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Schmidt FP, Geyer M, Sotiriou E, Ardic Y, Sadegh P, Schulz E, Münzel T, von Bardeleben RS. Guideline-endorsed follow-up after percutaneous valve therapies-non-attendance of TAVI and MitraClip patients. Herz 2024:10.1007/s00059-024-05245-2. [PMID: 38743296 DOI: 10.1007/s00059-024-05245-2] [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: 10/07/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Percutaneous valve therapies (PVT) are performed on a large number of patients. With increasing procedural volume, the need for follow-up has also increased. Follow-up in the heart valve clinic is endorsed by recent guidelines but utilization is unknown, making resource allocation in the clinic difficult. Central follow-up in valve centers may not be feasible for all patients in the future. METHODS In our center, follow-up for PVT patients is scheduled at 1 month and 12 months after the index procedure. Patients are reminded of their appointment by invitation letters or phone calls. We analyzed 150 consecutive patients who underwent transcutaneous aortic valve implantation (TAVI) and MitraClip implantation (n = 300) at our center. RESULTS At 1 month, 72.7% of patients attended their follow-up, while at 12 months the rate dropped to 58%. Patients who underwent TAVI were older than the MitraClip patients (82.7 vs. 76.1 years) but had lower mean logEuroSCORE (22.6% vs. 25.9%). There was no significant difference in 1‑year mortality between TAVI and MitraClip patients (20% vs. 17.3%). By contrast, the rate of missed follow-up visits was higher for TAVI compared to MitraClip patients (52% vs. 33.3%; p = 0.002). Female patients less frequently attended follow-up (p = 0.005), whereas age, EuroSCORE, NYHA class, ejection fraction, and health status (EQ-5DVAS) were not predictors of attendance in multivariable analysis. Although the result of the EQ-5D assessment was not associated with mortality or attendance, completing the questionnaire was associated with overall survival (p < 0.001). CONCLUSION In our heart valve clinic, we observed a high percentage of missed follow-up appointments (42% at 12 months) despite a structured follow-up plan. Factors significantly associated with non-attendance in multivariable analysis were female gender and having a TAVI rather than MitraClip. Future follow-up concepts should take such findings into account, and decentralized approaches need to be explored.
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Affiliation(s)
- Frank Patrick Schmidt
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany.
- Inneren Medizin 3, Klinikum Mutterhaus der Borromäerinnen, Feldstr. 16, 54290, Trier, Germany.
| | - Martin Geyer
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Efthymios Sotiriou
- Inneren Medizin 3, Klinikum Mutterhaus der Borromäerinnen, Feldstr. 16, 54290, Trier, Germany
| | - Yasemin Ardic
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Pantea Sadegh
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | | | - Thomas Münzel
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
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Garzia S, Capellini K, Gasparotti E, Pizzuto D, Spinelli G, Berti S, Positano V, Celi S. Three-Dimensional Multi-Modality Registration for Orthopaedics and Cardiovascular Settings: State-of-the-Art and Clinical Applications. SENSORS (BASEL, SWITZERLAND) 2024; 24:1072. [PMID: 38400229 PMCID: PMC10891817 DOI: 10.3390/s24041072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
The multimodal and multidomain registration of medical images have gained increasing recognition in clinical practice as a powerful tool for fusing and leveraging useful information from different imaging techniques and in different medical fields such as cardiology and orthopedics. Image registration could be a challenging process, and it strongly depends on the correct tuning of registration parameters. In this paper, the robustness and accuracy of a landmarks-based approach have been presented for five cardiac multimodal image datasets. The study is based on 3D Slicer software and it is focused on the registration of a computed tomography (CT) and 3D ultrasound time-series of post-operative mitral valve repair. The accuracy of the method, as a function of the number of landmarks used, was performed by analysing root mean square error (RMSE) and fiducial registration error (FRE) metrics. The validation of the number of landmarks resulted in an optimal number of 10 landmarks. The mean RMSE and FRE values were 5.26 ± 3.17 and 2.98 ± 1.68 mm, respectively, showing comparable performances with respect to the literature. The developed registration process was also tested on a CT orthopaedic dataset to assess the possibility of reconstructing the damaged jaw portion for a pre-operative planning setting. Overall, the proposed work shows how 3D Slicer and registration by landmarks can provide a useful environment for multimodal/unimodal registration.
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Affiliation(s)
- Simone Garzia
- BioCardioLab, Bioengineering Unit, Fondazione Toscana G. Monasterio, 54100 Massa, Italy; (S.G.); (K.C.); (E.G.); (V.P.)
- Department of Information Engineering, University of Pisa, 56122 Pisa, Italy;
| | - Katia Capellini
- BioCardioLab, Bioengineering Unit, Fondazione Toscana G. Monasterio, 54100 Massa, Italy; (S.G.); (K.C.); (E.G.); (V.P.)
| | - Emanuele Gasparotti
- BioCardioLab, Bioengineering Unit, Fondazione Toscana G. Monasterio, 54100 Massa, Italy; (S.G.); (K.C.); (E.G.); (V.P.)
| | - Domenico Pizzuto
- Department of Information Engineering, University of Pisa, 56122 Pisa, Italy;
| | - Giuseppe Spinelli
- Maxillofacial Surgery Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Firenze, Italy;
| | - Sergio Berti
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana G. Monasterio, 54100 Massa, Italy;
| | - Vincenzo Positano
- BioCardioLab, Bioengineering Unit, Fondazione Toscana G. Monasterio, 54100 Massa, Italy; (S.G.); (K.C.); (E.G.); (V.P.)
| | - Simona Celi
- BioCardioLab, Bioengineering Unit, Fondazione Toscana G. Monasterio, 54100 Massa, Italy; (S.G.); (K.C.); (E.G.); (V.P.)
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Izumi Y, Kagiyama N, Maekawara S, Terada M, Higuchi R, Saji M, Takamisawa I, Nanasato M, Isobe M. Transcatheter edge-to-edge mitral valve repair with extended clip arms for ventricular functional mitral regurgitation. J Cardiol 2023; 82:240-247. [PMID: 37116648 DOI: 10.1016/j.jjcc.2023.04.014] [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: 12/14/2022] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND The new sizing options of the MitraClip system (Abbott Vascular, Abbott Park, IL, USA) with extended clip arms were recently developed. Its applicability and effectiveness for ventricular functional mitral regurgitation (VFMR) are yet to be investigated. METHODS We retrospectively reviewed consecutive patients with symptomatic VFMR who underwent transcatheter edge-to-edge repair between 2018 and 2022 at the Sakakibara Heart Institute. Pre- and post-procedural mitral valve morphologies were assessed using three-dimensional transesophageal echocardiography. RESULTS In a total of 104 VFMR patients, the posterior mitral leaflet length was 12.8 ± 2.8 mm and 92 % was indicative of the extended arm (≥9 mm). Although baseline VFMR was more severe in the patients treated with the extended arms (n = 35, XT group) than the patients treated with the standard arms (n = 69, NT group), the decrease in VFMR was greater in the XT group (delta three-dimensional vena contracta area - 43 ± 33 mm2 vs. -31 ± 22 mm2, p = 0.030) and residual VFMR was similar between the groups, with a significantly greater reduction in the mitral annulus anterior-posterior diameter (-4.9 ± 2.2 mm vs -3.1 ± 2.1 mm, p < 0.001) and mitral annulus area in the XT group. The use of extended arms was independently associated with shorter procedure time (81 ± 26 min vs 108 ± 41 min) after adjustment for device generation and the number of clips (p = 0.017). CONCLUSIONS Most VFMR patients had enough leaflet lengths for transcatheter edge-to-edge repair using the MitraClip with the extended arms, which was associated with shorter procedure time and a greater decrease in the mitral annular size.
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Affiliation(s)
- Yuki Izumi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | | | - Mai Terada
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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Deferm S, Bertrand PB, Dhont S, von Bardeleben RS, Vandervoort PM. Arrythmia-Mediated Valvular Heart Disease. Heart Fail Clin 2023; 19:357-377. [PMID: 37230650 DOI: 10.1016/j.hfc.2023.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aging population is rising at record pace worldwide. Along with it, a steep increase in the prevalence of atrial fibrillation and heart failure with preserved ejection fraction is to be expected. Similarly, both atrial functional mitral and tricuspid regurgitation (AFMR and AFTR) are increasingly observed in daily clinical practice. This article summarizes all current evidence regarding the epidemiology, prognosis, pathophysiology, and therapeutic options. Specific attention is addressed to discern AFMR and AFTR from their ventricular counterparts, given their different pathophysiology and therapeutic needs.
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Affiliation(s)
- Sébastien Deferm
- Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; Department of Cardiology, Mainz University Hospital, Langenbeckstraße 1, Mainz, Germany. https://twitter.com/S_Deferm
| | - Philippe B Bertrand
- Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; Department of Cardiology, Hospital Oost-Limburg Genk, Schiepse Bos 6, 3600 Genk, Belgium. https://twitter.com/Ph_Bertrand
| | - Sebastiaan Dhont
- Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; Department of Cardiology, Hospital Oost-Limburg Genk, Schiepse Bos 6, 3600 Genk, Belgium. https://twitter.com/S_Dhont
| | - Ralph S von Bardeleben
- Department of Cardiology, Mainz University Hospital, Langenbeckstraße 1, Mainz, Germany. https://twitter.com/vonbardelebenRS
| | - Pieter M Vandervoort
- Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; Department of Cardiology, Hospital Oost-Limburg Genk, Schiepse Bos 6, 3600 Genk, Belgium.
