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WOS: 000311649900004, Background: There are limited data that examine the assessment of subsegmental branches of the pulmonary artery by intravascular ultrasound (IVUS). Aim: To assess the structural characteristics of pulmonary arteries by IVUS in the setting of severe mitral stenosis. Material and methods: Twenty-one consecutive patients (3 men and 18 women; mean age: 38 11 years) who were selected for percutaneous mitral balloon valvuloplasty entered the study. Subsegmental branches of the right lower lobe pulmonary artery were imaged by 40 MHz IVUS when the patients underwent right heart catheterization. Minimal lumen diameter (MLD), external elastic membrane diameter (EEMD), lumen area (LA), and area circumscribed by the external elastic membrane (the total vessel area - TVA) were measured. From these measurements, wall area (WA = TVA - LA), intima-media wall thickness [IMT = (EEMD - MLD)/2], relative wall thickness (RWT = IMT/EEMD), and relative wall area (RWA = WA/TVA) were derived. Results: We were able to perform the IVUS examination in all patients without complications. Several IVUS anatomic indexes correlated with hemodynamic data. Pulmonary artery IMT, RWT, and RWA correlated significantly with pulmonary artery systolic pressure (r = 0.763, p = 0.002; r = 0.698, p = 0.001; r = 0.717, p = 0.006, respectively). However, there was no significant correlation between ultrasound measurements and echocardiographic parameters of the mitral valve. Conclusions: The subsegmental branches of the pulmonary artery can be assessed by IVUS. Patients with pulmonary hypertension in the setting of mitral stenosis have greater pulmonary arterial WT. The severity of WT is correlated with pulmonary artery pressure, but it is not associated with mitral valve area. Intravascular ultrasound may provide useful additional information in the management of patients with mitral stenosis.

WOS: 000295570200003, Background: Conventional echocardiographic methods have already shown that successful mitral balloon valvuloplasty (MBV) can effectively increase left atrial (LA) functions. Aim: To evaluate LA functions after MBV using colour tissue Doppler imaging. Material and methods: Sixty-eight patients (58 females, mean age: 38 +/- 12 years) were included in the study. Within 24 h before MBV, all the patients underwent colour tissue Doppler study in addition to routine conventional echocardiographic examinations. Late diastolic velocities (A') measured at the LA wall adjacent to the septal and lateral annuli were recorded. All the measurements were repeated 24 h after MBV. The MBV was done using the Inoue technique. Successful MBV patients were included in group A and those who developed severe mitral regurgitation (MR) were included in group B. Results: Sixty-one patients underwent successful MBV while 7 developed MR. Mitral valve areas (MVA) in both groups were significantly increased. Maximum and mean gradients, LA diameter, systolic pulmonary arterial pressure and mean LA pressures were decreased while septal and lateral A' were significantly increased in group A. In group B, no significant change in any variable was found except for the increase in MVA Conclusions: After successful MBV, increase in A' velocity was seen in parallel to the recovery of LA functions. Early improvements in left atrial systolic functions after successful MBV can easily be determined by colour tissue Doppler as a quick and reliable method.

We report a case of aorta-right ventricular fistula associated with aortic and mitral valve replacements. We considered it as a para valvular leakage. Aorta-right ventricular fistula is a very rare variant of paravalvular leakage. We discuss the aetiology, diagnosis, and preventive and therapeutic options in the modern era.