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Valvular Heart Disease

EACVI Key Reference Library

Non-Invasive Imaging

Have a complete overview of valvular imaging with the Valvular Echo Box.



Guidelines and consensus documents

ESC Working Group on Valvular Heart Disease position paper-heart valve clinics: organization, structure, and experiences

Lancellotti P, Rosenhek R, Pibarot P, Iung B, Otto CM, Tornos P, Donal E, Prendergast B, Magne J, La Canna G, Piérard LA, Maurer G.
 Comment:
The position paper is to provide insights into the rationale, organization, structure and expertise needed to open and operate a heart valve clinic.
Reference: Eur Heart J. 2013 Jun;34(21):1597-606.

Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging.

 Lancellotti P, Tribouilloy C, Hagendorff A, Popescu BA, Edvardsen T, Pierard LA, Badano L, Zamorano JL; Scientific Document Committee of the European Association of Cardiovascular Imaging.

Comment:
Recently published executive summary of previous recommendations papers published form (former) European Association of Echocardiography on the assessment of native valvular regurgitation.
Reference:
Eur Heart J Cardiovasc Imaging. 2013 Jul;14(7):611-44.

 Guidelines on the management of valvular heart disease (version 2012).

Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS). Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M.

Comment:
The reference from European Society of Cardiology in valvular disease. Focused on clinical management, but also with an exhaustive revision of cardiac imaging techniques applied to valvular patients study
Reference:
Eur Heart J. 2012 Oct;33(19):2451-96.

 EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography

Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF, Franke A, Hung J, de Isla LP, Kamp O, Kasprzak JD, Lancellotti P, Marwick TH, McCulloch ML, Monaghan MJ, Nihoyannopoulos P, Pandian NG, Pellikka PA, Pepi M, Roberson DA, Shernan SK, Shirali GS, Sugeng L, Ten Cate FJ, Vannan MA, Zamorano JL, Zoghbi WA; American Society of Echocardiography; European Association of Echocardiography.

Comment:
Current recommendations for 3D use in clinical practice
Reference:
Eur Heart J Cardiovasc Imaging. 2012 Jan;13(1):1-46.

 EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease.

 Zamorano JL, Badano LP, Bruce C, Chan KL, Gonçalves A, Hahn RT, Keane MG, La Canna G, Monaghan MJ, Nihoyannopoulos P, Silvestry FE, Vanoverschelde JL, Gillam LD.

Comment:
Reference document for echo use in transcatheter aortic valve implantation, repair of paravalvular regurgitation, and percutaneous mitral reparation
Reference:
Eur Heart J. 2011 Sep;32(17):2189-214.

European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease).

Lancellotti P, Tribouilloy C, Hagendorff A, Moura L, Popescu BA, Agricola E, Monin JL, Pierard LA, Badano L, Zamorano JL; European Association of Echocardiography.

Comment:
Full version of the former EAE recommendations paper on aortic and pulmonary regurgitation (native valves)
Reference:
Eur J Echocardiogr. 2010 Apr;11(3):223-44.

European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease).

Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, Hagendorff A, Monin JL, Badano L, Zamorano JL; European Association of Echocardiography

Comment:
Full version of the former EAE recommendations paper on mitral and tricuspid regurgitation (native valves)
Reference:
Eur J Echocardiogr. 2010 May;11(4):307-32.

Recommendations for the practice of echocardiography in infective endocarditis.

Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, Voigt JU, Sicari R, Cosyns B, Fox K, Aakhus S; European Association of Echocardiography.

Comment:
Current recommendations for the practice of echocardiography in infective endocarditis aims to provide both an updated summary concerning the value and limitations of echocardiography in infective endocarditis and clear and simple recommendations for the optimal use of both transthoracic and transoesophageal echocardiography.
Reference:
Eur J Echocardiogr. 2010 Mar;11(2):202-19.

ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, t

Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O'Gara P, Rubin GD; American College of Cardiology Foundation Appropriate Use Criteria Task Force; Society of Cardiovascular Computed Tomography; American College of Radiology; American Heart Association; American Society of Echocardiography; American Society of Nuclear Cardiology; North American Society for Cardiovascular Imaging; Society for Cardiovascular Angiography and Interventions; Society for Cardiovascular Magnetic Resonance, Kramer CM, Berman D, Brown A, Chaudhry FA, Cury RC, Desai MY, Einstein AJ, Gomes AS, Harrington R, Hoffmann U, Khare R, Lesser J, McGann C, Rosenberg A, Schwartz R, Shelton M, Smetana GW, Smith SC Jr.

Comment:
This is the compilation of potential roles of Cardiac CT in clinical practice as stated by the major american imaging societies.
Reference:
J Am Coll Cardiol. 2010 Nov 23;56(22):1864-94.

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice.

Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quiñones M; American Society of Echocardiography; European Association of Echocardiography.
Comment:
Joint european/american echo associations recommendations paper on echo evaluation of valvular stenosis
Reference:
Eur J Echocardiogr. 2009 Jan;10(1):1-25.

Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the Europe
Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Zamorano JL; ESC Committee for Practice Guidelines.

Comment:
ESC guidelines  on infective endocarditis focused on diagnosis and clinical management of patients. For the first time this guidelines introduced the notion of timing of surgery and separation of patients on emergency (24 h) urgent (few days) or later after 1-2 weeks of antibiotic therapy.
Reference:
Eur Heart J. 2009 Oct;30(19):2369-413.

Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction

Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, Khandheria BK, Levine RA, Marx GR, Miller FA Jr, Nakatani S, Quiñones MA, Rakowski H, Rodriguez LL, Swaminathan M, Waggoner AD, Weissman NJ, Zabalgoitia M; American Society of Echocardiography's Guidelines and Standards Committee; Task Force on Prosthetic Valves; American College of Cardiology Cardiovascular Imaging Committee; Cardiac Imaging Committee of the American Heart Association; European Association of Echocardiography; European Society of Cardiology; Japanese Society of Echocardiography; Canadian Society of Echocardiography; American College of Cardiology Foundation; American Heart Association; European Association of Echocardiography; European Society of Cardiology; Japanese Society of Echocardiography; Canadian Society of Echocardiography.

Comment:
Current ASE recommendation paper on echo evaluation of prosthetic valves endorsed by the former European Association of Echocardiography
Reference:
J Am Soc Echocardiogr. 2009 Sep;22(9):975-1014
 

 ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness C

Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, Gerstad NA, Gillam LD, Hodgson JM, Kim RJ, Kramer CM, Lesser JR, Martin ET, Messer JV, Redberg RF, Rubin GD, Rumsfeld JS, Taylor AJ, Weigold WG, Woodard PK, Brindis RG, Hendel RC, Douglas PS, Peterson ED, Wolk MJ, Allen JM, Patel MR; American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group; American College of Radiology; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American Society of Nuclear Cardiology; North American Society for Cardiac Imaging; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology.

Comment:
This is the compilation of potential roles of Cardiac MRI in clinical practice as stated by the major american imaging societies.

Reference:
J Am Coll Cardiol. 2006 Oct 3;48(7):1475-97.

A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A.

Comment:
Not a guidelines or consensus document but the most important survey on valvular disease collecting data form 5000 patients across Europe. The survey provides unique contemporary data on characteristics and management of patients with valvular heart disease and is the best reference to start to work in the field.
Reference:
Eur Heart J. 2003Jul;24(13):1231-43.

Mitral stenosis

Management of Mitral Stenosis Using 2D and 3D Echo-Doppler Imaging Wunderlich NC, Beigel R, Siegel RJ.

Comment: Review paper of evaluation of mitral stenosis by echo, covering valve areas, mean Doppler gradients, and pulmonary pressures. This paper also adds the value of 3D TTE and TEE evaluation .

Reference: JACC Cardiovasc Imaging. 2013;6(11):1191-205.

Three-dimensional evaluation of the mitral valve area and commissural opening before and after percutaneous mitral commissurotomy in patients with mitral stenosis. Messika-Zeitoun D, Brochet E, Holmin C, Rosenbaum D, Cormier B, Serfaty JM, Iung B, Vahanian A.

Comment: Comparison between 2D and 3D methods for mitral valve area evaluation. 3D  provides accurate measurements similar to 2D planimetry performed by experienced operators and does not provide a real advantage for experienced operators, whereas it seems particularly helpful for less experienced operators. In addition, 3D improves the description of valvular anatomy.

Reference: Eur Heart J. 2007 Jan;28(1):72-9. Epub 2006 Aug 25.

Echocardiographic evaluation of the mitral valve area before and after percutaneous mitral commissurotomy: the pressure half-time method revisited. Messika-Zeitoun D, Meizels A, Cachier A, Scheuble A, Fondard O, Brochet E, Cormier B, Iung B, Vahanian A.

