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This study used cardiovascular magnetic resonance (CMR) to evaluate whether elevated extracellular volume (ECV) was associated with mitral valve prolapse (MVP) or if elevated ECV was a consequence of remodeling independent of primary mitral regurgitation (MR) etiology.Replacement fibrosis in primary MR is more prevalent in MVP; however, data on ECV as a surrogate for diffuse interstitial fibrosis in primary MR are limited.Patients with chronic primary MR underwent comprehensive CMR phenotyping and were stratified into an MVP cohort (2 mm leaflet displacement on a 3-chamber cine CMR) and a non-MVP cohort. Factors associated with ECV and replacement fibrosis were assessed. The association of ECV and symptoms related to MR and clinical events (mitral surgery and cardiovascular death) was ascertained.A total of 424 patients with primary MR (229 with MVP and 195 non-MVP) were enrolled. Replacement fibrosis was more prevalent in the MVP cohort (34.1% vs. 6.7%; p 0.001), with bi-leaflet MVP having the strongest association with replacement fibrosis (odds ratio: 10.5; p 0.001). ECV increased with MR severity in a similar fashion for both MVP and non-MVP cohorts and was associated with MR severity but not MVP on multivariable analysis. Elevated ECV was independently associated with symptoms related to MR and clinical events.Although replacement fibrosis was more prevalent in MVP, diffuse interstitial fibrosis as inferred by ECV was associated with MR severity, regardless of primary MR etiology. ECV was independently associated with symptoms related to MR and clinical events. (DeBakey Cardiovascular Magnetic Resonance Study [DEBAKEY-CMR]; NCT04281823).

Background Radiofrequency ablation at the region of the sinus of Valsalva carries a risk to the ostia of the coronary arteries. Coronary angiography is usually utilized to document a safe distance for mapping and ablation. Objective To show that catheter ablation in the aortic root could be guided by phased-array intra cardiac echocardiography (ICE) and electro anatomic mapping without the need for coronary angiography. Methods We reviewed all patients referred to our lab that underwent mapping and/or ablation in the sinus of Valsalva region. Procedures were carried out by operators that are skilled in the use of ICE. The need for angiography was documented, also the rate of success along with the immediate and 30-day complications rate. Results Seventy patients (average age 48.7 ± 13.8 years; 64.3% males) were referred for ablation of ventricular and atrial arrhythmias. PVC constituted 95.7% of the cases. All patients underwent mapping and/or ablation at the sinus of Valsalva region without the need for coronary angiography to visualize the coronary ostia. Acute and effective ablation was achieved in 57 out of 70 (81.4%) patients partially effective ablation was achieved in 10 (14.3%) patients, and failure to ablate in the remaining 3 patients (4.3%). There was no occurrence of any adverse events, neither immediately or at day 30 after the procedure. Conclusion In the hands of experienced operators, mapping and radiofrequency ablation in the sinus of Valsalva can be safely and reliably performed using intracardiac echocardiography alone without the need for supplementary catheter coronary angiography.

Objectives The authors sought to define the feasibility and performance of 3-dimensional (3D) vena contracta area (VCA) measurement in evaluating total residual mitral regurgitation (MR) following percutaneous edge-to-edge clip (E-EC) mitral valve repair. Background Residual MR severity after percutaneous repair is not only a determinant of procedural success, but also a major prognostic factor. To date, no single echocardiographic method has been recommended for post-procedural MR quantification, with the evaluation currently relying on a complex, multiparametric appraisal. Method The authors performed a retrospective study of patients undergoing the E-EC procedure, for which baseline and post-repair 3D color Doppler transesophageal echocardiogram datasets were available. Total VCA was recorded as the sum of individual VCAs (if more than 1) and compared with an expert multiparametric appraisal of MR severity as the reference standard. Receiver-operating characteristic analysis was performed. Results 155 patient studies were available for review. Total VCA correlated with hemodynamic parameters and was significantly reduced after E-EC. Receiver-operating characteristic analysis demonstrated a VCA threshold of 0.27 cm2 for identification of ≥moderate MR, with good diagnostic accuracy (area under the curve 0.81) and a negative predictive value of 92%. Smaller VCA was associated with clinical New York Heart Association functional class improvement at 30-day follow-up. Conclusions Measurement of VCA is feasible using 3D color Doppler transesophageal echocardiography and provides reliable quantification of MR following E-EC transcatheter mitral valve repair.

Background: The aim of our study was to evaluate the acute feasibility and short-term efficacy of mitral valve repair using the MitraClip device in patients with prior surgical repair. Mitral regur...

