Novel 4DCT Method to Measure Regional Left Ventricular Endocardial Shortening Before and After Transcatheter Mitral Valve Implantation

2021 ◽  
Author(s):  
Gabrielle M. Colvert ◽  
Ashish Manohar ◽  
Francisco J. Contijoch ◽  
James Yang ◽  
Jeremy Glynn ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricular ◽  
Before And After ◽  
Valve Implantation

scholarly journals One-shot transcatheter double valve replacement: six-month follow-up—a case report

2020 ◽  
Author(s):  
Georg Lutter ◽  
Mohamed Salem ◽  
Derk Frank ◽  
Thomas Puehler
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Young Patients ◽  
Heart Association ◽  
Left Ventricular ◽  
Mitral Valve Stenosis ◽  
Term Outcome ◽  
Transcatheter Mitral Valve Replacement ◽  
Valve Implantation

Abstract Background Transcatheter aortic valve replacement (TAVR) in combination with a valve-in-valve (V-i-V) transcatheter mitral valve replacement (TMVR) is a rare procedure in comparison to surgical therapy especially in young patients. We report on a young patient at high surgical risk, receiving a double valve implantation with two S3 transcatheter heart valves. Case summary A 59-year-old female patient with two previous mitral valve replacements due to endocarditis and re-endocarditis experienced a new onset of severe mitral valve stenosis in combination with progredient aortic stenosis. She was admitted to the hospital with severe dyspnoea and intermittent non-invasive ventilation [New York Heart Association (NYHA) III–IV]. An interventional transapical transcatheter double valve implantation was planned and carried out due to cardiac decompensation and high comorbidity preoperatively (STS score of 6.92). At 6-month follow-up, the patient presented herself in an improved condition with reduced symptoms (NYHA I–II), a good functional status of both valves and an advanced right and left ventricular function in the echocardiogram. Discussion Even in younger patients at high risk, a combined native TAVR and V-i-V TMVR procedure can be performed. In this case, a transcatheter SAPIEN 3 valve was transapically implanted with good clinical mid-term outcome at 6 months.

scholarly journals P295 Impact of Pre-existing Mitral Regurgitation on the Mid-Term Left Ventricular Mass Regression following Transcatheter Aortic Valve Implantation for Aortic Valve Stenosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H Horinouchi ◽  
T Nagai ◽  
Y Ohno ◽  
T Murakami ◽  
J Miyamoto ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Left Ventricular ◽  
Regurgitant Volume ◽  
Transcatheter Aortic Valve ◽  
Post Procedure ◽  
Lv Mass ◽  
Valve Implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) results in an immediate and greater aortic pressure gradient improvement in patients with severe aortic valve stenosis (AS), and induces early left ventricular (LV) mass regression, which may be related to favorable effects on the mid to long term outcomes. However, the extent of LV mass regression after unloading of chronic pressure overload is varying, and its determinants are still unknown. Thus, the study aims to identify echocardiographic determinants of LV mass regression following TAVI. Methods We retrospectively screened all TAVI procedures in symptomatic AS from 2017 to 2019, and selected 74 successful TAVI cases that had serial echocardiographic studies both at the baseline and at the mid-term follow-up (4 to 6 months after the procedure). Through the digitalized medical records, clinical and echocardiographic data as well as angiographic grading (0-3) of post-procedure paravalvular leakage (PVL) were obtained. LV mass was calculated by using Cube formula. Thus, the extent of LV mass regression was defined as the differences of left ventricular mas index (LVMI) between at the baseline and at the follow-up (ΔLVMI). Quantification of the baseline mitral valve regurgitant volume was performed by stroke volume method with pulmonic site measurement on the assumption of no pre-existing intra/extra cardiac shunt. Cases with prior mitral valve replacement were excluded. Results At the post-procedure angiogram, only 3 cases had significant PVL (grade 2≤). At the mid-term follow–up, average LVMI decreased significantly from the baseline (165 ± 38 g/m2vs 140 ± 37 mg/ m2, P < 0.0001) and 57 cases (70%) experienced the reduction of LVMI, although average relative wall thickness (2 × posterior wall thickness/left ventricular diastolic dimension) did not change (0.565 ± 0.135 vs 0.586 ± 0.168, P = 0.314). Among the baseline clinical and echocardiographic variables, the baseline peak A wave velocity, E/A ratio, mitral valve regurgitant volume and LVMI revealed simple correlation with ΔLVMI (γ=-0.298, p = 0.0188;γ=0.251, P = 0.0417;γ=0.354, p = 0.0041;γ=0.375, p < 0.0010; respectively), whereas no correlation was observed in angiographic PVL grade. Stepwise multiple regression analysis demonstrated baseline mitral valve regurgitant volume and LVMI as the determinants of ΔLVMI (β=0.344, p = 0.032; β=0.335 P < 0.0001; respectively). Conclusions Pre-existing mitral regurgitation has an impact on the mid–term left ventricular mass regression following TAVI. In severe AS, mitral regurgitation might be functioning as an afterload adjuster, and thus, produces protective effects on LV structure.