Comment: Other study addressing the complexity of the use of pressure half time in the setting of valvuloplasty. After the procedure half time pressure does not provide an accurate MVA evaluation but can still be used as a semiquantitative method because a PHT less than 130 milliseconds is associated with a good valve opening, which can be useful in difficult cases.  

Reference: J Am Soc Echocardiogr. 2005 Dec;18(12):1409-14

.Real-time three-dimensional echocardiography for rheumatic mitral valve stenosis evaluation: an accurate and novel approach. Zamorano J, Cordeiro P, Sugeng L, Perez de Isla L, Weinert L, Macaya C, Rodríguez E, Lang RM.

Comment: Description of real-time three-dimensional echocardiography as a feasible, accurate, and highly reproducible technique for assessing mitral valve area in mitral stenosis and as the tool with the  best agreement with invasive methods.

Reference: J Am Coll Cardiol. 2004 Jun 2;43(11):2091-6.

Dobutamine stress echocardiography for noninvasive assessment and risk stratification of patients with rheumatic mitral stenosis. Reis G, Motta MS, Barbosa MM, Esteves WA, Souza SF, Bocchi EA.

Comment: Evaluation of the role of dobutamine stress testing in mitral stenosis evaluation.  The test is safe and highly feasible. Mean gradient >18 mm Hg ion dibutamine identifies a subgroup of high-risk patients in whom a more aggressive approach may be warranted; on the other hand, patients with a DSE-MG <18 mm Hg predicts an uneventful clinical course and may justify a more conservative strategy.

Reference: J Am Coll Cardiol. 2004 Feb 4;43(3):393-401.

Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long- Palacios IF, Sanchez PL, Harrell LC, Weyman AE, Block PC.

Comment: Evaluation of variables related to long tern outcome after mitral balloon valvuloplasty. Postprocedure moderate to severe regurgitation, Wilkins score >8, prior surgical commissurotomy, NYHA functional class IV, high post valvuloplasty pulmonary artery pressure as independent predictors of combined events at long-term follow-up.

Reference: Circulation. 2002 Mar 26;105(12):1465-71.

Comparison of exercise and dobutamine stress echocardiography in assessing mitral stenosis. Hecker SL, Zabalgoitia M, Ashline P, Oneschuk L, O'Rourke RA, Herrera CJ.

Comment: This study demostrated that dobutamine elicited similar hemodynamic response to exercise and thus can be a safe and feasible alternative to exercise in patients with mitral stenosis of mild-to-moderate severity and ambiguous symptoms

Reference: Am J Cardiol. 1997 Nov 15;80(10):1374-7.

Measurement of mitral valve area in mitral stenosis: four echocardiographic methods compared with direct measurement of anatomic orifices. Faletra F, Pezzano A Jr, Fusco R, Mantero A, Corno R, Crivellaro W, De Chiara F, Vitali E, Gordini V, Magnani P, Pezzano A Sr.

Comment: Comparison of mitral valve areas determined by two-dimensional planimetry, pressure half-time, proximal flow convergence region and flow area method with values meassured directly on the corresponding excised specimen. Two-dimensional planimetry, pressure half-time and proximal flow convergence region reliably correlated with size of the anatomic orifice whereas the flow area method provided a less reliable correlation

Reference: J Am Coll Cardiol. 1996 Nov 1;28(5):1190-7.

Accurate measurement of the transmitral gradient in patients with mitral stenosis: a simultaneous catheterization and Doppler echocardiographic study. Nishimura RA, Rihal CS, Tajik AJ, Holmes DR Jr.

Comment: Demonstration that Doppler-derived mitral gradient in mitral stenosis is more accurate than that obtained by conventional cardiac catheterization compared with the reference method of transmitral gradient obtained by direct simultaneous measurement of left atrial and left ventricular pressures.  

Reference: J Am Coll Cardiol. 1994 Jul;24(1):152-8.

Inaccuracy of mitral pressure half-time immediately after percutaneous mitral valvotomy. Dependence on transmitral gradient and left atrial and ventricular compliance. Thomas JD, Wilkins GT, Choong CY, Abascal VM, Palacios IF, Block PC, Weyman AE.

Comment: This studio demonstrates that half pressure is not an true independent inverse measure of mitral valve area but is also directly proportional to net chamber compliance and the square root of the initial transmitral gradient. These other factors render half pressure method an unreliable measure of mitral valve area in the setting of acute mitral valvotomy.  

Reference: Circulation. 1988 Oct;78(4):980-93.

Doppler mitral pressure half-time: a clinical tool in search of theoretical justification. Thomas JD, Weyman AE.

Comment: This study reviews the development of the pressure half-time concept, presents an overall method for studying mitral valve flow using mathematical modeling and describes the effects of factors other than mitral valve area on pressure half-time.  

Reference: J Am Coll Cardiol. 1987 Oct;10(4):923-9.

Comparison of two-dimensional and Doppler echocardiography and intracardiac hemodynamics for quantification of mitral stenosis. Gonzalez MA, Child JS, Krivokapich J.

Comment: Study of the relationship between catheter derived and pressure half time derived  valve areas in mitral stenosis. The study did a validation of the half pressure time method and suggested that measurement of half pressure time in nonlinear velocity tracings is best achieved by a mid-diastolic line-drawing.

Reference: Am J Cardiol. 1987 Aug 1;60(4):327-32.

 

Tricuspid stenosis

Live/real time three-dimensional transthoracic echocardiographic assessment of tricuspid valve pathology: incremental value over the two-dimensional technique. Pothineni KR, Duncan K, Yelamanchili P, Nanda NC, Patel V, Fan P, Burri MV, Singh A, Panwar SR. Comment: Preliminary experience in 3D TTE echocardiographic evaluation of tricuspid valve pathology showing substantial incrmental value over 2D in the assessment of various patologies.

Reference: Echocardiography. 2007 May;24(5):541-52.

Role of echocardiography in the diagnosis and evaluation of severity of mitral and tricuspid stenosis. Pearlman AS.

Comment: Review article of echocardiographic imaging and Doppler techniques in tricuspid stenosis. Echo techniques provide an assessment of valve morphology and function that should be similarly to mitral valve case useful in clinical management decisions, although rigorous comparative studies have not been performed.

Reference: Circulation. 1991 Sep;84(3 Suppl):I193-7.

Doppler echocardiography in the evaluation of tricuspid stenosis. Fawzy ME, Mercer EN, Dunn B, al-Amri M, Andaya W.

Comment: This study demonstrated that Doppler echocardiography compares very well to cardiac catheterization in the quantification of tricuspid stenosis and in the assessment of concomitant tricuspid regurgitation.

Reference: Eur Heart J. 1989 Nov;10(11):985-90.

 

Pulmonary stenosis

Echocardiographic assessment of isolated pulmonary valve stenosis: which outpatient Doppler gradient has the most clinical validity? Silvilairat S, Cabalka AK, Cetta F, Hagler DJ, O'Leary PW.

Comment: Evaluation of the best Doppler variable to asssess severity of pulmonary stenosis. Mean gradient was most predictive of invasive gradient znd should be used to determine whether to intervene for patients with isolated pulmonary valve stenosis. Use of only the maximum Doppler gradient to assess pulmonary valve stenosis will lead to a systematic overstatement of the severity of the stenosis

Reference: J Am Soc Echocardiogr. 2005 Nov;18(11):1137-42.

Cross-sectional echocardiographic visualization of the stenotic pulmonary valve. Weyman AE, Hurwitz RA, Girod DA, Dillon JC, Feigenbaum H, Green D.

Comment: First demonstration of value of 2D echo as a direct, noninvasive method for visualizing the stenotic pulmonary valve that should be improvement over the indirect M-mode data.

Reference: Circulation. 1977 Nov;56(5):769-74.

Noninvasive prediction of transvalvular pressure gradient in patients with pulmonary stenosis by quantitative two-dimensional echocardiographic Doppler studies. Lima CO, Sahn DJ, Valdes-Cruz LM, Goldberg SJ, Barron JV, Allen HD, Grenadier E.

Comment: Validation of simplified Bernouilli equation in the specific setting of pulmonary stenosis.

Reference: Circulation. 1983 Apr;67(4):866-71.

 

Aortic regurgitation

Assessment of aortic valve complex by three-dimensional echocardiography: a framework for its effective application in clinical practice. Muraru D, Badano LP, Vannan M, Iliceto S.

Comment:Review article on the key principles of 3DE for assessing the AV pathology and the incremental clinical benefits in comparison with conventional 2DE and Doppler echocardiography., justifying its implementation in the diagnostic workup of aortic diseases.

Reference: Eur Heart J Cardiovasc Imaging. 2012 Jul;13(7):541-55.

