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Abdelghani M, Nunes MCP, Anwar AM, Prendergast B. Assessment of suitability for percutaneous mitral commissurotomy: a contemporary review of key anatomical criteria and predictive models. Eur Heart J Cardiovasc Imaging 2024; 25:739-753. [PMID: 38376989 DOI: 10.1093/ehjci/jeae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 02/22/2024] Open
Abstract
The immediate result of percutaneous balloon mitral commissurotomy is largely determined by the anatomy of the mitral valve complex. Several scores and models have been developed to assess anatomical suitability for percutaneous balloon mitral commissurotomy. Although none has an optimal predictive power, these models look at the valvular apparatus from different perspectives bearing the potential for a complementary role.
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Affiliation(s)
- Mohammad Abdelghani
- Cardiology Department, Al-Azhar University, Nasr City, 11651 Cairo, Egypt
- Cardiology Unit, Sohar Hospital, Muwelleh Street, 311 Sohar, Oman
- Cardiology Department, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Maria Carmo P Nunes
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ashraf M Anwar
- Cardiology Department, Al-Azhar University, Nasr City, 11651 Cairo, Egypt
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Bernard Prendergast
- Department of Cardiology, Guys and St Thomas' NHS Foundation Trust Hospital London, London, UK
- Heart, Vascular & Thoracic Institute, Cleveland Clinic London, London, UK
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Agricola E, Ancona F, Bartel T, Brochet E, Dweck M, Faletra F, Lancellotti P, Mahmoud-Elsayed H, Marsan NA, Maurovich-Hovart P, Monaghan M, Pontone G, Sade LE, Swaans M, Von Bardeleben RS, Wunderlich N, Zamorano JL, Popescu BA, Cosyns B, Donal E. Multimodality imaging for patient selection, procedural guidance, and follow-up of transcatheter interventions for structural heart disease: a consensus document of the EACVI Task Force on Interventional Cardiovascular Imaging: part 1: access routes, transcatheter aortic valve implantation, and transcatheter mitral valve interventions. Eur Heart J Cardiovasc Imaging 2023; 24:e209-e268. [PMID: 37283275 DOI: 10.1093/ehjci/jead096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/08/2023] Open
Abstract
Transcatheter therapies for the treatment of structural heart diseases (SHD) have expanded dramatically over the last years, thanks to the developments and improvements of devices and imaging techniques, along with the increasing expertise of operators. Imaging, in particular echocardiography, is pivotal during patient selection, procedural monitoring, and follow-up. The imaging assessment of patients undergoing transcatheter interventions places demands on imagers that differ from those of the routine evaluation of patients with SHD, and there is a need for specific expertise for those working in the cath lab. In the context of the current rapid developments and growing use of SHD therapies, this document intends to update the previous consensus document and address new advancements in interventional imaging for access routes and treatment of patients with aortic stenosis and regurgitation, and mitral stenosis and regurgitation.
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Affiliation(s)
- Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
- Vita-Salute San Raffaele University, via Olgettina 58, Milan 20132, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
| | - Thomas Bartel
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, 26th Street, Dubai, United Arab Emirates
| | - Eric Brochet
- Cardiology Department, Hopital Bichat, 46 rue Huchard, Paris 75018, France
| | - Marc Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Francesco Faletra
- Senior SHD Consultant Istituto Cardiocentro Via Tesserete 48, CH-6900 Lugano, Switzerland
- Senior Imaging Consultant ISMETT UPCM Hospital, Discesa dei Giudici, 4, 90133 Palermo, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman, Liège B4000, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | | | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh-Heart & Vascular Institute UPMC, 200 Lothrop St Ste E354.2, Pıttsburgh, PA 15213, USA
- Cardiology Department, Baskent University, Ankara, Turkey
| | - Martin Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Nina Wunderlich
- Asklepios Klinik Langen Röntgenstrasse 20, Langen 63225, Germany
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila' -Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania
| | - Bernard Cosyns
- Cardiology Department, Centrum voor Hart en Vaatziekten (CHVZ), Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Erwan Donal
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Universite´ de Rennes-1, Rennes, France
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Elsawah I, Amin A, Abdo AM, Taha M, Khalil E. Impact of 3D transesophageal echocardiography assessment of mitral valve on short-term outcome of Balloon Mitral Valvuloplasty using additional quantitative parameters. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.21/7077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The goals of this prospective observational study were to identify quantitative morphological factors that might aid in the prediction of PBMV outcome, as well as to define the function of 3D TEE in mitral valve evaluation. Material and Methods: The trial comprised seventy individuals who had isolated severe rheumatic Mitral Stenosis (MS) who were scheduled for PBMV between October 2017 and March 2021. Trans-thoracic echocardiography (TTE) was used for pre-procedural evaluation. Posterior to Anterior Leaflet Length Ratio (P/ALLR), Commissural Area Ratio (CAR), Doming Height (DH), and Calcification Score (Ca score) were also assessed using 2D and 3D-Trans-esophageal Echocardiography (TEE). Following that, all patients were monitored for three months. Results: We have had 50(71.5%) successful procedures and 20(28.5%) unsuccessful procedures. The additional parameters showed highly significant difference between successful and un-successful groups (P-value <0.001). The cut-off points that predict successful procedures were; P/A LLR >0.6 and >0.55 by 2-D and 3-D TEE respectively, CAR ≤ 1.28 and ≤ 1.25 by 2-D and 3-D TEE respectively, DH > 1.2 cm by 2-D TEE, and Ca Score ≤ 2. Conclusion: In our research, we discovered that these characteristics may predict the result of PBMV and contribute value to the semi-quantitative methodologies we adopted to use.