Graphical abstract, Highlights • There have been concerns regarding MitraClip interference with the subvalvular apparatus. • Noncentral MR can be successfully treated using a transcatheter approach. • Transcatheter edge-to-edge repair with the MitraClip can be used in noncentral MR.

Mitral regurgitation (MR) is a major cause of cardiovascular morbidity and mortality. MR is classified as primary (organic) if it is due to an intrinsic valve abnormality, or secondary (functional) if the etiology is because of remodeling of left ventricular geometry and/or valve annulus. Transthoracic echocardiography (TTE) is the initial modality for MR evaluation. Parameters used for the assessment of MR include valve structure, cardiac remodeling, and color and spectral Doppler. Quantitative measurements include effective regurgitant orifice area, regurgitant volume, and regurgitant fraction. Knowledge of advantages and limitations of echo-Doppler parameters is essential for accurate results. An integrative approach is recommended in overall grading of MR as mild, moderate, or severe since singular parameters may be affected by several factors. When the mechanism and/or grade of MR is unclear from the TTE or is discrepant with the clinical scenario, further evaluation with transesophageal echocardiography or cardiac magnetic resonance imaging is recommended, the latter emerging as a powerful MR quantitation tool.

Background: Assessment of left ventricular (LV) filling pressure is among the important components of a comprehensive echocardiographic report. Previous studies noted wide limits of agreement using 2009 American Society of Echocardiography/European Association of Echocardiography guidelines, but reproducibility of 2016 guidelines update in estimating LV filling pressure is unknown. Methods: Echocardiographic and hemodynamic data were obtained from 50 patients undergoing cardiac catheterization for clinical indications. Clinical and echocardiographic findings but not invasive hemodynamics were provided to 4 groups of observers, including experienced echocardiographers and cardiology fellows. Invasively acquired LV filling pressure was the gold standard. Results: In group I of 8 experienced echocardiographers from the guidelines writing committee, sensitivity for elevated LV filling pressure was 92% for all observers, and specificity was 93±6%. Fleiss κ-value for the agreement in group I was 0.80. In group II of 4 fellows in training, sensitivity was 91±2%, and specificity was 95±2%. Fleiss κ-value for the agreement in group II was 0.94. In group III of 9 experienced echocardiographers who had not participated in drafting the guidelines, sensitivity was 88±5%, and specificity was 91±7%. Fleiss κ-value for the agreement in group III was 0.76. In group IV of 7 other fellows, sensitivity was 91±3%, and specificity was 92±5%. Fleiss κ-value for the agreement in group IV was 0.89. Conclusions: There is a good level of agreement and accuracy in the estimation of LV filling pressure using the American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 recommendations update, irrespective of the experience level of the observer.

Barlow's disease is characterized by large prolapsing leaflets that can harbor significant amount of blood - prolapse volume (PV) - at end-systole. Barlow's left ventricles (LV) can be disproportionately enlarged relative to the severity of mitral regurgitation (MR), leading to speculation of a

Cardiac amyloidosis is an infiltrative cardiomyopathy with high morbidity and mortality. A 69 year-old lady presented with exertional dyspnea, light headedness, lower extremity swelling, & 20-pound weight gain over six months. Trans-thoracic echocardiography with provocation maneuver showed dynamic

Few data exist on mitral valve (MV) deformation during systole in humans. 3D echocardiography allows for dynamic MV imaging, enabling digital modeling of MV function in health and disease. 3D transesophageal echocardiography was performed in 32 patients with normal MV, and 48 with mitral valve

Secondary mitral regurgitation (MR) is mostly attributed to left ventricular (LV) remodeling and enlargement. The atrial chamber on the other side of the annulus can, however, play a similar role in causing MR. A 68-year-old male recently presented to our hospital for evaluation and possible repair

Percutaneous treatment of tricuspid regurgitation using devices such as the MitraClip (Abbott) remains technically challenging. We sought to 3D print patient-specific right ventricle (RV) and tricuspid valve (TV) geometry, reconstructed from CT images, to assess the potential utility of such models

Coronary computed tomography angiography (CCTA) has many advantages over invasive coronary angiography. It allows the detection of anomalous vessels and their relationship to heart structures. Dual left anterior descending coronary artery (LAD) anomaly is defined by the presence of two LADs. It is categorized on the basis of a long and short LAD. We present a novel type in which one long LAD branches from the right coronary artery (RCA) and the other LAD, a long vessel as well, branches from the left main coronary artery (LMCA). They course in parallel to terminate at the apex. This pattern defies the current short-long classification. We suggest it to be a novel pattern.