Munusamy, T (2007) Utility of Real Time three dimensional echocardiography in Balloon Mitral Valvuloplasty. Masters thesis, Madras Medical College, Chennai.
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Abstract
Mitral valve is much more complex than the semilunar valve. The mitral valve consists of six major anatomic components: The posterior left atrial wall, annulus, leaflet, chordae tendinae, papillary muscles and left ventricular free wall. The circumference of the normal mitral valve ranges from 8 to 10.5 cm (Mean 9.4). Mitral valve consists of two leaflets. The anterior leaflet has a much longer base to margin of closure width (2.3cm) than posterior leaflet (1.2cm), but the circumference (6cm) of the posterior leaflet (annular attachment) is about twice that of the anterior leaflet (3cm). The anterior leaflet is large and semicircular, and it partially separates the ventricular inflow and outflow tracts. However, unlike its right-sided counterpart, it also forms part of the outflow tract. The posterior mitral leaflet is rectangular and is usually divided into three scallops. The middle scallop is the largest of the three in more than 90 percent of normal hearts. Occasionally, however, either the anterolateral or the posteromedial scallop is larger, and rarely there are accessory scallops. Posterior mitral leaflet prolapse usually involves the middle scallop and may be associated with chordal rupture. Both mitral leaflets are normally similar in area. The anterior leaflet is twice the height of the posterior leaflet but has half its annular length. With advanced age, the mitral leaflets thicken somewhat, particularly along their closing edges. AIM OF THE STUDY: Three-dimensional echocardiography is a recently developed, evolving imaging technique that allows visualization of intra cardiac structures from any perspective. This study aims at utilizing real time three-dimensional transthoracic echocardiography (RT3DE) technique for comprehensive assessment of - cardiac anatomy, - cardiac pathophysiology, - pathomorphology, in patients with rheumatic mitral stenosis who underwent Balloon mitral valvotomy (BMV). CONCLUSIONS: 1. Three-dimensional echocardiographic reconstruction of the mitral valve obtained by transthoracic echocardiography during BMV is a new, noninvasive imaging technique that can more accurately visualize the mechanisms of successful BMV, as well as some of its complications. 2. This can potentially be used to further guide and optimize the results of BMV by visualizing the extent of commissural splitting so that a maximal mitral valve area can be obtained safely. It may also help to prevent the development of significant mitral regurgitation during the procedure. Visualizing a small tear of the mitral valve leaflet associated with only minimal valvular regurgitation may prevent another balloon inflation that may worsen the tear and create more significant mitral regurgitation. 3. Further improvements in the hardware and software of this echocardiographic system are needed to test this hypothesis so that larger studies transthoracic RT3DE is a feasible and accurate technique for measuring MVA in patients with Rheumatic mitral valve stenosis compared to the PHT method and 2D echo planimetry, RT3DE results have the best agreement with the invasively determined MVA, particularly in the immediate post-BMV period, where PHT is inaccurate.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Utility of Real Time three dimensional echocardiography in Balloon Mitral Valvuloplasty. |
| Subjects: | MEDICAL > Cardiology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 04 Jul 2017 03:49 |
| Last Modified: | 04 Jul 2017 03:49 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/865 |
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