Long-Term Efficacy of Mitral Valve Transcatheter Edge-to-Edge Repair (M-TEER) for Exercise-Induced Mitral Regurgitation in a Cardiac Resynchronization Therapy (CRT) Non-responder: A Three-Year Follow-Up

Figures

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  Figure 1. A timeline of the patient's treatment events and heart failure hospitalizations Blue boxes: heart failure hospitalizations; orange boxes: initial and current admissions AMI: acute myocardial infarction; VSR: ventricular septal rupture; PMI: pacemaker implantation; PCI: percutaneous coronary intervention; ASV: adaptive service ventilation; CRT: cardiac resynchronization therapy; M-TEER: mitral valve transcatheter edge-to-edge repair

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  Figure 2. Preoperative exercise echocardiography A: E and A wave velocities at rest; E wave: 70 cm/s; A wave: 85 cm/s, initial E/A ratio: 0.82, adjusted E/A ratio: 1.27, accounting for A wave onset at 30 cm/s (yellow line); B: trivial mitral regurgitation at rest; C: E and A wave velocities at 12.5 watts; D: severe mitral regurgitation at 12.5 watts; E: quantification of mitral regurgitation at 12.5 watts.

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  Figure 3. Perioperative transesophageal echocardiography A: pre-procedural three-dimensional mitral valve; B: pre-procedural two-dimensional mitral regurgitation; C: pre-procedural pulmonary vein flow; D: post-procedural three-dimensional mitral valve; E: post-procedural two-dimensional mitral regurgitation; F: post-procedural pulmonary vein flow

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  Figure 4. Exercise stress echocardiography at three minutes post-exercise, pre- and post-treatment Pre-treatment: A: transmitral flow (E/A 1.4); B: TRPG 61 mmHg, vitals: BP 126/70 mmHg, HR 96 bpm; Post-treatment: C: transmitral flow (E/A 0.65); D: TRPG 42 mmHg, vitals: BP 112/59 mmHg, HR 80 bpm At peak exercise post treatment, the patient exhibited E/A 1.0, TRPG 57 mmHg (PASP 67 mmHg), and moderate MR, indicating exercise-induced pulmonary hypertension. However, as shown, hemodynamic recovery was faster post-treatment. TRPG: tricuspid regurgitation pressure gradient; PASP: pulmonary artery systolic pressure; MR: mitral regurgitation; BP: blood pressure; HR: heart rate; bpm: beats per minute