Francesco Faletra

Three dimensional transthoracic echocardiography images of tricuspid stenosis

A 56 year old man was admitted for evaluation of exertional dyspnoea. His medical history was significant for rheumatic mitral and aortic valve disease. A transthoracic three dimensional (3D) echocardiography examination was performed using a Philips Sonos 7500 (Philips Medical Systems, Eindhoven, the Netherlands) and a new 4 MHz, 4X matrix transducer capable of providing real time …

Additional diagnostic value of multiplane echocardiography over biplane imaging in assessment of mitral prosthetic valves.

OBJECTIVE: To evaluate how often multiplane transoesophageal echocardiography yields new or complementary data in mitral prostheses in comparison with the exclusive use of biplane imaging. PATIENTS: 73 consecutive patients with mitral prostheses who underwent multiplane transoesophageal echocardiograpy between January 1993 and December 1994. METHODS: Biplane images (transverse and longitudinal planes) and multiplane images (transverse, longitudinal, and intermediate planes) were recorded on two separate videotapes. The data provided by multiplane transoesophageal echocardiography were evaluated as (a) new data (abnormalities missed by biplane imaging); (b) complementary data (better delineating lesions already visualised by biplane imaging); or (c) redundant data (data already provided by biplane imaging). RESULTS: Multiplane transoesophageal echocardiography revealed new abnormalities in seven patients (9.5%) (thrombi in three and paraprosthetic leaks in the remaining four) and complementary data in nine (12.3%). In patients with paraprosthetic regurgitation, the possibility of continuously visualising the sewing ring by means of sequential angulations allowed the circumferential extension of the leak to be measured. In seven patients with paravalvar regurgitation who underwent surgery, the extension of the leak as measured by the multiplane approach closely corresponded with the surgical data. CONCLUSIONS: In comparison with the exclusive use of biplane imaging, the multiplane approach added new or complementary data in a significant proportion of patients with mitral prostheses. The ability to obtain the sequential adjacent planes allowed a more reliable appraisal of the extension of the leak and other abnormalities.

Stenosi mitralica reumatica

Per molti anni, fino a quando le sequele della malattia reumatica si sono attenuate per poi scomparire (almeno nel mondo occidentale), l’ecocardiografia e la stenosi mitralica hanno avuto un rapporto privilegiato. Vale la pena di proporne, in poche righe, la storia. La stenosi mitralica e stata per la prima volta studiata con ecocardiografia negli anni Cinquanta da Edler e Hertz [88] e nei successivi venti anni e rimasta fra le patologie piu studiate con ecocardiografia M-mode. Nel 1975 Henry e collaboratori per la prima volta dimostrarono che l’ecocardiografia bidimensionale era in grado di visualizzare l’orifizio mitralico e misurarne l’area valvolare residua [89]. Questo studio fu importante perche, per la prima volta, fu dimostrato che una tecnica non invasiva poteva fornire dati quantitativi sulla stenosi mitralica (fino a quel momento possibili solo con il cateterismo cardiaco).

L’atrio sinistro

L’atrio sinistro ha una notevole importanza nella storia naturale e chirurgica della stenosi mitralica. Esso e la prima camera che risente dell’ostruzione al riempimento del ventricolo; al suo interno, la stasi ematica e l’effetto pro-coagulante che la stenosi determina possono favorire la formazione di trombi che condizionano pesantemente la morbilita e mortalita del paziente, indipendentemente dalla severita della stenosi. La dilatazione atriale e il substrato morfo-patologico che innesca la fibrillazione atriale che e, essa stessa, fattore indipendente di morbilita e mortalita. Per questi motivi l’atrio sinistro merita un capitolo tutto suo.