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Fesharaki MJ, Akbari T, Bayat F, Ghadirzadeh E, Charkazi E. The importance of intraoperative echocardiography in the early detection of mitral regurgitation as a postsurgical sequel of aortic valve replacement: a case report. J Med Case Rep 2023; 17:474. [PMID: 37907935 PMCID: PMC10619244 DOI: 10.1186/s13256-023-04176-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/11/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Mitral leaflet perforation (MLP) can rarely be a consequence of aortic valve replacement (AVR), resulting in mitral regurgitation (MR). Determining the cause and severity of MLP following AVR is crucial in preventing hemodynamic consequences, such as pulmonary hypertension and biventricular remodeling. However, the diagnosis of this rare complication requires detailed echocardiographic evaluations. CASE PRESENTATION In this paper, we report a 37-year-old Persian male with progressive dyspnea on exertion diagnosed with severe MR caused by anterior MLP following AVR and discuss the importance of intraoperative transesophageal echocardiography (TEE) in the proper and on-time diagnosis of this rare complication. CONCLUSION During AVR procedure, an evaluation with TEE could be beneficial for identifying and treating such condition. Echocardiography is beneficial in providing real-time guidance during surgery, early detection of potential complications, treatment of such complications if present, and prevention of adverse outcomes.
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Affiliation(s)
- Mehrdad Jafari Fesharaki
- Fellowship of Echocardiography, Department of Cardiology, School of Medicine, Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tooba Akbari
- Fellowship of Echocardiography, Department of Cardiology, School of Medicine, Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fariba Bayat
- Fellowship of Echocardiography, Department of Cardiology, School of Medicine, Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Ghadirzadeh
- Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Shekel E, Shuvy M, Danenberg H, Planer D, Gilon D, Leibowitz D, Beeri R. Mitral Regurgitation Severity Assessment after Transcutaneous Edge-to-Edge Mitral Valve Repair: Recommended Integration versus Volumetric Assessment Guidelines. J Clin Med 2023; 12:6347. [PMID: 37834991 PMCID: PMC10573124 DOI: 10.3390/jcm12196347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/30/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
Objectives: This article aims to evaluate the accuracy of the color-Doppler-based technique to evaluate residual mitral regurgitation post TEER. Background: The evaluation of residual mitral regurgitation (MR) post-mitral transcutaneous edge-to-edge repair (mitral TEER) is a critical determinant in patients' outcomes. The common methods used today, based on the integration of color flow Doppler parameters, may be misleading because of the multiple jets and high velocities created by the TEER devices. Methods: Patients undergoing TEER at Hadassah hospital were recruited between 2015 and 2019. Post-procedural MR was evaluated using the integrated qualitative approach as recommended by the guidelines. In addition, the MR volume for each patient was calculated by subtracting the forward stroke volume (calculated by multiplying the LVOT area with the velocity time integral of the LVOT systolic flow) from the total stroke volume (calculated by the biplane Simpson method of discs). We compared the two methods for concordance. Results: Overall, 112 cases were enrolled. In 55.4% of cases, the volumetric residual MR was milder than the MR severity assessed by the guidelines' recommended method. In 25.1%, the MR severity was similar in both methods. In 16.2%, the MR severity was worse when calculated using the volumetric method (pValue < 0.001, Kappameasure of agreement = 0.053). The lower residual MR degree using the volumetric approach was mostly observed in patients classified as "moderate" by the integrated approach. Conclusions: MR severity after TEER is often overestimated by the guideline-recommended integrative method when compared with a volumetric method. Alternative methods should be considered to assess the MR severity after mitral TEER.
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Affiliation(s)
- Efrat Shekel
- Heart Institute, Hadassah University Medical Center, Jerusalem 9112001, Israel (D.P.); (D.G.); (D.L.)
| | - Mony Shuvy
- Cardiology Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel;
| | - Haim Danenberg
- Heart Center, Wolfson Medical Center, Holon 5822012, Israel;
| | - David Planer
- Heart Institute, Hadassah University Medical Center, Jerusalem 9112001, Israel (D.P.); (D.G.); (D.L.)
| | - Dan Gilon
- Heart Institute, Hadassah University Medical Center, Jerusalem 9112001, Israel (D.P.); (D.G.); (D.L.)
| | - David Leibowitz
- Heart Institute, Hadassah University Medical Center, Jerusalem 9112001, Israel (D.P.); (D.G.); (D.L.)
| | - Ronen Beeri
- Heart Institute, Hadassah University Medical Center, Jerusalem 9112001, Israel (D.P.); (D.G.); (D.L.)
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3
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Altes A, Vermes E, Levy F, Vancraeynest D, Pasquet A, Vincentelli A, Gerber BL, Tribouilloy C, Maréchaux S. Quantification of primary mitral regurgitation by echocardiography: A practical appraisal. Front Cardiovasc Med 2023; 10:1107724. [PMID: 36970355 PMCID: PMC10036770 DOI: 10.3389/fcvm.2023.1107724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
The accurate quantification of primary mitral regurgitation (MR) and its consequences on cardiac remodeling is of paramount importance to determine the best timing for surgery in these patients. The recommended echocardiographic grading of primary MR severity relies on an integrated multiparametric approach. It is expected that the large number of echocardiographic parameters collected would offer the possibility to check the measured values regarding their congruence in order to conclude reliably on MR severity. However, the use of multiple parameters to grade MR can result in potential discrepancies between one or more of them. Importantly, many factors beyond MR severity impact the values obtained for these parameters including technical settings, anatomic and hemodynamic considerations, patient's characteristics and echocardiographer' skills. Hence, clinicians involved in valvular diseases should be well aware of the respective strengths and pitfalls of each of MR grading methods by echocardiography. Recent literature highlighted the need for a reappraisal of the severity of primary MR from a hemodynamic perspective. The estimation of MR regurgitation fraction by indirect quantitative methods, whenever possible, should be central when grading the severity of these patients. The assessment of the MR effective regurgitant orifice area by the proximal flow convergence method should be used in a semi-quantitative manner. Furthermore, it is crucial to acknowledge specific clinical situations in MR at risk of misevaluation when grading severity such as late-systolic MR, bi-leaflet prolapse with multiple jets or extensive leak, wall-constrained eccentric jet or in older patients with complex MR mechanism. Finally, it is debatable whether the 4-grades classification of MR severity would be still relevant nowadays, since the indication for mitral valve (MV) surgery is discussed in clinical practice for patients with 3+ and 4+ primary MR based on symptoms, specific markers of adverse outcome and MV repair probability. Primary MR grading should be seen as a continuum integrating both quantification of MR and its consequences, even for patients with presumed “moderate” MR.
