Features of degenerative mitral valve prolapse in the North East of China: repair characteristics, and short-term follow-up results
Minerva Cardioangiologica, 2020
BACKGROUND We aimed to assess the clinical and echocardiographic characteristics of patients who ... more BACKGROUND We aimed to assess the clinical and echocardiographic characteristics of patients who underwent surgery for degenerative mitral valve prolapse (MVP) in our center, and its relation to outcomes. METHODS We enrolled 117 consecutive patients from North-East China with an echocardiographic diagnosis of MVP related mitral regurgitation (MR) between April 2018 and November 2019. A complexity scoring system was used for valve anatomy, and patients were re-evaluated at 3-6 months after surgery. RESULTS Most patients (57.3%) were 40-59 years old. Ejection fraction was <60% in one third, and pulmonary hypertension was present in 64.3% of operated patients. Etiology was myxomatous in 58.9%, with flail as main lesion. Leaflet involvement was posterior in 59.8% patients, anterior in 32.5%, bileaflet in 6%, and commissural in 25.6%. Lesion score was intermediate in >50% of patients, and myxomatous lesions scored higher compared to fibroelastic deficiency (FED). Degree of MR left atrial volume and estimated wedge pressure were significantly higher in intermediate and complex lesions. Repair was performed in 93/101 patients (95.8% success rate). No in-hospital major adverse events, nor deaths at follow-up were reported. Residual MR was ≤ mild in 86.7% of patients at follow-up and was associated with FED etiology and complex lesions. CONCLUSIONS Compared to Western countries, in our sample of Chinese population degenerative severe MR occurred in younger patients. The MVP lesion characteristics are similar, can be accurately detected by non-invasive preoperative evaluation, allowing predictable results. Advanced tailored repair techniques allow excellent immediate and short-term results regardless of the underlying complexity.
[The improvement of the Doppler echocardiographic method for the estimation of pulmonary systolic pressure]
Cardiologia (Rome, Italy), 1993
The formulas currently utilized for noninvasive evaluation of right ventricular systolic pressure... more The formulas currently utilized for noninvasive evaluation of right ventricular systolic pressure (RVSP) include right ventricular-right atrial pressure gradient (RV-RAG) and right atrial pressure (RAP). The former is expressed by trans-tricuspid systolic flow velocity, the latter is generally assumed. We recently observed that ultrasound estimation of RAP through inferior vena cava collapsibility index (CI) may help in the choice of the more appropriate formula for the evaluation of RVSP. However, these traditional methods (method A:RV-RAG + 10; method B:RV-RAG x 1.1 + 14) have limitations, particularly when RAP is low. The present study was undertaken to improve noninvasive estimation of RVSP through new formulas based on CI prediction of RAP. One hundred and four patients, in whom tricuspid regurgitation was adequately documented with CW-Doppler, were included in this study. They were classified into 3 groups: Group 1 with CI > 45%, Group 2 with CI < or = 35%, Group 3 with ...
Accepted for publication 18 February 1993 Abstract Objective-To investigate the pathophysiologica... more Accepted for publication 18 February 1993 Abstract Objective-To investigate the pathophysiological (cardiac fimction and physical performance) significance of clinically silent interstitial lung water accumulation in patients with moderate heart failure; to use isolated ultrafiltration as a means of extravascular fluid reabsorption. Design-Echocardiographic, Doppler, chest x-ray evaluations, and cardiopulmonary tests at baseline, soon after ultrafiltration (veno venous extracorporeal circuit), and four days, one month, and three months later. Setting-University institute of cardiology. Subjects-24 patients with heart failure due to idiopathic dilated cardiomyopathy or ischaemic myocardial disease with sinus rhythm and ejection fraction less than 35%. Twelve were randomised to ultrafiltration and 12 were taken as controls. Main outcome measures-Left ventricular systolic function (from ultrasonography); Doppler evaluation of mitral, tricuspid, and aortic flow and echoDoppler determina...
Extent of aortic root (AR) systolic anterior movement has been explained as determined by left ve... more Extent of aortic root (AR) systolic anterior movement has been explained as determined by left ventricular (LV) ejection and correlated to stroke volume. Further, the AR "sits" on the anterior left atrial (LA) wall and diastolic posterior displacement of AR has been related to LV diastolic filling and LA emptying. Aim: Because past and recent evidence suggests a reciprocal interaction between LA reservoir function and LV stroke volume, aim of this study was that to demonstrate that the AR is directly displaced by extent of LA expansion during reservoir, as a function of LV stroke volume. Methods: in 20 normal subjects and 80 consecutive patients undergoing diagnostic echocardiography (age 59±15) we analyzed the ability to predict anterior movement of AR, measured in parasternal view with respect to transducer position, of different LA dimensions non contiguous to the AR in the apical 4-chamber (superoinferior, medio-lateral diameters and area) and 2-chamber (supero-inferior, anteroposterior diameters and area) views. For all dimensions, LA reservoir indexes were calculated as maximum-minimum dimension. Results: at multiple regression analysis, reservoir expansion of 2-chamber superoinferior and 4-chamber medio-lateral diameters, and LV biplane stroke volume predicted (<. 002) with decreasing importance anterior movement of AR, independently from BSA, age, heart rate, LA and AR dimensions, LV preload and ejection fraction, and heart disease. When LA reservoir function indexes were excluded from analysis, only LV stroke volume predicted (p<.001) AR movement. Conclusion: our analysis suggests that LV stroke volume influences indirectly the systolic anterior displacement of the AR through the direct influence of LA reservoir expansion. 147 Is the diastolic velocity decay from the left ventricular inflow tract to the left ventricular outflow tract affected by the systolic function?
