**5. References**

22 Echocardiography – In Specific Diseases

issue may appear. This should also be clearly pointed out by the post-pump echocardiographic examination. In this case, further surgery for the mitral valve might not

The main problem with residual mitral regurgitation arises in patients with moderate insufficiency. In loose teams, the surgeon tends to underestimates the importance of the mitral regurgitation. Because the echocardiography is a semi quantitative method, in every day practice the surgeon will go easier to the second run pump only if the echocardiographer was able to 100% accurately identify the preoperative lesions, compared to the intraoperative findings. Therefore, an excellent preoperative assessment will bond the team, creating a trustful relationship between the surgeon and the echocardiographer.

The evaluation of the outcome after mitral repair has been done mainly using the Colour Doppler mapping. When the residual regurgitation is absent or of mild degree, the result is judged as adequate. Generally, superior degrees of residual regurgitation, naturally correlated with the coaptation and geometrical analysis, indicate the need for a second pump run. In selected cases (e.g. old patients or significant comorbidities), moderate or more than moderate residual regurgitation might be accepted when the risk of a second pump run to correct the valvular problem exceeds the potential benefit for the patient.

The annuloplasty ring is used in almost all operated patients. From an echocardiographic technical perspective this might determine difficulties in the postoperative evaluation of the repaired mitral valve when performing the distal esophageal long axis views. Usually, the presence of the annuloplasty ring might 'hide' the mitral valve leaflets by posterior shadowing immediately after surgery. To overcome this problem a valid solution could be

The standardization of the preoperative, intraoperative and postoperative echocardiographic examination is crucial for the skilled dialogue with the surgical team and for the results. As the surgery of degenerative mitral insufficiency is somehow standardised, echocardiography should also be as standardised as possible. The use of a specific pattern of lesion confers better and tailored surgical planning, adapted to each given case. Use of different types of patterns such as mitral valve flail, undulating valve or marginal prolapse

Alongside specific patterns of lesions, a crucial point in surgical repair is the evaluation of the mitral geometry. Apart from the three dimensional echo, the main tool in assessing the

The echocardiographer must consider the mitral valve as an eight-element anatomical structure, and separately assess each segment. The preoperative exam has to be done based on a structural echocardiographic algorithm and finally expressed as a prolapsing score.

In dedicated centres, the mitral valve repair for degenerative disease is possible with more than 95% rate of success. The use of the triangle of coaptation, coaptation length and

the evaluation from the deep transgastric short-axis and long axis views.

mitral valve geometry by 2 D echocardiography, is the coaptation triangle.

By using this strategy, the mitral valve repair is feasible, with excellent results.

be needed, but only ventricular assistance.

**3. Conclusion** 

facilitates the dialog with the surgeon.


**2** 

Gani Bajraktari

*Republic of Kosovo* 

**Echocardiography in Severe Aortic Stenosis** 

Aortic stenosis (AS) is the most frequent valvular heart disease in west developed and developing countries, with prevalence between 0.02% in adults under 44 years and 3-9% in elderly over 80 years. Patients with this disease may remain asymptomatic for years, particularly in elderly with naturally limited exercise. If the patients remain untreated after they become symptomatic, the mortality at 10 years follow-up is 80-90%. Based on the etiology, mainly are three types of AS: 1) Calcific AS, which is most frequent type in adults of advanced age (2–7% of the population), 2) Congenital, which dominates in the younger

Patient history and physical examination remain important in the diagnosis of AS. For the proper patient management, the evidence of the symptoms characteristic for AS: exertional shortness of breath, angina, dizziness, or syncope. Further diagnostic right direction is

Aortic valve replacement (AVR) is the only effective treatment for severe aortic AS. It is performed either isolated or concomitantly with coronary artery by-pass graft operation, which take place in almost 50% of patients with AS. The overall mortality of isolated AVR is 3-5% in patients below 70 years and 5-15% in elderly. After successful AVR, symptoms and quality of live improves significantly. The long term 10 years survival after successful AVR is very satisfied and it resulted till 75%. The most important factors that may affect the survival are old age, high NYHA functional class, associated aortic regurgitation,

Echocardiography is the key diagnostic tool, not only to confirm the presence of AS, but also to assesses the degree of valve calcification, LV function and wall thickness. Today,

The severity of AS is provided with a very high sensitivity and specificity by Doppler echocardiography. A valve area 1.0 cm2 in a patient with AS is considered severe. The indexing of aortic valve area to body surface area is more powerful parameter, and a cut-off value of 0.6 cm2/m2 is considered severe AS. However, valve area detected by Doppler

patients, and 3) Rheumatic AS, which is becoming rare in developed countries.

The disappearance of the second aortic sound is specific to severe AS.

concomitant coronary aortic by-pass graft and atrial fibrillation.

echocardiography provides prognostic information in patients with AS.

**2. Echocardiography in aortic stenosis patients** 

**1. Introduction** 

characteristic systolic murmur.

*Service of Cardiology, University Clinical Centre of Kosova, Prishtina* 

