No abstract

An attempt was made to determine whether mitral regurgitation could be detected and its severity evaluated semiquantitatively by newly developed real-time two-dimensional Doppler flow imaging in 109 patients who underwent left ventriculography. In the Doppler flow imaging technique, Doppler signals due to blood flow in the cardiac chambers are processed using a high speed autocorrelation technique, so that the direction, velocity and turbulence of the intracardiac blood flow are displayed in the color-coded mode on the monochrome B-mode echocardiogram in real time. Mitral regurgitant flow was imaged as a jet spurting out from the mitral valve orifice into the left atrial cavity. It was noted that the regurgitant jet in the left atrial cavity had a variety of orientations and dynamic features when studied by the present technique. The sensitivity of the technique in the detection of mitral regurgitation was 86% as compared with that of left ventriculography. Mitral regurgitation in the false negative cases was mostly mild. On the basis of the farthest distance reached by the regurgitant flow signal from the mitral valve orifice, the severity of regurgitation was graded on a four point scale and these results were compared with those of angiography. A significant correlation (r = 0.87) was found between Doppler imaging and angiography in the evaluation of the severity of mitral regurgitation. A similar result was obtained for the evaluation based on the area covered by the regurgitant signals in the left atrial cavity. Thus, noninvasive semiquantitative evaluation by real-time two-dimensional Doppler flow imaging appears to be a promising clinical technique.

The aim of the present study was to elucidate the mechanisms of mitral regurgitation accompanying myocardial infarction. Severity and site of mitral regurgitation was evaluated by the real-time two-dimensional Doppler flow imaging technique in 81 patients with old myocardial infarction. The incidence of mitral regurgitation did not depend on the region of infarction. There was, however, a close relationship between the site of regurgitation and the region of infarction. In patients with mitral regurgitation spurting from the posteromedial area of the valve, the inferior wall was involved in infarction without exception and in some of these patients, the posteromedial papillary muscle was also found to be affected by myocardial infarction; in those with regurgitation spurting from the anterolateral area, the anterior wall showed asynergy. On the other hand in patients with mitral regurgitation spurting from the central area, the region of infarction varied. In these patients, however, the larger the diameter of the mitral anulus, the more severe the grade of regurgitation. The extent of asynergy was another factor related to the severity of mitral regurgitation. Both longitudinally and transversely, broad infarction leads to the enlargement of the mitral anulus. However, even if the mitral anulus is not so dilated, severe involvement of either commissural area results in severe mitral regurgitation from the same commissural side. Thus, there are two major causative factors of mitral regurgitation: (1) asynergy of the papillary muscle or the ventricle that results in mitral regurgitation located in the commissural area of the same side as asynergy, and (2) enlargement of mitral anulus, which results in regurgitation from the central area of the orifice. The mechanisms of mitral regurgitation unveiled in the present study will contribute much to the clarification of the concept of so-called papillary muscle dysfunction." Circulation 76, No. 4, 777-785, 1987. MITRAL REGURGITATION is frequently observed in patients with myocardial infarction. Since it develops in the absence of any lesions in the mitral valve leaflet, its pathogenesis has been explained by the concept of "papillary muscle dysfunction" proposed by Burch et al. 1 At present, papillary muscle dysfunction is thought to be a sequence of unsuccessful coordination of the whole mitral apparatus (which is composed of the anulus, leaflets, chordae tendineae, papillary muscles, and the left ventricular wall), rather than a mere disorder of the papillary muscle. However, the concept of papillary muscle dysfunction is a rather theoretical one and its existence has not been proven from the point of view of functional anatomy. The purpose of this present study was to elucidate the pathogenesis of mitral regurgitation observed in patients with old myocardial infarction by assessment of the topographic features of regurgitation with a realtime two-dimensional Doppler flow imaging technique as well as two-dimensional echocardiography. Materials and methods...

SUMMARY We analyzed tricuspid regurgitation noninvasively using ultrasonic pulsed Doppler and twodimensional echocardiography in 66 patients in whom tricuspid regurgitation was suspected from routine clinical evaluation. All of the patients also underwent right ventriculography. Ten healthy subjects served as controls.In 62 of 66 patients, the study was adequately performed. In 58 of 62 patients, pansystolic abnormal Doppler signals were detected in the right atrial cavity, and were interpreted to indicate tricuspid regurgitant flow. Two-dimensional echocardiograms in the parasternal four-chamber view demonstrated that the region in which the abnormal Doppler signals were detected was spindle-shaped and extended from the tricuspid orifice toward the right atrial posterior wall parallel to the interatrial septum.The severity of regurgitation was graded on a four-point scale, based on the distance reached by the abnormal signals from the tricuspid orifice toward the posterior wall. For comparison, the right ventriculograms were evaluated on a four-point scale similar to the Sellers classification of mitral regurgitation. The grades by the two methods matched exactly in 36 cases, differed by one level in 23 and by two levels in three. Thus, the two methods showed a good correspondence. Similar results were obtained for the grading based on the area covered by the abnormal signals. We conclude that noninvasive grading of tricuspid regurgitation by ultrasonic pulsed Doppler and two-dimensional echocardiography is practicable.ALTHOUGH tricuspid valve regurgitation can be due to organic disease of the tricuspid valve, it is generally a functional disorder, and frequently occurs after valvular disease of the left heart or in association with congenital heart disease.' Although tricuspid regurgitation is functional, it can adversely affect the hemodynamic state of the patient.2 Thus, methods for assessing the severity of tricuspid regurgitation are needed, but there are none available.)8 Attempts have been made to assess the degree of regurgitation by contrast echocardiography,9' but this method requires the injection of contrast material.The ultrasonic pulsed Doppler technique has proved useful for detecting blood flow disturbances in the right heart." 16 This technique is reported to be sensitive in detecting tricuspid regurgitation. 17-'() In the present study, we analyzed tricuspid regurgitation in detail using ultrasonic pulsed Doppler and two-dimensional echocardiography;2 we specifically evaluated the severity of tricuspid regurgitation. Materials and Methods

No abstract