Introduction The literature reports very few cases of cor triatriatum in the general population a... more Introduction The literature reports very few cases of cor triatriatum in the general population and very rare cases of cor triatriatum in competitive athletes. Case report This case report illustrates an original case, which concerns a middleaged triathlete with no history of cardiac disease, but one who was found suffering from non-obstructive cor triatriatum sinister that was discovered incidentally by twodimensional trans-thoracic echocardiography examination. The diagnosis required subsequent investigation with cardiovascular magnetic resonance imaging. This case report raises questions and sheds light on the obvious implications of this finding in cardiology and sports medicine. Conclusion As it is widely known, cor triatriatum has been incidentally diagnosed in asymptomatic adults; however, this case demonstrates that the presence of this rare congenital heart defect can be absolutely compatible with excellent physical performance, taking into account that the particular anatomy of this congenital heart malformation does not create any functional limitations in the cardiorespiratory system.
The diffusion of techniques to digitalize echocardiographic images (video clips) and the increase... more The diffusion of techniques to digitalize echocardiographic images (video clips) and the increase in available bandwith to transmit video clips have made teleechocardiography feasible. However, the dimensions of video clips produced by the lossy compression algorythm "Moving Pictures Expert Group" (MPEG)-2 requires expensive, high bandwidth trasmission networks to realize realtime teleechocardiography. Aim: we designed a transmitter-receiver system to allow effective, broad territorial use of tele-echocardiography, by integrating transmission over Integrated Service Digital Network (ISDN) telephone lines with lossy MPEG-4 compression algorythm. Methods: in the prototype system, 2 laptop computers are connected by a ISDN line (velocity 128 Kbit/s). The echocardiogram is acquired at the transmitting station as a sequence of video clips (clinical compression) through an external portable analog to digital conversion board connected to the s-VHS video output of the ultrasound unit, preserving original video format (24 bit color, 720 x 576 pixel resolution, 25 fps). The station automatically edits and converts video clips to MPEG-4 (with variable bitrate), ensuring minimal file dimensions and privacy of data. The receiver station provides decoding and playback of video clips. Results: we have used the system to: 1) code and transmit video clips of 2D and color Doppler "markers" (i.e., valve structures, masses, regurgitant jets and shunts) with no perceptible loss of dynamic image details compared to the original uncompressed images; 2) code and transmit complete echocardiograms, with reduction of the dimensions of a representative exam (20 3" video clips + 10 still frames) from 2,500 MB to 2.5 MB, and resultant minimum delay in exam trasmission time (between acquisition + transmission and reception + playback), which was kept within 1 video clip clinical compression and acquisition times. Conclusion: integration of low-cost low bandwith ISDN lines and MPEG-4 video compression technology has the potential to provide immediate feasibility of "nearrealtime" tele-echocardiography for remote access, overcoming economic barriers. To this end, reliability in echocardiography of different MPEG-4 lossy compression algorythms remains to established.
[Cardiovascular abnormalities in Kawasaki disease. An Italian prospective study]
Cardiologia (Rome, Italy), 1998
We report a prospective study performed over a 9 year period in 96 children with Kawasaki disease... more We report a prospective study performed over a 9 year period in 96 children with Kawasaki disease (mean age 35 +/- 29 months), 84 of whom < 5 years of age. The male/female ratio was 1.5 (57/39). A total of 38 patients had cardiac involvement, including flattened T waves in the ECG (10 patients), pericardial effusion (6 patients), myocarditis (1 patient), and coronary artery aneurysms (25 patients; frequency of aneurysms: 26%). All patients were evaluated during the acute phase (first month) of the illness. The first echocardiographic examination was performed 15 days (range 4.30 days) from the appearance of fever, and coronary aneurysms were observed in 23 patients; in 2 patients, however, aneurysms appeared later (2 and 6 months). Aneurysms were small (< or = 4.5 mm) in 12, medium (4.5-7 mm) in 11, and large (> 7 mm) in 12 patients. Male sex (p = 0.02), age < 12 months (p = 0.005), ESR (p = 0.001), platelet count (p = 0.009), and pericardial effusion (p = 0.02) were sig...
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Papers by Paolo Barbier