BACKGROUND: Management of recurrent mitral regurgitation (MR) or relevant iatrogenic mitral valve (MV) stenosis after mitral transcatheter edge-to-edge repair (M-TEER) emerges as an increasingly relevant clinical issue. Surgery after M-TEER is associated with higher morbidity and mortality. Electrosurgical leaflet laceration and stabilization of the implant (ELASTA-Clip) followed by transcatheter mitral valve replacement (TMVR) is an innovative, less-invasive treatment option for patients with TEER failure. OBJECTIVES: The authors sought to evaluate the early results of ELASTA-Clip followed by transapical TMVR in patients with symptomatic failed M-TEER (defined as persistent or recurrent MR, or iatrogenic MV stenosis). METHODS: Data from symptomatic patients with failed M-TEER who underwent ELASTA-Clip followed by compassionate use or commercial transapical TMVR using the Abbott Tendyne system were retrospectively collected from 8 tertiary care centers in 4 countries. Safety and efficacy of the procedure were assessed up to 1 year according to Mitral Valve Academic Research Consortium (MVARC) criteria. RESULTS: A total of 22 patients (mean age 77.8 ± 9.2 years, 40.9% [9/22] female) at high surgical risk (EuroSCORE II 8.0 ± 0.4, STS score 7.2% ± 1.1%) with symptomatic residual MR ≥3+ (n = 21) or iatrogenic MV stenosis (n = 1) after failed M-TEER were followed for a median period of 8.5 [Q1-Q3: 2.6-11.6] months. The ELASTA-Clip procedure (90.9% [20/22] transseptal, 9.1% [2/22] transapical) followed by TMVR were successful in all patients (22/22). Technical success according to MVARC was achieved in 21 patients (21/22, 95.4%) without left ventricular outflow tract obstruction or conversion to sternotomy. At 30 days, 3 patients had paravalvular leak progression, ischemic stroke occurred in 3 patients (3/20, 15.0%). Baseline MR (≥3+ in 95.5% [21/22]) was reduced to grade 1+ or less in all patients with durable results in 89.5% (17/19) (P < 0.001). NYHA functional class significantly improved to ≤II in 81.3% (13/16) at discharge (P < 0.001) and 72.2% (13/18) at last follow-up (P < 0.001). At 30 days, all patients (20/20) were alive. Three patients (3/20, 15.0%) were rehospitalized for heart failure (uncontrolled atrial fibrillation in 2 cases) and 1 of them (1/22, 4.5%) underwent a reintervention (valve retensioning). CONCLUSIONS: Transapical TMVR after ELASTA-Clip is a feasible and less invasive option for the management of failed M-TEER that can be performed with acceptable results in a carefully selected patient population. Particular attention is required to avoid paravalvular leakage and measures to minimize the risk of periprocedural cerebrovascular events need to be implemented in future larger-scale prospective studies with longer-term follow-up.
- MeSH
- Time Factors MeSH
- Heart Valve Prosthesis Implantation * instrumentation adverse effects MeSH
- Compassionate Use Trials MeSH
- Electrosurgery adverse effects MeSH
- Iatrogenic Disease MeSH
- Humans MeSH
- Mitral Valve * surgery diagnostic imaging physiopathology MeSH
- Mitral Valve Insufficiency * surgery diagnostic imaging physiopathology etiology MeSH
- Mitral Valve Stenosis * surgery diagnostic imaging physiopathology etiology MeSH
- Treatment Failure MeSH
- Recovery of Function MeSH
- Recurrence * MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Heart Valve Prosthesis * MeSH
- Cardiac Catheterization * instrumentation adverse effects MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Europe MeSH
AIMS: Identification of heart failure (HF) patients with secondary mitral regurgitation (SMR) that benefit from mitral valve (MV) repair remains challenging. We have focused on the role of left ventricular global longitudinal strain (LV-GLS) and reservoir left atrial longitudinal strain (LASr) for the prediction of long-term survival and reverse remodelling in patients with SMR undergoing endoscopic MV repair. METHODS AND RESULTS: The study population consisted of 110 patients (age 67 ± 11 years, 66% men) with symptomatic SMR undergoing isolated MV repair using a minimally invasive surgical approach. Speckle tracking-derived LV-GLS and LASr were assessed in apical views using vendor-independent software. Over a median of 7.7 years (IQRs 2.9-11.2), 64 patients (58%) died. Significant reverse LV (↓ LVESVI >10 mL/m2 ), LA (↓ LAVI >10 mL/m2 ) remodelling or both were observed in 43 (39%), 37 (34%) and 19 (17%) patients, respectively. LV-GLS (HR 0.68, 95% CI 0.58-0.79, P < 0.001) and LASr (HR 0.93, 95% CI 0.88-0.97, P < 0.01) but not LV ejection fraction (LVEF) and LA volume index (LAVi) emerged as independent predictors of all-cause mortality in Cox regression analysis. LV-GLS was the only independent predictor of LV reverse remodelling (OR 1.24, 95% CI 1.05-1.43, P < 0.001) whereas LAVi and LASr were both independent predictors of LA reverse remodelling (both P < 0.05). In patients with atrial fibrillation at baseline, only LASr was an independent predictor (P < 0.05) of LA reverse remodelling. CONCLUSIONS: In patients with SMR undergoing endoscopic MV repair, LV-GLS and LASr are independently associated with long-term survival and reverse remodelling and may be helpful in selecting SMR patients who may benefit from this procedure.
