Tricuspid regurgitation severity was assessed preoperatively with Doppler color flow mapping and these assessments were compared with surgical findings in 90 patients undergoing mitral or aortic valve replacement, or both. Group I (n = 52) required tricuspid valve annuloplasty because tricuspid regurgitation was judged intraoperatively to be severe; in Group II (n = 38), tricuspid valve annuloplasty was not performed because tricuspid regurgitation was judged intraoperatively not to be severe. With use of the apical four chamber and parasternal short-axis imaging planes, the severity of tricuspid regurgitation by Doppler color flow mapping was assessed by comparing the maximal area of tricuspid regurgitant signals with the right atrial area taken in the same frame in which the maximal tricuspid regurgitant signals were noted. This ratio was found to be greater than or equal to 34% (mean 50.2 +/- 11.8%) in 50 (96%) of 52 patients in Group I and less than 34% (mean 27.5 +/- 6.9%) in 36 (95%) of 38 patients in Group II (p less than 0.001). The maximal diastolic tricuspid anulus diameter measured with the same two-dimensional imaging planes was greater than or equal to mm/m2 body surface area (mean 26.7 +/- 5.2 mm/m2) in 46 patients (88%) in Group I and less than 21 mm/m2 (mean 17.8 +/- 2.5 mm/m2) in 36 patients (95%) in Group II (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Terminalia arjuna (Hindi name Arjuna, FamilyCombretacae) has been used in the treatment of cardiovascular disorders by Ayurvedic physicians. However, its properties have not been scientifically evaluated so far. Therefore, the present study was carried out to examine the underlying mechanism of the cardiovascular effects of aqueous solution of Terminalia arjuna extract. Intravenous (I. V.) administration of the extract was found to induce dose dependent decrease in blood pressure (B. P.) and heart rate (H. R.). These extracts also inhibited carotid occlusion response, without affecting the pressor responses, induced by intravenous injection of norepinephrine and by electrical stimulation of preganglionic fibres of the abdominal splanchnic nerve. Hypotension and bradycardia were also observed following the injection of the extract into the lateral cerebral ventricle and vertebral artery. The results of the present study show that the hypotensive and bradycardiac effects of T. arjuna are mainly of central ongin.

Dr Yash Lokhandwala, and 10 or more other experts, including non-CSI members wherever additional expertise was thought necessary. The first and second drafts were circulated to the Expert Panel in August and October 2011. The Expert Panel met in December 2011 during the Annual Meeting in Mumbai, and the third draft was presented to CSI in an academic session the next day, with over 3 h of discussion, and their recommendations were incorporated. v Members of Task Force/Writing Committee. w Late.

Doppler color flow mapping and color-guided conventional Doppler studies were performed on 119 patients with 126 prosthetic valves (mitral alone in 60, aortic alone in 52 and both mitral and aortic in 7 patients) within 2 weeks of the catheterization study or surgery, or both. The mean pressure gradients derived by color-guided continuous wave Doppler ultrasound correlated well with those obtained at catheterization for both the tissue and mechanical mitral and aortic prostheses (r = 0.85 to 0.87). For the effective prosthetic orifice areas, better correlation with catheterization results were obtained with the tissue mitral (r = 0.94) and tissue aortic (r = 0.87) prostheses than with the mechanical mitral (r = 0.79) and mechanical aortic (r = 0.76) prostheses. The maximal width of the color flow signals at their origin from the tissue mitral prostheses also correlated well with the effective prosthetic orifice area at catheterization (r = 0.81). Doppler color flow mapping identified prosthetic valvular regurgitation with a sensitivity and specificity of 89% and 100%, respectively, for the mitral and 92% and 83% for the aortic prostheses. There was complete agreement between the Doppler color flow mapping and angiographic grading of the severity of prosthetic valvular regurgitation in 90% of mitral and 73.5% of the aortic regurgitant prostheses with under- or overestimation by greater than 1 grade in only two cases. Valvular and paravalvular regurgitation was correctly categorized by Doppler color flow mapping in relation to the surgical findings in 94% of the mitral and 80.5% of the aortic prostheses.

The severity of valvular aortic stenosis was assessed by Doppler color flow mapping in 100 consecutive patients who underwent successful cardiac catheterization within 2 weeks of the Doppler study. The maximal width of the aortic stenosis jet seen in 61 of these patients (Group A) was measured at the aortic valve. Color-guided continuous wave Doppler examination was used to measure the mean transaortic pressure gradient, and the aortic valve area was estimated using the simplified continuity equation. The aortic stenosis jet was not seen in 39 patients (Group B), and the mean pressure gradient and aortic valve area in these patients were assessed by conventional Doppler echocardiography alone. The mean pressure gradient obtained by continuous wave Doppler study and cardiac catheterization in the 61 Group A patients correlated well (r = 0.90); the correlation was lower in the 39 Group B patients (r = 0.70). The overall correlation for the combined Groups A and B was good (r = 0.82). The aortic valve area estimated by continuous wave Doppler study and cardiac catheterization in 54 Group A patients correlated well (r = 0.92); the correlation in 22 Group B patients was lower (r = 0.71). The correlation for all 76 patients (Groups A and B) was good (r = 0.80). The maximal aortic stenosis jet width also correlated well with the aortic valve area estimated at catheterization in 54 patients (r = 0.90). Group C represented an additional 14 patients in whom the left ventricle could not be entered during cardiac catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)