Comparison of semiquantitative and quantitative assessment of severity of aortic regurgitation: clinical implications Messika-Zeitoun D, Detaint D, Leye M, Tribouilloy C, Michelena HI, Pislaru S, Brochet E, Iung B, Vahanian A, Enriquez-Sarano M.

Comment: Evaluation of the utility of semiquantitative methods in aortic regurgitation evaluation. For all methods current thresholds appeared to be specific but poorly sensitive, except for vena contracta, which provides good discriminative value.

Reference: J Am Soc Echocardiogr. 2011;24(11):1246-52.

Accuracy of the flow convergence method for quantification of aortic regurgitation in patients with central versus eccentric jets. Pouleur AC, le Polain de Waroux JB, Goffinet C, Vancraeynest D, Pasquet A, Gerber BL, Vanoverschelde JL.

Comment: Evaluation of accuracy of PISA method in aortic regurgitation with eccentric jets and in  PISA accuracy using apical versus parasternal approaches in comparison to CMR

Reference: Am J Cardiol. 2008 Aug 15;102(4):475-80

Functional anatomy of aortic regurgitation: accuracy, prediction of surgical repairability, and outcome implications of transesophageal echocardiography. le Polain de Waroux JB, Pouleur AC, Goffinet C, Vancraeynest D, Van Dyck M, Robert A, Gerber BL, Pasquet A, El Khoury G, Vanoverschelde JL.

Comment: Pivotal reference paper about the role of TEE in the evaluation of the mechanism of aortic regurgitation and in the prediction of surgical valve repair.

Reference: Circulation. 2007 Sep 11;116(11 Suppl):I264-9.

Assessment of aortic regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area: usefulness and validation. Fang L, Hsiung MC, Miller AP, Nanda NC, Yin WH, Young MS, Velayudhan DE, Rajdev S, Patel V.

Comment: Validation of vena contracta method in 3D transthoracic ecchocardiography in comparison to left heart catheterization with aortography or cardiac surgery in aortic insufficiency.

Reference: Echocardiography. 2005 Oct;22(9):775-8

Assessment of severity of aortic regurgitation using the width of the vena contracta: A clinical color Doppler imaging study. Tribouilloy CM, Enriquez-Sarano M, Bailey KR, Seward JB, Tajik AJ.

Comment: Validation of vena contracta method in the evaluation of aortic regurgitation severity. Comparison to quantitative Doppler and aortography

Reference: Circulation. 2000 Aug 1;102(5):558-64.

Application of the proximal flow convergence method to calculate the effective regurgitant orifice area in aortic regurgitation. Tribouilloy CM, Enriquez-Sarano M, Fett SL, Bailey KR, Seward JB, Tajik AJ.

Comment: Feasibility study of the PISA method for calculation of effective regurgitant orifice in aortic regurgitation compared with quantitative Doppler and quantitative 2D echocardiography

Reference: J Am Coll Cardiol. 1998 Oct;32(4):1032-9.

End diastolic flow velocity just beneath the aortic isthmus assessed by pulsed Doppler echocardiography: a new predictor of the aortic regurgitant fraction. Tribouilloy C, Avinée P, Shen WF, Rey JL, Slama M, Lesbre JP.

Comment: Description of flow reversal in descending thoracic aorta as an useful tool in aortic regurgitation evaluation

Reference: Br Heart J. 1991 Jan;65(1):37-40.

The effects of regurgitant orifice size, chamber compliance, and systemic vascular resistance on aortic regurgitant velocity slope and pressure half-time. Griffin BP, Flachskampf FA, Siu S, Weyman AE, Thomas JD.

Comment: Evaluation of the utility of the slope and pressure half time in the discrimination of regurgitant orifices of different sizes by correlation to regurgitant fraction  

Reference: Am Heart J. 1991 Oct;122(4 Pt 1):1049-56.

Evaluation of aortic insufficiency by Doppler color flow mapping. Perry GJ, Helmcke F, Nanda NC, Byard C, Soto B.

Comment: First report on color Doppler evaluation of aortic regurgitation in a 29 patient comparison to aortic angiogram  

Reference: J Am Coll Cardiol. 1987 Apr;9(4):952-9.

 

Mitral regurgitation

Echo-Guided Mitral Repair Drake DH, Zimmerman KG, Hepner AM, Nichols CD.

Comment: Evaluation of the usefulness of echo to define reparable mitral valve disease and to guide intervention.

Reference: Circ Cardiovasc Imaging. 2013 Nov 11. [Epub ahead of print]

Ischaemic mitral regurgitation: mechanisms and diagnosis. Marwick TH, Lancellotti P, Pierard L.

Comment: Review of ischaemic mitral regurgitation focused on echocardiographic evaluation.  

Reference: Heart. 2009 Oct;95(20):1711-8. doi: 10.1136/hrt.2007.135335. Review.

Direct measurement of vena contracta area by real-time 3-dimensional echocardiography for assessing severity of mitral regurgitation. Yosefy C, Hung J, Chua S, Vaturi M, Ton-Nu TT, Handschumacher MD, Levine RA.

Comment: Validation of vena contracta cross sectional area in mitral regurgitation severity assessment measured by 3D echo compared to effective regurgitant orifice area derived from regurgitant stroke volume.

Reference: Am J Cardiol. 2009 Oct 1;104(7):978-83.

The role of imaging in chronic degenerative mitral regurgitation. O'Gara P, Sugeng L, Lang R, Sarano M, Hung J, Raman S, Fischer G, Carabello B, Adams D, Vannan M.

Comment: Multidisciplinary review of degenerative mitral regurgitation covering essential echocardiographic mitral valve anatomy, quantitation of diesase and evaluation for surgical or percutaneous repair.  

Reference: JACC Cardiovasc Imaging. 2008 Mar;1(2):221-37.

Ischemic mitral regurgitation: mechanisms and echocardiographic classification. Agricola E, Oppizzi M, Pisani M, Meris A, Maisano F, Margonato A.

Comment: Review of ischaemic mitral regurgitation covering pathophisiological mechanisms, echocardiographic evaluation, surgical repair techniques and predictors of failure repair.  

Reference:  Eur J Echocardiogr. 2008 Mar;9(2):207-21.

Geometry of the proximal isovelocity surface area in mitral regurgitation by 3-dimensional color Doppler echocardiography: difference between functional mitral regurgitation and prolapse regurgitation. Matsumura Y, Fukuda S, Tran H, Greenberg NL, Agler DA, Wada N, Toyono M, Thomas JD, Shiota T.

Comment: Description of the geometry of mitral regurgitation jets and PISA convergence zones in 3D echo. The geometry of PISA en functional MR is elongated and different from the more focal pathology of prolapse leading to understimation by vena contracta or PISA method.

Reference: Am Heart J. 2008 Feb;155(2):231-8. doi: 10.1016/j.ahj.2007.09.002. Epub 2007 Oct 25.

Echocardiographic predictors of successful versus unsuccessful mitral valve repair in ischemic mitral regurgitation. Kongsaerepong V, Shiota M, Gillinov AM, Song JM, Fukuda S, McCarthy PM, Williams T, Savage R, Daimon M, Thomas JD, Shiota T.

Comment: Evaluation of predictors of mitral valve unsuccessful repair in ischemic mitral regurgitation by intraoperative TEE. Higher mitral annular diameter, higher tenting area and higher disease severity were the independent predictors of  repair failure.

Reference: Am J Cardiol. 2006 Aug 15;98(4):504-8.

Comparison of orifice area by transthoracic three-dimensional Doppler echocardiography versus proximal isovelocity surface area (PISA) method for assessment of mitral regurgitation. Iwakura K, Ito H, Kawano S, Okamura A, Kurotobi T, Date M, Inoue K, Fujii K.

Comment: Direct comparison of orifice area measured by 3D to computed by the PISA method. 3D echo showed than more than half cases have elliptical shaped orifices where PISA underestimated the severity of mitral regurgitation.

Reference: Am J Cardiol. 2006 Jun 1;97(11):1630-7.

Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Lancellotti P, Troisfontaines P, Toussaint AC, Pierard LA.

Comment: Evaluation of exercise induced changes in the degree of mitral regurgitation relationship to patient prognosis. ERO increase during exercise was an independent predictor of mortality whereas there were no events in patients with MR reduction during exercise.

Reference: Circulation. 2003 Oct 7;108(14):1713-7.

Intraoperative transesophageal echocardiography accurately predicts mitral valve anatomy and suitability for repair. Omran AS, Woo A, David TE, Feindel CM, Rakowski H, Siu SC.

Comment: Evaluation of predictors of mitral valve repair failure in mitral valve prolapse by intraoperative TEE. Success rate was lowest in presence of extensive bileaflet disease, central jets and calcification or severe dilatation of the mitral annulus.

