J Heart Valve Dis
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The aim of this study was to investigate the factors related to the presence of left atrial spontaneous echo contrast in mitral valve disease, and to ascertain whether it is a predictor of thromboembolism. One hundred and one patients (47 men, 54 women) with a mean age of 57.04 +/- 10.6 years who underwent transthoracic and transesophageal echocardiography were included in the study. Forty-five (44.5%) had isolated or predominant mitral valve stenosis, 12 (11.9%) predominant mitral insufficiency and 44 (43.6%) had had previous mitral valve replacement. ⋯ The finding of left atrial spontaneous echo contrast was related to the presence of atrial fibrillation or enlarged left atrium, the severity of mitral stenosis and the absence of significant mitral insufficiency. Anticoagulant therapy was not significantly associated with spontaneous left atrial echo contrast, but a stepwise linear regression analysis showed that its presence was the only independent predictor of thromboembolism (p < 0.0001). We conclude that left atrial spontaneous echo contrast in mitral valve disease can be discovered mainly by transesophageal echocardiography, and is correlated with factors which are associated with low left atrial blood flow velocity such as atrial fibrillation, enlarged left atrium, mitral stenosis of increased severity and the absence of significant mitral insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)
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Color flow imaging shows that the transmitral flow is initially directed to the left ventricular (LV) apex and then turns around facing the aortic valve. A pulsed wave Doppler sample placed in the LV outflow tract (LVOT) records two peaks of diastolic flow waves, Er and Ar waves, which follow E and A waves of the transmitral flow respectively. The Er and Ar waves represent transmitted E and A flow waves to the LVOT. ⋯ Studies designed to test this hypothesis in a pulsatile LV model showed a linear relationship between the rate of diastolic flow wave propagation inside the LV and its stiffness. These preliminary data suggest that the velocity of A wave transmission inside the LV reflects LV late diastolic stiffness non-invasively. It is expected to be independent of a direct effect of heart rate and of preload.
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Case Reports
Perforated aneurysm of the anterior mitral leaflet: late assessment with transesophageal echocardiography.
We present a case study of a 54-year-old patient with a perforated aneurysm of the anterior mitral valve leaflet, diagnosed 13 years after an episode of bacterial endocarditis by transesophageal echocardiography. This report illustrates the superiority of transesophageal echocardiography in the diagnosis and management of valvular endocarditis.