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Affiliation(s)
- Alexandre Altes
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | | | - Franck Levy
- Department of Cardiology, Center Cardio-Thoracique de Monaco, Monaco, Monaco
| | - David Vancraeynest
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Agnès Pasquet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - André Vincentelli
- Cardiac Surgery Department, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Bernhard L. Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | | | - Sylvestre Maréchaux
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
- Correspondence: Sylvestre Maréchaux
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4
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Power JE, Reiff C, Tsangaris A, Hall A, Raveendran G, Yannopoulos D, Gurevich S. Invasive hemodynamics are equivocal for functional outcomes after MitraClip. Health Sci Rep 2022; 5:e471. [PMID: 35036576 PMCID: PMC8753491 DOI: 10.1002/hsr2.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/07/2021] [Accepted: 11/24/2021] [Indexed: 11/08/2022] Open
Abstract
Objectives To evaluate invasive hemodynamics in assessing MC therapy success as well as evaluate its effectiveness as a predictor of functional outcomes. Background Mitral regurgitation grade is a poor predictor of functional outcomes after a MitraClip. There is a paucity of data on invasive hemodynamics as a predictor of outcomes. Methods Sixty-nine patients underwent MC between 2015 and 2018 at the University of Minnesota Medical Center and were retrospectively analyzed. Invasive hemodynamics were performed before and after device deployment with transesophageal echocardiographic guidance. Statistical analysis was performed using STATA version 16. Student's t test was used for continuous variables and Pearson's chi-squared test for categorical variables. Mann-Whitney test was performed for continuous variables where data were not normally distributed. Logistic and linear regression were used to investigate relationships between variables and outcomes. Results A total of 69 patients were included in the study. The mean age was 83 (75-87) years and 38 (55%) were male. Eighty-one percentage had >/= NYHA III symptoms. Eighty-seven percentage had severe MR. Pulmonary capillary wedge pressure was 20 (15-24). Overall, there was significant improvement in left atrial pressure including mean left atrial pressure index, MR, and NYHA class after MC (<.001). There was no significant association between invasive hemodynamics (including left atrial mean pressure index or its reduction rate) and functional outcomes (p = NS). MR grade was also not predictive of functional outcomes. Conclusion Left atrial pressure may not be a significant predictor of functional outcomes, and, in isolation, may not be an improvement over MR grade.
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Affiliation(s)
- Juliette E Power
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Chris Reiff
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Adamantios Tsangaris
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Alexandra Hall
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Ganesh Raveendran
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Demetris Yannopoulos
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Sergey Gurevich
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
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Sudarsky D, Kusniec F, Grosman-Rimon L, Lubovich A, Kinany W, Hazanov E, Gelbstein M, Birati EY, Carasso S. Immediate Post-Procedural and Discharge Assessment of Mitral Valve Function Following Transcatheter Edge-to-Edge Mitral Valve Repair: Correlation and Association with Outcomes. J Clin Med 2021; 10:jcm10225448. [PMID: 34830731 PMCID: PMC8624366 DOI: 10.3390/jcm10225448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022] Open
Abstract
The correlation between residual mitral regurgitation (rMR) grade or mitral valve pressure gradient (MVPG), at transcatheter edge-to-edge mitral valve repair (TEEMr) completion and at discharge, is unknown. Furthermore, there is disagreement regarding rMR grade or MVPG from which prognosis diverts. We retrospectively studied 82 patients that underwent TEEMr. We tested the correlation between rMR or MVPG and evaluated their association, with outcomes. Moderate or less rMR (rMR ≤ 2) at TEEMr completion was associated with improved survival, whereas mild or less rMR (rMR ≤ 1) was not. Patients with rMR ≤ 1 at discharge demonstrated a longer time of survival, of first heart failure hospitalization and of both. The correlation for both rMR grade (r = 0.5, p < 0.001) and MVPG (r = 0.51, p < 0.001), between TEEMr completion and discharge, was moderate. MR ≤ 2 at TMEER completion was the strongest predictor for survival (HR 0.08, p < 0.001) whereas rMR ≤ 1 at discharge was independently associated with a lower risk of the combined endpoint (HR 4.17, p = 0.012). MVPG was not associated with adverse events. We conclude that the assessments for rMR grade and MVPG, at the completion of TEEMr and at discharge, should be distinctly reported. Improved outcome is expected with rMR ≤ 2 at TEEMr completion and rMR ≤ 1 at discharge. Higher MVPG is not associated with unfavorable outcomes.