scholarly journals Moderated Posters: Deformation imagingP96How accurate can different strain analysis tools detect regional function?abnormalities, a report from the second inter-vendor comparison?studyP97Variability and reproducibility of segmental longitudinal strain measurements, a report form the second intervendor comparison studyP98Systolic and diastolic left atrial deformation parameters before and after optimization of dual chamber pacemaker parametersP99The timing of the post systolic shortening in prediction of scarred myocardiumP100Altered contribution of longitudinal and radial motion to right ventricular ejection and filling in heart transplant recipientsP101Left ventricular and atrial function in old patients underwent transcatheter aortic valve implantation, evaluated by two and three-dimensional speckle tracking at eighteen-month follow-upP102Age-related changes in left ventricular strain measured by speckle-tracking echocardiography and association with telomere length in healthy peopleP103Intracardiac speckle tracking echocardiography-based method for assessment of pulmonary vein isolation in patients with atrial fibrillation

2016 ◽  
Vol 17 (suppl 2) ◽  
pp. ii9-ii11
Author(s):  
O. Mirea ◽  
O. Mirea ◽  
A. Karuzas ◽  
E. Nestaas ◽  
BK. Lakatos ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Three Dimensional ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Old Patients ◽  
Left Ventricular Strain ◽  
Transcatheter Aortic Valve ◽  
Before And After ◽  
Valve Implantation

scholarly journals Left Ventricular Outflow Tract Area After Percutaneous Transseptal Transcatheter Mitral Valve Implantation; A Three-dimensional Transesophageal Echocardiography Study

2021 ◽  
Author(s):  
atsushi hayashi ◽  
hiroki ikenaga ◽  
takafumi nagaura ◽  
Jun Yoshida ◽  
Florian Rader ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Transesophageal Echocardiography ◽  
Left Ventricular Outflow Tract ◽  
Strong Association ◽  
Multivariable Analysis ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Left Ventricular Outflow ◽  
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 left ventricular outflow tract area after TMVI using 3-diensional (3D) transesophageal echocardiography (TEE) and to investigate the pre-procedural cardiac geometry 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 post-procedure 3D cross sectional area (CSA) 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: TMVI 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 mmHg; n=33), patients with increase in LVOT gradient (∆PG ≥10 mmHg; n=10) had smaller LV end-systolic volume (LVESV), greater LV ejection fraction (LVEF) and smaller aorto-mitral (AM) angle. CSA at the valve stent distal edge showed strong association with ∆PG (r=-0.68, P<0.0001). Only small AM angle was associated with small CSA at the valve stent ventricular edge on multivariable analysis, independent of LVESV and LVEF. Conclusion: Pre-procedural AM angle as well as LVESV and LVEF were associated with LVOT narrowing in patients undergoing transcatheter mitral valve-in-valve, valve-in-ring, and valve-in-native valve implantation. These data may be useful for preprocedural planning.

scholarly journals Transseptal mitral valve-in-valve implantation in a degenerated mitral bioprosthesis: a case report and literature review

2021 ◽  
Author(s):  
Nils Perrin ◽  
Hajo Muller ◽  
Stephane Noble
Keyword(s):  
Mitral Valve ◽  
Literature Review ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Heart Valve ◽  
Edwards Sapien ◽  
Valve In Valve ◽  
Valve Implantation ◽  
Mitral Bioprosthesis

We present hereby the case of a 75-year-old woman with a degenerated mitral bioprosthesis and severely reduced left ventricular ejection fraction who underwent a successful trans-septal mitral valve-in-valve (TMViV) replacement using a 29mm Edwards Sapien S3 transcatheter heart valve. We also performed a literature review.

