Paravalvular leak (PVL) on a surgically implanted mitral valve (mitral valve replacement, MVR) is a relatively common complication. Repeat surgery was the only possibility of its management in the past. Gradually, however, catheterisation procedures have been developed to allow closure without a conventional surgical approach. Catheter closure of PVL reduces the duration of procedure, the length of hospital stay, and the number of complications including death. We report the indications, diagnostic methods, catheterisation procedures, materials used, and clinical outcomes of PVL closure after MVR.
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- Klíčová slova
- paravalvulární leak, katetrizační uzávěr,
- MeSH
- chirurgická náhrada chlopně MeSH
- lidé MeSH
- pooperační komplikace MeSH
- srdeční chlopně umělé * škodlivé účinky MeSH
- srdeční katetrizace * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Left atrial (LA) enlargement is a predictor of worse outcome after catheter ablation for atrial fibrillation (AF). Widely used two-dimensional (2D)-echocardiography is inaccurate and underestimates real LA volume (LAV). We hypothesized that baseline clinical characteristics of patients can be used to adjust 2D-ECHO indices of LAV in order to minimize this disagreement. METHODS: The study enrolled 535 patients (59 ± 9 years; 67% males; 43% paroxysmal AF) who underwent catheter ablation for AF in three specialized centers. We investigated multivariately the relationship between 2D-echocardiographic indices of LA size, specifically LA diameter in M-mode in the parasternal long-axis view (LAD), LAV assessed by the prolate-ellipsoid method (LAVEllipsoid), LAV by the planimetric method (LAVPlanimetry), and LAV derived from 3D-electroanatomic mapping (LAVCARTO). RESULTS: Cubed LAD of 106 ± 45 ml, LAVEllipsoid of 72 ± 24 ml and LAVPlanimetry of 88 ± 30 ml correlated only modestly (r = 0.60, 0.69, and 0.53, respectively) with LAVCARTO of 137 ± 46 ml, which was significantly underestimated with a bias (±1.96 standard deviation) of -31 (-111; +49) ml, -64 (-132; +2) ml, and -49 (-125; +27) ml, respectively; p < 0.0001 for their mutual difference. LA enlargement itself, age, gender, type of AF, and the presence of structural heart disease were independent confounders of measurement error of 2D-echocardiographic LAV. CONCLUSION: Accuracy and precision of all 2D-echocardiographic LAV indices are poor. Their agreement with true LAV can be significantly improved by multivariate adjustment to clinical characteristics of patients.
- MeSH
- echokardiografie * MeSH
- fibrilace síní ultrasonografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- multivariační analýza MeSH
- regresní analýza MeSH
- ROC křivka MeSH
- srdeční síně patologie ultrasonografie MeSH
- velikost orgánu MeSH
- zobrazování trojrozměrné * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