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Advances in Rheumatic Mitral Stenosis: Echocardiographic, Pathophysiologic, and Hemodynamic Considerations. J Am Soc Echocardiogr 2021; 34:709-722.e1. [PMID: 33652082 DOI: 10.1016/j.echo.2021.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/23/2022]
Abstract
Echocardiography is the primary imaging modality used in patients with mitral stenosis. Doppler-derived measurements of mitral pressure half-time are commonly used to calculate mitral valve area, but a number of hemodynamic confounders associated with advanced age limit its utility. Planimetry remains the gold standard for determining mitral valve area and may be performed using two- or three-dimensional imaging. Although the Wilkins score has been used for >30 years to predict balloon mitral valvuloplasty outcomes, newer scoring systems have been proposed to improve predictive accuracy. Some patients undergoing technically successful balloon mitral valvuloplasty may not have satisfactory clinical outcomes. These individuals may be identified by the presence of reduced net atrioventricular compliance, which can be measured echocardiographically. Exercise testing may be useful in patients with mitral stenosis whose symptomatic status is incongruous their mitral valve area. Last, reduced left atrial systolic strain, an indicator of poor left atrial compliance, has been shown to reliably predict adverse outcomes in patients with mitral stenosis. The author discusses the hemodynamics and path ophysiology of mitral stenosis and reviews current and emerging roles of echocardiography in its evaluation.
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Abstract
Mitral stenosis (MS) is a progressive and devastating disease and most often occurs among young women. Given its considerable prevalence in Mediterranean and Eastern European countries according to the Euro Heart Survey, new imaging modalities are warranted to improve the management of patients with this condition. A wide spectrum of abnormalities occurs involving all parts of this complex structure and causing different grades of MS and/or regurgitation as a consequence of rheumatic affection. Novel imaging modalities significantly improved the assessment of several aspects of this rheumatic destructive process including the morphological alterations of the mitral valve (MV) apparatus, left atrial (LA) function, LA appendage, right and left ventricular (LV) functions, and complications, namely, atrial fibrillation and thromboembolic events. Furthermore, new imaging modalities improved the prediction of outcome of patients who underwent percutaneous balloon mitral comissurotomy and changed the paradigm of patient selection for intervention and risk stratification. The present review aimed to summarize the role of new multimodality, multiparametric imaging approaches to assess the morphological characteristics of the rheumatic MS and its associated complications, and to guide patient management.