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Paukovitsch M, Felbel D, Jandek M, Keßler M, Rottbauer W, Markovic S, Groeger M, Tadic M, Schneider LM. Transcatheter edge-to-edge-repair of functional mitral regurgitation induces significant remodeling of mitral annular geometry. Front Cardiovasc Med 2023; 10:1143702. [PMID: 37424917 PMCID: PMC10326617 DOI: 10.3389/fcvm.2023.1143702] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/23/2023] [Indexed: 07/11/2023] Open
Abstract
Background Mitral annular alterations in the context of heart failure often lead to severe functional mitral regurgitation (FMR), which should be treated with transcatheter edge-to-edge repair (M-TEER) according to current guidelines. M-TEER's effects on mitral valve (MV) annular remodeling have not been well elucidated. Methods 141 consecutive patients undergoing M-TEER for treatment of FMR were included in this investigation. Comprehensive intraprocedural transesophageal echocardiography was used to assess the acute effects of M-TEER on annular geometry. Results Average patient age was 76.2 ± 9.6 years and 46.1% were female patients. LV ejection fraction was reduced (37.0% ± 13.7%) and all patients had mitral regurgitation (MR) grade ≥III. M-TEER achieved optimal MR reduction (MR ≤ I) in 78.6% of patients. Mitral annular anterior-posterior diameters (A-Pd) were reduced by -6.2% ± 9.5% on average, whereas anterolateral-posteromedial diameters increased (3.7% ± 8.9%). Overall, a reduction in MV annular areas was observed (2D: -1.8% ± 13.1%; 3D: -2.7% ± 13.7%), which strongly correlated with A-Pd reduction (2D: r = 0.6, p < 0.01; 3D: r = 0.65, p < 0.01). Patients that achieved A-Pd reduction above the median (≥6.3%) showed significantly lower rates of the composite endpoint rehospitalization for heart failure or all-cause mortality than those with less A-Pd reduction (9.9% vs. 28.6%, p = 0.037, log-rank p = 0.039). Furthermore, patients reaching the composite endpoint had an increase in annular area (2D: 3.0% ± 15.4%; 3D: 1.9% ± 15.3%), whereas those not reaching the endpoint showed a decrease (2D: -2.7% ± 12.4%; 3D: -3.6% ± 13.3%), although residual MR after M-TEER was similar between these groups (p = 0.57). In multivariate Cox regression adjusted for baseline MR, A-Pd reduction ≥6.3% remained a significant predictor of the combined endpoint (OR: 0.35, 95% CI: 0.14-0.85, p = 0.02). Conclusion Our findings indicate that effects of M-TEER in FMR are not limited to MR reduction, but also have significant impact on annular geometry. Moreover, A-Pd reduction, which mediates annular remodeling, has a significant impact on clinical outcome independent of residual MR.
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Eqbal A, Gupta S, Fam N, Ong G, Bisleri G. The impact of transcatheter edge-to-edge repair on mitral valve annular geometry. Curr Opin Cardiol 2022; 37:150-155. [PMID: 35058414 DOI: 10.1097/hco.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Mitral valve transcatheter edge-to-edge repair (TEER) is becoming increasingly common to treat severe mitral regurgitation. However, the lack of concomitant annuloplasty raises concerns regarding its durability. As a result, there is an emerging body of literature evaluating the impacts of TEER on mitral annular geometry. In this review, we summarize the most recent literature evaluating the impacts of TEER on annular geometry in the acute, intermediate and long-term. We also review the relationship between changes in annular geometry and clinical endpoints. RECENT FINDINGS Current evidence suggests that TEER acutely induces favourable changes in mitral annular size and shape, which may persist for at least up to 1 year. Few studies suggest that TEER-induced annular remodelling is associated with positive clinical outcomes. SUMMARY The current body of literature is sparse and limited to primarily small case series. Data from the surgical literature suggest that ringless edge-to-edge repair is associated with eventual failure. Unfortunately, few studies evaluate TEER-induced annular changes beyond the acute postprocedural phase. Future research needs to focus on and evaluate the significance of TEER-induced changes in annular dimensions in the long-term.
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Affiliation(s)
- Adam Eqbal
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton
| | - Saurabh Gupta
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton
| | - Neil Fam
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Géraldine Ong
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gianluigi Bisleri
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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7
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Tusa MB, Barletta M, Popolo Rubbio A, Travaglio N, Saffioti S, Granata G, Mantovani V, Stefanini E, Corciu AI, Testa L, Bedogni F. Acute changes in mitral valve geometry after percutaneous valve repair with MitraClip XT R by three-dimensional echocardiography. Echocardiography 2021; 38:1913-1923. [PMID: 34755379 DOI: 10.1111/echo.15238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/13/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mitral valve (MV) repair with MitraClip system is a safe treatment option for high-risk patients with significant mitral regurgitation (MR). We aimed to characterize, by three-dimensional echocardiography (3D-E), changes occurring in MV after implantation of third generation MitraClip XTR device, with specific reference to the underlying MR mechanism (functional vs degenerative, FMR vs DMR). METHODS We prospectively enrolled 59 patients, who underwent intra-procedural 3D-E before and after device deployment. Three-D datasets were analyzed off-line, using a dedicated semiautomatic software, to obtain parametric quantification of mitral anatomy. RESULTS Post-procedural MR of mild or lesser degree was achieved in 40 patients (68%), with no differences between FMR and DMR (p 0.9). After MitraClip XTR implantation, the FMR group experienced an immediate annular resizing, with reduction of antero-posterior diameter (p 0.024) and sphericity index (p 0.017), next to a recovery of physiological saddle-shape, defined by lower non-planar angle (p ≤0.001) and higher annulus height to commissural width ratio (p ≤0.001). On the opposite, the DMR group revealed a significant decrease of maximum annular velocity (p 0.027), addressing a mechanic effect of the device deployment. Finally, baseline anterior mitral leaflet angle was found as an independent predictor of acute procedural result (OR 6.7, [CI 1.01-44.33], p 0.049). CONCLUSIONS MitraClip XTR implantation acts in restoring the original mitral geometry, with distinctive effects according to MR mechanism. Three-D parametric quantification of MV sheds new light on changes occurring in the valvular apparatus, and helps identifying possible new predictors of acute procedural success.
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Affiliation(s)
- Maurizio B Tusa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marta Barletta
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Nicole Travaglio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Silvia Saffioti
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giuseppina Granata
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Valentina Mantovani
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Elisa Stefanini
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Anca I Corciu
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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8
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Kassar M, Praz F, Hunziker L, Pilgrim T, Windecker S, Seiler C, Brugger N. Anatomical and Technical Predictors of Three-Dimensional Mitral Valve Area Reduction After Transcatheter Edge-To-Edge Repair. J Am Soc Echocardiogr 2021; 35:96-104. [PMID: 34506920 DOI: 10.1016/j.echo.2021.08.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Among current transcatheter therapies for the treatment of mitral regurgitation, the MitraClip (MC; Abbott Vascular, Abbott Park, IL) system is the most commonly used. MitraClip implantation is usually contraindicated in patients with a mitral valve area (MVA) < 4.0 cm2. However, little is known about the real impact of MC implantation on MVA. Our goal was to investigate the factors influencing MVA reduction and derive the minimal MVA required to prevent the development of a clinically significant mitral stenosis (MVA < 1.5 cm2) in different clinical scenarios. METHODS Using three-dimensional data sets, the annulus and leaflet anatomy and MVA before clip implantation (MVABC) were assessed. After each MC implant (NTR or XTR), the relative MVA reduction and the absolute residual MVA were measured and their predictors evaluated. RESULTS The present analysis included 116 patients. An MC XTR was the first device implanted in 50% of the subjects, and 53% were treated with a single implant. The MVA reduction following one XTR was 57% ± 7% versus 52% ± 8% after one NTR (P = .001). A lower MVA reduction was observed when the MC was placed commissural/central versus paracentral (50% ± 8% vs 57% ± 7%, P < .0001). After a second device, the additional MVA reduction was higher when creating a triple-compared with a double-orifice morphology (34% ± 11% vs 25% ± 9%, P = .001). The MVA after one MC correlated with MVABC as well as with the clip type and position (r = 0.91, P < .0001). The MVABC, orifice morphology, and first device position predicted MVA after two implants (r = 0.82, P < .0001). Based on the mathematical relationship between these parameters, the minimal MVABC needed in eight different clinical scenarios was summarized in a decision algorithm: the values ranged from 3.5 to 4.7 cm2 for one and 4.5 to 6.3 cm2 for two MC strategies. CONCLUSIONS The minimal native MVA preventing clinically relevant MS after transcatheter edge-to-edge repair is predicted by the number and location of clip(s), orifice morphology, and device type. Based on these parameters, an algorithm has been derived to optimize patient selection and preprocedural planning.
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Affiliation(s)
- Mohammad Kassar
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Christian Seiler
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
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Kreidel F, Zaid S, Tamm AR, Ruf TF, Beiras-Fernandez A, Reinold J, Geyer M, da Rocha E Silva J, Schnitzler K, Michaela H, Münzel T, Tang GHL, von Bardeleben RS. Impact of Mitral Annular Dilation on Edge-to-Edge Therapy With MitraClip-XTR. Circ Cardiovasc Interv 2021; 14:e010447. [PMID: 34304600 DOI: 10.1161/circinterventions.120.010447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Syed Zaid
- Department of Cardiology, Westchester Medical Center, Valhalla, NY (S.Z.)
| | - Alexander R Tamm
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Tobias F Ruf
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Andres Beiras-Fernandez
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Jenny Reinold
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Martin Geyer
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Jaqueline da Rocha E Silva
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Katharina Schnitzler
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Hell Michaela
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, NY (G.H.L.T.)