Reference: J Am Soc Echocardiogr. 2002 Sep;15(9):950-7.

Determinants of pulmonary venous flow reversal in mitral regurgitation and its usefulness in determining the severity of regurgitation. Enriquez-Sarano M, Dujardin KS, Tribouilloy CM, Seward JB, Yoganathan AP, Bailey KR, Tajik AJ.

Comment: Description of pulmonary venous flow reversal as an useful sign of severe mitral regurgitation but of relatively low sensitivity. Reference: Am J Cardiol. 1999 Feb 15;83(4):535-41.

Assessment of mitral regurgitation severity by Doppler color flow mapping of the vena contracta. Hall SA, Brickner ME, Willett DL, Irani WN, Afridi I, Grayburn PA.

Comment: Evaluation of vena contracta mapping in transthoracic echocardiography in the assessment of mitral regurgitation compared to effective regurgitant orifice computed by volumetric Doppler method.  

Reference: Circulation. 1997 Feb 4;95(3):636-42.

Multiplane transoesophageal echocardiography and morphology of regurgitant mitral valves in surgical repair. Caldarera I, Van Herwerden LA, Taams MA, Bos E, Roelandt JR.

Comment: Evaluation of the role of multiplane transoesophageal echocardiography in the evaluation of mitral valve components and the mechanisms of mitral regurgitation before mitral valve surgical repair by comparison to findings at visual inspection during surgery

Reference: Eur Heart J. 1995 Jul;16(7):999-1006.

Effective mitral regurgitant orifice area: clinical use and pitfalls of the proximal isovelocity surface area method. Enriquez-Sarano M, Miller FA Jr, Hayes SN, Bailey KR, Tajik AJ, Seward JB. Comment: Description of the geometry of mitral regurgitation jets and PISA convergence zones in 3D echo. The geometry of PISA en functional MR is elongated and different from the more focal pathology of prolapse leading to understimation by vena contracta or PISA method. Reference: J Am Coll Cardiol. 1995 Mar 1;25(3):703-9.

Mitral to aortic velocity-time integral ratio. A non-geometric pulsed-Doppler regurgitant index in isolated pure mitral regurgitation. Tribouilloy C, Shen WF, Rey JL, Adam MC, Lesbre JP.

Comment: Description of mitral to aortic velocity time integral ratio >1.4 as strongly suggestive of severe mitral regurgitation whereas the ratio <1 is in fauvour of mild disease.

Reference: Eur Heart J. 1994 Oct;15(10):1335-9.

Assessment of severity of mitral regurgitation by measuring regurgitant jet width at its origin with transesophageal Doppler color flow imaging. Tribouilloy C, Shen WF, Quéré JP, Rey JL, Choquet D, Dufossé H, Lesbre JP.

Comment: Description of vena contracta as an useful tool in the evaluation of mitral regurgitation severity measured by 2D TEE and compared to cardiac catheterization and angiography.

Reference: Circulation. 1992 Apr;85(4):1248-53.

 

Tricuspid regurgitation

Assessment of functional tricuspid regurgitation. Badano LP, Muraru D, Enriquez-Sarano M.

Comment: Review paper of functional tricuspid regurgitation with discussion of the anatomy of the normal TV, the pathophysiology of disease the assessment of its severity and functional significance, and the proposal of an algorithm for selecting patients for surgical treatment.    

Reference: Eur Heart J. 2013 Jul;34(25):1875-85.

The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Rogers JH, Bolling SF.

Comment: Excellent review of tricuspid regurgitation covering anatomy, pathophysiology and the value of mechanical correction of regurgitation including potential transcatheter therapies.  

Reference: Circulation. 2009 May 26;119(20):2718-25.

Evaluation of the tricuspid valve morphology and function by transthoracic real-time three-dimensional echocardiography. Badano LP, Agricola E, Perez de Isla L, Gianfagna P, Zamorano JL.

Comment: This review details the current status of real-time three-dimensional echocardiography evaluation of TV morphology and function with its clinical applications and limitations.

Reference: Eur J Echocardiogr. 2009 Jun;10(4):477-84.

Determinants of the severity of functional tricuspid regurgitation. Kim HK, Kim YJ, Park JS, Kim KH, Kim KB, Ahn H, Sohn DW, Oh BH, Park YB, Choi YS.

Comment: Evaluation of the factors associated with the degree of functional tricuspid regurgitation. The end-systolic RV eccentricity index, tricuspid valve tethering area and end-diastolic tricuspid annulus diameter showed independent associations with regurgitant orifice area. Reference: Am J Cardiol. 2006 Jul 15;98(2):236-42.

Quantification of tricuspid regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area. Velayudhan DE, Brown TM, Nanda NC, Patel V, Miller AP, Mehmood F, Rajdev S, Fang L, Frans EE, Vengala S, Madadi P, Yelamanchili P, Baysan O.

Comment: Validation of 3D echo vena contracta area for evaluation of the severity of tricuspid regurgitation. Live 3D TTE color Doppler measurements of vena contracta area can be used for quantitative assessment of TR and offer incremental value for quantification of particularly severe regurgitant lesions.

Reference: Echocardiography. 2006 Oct;23(9):793-800.

Progression of tricuspid regurgitation after repaired functional ischemic mitral regurgitation. Matsunaga A, Duran CM. Comment: Evaluation of tricuspid regurgitation after mitral regurgitation surgery. IN the follow up about 50% of patients developed siginificant TR. Preoperative tricuspid annulus dilatiation was a predictor of late TR.   Reference: Circulation. 2005 Aug 30;112(9 Suppl):I453-7.

Contrasting effect of similar effective regurgitant orifice area in mitral and tricuspid regurgitation: a quantitative Doppler echocardiographic study. Tribouilloy CM, Enriquez-Sarano M, Capps MA, Bailey KR, Tajik AJ.

Comment: Comparison of the effect of similar regurgitatn orifice areas in mitral and tricuspid regurgitation. Similar ERO areas have similar consequences with regard to venous flow reversal. Therefore, a similar ERO area grading scheme can be used, and an ERO area of 40 mm2 or greater is consistent with severe regurgitation in both TR and MR.  

Reference: J Am Soc Echocardiogr. 2002 Sep;15(9):958-65.

Quantification of tricuspid regurgitation by measuring the width of the vena contracta with Doppler color flow imaging: a clinical study. Tribouilloy CM, Enriquez-Sarano M, Bailey KR, Tajik AJ, Seward JB.

Comment: Translation of vena contracta width to evaluation of the severity of tricuspid regurgitation. This method is simple, provides a diagnostic value superior to that of jet size and represents a useful tool for comprehensive, noninvasive quantitation of TR.

Reference: J Am Coll Cardiol. 2000 Aug;36(2):472-8.

Comparison of the proximal flow convergence method and the jet area method for the assessment of the severity of tricuspid regurgitation. Grossmann G, Stein M, Kochs M, Höher M, Koenig W, Hombach V, Giesler M.

Comment: Comparison of the value of the proximal flow convergence method and the jet area method for the determination of the severity of tricuspid regurgitation. Both methods have similar value and differentiated mild to moderate from severe tricuspid regurgitation in most patients. Reference: Eur Heart J. 1998 Apr;19(4):652-9.

Assessment of tricuspid regurgitation by Doppler color flow imaging: angiographic correlation. Gonzalez-Vilchez F, Zarauza J, Vazquez de Prada JA, Martín Durán R, Ruano J, Delgado C, Figueroa A. Comment: Description of Doppler colour mapping in the evaluation of tricuspid regurgitation compared to angiographic severity. Reference: Int J Cardiol. 1994 May;44(3):275-83.

Significance of laminar systolic regurgitant flow in patients with tricuspid regurgitation: a combined pulsed-wave, continuous-wave Doppler and two-dimensional echocardiographic study. Minagoe S, Rahimtoola SH, Chandraratna PA.

Comment: Laminar tricuspid regurgitation flow is strongly suggestive of the presence of severe TR and it is probably due to a large regurgitant orifice.

Reference Am Heart J. 1990 Mar;119(3 Pt 1):627-35.

 

Pulmonary regurgitation

Pulmonary regurgitation: determining severity by echocardiography and magnetic resonance imaging. Puchalski MD, Askovich B, Sower CT, Williams RV, Minich LL, Tani LY.

Comment: Description of pulmonary regurgitation jet/annulus ratio and diastolic flow reversal as the most valuable echocardiographic measures for assessing pulmonary regurgitation  in a direct comparison between echo and CMR.  

Reference: Congenit Heart Dis. 2008 May-Jun;3(3):168-75.

Live/real time three-dimensional transthoracic echocardiographic assessment of pulmonary regurgitation. Pothineni KR, Wells BJ, Hsiung MC, Nanda NC, Yelamanchili P, Suwanjutah T, Prasad AN, Hansalia S, Lin CC, Yin WH, Young MS.

