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Query: UMLS:C0264733 (ventricular dilatation)
 2,163 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A series of 20 patients with pure and severe major aortic incompetence was studied, and three different groups were distinguished: group I, with no previous defect in function; group II, with cardiac failure as a result of aortic incompetence of more than 5 years' standing; group III, with cardiac failure secondary to acute aortic incompetence. The internal diameter of the left ventricle and the mode of closure of the mitral valve were studied by echocardiography, and compared with the clinical and haemodynamic findings. Left ventricular dilatation appeared early, and occurred to the same degree in the three groups. The diastolic diameter of the left ventricle showed a fairly close correlation (r equals 0.61) with the degree of regurgitation as measured from clour dilution curves; by contrast, the length of time the aortic incompetence had been present had little influence on the degree of dilatation of the left ventricle. Premature closure of the mitral valve was significantly associated with a raised LVEDP and a low systolic index; it represents a defect in the compliance of the left ventricle, and is a poor prognostic factor because of the clinical progression into very rapid and severe heart failure. Moreover, there is a distinct aetiological factor (Infective endocaditis) in the most marked forms of premature closure. The other ecocardiographic findings (appearances of the aorta, mitral echo, slope EF of the mitral valve) give no information on the degree of tolerance to the cardiac defect.
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PMID:[Echocardiographic study of the left ventricle in aortic insufficiency. Comparison with the data of clinical development and hemodynamic results]. 41 49

The dynamics of acute mitral regurgitation were studied in six open-chest dogs in whom a portion of the anterior leaflet was excised. Phasic mitral and aortic flows were measured electromagnetically and left ventricular filling volume, regurgitant volume (RV) and forward stroke volume (SV) were calculated. The systolic pressure gradient (SPG) between the left ventricle (LV) and left atrium (LA) was obtained from high-fidelity pressure transducers. The effective mitral regurgitant orifice area (MRA) was calculated from the hydraulic equation of Gorlin. Volume infusion resulted in significant increases in both left atrial and left ventricular pressures; thus, the SPG was unchanged and the increase in RV was due primarily to the increase in MRA. Angiotensin infused to raise arterial pressure resulted in greater increments in left ventricular than left atrial pressure, so that SPG rose significantly. The increase in RV was due to increases in both MRA and SPG. Norepinephrine infusion increased systolic left ventricular pressure and SPG, while left ventricular end-diastolic pressure and left atrial pressure diminished. Despite a significant increase in SPG, RV did not increase, due to a substantial decrease in MRA. Thus, angiotensin and volume infusion induced a substantial increase in regurgitation due to the increase in MRA, while augmentation of contractility after norepinephrine infusion resulted in a decrease in regurgitation through reduction of MRA. These findings support the clinical view that maintaining a small LV with sustained myocardial contractility will reduce mitral regurgitation. Alternatively, left ventricular dilatation can enhance mitral regurgitation by increasing the effective regurgitant orifice independent of SPG.
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PMID:Dynamic aspects of acute mitral regurgitation: effects of ventricular volume, pressure and contractility on the effective regurgitant orifice area. 44 20

Twenty-four patients with aortic valve disease were studied before and 19+/-12 months following valve replacement with a well functioning prosthesis. Biplane left ventricular angiography and pressures were utilized to determine end-diastolic volume/m2 (EDV), end-systolic volume/m2 (ESV), ejection fraction (EF), left ventricular mass/m2 (LVM) and stroke work (SW). There were nine patients with aortic stenosis (AS), ten patients with combined stenosis and regurgitation (AS-AR), and five patients with aortic regurgitation (AR). Following surgery, patients with regurgitation preoperatively showed marked regression in EDV and ESV. All groups demonstrated regression in LVM. Fifteen patients with a normal EF preoperatively (65+/-11%) had no change after surgery; the nine patients with a low EF before surgery (38+/-8%) had a normal EF after surgery (60+/-16%). We conclude that left ventricular dilatation, hypertrophy, and reduced left ventricular pump function are largely reversible after successful aortic valve replacement.
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PMID:Left ventricular function before and following aortic valve replacement. 92 63

