Key result
A small aorto-mitral angle was independently associated with left ventricular outflow tract narrowing after transcatheter mitral valve implantation (r = -0.68, P < 0.0001).
Why the study?
LVOT obstruction increases mortality in patients undergoing TMVI, but the postprocedure LVOT area assessed by 3D TEE and the preprocedural cardiac geometry affecting it required evaluation.
What preprocedural cardiac geometric factors predict LVOT narrowing after transcatheter mitral valve implantation?
Observational (n=43)
What preprocedural cardiac geometric factors predict LVOT narrowing after transcatheter mitral valve implantation?
Answers are grounded in this paper and cite their sources.
A small preprocedural aorto-mitral angle assessed by 3D TEE is an independent predictor of LVOT narrowing following transcatheter mitral valve implantation.
BACKGROUND: Left ventricular (LV) outflow tract (LVOT) obstruction increases mortality in patients undergoing transcatheter mitral valve implantation (TMVI) in degenerated bioprostheses, annuloplasty rings, and native mitral valves. We aimed to evaluate the LVOT area after TMVI using 3-dimensional (3D) transesophageal echocardiography (TEE) and to investigate the preprocedural cardiac geometry that affects the LVOT area after TMVI. METHODS: We retrospectively reviewed echocardiography data in 43 patients who had TMVI. A change in pressure gradient across LVOT from before to after TMVI (∆PG) and postprocedure 3D LVOT cross-sectional area at the level of the most distal portion of the mitral valve stent that was closest to the LV apex were assessed as evidence of LVOT narrowing. RESULTS: Transcatheter mitral valve implantation with the use of balloon-expandable valve system was performed for 24 bioprostheses, 7 annuloplasty rings, and 12 native valves. Compared to patients without increase in LVOT gradient (∆PG <10 mm Hg; n = 33), patients with increase in LVOT gradient (∆PG ≥10 mm Hg; n = 10) had smaller LV end-systolic volume (LVESV), greater LV ejection fraction (LVEF), and smaller aorto-mitral (AM) angle. The LVOT area at the valve stent distal edge showed strong association with ∆PG (r = -.68, P < .0001). Only a small AM angle was associated with a small LVOT area at the valve stent distal edge on multivariable analysis, independent of LVESV and LVEF. CONCLUSION: Small LV size, preserved LVEF, and small AM angle were associated with LVOT narrowing. 3D-derived AM angle might be independently associated with LVOT narrowing in patients undergoing transcatheter mitral valve-in-valve, valve-in-ring, and valve-in-native valve implantation, independent of LVESV and LVEF.
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Hayashi et al. (2021) conducted an observational in Transcatheter mitral valve implantation (n=43). Preprocedural cardiac geometry (small aorto-mitral angle, small LV size, preserved LVEF) vs. Patients without increase in LVOT gradient (∆PG <10 mm Hg) was evaluated on Left ventricular outflow tract (LVOT) narrowing (change in pressure gradient ≥10 mm Hg and postprocedure 3D LVOT cross-sectional area) (r = -0.68, p=< .0001). A small aorto-mitral angle was independently associated with left ventricular outflow tract narrowing after transcatheter mitral valve implantation (r = -0.68, P < 0.0001).
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