Percutaneous mitral valve repair reduced regurgitant volume from 84.1 mL to 35.6 mL, as assessed by 3D transesophageal echocardiography.
Observational (n=39)
Does percutaneous mitral valve repair (MitraClip) reduce mitral regurgitant volume and improve cardiac remodeling in high-risk surgical patients with functional mitral regurgitation?
3D TEE demonstrates significant reduction of regurgitant volume and allows improved understanding of morphological changes after percutaneous mitral valve repair.
Absolute Event Rate: 35.6% vs 84.1%
BACKGROUND: Analysis of procedural effects in patients undergoing percutaneous mitral valve repair (PMVR) using the edge-to-edge technique is complex, and common methods to define mitral regurgitation severity based on 2-dimensional (2D) echocardiography are not validated for postprocedural double-orifice mitral valve. This study used 3D transesophageal echocardiography (TEE) to determine the functional and morphological effects of PMVR. METHODS AND RESULTS: In 39 high-risk surgical patients with moderate to severe functional mitral valve regurgitation, 3D TEE with and without color Doppler as well as 2D transthoracic and TEE was performed before and after PMVR (MitraClip device). Mitral valve regurgitant volume by color Doppler 3D TEE was determined as the product of vena contracta areas defined by direct planimetry and velocity time integral using continuous-wave Doppler. Regurgitant volume was reduced from 84.1±38.3 mL preintervention to 35.6±25.6 mL postintervention. Patients in whom vena contracta area could be reduced >50% had a smaller preprocedural mitral annulus area compared with patients with ≤50% reduction (11.9±3.9 versus 16.1±8.5 cm(2), respectively; P=0.036) and tended to have a smaller mitral annulus circumference (13.0±2.0 versus 14.8±4.1 cm, respectively; P=0.112). At 6 months follow-up, left atrial and left ventricular end-diastolic volumes were significantly more reduced in patients in whom regurgitant vena contracta area was reduced by >50% compared with those with less reduction (-11.4±5.2 versus -4.8±7.7%; P=0.005, and -11.0±7.2 versus -4.5±9.3%; P=0.028). The maximum diastolic mitral valve area decreased from 6.0±2.0 to 2.9±0.9 cm(2) (P<0.0001). CONCLUSIONS: Three dimensional TEE demonstrates significant reduction of regurgitant volume after PMVR. The unique visualization of the mitral valve by 3D TEE allows improved understanding of the morphological and functional changes induced by PMVR.
Altiok et al. (Sat,) conducted a observational in moderate to severe functional mitral valve regurgitation (n=39). Percutaneous mitral valve repair (MitraClip) vs. Preintervention (baseline) was evaluated on Mitral valve regurgitant volume. Percutaneous mitral valve repair reduced regurgitant volume from 84.1 mL to 35.6 mL, as assessed by 3D transesophageal echocardiography.