scholarly journals New stent for transapical mitral valve replacement in acute swine experiment

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yu Zou ◽  
Peng Teng ◽  
Liang Ma
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
The Self ◽  
Design Parameters ◽  
Transcatheter Mitral Valve Replacement ◽  
Before And After ◽  
The Mean

Abstract Background Many patients with mitral regurgitation are denied open-heart surgery due to perceived high risk. Transcatheter mitral valve replacement is a therapeutic alternative for patients at high surgical risk. This study aimed to assess the feasibility of a new self-expanding valved stent for transcatheter mitral valve replacement via apex in an acute animal model. Methods Eight porcine experiments were performed in the acute study. A left thoracotomy was performed, and the new self-expanding transcatheter valved stent was deployed under fluoroscopic guidance in the native mitral annulus via apex. Hemodynamic data were recorded before and after implantation. Mitral annulus diameter and valve area were measured using echocardiography. Transvalvular and left ventricular outflow tract pressure gradients were measured using invasive methods. Results Seven animals underwent successful transapical mitral valve replacement; the implantation was unsuccessful in one animal. The mean procedure time, defined from placement to tightening of the purse-string suture, was 17.14 ± 7.86 min. Hemodynamic data before and after transapical mitral valve replacement showed no difference in statistical analysis. The mean diameter of the self-expanding device after implantation was 2.58 ± 1.04 cm; the mean functional area was 2.70 ± 0.26 cm2. Trace-to-mild central and paravalvular leaks were detected in 7 valves. The mean pressure gradient across the self-expanding device was 2.00 ± 0.82 mmHg; the corresponding gradient across the LVOT was 3.28 ± 1.11 mmHg. Postmortem evaluation confirmed precise device positioning in 7 animals with no signs of LVOT obstruction. Conclusion Transcatheter mitral replacement of the new valved stent was confirmed feasible in acute preclinical models. The new stent reveals optimal design parameters.

scholarly journals Valve-in-Valve and Valve-in-Ring Transcatheter Mitral Valve Implantation in Young Women Contemplating Pregnancy

2020 ◽  
Vol 13 (12) ◽  
Author(s):  
Adeline Fuchs ◽  
Marina Urena ◽  
Caroline Chong-Nguyen ◽  
John Kikoïne ◽  
Eric Brochet ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Young Women ◽  
Left Ventricular ◽  
Systolic Pulmonary Artery Pressure ◽  
Vaginal Deliveries ◽  
Valve In Valve ◽  
Valve Implantation

Background: Transcatheter mitral valve implantation (TMVI) is emerging as an alternative to surgical mitral valve replacement in selected high-risk patients. Delaying definitive mechanical mitral valve replacement and the constraints of anticoagulation thanks to TMVI may be an attractive option in young women contemplating pregnancy and suffering from failure of mitral bioprosthesis or annuloplasty. The aim of the study was to evaluate the possibility, safety, and outcomes of pregnancy after TMVI in this population. Methods: From 2013 to 2019, 12 young women contemplating pregnancy underwent transseptal valve-in-valve or valve-in-ring TMVI using the Edwards SAPIEN XT/3 valves and were prospectively followed up at 1 month, 6 months, 1 year, and yearly thereafter. Results: Mean age of the patients was 30±6 years. Bioprosthesis degeneration was observed in 7 cases and annuloplasty failure in 5. Three valve-in-ring patients required the implantation of a second valve, which led to an overall procedural success rate of 75%. One delayed left ventricular outflow tract obstruction required elective surgical mitral valve replacement. At 6 months/1 year, 83% of the patients were in New York Heart Association classes I/II. Mitral regurgitation was ≤2+ in all the cases and mean gradient was 7±2 mm Hg. Four patients could complete 6 full-term pregnancies. One symptomatic thrombosis occurred and resolved under aspirin and anticoagulation therapy. All others pregnancies were uneventful. Predelivery mean gradient was 11 mm Hg, and systolic pulmonary artery pressure was 32 mm Hg. There were 4 vaginal deliveries and 2 cesarians. Newborns were alive and healthy. At last follow-up, there was no death, and 3 patients required elective surgical mitral valve replacement at 6- to 54-month follow-up. Conclusions: Our study suggests that, in young women, transseptal TMVI to treat failing bioprostheses may result in good short-term outcomes that allow uneventful pregnancies. The results are less favorable in women with failed annuloplasty rings.

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