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Affiliation(s)
- Doron Sudarsky
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
- Correspondence:
| | - Fabio Kusniec
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Liza Grosman-Rimon
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Ala Lubovich
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Wadia Kinany
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Evgeni Hazanov
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Michael Gelbstein
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Edo Y. Birati
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Shemy Carasso
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
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6
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da Silva TL, Pazin-Filho A, Romano MMD, Ferriani VPL, Marin-Neto JA, Maciel BC, Schmidt A. Mitral valve thickening in acute rheumatic fever as a predictor of late valvar dysfunction. PLoS One 2021; 16:e0259737. [PMID: 34788321 PMCID: PMC8598055 DOI: 10.1371/journal.pone.0259737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 10/25/2021] [Indexed: 12/04/2022] Open
Abstract
Background Rheumatic heart disease (RHD) complicating acute rheumatic fever (ARF) remains an important health problem in developing countries. No definitive diagnostic test for ARF exists and the role of Doppler echocardiography (DEC) for long-term prognostic evaluation following ARF is not well established. Objective To investigate the prognostic value of DEC in patients with ARF as a predictor of chronic valve dysfunction. Methods Prospectively enrolled patients with clinical ARF had a DEC performed soon after diagnosis and repeated at 1, 3, 6 and 12 months and thereafter at every 1–2 years. We defined chronic valve dysfunction by ≥ 3 of the following: increased valve thickening, commissure fusion, subvalvular thickening, reduced leaflet mobility, non-trivial mitral and/or aortic regurgitation. We performed univariate analysis and developed multivariate logistic regression models to identify variables that may influence evolution to RHD. p <0.05 was considered significant. Results We evaluated 70(57% men) patients, 10.8±5.6 years-old during the ARF episode and followed for 95±26 months. Chronic valve dysfunction was identified in 36(51.4%) which fulfilled criteria for RHD and 10(27.8%) of them died or underwent valve surgery. Univariate analysis showed that mitral valve thickening and presence of mitral regurgitation at baseline DEC, were associated with RHD(p<0.01). Multivariate logistic regression showed that only mitral valve thickness either as a continuous (Odds-Ratio:5.8;95%CI:1.7–19.7) or as a categorical variable (Odds-Ratio:4.04;95%CI:1.06–15.3) was an independent predictor of chronic valve dysfunction. Conclusions Mitral leaflets thickening documented at the time of diagnosis of ARF is a consistent prognostic marker for the subsequent evolution to RHD.
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Affiliation(s)
- Telêmaco Luis da Silva
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Antonio Pazin-Filho
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Minna M. D. Romano
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Virgínia P. L. Ferriani
- Pediatrics Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - José A. Marin-Neto
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Benedito C. Maciel
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - André Schmidt
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
- * E-mail:
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7
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Impact of Mitral Regurgitation on the Flow in a Model of a Left Ventricle. Cardiovasc Eng Technol 2020; 11:708-718. [DOI: 10.1007/s13239-020-00490-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022]
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8
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Papolla C, Adda J, Rique A, Habib G, Rieu R. In Vitro Quantification of Mitral Regurgitation of Complex Geometry by the Modified Proximal Isovelocity Surface Area Method. J Am Soc Echocardiogr 2020; 33:838-847.e1. [DOI: 10.1016/j.echo.2020.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 12/12/2022]
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9
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[Edge-to-edge repair : What has changed compared to the position paper in 2013?]. Herz 2019; 44:586-591. [PMID: 31628494 DOI: 10.1007/s00059-019-04847-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This short review article aims to explain the changes in the treatment strategies of interventional care designed to treat secondary mitral valve regurgitation with edge-to-edge repair in comparison to the position paper published in 2013 by the German Society of Cardiology and the German Society of Thoracic and Cardiovascular Surgery. To this end the current data situation with respect to the European Society of Cardiology (ESC) guidelines from 2017, the intraprocedural assessment of mitral valve regurgitation and new technical developments are discussed.
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10
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Changing the Tide of Left Atrial Inflow. JACC Cardiovasc Imaging 2019; 12:1914-1916. [DOI: 10.1016/j.jcmg.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 11/17/2022]
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11
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Zoghbi WA, Asch FM, Bruce C, Gillam LD, Grayburn PA, Hahn RT, Inglessis I, Islam AM, Lerakis S, Little SH, Siegel RJ, Skubas N, Slesnick TC, Stewart WJ, Thavendiranathan P, Weissman NJ, Yasukochi S, Zimmerman KG. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement. J Am Soc Echocardiogr 2019; 32:431-475. [DOI: 10.1016/j.echo.2019.01.003] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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12
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Guérin P. Continuous Direct Left Atrial Pressure During MitraClip Therapy: One Key to Clinical Success? JACC Cardiovasc Interv 2019; 12:137-139. [PMID: 30594515 DOI: 10.1016/j.jcin.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/24/2018] [Accepted: 10/02/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Patrice Guérin
- University Hospital of Nantes, l'Institut du Thorax, Interventional Cardiology Unit, Nantes, France.
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13
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Kuwata S, Taramasso M, Czopak A, Luciani M, Pozzoli A, Ho E, Ferrero Guadagnoli A, Saccocci M, Gaemperli O, Nietlispach F, Zuber M, Feldman T, Maisano F. Continuous Direct Left Atrial Pressure. JACC Cardiovasc Interv 2019; 12:127-136. [DOI: 10.1016/j.jcin.2018.07.051] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/16/2018] [Accepted: 07/31/2018] [Indexed: 12/21/2022]
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14
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Nyman CB, Mackensen GB, Jelacic S, Little SH, Smith TW, Mahmood F. Transcatheter Mitral Valve Repair Using the Edge-to-Edge Clip. J Am Soc Echocardiogr 2018; 31:434-453. [PMID: 29482977 DOI: 10.1016/j.echo.2018.01.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Indexed: 12/20/2022]
Abstract
Percutaneous intervention for mitral valve (MV) disease has been established as an alternative to open surgical MV repair in patients with prohibitive surgical risk. Multiple percutaneous approaches have been described and are in various stages of development. Edge-to-edge leaflet plication with the MitraClip (Abbott, Menlo Park, CA) is currently the only Food and Drug Administration-approved device specifically for primary or degenerative lesions. Use of the edge-to-edge clip for secondary mitral regurgitation is currently under investigation and may result in expanded indications. Echocardiography has significantly increased our understanding of the anatomy of the MV and provided us with the ability to classify and quantify the associated mitral regurgitation. For percutaneous interventions of the MV, transesophageal echocardiography imaging is used for patient screening, intraprocedural guidance, and confirmation of the result. Optimal outcomes require the echocardiographer and the proceduralist to have a thorough understanding of intra-atrial septal and MV anatomy, as well as an appreciation for the key points and potential pitfalls of each of the procedural steps. With increasing experience, more complex valvular pathology can be successfully percutaneously treated. In addition to two-dimensional echocardiography, advances in three-dimensional echocardiography and fusion imaging will continue to support the refinement of current technologies, the expansion of clinical applications, and the development of novel devices.
