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Introduction: Mitral stenosis (MS) causes structural and functional abnormalitiesof the left atrium (LA) and left atrial appendage (LAA), and studies show that LAA performance improves within a short time after percutaneous transvenous mitral commissurotomy (PTMC). This study aimed to investigate the effects of PTMC on leftatrial function by transesophageal echocardiography (TEE).Methods: We enrolled 56 patients with severe mitral stenosis (valve area less than1.5 CM2). All participants underwent mitral valvuloplasty; they also underwenttransesophageal echocardiography before and at least one month after PTMC.Results: Underlying heart rhythm was sinus rhythm (SR) in 28 patients and atrialfibrillation (AF) in remainder 28 cases. There was no significant change in the leftventricular ejection fraction (LVEF), left ventricular end diastolic dimension (LVEDD),or the left ventricular end systolic dimension (LVESD) before and after PTMC in bothgroups. However, both groups showed a significant decrease in the left atrial volumeindex (LAVI) following PTMC (P=0.032 in SR and P=0.015 in AF group). LAA ejectionfraction (LAAEF) and the LAA emptying velocity (LAAEV) were improved significantlyafter PTMC in both groups with SR and AF (P

Background: To quantify valvular morphological assessment, some two-dimensional (2D) and three-dimensional (3D) scoring systems have been developed to target the patients for balloon mitral valvuloplasty; however, each scoring system has some potential limitations. To achieve the best scoring system with the most features and the least restrictions, it is necessary to check the degree of overlap of these systems. Also the factors related to the accuracy of these systems should be studied. We aimed to determine the correlation between the 2D Wilkins and real-time transesophageal three-dimensional (RT3D-TEE) scoring systems. Methods: This cross-sectional study was performed on 156 patients with moderate to severe mitral stenosis who were candidates for percutaneous balloon valvuloplasty. To morphologic assessment of mitral valve, patients were examined by 2D-transthoracic echocardiography and RT3D-TEE techniques on the same day. Results: A strong association was found between total Wilkins and total RT3D-TEE scores (r = 0.809, p < 0.001). The mean mitral valve area assessed by the 2D and 3D was 1.07 ± 0.25 and 1.03 ± 0.26, respectively, indicating a mean difference of 0.037 cm2 (p = 0.001). We found a strong correlation between the values of mitral valve area assessed by 2D and 3D techniques (r = 0.846, p < 0.001). Conclusion: There is a high correlation between the two scoring systems in terms of evaluating dominant morphological features. Partially, mitral valve area overestimation in the 2D-transthoracic echocardiography and its inability to assess commissural involvement as well as its dependence on patient age were exceptions in this study. [ABSTRACT FROM AUTHOR]

Myxomas are rare cardiac neoplasms and may present as single or multiple tumors. Only a few cases of single biatrial myxomas have been reported. We report a very rare case of this condition in a middle-aged woman, presenting with exertional dyspnea and cough. The patient had a resting tachycardia of 105 beats per minute, and cardiac auscultation discovered a mid-diastolic murmur across the mitral valve, followed by a tumor plop focused on the apex and elevated levels of C-reactive protein (1+) and creatine phosphokinase in lab data. The diagnosis was made via transesophageal and transthoracic echocardiographic examinations, showing the tumor extension through a patent foramen ovale (PFO). The operation was undertaken, the myxoma was excised, and the PFO was repaired. She was discharged with no further complications. Although myxomas are rare, considering this condition before surgery is significant. The involvement of both atria via a PFO is possible. [ABSTRACT FROM AUTHOR]

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Background: Echocardiographic evaluations of the longitudinal axis of the left ventricular (LV) function have been used in the diagnosis and assessment of heart failure with normal ejection fraction (HFNEF). The evaluation of the global and segmental peak systolic longitudinal strains (PSLSs) by two-dimensional speckle tracking echocardiography (STE) may correlate with conventional echocardiography findings. We aimed to use STE to evaluate the longitudinal function of the LV in patients with HFNEF. Methods: In this study, 126 patients with HFNEF and diastolic dysfunction and 60 normal subjects on conventional echocardiography underwent STE evaluations, including LV end-diastolic and end-systolic dimensions; interventricular septal thickness; posterior wall thickness; LV volume; LV ejection fraction; left atrial volume index; early diastolic peak flow velocity (E); late diastolic peak flow velocity (A); E/A ratio; deceleration time of E; early diastolic myocardial velocity (e′); late diastolic myocardial velocity (A′); systolic myocardial velocity (S); and global, basal, mid, and apical PSLSs. The correlations between these methods were assessed. Results: The mean age was 57.50 ± 10.07 years in the HFNEF patients and 54.90 ± 7.17 years in the control group. The HFNEF group comprised 69.8% males and 30.2% females, and the normal group consisted of 70% males and 30% females. The global, basal, mid, and apical PSLSs were significantly lower in the HFNEF group (p value < 0.001 for all). There was a significant positive correlation between the global PSLS and the septal e’ (p value < 0.001). There was a negative correlation between the global PSLS and the E/e’ ratio (p value = 0.001). There was a significant negative correlation between the E/e’ ratio and the mid PSLS (p value = 0.002) and the basal PSLS (p value = 0.001). There was a weak positive correlation between the septal e’ and the mid PSLS (p value = 0.001) and the basal PSLS (p value < 0.001). There were also weak negative correlations between the isovolumic relaxation time and the global PSLS (p value = 0.022) and the mid PSLS (p value = 0.018) and also between the New York Heart Association functional class and the mid PSLS (p value = 0.041) and the basal PSLS (p value = 0.009). Conclusion: Our HFNEF patients on conventional echocardiography had different STE findings compared to our normal subjects, which is indicative of diastolic dysfunction. The longitudinal systolic function of the LV, which was measured by STE, was reduced in all the segments, denoting some degree of subclinical systolic dysfunction in these patients. [ABSTRACT FROM AUTHOR]