A 76-year-old man was referred to our hospital with complaints of productive cough, dyspnea and peripheral cyanosis. The chest X-ray film indicated the pulmonary emphysema and acute bronchitis, but no abnormal intracardiac calcification. The electrocardiogram revealed a peaked P-wave, complete left bundle branch block, and ventricular premature contraction. Chest tomography demonstrated abnormal intracardiac calcium deposition in the right heart region. Two-dimensional echocardiography revealed the tricuspid annular calcification in the postero-lateral portion, showing a synchronous movement with tricuspid annular motion throughout the cardiac cycle. The size of calcification was 10 x 14 mm. The tricuspid valve showed no significant regurgitation. Left ventricular dilatation, associated with mild mitral regurgitation and impairment of systolic function (EF = 49%) was revealed by echocardiography. Serum examination revealed positive in Wassermann reaction. This case of tricuspid annular calcification might be caused by atherosclerotic degenerative change related to the aging process, or by an unknown mechanism related to pulmonary emphysema.
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PMID:[A case of tricuspid annular calcification]. 179 47

Using Tl-201 myocardial single photon emission computed tomography (SPECT), we tried to utilize the Tl-defects to determine the timing for aortic or mitral valve replacement in cases with chronic aortic (AR) or mitral regurgitation (MR), or both. Examinations including echocardiography and angiography were performed to evaluate left ventricular dilatation. Subjects consisted of 80 patients, including 22 with AR, 26 with MR, 17 with AR+MR, and 15 post-operative cases. The Tl-scores (sum of the grade of Tl-defects) correlated well with T wave abnormalities (V5) and NYHA functional class. The scores also correlated with left ventricular end-diastolic dimension (LVDd) and LV ejection fraction (LVEF), indicating that the LV wall defect progressed as the LV dimension increased with the increase in the volume load. Exercise Tl-201 myocardial SPECT revealed redistribution at an early stage of valvular regurgitation, indicating the development of LV wall damage in cases of LV enlargement due to regurgitation. Valve replacement caused a decrease in LVDd, with mild improvement in the Tl-score. We concluded that, in addition to the T wave changes and the echocardiographic measurements, Tl-201 myocardial SPECT should be included in the criteria for valve replacement.
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PMID:[Left ventricular wall damage as an indicator for valve replacement in patients with volume overload: a radionuclide study]. 184 51

We experienced four boys (two siblings) whose cardiac valves were all prolapsed, which have never been reported as a recognized disease. All had hyperextensive joints without any other stigmata of Marfan or Ehlers-Danlos syndrome. The severity and progression of regurgitation of each valve differed by a case, though they had similar echocardiographic findings consistent with the diagnosis of multiple floppy valves. Three of the four patients had severe aortic regurgitation, and two received aortic valve replacement. Their excised valves revealed myxomatous degeneration. The tricuspid valves were more thickened and redundant than the mitral valves. Although three patients had moderate tricuspid regurgitation, none of them had clinically important mitral regurgitation. We recommend aortic and/or mitral valve replacement, whenever the regurgitation exacerbates left ventricular dilatation. Aortic regurgitation deteriorated rapidly in one case due to valve rupture. In this case, moderate tricuspid regurgitation was relieved after aortic valve replacement. Skin fibroblast did not show any abnormalities in collagen biosynthesis.
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PMID:[Four boys with multiple floppy valves involving all cardiac valves and hyperextensive joints]. 188 61

This study clarified the clinical profile and echocardiographic findings of severe idiopathic tricuspid regurgitation (TR). Among 8,538 consecutive ultrasonic examinations, a total of 63 patients had severe TR, which was depicted by color flow mapping as a regurgitant signal more than 4 cm from the tricuspid valve orifice. Thirteen of the 63 patients had no underlying diseases, and these patients with severe idiopathic TR were the subjects of the present study. All 13 patients were over 66 years of age (mean 77.3 +/- 5.6 years old) and had had episodes of right heart failure which responded effectively to diuretics. All 13 patients had atrial fibrillation. Using two-dimensional echocardiography, thickening (77%), prolapse (69%) and malaligned coaptation (54%) of the tricuspid valves were observed. The tricuspid annular diameters, cross-sectional areas of the right and left atria and the right ventricular end-diastolic dimensions were significantly greater than those of the age-and-gender-matched lone atrial fibrillation group and the normal control group (p less than 0.01). The left ventricular dimension and ejection fraction did not differ from those of the matched lone atrial fibrillation group. Other valvular regurgitations were also detected (AR 77%, MR 100%, PR 69%), but the degrees of regurgitation were minimal. We proposed severe TR with tricuspid annular dilatation, right atrial and right ventricular dilatation observed in the aged as a distinct cardiac disease entity.
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PMID:[Clinical evaluation of severe idiopathic tricuspid regurgitation]. 213 28