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
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Recurrence of Functional Versus Organic Mitral Regurgitation After Transcatheter Mitral Valve Repair: Implications from Three-Dimensional Echocardiographic Analysis of Mitral Valve Geometry and Left Ventricular Dilation for a Point of No Return. J Am Soc Echocardiogr 2021; 34:744-756. [DOI: 10.1016/j.echo.2021.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 11/21/2022]
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Changes in mitral valve geometry after percutaneous valve repair with the MitraClip® System. Int J Cardiovasc Imaging 2021; 37:1577-1585. [PMID: 33433747 DOI: 10.1007/s10554-020-02137-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
The aim of our study was to assess the anatomical changes of the mitral valve apparatus after percutaneous repair with the MitraClip® system. We included consecutive patients who underwent MitraClip® implantation in our center. Patients were assessed by 2- and 3-dimensional transesophageal echocardiography, acquired before and immediately after MitraClip® implantation. Off-line images analysis was performed to assess mitral annular diameters (antero-posterior and inter-commisural), area and circumference. Mitral tenting distance, area and volume were evaluated for functional mitral regurgitation. Patients had a 2-dimensional transthoracic echocardiography at follow-up (8 months). 38 patients with successful results (residual mitral regurgitation grade ≤ II) were included. The anteroposterior annulus diameter (ADP) decreased (from 35 ± 5 to 28 ± 5 mm, p < 0.001) with smaller decreases in the annular area and circumference and in the inter-commissural diameter. Annular ellipticity improved. The reduction in APD and tenting distance was sustained at follow-up. Successful percutaneous mitral valve repair with the MitraClip® system induces a stable change in mitral valve geometry mainly at the ADP, suggesting a significant annuloplasty that contributes to the reduction of mitral regurgitation.
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Ruf TF, Kreidel F, Tamm AR, Geyer M, Hahad O, Zirbs JC, Schwidtal BL, Beiras-Fernandez A, Witte KK, Münzel T, von Bardeleben RS. Transcatheter indirect mitral annuloplasty induces annular and left atrial remodelling in secondary mitral regurgitation. ESC Heart Fail 2020; 7:1400-1408. [PMID: 32501644 PMCID: PMC7373883 DOI: 10.1002/ehf2.12710] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/14/2022] Open
Abstract
Aims Mitral annuloplasty using the Carillon Mitral Contour System (CMCS) reduces secondary mitral regurgitation (SMR) and leads to reverse left ventricular remodelling. The aim of this study was to evaluate the effect of the CMCS on the mitral valve annulus (MA) and left atrial volume (LAV). Methods and results We retrospectively evaluated the data of all patients treated with the CMCS at our centre. Using transthoracic echocardiography, MA diameters were assessed by measuring the anterolateral to posteromedial extend (ALPM) and the anterior to posterior (AP) dimensions, respectively. Also, LAV and left ventricular end‐diastolic volume (LVEDV) were assessed. Patients were examined at three time points: baseline, at 20–60 days (30dFUP), and at 9–15 months (1yFUP), using paired analysis. From July 2014 until March 2019, 75 cases of severe SMR were treated using CMCS. Cases in which other devices were used in combination (COMBO therapy, n = 35) or in which the device could not be implanted (implant failure, n = 3) were excluded, leaving 37 patients in the present analysis. Analysis at 30dFUP showed a significant reduction of 16% in the mean ALPM diameter (7.27 ± 5.40 mm) and 15% in the AP diameter (6.57 ± 5.33 mm). Analysis of LAV also showed a significant reduction of 21% (36.61 ± 82.67 mL), with no significant change in LVEDV. At 1yFUP, the reduction of both the mean ALPM diameter of 14% (6.24 ± 5.70 mm) and the mean AP diameter of 12% (5.46 ± 4.99 mm) remained significant and stable. The reduction in LAV was also maintained at 23% (37.03 ± 56.91 mL). LAV index was significantly reduced by 17% at 30dFUP (15.44 ± 40.98 mL/m2) and by 13% at 1yFUP (11.56 ± 31.87 mL/m2), respectively. LVEDV index showed no significant change at 30dFUP and a non‐significant 10% reduction at 1yFUP (17.75 ± 58.79 mL/m2). Conclusions The CMCS successfully treats symptomatic SMR with a stable reduction of not only the AP diameter of the MA, but the current study also demonstrates an additional reduction of the ALPM dimension at both 30dFUP and 1yFUP. We have also shown for the first time that LAV and LAV index are significantly reduced at both 30dFUP and 1yFUP and a non‐significant positive remodelling of the LVEDV. This positive left atrial remodelling has not been looked for and demonstrated in earlier randomized studies of CMCS.
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Affiliation(s)
- Tobias Friedrich Ruf
- Heart Valve Center Mainz, Center for Cardiology I, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Felix Kreidel
- Heart Valve Center Mainz, Center for Cardiology I, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Alexander Robert Tamm
- Heart Valve Center Mainz, Center for Cardiology I, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Martin Geyer
- Heart Valve Center Mainz, Center for Cardiology I, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Omar Hahad
- Heart Valve Center Mainz, Center for Cardiology I, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Julia Claudia Zirbs
- Heart Valve Center Mainz, Center for Cardiology I, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ben Luca Schwidtal
- Heart Valve Center Mainz, Center for Cardiology I, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Andres Beiras-Fernandez
- Heart Valve Center Mainz, Department of Heart and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Klaus K Witte
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Thomas Münzel
- Heart Valve Center Mainz, Center for Cardiology I, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Heart Valve Center Mainz, Center for Cardiology I, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Ge Z, Pan W, Zhou D, Li W, Wei L, Liu X, Pu Z, Shu X, Pan C, Ge J. Effect of a novel transcatheter edge-to-edge repair device on the three-dimensional geometry of mitral valve in degenerative mitral regurgitation. Catheter Cardiovasc Interv 2020; 97:177-185. [PMID: 32497395 DOI: 10.1002/ccd.29002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/11/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We sought to assess the acute intraprocedural effects of the ValveClamp system in DMR patients on the mitral valve (MV) three-dimensional (3D) geometry and the association of these effects with mitral regurgitation (MR) reduction. BACKGROUND Few data are available about the specific impact of transcatheter edge-to-edge repair in patients with degenerative mitral regurgitation (DMR). METHODS Thirty-five symptomatic patients (age 74.26 ± 6.61 years) with Grade 3 to 4+ degenerative MR underwent 3D transoesophageal echocardiography (TEE) during ValveClamp implantation. Volumetric data sets were retrospectively analyzed using mitral valve quantitative 3D modeling software. RESULTS Mitral valve annular anterior-posterior (AP) diameter decreased from 33.24 ± 4.03 to 31.12 ± 3.66 mm (p < .001), and prolapse height from 4.78 ± 2.19 to 2.32 ± 1.92 mm (p < .001), and total exposed leaflet area from 1,110.29 ± 224.21 mm2 to 1,013.44 ± 228.71 mm (p = .004). Accordingly, we observed a significant reduction of MR severity after ValveClamp implantation. Multivariable analysis revealed postprocedural MR reduction was associated with shortening in anterior-posterior diameter (coefficient 0.427, p = .008) and reduction in prolapse height (coefficient 0.369, p = .021). CONCLUSIONS ValveClamp implantation exerts an acute effect on the 3D MV geometry. Postprocedural reduction in AP diameter and reduction in prolapse height correlates with MR downgrading in patients with degenerative MR.
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Affiliation(s)
- Zhenyi Ge
- Department of Echocardiography, Shanghai Institute of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenzhi Pan
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Li
- Department of Echocardiography, Shanghai Institute of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lai Wei
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhaoxia Pu
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xianhong Shu
- Department of Echocardiography, Shanghai Institute of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cuizhen Pan
- Department of Echocardiography, Shanghai Institute of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
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Caballero A, Mao W, McKay R, Hahn RT, Sun W. A Comprehensive Engineering Analysis of Left Heart Dynamics After MitraClip in a Functional Mitral Regurgitation Patient. Front Physiol 2020; 11:432. [PMID: 32457650 PMCID: PMC7221026 DOI: 10.3389/fphys.2020.00432] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/08/2020] [Indexed: 12/14/2022] Open
Abstract
Percutaneous edge-to-edge mitral valve (MV) repair using MitraClip has been recently established as a treatment option for patients with heart failure and functional mitral regurgitation (MR), which significantly expands the number of patients that can be treated with this device. This study aimed to quantify the morphologic, hemodynamic and structural changes, and evaluate the biomechanical interaction between the MitraClip and the left heart (LH) complex of a heart failure patient with functional MR using a fluid-structure interaction (FSI) modeling framework. MitraClip implantation using lateral, central and double clip positions, as well as combined annuloplasty procedures were simulated in a patient-specific LH model that integrates detailed anatomic structures, incorporates age- and gender-matched non-linear elastic material properties, and accounts for mitral chordae tethering. Our results showed that antero-posterior distance, mitral annulus spherecity index, anatomic regurgitant orifice area, and anatomic opening orifice area decreased by up to 28, 39, 52, and 71%, respectively, when compared to the pre-clip model. MitraClip implantation immediately decreased the MR severity and improved the hemodynamic profile, but imposed a non-physiologic configuration and loading on the mitral apparatus, with anterior and posterior leaflet stress significantly increasing up to 210 and 145% during diastole, respectively. For this patient case, while implanting a combined central clip and ring resulted in the highest reduction in the regurgitant volume (46%), this configuration also led to mitral stenosis. Patient-specific computer simulations as used here can be a powerful tool to examine the complex device-host biomechanical interaction, and may be useful to guide device positioning for potential favorable clinical outcomes.
