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The MitraClip system can be used to control regurgitant blood flow in patients with mitral regurgitation who cannot tolerate open surgery to replace the mitral valve. Technical limitations make the right femoral vein the standard access point for placing the MitraClip. However, this route is not always suitable. We present the case of an 85-year-old woman in whom we successfully used a left-sided approach for inserting a MitraClip because her right femoral vein was occluded. This apparently novel left femoral approach merits consideration as an option for device insertion when right femoral vein access is precluded.

Right ventricular endomyocardial biopsy has been the traditional gold standard for determining cardiac transplant rejection. Although endomyocardial biopsy has proved useful in guiding rejection therapy, this procedure is not without risk. The objective of the present study was to determine whether a noninvasive method for assessing cardiac diastolic function would be of value in predicting biopsy scores. Doppler echocardiographic indices of left ventricular function were compared with biopsy scores in 43 studies from 23 patients (age 50  ± 8 years). The average time from transplant to echocardiographic study was 1.5 years. Standard clinical indices of diastolic function failed to predict biopsy results. The A-Ar interval, evaluated in 36 studies, was found to significantly decrease (p< 0.003) with increasing biopsy scores. Preliminary results suggest that this echocardiographic parameter may prove useful in predicting biopsy results. (J Am Soc Echocardiogr 1997;10:526-31.)

In patients with combined mitral stenosis (MS) and aortic regurgitation (AR), the Doppler-determined mitral valve area (MVA) may be overestimated due to a shorter than expected pressure half-time. We performed Doppler echocardiography at baseline and after inhalation of amyl nitrite in 10 patients with combined MS and AR (Group I) and in five patients with MS alone (Group II). AR severity was reduced by amyl nitrite inhalation in all Group I patients, with a decrease in mean jet height/LVOT ratio from 32% to 21% (p< 0.01). Pressure half-time increased in Group I after amyl nitrite, with a mean reduction in the calculated MVA of 0.15 cm2(p< 0.01). Group II had no significant changes in pressure half-time or Doppler-determined MVA after amyl nitrite, whereas both groups had comparable increases in heart rate, mean transmitral velocity, and mean transmitral pressure gradient. In patients with combined MS and AR, we conclude that amyl nitrite significantly increases pressure half-time while reducing the severity of AR. These findings support earlier reports of MVA overestimation when pressure half-time is used in the presence of AR.

Flow propagation velocity is a new color Doppler M-mode measurement of left ventricular filling characteristics. This study was designed to establish normal values for this measurement in healthy individuals and to compare these findings with pulsed Doppler transmitral velocities. Complete M-mode, two-dimensional, and Doppler echocardiographic studies were performed on 64 volunteers between 21 and 79 years of age. Significant negative correlations (p< 0.001) with age were noted for flow propagation velocity (r= -0.59), peak early diastolic filling velocity (r= -0.65), and peak early diastolic filling/peak atrial filling ratio (r= -0.80). Positive correlations (p< 0.001) with age were observed for peak atrial filling velocity (r= 0.50) and atrial filling velocity integral (r= 0.71). Flow propagation velocity decreased by 44% between the youngest and oldest age groups. We conclude that flow propagation velocity is influenced by age and that it compares favorably with transmitral Doppler indices of left ventricular filling in this regard. These age-related alterations are present in healthy individuals, in the absence of any apparent cardiovascular disease. (J Am Soc Echocardiogr 1998;11:20-5.)

A Hipertensão Pulmonar (HP) é considerada geralmente uma contra-indicação para Biópsia Pulmonar por Broncoscopia (BPB) porque existe um grande risco de hemorragia.