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Farrag HMA, Setouhi AM, El-Mokadem MO, El-Swasany MA, Mahmoud KS, Mahmoud HB, Ibrahim AM. Additive value of 3D-echo in prediction of immediate outcome after percutaneous balloon mitral valvuloplasty. Egypt Heart J 2019; 71:19. [PMID: 31659518 PMCID: PMC6821434 DOI: 10.1186/s43044-019-0019-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/23/2019] [Indexed: 11/22/2022] Open
Abstract
Background Results of percutaneous balloon mitral valvuloplasty (BMV) are basically dependent on suitable patient selection. Currently used two-dimensional (2D) echocardiography (2DE) scores have many limitations. Three-dimensional (3D) echocardiography (3DE)-based scores were developed for better patient selection and outcome prediction. We aimed to compare between 3D-Anwar and 2D-Wilkins scores in mitral assessment for BMV, and investigate the additive value of 3DE in prediction of immediate post-procedural outcome. Fifty patients with rheumatic mitral stenosis and candidates for BMV were included. Patients were subjected to 2D- and real-time 3D-transthoracic echocardiography (TTE) before and immediately after BMV for assessing MV area (MVA), 2D-Wilkins and 3D-Anwar score, commissural splitting, and mitral regurgitation (MR). Transesophageal echocardiography (TEE) was also undertaken immediately before and intra-procedural. Percutaneous BMV was performed by either multi-track or Inoue balloon technique. Results The 2DE underestimated post-procedural MVA than 3DE (p = 0.008). Patients with post-procedural suboptimal MVA or significant MR had higher 3D-Anwar score compared to 2D-Wilkins score (p = 0.008 and p = 0.03 respectively). The 3D-Anwar score showed a negative correlation with post-procedural MVA (r = − 0.48, p = 0.001). Receiver operating characteristic (ROC) curve analysis for both scores revealed superior prediction of suboptimal results by 3D-Anwar score (p < 0.0001). The 3DE showed better post-procedural posterior-commissural splitting than 2DE (p = 0.004). Results of both multi-track and Inoue balloon were comparable except for favorable posterior-commissural splitting by multi-track balloon (p = 0.04). Conclusion The 3DE gave valuable additive data before BMV that may predict immediate post-procedural outcome and suboptimal results. Electronic supplementary material The online version of this article (10.1186/s43044-019-0019-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hazem M A Farrag
- Cardiology Department, Faculty of Medicine, Minia University, Minya, 61111, Egypt.
| | - Amr M Setouhi
- Cardiology Department, Faculty of Medicine, Minia University, Minya, 61111, Egypt
| | - Mustafa O El-Mokadem
- Cardiology Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | | | - Khalid S Mahmoud
- Cardiology Department, Faculty of Medicine, Minia University, Minya, 61111, Egypt
| | - Hesham B Mahmoud
- Cardiology Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Alaa M Ibrahim
- Cardiology Department, Faculty of Medicine, Minia University, Minya, 61111, Egypt
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Nunes MCP, Nascimento BR, Lodi-Junqueira L, Tan TC, Athayde GRS, Hung J. Update on percutaneous mitral commissurotomy. Heart 2016; 102:500-7. [PMID: 26743926 DOI: 10.1136/heartjnl-2015-308091] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/02/2015] [Indexed: 11/04/2022] Open
Abstract
Percutaneous mitral commissurotomy (PMC) is the first-line therapy for managing rheumatic mitral stenosis. Over the past two decades, the indications of the procedure have expanded to include patients with unfavourable valve anatomy as a consequence of epidemiological changes in patient population. The procedure is increasingly being performed in patients with increased age, more deformed valves and associated comorbidities. Echocardiography plays a crucial role in patient selection and to guide a more efficient procedure. The main echocardiographic predictors of immediate results after PMC are mitral valve area, subvalvular thickening and valve calcification, especially at the commissural level. However, procedural success rate is not only dependent on valve anatomy, but a number of other factors including patient characteristics, interventional management strategies and operator expertise. Severe mitral regurgitation continues to be the most common immediate procedural complication with unchanged incidence rates over time. The long-term outcome after PMC is mainly determined by the immediate procedural results. Postprocedural parameters associated with late adverse events include mitral valve area, mitral regurgitation severity, mean gradient and pulmonary artery pressure. Mitral restenosis is an important predictor of event-free survival rates after successful PMC, and repeat procedure can be considered in cases with commissural refusion. PMC can be performed in special situations, which include high-risk patients, during pregnancy and in the presence of left atrial thrombus, especially in centres with specialised expertise. Therefore, procedural decision-making should take into account the several determinant factors of PMC outcomes. This paper provides an overview and update of PMC techniques, complications, immediate and long-term results over time, and assessment of suitability for the procedure.
