Asimul H. Ansari

Quantitative assessment of in-stent dimensions: A comparison of 64 and 16 detector multislice computed tomography to intravascular ultrasound

To determine the utility of multislice computed tomography (MSCT) technology to evaluate coronary stent luminal diameter.

Prosthesis-patient mismatch in bovine pericardial aortic valves: Evaluation using 3 different modalities and associated medium-term outcomes

Background— The prevalence of prosthesis-patient mismatch (PPM) and its impact on survival after aortic valve replacement have not been clearly defined. Historically, the presence of PPM was identified from postoperative echocardiograms or preoperative manufacturer-provided charts, resulting in wide discrepancies. The 2009 American Society of Echocardiography (ASE) guidelines proposed an algorithmic approach to calculate PPM. This study compared PPM prevalence and its impact on survival using 3 modalities: (1) the ASE guidelines–suggested algorithm (ASE PPM); (2) the manufacturer-provided charts (M PPM); and (3) the echocardiographically measured, body surface area–indexed, effective orifice area (EOAi PPM) measurement. Methods and Results— A total of 614 patients underwent aortic valve replacement with bovine pericardial valves from 2004 to 2009 and had normal preoperative systolic function. EOAi PPM was severe if EOAi was ≤0.60 cm2/m2, moderate if EOAi was 0.60 to 0.85 cm2/m2, and absent (none) if EOAi was ≥0.85 cm2/m2. ASE PPM was severe in 22 (3.6%), moderate in 6 (1%), and absent (none) in 586 (95.4%). ASE PPM was similar to manufacturer-provided PPM ( P =1.00). ASE PPM differed significantly from EOAi PPM ( P <0.001), which identified severe mismatch in 170 (29.7%), moderate in 191 (33.4%), and absent (none) in 211 patients (36.9%). Irrespective of the PPM classification method, PPM did not adversely affect midterm survival (average follow-up, 4.1±1.8 years; median, 3.9 years; range, 0.01–8 years). There were no reoperations for PPM. Conclusions— In patients with normal systolic function undergoing bovine pericardial aortic valve replacement, the prevalence of PPM using the algorithmic-ASE approach was low and correlated well with manufacturer-provided PPM. Independent of the method of PPM assessment, PPM was not associated with medium-term mortality.Background— The prevalence of prosthesis-patient mismatch (PPM) and its impact on survival after aortic valve replacement have not been clearly defined. Historically, the presence of PPM was identified from postoperative echocardiograms or preoperative manufacturer-provided charts, resulting in wide discrepancies. The 2009 American Society of Echocardiography (ASE) guidelines proposed an algorithmic approach to calculate PPM. This study compared PPM prevalence and its impact on survival using 3 modalities: (1) the ASE guidelines–suggested algorithm (ASE PPM); (2) the manufacturer-provided charts (M PPM); and (3) the echocardiographically measured, body surface area–indexed, effective orifice area (EOAi PPM) measurement. Methods and Results— A total of 614 patients underwent aortic valve replacement with bovine pericardial valves from 2004 to 2009 and had normal preoperative systolic function. EOAi PPM was severe if EOAi was ⩽0.60 cm2/m2, moderate if EOAi was 0.60 to 0.85 cm2/m2, and absent (none) if EOAi was ≥0.85 cm2/m2. ASE PPM was severe in 22 (3.6%), moderate in 6 (1%), and absent (none) in 586 (95.4%). ASE PPM was similar to manufacturer-provided PPM (P=1.00). ASE PPM differed significantly from EOAi PPM (P<0.001), which identified severe mismatch in 170 (29.7%), moderate in 191 (33.4%), and absent (none) in 211 patients (36.9%). Irrespective of the PPM classification method, PPM did not adversely affect midterm survival (average follow-up, 4.1±1.8 years; median, 3.9 years; range, 0.01–8 years). There were no reoperations for PPM. Conclusions— In patients with normal systolic function undergoing bovine pericardial aortic valve replacement, the prevalence of PPM using the algorithmic-ASE approach was low and correlated well with manufacturer-provided PPM. Independent of the method of PPM assessment, PPM was not associated with medium-term mortality.