- MeSH
- Ventricular Function, Left MeSH
- Cardiac Surgical Procedures * MeSH
- Middle Aged MeSH
- Humans MeSH
- Mitral Valve diagnostic imaging surgery MeSH
- Mitral Valve Insufficiency * diagnosis surgery MeSH
- Aged MeSH
- Stroke Volume MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Consensus MeSH
- Humans MeSH
- Mitral Valve diagnostic imaging MeSH
- Heart Valve Diseases * MeSH
- Mitral Valve Prolapse * complications diagnostic imaging MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Latin America MeSH
- MeSH
- Cardiac Surgical Procedures * adverse effects MeSH
- Humans MeSH
- Mitral Valve diagnostic imaging surgery MeSH
- Mitral Valve Insufficiency * diagnostic imaging surgery MeSH
- Robotic Surgical Procedures * adverse effects MeSH
- Robotics * MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: The study analyzes changes in lung function, pulmonary pressure and diffusing capacity of the lung in patients with mitral valve regurgitation (MR) treated by MitraClip implantation. METHODS: A total of 43 patients (19 women and 24 men with an average age of 78.0 ± 6.6 years) who were able to perform pulmonary function testing including diffusing capacity of the lung for carbon monoxide (DLCO), vital capacity (VC), total lung capacity (TLC), residual volume (RV) and forced expiratory volume in 1 s (FEV1) before and 6 weeks after MitraClip implantation participated in this study. Furthermore, clinical and echocardiographic parameters including systolic pulmonary artery pressure (sPAP), left ventricular ejection fraction (LVEF) and left atrial diameter (LAD) measurements were recorded in all patients. RESULTS: The procedure was performed successfully in all 43 patients leading to a reduction of MR in 97.7% of cases. One patient died on day 4 after the intervention most likely due to pulmonary artery embolism. Six weeks after the implantation 79.1% of patients showed a MR of at most mild to moderate. Furthermore, we could demonstrate a significant reduction of systolic pulmonary artery pressure during follow-up (from 48.8 ± 11.4 mmHg to 42.9 ± 9.0 mmHg (t(41) = - 2.6, p = 0.01). However, no changes in LVEF were detected. Comparing pre and post implant lung function tests, no significant alterations were seen for VC, TLC, DLCO and FEV1. Though, in a subgroup of patients with moderate to severe preexisting deterioration of DLCO at the baseline (max. 50%) the MitraClip procedure resulted in a significant improvement in DLCO (37.8% ± 9.0 to 41.6% ± 10.0, p < 0.001). CONCLUSIONS: Treatment of MR with the MitraClip system successfully reduces MR severity in the vast majority of patients. Consecutively, a reduction in pulmonary pressure could be observed, however no changes in LVEF were obvious. Lung function tests remained unaltered during follow-up. However, in a subgroup of patients with severe preexisting deterioration of DLCO the MitraClip procedure resulted in a significant improvement in DLCO. TRIAL REGISTRATION: Name of the registry: Die Auswirkung der interventionellen Mitralklappenreparatur mit MitraClip-System auf die Ergebnisse der Lungenfunktionsmessung. TRIAL REGISTRATION NUMBER: DRKS00022435; Date of registration: 09/07/2020 'Retrospectively registered'; URL of trial registry record: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022435 .