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Affiliation(s)
- Maria Carmo P Nunes
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruno Ramos Nascimento
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Lodi-Junqueira
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, University of Western Sydney, Sydney, New South Wales, Australia
| | | | - Judy Hung
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Bouleti C, Iung B, Himbert D, Messika-Zeitoun D, Brochet E, Garbarz E, Cormier B, Vahanian A. Relationship Between Valve Calcification and Long-Term Results of Percutaneous Mitral Commissurotomy for Rheumatic Mitral Stenosis. Circ Cardiovasc Interv 2014; 7:381-9. [DOI: 10.1161/circinterventions.113.000858] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Claire Bouleti
- From the Department of Cardiology, Assistance Publique–Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France
| | - Bernard Iung
- From the Department of Cardiology, Assistance Publique–Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France
| | - Dominique Himbert
- From the Department of Cardiology, Assistance Publique–Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France
| | - David Messika-Zeitoun
- From the Department of Cardiology, Assistance Publique–Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France
| | - Eric Brochet
- From the Department of Cardiology, Assistance Publique–Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France
| | - Eric Garbarz
- From the Department of Cardiology, Assistance Publique–Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France
| | - Bertrand Cormier
- From the Department of Cardiology, Assistance Publique–Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France
| | - Alec Vahanian
- From the Department of Cardiology, Assistance Publique–Hôpitaux de Paris, Bichat Hospital, Paris-Diderot University, Paris, France
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9
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Andrawes MN, Feinman JW. 3-dimensional echocardiography and its role in preoperative mitral valve evaluation. Cardiol Clin 2014; 31:271-85. [PMID: 23743077 DOI: 10.1016/j.ccl.2013.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Echocardiography plays a key role in the preoperative evaluation of mitral valve disease. 3-dimensional echocardiography is a relatively new development that is being used more and more frequently in the evaluation of these patients. This article reviews the available literature comparing the use of this new technology to classic techniques in the assessment of mitral valve pathology. The authors also review some of the novel insights learned from 3-dimensional echocardiography and how they may be used in surgical decision making and planning.
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Affiliation(s)
- Michael N Andrawes
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Wunderlich NC, Beigel R, Siegel RJ. Management of Mitral Stenosis Using 2D and 3D Echo-Doppler Imaging. JACC Cardiovasc Imaging 2013; 6:1191-205. [DOI: 10.1016/j.jcmg.2013.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/03/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
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Eng MH, Salcedo EE, Kim M, Quaife RA, Carroll JD. Implementation of real-time three-dimensional transesophageal echocardiography for mitral balloon valvuloplasty. Catheter Cardiovasc Interv 2013; 82:994-8. [DOI: 10.1002/ccd.25052] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/23/2013] [Accepted: 06/01/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Marvin H. Eng
- Department of Medicine, Division of Cardiology, University of Texas Health Sciences Center; San Antonio Texas
| | - Ernesto E. Salcedo
- Department of Medicine, Division of Cardiology, University of Colorado Denver; Aurora Colorado
| | - Michael Kim
- Department of Medicine, Division of Cardiology, University of Colorado Denver; Aurora Colorado
| | - Robert A. Quaife
- Department of Medicine, Division of Cardiology, University of Colorado Denver; Aurora Colorado
| | - John D. Carroll
- Department of Medicine, Division of Cardiology, University of Colorado Denver; Aurora Colorado
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Abstract
Percutaneous cardiac valve interventions have significantly extended the therapeutic options for patients with diseased cardiac valves. Technical miniaturization and major advancements in cardiac imaging techniques are the cornerstones of this successful development. Regarding mitral valve interventions periprocedural echocardiography in particular is of uttermost importance. This review describes the state of the art echocardiographic imaging techniques focusing on the clinically established mitral valve interventions: MitraClip® implantation, percutaneous closure of periprosthetic leaks and mitral balloon valvuloplasty.
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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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Eleid MF, Nishimura RA, Lennon RJ, Sorajja P. Left ventricular diastolic dysfunction in patients with mitral stenosis undergoing percutaneous mitral balloon valvotomy. Mayo Clin Proc 2013; 88:337-44. [PMID: 23398813 DOI: 10.1016/j.mayocp.2012.11.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 11/05/2012] [Accepted: 11/21/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the effect of left ventricular diastolic dysfunction on outcome in patients with mitral stenosis undergoing percutaneous mitral balloon valvotomy (PMBV). PATIENTS AND METHODS We evaluated consecutive patients with mitral stenosis who underwent PMBV from November 1, 2002, through October 30, 2011, at our institution. RESULTS Of 107 total patients, 35 (32.7%) had diastolic dysfunction, defined as a preprocedural elevation in left ventricular end-diastolic pressure (LVEDP) (>15 mm Hg). The LVEDP was normal in the remaining 72 patients (≤ 15 mm Hg). Clinical factors associated with diastolic dysfunction were body mass index (32 ± 7 vs 28 ± 5; P=.004) and diabetes mellitus (29% vs 6%; P=.002), but no differences were found in severity of pulmonary hypertension or degree of improvement in mitral valve hemodynamics after PMBV between the 2 groups. Survival free of recurrent severe symptoms, repeated PMBV, or mitral valve replacement was worse in patients with elevated LVEDP vs normal LVEDP (1-year estimate, 42% vs 81%; hazard ratio, 2.83; 95% CI, 1.62-4.96). CONCLUSION In patients referred for treatment of symptomatic mitral stenosis, left ventricular diastolic dysfunction may contribute to elevated left atrial pressure, and its presence is associated with a greater risk of failure of PMBV to improve symptoms. These data have implications for counseling and patient selection for PMBV.
