioprostheses (NS). Valve thrombosis was not observed in bioprostheses; 97.9% of patients with mechanical valves were free of valve thrombosis at 6.5 years. Haemorrhagic risk was lower with bioprostheses than with mechanical valves 0.2% patient/year vs 2.33 (P less than 0.005). The most important factor influencing thromboembolic and haemorrhagic risks is the quality of anticoagulant therapy. Other contributing factors are the date of the operation and associated mitral disease.

Actuarial Analysis↗

PubMed1984

[2-dimensional echography in the preoperative evaluation of mitral stenosis].

2D echocardiography has become one of the most important investigations in the preoperative assessment of mitral stenosis. This study was undertaken to determine the reliability of the information so obtained, by comparison with the surgical appearances. The study population consisted of 104 patients (average age 45 years, 76% women) undergoing open heart surgery for pure mitral stenosis (72%) or mixed mitral valve disease (28%) between 1980 and 1981. All underwent 2D echo using a phased array Aloka SSD 800 80 degrees sector scanner. Cardiac catheterisation was performed in 102 cases and left ventricular angiography in 89 cases. The echocardiogramme was interpreted by an observer who had no knowledge of the surgical results. The mitral surface area, the condition of the valves and subvalvular apparatus and the predictive value of the possible surgical technique were analysed. The 2D echo mitral surface area was estimated by planimetry and quantitatively by using the Gorlin formula during catheterisation and by the surgical description preoperatively. 2D echo was more sensitive than M mode in the detection of severe mitral stenosis (90% vs 73%, p less than 0,01). The 2D echo-Gorlin correlation was quite good (R = 0,70, p less than 0,01) but was worse when the valves were very thickened. When compared with the surgical observations, 87% of the 2D echo data was correct. The thickness of the valves, their amplitude, the diastolic bowing of the anterior leaflet and the presence of calcification were assessed by 2D echo. The echo-surgical results matched perfectly in 76% of cases. The usual cause of error was underestimation of the degree of valvular damage. The valvular bowing and thickness were the most useful signs. Dense, brilliant echos of valvular calcification were found in only 58% of surgically proven cases of valvular calcification, but the error was often related to fine calcification, not visible on fluoroscopy, or to its localisation on the posterior leaflet. The subvalvular apparatus was evaluated in over 93% of patients, a complete study being possible in 73% of them. The 2D echo-surgical correlations were excellent in 90% of the cases in which it had been completely visualised. The chordal thickening was correctly predicted in 79% of cases. The surgical assessment was more pessimistic in 1/3 of cases in which the chordae appeared to be of normal thickness. The length of the chordae was correctly predicted in 68% of cases. The surgical assessment was more pessimistic in 1/2 of cases in which the chordae appeared to be of normal length.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