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Affiliation(s)
- Andrés Caballero
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Wenbin Mao
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Raymond McKay
- Division of Cardiology, The Hartford Hospital, Hartford, CT, United States
| | - Rebecca T. Hahn
- Division of Cardiology, Columbia University Medical Center, New York, NY, United States
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
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Kong F, Caballero A, McKay R, Sun W. Finite element analysis of MitraClip procedure on a patient-specific model with functional mitral regurgitation. J Biomech 2020; 104:109730. [DOI: 10.1016/j.jbiomech.2020.109730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
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16
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Cimino S, Maestrini V, Cantisani D, Petronilli V, Filomena D, Mancone M, Sardella G, Benedetti G, Fedele F, Agati L. Mid-term repair durability after MitraClip implantation in patients with functional mitral regurgitation. J Cardiovasc Med (Hagerstown) 2020; 20:701-708. [PMID: 31343448 DOI: 10.2459/jcm.0000000000000846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this study was to identify variables that are associated with the durability of percutaneous repair of secondary mitral regurgitation at 6-month follow-up. METHODS AND RESULTS Thirty-five consecutive patients with functional mitral regurgitation scheduled for MitraClip implant were enrolled. Left ventricular (LV) volumes and function and mitral valve characteristics were assessed before and immediately after MitraClip implantation using three-dimensional transesophageal echocardiography. Five patients with an unsuccessful procedure were excluded. The other patients were subdivided according to repair durability: group 1 with a durable repair (19 patients, 65%) and group 2 with significant mitral regurgitation recurrence (11 patients, 35%). At baseline, group 1 patients had smaller and more elliptical mitral valve annulus (1055 ± 241 vs. 1273 ± 359 mm, P = 0.02 and 125 ± 11 vs. 117 ± 16%, P = 0.02), a smaller left atrial volume (54.1 ± 26 vs. 71.5 ± 20 ml, P = 0.005) and lower systolic pulmonary artery pressure (38 ± 11 vs. 49 ± 12 mmHg, P = 0.03). Baseline LV end systolic volume had a linear correlation with the 3D annulus area (P = 0.048) and an inverse correlation with annulus ellipticity (P = 0.021). Group 1 patients showed an increase in annulus ellipticity after MitraClip (125 ± 17 vs. 141 ± 23%, P = 0.014). CONCLUSION Percutaneous mitral valve repair leads to a significant and stable mitral regurgitation reduction in a large number of patients. Annulus dimensions and remodeling as well as left atrial area and pulmonary hypertension seem to be associated with durability of the procedure.
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Melillo E, Godino C, Falasconi G, Ancona F, Stella S, Capogrosso C, Ancona M, Agricola E, Montorfano M. Acute Mitral Annular Remodeling After Percutaneous Repair With MitraClip: Annuloplasty-Like Effect. JACC Cardiovasc Interv 2019; 12:2432-2433. [PMID: 31326425 DOI: 10.1016/j.jcin.2019.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/02/2019] [Accepted: 05/21/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Enrico Melillo
- Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
| | - Cosmo Godino
- Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Falasconi
- Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Stella
- Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Capogrosso
- Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Ancona
- Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy
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Praz F, Windecker S. Two-year outcomes of the MITRA-FR trial: towards an integrated approach in the evaluation of patients with secondary mitral regurgitation. Eur J Heart Fail 2019; 21:1628-1631. [PMID: 31773876 DOI: 10.1002/ejhf.1652] [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: 11/10/2022] Open
Affiliation(s)
- Fabien Praz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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19
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Pleger ST, Geis N, Kreusser M, Abu-Sharar H, Sebening C, Szabo G, Katus HA, Raake PWJ. Percutaneous mitral valve repair in recurrent severe mitral valve regurgitation after mitral annuloplasty : MitraClip-in-the-ring as a complementary strategy. Herz 2019; 46:54-60. [PMID: 31773184 DOI: 10.1007/s00059-019-04868-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/02/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with reduced left ventricular (LV) function undergoing coronary artery bypass graft surgery or/and aortic valve replacement occasionally show severe mitral valve (MV) regurgitation and thus also undergo surgical mitral annuloplasty. Over time, further deterioration of LV function and additional ischemic events cause recurrence of severe MV regurgitation due to the Carpentier IIIb morphology of the MV that is not adequately addressed by the previously implanted annuloplasty ring. METHODS Seven patients (Society of Thoracic Surgeons score: 7.5 ± 1.5%) with Carpentier type-IIIb recurrent severe MV regurgitation, having undergone prior cardiothoracic surgery (median: 40 months) including mitral annuloplasty, were treated with the MitraClip device. RESULTS MitraClip implantation resulted in significantly reduced MV regurgitation and improved New York Heart Association functional state, translating into an increased exercise capability and improved cardiac biomarkers. The morphology of the MV was adequately addressed without causing relevant MV stenosis, while the MV annulus area remained unaltered. The procedure was safe with a 30-day mortality rate of 0%. CONCLUSION MitraClip-in-the-ring is feasible and in principle safe for treating Carpentier type IIIb severe MV regurgitation after surgical MV repair using mitral annuloplasty. MitraClip-in-the-ring resulted in immediate amelioration of clinical symptoms and increased physical exercise capacity.
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Affiliation(s)
- Sven T Pleger
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Nicolas Geis
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Michael Kreusser
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Haitham Abu-Sharar
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Christian Sebening
- Department of Cardiac Surgery, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Gabor Szabo
- Department of Cardiac Surgery, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Philip W J Raake
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Zhang Y, Wang VY, Morgan AE, Kim J, Handschumacher MD, Moskowitz CS, Levine RA, Ge L, Guccione JM, Weinsaft JW, Ratcliffe MB. Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation - A finite element modeling study. PLoS One 2019; 14:e0223472. [PMID: 31600276 PMCID: PMC6786765 DOI: 10.1371/journal.pone.0223472] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 09/23/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose MitraClip is the sole percutaneous device approved for functional mitral regurgitation (MR; FMR) but MR recurs in over one third of patients. As device-induced mechanical effects are a potential cause for MR recurrence, we tested the hypothesis that MitraClip increases leaflet stress and procedure-related strain in sub-valvular left ventricular (LV) myocardium in FMR associated with coronary disease (FMR-CAD). Methods Simulations were performed using finite element models of the LV + mitral valve based on MRI of 5 sheep with FMR-CAD. Models were modified to have a 20% increase in LV volume (↑LV_VOLUME) and MitraClip was simulated with contracting beam elements (virtual sutures) placed between nodes in the center edge of the anterior (AL) and posterior (PL) mitral leaflets. Effects of MitraClip on leaflet stress in the peri-MitraClip region of AL and PL, septo-lateral annular diameter (SLAD), and procedure-related radial strain (Err) in the sub-valvular myocardium were calculated. Results MitraClip increased peri-MitraClip leaflet stress at end-diastole (ED) by 22.3±7.1 kPa (p<0.0001) in AL and 14.8±1.2 kPa (p<0.0001) in PL. MitraClip decreased SLAD by 6.1±2.2 mm (p<0.0001) and increased Err in the sub-valvular lateral LV myocardium at ED by 0.09±0.04 (p<0.0001)). Furthermore, MitraClip in ↑LV_VOLUME was associated with persistent effects at ED but also at end-systole where peri-MitraClip leaflet stress was increased in AL by 31.9±14.4 kPa (p = 0.0268) and in PL by 22.5±23.7 kPa (p = 0.0101). Conclusions MitraClip for FMR-CAD increases mitral leaflet stress and radial strain in LV sub-valvular myocardium. Mechanical effects of MitraClip are augmented by LV enlargement.
