The VC and PISA measurements for distinction of severe versus nonsevere MR are only modestly reliable and associated with suboptimal interobserver agreement. The presence of an identifiable effective regurgitant orifice improves reproducibility of VC and a central regurgitant jet predicts substantial agreement among multiple observers of PISA assessment.

Objective We aimed to determine the prevalence of dilatation and abnormal elastic properties of aortic root in first degree relatives (FDRs) of bicuspid aortic valve patients. Background Evidence indicates that BAV is a genetic disorder. While FDRs of affected individuals have increased prevalence of BAV, their risk of aortic root abnormalities is unknown. Methods We studied dimensions as well as the elastic properties of the ascending aorta in 48 FDRs with morphologically normal, tricuspid aortic valves, 54 BAV patients, and 45 controls using two-dimensional echocardiography. Results The prevalence of aortic root dilatation was 32% in FDRs and 53% in BAV patients, whereas all controls demonstrated normal aortic dimensions (p<0.001). FDRs and BAVs had significantly lower aortic distensibility (1.7±1.4 and 1.4±2.0 vs. 2.5±1.6×10−3 mmHg, p<0.001) and greater aortic stiffness index (26.7±25.8 and 55.92±76.8 vs. 18.7±40.1, p=0.001) compared to controls. This difference remained significant in subjects without aortic root dilatation or hypertension (p=0.002 and p=0.004, respectively). Conclusions The aortic root is functionally abnormal and dilatation is common (32%) in first degree relatives of patients with BAV. Screening of FDRs by transthoracic 2-dimensional echocardiography should be considered for detection of aortic valve malformation and dilated ascending aorta.

Cross-sectional 3D echocardiographic sizing of the aortic annulus dimension offers discrimination of post-TAVR paravalvular AR that is significantly superior to that of 2D-TEE. Cross-sectional data should be sought from 3D-TEE if good CT data are unavailable for TAVR sizing.

Successful MV repair with the MitraClip system results in an immediate and significant improvement in FSV, CO, and LV loading conditions. There was no evidence of a low CO state following MitraClip treatment for MR. These favorable hemodynamic effects with the MitraClip appear to reduce the risk of developing a low CO state, a complication occasionally observed after surgical MV repair for severe MR.