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Affiliation(s)
- Charles B Nyman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| | - G Burkhard Mackensen
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Srdjan Jelacic
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Stephen H Little
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Thomas W Smith
- Department of Internal Medicine, Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
| | - Feroze Mahmood
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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15
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Zürcher F, Brugger N, Jahren SE, de Marchi SF, Seiler C. Quantification of Multiple Mitral Regurgitant Jets: An In Vitro Validation Study Comparing Two- and Three-Dimensional Proximal Isovelocity Surface Area Methods. J Am Soc Echocardiogr 2018; 30:511-521. [PMID: 28274714 DOI: 10.1016/j.echo.2016.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND The accuracy of the proximal isovelocity surface area (PISA) method for the quantification of mitral regurgitation (MR), in the case of multiple jets, is unknown. The aim of this study was to evaluate different two-dimensional (2D) and three-dimensional (3D) PISA methods using 3D color Doppler data sets. METHODS Several regurgitant volumes (Rvols) were simulated using a pulsatile pump connected to a phantom equipped with single and double regurgitant orifices of different sizes and interspaces. A flowmeter served as the reference method. Transthoracic (TTE) and transoesophageal echocardiography (TEE) were used to acquire the 3D data sets. Offline, Rvols were calculated by 2D PISA methods based on hemispheric and hemicylindric assumptions and by 3D integrated PISA. RESULTS A fusion of the PISA was observed in the setting of narrow-spaced regurgitant orifices; compared with flowmeter, Rvol was underestimated using the single hemispheric PISA model (TTE: Bland-Altman bias ± limit of agreement, -17.5 ± 8.9 mL; TEE: -15.9 ± 7.3 mL) and overestimated using the double hemispheric PISA model (TTE: +7.1 ± 14.6 mL; TEE: +10.4 ± 11.9 mL). The combined approach (hemisphere for single orifice, hemicylinder with two bases for nonfused PISAs, and hemicylinder with one base for fused PISAs) was more precise (TTE: -3.4 ± 6.3 mL; TEE: -1.9 ± 5.6 mL). Three-dimensional integrated PISA was the most accurate method to quantify Rvol (TTE: -2.1 ± 6.5 mL; TEE -3.2 ± 4.8 mL). CONCLUSIONS In the setting of double MR orifices, the 2D combined approach and integrated 3D PISA appear to be superior as compared with the conventional hemispheric method, thus providing tools for the challenging quantification of MR with multiple jets.
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Affiliation(s)
- Fabian Zürcher
- Department of Cardiology, University Hospital, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | | | | | - Christian Seiler
- Department of Cardiology, University Hospital, Bern, Switzerland.
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Baldus S, Kuck KH, Rudolph V, Nef H, Eggebrecht H, Boekstegers P, Wöhrle J, Ince H, Möllmann H, Stellbrink C, Hausleiter J, v. Bardeleben S, Kelm M, Elsässer A. Interventionelle Therapie von AV-Klappenerkrankungen – Fokus Mitralklappeninsuffizienz. KARDIOLOGE 2018. [DOI: 10.1007/s12181-018-0232-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dietl A, Prieschenk C, Eckert F, Birner C, Luchner A, Maier LS, Buchner S. 3D vena contracta area after MitraClip© procedure: precise quantification of residual mitral regurgitation and identification of prognostic information. Cardiovasc Ultrasound 2018; 16:1. [PMID: 29310672 PMCID: PMC5759791 DOI: 10.1186/s12947-017-0120-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/19/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Percutaneous mitral valve repair (PMVR) is increasingly performed in patients with severe mitral regurgitation (MR). Post-procedural MR grading is challenging and an unsettled issue. We hypothesised that the direct planimetry of vena contracta area (VCA) by 3D-transoesophageal echocardiography allows quantifying post-procedural MR and implies further prognostic relevance missed by the usual ordinal scale (grade I-IV). METHODS Based on a single-centre PMVR registry containing 102 patients, the association of VCA reduction and patients' functional capacity measured as six-minute walk distance (6 MW) was evaluated. 3D-colour-Doppler datasets were available before, during and 4 weeks after PMVR. RESULTS Twenty nine patients (age 77.0 ± 5.8 years) with advanced heart failure (75.9% NYHA III/IV) and severe degenerative (34%) or functional (66%) MR were eligible. VCA was reduced in all patients by PMVR (0.99 ± 0.46 cm2 vs. 0.22 ± 0.15 cm2, p < 0.0001). It remained stable after median time of 33 days (p = 0.999). 6 MW improved after the procedure (257.5 ± 82.5 m vs. 295.7 ± 96.3 m, p < 0.01). Patients with a decrease in VCA less than the median VCA reduction showed a more distinct improvement in 6 MW than patients with better technical result (p < 0.05). This paradoxical finding was driven by inferior results in very large functional MR. CONCLUSIONS VCA improves the evaluation of small residual MR. Its post-procedural values remain stable during a short-term follow-up and imply prognostic information for the patients' physical improvement. VCA might contribute to a more substantiated estimation of treatment success in the heterogeneous functional MR group.