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Affiliation(s)
- Yue Zhang
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Vicky Y. Wang
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Ashley E. Morgan
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Jiwon Kim
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America
| | - Mark D. Handschumacher
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Chaya S. Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Robert A. Levine
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Liang Ge
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Julius M. Guccione
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Jonathan W. Weinsaft
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America
| | - Mark B. Ratcliffe
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
- * E-mail:
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Nagaura T, Hayashi A, Yoshida J, Ikenaga H, Yamaguchi S, Utsunomiya H, Rader F, Siegel RJ, Kar S, Shiota T. Percutaneous Edge-to-Edge Repair for Atrial Functional Mitral Regurgitation. JACC Cardiovasc Imaging 2019; 12:1881-1883. [DOI: 10.1016/j.jcmg.2019.02.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/03/2019] [Accepted: 02/06/2019] [Indexed: 11/30/2022]
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22
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Kim J, Alakbarli J, Palumbo MC, Xie LX, Rong LQ, Tehrani NH, Brouwer LR, Devereux RB, Wong SC, Bergman GW, Khalique OK, Levine RA, Ratcliffe MB, Weinsaft JW. Left ventricular geometry predicts optimal response to percutaneous mitral repair via MitraClip: Integrated assessment by two- and three-dimensional echocardiography. Catheter Cardiovasc Interv 2019; 93:1152-1160. [PMID: 30790417 PMCID: PMC6537596 DOI: 10.1002/ccd.28147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/28/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To assess impact of left ventricular (LV) chamber remodeling on MitraClip (MClp) response. BACKGROUND MitraClip is the sole percutaneous therapy approved for mitral regurgitation (MR) but response varies. LV dilation affects mitral coaptation; determinants of MClp response are uncertain. METHODS LV and mitral geometry were quantified on pre- and post-procedure two-dimensional (2D) transthoracic echocardiography (TTE) and intra-procedural three-dimensional (3D) transesophageal echocardiography (TEE). Optimal MClp response was defined as ≤mild MR at early (1-6 month) follow-up. RESULTS Sixty-seven degenerative MR patients underwent MClp: Whereas MR decreased ≥1 grade in 94%, 39% of patients had optimal response (≤mild MR). Responders had smaller pre-procedural LV end-diastolic volume (94 ± 24 vs. 109 ± 25 mL/m2 , p = 0.02), paralleling smaller annular diameter (3.1 ± 0.4 vs. 3.5 ± 0.5 cm, p = 0.002), and inter-papillary distance (2.2 ± 0.7 vs. 2.5 ± 0.6 cm, p = 0.04). 3D TEE-derived annular area correlated with 2D TTE (r = 0.59, p < 0.001) and was smaller among optimal responders (12.8 ± 2.1 cm2 vs. 16.8 ± 4.4 cm2 , p = 0.001). Both 2D and 3D mitral annular size yielded good diagnostic performance for optimal MClp response (AUC 0.73-0.84, p < 0.01). In multivariate analysis, sub-optimal MClp response was associated with LV end-diastolic diameter (OR 3.10 per-cm [1.26-7.62], p = 0.01) independent of LA size (1.10 per-cm2 [1.02-1.19], p = 0.01); substitution of mitral annular diameter for LV size yielded an independent association with MClp response (4.06 per-cm2 [1.03-15.96], p = 0.045). CONCLUSIONS Among degenerative MR patients undergoing MClp, LV and mitral annular dilation augment risk for residual or recurrent MR, supporting the concept that MClp therapeutic response is linked to sub-valvular remodeling.
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Affiliation(s)
- Jiwon Kim
- Greenberg Cardiology Division, Weill Cornell Medicine (New York, New York)
| | - Javid Alakbarli
- Greenberg Cardiology Division, Weill Cornell Medicine (New York, New York)
| | | | - Lola X. Xie
- Division of Cardiology, Memorial Sloan Kettering Cancer Center (New York, New York)
| | - Lisa Q. Rong
- Greenberg Cardiology Division, Weill Cornell Medicine (New York, New York)
| | - Nathan H. Tehrani
- Greenberg Cardiology Division, Weill Cornell Medicine (New York, New York)
| | - Lillian R. Brouwer
- Greenberg Cardiology Division, Weill Cornell Medicine (New York, New York)
| | | | - Shing Chiu Wong
- Greenberg Cardiology Division, Weill Cornell Medicine (New York, New York)
| | | | - Omar K. Khalique
- Division of Cardiology, Columbia University Medical Center (New York, New York)
| | - Robert A. Levine
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School (Boston, MA)
| | - Mark B. Ratcliffe
- Department of Bioengineering, University of California, San Francisco, Veterans Affairs Medical Center (San Francisco, CA)
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Patzelt J, Zhang Y, Magunia H, Ulrich M, Jorbenadze R, Droppa M, Zhang W, Lausberg H, Walker T, Rosenberger P, Seizer P, Gawaz M, Langer HF. Improved mitral valve coaptation and reduced mitral valve annular size after percutaneous mitral valve repair (PMVR) using the MitraClip system. Eur Heart J Cardiovasc Imaging 2019; 19:785-791. [PMID: 28977372 DOI: 10.1093/ehjci/jex173] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/13/2017] [Indexed: 12/24/2022] Open
Abstract
Aims Improved mitral valve leaflet coaptation with consecutive reduction of mitral regurgitation (MR) is a central goal of percutaneous mitral valve repair (PMVR) with the MitraClip® system. As influences of PMVR on mitral valve geometry have been suggested before, we examined the effect of the procedure on mitral annular size in relation to procedural outcome. Methods and results Geometry of the mitral valve annulus was evaluated in 183 patients undergoing PMVR using echocardiography before and after the procedure and at follow-up. Mitral valve annular anterior-posterior (ap) diameter decreased from 34.0 ± 4.3 to 31.3 ± 4.9 mm (P < 0.001), and medio-lateral (ml) diameter from 33.2 ± 4.8 to 32.4 ± 4.9 mm (P < 0.001). Accordingly, we observed an increase in MV leaflet coaptation after PMVR. The reduction of mitral valve ap diameter showed a significant inverse correlation with residual MR. Importantly, the reduction of mitral valve ap diameter persisted at follow-up (31.3 ± 4.9 mm post PMVR, 28.4 ± 5.3 mm at follow-up). Conclusion This study demonstrates mechanical approximation of both mitral valve annulus edges with improved mitral valve annular coaptation by PMVR using the MitraClip® system, which correlates with residual MR in patients with MR.
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Affiliation(s)
- Johannes Patzelt
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Yingying Zhang
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Harry Magunia
- Department of Anaesthesiology, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Miriam Ulrich
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Rezo Jorbenadze
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Michal Droppa
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Wenzhong Zhang
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Henning Lausberg
- Department of Cardiovascular Surgery, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Tobias Walker
- Department of Cardiovascular Surgery, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Peter Rosenberger
- Department of Anaesthesiology, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Peter Seizer
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Harald F Langer
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
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Donmez E, Salcedo EE, Quaife RA, Burke JM, Gill EA, Carroll JD. The acute effects of edge‐to‐edge percutaneous mitral valve repair on the shape and size of the mitral annulus and its relation to mitral regurgitation. Echocardiography 2019; 36:732-741. [DOI: 10.1111/echo.14284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 12/28/2018] [Accepted: 01/24/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Esra Donmez
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
- Department of CardiologyTurkish Ministry of Health Bakirkoy Dr. Sadi Konuk Training and Research Hospital Bakirkoy, Istanbul Turkey
| | - Ernesto E. Salcedo
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - Robert A. Quaife
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - Joseph M. Burke
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - Edward A. Gill
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - John D. Carroll
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
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25
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Tang Z, Fan YT, Wang Y, Jin CN, Kwok KW, Lee APW. Mitral Annular and Left Ventricular Dynamics in Atrial Functional Mitral Regurgitation: A Three-Dimensional and Speckle-Tracking Echocardiographic Study. J Am Soc Echocardiogr 2019; 32:503-513. [PMID: 30679142 DOI: 10.1016/j.echo.2018.11.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with atrial fibrillation (AF) and left atrial (LA) enlargement may develop functional, normal leaflet motion mitral regurgitation (MR) without left ventricular (LV) remodeling. Mitral annular dynamics and LV mechanics are important for preserving normal mitral valve function. The aim of this study was to assess the annular and LV dynamics in patients with AF and functional MR. METHODS Twenty-one patients with AF with moderate or more MR (AFMR+ group), 46 matched patients with AF with no or mild MR (AFMR- group), and 19 normal patients were retrospectively studied. Mitral annular dynamics were quantitatively assessed using three-dimensional echocardiography. Systolic LV global longitudinal strain (GLS), global circumferential strain, and LA strain were measured using two-dimensional speckle-tracking echocardiography. RESULTS The normal annulus displayed presystolic followed by systolic contraction and increase in saddle shape (P < .01 for all). Presystolic annular dynamics were abolished in both groups of patients with AF (P > .05 vs normal). In contrast, systolic and total annular dynamics during the cardiac cycle were preserved in AFMR- patients (P > .10 vs normal) but impaired in AFMR+ patients (P < .05 vs normal and AFMR-). LV GLS (P < .0001) and LA strain (P = .02), but not LV global circumferential strain (P = .97), were impaired in AFMR+ compared with AFMR- patients despite comparable LA and LV volumes. MR severity correlated with systolic annular contraction (r = 0.64, P < .0001), saddle deepening (r = 0.53, P = .003), and LV GLS (r = 0.46, P < .0001). Multivariate analysis identified that impaired systolic contraction (odds ratio, 2.18; P = .001) and saddle deepening (odds ratio, 2.68; P = .04) were independently associated with MR. Excluding annular dynamics from the model, less negative LV GLS, but not LA strain, became associated with MR (odds ratio, 1.93; P < .0001). CONCLUSIONS In patients with AF and absent LA contraction, the normal predominantly "atriogenic" annular dynamics become "ventriculogenic." Isolated LA enlargement is insufficient to cause important MR without coexisting abnormal LV mechanics and annular dynamics during systole. "Atrial" functional MR may not be purely an atrial disorder.