Infective Endocarditis: An Update on the Role of Echocardiography

The evaluation of valvular and nonvalvular structures is of central importance in the diagnosis, management, and treatment of infective endocarditis (IE). The incidence of IE has remained constant due to changing substrate, with notably higher prevalence observed in the elderly. Mortality and morbidity continue to remain high, despite advances in medical and surgical treatment. This article reviews the technical and practical aspects of the use of echocardiography to evaluate patients with suspected IE.

Response to Letter Regarding Article, “Prosthesis-Patient Mismatch in Bovine Pericardial Aortic Valves: Evaluation Using 3 Different Modalities and Associated Medium-Term Outcomes”

We thank House et al1 for a thoughtful critical review of our study.2 To keep the study cohort homogenous, we preselected only patients with normal systolic function who underwent an aortic valve replacement with a pericardial tissue valve. We agree that there is a small likelihood of underestimation of the prevalence of prosthesis–patient mismatch (PPM) in our cohort because of low gradient aortic stenosis and normal systolic function, a group of patients who are challenging to evaluate and manage.3 However, among patients from our cohort undergoing aortic valve replacement for aortic stenosis (79% of the cohort), the average preoperative mean gradient was 43.5 mm Hg, suggesting that the likelihood …

Prosthesis-Patient Mismatch in Bovine Pericardial Aortic ValvesClinical Perspective

Background— The prevalence of prosthesis-patient mismatch (PPM) and its impact on survival after aortic valve replacement have not been clearly defined. Historically, the presence of PPM was identified from postoperative echocardiograms or preoperative manufacturer-provided charts, resulting in wide discrepancies. The 2009 American Society of Echocardiography (ASE) guidelines proposed an algorithmic approach to calculate PPM. This study compared PPM prevalence and its impact on survival using 3 modalities: (1) the ASE guidelines–suggested algorithm (ASE PPM); (2) the manufacturer-provided charts (M PPM); and (3) the echocardiographically measured, body surface area–indexed, effective orifice area (EOAi PPM) measurement. Methods and Results— A total of 614 patients underwent aortic valve replacement with bovine pericardial valves from 2004 to 2009 and had normal preoperative systolic function. EOAi PPM was severe if EOAi was ≤0.60 cm2/m2, moderate if EOAi was 0.60 to 0.85 cm2/m2, and absent (none) if EOAi was ≥0.85 cm2/m2. ASE PPM was severe in 22 (3.6%), moderate in 6 (1%), and absent (none) in 586 (95.4%). ASE PPM was similar to manufacturer-provided PPM ( P =1.00). ASE PPM differed significantly from EOAi PPM ( P <0.001), which identified severe mismatch in 170 (29.7%), moderate in 191 (33.4%), and absent (none) in 211 patients (36.9%). Irrespective of the PPM classification method, PPM did not adversely affect midterm survival (average follow-up, 4.1±1.8 years; median, 3.9 years; range, 0.01–8 years). There were no reoperations for PPM. Conclusions— In patients with normal systolic function undergoing bovine pericardial aortic valve replacement, the prevalence of PPM using the algorithmic-ASE approach was low and correlated well with manufacturer-provided PPM. Independent of the method of PPM assessment, PPM was not associated with medium-term mortality.Background— The prevalence of prosthesis-patient mismatch (PPM) and its impact on survival after aortic valve replacement have not been clearly defined. Historically, the presence of PPM was identified from postoperative echocardiograms or preoperative manufacturer-provided charts, resulting in wide discrepancies. The 2009 American Society of Echocardiography (ASE) guidelines proposed an algorithmic approach to calculate PPM. This study compared PPM prevalence and its impact on survival using 3 modalities: (1) the ASE guidelines–suggested algorithm (ASE PPM); (2) the manufacturer-provided charts (M PPM); and (3) the echocardiographically measured, body surface area–indexed, effective orifice area (EOAi PPM) measurement. Methods and Results— A total of 614 patients underwent aortic valve replacement with bovine pericardial valves from 2004 to 2009 and had normal preoperative systolic function. EOAi PPM was severe if EOAi was ⩽0.60 cm2/m2, moderate if EOAi was 0.60 to 0.85 cm2/m2, and absent (none) if EOAi was ≥0.85 cm2/m2. ASE PPM was severe in 22 (3.6%), moderate in 6 (1%), and absent (none) in 586 (95.4%). ASE PPM was similar to manufacturer-provided PPM (P=1.00). ASE PPM differed significantly from EOAi PPM (P<0.001), which identified severe mismatch in 170 (29.7%), moderate in 191 (33.4%), and absent (none) in 211 patients (36.9%). Irrespective of the PPM classification method, PPM did not adversely affect midterm survival (average follow-up, 4.1±1.8 years; median, 3.9 years; range, 0.01–8 years). There were no reoperations for PPM. Conclusions— In patients with normal systolic function undergoing bovine pericardial aortic valve replacement, the prevalence of PPM using the algorithmic-ASE approach was low and correlated well with manufacturer-provided PPM. Independent of the method of PPM assessment, PPM was not associated with medium-term mortality.