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Affiliation(s)
- Alexander Dietl
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany. .,Comprehensive Heart Failure Center Würzburg, University Hospital and University of Würzburg, Würzburg, Germany.
| | - Christine Prieschenk
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany
| | - Franziska Eckert
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany
| | - Andreas Luchner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany.,Department of Internal Medicine I, Klinikum St. Marien, Amberg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany
| | - Stefan Buchner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany.,Department of Internal Medicine II, Sana Kliniken Cham, Cham, Germany
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Gajjar M, Yadlapati A, Van Assche LM, Puthumana J, Malaisrie SC, Davidson CJ, Thomas J, Ricciardi MJ. Real-Time Continuous Left Atrial Pressure Monitoring During Mitral Valve Repair Using the MitraClip NT System. JACC Cardiovasc Interv 2017; 10:1466-1467. [DOI: 10.1016/j.jcin.2017.05.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/10/2017] [Accepted: 05/22/2017] [Indexed: 12/01/2022]
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Jamil M, Ahmad O, Poh KK, Yap CH. Feasibility of Ultrasound-Based Computational Fluid Dynamics as a Mitral Valve Regurgitation Quantification Technique: Comparison with 2-D and 3-D Proximal Isovelocity Surface Area-Based Methods. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1314-1330. [PMID: 28434658 DOI: 10.1016/j.ultrasmedbio.2017.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 02/09/2017] [Accepted: 02/12/2017] [Indexed: 06/07/2023]
Abstract
Current Doppler echocardiography quantification of mitral regurgitation (MR) severity has shortcomings. Proximal isovelocity surface area (PISA)-based methods, for example, are unable to account for the fact that ultrasound Doppler can measure only one velocity component: toward or away from the transducer. In the present study, we used ultrasound-based computational fluid dynamics (Ub-CFD) to quantify mitral regurgitation and study its advantages and disadvantages compared with 2-D and 3-D PISA methods. For Ub-CFD, patient-specific mitral valve geometry and velocity data were obtained from clinical ultrasound followed by 3-D CFD simulations at an assumed flow rate. We then obtained the average ratio of the ultrasound Doppler velocities to CFD velocities in the flow convergence region, and scaled CFD flow rate with this ratio as the final measured flow rate. We evaluated Ub-CFD, 2-D PISA and 3-D PISA with an in vitro flow loop, which featured regurgitation flow through (i) a simplified flat plate with round orifice and (ii) a 3-D printed realistic mitral valve and regurgitation orifice. The Ub-CFD and 3-D PISA methods had higher precision than the 2-D PISA method. Ub-CFD had consistent accuracy under all conditions tested, whereas 2-D PISA had the lowest overall accuracy. In vitro investigations indicated that the accuracy of 2-D and 3-D PISA depended significantly on the choice of aliasing velocity. Evaluation of these techniques was also performed for two clinical cases, and the dependency of PISA on aliasing velocity was similarly observed. Ub-CFD was robustly accurate and precise and has promise for future translation to clinical practice.
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Affiliation(s)
- Muhammad Jamil
- Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Omar Ahmad
- Comsats Institute of Information Technology, Islamabad, Pakistan
| | - Kian Keong Poh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Choon Hwai Yap
- Department of Biomedical Engineering, National University of Singapore, Singapore.
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Impact of interventional edge-to-edge repair on mitral valve geometry. Int J Cardiol 2017; 230:468-475. [DOI: 10.1016/j.ijcard.2016.12.081] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/14/2016] [Accepted: 12/16/2016] [Indexed: 11/18/2022]
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Li CH, Arzamendi D, Carreras F. Role of Imaging Techniques in Percutaneous Treatment of Mitral Regurgitation. ACTA ACUST UNITED AC 2016; 69:421-36. [PMID: 26926991 DOI: 10.1016/j.rec.2015.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Abstract
Mitral regurgitation is the most prevalent valvular heart disease in the United States and the second most prevalent in Europe. Patients with severe mitral regurgitation have a poor prognosis with medical therapy once they become symptomatic or develop signs of significant cardiac dysfunction. However, as many as half of these patients are inoperable because of advanced age, ventricular dysfunction, or other comorbidities. Studies have shown that surgery increases survival in patients with organic mitral regurgitation due to valve prolapse but has no clinical benefit in those with functional mitral regurgitation. In this scenario, percutaneous repair for mitral regurgitation in native valves provides alternative management of valvular heart disease in patients at high surgical risk. Percutaneous repair for mitral regurgitation is a growing field that relies heavily on imaging techniques to diagnose functional anatomy and guide repair procedures.
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Affiliation(s)
- Chi-Hion Li
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Unidad de Hemodinámica, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Dabit Arzamendi
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Francesc Carreras
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Buzzatti N, De Bonis M, Denti P, Barili F, Schiavi D, Di Giannuario G, La Canna G, Alfieri O. What is a “good” result after transcatheter mitral repair? Impact of 2+ residual mitral regurgitation. J Thorac Cardiovasc Surg 2016; 151:88-96. [DOI: 10.1016/j.jtcvs.2015.09.099] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/07/2015] [Accepted: 09/10/2015] [Indexed: 10/23/2022]
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Imaging During Percutaneous Valvular Heart DiseaseInterventions: Is More Better or Less? CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gruner C, Herzog B, Bettex D, Felix C, Datta S, Greutmann M, Gaemperli O, Müggler SA, Tanner FC, Gruenenfelder J, Corti R, Biaggi P. Quantification of Mitral Regurgitation by Real Time Three-Dimensional Color Doppler Flow Echocardiography Pre- and Post-Percutaneous Mitral Valve Repair. Echocardiography 2014; 32:1140-6. [DOI: 10.1111/echo.12809] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Christiane Gruner
- Echocardiography Laboratory; University Hospital Zurich; Zurich Switzerland
| | - Bernhard Herzog
- Echocardiography Laboratory; University Hospital Zurich; Zurich Switzerland