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Affiliation(s)
- Zhe Tang
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Yi-Ting Fan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Yu Wang
- Cardiology Department, Chinese PLA General Hospital, Beijing, China
| | - Chun-Na Jin
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Noack T, Kiefer P, Mallon L, Lurz P, Bevilacqua C, Banusch J, Emrich F, Holzhey DM, Vannan M, Thiele H, Mohr FW, Borger MA, Ender J, Seeburger J. Changes in dynamic mitral valve geometry during percutaneous edge-edge mitral valve repair with the MitraClip system. J Echocardiogr 2018; 17:84-94. [PMID: 30291509 DOI: 10.1007/s12574-018-0398-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/27/2018] [Accepted: 09/25/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this study was to quantify the acute dynamic changes of mitral valve (MV) geometry throughout the cardiac cycle-during percutaneous MV repair with the MitraClip system by 3-dimensional transesophageal echocardiography (3D TEE). METHODS The MV was imaged throughout the cardiac cycle (CC) before and after the MitraClip procedure using 3D TEE in 28 patients (mean age, 77 ± 8 years) with functional mitral regurgitation (FMR). Dynamic changes in the MV annulus geometry and anatomical MV orifice area (AMVOA) were quantified using a novel semi-automated software. RESULTS Percutaneous MV repair decreased anterior-posterior diameter by up to 9% (at 50% of CC; from 34.5 to 31.9 mm; p < 0.001) throughout the CC and increased the diastolic lateral-medial diameter by up to 7% (at 60% of the CC; from 39.7 to 42.3 mm; p < 0.001), whereas the annular circumference and area were not significantly affected. Annulus sphericity index was reduced up to 13% (at 50% of the CC; from 0.89 to 0.78, p < 0.001). The AMVOA also decreased during systole, the maximum decrease being from 0.6 to 0.2 mm2 (at 0% of CC; p = 0.007), and during diastole the maximum decrease being from 4.6 to 1.6 cm2 (at 50% of CC; p < 0.001). CONCLUSIONS Percutaneous MV repair reduces the MR by an improved coaptation of MV leaflets joint with a simultaneous indirect reduction of anterior-posterior diameter. Further, the MitraClip procedure leads to a reduction of AMVOA of more than 60% during diastole.
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Affiliation(s)
- Thilo Noack
- Department of Cardiac Surgery, Heart Center Leipzig University, 04289, Leipzig, Germany.
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig University, 04289, Leipzig, Germany
| | - Linda Mallon
- Department of Cardiac Surgery, Heart Center Leipzig University, 04289, Leipzig, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig University, Leipzig, Germany
| | - Carmine Bevilacqua
- Division of Anesthesiology, Heart Center Leipzig University, Leipzig, Germany
| | - Joergen Banusch
- Division of Anesthesiology, Heart Center Leipzig University, Leipzig, Germany
| | - Fabian Emrich
- Department of Cardiac Surgery, Heart Center Leipzig University, 04289, Leipzig, Germany
| | - David M Holzhey
- Department of Cardiac Surgery, Heart Center Leipzig University, 04289, Leipzig, Germany
| | - Mani Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, USA
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig University, Leipzig, Germany
| | | | - Michael Andrew Borger
- Department of Cardiac Surgery, Heart Center Leipzig University, 04289, Leipzig, Germany
| | - Joerg Ender
- Division of Anesthesiology, Heart Center Leipzig University, Leipzig, Germany
| | - Joerg Seeburger
- Department of Cardiac Surgery, Heart Center Leipzig University, 04289, Leipzig, Germany
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27
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Mantegazza V, Pasquini A, Agati L, Fusini L, Muratori M, Gripari P, Ghulam Ali S, Vignati C, Bartorelli AL, Ferrari C, Alamanni F, Pepi M, Tamborini G. Comprehensive Assessment of Mitral Valve Geometry and Cardiac Remodeling With 3-Dimensional Echocardiography After Percutaneous Mitral Valve Repair. Am J Cardiol 2018; 122:1195-1203. [PMID: 30082038 DOI: 10.1016/j.amjcard.2018.06.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 01/01/2023]
Abstract
MitraClip is a validated treatment for significant mitral regurgitation (MR) in high-risk patients. Aims of the study were to evaluate immediate changes in mitral valve (MV) geometry induced by MitraClip and correlations between baseline geometry and cardiac remodeling. Eighty patients who underwent MitraClip for primary (48%) or secondary (52%) MR were enrolled. Intraoperative transesophageal echocardiographic 3D images were acquired immediately before and after the procedure for MV annulus (MVA) morphology analysis. Transthoracic 3D echocardiography was performed preoperatively and at 6 months follow-up (6MFU). Patients were classified on the basis of MR reduction (ΔMR) at 6MFU as Optimal (ΔMR ≥ 2) or Suboptimal (ΔMR < 2). An optimal result was reached in 60 (75%) patients, whereas 20 subjects showed a ΔMR< 2 at 6MFU. The Optimal showed significantly smaller baseline MVA (antero-posterior diameter 4.05 ± 0.59 vs 4.43 ± 0.68 cm; anterolateral-posteromedial diameter 4.38 ± 0.56 vs 4.70 ± 0.73 cm; MVA circumference 14.1 ± 1.7 vs 15.1 ± 2.3 cm; and 3D area 14.8 ± 3.9 vs 17.4 ± 5.3 cm2), lower sphericity index and nonplanar angle compared with Suboptimal. A value of antero-posterior diameter ≥4.44cm was identified (receiver-operating characteristic curve) as a possible cut-off for preoperative identification of Suboptimal patients. Postoperatively, MitraClip induced reduction of MVA flattening (nonplanar angle), sphericity index, and size (as expressed by antero-posterior diameter, MVA circumference and area). At 6MFU, the Optimal showed significant decrease in left ventricular volumes and pulmonary artery systolic pressure. In conclusion, MitraClip induces remarkable changes in MVA geometry and favorable left ventricular remodeling is detected in patients with optimal mid-term outcome; a preprocedural antero-posterior diameter <4.44cm seems to be a potential predictor of mid-term optimal result.
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28
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Liu XH, Shi JY, Feng XJ, Feng DC, Wang L, Pang HY, Xie HZ, Wang FF, Hsu J, Jia FW, Chen W. Short-term and 1-year outcomes after MitraClip therapy in functional versus degenerative mitral regurgitation patients: a systematic review and meta-analysis. J Thorac Dis 2018; 10:4156-4168. [PMID: 30174860 DOI: 10.21037/jtd.2018.06.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Differences in short-term and 1-year outcomes of percutaneous edge-to-edge mitral repair between patients with functional and degenerative mitral regurgitation (MR) remain unclear. We performed a systematic review and meta-analysis to investigate the safety and efficacy of MitraClip (MC) in patients with different MR etiologies. Methods This study systematically searched three common databases for studies on MC therapy until November 2017. The studies meeting the standard inclusion criteria were included. The data at baseline, short-term and 1-year clinical and echocardiographic outcomes were obtained and analyzed. All data were checked by another reviewer. Results Thirteen studies totalling 2,351 patients investigating the short-term and 1-year outcomes of MC in patients with functional MR (FMR) versus degenerative MR (DMR) were included for further analysis. FMR patients presented a higher risk profile at baseline. There was no difference in short-term outcomes between DMR and FMR for post-procedural MR grade 0-2 (76.8% vs. 77.1%; P=0.428), mean trans-mitral gradient (3.92 vs. 3.50 mmHg; P=0.098), 30-day mortality rate (0.05% vs. 0.03%; P=0.118) and 30-day NYHA I-II (85.3% vs. 78.7%; P=0.211). FMR patients had a higher rate of acute procedural success compared to the DMR patient group (91.2% vs. 95.2%; P=0.016). A greater portion of DMR patients implanted two or more MCs than the FMR patients (41.4% vs. 35.7%; P=0.043). For the 1-year outcomes, no difference was found in the mortality rate (13.0% vs. 15.2%; P=0.268) and proportion of patients with post-procedural MR grades 0-2 (75.0% vs. 80.7%; P=0.106). Conclusions Despite a higher risk profile in FMR patients, the short-term and 1-year outcomes were not significantly different. We conclude that MC therapy is similar between FMR and DMR patients until 1-year follow-up. Large randomized trials are warranted to fully and further assess the clinical impact of the procedure in these two MR etiologies over a longer period of time.