- MeSH
- Pulmonary Artery diagnostic imaging physiopathology MeSH
- Arterial Pressure * MeSH
- Time Factors MeSH
- Heart Valve Prosthesis Implantation adverse effects instrumentation MeSH
- Pulmonary Diffusing Capacity * MeSH
- Humans MeSH
- Mitral Valve diagnostic imaging physiopathology surgery MeSH
- Mitral Valve Insufficiency diagnostic imaging physiopathology surgery MeSH
- Recovery of Function MeSH
- Lung physiopathology MeSH
- Prospective Studies MeSH
- Prosthesis Design MeSH
- Registries MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Heart Valve Prosthesis * MeSH
- Cardiac Catheterization adverse effects instrumentation MeSH
- Severity of Illness Index MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
Incidentální echokardiografické nálezy u asymptomatických pacientů mohou při rozhodování v klinické praxi představovat problém. Regurgitace mitrální chlopně je častou srdeční vadou a hlavní příčinou rozvoje městnavého srdečního selhání a úmrtí. Přes řadu možností léčby se v případě vhodných anatomických poměrů dává přednost plastice mitrální chlopně. Transapikální metoda plastiky mitrální chlopně s implantací umělých šlašinek představuje novou a minimálně invazivní metodu pro pacienty s degenerativním postižením mitrální chlopně. Je prokázáno, že tento výkon je bezpečný, účinný a má vynikající dlouhodobé výsledky. I když se tato metoda při plastice srdeční chlopně používá často, v případě mitrální chlopně se tento výkon provádí vzácně. V tomto článku popisujeme případ asymptomatického pacienta s kombinací plastiky mitrální a trikuspidální chlopně s použitím umělých šlašinek. © 2021, ČKS.
Incidental echocardiographic findings in asymptomatic patients could be challenging in clinical decision-making. Mitral regurgitation is a common valvular heart disease, which is the leading cause of congestive heart failure and death. Although there is a variety of treatment options, mitral valve repair remains the preferred treatment when the anatomy is suitable. Transapical mitral valve repair with artificial neochordae implantation is a novel and minimally invasive technique for patients with degenerative mitral valve dis- ease. It has been shown that this procedure is safe, effective and has excellent long-term results. Although this technique is frequently used in valve repair, it is rarely used for mitral prosthesis. Herein, we present an asymptomatic patient with a combination of mitral and tricuspid valve prostheses with artificial neochordae.
- MeSH
- Clinical Decision-Making MeSH
- Humans MeSH
- Mitral Valve * surgery diagnostic imaging MeSH
- Aged MeSH
- Heart Valve Prosthesis * MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
To assess subclinical cardiac function impairment in Duchenne dystrophy (DMD) female carriers. Forty-four female subjects proved as DMD carriers underwent echocardiographic examination including tissue Doppler imaging (TDI) of mitral and tricuspid annulus. Seventeen age-matched healthy female subjects served as controls. A significant differences in peak systolic annular velocity (Sa) between carriers and controls were found for lateral and septal part of the mitral annulus and for tricuspid annulus (0.09 vs. 0.11 m/s, p < 0.001, 0.08 vs. 0.09 m/s, p < 0.01 and 0.13 vs. 0.14 m/s, p = 0.02 respectively). There was also difference in early diastolic velocity (Ea) of the septal part of the mitral annulus (0.11 vs. 0.13 m/s, p = 0.03). The subclinical deterioration of systolic function is presented even in asymptomatic DMD female carriers.
- MeSH
- Echocardiography, Doppler MeSH
- Adult MeSH
- Muscular Dystrophy, Duchenne diagnostic imaging genetics physiopathology MeSH
- Ventricular Dysfunction, Left diagnostic imaging physiopathology MeSH
- Heterozygote * MeSH
- Middle Aged MeSH
- Humans MeSH
- Mitral Valve diagnostic imaging MeSH
- Blood Flow Velocity MeSH
- Case-Control Studies MeSH
- Systole MeSH
- Tricuspid Valve diagnostic imaging MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Jednostranný plicní edém představuje asi 2 % kardiálních plicních edémů. Etiologie může být velmi různorodá, nicméně nejčastěji se jedná o těžkou mitrální regurgitaci. U většiny pacientů se vyskytuje v pravém horním plicním laloku. Vzhledem k atypické prezentaci bývá zahájení náležité léčby opožděno. Popisujeme případ pacienta s velmi dramatickou a netypickou mechanickou komplikací malého infarktu myokardu, jehož stav byl vstupně chybně hodnocen jako pneumonie. Pacient byl přijat pro rozvoj těžké respirační insuficience, byla zajištěna umělá plicní ventilace a stav vyžadoval zavedení venovenózní extrakorporální membránové oxygenace (VV ECMO). Až následně byla echokardiograficky zjištěna akutní těžká mitrální regurgitace při vlajícím zadním cípu s excentrickým proudem směřujícím k pravostranným plicním žilám. Selektivní koronarografií byla verifikována kritická stenóza ramus circumflexus před odstupem druhého ramus marginalis sinister a byla provedena prostá balonková angioplastika. S odstupem tří dnů byla provedena chirurgická náhrada mitrální chlopně. Cílem článku je popis neobvyklého případu a jeho patofyziologie.
