To determine prospectively the prevalence of mitral, aortic, tricuspid, and pulmonary regurgitation in normal persons, 211 consecutive, apparently healthy volunteers were examined with a color Doppler flow imaging system. The subjects were divided into five age groups (group 1, 6-9 years old; group 2, [10][11][12][13][14][15][16][17][18][19]
To assess the prevalence of valvular regurgitation in the aged, we studied 176 apparently healthy volunteers with no history or physical evidence of cardiac abnormality. Their ages ranged from 40 to 90 (66 ± 14, mean ± SD) years. We examined these subjects by pulsed Doppler echocardiography combined with two-dimensional echocardiography to determine the prevalence of valvular regurgitation. Regurgitation began to appear in subjects in their fifties, increasing in prevalence with advancing age (r = .81, p < .001), and was documented in all over age 80. Similarly, regurgitation involving more than one valve appeared in those 60 years and older, and was very common (89%) in subjects in their eighties. With each type of valvular regurgitation, the prevalence of each type of regurgitation increased with aging, but this tendency was most prominent for aortic regurgitation. We conclude that (1) single or multivalvular regurgitation as detected by pulsed Doppler echocardiography is very common in the aged and may be considered a normal finding in the absence of other evidence of heart disease, and (2) the high prevalence of regurgitation in the aged must be taken into account when Doppler examinations are being performed. Circulation 76, No. 2, 262-265, 1987. PULSED DOPPLER echocardiography is a noninvasive technique that has proved useful in the detection of valvular regurgitation. The high degree of specificity and sensitivity of this technique has been reported. 1 11 The atrioventricular valves are known to become thicker and more opaque with advancing age,12 15 and similar changes may occur in the semilunar valves. The grade of these changes is in part genetically determined and in part age related. 12 16 Therefore, multivalvular regurgitation of little or no clinical significance can be expected to occur in older subjects. The purpose of this study was to investigate the prevalence of valvular regurgitation in the aged by pulsed Doppler echocardiography. Subjects and methodsApparently healthy volunteers without cardiac symptoms were studied. All were outpatients or inpatients of the Depart- ment of Ophthalmology of Kobe General Hospital who were undergoing routine vision testing or were being considered for cataract surgery. None had received a prior diagnosis of cardiac disease or had valvular regurgitation of a known cause such as rheumatic fever, myocardial infarction, hypertension, or mitral valve prolapse. Before the pulsed Doppler echocardiographic study, a physical examination was performed and a 12-lead electrocardiogram as well as a two-dimensional echocardiogram were recorded to exclude known causes of valvular regurgitation. Patients were excluded if they had a significant murmur, atrial fibrillation, left ventricular hypertrophy, evidence of previous myocardial infarction, asynergy of the left ventricle, mitral annular calcification, or a perceptible aortic valve abnormality. Finally, 176 of 227 apparently healthy volunteers were studied by pulsed Doppler echocardiography. Their ages range...
Infection of the mitral-aortic intervalvular fibrosa occurs most commonly in association with infective endocarditis of the aortic valve. Infection of the aortic valve results in a regurgitant jet that presumably strikes this subaortic interannular zone of fibrous tissue and produces a secondary site of infection. Infection of this interannular zone then leads to the formation of subaortic abscess or pseudoaneurysm of the left ventricular outflow tract. This infected zone of mitral-aortic intervalvular fibrosa or subaortic aneurysm can subsequently rupture into the left atrium with systolic ejection of blood from the left ventricular outflow tract to the left atrium. This report describes the echocardiographic findings in three patients with pathologically proved left ventricular outflow tract to left atrial communication. Precise preoperative diagnosis is important, and this lesion should be differentiated from ruptured aneurysm of the sinus of Valsalva and perforation of the anterior mitral leaflet. Transthoracic echocardiography using color flow imaging and conventional Doppler techniques may show an eccentric mitral regurgitation type of signal in the left atrium originating from the region of the left ventricular outflow tract. However, transesophageal echocardiography provides an accurate preoperative diagnosis and should be used intraoperatively during repair of such lesions.
To evaluate left-to-right shunts after percutaneous balloon mitral valvuloplasty, we studied 15 consecutive patients by using transesophageal color Doppler flow-imaging system. Transesophageal color Doppler examinations were performed five times in each patient (before valvuloplasty and 1 day, 1 week, 1 month, and 6 months after valvuloplasty). No shunt flow was observed before valvuloplasty. On 1 day after mitral valvuloplasty, transesophageal color Doppler echocardiography demonstrated left-to-right shunts in 13 (87%) of 15 patients. However, a significant oxygen step-up was present in the right heart in only one patient. The mean diameter of the interatrial septal defect detected by transesophageal two-dimensional echocardiography was 1.8± 1.0 mm. The mean velocity of left-to-right shunting flow measured by high-pulse repetition frequency Doppler technique was 0.83±0.38 m/sec. One week after the procedure, left-to-right shunt flow was detected in 11 (73%) patients. One month after valvuloplasty, left-to-right shunting flow was detected in seven (47%) of 15 patients. There was a significant decrease in the diameter of an interatrial septal defect between 1 day and 1 week (p<0.01), between 1 week and 1 month (p<0.01), and between 1 month and 6 months (p<0.05). Six months after valvuloplasty, left-to-right shunting flow remained in three (20%) patients. By using transthoracic color Doppler echocardiography, we detected left-to-right shunting flow in two patients on 1 day after the procedure. In these patients, no shunting flow was detected 1 month after mitral valvuloplasty from the transthoracic approach. Oximetry demonstrated left-to-right shunts of pulmonary-to-systemic flow ratio of 1.3:1 in one patient immediately after mitral valvuloplasty. Thus, transesophageal color Doppler echocardiography is useful in the detection of left-to-right shunts after percutaneous mitral valvuloplasty, and most of the patients undergoing percutaneous mitral valvuloplasty had small left-to-right shunts that were not detected by oximetry. (Circulation 1989;80:1521-1526
Sixteen patients with coronary artery fistula proved by coronary angiography or surgery were studied using two-dimensional echocardiography and Doppler color flow mapping. The coronary artery fistula drained into the right atrium in 4 patients, the right ventricle in 2 and the pulmonary artery in 10. The dilated coronary artery was visualized in 7 of the 16 patients with a fistula, as compared with none of the 40 control subjects. These 7 patients included 5 of 6 patients with a fistula draining into the right atrium or right ventricle and only 2 of 10 patients with a fistula draining into the pulmonary artery. Abnormal flow signals in the dilated coronary artery were visualized with Doppler color flow mapping in five of these seven patients. Color flow imaging visualized abnormal flow signals with mosaic appearance in the pulmonary artery in eight patients, the right atrium in four and the right ventricle in two. The chamber in which abnormal signals were detected corresponded with the entry site of the fistula by angiography. Intraoperative imaging during surgical repair was needed in two cases to confirm ligation of all arteries feeding into the fistula network. In conclusion, Doppler color flow imaging is diagnostically useful to visualize shunt flows originating from the opening or exit of a coronary artery fistula. Furthermore, intraoperative use of this technique may provide confirmation of successful surgical ligation of the fistula.
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