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Affiliation(s)
- Xiao-Hang Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jia-Yu Shi
- Department of Cardiology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Jiangsu 226001, China
| | - Xiao-Jin Feng
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Dong-Cai Feng
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Lin Wang
- Division of Cardiac imaging, St. Francis Hospital Heart Center, Long Island, NY, USA
| | - Hai-Yu Pang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100730, China
| | - Hong-Zhi Xie
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Fang-Fei Wang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jeffrey Hsu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Fu-Wei Jia
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Wei Chen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Utsunomiya H, Itabashi Y, Kobayashi S, Yoshida J, Ikenaga H, Rader F, Hussaini A, Makar M, Trento A, Siegel RJ, Kar S, Shiota T. Comparison of mitral valve geometrical effect of percutaneous edge-to-edge repair between central and eccentric functional mitral regurgitation: clinical implications. Eur Heart J Cardiovasc Imaging 2018; 20:455-466. [DOI: 10.1093/ehjci/jey117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/01/2018] [Accepted: 07/23/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hiroto Utsunomiya
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Yuji Itabashi
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Sayuki Kobayashi
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Jun Yoshida
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Hiroki Ikenaga
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Asma Hussaini
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Moody Makar
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Alfredo Trento
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Saibal Kar
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
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30
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Geis N, Raake P, Lewening M, Mereles D, Chorianopoulos E, Frankenstein L, Katus HA, Bekeredjian R, Pleger ST. Percutaneous repair of mitral valve regurgitation in patients with severe heart failure: comparison with optimal medical treatment. Acta Cardiol 2018; 73:378-386. [PMID: 29161956 DOI: 10.1080/00015385.2017.1401275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Occurrence of severe mitral valve (MV) regurgitation (MR) is an independent negative predictor of mortality in patients with severe systolic heart failure (HF). This study examines clinical effects and cardiac reverse remodelling in patients with severe systolic HF receiving percutaneous mitral valve repair (PMVR) using MitraClip in comparison to patients receiving optimal medical therapy only. METHODS Between 2010 and 2014, 86 patients (Society of Thoracic Surgeons score: 10.5% ± 1.2%) with severe HF (left ventricular [LV] ejection fraction; LVEF: 25% ± 2%; LV endsystolic diameter [LVESD]: 55 ± 3 mm) and severe MR received PMVR using MitraClip. Cardiac reverse remodelling and clinical parameters were compared to HF patients with severe MR (from our HF outpatient clinic; n = 69; LVEF: 26% ± 1.4%; LVESD: 53 ± 2 mm) receiving optimal medical therapy (OMT) only. All patients received stable OMT and were characterised by echocardiography, 6-minwalk-distance test and cardiac biomarkers within a 24 months observation period. RESULTS PMVR in patients with end-stage HF and severe MR resulted in reduction of MR and significant additional cardiac reverse remodelling (LVEF: 26 ± 1.4 vs. 33% ± 2%, p < .05; LVESD: 53 ± 2 vs. 47 ± 2 mm, p < .05) over the 24 months observation period as compared to pharmacologically-only managed comparators. CONCLUSIONS Both OMT and PMVR cause cardiac reverse remodelling and relief of symptoms in patients with HF and severe MR. PMVR results in significant additional cardiac reverse remodelling compared to pharmacologically-only managed patients.
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Affiliation(s)
- Nicolas Geis
- Department of Internal Medicine III, Division of Cardiology, Im Neuenheimer Feld 410, University of Heidelberg, Heidelberg, Germany
| | - Philip Raake
- Department of Internal Medicine III, Division of Cardiology, Im Neuenheimer Feld 410, University of Heidelberg, Heidelberg, Germany
| | - Markus Lewening
- Department of Internal Medicine III, Division of Cardiology, Im Neuenheimer Feld 410, University of Heidelberg, Heidelberg, Germany
| | - Derliz Mereles
- Department of Internal Medicine III, Division of Cardiology, Im Neuenheimer Feld 410, University of Heidelberg, Heidelberg, Germany
| | - Emmanuel Chorianopoulos
- Department of Internal Medicine III, Division of Cardiology, Im Neuenheimer Feld 410, University of Heidelberg, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Internal Medicine III, Division of Cardiology, Im Neuenheimer Feld 410, University of Heidelberg, Heidelberg, Germany
| | - Hugo A. Katus
- Department of Internal Medicine III, Division of Cardiology, Im Neuenheimer Feld 410, University of Heidelberg, Heidelberg, Germany
| | - Raffi Bekeredjian
- Department of Internal Medicine III, Division of Cardiology, Im Neuenheimer Feld 410, University of Heidelberg, Heidelberg, Germany
| | - Sven T. Pleger
- Department of Internal Medicine III, Division of Cardiology, Im Neuenheimer Feld 410, University of Heidelberg, Heidelberg, Germany
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Colli A, Besola L, Montagner M, Soriani N, Manzan E, Bizzotto E, Zucchetta F, Azzolina D, Bellu R, Sarais C, Pittarello D, Gerosa G. Acute intraoperative echocardiographic changes after transapical off-pump mitral valve repair with NeoChord implantation. Int J Cardiol 2018; 257:230-234. [DOI: 10.1016/j.ijcard.2018.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 11/22/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
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Different indicators for postprocedural mitral stenosis caused by single- or multiple-clip implantation after percutaneous mitral valve repair. J Cardiol 2018; 71:336-345. [DOI: 10.1016/j.jjcc.2017.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/04/2017] [Accepted: 10/18/2017] [Indexed: 01/11/2023]
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Herbrand T, Eschenhagen S, Zeus T, Kehmeier E, Hellhammer K, Veulemans V, Kelm M, Balzer J. Acute reverse annular remodeling during MitraClip ® therapy predicts improved clinical outcome in heart failure patients: a 3D echocardiography study. Eur J Med Res 2017; 22:33. [PMID: 28931437 PMCID: PMC5607606 DOI: 10.1186/s40001-017-0273-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 09/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transcatheter mitral valve repair (TMVR) has been shown to have acute effects on mitral valve geometry in patients with functional mitral regurgitation (FMR). This study investigates the impact of MitraClip® therapy-induced annular remodeling on clinical outcome and mitral regurgitation in heart failure patients. METHODS TMVR was performed successfully in 45 patients with FMR. In this study, mitral valve datasets were obtained before and directly after MitraClip® implantation using three-dimensional (3D) transesophageal echocardiography, and were analyzed offline retrospectively using dedicated 3D reconstruction software. Patients underwent clinical and echocardiographic evaluation at baseline and after 6 months. At follow-up, the patients were allocated into two groups according to their improvement in New York Heart Association (NYHA) functional class: a Low Responder group with ΔNYHA <1.5 (n = 25); and a High Responder group with ΔNYHA ≥1.5 (n = 20). RESULTS At 6-month follow-up, data analysis revealed that while mitral regurgitation was reduced significantly in both groups, only the High Responder group had experienced significant downsizing of the 3D circumference (137 ± 14 mm to 126 ± 13 mm; p < 0.01) and the anterior-to-posterior diameter (33 ± 5 mm to 29 ± 4 mm; p < 0.01) of the mitral annulus during the intervention. Furthermore, only the High Responder group with reverse annular remodeling as shown had substantial advances in quality of life (Minnesota living with heart failure questionnaire: 55 ± 10 to 34 ± 14 points; p < 0.01) and functional status (6-min walk distance: 290 ± 104 m to 462 ± 111 m; p = 0.07). CONCLUSION Our study demonstrates that instantaneous left ventricular annular remodeling during MitraClip® implantation is associated with improved clinical outcome of heart failure patients with functional mitral regurgitation. Trial registration The study was approved by the local ethics committee (Study Number 4497R, Registration ID: 2013121585). TRIAL REGISTRATION NCT02033811 Retrospectively registered January 9, 2014.
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Affiliation(s)
- Theresa Herbrand
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Silke Eschenhagen
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Tobias Zeus
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Eva Kehmeier
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Katharina Hellhammer
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Verena Veulemans
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Malte Kelm
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Jan Balzer
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
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Benito-González T, Estévez-Loureiro R, Cardona JG, Prado APD, Ruiz MC, Fernández-Vázquez F. Percutaneous Treatment of Mitral and Tricuspid Regurgitation in Heart Failure. Interv Cardiol 2017. [DOI: 10.5772/intechopen.68493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Bertrand PB, Schwammenthal E, Levine RA, Vandervoort PM. Exercise Dynamics in Secondary Mitral Regurgitation: Pathophysiology and Therapeutic Implications. Circulation 2017; 135:297-314. [PMID: 28093494 DOI: 10.1161/circulationaha.116.025260] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Secondary mitral valve regurgitation (MR) remains a challenging problem in the diagnostic workup and treatment of patients with heart failure. Although secondary MR is characteristically dynamic in nature and sensitive to changes in ventricular geometry and loading, current therapy is mainly focused on resting conditions. An exercise-induced increase in secondary MR, however, is associated with impaired exercise capacity and increased mortality. In an era where a multitude of percutaneous solutions are emerging for the treatment of patients with heart failure, it becomes important to address the dynamic component of secondary MR during exercise as well. A critical reappraisal of the underlying disease mechanisms, in particular the dynamic component during exercise, is of timely importance. This review summarizes the pathophysiological mechanisms involved in the dynamic deterioration of secondary MR during exercise, its functional and prognostic impact, and the way current treatment options affect the dynamic lesion and exercise hemodynamics in general.
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Affiliation(s)
- Philippe B Bertrand
- From Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.B.B., P.M.V.); Faculty of Medicine and Life Sciences, Hasselt University, Belgium (P.B.B., P.M.V.); Heart Center, Sheba Medical Center, Tel Hashomer, Israel (E.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.).