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Affiliation(s)
- Mackram F Eleid
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Krapf L, Dreyfus J, Cueff C, Lepage L, Brochet É, Vahanian A, Messika-Zeitoun D. Anatomical features of rheumatic and non-rheumatic mitral stenosis: Potential additional value of three-dimensional echocardiography. Arch Cardiovasc Dis 2013; 106:111-5. [DOI: 10.1016/j.acvd.2012.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 10/10/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022]
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Sadaka M, Elsharkawy E, Ali R, Rashwan M. The impact of commissural morphology on clinical outcome in patients undergoing percutaneous balloon mitral valvuloplasty. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2012.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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18
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Cavalcante JL, Rodriguez LL, Kapadia S, Tuzcu EM, Stewart WJ. Role of Echocardiography in Percutaneous Mitral Valve Interventions. JACC Cardiovasc Imaging 2012; 5:733-46. [DOI: 10.1016/j.jcmg.2012.03.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 03/15/2012] [Accepted: 03/16/2012] [Indexed: 12/27/2022]
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New Scores for the Assessment of Mitral Stenosis Using Real-Time Three-Dimensional Echocardiography. CURRENT CARDIOVASCULAR IMAGING REPORTS 2011; 4:370-377. [PMID: 21949566 PMCID: PMC3165135 DOI: 10.1007/s12410-011-9099-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nonsurgical management of patients with symptomatic mitral valve stenosis has been established as the therapeutic modality of choice for two decades. Catheter-based balloon dilation of the stenotic valvular area has been shown, at least, as effective as surgical interventions. Unfavorable results of catheter-based interventions are largely due to unfavorable morphology of the valve apparatus, particularly leaflets calcification and subvalvular apparatus involvement. A mitral valve score has been proposed in Boston, MA, about two decades ago, based on morphologic assessment of mitral valve apparatus by two-dimensional (2D) echocardiography to predict successful balloon dilation of the mitral valve. Several other scores have been developed in the following years in order to more successfully predict balloon dilatation outcome. However, all those scores were based on 2D echocardiography, which is limited by ability to distinguish calcification and subvalvular involvement. The introduction of new matrix-based ultrasound probe has allowed 3D echocardiography (3DE) to provide more detailed morphologic analysis of mitral valve apparatus including calcification and subvalvular involvement. Recently, a new 3DE scoring system has been proposed by our group, which represents an important leap into refinement of the use of echocardiography guiding mitral valve interventions.
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Schlosshan D, Aggarwal G, Mathur G, Allan R, Cranney G. Real-Time 3D Transesophageal Echocardiography for the Evaluation of Rheumatic Mitral Stenosis. JACC Cardiovasc Imaging 2011; 4:580-8. [DOI: 10.1016/j.jcmg.2010.12.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 11/08/2010] [Accepted: 12/02/2010] [Indexed: 11/29/2022]
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Rahimtoola SH. The Year in Valvular Heart Disease. J Am Coll Cardiol 2010; 55:1729-42. [DOI: 10.1016/j.jacc.2010.02.003] [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: 10/13/2009] [Revised: 12/03/2009] [Accepted: 02/01/2010] [Indexed: 10/19/2022]
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Aguilar-Torres R, Gómez de Diego JJ, Forteza-Albert JF, Vivancos-Delgado R. Actualización en técnicas de imagen cardiaca: ecocardiografía, cardiorresonancia y tomografía computarizada. Rev Esp Cardiol 2010; 63 Suppl 1:116-31. [DOI: 10.1016/s0300-8932(10)70145-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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23
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Messika-Zeitoun D, Blanc J, Iung B, Brochet E, Cormier B, Himbert D, Vahanian A. Reply. JACC Cardiovasc Imaging 2009. [DOI: 10.1016/j.jcmg.2009.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Gill EA, Kim MS, Carroll JD. 3D TEE for Evaluation of Commissural Opening Before and During Percutaneous Mitral Commissurotomy. JACC Cardiovasc Imaging 2009; 2:1034-5; author reply 1035-6. [DOI: 10.1016/j.jcmg.2009.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 05/26/2009] [Indexed: 11/26/2022]
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25
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Hilliard AA, Nishimura RA. The Interventional Cardiologist and Structural Heart Disease. JACC Cardiovasc Imaging 2009; 2:8-10. [DOI: 10.1016/j.jcmg.2008.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 08/17/2008] [Indexed: 10/21/2022]
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