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Ultrasound lung comet images (ULC) are useful for the noninvasive assessment of extravascular lung water (EVLW). We investigated the modification of EVLW, its relation to indices of left ventricular systolic and diastolic function, and noninvasively determined pulmonary capillary wedge pressure (PCWP) (PCWP = 1.24 ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus [E/Em] + 1.9) at rest and its variation during exercise echocardiography. A total of 72 patients (mean age 66.4 +/- 8.4 years) with mean ejection fraction of 41.2 +/- 14.4% underwent symptoms-limited exercise echocardiography. The sum of the ULC yielded a score of EVLW. The ULC increased significantly from baseline to postexercise (5.9 +/- 14.9 vs 11 +/- 20.7, P = .0001). Positive linear correlations were found between baseline ULC score and baseline ejection fraction (r = -0.37, P = .002), systolic pulmonary artery pressure (r = 0.69, P = .0001), E/Em (r = 0.70, P = .0001), and estimated PCWP (r = 0.69, P = .0001). The variation between postexercise and baseline ULC score correlated significantly with the variation between peak stress and rest PCWP (r = 0.62, P = .0001), systolic pulmonary artery pressure (r = 0.44, P = .0001), wall-motion score index (r = 0.30, P = .01), and peak stress E/Em (r = 0.71, P = .0001), whereas no significant correlations were found between variations of ULC score and ejection fraction. This study shows that ULC represents a simple way to assess the presence of excess EVLW. Increased EVLW is associated with estimated PCWP and indices of left ventricular systolic and diastolic dysfunction. The additional exercise-induced increase of PCWP, the worsening of left ventricular diastolic function, and extensive wall-motion abnormalities correlate with variations of EVLW.

Mitral-valve repair in Barlow's disease is challenging; conventional techniques are difficult to perform, and there is a high risk of a postoperative suboptimal result. Double-orifice repair has been applied in a standardized approach to treat patients with severe mitral regurgitation and bileaflet prolapse due to Barlow's disease.

Repair of mitral regurgitation (MR) is more demanding in case of prolapse of the anterior leaflet, posterior leaflet with calcified annulus, or prolapse of both leaflets. We evaluated a repair which consists of anchoring the free edge of the prolapsing leaflet to the corresponding free edge of the facing leaflet: the 'edge-to-edge' (E-to-E) technique. The correction results in a double orifice valve when the prolapse is in the middle portion of the leaflet and in a smaller valve orifice when the prolapse is close to a commissure.

Purpose: The coexistence of mitral regurgitation (MR) and severe aortic stenosis is a common problem in elderly patients that limits the indication for percutaneous aortic prosthesis (TAVI). However, recent publications indicate a decrease in MR after TAVI because of the improvement of left ventricle (LV) hemodynamic conditions. The aim of our study was to investigate clinical and echocardiographic predictors of MR after TAVI. Methods: We included patients undergoing TAVI from May 2008 to November 2012. It was performed a 3D transesophageal echocardiogram during the procedure and a transthoracic echocardiogram before discharge and 12 months after implantation. We studied the etiology of MR before procedure, LV ejection fraction, chambers volume, pulmonary hypertension and tricuspid regurgitation, as well as clinical and technical variables related to the procedure. Results: 90 patients underwent TAVI successfully (Table). At the beginning, 21% of patients had MR at least grade III/IV. After TAVI, 84.4% of patients showed no change in MR degree, 12.2% improved and only 3.3% worsened. Variables related with MR worsening were rheumatic MR etiology, history of atrial fibrillation (AF) and the coexistence of significant tricuspid regurgitation (TR) in the baseline study (p <0.04, p <0.01; p <0.03, respectively). Conclusions: In patients undergoing TAVI, the rheumatic etiology of MR, the previous history of AF and significant TR coexistence were factors related to MR worsening after the procedure.   Baseline characteristics. N = 90Age81.9 ± 6.9Women49 (54.4%)LVEF56 % ± 11.6Previous stroke16 (18%)Previous AF36 (42.4%)Baseline creatinine serum level1.3 mg/dl ± 0.5EuroSCORE16.8 ± 9.2Transfemoral approach71 (79.8%)Transapical approach18 (20.2%) LVEF: ejection fraction of the left ventricle. AF: atrial fibrillation