| | - Ehud Schwammenthal
- From Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.B.B., P.M.V.); Faculty of Medicine and Life Sciences, Hasselt University, Belgium (P.B.B., P.M.V.); Heart Center, Sheba Medical Center, Tel Hashomer, Israel (E.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Robert A Levine
- From Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.B.B., P.M.V.); Faculty of Medicine and Life Sciences, Hasselt University, Belgium (P.B.B., P.M.V.); Heart Center, Sheba Medical Center, Tel Hashomer, Israel (E.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Pieter M Vandervoort
- From Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.B.B., P.M.V.); Faculty of Medicine and Life Sciences, Hasselt University, Belgium (P.B.B., P.M.V.); Heart Center, Sheba Medical Center, Tel Hashomer, Israel (E.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
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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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37
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Hidalgo F, Mesa D, Ruiz M, Delgado M, Rodríguez S, Pardo L, Pan M, López A, Romero MA, Suárez de Lezo J. Impacto del remodelado del anillo mitral tras el procedimiento MitraClip en la reducción de la insuficiencia mitral funcional. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.02.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hidalgo F, Mesa D, Ruiz M, Delgado M, Rodríguez S, Pardo L, Pan M, López A, Romero MA, Suárez de Lezo J. Effects of Mitral Annulus Remodeling Following MitraClip Procedure on Reduction of Functional Mitral Regurgitation. ACTA ACUST UNITED AC 2016; 69:1020-1025. [PMID: 27212447 DOI: 10.1016/j.rec.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 02/04/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES The percutaneous mitral valve repair procedure (MitraClip) appears to reduce mitral annulus diameter in patients with functional mitral regurgitation, but the relationship between this and regurgitation severity has not been demonstrated. The aim of this study was to determine the effect of mitral annulus remodeling on the reduction of mitral regurgitation in patients with functional etiology. METHODS The study included all patients with functional mitral regurgitation treated with MitraClip at our hospital until January 2015. Echocardiogram (iE33 model, Philips) was performed in all patients immediately after device positioning. Changes in the mitral annulus correlated with mitral regurgitation severity, as assessed using the effective regurgitant orifice area. RESULTS The study included 23 patients (age, 65±14 years; 74% men; left ventricular ejection fraction, 31%±13%; systolic pulmonary artery pressure, 47±10 mmHg). After the procedure, the regurgitant orifice area decreased by 0.30 cm2±0.04 cm2 (P<.0005), from a baseline of 0.49 cm2±0.09 cm2. Anteroposterior diameter decreased by 3.14 mm±1.01 mm (P<.0005) from a baseline of 28.27 mm±4.9 mm, with no changes in the intercommissural diameter (0.50 mm±0.91 mm vs 40.68 mm±4.7 mm; P=.26). A significant association was seen between anteroposterior diameter reduction and regurgitant orifice area reduction (r=.49; P=.020). CONCLUSIONS In patients with functional mitral regurgitation, the MitraClip device produces an immediate reduction in the anteroposterior diameter. This remodeling may be related to the reduction in mitral regurgitation.
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Affiliation(s)
- Francisco Hidalgo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
| | - Dolores Mesa
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Martín Ruiz
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Mónica Delgado
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Sara Rodríguez
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Laura Pardo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Manuel Pan
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Amador López
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Miguel A Romero
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
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Al Amri I, Debonnaire P, van der Kley F, Schalij MJ, Bax JJ, Marsan NA, Delgado V. Acute effect of MitraClip implantation on mitral valve geometry in patients with functional mitral regurgitation: insights from three-dimensional transoesophageal echocardiography. EUROINTERVENTION 2016; 11:1554-61. [DOI: 10.4244/eijy15m09_09] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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40
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Athappan G, Raza MQ, Kapadia SR. MitraClip Therapy for Mitral Regurgitation: Primary Mitral Regurgitation. Interv Cardiol Clin 2016; 5:71-82. [PMID: 27852483 DOI: 10.1016/j.iccl.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Primary mitral regurgitation (MR) owing to degenerative changes in the structural components of the mitral valve is a common acquired valvular pathology in the elderly. Surgical correction with mitral valve repair (MVRe) or replacement (MVR) is the mainstay of therapy. A significant proportion of patients are ineligible for MVRe/MVR owing to prohibitive surgical risk from advanced age, poor ventricular function, or associated comorbidities. Percutaneous mitral valve repair techniques have been developed to fill this void. The edge-to-edge MitraClip has accrued the largest human experience. This paper reviews the available literature on the MitraClip device for treatment of primary MR.
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Affiliation(s)
- G Athappan
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Mohammad Qasim Raza
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Samir R Kapadia
- Cardiac Catheterization Laboratory, Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA.
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41
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Schäfer U, Frerker C, Thielsen T, Schewel D, Bader R, Kuck KH, Kreidel F. Targeting systolic anterior motion and left ventricular outflow tract obstruction in hypertrophic obstructed cardiomyopathy with a MitraClip. EUROINTERVENTION 2015; 11:942-7. [DOI: 10.4244/eijy14m08_13] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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42
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Lurz P, Serpytis R, Blazek S, Seeburger J, Mangner N, Noack T, Ender J, Mohr FW, Linke A, Schuler G, Gutberlet M, Thiele H. Assessment of acute changes in ventricular volumes, function, and strain after interventional edge-to-edge repair of mitral regurgitation using cardiac magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2015; 16:1399-404. [DOI: 10.1093/ehjci/jev115] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/14/2015] [Indexed: 11/13/2022] Open
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43
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Salerno G, Schmidt FP, Bigazzi MC, Sordelli C, Bianchi R, Golino P, Calabrò P, Russo MG, Calabrò R, Pacileo G. Preoperative evaluation before MitraClip®: present and future perspective. Future Cardiol 2014; 10:725-44. [PMID: 25495815 DOI: 10.2217/fca.14.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Mitral regurgitation (MR) is the second most common heart valve disease worldwide. Currently, the management of MR is based on medical therapy (including biventricular pacing), surgery (mitral valve replacement or repair) and percutaneous therapy. However, in spite of guideline recommendations, 50% of individuals assessed in the Euro Heart Survey were not referred to surgical intervention due to comorbidities or real or perceived high risks for cardiac surgery; thus, in recent years, the focus of research has shifted to the development of percutaneous approaches to treat severe MR in order to restore valve function in a minimally invasive fashion. Among these techniques, the percutaneous mitral valve repair procedure using the MitraClip(®) system (Abbott Vascular, IL, USA) is one of the most promising. Usually, patient selection for MitraClip implantation is based on careful echocardiographic assessment of valve disease; however, although definitive data are lacking, evidence is mounting for a multiparametric approach including the evaluation of the functional status of patients.
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Affiliation(s)
- Gemma Salerno
- Department of Cardiology, Second University of Naples, Ospedale dei Colli, Naples, Italy
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44
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Bhamra-Ariza P, Muller DWM. The MitraClip experience and future percutaneous mitral valve therapies. Heart Lung Circ 2014; 23:1009-19. [PMID: 25035158 DOI: 10.1016/j.hlc.2014.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 11/16/2022]
Abstract
Mitral regurgitation is the most common valve abnormality worldwide and its prevalence is expected to increase in the future due to aging of the population. Percutaneous mitral valve repair therapies may offer an opportunity to treat severe MR in the elderly or other high-risk groups who would otherwise be ineligible for surgery. The MitraClip system uses edge-to-edge coaptation of the mitral leaflets to create a double-orifice valve and reduce MR. It has been performed in over 10 000 patients to date, and as experience has improved, procedural times have shortened from over 200 minutes to less than 100 minutes, with increasing numbers of patients being left with ≤ grade 2+ MR. This review will focus on the literature available on MitraClip and other novel percutaneous techniques that are being developed for the treatment of severe MR.
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Affiliation(s)
- Paul Bhamra-Ariza
- Cardiology Dept, St Vincent's Hospital, Victoria St, Darlinghurst, NSW 2010, Australia
| | - David W M Muller
- Cardiology Dept, St Vincent's Hospital, Victoria St, Darlinghurst, NSW 2010, Australia.
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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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Plein S, Edvardsen T, Pierard LA, Saraste A, Knuuti J, Maurer G, Lancellotti P. The year 2013 in the European Heart Journal - Cardiovascular Imaging: Part II. Eur Heart J Cardiovasc Imaging 2014; 15:837-41. [DOI: 10.1093/ehjci/jeu088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Cardiac magnetic resonance imaging in patients undergoing percutaneous mitral valve repair with the MitraClip system. Clin Res Cardiol 2014; 103:397-404. [DOI: 10.1007/s00392-014-0670-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 01/14/2014] [Indexed: 11/26/2022]
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Gripari P, Muratori M, Fusini L, Tamborini G, Pepi M. Three-Dimensional Echocardiography: Advancements in Qualitative and Quantitative Analyses of Mitral Valve Morphology in Mitral Valve Prolapse. J Cardiovasc Echogr 2014; 24:1-9. [PMID: 28465897 PMCID: PMC5353406 DOI: 10.4103/2211-4122.131985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Degenerative mitral valve disease (MVD) is the leading cause of organic mitral regurgitation (MR), one of the most common valvular heart disease in western countries. Substantial progresses in the surgical treatment of degenerative MVD have improved life expectancy of patients with significant MR. However, prognosis, surgical decision and timing of surgery strongly depend on the accurate characterization of mitral valve (MV) anatomy and pathology and on the precise quantification of MR. Three-dimensional (3D) echocardiography, a major technological breakthrough in the field of cardiovascular imaging, provides several advantages over two-dimensional (2D) imaging in the qualitative and quantitative evaluations of MV apparatus. In this review, we focus on the contribution of this new modality to the diagnosis of degenerative MVD, the quantitative assessment of MR severity, the selection and monitoring of surgical and percutaneous procedures, the evaluation of procedural outcomes. The results of a systematic and exhaustive search of the existing literature, restricted to real-time 3D echocardiography in adults, are here reported.
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Affiliation(s)
- Paola Gripari
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
| | - Manuela Muratori
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
| | - Gloria Tamborini
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico, Milano, Italy
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Maffessanti F, Tamborini G, Fusini L, Stevanella M, Sotaquira M, Caiani E, Pepi M. Advances in echocardiography: insights into the mitral valve and implications for surgical and percutaneous repair. Interv Cardiol 2013. [DOI: 10.2217/ica.13.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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50
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Plicht B, Buck T. Novel Aspects of 3D Echocardiography in Percutaneous Mitral Valve Interventions: Update 2013. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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