Comment: Description of 3D vena contracta usefulness in pulmonary regurgitation evaluation compared to conventional 2D echocardiographic techniques .  

Reference: Echocardiography. 2008 Sep;25(8):911-7.

Pulmonary regurgitation: not a benign lesion. Bouzas B, Kilner PJ, Gatzoulis MA.

Comment: Comprehensive review of pulmonary regurgitation disease. Common causes, impact in right ventricular function, non invasive imaging including CMR and management are covered.  

Reference: Eur Heart J. 2005 Mar;26(5):433-9.

Pressure half-time predicts hemodynamically significant pulmonary regurgitation in adult patients with repaired tetralogy of fallot Silversides CK, Veldtman GR, Crossin J, Merchant N, Webb GD, McCrindle BW, Siu SC, Therrien J.

Comment: Validation of pulmonary pressure half time <100 ms as a good indicator of hemodinymically significant pulmonary regurgitation using CMR.

Reference: J Am Soc Echocardiogr. 2003 Oct;16(10):1057-62.

Comparison of Doppler echocardiography with angiography for determining the severity of pulmonary regurgitation. Williams RV, Minich LL, Shaddy RE, Pagotto LT, Tani LY.

Comment: Description of colour Doppler flow in the assessment of pulmonary regurgitation in a small retrospective group of patients comparing echo versus pulmonary angiography

Reference: Am J Cardiol. 2002 Jun 15;89(12):1438-41.

Reappraisal of quantitative evaluation of pulmonary regurgitation and estimation of pulmonary artery pressure by continuous wave Doppler echocardiography. Lei MH, Chen JJ, Ko YL, Cheng JJ, Kuan P, Lien WP.

Comment: Description of the role of the decay slope in continuous wave Doppler tracing in the evaluation of pulmonary regurgitation compared to colour flow mapping and cardiac catheterization.

Reference: Cardiology. 1995;86(3):249-56.

Color flow Doppler mapping studies of "physiologic" pulmonary and tricuspid regurgitation: evidence for true regurgitation as opposed to a valve closing volume. Maciel BC, Simpson IA, Valdes-Cruz LM, Recusani F, Hoit B, Dalton N, Weintraub R, Sahn DJ.

Comment: Description of the differences between pathological versus physiological pulmonary regurgitation by colour flow Doppler.  

Reference: J Am Soc Echocardiogr. 1991 Nov-Dec;4(6):589-97

Quantitative assessment by Doppler echocardiography of pulmonary or aortic regurgitation. Goldberg SJ, Allen HD.

Comment: Evaluation of severity of the disease by assessment of forward and reverse flow at the pulmonary annulus and in the pulmonary artery to calculate regurgitant volume an regurgitant fraction.

Reference: Am J Cardiol. 1985 Jul 1;56(1):131-5.

 

Stress echo in valvular diseases

Stress echo applications beyond coronary artery disease Picano E, Pellikka PA.

Comment: Review paper covering stress testing employing a variety of technologies (from M-Mode to 2D and pulsed, continuous and colour Doppler, to lung ultrasound and real-time 3D echo, 2D speckle tracking and myocardial contrast echo) on patients covering the entire spectrum of diseases. Author shows dedicated stress protocols covering valvular disease.

Reference: Eur Heart J. 2013 Oct 14. (Epub ahead of print)

 

Prosthetic valve evaluation

Impact of prosthesis-patient mismatch on survival after mitral valve replacement. Magne J, Mathieu P, Dumesnil JG, Tanné D, Dagenais F, Doyle D, Pibarot P.

Comment: Evaluation of clinical role of prosthesis mismatch for valves in mitral position. Severe mismatch was an independent predictor of mortality after mitral valve replacement that can be avoided or reduced with the use of a prospective strategy at the time of operatiom.

Reference: Circulation. 2007 Mar 20;115(11):1417-25. Epub 2007 Mar 5.

Are all echocardiographic findings equally predictive for diagnosis in prosthetic endocarditis? Ronderos RE, Portis M, Stoermann W, Sarmiento C.

Comment: Evaluation of possible echocardiographic findings for diagnosis in prosthetic endicarditis. Risk criteria were vegetations, abscesses, valve dehiscence and perivalvular regurgitation. Isolated mild perivalvular regurgitation should not be used as diagnostic criteria in patients with suggested prosthetic valve endocarditis.

Reference: J Am Soc Echocardiogr. 2004 Jun;17(6):664-9.

Assessment of severity of mechanical prosthetic mitral regurgitation by transoesophageal echocardiography. Vitarelli A, Conde Y, Cimino E, Leone T, D'Angeli I, D'Orazio S, Stellato S.

Comment: TEE correctly identified angiographically severe prosthetic mitral regurgitation by the assessment of the flow convergence region and the proximal diameter of the regurgitant jet.

Reference: Heart. 2004 May;90(5):539-44.

Normal values for Doppler echocardiographic assessment of heart valve prostheses. Rosenhek R, Binder T, Maurer G, Baumgartner H. Comment: This study provides an updated overview on the available data of normal values to facilitate adequate interpretation of Doppler data in prosthetic valve evaluation.

Reference: J Am Soc Echocardiogr. 2003 Nov;16(11):1116-27.

Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement. Blais C, Dumesnil JG, Baillot R, Simard S, Doyle D, Pibarot P.

Comment: Patient to prosthesis mismatch was described ina series of 1266 patients as a strong and independent predictor of short-term mortality among patients undergoing aortic valve replacement. Moderate-severe mismatch can be largely avoided with the use of a prospective strategy at the time of operation.

Reference: Circulation. 2003 Aug 26;108(8):983-8.

Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valve. Pibarot P, Dumesnil JG, Lemieux M, Cartier P, Métras J, Durand LG.

Comment: Description of clinical impact of aortic prosthesis mismatch. Patients with mismatch have less symptomatic improvement and worse hemodynamics that continue to deteriorate with time. However, medium-term prognosis (up to seven years) is relatively good.

Reference: J Heart Valve Dis. 1998 Mar;7(2):211-8.

Serial doppler echocardiographic evaluation of bioprosthetic valves in the tricuspid position. Kobayashi Y, Nagata S, Ohmori F, Eishi K, Nakano K, Miyatake K. Comment: The long-term durability of bioprosthetic valves in the tricuspid position was substantially lower in our study than that reported in previous studies. Tricuspid bioprosthetic valve dysfunction increased progressively in a linear manner beginning 1 to 2 years after tricuspid valve replacement. Reference: J Am Coll Cardiol. 1996 Jun;27(7):1693-7.

Transesophageal echocardiography for the diagnosis and management of nonobstructive thrombosis of mechanical mitral valve prosthesis. Gueret P, Vignon P, Fournier P, Chabernaud JM, Gomez M, LaCroix P, Bensaid J.

Comment: Study of clinical value of TEE in prosthesis thrombosis. TEE was a reliable method to diagnose thrombi in mitral valve prosthesis, even when transthoracic Doppler echocardiographic parameters appear to be normal. TEE assessment of thrombus size may be helpful in deciding between treatment options.

Reference: Circulation. 1995 Jan 1;91(1):103-10.

Discrepancies between Doppler and catheter gradients in aortic prosthetic valves in vitro. A manifestation of localized gradients and pressure recovery. Baumgartner H, Khan S, DeRobertis M, Czer L, Maurer G. Comment: Description of pressure recovery as cause of discrepancies between Doppler and catheter based evaluation of prosthetic valves. Valve type, size, flow rate and catheter are important factors to be considered.   Reference: Circulation. 1990 Oct;82(4):1467-75.

Continuous wave Doppler echocardiographic measurement of prosthetic valve gradients. A simultaneous Doppler-catheter correlative study. Burstow DJ, Nishimura RA, Bailey KR, Reeder GS, Holmes DR Jr, Seward JB, Tajik AJ.

Comment: Validation of continuous wave Doppler echocardiography in the evaluation of gradient across prosthetic valves.

Reference: Circulation. 1989 Sep;80(3):504-14.

 

Endocarditis

Usefulness of real-time three-dimensional echocardiography for diagnosis of infective endocarditis. Liu YW, Tsai WC, Lin CC, Hsu CH, Li WT, Lin LJ, Chen JH.

Comment: Comparison of 2D and 3D transthoracic echocardiography in the evaluation of clinically suspected infective endocarditis. The sensitivity of 2D and 3D was similar, but the specificity of 3D was higher. Mobile nodules viewed by 3D showed to be an useful finding for vegetation detection.

Reference: Scand Cardiovasc J. 2009;43(5):318-23.

Heart failure in left-sided native valve infective endocarditis: characteristics, prognosis, and results of surgical treatment. Nadji G, Rusinaru D, Rémadi JP, Jeu A, Sorel C, Tribouilloy C.

