Objective. Although preservation of mitral annulus and papillary muscle alignment is important in mitral valve surgery, it has been difficult to measure the precise distance between mitral annulus and papillary muscles in clinical setting. We sought to quantify the distances between mitral annulus and papillary muscles by using the 3D quantitation software system, REAL VIEW®. Methods. We examined 10 patients with functional mitral regurgitation due to dilated cardiomyopathy and 10 normal controls by real-time 3D echocardiography. Using REAL VIEW®, the 3D images of mitral annulus and the tips of papillary muscles were reconstructed in end-systole. Mitral annular area and circumference, mitral leaflet tenting length and volume, and the 6 distances between the tips of papillary muscles and corresponding points of the mitral annulus were measured three-dimensionally. Results. Patients with functional mitral regurgitation due to dilated cardiomyopathy had larger annular size, apparent leaflet tenting and longer papillary muscle to mitral annular distances compared with the controls. Conclusions. We demonstrated 3D echocardiographic measurements of papillary muscle to mitral annular distances with REAL VIEW®, in clinical setting. This technique should be applicable to understandable demonstration and quantitative evaluation of subvalvular geometry in various mitral valve diseases.
Background. Basic mechanism of ischemic mitral regurgitation (MR) is displacement of papillary muscles (PMs) due to left ventricular (LV) remodeling. Variability in LV remodeling can potentially cause heterogeneous PM displacements. The aim of this study is to compare the mitral valve complex geometry in patients with ischemic MR due to inferior and anterior myocardial infarction (MI). Methods. In 33 patients with prior inferior MI, 61 with anterior MI, and 22 controls, LV volume, mitral annular area, PM tethering distance, and MR were quantified by echocardiography. Results. Significant MR (MR fraction > 20%) was observed in 12 of the 33 with inferior MI and 7 of the 61 with anterior MI. In patients with MR due to inferior MI, tethering distance was significantly longer in medial compared to lateral PM (42.6 ± 4.9 vs. 36.1 ± 1.7 mm, p < 0.001), demonstrating asymmetric medial PM displacement. Patients with MR due to anterior MI had comparable increases in both PM tethering distances (41.0 ± 2.4 vs. 41.4 ± 1.8 mm, n.s.), demonstrating symmetric bilateral PM displacement. Conclusions. Although patients with ischemic MR due to inferior MI have asymmetrically predominant medial PM displacement, those with ischemic MR due to anterior MI have symmetric bilateral PM displacements.
The incidence of aortic stenosis (AS) is increasing, and the progression of AS is more rapid in chronic renal failure patients treated by dialysis than those in the general population. We present 2 cases of rapid progression of AS in chronic renal failure patients treated by dialysis. Both cases had no findings of AS at the first echocardiographic examination. After 3.5 years (case 1) and 2 years (case 2) later, severe AS was noted in both patients. The progression of AS was more rapid in our 2 cases compared with previous reports. Frequent echocardiographic examination should be performed to evaluate valvular calcification and stenosis in patients with chronic renal failure treated by chronic dialysis.
A 28 year-old Japanese woman presented with symptoms of a common cold and visited her primary care physician 60 days after giving birth to her first baby. A few days later, she was brought to our institution in the state of cardiac shock, with fulminant myocarditis. Echocardiography showed severely reduced cardiac systolic function. The electrocardiogram revealed complete atrioventricular block with ST-T wave changes. She underwent mechanical support with percutaneous cardiopulmonary support, intra-aortic balloon pump and left ventricular assist system. However, a massive thrombus was found within all the cardiac chambers (left ventricle, left atrium, right ventricle and right atrium) and the patient died on day 9 of hospitalization.