| | - Dominique Bettex
- Department of Anesthesiology; University Hospital Zurich; Zurich Switzerland
| | - Christian Felix
- Department of Anesthesiology; University Hospital Zurich; Zurich Switzerland
| | - Saurabh Datta
- Siemens Medical Solutions USA Inc.; Mountain View California
| | - Matthias Greutmann
- Echocardiography Laboratory; University Hospital Zurich; Zurich Switzerland
| | - Oliver Gaemperli
- Andreas Grüntzig Cardiac Catheterization Laboratory; Cardiology; University Hospital Zurich; Zurich Switzerland
| | - Simon A. Müggler
- Department of Internal Medicine; University Hospital Zurich; Zurich Switzerland
| | - Felix C. Tanner
- Echocardiography Laboratory; University Hospital Zurich; Zurich Switzerland
| | | | - Roberto Corti
- Andreas Grüntzig Cardiac Catheterization Laboratory; Cardiology; University Hospital Zurich; Zurich Switzerland
| | - Patric Biaggi
- Echocardiography Laboratory; University Hospital Zurich; Zurich Switzerland
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Schueler R, Momcilovic D, Weber M, Welz A, Werner N, Mueller C, Ghanem A, Nickenig G, Hammerstingl C. Acute Changes of Mitral Valve Geometry During Interventional Edge-to-Edge Repair With the MitraClip System Are Associated With Midterm Outcomes in Patients With Functional Valve Disease. Circ Cardiovasc Interv 2014; 7:390-9. [DOI: 10.1161/circinterventions.113.001098] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert Schueler
- From the Departments of Medicine II (R.S., D.M., M.W., N.W., C.M., A.G., G.N., C.H.) and Cardiovascular Surgery (A.W.), Heart Centre Bonn, University Hospital Bonn, Bonn, Germany
| | - Diana Momcilovic
- From the Departments of Medicine II (R.S., D.M., M.W., N.W., C.M., A.G., G.N., C.H.) and Cardiovascular Surgery (A.W.), Heart Centre Bonn, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- From the Departments of Medicine II (R.S., D.M., M.W., N.W., C.M., A.G., G.N., C.H.) and Cardiovascular Surgery (A.W.), Heart Centre Bonn, University Hospital Bonn, Bonn, Germany
| | - Armin Welz
- From the Departments of Medicine II (R.S., D.M., M.W., N.W., C.M., A.G., G.N., C.H.) and Cardiovascular Surgery (A.W.), Heart Centre Bonn, University Hospital Bonn, Bonn, Germany
| | - Nikos Werner
- From the Departments of Medicine II (R.S., D.M., M.W., N.W., C.M., A.G., G.N., C.H.) and Cardiovascular Surgery (A.W.), Heart Centre Bonn, University Hospital Bonn, Bonn, Germany
| | - Cornelius Mueller
- From the Departments of Medicine II (R.S., D.M., M.W., N.W., C.M., A.G., G.N., C.H.) and Cardiovascular Surgery (A.W.), Heart Centre Bonn, University Hospital Bonn, Bonn, Germany
| | - Alexander Ghanem
- From the Departments of Medicine II (R.S., D.M., M.W., N.W., C.M., A.G., G.N., C.H.) and Cardiovascular Surgery (A.W.), Heart Centre Bonn, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- From the Departments of Medicine II (R.S., D.M., M.W., N.W., C.M., A.G., G.N., C.H.) and Cardiovascular Surgery (A.W.), Heart Centre Bonn, University Hospital Bonn, Bonn, Germany
| | - Christoph Hammerstingl
- From the Departments of Medicine II (R.S., D.M., M.W., N.W., C.M., A.G., G.N., C.H.) and Cardiovascular Surgery (A.W.), Heart Centre Bonn, University Hospital Bonn, Bonn, Germany
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Mathew S, Raj R. Iatrogenic Mitral Valve Perforation following CABG and Aortic Valve Replacement: A Rare Complication detected by Post-bypass Transesophageal Echocardiography. ACTA ACUST UNITED AC 2014. [DOI: 10.5005/jp-journals-10034-1027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Iatrogenic mitral valve perforation following aortic valve replacement is a rare complication. We present a case of anterior mitral leaflet perforation following coronary artery bypass grafting (CABG) and aortic valve replacement detected by intraoperative transesophageal echocardiography (TEE). A 57-year-old male patient with preoperative diagnosis of coronary artery disease, sclerodegenerative aortic valve with severe aortic stenosis and mild central mitral regurgitation (MR) underwent CABG and aortic valve replacement. A post bypass TEE in midesophageal long axis view showed an additional MR jet across the body of the anterior mitral leaflet. We present intraoperative TEE images with a discussion on role of TEE in detection of mitral valve perforation and surgical decision making.
Abbreviations
AVR: Aortic valve replacement C ABG: Coronary artery bypass grafting 2D: Two-dimensional MR: Mitral regurgitation TEE: Transesophageal echocardiography TTE: Transthoracic echocardiography
How to cite this article
Raj R, Mathew S, Puri GD. Iatrogenic Mitral Valve Perforation following CABG and Aortic Valve Replacement: A Rare Complication detected by Post-bypass Transesophageal Echocardiography. J Perioper Echocardiogr 2014;2(2):75-76.
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Wunderlich NC, Siegel RJ. Peri-interventional echo assessment for the MitraClip procedure. Eur Heart J Cardiovasc Imaging 2013; 14:935-49. [DOI: 10.1093/ehjci/jet060] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Boekstegers P, Hausleiter J, Baldus S, von Bardeleben RS, Beucher H, Butter C, Franzen O, Hoffmann R, Ince H, Kuck KH, Rudolph V, Schäfer U, Schillinger W, Wunderlich N. Percutaneous interventional mitral regurgitation treatment using the Mitra-Clip system. Clin Res Cardiol 2013; 103:85-96. [DOI: 10.1007/s00392-013-0614-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 08/21/2013] [Indexed: 01/05/2023]
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Leong DP, Joseph MX, Sinhal A, Selvanayagam JB. The evolving role of cardiac imaging in percutaneous valvular intervention. Heart Lung Circ 2013; 22:704-16. [PMID: 23721698 DOI: 10.1016/j.hlc.2013.03.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 07/04/2012] [Accepted: 03/20/2013] [Indexed: 11/15/2022]
Abstract
Surgical therapies have represented the primary evidence-based intervention to alter the natural history of valvular heart disease (VHD), however, the increasing incidence of patients at high surgical risk due to age and related co-morbid conditions has given rise to the need for alternative strategies. Thus, percutaneous approaches to VHD therapy have emerged as an important therapeutic option. Cardiovascular imaging plays a critical role in patient screening for percutaneous valvular interventions, during the procedure itself, and as part of follow-up for the identification of implant success/failure and complications. The technical demands on imaging in this context are highly specific. Although imaging has a significant role in the broader evaluation of valvular heart disease mechanism and severity, the purpose of this paper is to summarise the particular goals of cardiovascular imaging in the work-up for, during, and in the follow-up of percutaneous valvular intervention.