Background: Percutaneous balloon mitral valvotomy (BMV) is the gold standard treatment for rheumatic mitral stenosis (MS) in that it causes significant changes in mitral valve area (MVA) and improves leaflet mobility. Development of or increase in mitral regurgitation (MR) is common after BMV. This study evaluated MR severity and its changes after BMV in Iranian patients. Methods: We prospectively evaluated consecutive patients with severe rheumatic MS undergoing BMV using the Inoue balloon technique between February 2010 and January 2013 in Madani Heart Center, Tabriz, Iran. New York Heart Association (NYHA) functional class and echocardiographic and catheterization data, including MVA, mitral valve mean and peak gradient (MVPG and MVMG), left atrial (LA) pressure, pulmonary artery systolic pressure (PAPs), and MR severity before and after BMV, were evaluated. Results: Totally, 105 patients (80% female) at a mean age of 45.81 ± 13.37 years were enrolled. NYHA class was significantly improved after BMV: 55.2% of the patients were in NYHA functional class III before BMV compared to 36.2% after the procedure (p value < 0.001). MVA significantly increased (mean area = 0.64 ± 0.29 cm² before BMV vs. 1.90 ± 0.22 cm² after BMV; p value < 0.001) and PAPs, LA pressure, MVPG, and MVMG significantly decreased. MR severity did not change in 82 (78.1%) patients, but it increased in 18 (17.1%) and decreased in 5 (4.8%) patients. Patients with increased MR had a significantly higher calcification score (2.03 ± 0.53 vs. 1.50 ± 0.51; p value < 0.001) and lower MVA before BMV (0.81 ± 0.23 vs. 0.94 ± 0.18; p value = 0.010). There were no major complications. Conclusion: In our study, BMV had excellent immediate hemodynamic and clinical results inasmuch as MR severity increased only in some patients and, interestingly, decreased in a few. Our results, underscore BMV ejficacy in severe MS. The echocardiographic calcification score was useful for identifying patients likely to have MR development or MR increase after BMV. [ABSTRACT FROM AUTHOR]

Background: Echocardiographic evaluations of the longitudinal axis of the left ventricular (LV) function have been used in the diagnosis and assessment of heart failure with normal ejection fraction (HFNEF). The evaluation of the global and segmental peak systolic longitudinal strains (PSLSs) by two-dimensional speckle tracking echocardiography (STE) may correlate with conventional echocardiography findings. We aimed to use STE to evaluate the longitudinal function of the LV in patients with HFNEF., Methods: In this study, 126 patients with HFNEF and diastolic dysfunction and 60 normal subjects on conventional echocardiography underwent STE evaluations, including LV end-diastolic and end-systolic dimensions; interventricular septal thickness; posterior wall thickness; LV volume; LV ejection fraction; left atrial volume index; early diastolic peak flow velocity (𝐸); late diastolic peak flow velocity (𝐴); 𝐸/𝐴 ratio; deceleration time of 𝐸; early diastolic myocardial velocity (e'); late diastolic myocardial velocity (A'); systolic myocardial velocity (S); and global, basal, mid, and apical PSLSs. The correlations between these methods were assessed., Results: The mean age was 57.50 ± 10.07 years in the HFNEF patients and 54.90 ± 7.17 years in the control group. The HFNEF group comprised 69.8% males and 30.2% females, and the normal group consisted of 70% males and 30% females. The global, basal, mid, and apical PSLSs were significantly lower in the HFNEF group (p value < 0.001 for all). There was a significant positive correlation between the global PSLS and the septal e' (p value < 0.001). There was a negative correlation between the global PSLS and the E/e' ratio (p value = 0.001). There was a significant negative correlation between the E/e' ratio and the mid PSLS (p value = 0.002) and the basal PSLS (p value = 0.001). There was a weak positive correlation between the septal e' and the mid PSLS (p value = 0.001) and the basal PSLS (p value < 0.001). There were also weak negative correlations between the isovolumic relaxation time and the global PSLS (p value = 0.022) and the mid PSLS (p value = 0.018) and also between the New York Heart Association functional class and the mid PSLS (p value = 0.041) and the basal PSLS (p value = 0.009)., Conclusion: Our HFNEF patients on conventional echocardiography had different STE findings compared to our normal subjects, which is indicative of diastolic dysfunction. The longitudinal systolic function of the LV, which was measured by STE, was reduced in all the segments, denoting some degree of subclinical systolic dysfunction in these patients.