Prosthesis-Patient Mismatch in Bovine Pericardial Aortic ValvesClinical Perspective: Evaluation Using 3 Different Modalities and Associated Medium-Term Outcomes

Background— The prevalence of prosthesis-patient mismatch (PPM) and its impact on survival after aortic valve replacement have not been clearly defined. Historically, the presence of PPM was identified from postoperative echocardiograms or preoperative manufacturer-provided charts, resulting in wide discrepancies. The 2009 American Society of Echocardiography (ASE) guidelines proposed an algorithmic approach to calculate PPM. This study compared PPM prevalence and its impact on survival using 3 modalities: (1) the ASE guidelines–suggested algorithm (ASE PPM); (2) the manufacturer-provided charts (M PPM); and (3) the echocardiographically measured, body surface area–indexed, effective orifice area (EOAi PPM) measurement. Methods and Results— A total of 614 patients underwent aortic valve replacement with bovine pericardial valves from 2004 to 2009 and had normal preoperative systolic function. EOAi PPM was severe if EOAi was ≤0.60 cm2/m2, moderate if EOAi was 0.60 to 0.85 cm2/m2, and absent (none) if EOAi was ≥0.85 cm2/m2. ASE PPM was severe in 22 (3.6%), moderate in 6 (1%), and absent (none) in 586 (95.4%). ASE PPM was similar to manufacturer-provided PPM ( P =1.00). ASE PPM differed significantly from EOAi PPM ( P <0.001), which identified severe mismatch in 170 (29.7%), moderate in 191 (33.4%), and absent (none) in 211 patients (36.9%). Irrespective of the PPM classification method, PPM did not adversely affect midterm survival (average follow-up, 4.1±1.8 years; median, 3.9 years; range, 0.01–8 years). There were no reoperations for PPM. Conclusions— In patients with normal systolic function undergoing bovine pericardial aortic valve replacement, the prevalence of PPM using the algorithmic-ASE approach was low and correlated well with manufacturer-provided PPM. Independent of the method of PPM assessment, PPM was not associated with medium-term mortality.Background— The prevalence of prosthesis-patient mismatch (PPM) and its impact on survival after aortic valve replacement have not been clearly defined. Historically, the presence of PPM was identified from postoperative echocardiograms or preoperative manufacturer-provided charts, resulting in wide discrepancies. The 2009 American Society of Echocardiography (ASE) guidelines proposed an algorithmic approach to calculate PPM. This study compared PPM prevalence and its impact on survival using 3 modalities: (1) the ASE guidelines–suggested algorithm (ASE PPM); (2) the manufacturer-provided charts (M PPM); and (3) the echocardiographically measured, body surface area–indexed, effective orifice area (EOAi PPM) measurement. Methods and Results— A total of 614 patients underwent aortic valve replacement with bovine pericardial valves from 2004 to 2009 and had normal preoperative systolic function. EOAi PPM was severe if EOAi was ⩽0.60 cm2/m2, moderate if EOAi was 0.60 to 0.85 cm2/m2, and absent (none) if EOAi was ≥0.85 cm2/m2. ASE PPM was severe in 22 (3.6%), moderate in 6 (1%), and absent (none) in 586 (95.4%). ASE PPM was similar to manufacturer-provided PPM (P=1.00). ASE PPM differed significantly from EOAi PPM (P<0.001), which identified severe mismatch in 170 (29.7%), moderate in 191 (33.4%), and absent (none) in 211 patients (36.9%). Irrespective of the PPM classification method, PPM did not adversely affect midterm survival (average follow-up, 4.1±1.8 years; median, 3.9 years; range, 0.01–8 years). There were no reoperations for PPM. Conclusions— In patients with normal systolic function undergoing bovine pericardial aortic valve replacement, the prevalence of PPM using the algorithmic-ASE approach was low and correlated well with manufacturer-provided PPM. Independent of the method of PPM assessment, PPM was not associated with medium-term mortality.