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Affiliation(s)
- Darryl P Leong
- Flinders Centre for Cardiovascular Magnetic Resonance Research, Adelaide, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia; Discipline of Medicine, Flinders University, Adelaide, Australia; Discipline of Medicine, University of Adelaide, Adelaide, Australia
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Wunderlich NC, Beigel R, Siegel RJ. The role of echocardiography during mitral valve percutaneous interventions. Cardiol Clin 2013; 31:237-70. [PMID: 23743076 DOI: 10.1016/j.ccl.2013.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Transesophageal echocardiography is routinely used to guide percutaneous interventions involving the mitral valve. Mitral balloon valvuloplasty for rheumatic mitral valve stenosis (MS) was the first percutaneous intervention to gain wide acceptance. New techniques have been developed to treat degenerative and functional mitral regurgitation (MR) as well as paravalvular mitral leak (PVML). This review describes the use of echocardiography for transcatheter treatment of MS, MR, and PVML.
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Boekstegers P, Hausleiter J, Baldus S, von Bardeleben R, Beucher H, Butter C, Franzen O, Hoffmann R, Ince H, Kuck K, Rudolph V, Schäfer U, Schillinger W, Wunderlich N. Interventionelle Behandlung der Mitralklappeninsuffizienz mit dem MitraClip®-Verfahren. KARDIOLOGE 2013. [DOI: 10.1007/s12181-013-0492-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Armstrong EJ, Rogers JH, Swan CH, Upadhyaya D, Viloria E, McCulloch C, Slater J, Qureshi M, Williams J, Whisenant B, Feldman T, Foster E. Echocardiographic predictors of single versus dual MitraClip device implantation and long-term reduction of mitral regurgitation after percutaneous repair. Catheter Cardiovasc Interv 2013; 82:673-9. [DOI: 10.1002/ccd.24645] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 08/28/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Ehrin J. Armstrong
- Division of Cardiovascular Medicine; University of California; Davis Medical Center; Sacramento; California
| | - Jason H. Rogers
- Division of Cardiovascular Medicine; University of California; Davis Medical Center; Sacramento; California
| | - Christo H. Swan
- Division of Cardiology; University of California; San Francisco; California
| | - Deepa Upadhyaya
- Division of Cardiology; University of California; San Francisco; California
| | - Esperanza Viloria
- Division of Cardiology; University of California; San Francisco; California
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics; University of California; San Francisco; California
| | - James Slater
- Division of Cardiology; New York University Medical Center; New York
| | - Mansoor Qureshi
- Division of Cardiology; St Joseph Mercy Hospital; Ypsilanti; Michigan
| | - John Williams
- Division of Cardiology; Oklahoma Cardiovascular Research Group; Oklahoma City; Oklahoma
| | - Brian Whisenant
- Division of Cardiology; Intermountain Medical Center; Murray; Utah
| | - Ted Feldman
- Division of Cardiology; Evanston Hospital; NorthShore University HealthSystem; Evanston; IL
| | - Elyse Foster
- Division of Cardiology; University of California; San Francisco; California
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Altiok E, Hamada S, Brehmer K, Kuhr K, Reith S, Becker M, Schröder J, Almalla M, Lehmacher W, Marx N, Hoffmann R. Analysis of procedural effects of percutaneous edge-to-edge mitral valve repair by 2D and 3D echocardiography. Circ Cardiovasc Imaging 2012; 5:748-55. [PMID: 23001897 DOI: 10.1161/circimaging.112.974691] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Analysis of procedural effects in patients undergoing percutaneous mitral valve repair (PMVR) using the edge-to-edge technique is complex, and common methods to define mitral regurgitation severity based on 2-dimensional (2D) echocardiography are not validated for postprocedural double-orifice mitral valve. This study used 3D transesophageal echocardiography (TEE) to determine the functional and morphological effects of PMVR. METHODS AND RESULTS In 39 high-risk surgical patients with moderate to severe functional mitral valve regurgitation, 3D TEE with and without color Doppler as well as 2D transthoracic and TEE was performed before and after PMVR (MitraClip device). Mitral valve regurgitant volume by color Doppler 3D TEE was determined as the product of vena contracta areas defined by direct planimetry and velocity time integral using continuous-wave Doppler. Regurgitant volume was reduced from 84.1±38.3 mL preintervention to 35.6±25.6 mL postintervention. Patients in whom vena contracta area could be reduced >50% had a smaller preprocedural mitral annulus area compared with patients with ≤50% reduction (11.9±3.9 versus 16.1±8.5 cm(2), respectively; P=0.036) and tended to have a smaller mitral annulus circumference (13.0±2.0 versus 14.8±4.1 cm, respectively; P=0.112). At 6 months follow-up, left atrial and left ventricular end-diastolic volumes were significantly more reduced in patients in whom regurgitant vena contracta area was reduced by >50% compared with those with less reduction (-11.4±5.2 versus -4.8±7.7%; P=0.005, and -11.0±7.2 versus -4.5±9.3%; P=0.028). The maximum diastolic mitral valve area decreased from 6.0±2.0 to 2.9±0.9 cm(2) (P<0.0001). CONCLUSIONS Three dimensional TEE demonstrates significant reduction of regurgitant volume after PMVR. The unique visualization of the mitral valve by 3D TEE allows improved understanding of the morphological and functional changes induced by PMVR.