Unilateral pulmonary edema accounts for 2% of cardiogenic pulmonary edemas. Etiology is variable, severe mitral regurgitation being the most common. In the majority of cases, pulmonary edema occurs in the right upper lobe. Due to unusual presentation, the initiation of appropriate treatment tends to be delayed. We present a case of a very dramatic and rare mechanical complication of a small myocardial infarction. The patient’s condition was initially incorrectly described as pneumonia. He was admitted due to severe respiratory insufficiency, his condition required mechanical ventilation, later V-V ECMO was initiated. Afterwards, echocardiography revealed acute severe mitral regurgitation with flail posterior leaflet and eccentric jet directed towards right pulmonary veins. Selective coronarography revealed severe stenosis of the left circumflex artery and plain old balloon angioplasty was performed. Subsequently, surgical valve replacement took place. The objective of this paper is to present an unusual case and its pathophysiology.
- MeSH
- Angioplasty, Balloon, Coronary MeSH
- Heart Valve Prosthesis Implantation MeSH
- Diagnostic Errors MeSH
- Dyspnea etiology MeSH
- Echocardiography MeSH
- Thorax diagnostic imaging MeSH
- Myocardial Infarction complications MeSH
- Coronary Angiography MeSH
- Coronary Stenosis surgery diagnostic imaging pathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Mitral Valve surgery diagnostic imaging physiopathology MeSH
- Mitral Valve Insufficiency * diagnostic imaging complications physiopathology MeSH
- Lung diagnostic imaging MeSH
- Pulmonary Edema * etiology MeSH
- Pneumonia diagnostic imaging pathology MeSH
- Tomography, X-Ray Computed MeSH
- Respiratory Insufficiency etiology therapy MeSH
- Heart Rupture pathology MeSH
- Tachycardia, Sinus etiology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Publication type
- Case Reports MeSH
BACKGROUND: To report single-institution experience with minimally invasive mitral valve operations through the right minithoracotomy over a 5-year period. METHODS: Patients who underwent minimally invasive mitral valve surgery (MIMVS) between January 2012 and December 2016 were included. Clinical follow-up data were collected in a prospective database and analyzed retrospectively. RESULTS: Data from 151 patients were assessed (mean age, 63.4 ± 9.7 years; 55% were females). Overall 30-day mortality was 0.7% (n = 1). Mean operating time, cardiopulmonary bypass, and aortic cross-clamp times were 254.9 ± 48.7, 140.5 ± 36.1, and 94.8 ± 27.0 minutes, respectively. Associated procedures were tricuspid valve annuloplasty (37.1%, n = 56) and closure of atrial septal defect (6.0%, n = 9). Cryoablation was performed in 43.7% of patients (n = 66). One patient (0.7%) required conversion to median sternotomy and six patients (4.0%) underwent re-explorations due to bleeding. Median postoperative hospital stay was 12 days. Overall survival at 5 years was 94.1% ± 2.0%. Freedom from reoperation was 94.6% ± 2.9% at 5 years. CONCLUSIONS: MIMVS is a feasible, safe, and reproducible approach with low mortality and morbidity. Mitral valve surgery through a small thoracotomy is a good alternative to conventional surgical access.
- MeSH
- Mitral Valve Annuloplasty * adverse effects mortality MeSH
- Time Factors MeSH
- Heart Valve Prosthesis Implantation * adverse effects mortality MeSH
- Databases, Factual MeSH
- Echocardiography MeSH
- Middle Aged MeSH
- Humans MeSH
- Mitral Valve diagnostic imaging physiopathology surgery MeSH
- Mitral Valve Insufficiency diagnostic imaging mortality physiopathology surgery MeSH
- Postoperative Complications etiology surgery MeSH
- Reoperation MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Aged MeSH
- Feasibility Studies MeSH
- Thoracotomy adverse effects methods mortality MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