Comment: Study of heart failure in infective endocarditis. Left-sided native valve infective endocarditis complicated by heart failure is more frequent in aortic disease and is associated with severe regurgitation. Congestive heart failure is an independent predictor of in-hospital and 1 year mortality. In heart failure patients, early surgery is independently associated with reduced mortality and should be widely considered to improve outcome.

Reference: Eur J Heart Fail. 2009 Jul;11(7):668-75.

Prosthetic valve endocarditis: current approach and therapeutic options. Habib G, Thuny F, Avierinos JF.

Comment: Review paper covering prosthetic valve endocarditis covering diagnosis, prognosis evaluation and therapeutic strategies.

Reference: Prog Cardiovasc Dis. 2008 Jan-Feb;50(4):274-81.

Abscess in infective endocarditis: the value of transesophageal echocardiography and outcome: a 5-year study. Hill EE, Herijgers P, Claus P, Vanderschueren S, Peetermans WE, Herregods MC.

Comment: Role of TEE in evaluation of local complications of infective endocarditis. Detection of abscess by TEE seemed to be underestimated. In most cases, abscess was missed in the presence of calcification in the posterior mitral annulus. Age, abscess, and staphylococcal infection predicted 6-month mortality.

Reference: Am Heart J. 2007 Nov;154(5):923-8.

The impact of intraoperative transesophageal echocardiography in infective endocarditis Shapira Y, Weisenberg DE, Vaturi M, Sharoni E, Raanani E, Sahar G, Vidne BA, Battler A, Sagie A.

Comment: This article discuss the role of intraoperative TEE in infective endocarditis. Data showed that TEE changed management of 35% of patients suggesting that TEE should be routinely implemented in infective endicarditis surgery.

Reference: Isr Med Assoc J. 2007 Apr;9(4):299-302.

Echocardiographic guidance and assessment of percutaneous repair for mitral regurgitation with the Evalve MitraClip: lessons learned from EVEREST I. Silvestry FE, Rodriguez LL, Herrmann HC, Rohatgi S, Weiss SJ, Stewart WJ, Homma S, Goyal N, Pulerwitz T, Zunamon A, Hamilton A, Merlino J, Martin R, Krabill K, Block PC, Whitlow P, Tuzcu EM, Kapadia S, Gray WA, Reisman M, Wasserman H, Schwartz A, Foster E, Feldman T, Wiegers SE.

Comment: Evaluation of the role of TEE in mitral valve repair procedure.  TEE is essential to the guidance of percutaneous MitraClip repair. A streamlined approach to echocardiographic guidance, using predetermined standardized views, a common anatomic-based vocabulary, preprocedural strategy meetings, and a display of echocardiographic aids in the catheterization laboratory shortens the procedure time and allows for efficient percutaneous repair.

Reference: J Am Soc Echocardiogr. 2007 Oct;20(10):1131-40.

Infective endocarditis in Europe: lessons from the Euro heart survey. Tornos P, Iung B, Permanyer-Miralda G, Baron G, Delahaye F, Gohlke-Bärwolf Ch, Butchart EG, Ravaud P, Vahanian A.

Comment: Main conclusions of Euro Heart Survey on valvular heart disease related to endocartis. Data showed patients with active endocarditis have a high risk profile and often undergo surgery. There are deficiencies in obtaining blood cultures and applying prophylaxis. Mortality remains high, which is a justification for the improvement of patient management.    Reference: Heart. 2005 May;91(5):571-5.

Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Thuny F, Di Salvo G, Belliard O, Avierinos JF, Pergola V, Rosenberg V, Casalta JP, Gouvernet J, Derumeaux G, Iarussi D, Ambrosi P, Calabró R, Riberi A, Collart F, Metras D, Lepidi H, Raoult D, Harle JR, Weiller PJ, Cohen A, Habib G.

Comment: Description of echocardiography as a valuable tool in risk evaluation of embolic events in infective endocarditis. Vegetation length was described as a strong predictor of new embolic events and mortality. In combination with clinical and microbiological findings, echocardiography may identify high-risk patients who will need a more aggressive therapeutic strategy

Reference: Circulation. 2005 Jul 5;112(1):69-75.

Repeated echocardiographic examinations of patients with suspected infective endocarditis. Vieira ML, Grinberg M, Pomerantzeff PM, Andrade JL, Mansur AJ.

Comment: Evaluation of the usefulness of echo repetition for the diagnosis of infective endocarditis The diagnostic contribution of repeated TTE or TOE decreased as the number of repetitions increased. Data did not substantiate more than three TTE or TOE examinations as an efficient strategy. Reference: Heart. 2004 Sep;90(9):1020-4.

New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Durack DT, Lukes AS, Bright DK Comment: Original description of the Duke criteria for diagnosis of infective endicarditis including for first time echocardiographic findings. Duke criteria are today the cornerstone in the evaluation of patients with suspected endocarditis   

Reference: Am J Med. 1994 Mar;96(3):200-9.

 

Echo in the interventionism for structural diseases

Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. Makkar RR, Fontana GP, Jilaihawi H, Kapadia S, Pichard AD, Douglas PS, Thourani VH, Babaliaros VC, Webb JG, Herrmann HC, Bavaria JE, Kodali S, Brown DL, Bowers B, Dewey TM, Svensson LG, Tuzcu M, Moses JW, Williams MR, Siegel RJ, Akin JJ, Anderson WN, Pocock S, Smith CR, Leon MB; PARTNER Trial Investigators.

Comment: First relevant study on clinical role of TAVI. TAVI was tested in selected patients with severe aortic stenosis but not suitable candidates for surgery, In this group TAVI reduced the rates of death and hospitalization, with a decrease in symptoms and an improvement in valve hemodynamics that were sustained at 2 years of follow-up.  

Reference: N Engl J Med. 2012 May 3;366(18):1696-704.

Percutaneous repair or surgery for mitral regurgitation. Feldman T, Foster E, Glower DD, Kar S, Rinaldi MJ, Fail PS, Smalling RW, Siegel R, Rose GA, Engeron E, Loghin C, Trento A, Skipper ER, Fudge T, Letsou GV, Massaro JM, Mauri L; EVEREST II Investigators. Comment: Comparison of percutaneous repair with the MitraClip system with conventional surgery in a group of 279 patients with moderate or severe mitral regurgitation. Although percutaneous repair was less effective at reducing mitral regurgitation than conventional surgery, the procedure was associated with superior safety and similar improvements in clinical outcomes.

Reference: N Engl J Med. 2011 Apr 14;364(15):1395-406

Echocardiography: guidance during valve implantation. Gonçalves A, Marcos-Alberca P, Zamorano JL.

Comment: Review of the role of echo in TAVI. Echocardiography is a fundamental tool in patients' selection for TAVI, for guiding the intervention, evaluation of complications as well as evaluating the position, deployment and function of the prosthesis.  

Reference: EuroIntervention. 2010 May;6 Suppl G:G14-9.

Utility of real-time three-dimensional transesophageal echocardiography in evaluating the success of percutaneous transcatheter closure of mitral paravalvular leaks. García-Fernández MA, Cortés M, García-Robles JA, Gomez de Diego JJ, Perez-David E, García E.

Comment: Preliminary study showing 3D TEE can improve understanding of the causes underlying failure of percutaneous  paravalvular leak closure this improving patient selection and procedure results.

Reference: J Am Soc Echocardiogr. 2010 Jan;23(1):26-32.

The role of 3D transesophageal echocardiography during percutaneous closure of paravalvular mitral regurgitation. Hamilton-Craig C, Boga T, Platts D, Walters DL, Burstow DJ, Scalia G. Comment: Image series showing the use of TEE and live 3D TEE in guidance of transcatheter percutaneous closure of paravalvular mitral regurgitation. The importance of echocardiographic imaging is highlighted, including the assessment of large defects unsuitable for percutaneous closure and detection of complications. Reference: JACC Cardiovasc Imaging. 2009 Jun;2(6):771-3.

Use of real time three-dimensional transesophageal echocardiography in intracardiac catheter based interventions. Perk G, Lang RM, Garcia-Fernandez MA, Lodato J, Sugeng L, Lopez J, Knight BP, Messika-Zeitoun D, Shah S, Slater J, Brochet E, Varkey M, Hijazi Z, Marino N, Ruiz C, Kronzon I.

Comment: The authors used 3D TEE to guide 72 catheter-based cardiac interventions. They found that 3D allowed a better visualization  of intracardiac catheters and the balloons or devices they carry and also to demonstrate certain structures in an "en face" view, enabling appreciation of the exact nature of the lesion that is undergoing intervention.

Reference: J Am Soc Echocardiogr. 2009 Aug;22(8):865-82.

Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. Feldman T, Kar S, Rinaldi M, Fail P, Hermiller J, Smalling R, Whitlow PL, Gray W, Low R, Herrmann HC, Lim S, Foster E, Glower D; EVEREST Investigators.

Comment: First relevant clinical study evaluating the feasibility and efficacy of mitral valve repair with the MitraClip system. Percutaneous repair with the MitraClip system can be accomplished with low rates of morbidity and mortality and with acute MR reduction to < 2+ in the majority of patients, and with sustained freedom from death, surgery, or recurrent MR in a substantial proportion.

Reference: J Am Coll Cardiol. 2009 Aug 18;54(8):686-94.

Role of echocardiography in percutaneous aortic valve implantation. Moss RR, Ivens E, Pasupati S, Humphries K, Thompson CR, Munt B, Sinhal A, Webb JG. Comment: This study was designed to investigate the usefulness and limitations of echocardiography in optimizing the outcome of TAVI. Echocardiography had an important role in case selection, in guiding device placement, and in detecting complications of percutaneous aortic valve implantation. Reference: JACC Cardiovasc Imaging. 2008 Jan;1(1):15-24.

Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, Derumeaux G, Anselme F, Laborde F, Leon MB.

Comment: First case description of TAVI implant suggesting nonsurgical implantation of a prosthetic heart valve can be successfully achieved with immediate and midterm hemodynamic and clinical improvement.

Reference: Circulation. 2002 Dec 10;106(24):3006-8.

The double-orifice technique in mitral valve repair: a simple solution for complex problems. Alfieri O, Maisano F, De Bonis M, Stefano PL, Torracca L, Oppizzi M, La Canna G

Comment: Original description of the Alfieri's surgical technique for mitral valve repair in a series of 260 patients over a period of 7 years. Reference: J Thorac Cardiovasc Surg. 2001 Oct;122(4):674-81.

 

Cardiac CT in valve diseases

Transcatheter aortic valve implantation: implications of multimodality imaging in patient selection, procedural guidance, and outcomes. Delgado V, Kapadia S, Schalij MJ, Schuijf JD, Tuzcu EM, Bax JJ.

Comment: Review of cardiac imaging techniques in TAVI. Conventional echo, 3D and cardiac CT roles are discussed in the patient selection, procedure monitoring and follow up stages.  

Reference: Heart. 2012 May;98(9):743-54.

3-dimensional aortic annular assessment by multidetector computed tomography predicts moderate or severe paravalvular regurgitation after transcatheter aortic valve replacement: a multicenter retrospective analysis. Willson AB, Webb JG, Labounty TM, Achenbach S, Moss R, Wheeler M, Thompson C, Min JK, Gurvitch R, Norgaard BL, Hague CJ, Toggweiler S, Binder R, Freeman M, Poulter R, Poulsen S, Wood DA, Leipsic J.

Comment: Evaluation of cardiac TC aortic valve annular measurements for the prediction of paravalvular aortic regurgitation after procedure. This is the first work showing a relationship of paravalvular regurgitation after TAVI with prosthesis undersizing relative to CT data. Reference: J Am Coll Cardiol. 2012 Apr 3;59(14):1287-94. doi: 10.1016/j.jacc.2011.12.015. Epub 2012 Feb 22.

Cross-sectional computed tomographic assessment improves accuracy of aortic annular sizing for transcatheter aortic valve replacement and reduces the incidence of paravalvular aortic regurgitation. Jilaihawi H, Kashif M, Fontana G, Furugen A, Shiota T, Friede G, Makhija R, Doctor N, Leon MB, Makkar RR.

Comment: Striking work suggesting TEE has a potential systematic bias to underestimate aortic annulus size that can be prevented by evaluation using CT. This is the first work suggesting the use of Cardiac CT for TAVI sizing as an effective way to prevent paravalvular regurgitation after TAVI procedure.

Reference: J Am Coll Cardiol. 2012 Apr 3;59(14):1275-86.

Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Cueff C, Serfaty JM, Cimadevilla C, Laissy JP, Himbert D, Tubach F, Duval X, Iung B, Enriquez-Sarano M, Vahanian A, Messika-Zeitoun D.

Comment: Evaluation of aortic valve calcium score as a tool in the evaluation of aortic valve severity. In this paper a score higher than 1651 correlated to severe disease. Due to the fact than calcium scoring is independent of flow, it can be useful as adjuntive tool y complex cases evaluation. of pulmonary pressure half time <100 ms as a good indicator of hemodinymically significant pulmonary regurgitation using CMR. Reference: Heart. 2011 May;97(9):721-6.

Planimetric measurement of the regurgitant orifice area using multidetector CT for aortic regurgitation: a comparison with the use of echocardiography. Jeon MH, Choe YH, Cho SJ, Park SW, Park PW, Oh JK.

Comment: First report of cardiac CT in aortic regurgitation evaluation using direct planimetry of the leaflet coaptation defect compared to severity evaluation in echocardiography. Reference: Korean J Radiol. 2010 Mar-Apr;11(2):169-77.

Comprehensive assessment of the severity and mechanism of aortic regurgitation using multidetector CT and MR. Goffinet C, Kersten V, Pouleur AC, le Polain de Waroux JB, Vancraeynest D, Pasquet A, Vanoverschelde JL, Gerber BL.

Comment: Evaluation of cardiac CT in the evaluation of severity and mechanism of aortic regurgitation compared to CMR. CT had an excellent agreement in correctly assessing the mechanisms of aortic regurgitation whereas measurement of anatomical regurgitant orifice correlated well with regurgitant volume in phase contrast CMR.

Reference: Eur Radiol. 2010 Feb;20(2):326-36.

Mitral valve prolapse: evaluation with ECG-gated cardiac CT angiography. Shah RG, Novaro GM, Blandon RJ, Wilkinson L, Asher CR, Kirsch J

Comment: First report of cardiac CT in the anatomical evaluation of mitral valve prolapse showing low sensitivity but excellent specificity compared to standard TTE .

Reference: AJR Am J Roentgenol. 2010 Mar;194(3):579-84. doi: 10.2214/AJR.09.2545.

Evaluation of anatomic valve opening and leaflet morphology in aortic valve bioprosthesis by using multidetector CT: comparison with transthoracic echocardiography Chenot F, Montant P, Goffinet C, Pasquet A, Vancraeynest D, Coche E, Vanoverschelde JL, Gerber BL.

Comment: Cardiac TC showed good correlation to TTE in the evaluation of effective prosthetic area and was able to describe morphological abnormalities in dysfunctional bioprosthesis potentially unmasking the mechanism of dysfunction.

Reference: Radiology. 2010 May;255(2):377-85.

Transcatheter aortic valve implantation: role of multi-detector row computed tomography to evaluate prosthesis positioning and deployment in relation to valve function. Delgado V, Ng AC, van de Veire NR, van der Kley F, Schuijf JD, Tops LF, de Weger A, Tavilla G, de Roos A, Kroft LJ, Schalij MJ, Bax JJ.

Comment: First demonstration of potential role of CT in the evaluation of the post-TAVI patient. In this paper non circular valve deployment was related to the development of perivalvular regurgitation.  

Reference: Eur Heart J. 2010 May;31(9):1114-23.

Assessment of mitral valve anatomy and geometry with multislice computed tomography. Delgado V, Tops LF, Schuijf JD, de Roos A, Brugada J, Schalij MJ, Thomas JD, Bax JJ.

Comment: Proof of concept paper about the usefulness of the extremely detailed valvular imaging achieved by CT in the evaluation of valve mechanisms of disease. In this paper CT data were used to evaluate mitral valve distortion in heart failure patients.

Reference: JACC Cardiovasc Imaging. 2009 May;2(5):556-65.

Sixty-four slice CT evaluation of aortic stenosis using planimetry of the aortic valve area. Feuchtner GM, Müller S, Bonatti J, Schachner T, Velik-Salchner C, Pachinger O, Dichtl W.

Comment: Comparison of aortic valve area measured by 64 slice CT planimetry with TTE and TEE echocardiography in patients with aortic stenosis. CT had a good correlation to valve area computed by TTE continuity equation and excellent correlation to valve area measured by TEE planimetry. Reference: AJR Am J Roentgenol. 2007 Jul;189(1):197-203.

Aortic valve area assessment: multidetector CT compared with cine MR imaging and transthoracic and transesophageal echocardiography Pouleur AC, le Polain de Waroux JB, Pasquet A, Vanoverschelde JL, Gerber BL.

Comment: Comparison of aortic valve area evaluation with all major imaging techniques, TTE, TEE, CMR and cardiac CT. Measured areas by planimetry in TEE, CMR and CT were essentially the same but significantly larger than derived from TTE continuity equation. CT also depicted all bicuspid aortic valve cases.