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Affiliation(s)
- Ertunc Altiok
- Department of Cardiology, Pneumology, Angiology, Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
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Hyodo E, Iwata S, Tugcu A, Arai K, Shimada K, Muro T, Yoshikawa J, Yoshiyama M, Gillam LD, Hahn RT, Di Tullio MR, Homma S. Direct Measurement of Multiple Vena Contracta Areas for Assessing the Severity of Mitral Regurgitation Using 3D TEE. JACC Cardiovasc Imaging 2012; 5:669-76. [DOI: 10.1016/j.jcmg.2012.03.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 03/08/2012] [Accepted: 03/15/2012] [Indexed: 11/25/2022]
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Prakash A, Lacro RV, Sleeper LA, Minich LL, Colan SD, McCrindle B, Covitz W, Golding F, Hlavacek AM, Levine JC, Cohen MS. Challenges in echocardiographic assessment of mitral regurgitation in children after repair of atrioventricular septal defect. Pediatr Cardiol 2012; 33:205-14. [PMID: 21909774 PMCID: PMC3265615 DOI: 10.1007/s00246-011-0107-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 08/19/2011] [Indexed: 01/17/2023]
Abstract
The validity and reproducibility of echocardiographic methods used to quantify mitral regurgitation (MR) in children with congenital heart disease are unknown. We evaluated the usefulness of methods used to quantify MR in children enrolled in a multicenter trial of enalapril 6 months after surgical repair of an atrioventricular septal defect (AVSD). MR severity in this trial was assessed using body surface area (BSA)-adjusted vena contracta lateral (i-VCW(lat)) and anterior-posterior (i-VCW(ap)) dimensions and cross-sectional area (i-VCA), regurgitant volume/BSA, regurgitant fraction, and qualitative MR grade. For each method, association with left ventricular end-diastolic volume (LVEDVz) and end-diastolic dimension (LVEDDz) z-scores and interobserver agreement were assessed. In 149 children (median age 1 year), i-VCW(lat), i-VCW(ap), and i-VCA were best associated with LVEDVz (r (2) = 0.54, r (2) = 0.24, and r (2) = 0.46, respectively; p < 0.001 for all) and showed the highest interobserver agreement (intraclass correlation coefficient = 0.62, 0.73, and 0.68, respectively). Qualitative MR grade was also associated with LVEDVz (r (2) = 0.31, p < 0.001) and showed modest interobserver agreement (kappa 0.56). Regurgitant volume/BSA and regurgitant fraction were associated with LVEDVz (r (2) = 0.45 and r (2) = 0.45, p < 0.001 for both) but showed poor interobserver agreement [ICC = 0.28 (n = 91) and ICC = 0.17 (n = 76), respectively], and their values were negative in 75% of subjects. In conclusion, echocardiographic assessment of MR severity after AVSD remains challenging. Among the quantitative methods used in this trial, i-VCW and i-VCA performed the best but offered little advantage compared with qualitative MR grade. The utility of regurgitant volume and fraction was severely limited by poor interobserver agreement and frequently negative values.
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Affiliation(s)
- Ashwin Prakash
- Department of Cardiology, Children's Hospital, Boston, MA 02115, USA.
| | - Ronald V. Lacro
- Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
| | | | | | - Steven D. Colan
- Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA. New England Research Institutes, Watertown, MA, USA
| | | | - Wesley Covitz
- Wake Forest University Health Sciences, Winston Salem, NC, USA
| | | | | | - Jami C. Levine
- Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Meryl S. Cohen
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Perlowski A, Feldman T. Percutaneous Treatment of Mitral Regurgitation: The MitraClip Experience. Interv Cardiol Clin 2012; 1:63-72. [PMID: 28582068 DOI: 10.1016/j.iccl.2011.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The MitraClip device is a percutaneous catheter-delivered, implantable clip that reduces mitral regurgitation by approximating the edges of the mitral leaflets, creating an "edge-to-edge" repair. The MitraClip is the first percutaneous technology developed to provide a minimally invasive option for patients at high risk for traditional mitral valve surgery. Although percutaneous repair was less effective at reducing mitral regurgitation than conventional surgery in the EVEREST randomized trial, the procedure was associated with superior safety and similar improvements in clinical outcomes. Older, high-risk or inoperable patients with functional or degenerative mitral regurgitation seem to benefit most from this therapy.
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Affiliation(s)
| | - Ted Feldman
- Cardiac Catheterization Laboratory, NorthShore University HealthSystem, Evanston Hospital, 2650 Ridge Avenue, Burch Building, Evanston, IL 60201, USA.
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Maisano F, La Canna G, Colombo A, Alfieri O. The Evolution From Surgery to Percutaneous Mitral Valve Interventions. J Am Coll Cardiol 2011; 58:2174-82. [DOI: 10.1016/j.jacc.2011.07.046] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/08/2011] [Accepted: 07/12/2011] [Indexed: 11/27/2022]
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Grayburn PA. The Importance of Regurgitant Orifice Shape in Mitral Regurgitation. JACC Cardiovasc Imaging 2011; 4:1097-9. [DOI: 10.1016/j.jcmg.2011.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 08/02/2011] [Indexed: 10/16/2022]
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Zamorano JL, Badano LP, Bruce C, Chan KL, Gonçalves A, Hahn RT, Keane MG, La Canna G, Monaghan MJ, Nihoyannopoulos P, Silvestry FE, Vanoverschelde JL, Gillam LD. EAE/ASE Recommendations for the Use of Echocardiography in New Transcatheter Interventions for Valvular Heart Disease. J Am Soc Echocardiogr 2011; 24:937-65. [DOI: 10.1016/j.echo.2011.07.003] [Citation(s) in RCA: 167] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Zamorano JL, Badano LP, Bruce C, Chan KL, Gonçalves A, Hahn RT, Keane MG, La Canna G, Monaghan MJ, Nihoyannopoulos P, Silvestry FE, Vanoverschelde JL, Gillam LD. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. Eur Heart J 2011; 32:2189-214. [PMID: 21885465 DOI: 10.1093/eurheartj/ehr259] [Citation(s) in RCA: 245] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zamorano JL, Badano LP, Bruce C, Chan KL, Goncalves A, Hahn RT, Keane MG, La Canna G, Monaghan MJ, Nihoyannopoulos P, Silvestry FE, Vanoverschelde JL, Gillam LD, Vahanian A, Di Bello V, Buck T. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:557-84. [DOI: 10.1093/ejechocard/jer086] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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