A complex angiographic examination was performed in 28 patients with rheumatic aortic valvular disease. The major mechanism of compensation in aortic failure was found to be an increase in left ventricular end-diastolic volume at the expense of added regurgitating blood volume. It was shown that isolated aortic failure was a good compensated defect with high functional myocardial reserves and coronary circulation along with adequate left ventricular dilatation and normal-stress nature of left ventricular hypertrophy. Left ventricular dilation at a regurgitation fraction of less than 30% and intramyocardial tension increase were demonstrated to be unfavorable predictive signs and to be indicative of profound myocardial dysfunction.
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PMID:[Intracardiac mechanisms of compensation of isolated aortic insufficiency]. 215 56

Doppler echocardiography has become a very useful and widely employed imaging technique for evaluating valvular regurgitation, and has thus lead to the discovery of regurgitation in unexpected subjects. In this study, we examined left-sided valvular regurgitation in 31 healthy subjects, 35 patients with hypertension and 43 patients with old myocardial infarction by Doppler echocardiography. Aortic regurgitation was found in 3% of healthy subjects, 8% of hypertensive patients and 5% of patients with myocardial infarction. Mitral regurgitation was found in 35% of healthy subjects, 69% of hypertensive patients and 84% of patients with myocardial infarction. The pathogenesis of mitral regurgitation in hypertension is considered to be the impairment of the mitral leaflets, since neither anatomical nor functional abnormalities were found in the subvalvular mitral apparatus. Left ventricular dilatation and asynergy near the papillary muscles were related to the pathogenesis of mitral regurgitation in myocardial infarction. Mitral regurgitation in healthy subjects and hypertensive patients was mild and resistant to afterload stress, suggesting that it was less pathological. On the other hand, mitral regurgitation in myocardial infarction was easily worsened by afterload stress. Doppler echocardiography has thus provided us with new insights into valvular regurgitation in healthy subjects and patients without rheumatic valvular disease.
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PMID:Evaluation of left-sided valvular regurgitation in healthy, hypertensive and myocardial infarction subjects by Doppler echocardiography. 236 14

Since several methods based on doppler-echocardiography have been suggested to quantify aortic valve regurgitation, we compared two of these methods--left ventricular diastolic jet mapping and evaluation of blood flow in the descending aorta--with the results of left heart catheterization in 82 patients with aortic regurgitation. The invasive quantification rested on the degree of left ventricular opacification after contrast injection into the supra-sigmoid aorta, the results being classified into 3 grades. Left ventricular mapping was carried out using pulsed doppler ultrasound by the apical route; results were expressed as 3 grades of increasing severity. Blood flow in the aorta was recorded using pulsed doppler velocimetry by the suprasternal route at the level of the aortic isthmus where we measured the diastolic to systolic velocity integrals ratio (D/S). Apical mapping could be performed in 81 of the 82 patients, whereas suprasternal planimetry could be performed in only 56 patients (68 p. 100). Mapping provided good correlations with catheterization in 65 patients (80 p. 100); discordances were observed mainly in patients with aortic leakage due to prosthetic valve dysfunction (4/8 prosthetic valves) or with major left ventricular dilatation (found in 7 out of 9 cases of underestimation of leakage by the doppler system). The D/S ratio values obtained by the suprasternal route ranged from 16 to 28 p. 100 for mild angiographic leakage, from 34 to 66 p. 100 for moderate leakage, and from 52 to 155 p. 100 for severe leakage. "Borderline" values of 30 and 60 p. 100 respectively enabled the various degrees of aortic regurgitation to be separated. Despite their limitations, the non-invasive methods used in combination are effective in quantifying aortic regurgitation in most cases; mapping offers the advantage of simplicity: the suprasternal study is more accurate but cannot be performed in all patients.
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PMID:[Pulsed Doppler echography in the quantification of aortic insufficiency in adults]. 250 92


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