Prosthesis-Patient Mismatch in Bovine Pericardial Aortic Valves: Evaluation Using Three Different Modalities and Associated Medium Term Outcomes

Background— The prevalence of prosthesis-patient mismatch (PPM) and its impact on survival after aortic valve replacement have not been clearly defined. Historically, the presence of PPM was identified from postoperative echocardiograms or preoperative manufacturer-provided charts, resulting in wide discrepancies. The 2009 American Society of Echocardiography (ASE) guidelines proposed an algorithmic approach to calculate PPM. This study compared PPM prevalence and its impact on survival using 3 modalities: (1) the ASE guidelines–suggested algorithm (ASE PPM); (2) the manufacturer-provided charts (M PPM); and (3) the echocardiographically measured, body surface area–indexed, effective orifice area (EOAi PPM) measurement. Methods and Results— A total of 614 patients underwent aortic valve replacement with bovine pericardial valves from 2004 to 2009 and had normal preoperative systolic function. EOAi PPM was severe if EOAi was ≤0.60 cm2/m2, moderate if EOAi was 0.60 to 0.85 cm2/m2, and absent (none) if EOAi was ≥0.85 cm2/m2. ASE PPM was severe in 22 (3.6%), moderate in 6 (1%), and absent (none) in 586 (95.4%). ASE PPM was similar to manufacturer-provided PPM ( P =1.00). ASE PPM differed significantly from EOAi PPM ( P <0.001), which identified severe mismatch in 170 (29.7%), moderate in 191 (33.4%), and absent (none) in 211 patients (36.9%). Irrespective of the PPM classification method, PPM did not adversely affect midterm survival (average follow-up, 4.1±1.8 years; median, 3.9 years; range, 0.01–8 years). There were no reoperations for PPM. Conclusions— In patients with normal systolic function undergoing bovine pericardial aortic valve replacement, the prevalence of PPM using the algorithmic-ASE approach was low and correlated well with manufacturer-provided PPM. Independent of the method of PPM assessment, PPM was not associated with medium-term mortality.Background— The prevalence of prosthesis-patient mismatch (PPM) and its impact on survival after aortic valve replacement have not been clearly defined. Historically, the presence of PPM was identified from postoperative echocardiograms or preoperative manufacturer-provided charts, resulting in wide discrepancies. The 2009 American Society of Echocardiography (ASE) guidelines proposed an algorithmic approach to calculate PPM. This study compared PPM prevalence and its impact on survival using 3 modalities: (1) the ASE guidelines–suggested algorithm (ASE PPM); (2) the manufacturer-provided charts (M PPM); and (3) the echocardiographically measured, body surface area–indexed, effective orifice area (EOAi PPM) measurement. Methods and Results— A total of 614 patients underwent aortic valve replacement with bovine pericardial valves from 2004 to 2009 and had normal preoperative systolic function. EOAi PPM was severe if EOAi was ⩽0.60 cm2/m2, moderate if EOAi was 0.60 to 0.85 cm2/m2, and absent (none) if EOAi was ≥0.85 cm2/m2. ASE PPM was severe in 22 (3.6%), moderate in 6 (1%), and absent (none) in 586 (95.4%). ASE PPM was similar to manufacturer-provided PPM (P=1.00). ASE PPM differed significantly from EOAi PPM (P<0.001), which identified severe mismatch in 170 (29.7%), moderate in 191 (33.4%), and absent (none) in 211 patients (36.9%). Irrespective of the PPM classification method, PPM did not adversely affect midterm survival (average follow-up, 4.1±1.8 years; median, 3.9 years; range, 0.01–8 years). There were no reoperations for PPM. Conclusions— In patients with normal systolic function undergoing bovine pericardial aortic valve replacement, the prevalence of PPM using the algorithmic-ASE approach was low and correlated well with manufacturer-provided PPM. Independent of the method of PPM assessment, PPM was not associated with medium-term mortality.