Reference: Radiology. 2007 Sep;244(3):745-54. Epub 2007 Jul 13.

Multislice computed tomography for detection of patients with aortic valve stenosis and quantification of severity. Feuchtner GM, Dichtl W, Friedrich GJ, Frick M, Alber H, Schachner T, Bonatti J, Mallouhi A, Frede T, Pachinger O, zur Nedden D, Müller S.

Comment: First report on evaluation of aortic stenosis using Cardiac CT. Valvular area by 16 slice  CT  planimetry correlated well to TTE derived area using the continuity equation.

Reference: J Am Coll Cardiol. 2006 Apr 4;47(7):1410-7.

Assessment of the mitral valve area in patients with mitral stenosis by multislice computed tomography. Messika-Zeitoun D, Serfaty JM, Laissy JP, Berhili M, Brochet E, Iung B, Vahanian A.

Comment: First report of potential value of cardiac TC in the evaluation of mitral stenosis by valve direct planimetry .

Reference: J Am Coll Cardiol. 2006 Jul 18;48(2):411-3. Epub 2006 Jun 22. No abstract available.

 

Cardiac MR in valve diseases

A multi-center inter-manufacturer study of the temporal stability of phase-contrast velocity mapping background offset errors. Gatehouse PD, Rolf MP, Bloch KM, Graves MJ, Kilner PJ, Firmin DN, Hofman MB.

Comment: First report suggesting a potential role of magnetic resonance phase shift techniques in the quantitative evaluation of flow.

Reference: J Cardiovasc Magn Reson. 2012 Oct 20;14:72.

Comprehensive assessment of the severity and mechanism of aortic regurgitation using multidetector CT and MR. Goffinet C, Kersten V, Pouleur AC, le Polain de Waroux JB, Vancraeynest D, Pasquet A, Vanoverschelde JL, Gerber BL.

Comment: Evaluation of cardiac CT in the evaluation of severity and mechanism of aortic regurgitation compared to CMR. CT had an excellent agreement in correctly assessing the mechanisms of aortic regurgitation whereas measurement of anatomical regurgitant orifice correlated well with regurgitant volume in phase contrast CMR.

Reference: Eur Radiol. 2010 Feb;20(2):326-36.

Flow measurement by cardiovascular magnetic resonance: a multi-centre multi-vendor study of background phase offset errors that can compromise the accuracy of derived regurgitant or shunt flow measurements. Gatehouse PD, Rolf MP, Graves MJ, Hofman MB, Totman J, Werner B, Quest RA, Liu Y, von Spiczak J, Dieringer M, Firmin DN, van Rossum A, Lombardi M, Schwitter J, Schulz-Menger J, KilnerPJ.

Comment: Critical review of phase contrast imaging limitations suggesting the need of post-acquisition correction to achieve consistently reliable breath-hold measurements of flow.

Reference: J Cardiovasc Magn Reson. 2010 Jan 14;12:5.

Cardiovascular magnetic resonance imaging for valvular heart disease: technique and validation. Cawley PJ, Maki JH, Otto CM.

Comment: Excellent review paper that summarize the general principles of CMR and validate CMR as a tool for evaluation of valvular heart disease. Reference: Circulation. 2009 Jan 27;119(3):468-78.

Valvular heart disease: what does cardiovascular MRI add? Masci PG, Dymarkowski S, Bogaert J.

Comment: Review paper focused on the usefulness of cardiac MR in the diagnosis and management of valvular heart disease, pointing out its added value in comparison with more conventional diagnostic means.

Reference: Eur Radiol. 2008 Feb;18(2):197-208. Epub 2007 Aug 29.

Towards comprehensive assessment of mitral regurgitation using cardiovascular magnetic resonance. Chan KM, Wage R, Symmonds K, Rahman-Haley S, Mohiaddin RH, Firmin DN, Pepper JR, Pennell DJ, Kilner PJ.

Comment: Comprehensive review of the evaluation of mitral regurgitation using CMR. CMR  is feasible and enables determination of mitral regurgitation severity, associated leaflet prolapse or restriction, ventricular function and viability in a single examination.

Reference: J Cardiovasc Magn Reson. 2008 Dec 22;10:61.

Assessment of aortic valve area in aortic stenosis using cardiac magnetic resonance tomography: comparison with echocardiography. Malyar NM, Schlosser T, Barkhausen J, Gutersohn A, Buck T, Bartel T, Erbel R.

Comment: Comparative study of aortic valve area measurement by CMR compared to transthoracic and transoesophageal echocardiography showing good correlation between techniques.

Reference: Cardiology. 2008;109(2):126-34.

Planimetric and continuity equation assessment of aortic valve area: Head to head comparison between cardiac magnetic resonance and echocardiography. Pouleur AC, le Polain de Waroux JB, Pasquet A, Vancraeynest D, Vanoverschelde JL, Gerber BL.

Comment: Comparison of the accuracy of planimetric and continuity equation measurements of aortic valve area by cardiac MR to each other and against transthoracic and transesophageal echocardiography. Both planimetry and continuity equation-based measurements of AVA by cMR are equally accurate. However, similar to echo TEE, CMR aortic valve area was larger by planimetry than by continuity equation. This is consistent with the contention that the anatomical maximum opening of a stenotic aortic valve is larger than the size of the functional vena contracta.

Reference: J Magn Reson Imaging. 2007 Dec;26(6):1436-43.

Absolute assessment of aortic valve stenosis by planimetry using cardiovascular magnetic resonance imaging: comparison with transesophageal echocardiography, transthoracic echocardiography, and cardiac catheterisation. Reant P, Lederlin M, Lafitte S, Serri K, Montaudon M, Corneloup O, Roudaut R, Laurent F.

Comment: Demonstration of the potential role of effective aortic valve planimetry by CMR in aortic stenosis as a reliable alternative to echocardiography or cardiac catheterisation.

Reference: Eur J Radiol. 2006 Aug;59(2):276-83.

Quantification of regurgitant fraction in mitral regurgitation by cardiovascular magnetic resonance: comparison of techniques. Kon MW, Myerson SG, Moat NE, Pennell DJ.

Comment: Description of the technique of subtracting aortic flow volume from left ventricular systolic volume by Simpson for mitral regurgitation quantification as superior to the left to right ventricle stroke volume comparison.

Reference: J Heart Valve Dis. 2004 Jul;13(4):600-7.

Quantification of stenotic mitral valve area with magnetic resonance imaging and comparison with Doppler ultrasound. Lin SJ, Brown PA, Watkins MP, Williams TA, Lehr KA, Liu W, Lanza GM, Wickline SA, Caruthers SD.

Comment: Evaluation of the reliability of the pressure half-time method by velocity-encoded cardiovascular magnetic resonance for estimating mitral valve areas in mitral stenosis  compared with paired Doppler ultrasound.

Reference: J Am Coll Cardiol. 2004 Jul 7;44(1):133-7.

Aortic and mitral regurgitation: quantification using moving slice velocity mapping. Kozerke S, Schwitter J, Pedersen EM, Boesiger P. Comment: Description of the moving slice velocity mapping technique in the evaluation of aortic and mitral regurgitation by CMR. The paper demonstrates the importance of correction for valvular through-plane motion to avoid understimation of regurgitant volume and fraction.. Reference: J Magn Reson Imaging. 2001 Aug;14(2):106-12.

Prosthetic heart valves and annuloplasty rings: assessment of magnetic field interactions, heating, and artifacts at 1.5 Tesla. Shellock FG. Comment: Evaluation of magnetic field interactions of some valve prosthesis and rings showing the lack of substantial magnetic field interactions and relatively minor hearing indicated that MR procedures may be conducted safetly in patients with these implants in static magnetic fields of 1.5 T or less.

Reference: J Cardiovasc Magn Reson. 2001;3(4):317-24.

Quantification of mitral regurgitation by velocity-encoded cine nuclear magnetic resonance imaging. Fujita N, Chazouilleres AF, Hartiala JJ, O'Sullivan M, Heidenreich P, Kaplan JD, Sakuma

Comment: Evaluation of the feasibility of velocity-encoded cine magnetic resonance (NMR) to measure regurgitant volume and regurgitant fraction in patients with mitral regurgitation.

Reference: J Am Coll Cardiol. 1994 Mar 15;23(4):951-8.

An in vivo validation of quantitative blood flow imaging in arteries and veins using magnetic resonance phase-shift techniques. Van Rossum AC, Sprenger M, Visser FC, Peels KH, Valk J, Roos JP.

Comment: Critical review of phase contrast imaging limitations suggesting the need of post-acquisition correction to achieve consistently reliable breath-hold measurements of flow.

Reference: Eur Heart J. 1991 Feb;12(2):117-26.