scholarly journals Vena contracta area size predicts effectiveness of interventional edge-to-edge repair in tricuspid valve regurgitation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
B Goebel ◽  
C Salomon ◽  
H Awada ◽  
E Costello ◽  
N Sassenberg ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Roc Curves ◽  
Right Atrial ◽  
Colour Doppler ◽  
Grade Group ◽  
Vena Contracta ◽  
Before And After ◽  
Group 2 ◽  
Regurgitant Orifice Area ◽  
Vena Contracta Area

Abstract Funding Acknowledgements Type of funding sources: None. Background Percutaneous tricuspid valve edge-to-edge repair (pTVR) is a promising interventional technique for patients with tricuspid regurgitation (TR), but guidance regarding patient selection and echocardiographic screening is lacking. The aim of this study was to identify echocardiographic measurements which may predict pTVR success. Methods Before and after pTVR, echocardiographic data, including 3D full-volume datasets, were obtained and quantified. Right ventricular assessments included ejection fraction (RVEF3D) and diastolic (RVVd3D) and systolic (RVVs3D) volumes. Also evaluated were: right atrial (RA) volume, effective regurgitant orifice area by PISA method (EROAPISA), vena contracta area (VCA3D) by multiplanar reconstruction from a 3D colour Doppler loop (Figure 1a), maximal diastolic tricuspid annulus area from a 3D zoom image (Figure 1b), and tricuspid tenting area. TR severity was graded according to EROAPISA and VCA3D as grade 1+ to 5+. Results Patients (n= 44, age 72 ± 9 years, 20 male) with at least moderate to severe TR undergoing pTVR were consecutively included. The patients were divided into groups according to their post-pTVR TR grade. Group 1 had TR grade ≤2+, and group 2 had TR grade ≥3+.Echocardiographic parameters before pTVR for both groups are presented in Table 1. As expected, patients with TVR ≥3+ after pTVR had significantly worse pre-intervention echocardiographic measurements of TR severity, valve dimensions, and chamber volumes. ROC curves for the prediction of TR ≤2+ (mild to moderate) after pTVR (defined as VCA3D <0.75 cm² and EROAPISA <0.4 cm²) were drawn for different echocardiographic features (Figure 2). VCA3D by 3D colour Doppler yielded the highest area under the ROC curve followed by TV anatomy measurements (Annulus area3D, Tenting area) and right atrial volume. Conclusion A thorough evaluation of TR and valve dimensions by 3D echocardiography, particulary the evaluation of VCA3D by 3D colour Doppler, aids in the prediction of the probability of pTVR success. Abstract Figure.

scholarly journals Effect of interventional edge-to-edge repair in tricuspid regurgitation on ring dimensions

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Goebel ◽  
C Salomon ◽  
M Abdulrahman ◽  
S Richter ◽  
M El Garhy ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Right Atrial ◽  
Area Change ◽  
Vena Contracta ◽  
Eccentricity Index ◽  
Ring Shape ◽  
Maximal Diameter ◽  
Reduced Ring ◽  
The Impact ◽  
Full Volume

Abstract Background The concept of percutaneous tricuspid valve edge-to-edge repair (pTVR) is based on the connection of leaflets in the area of insufficiency using a coaptation device. By closing the coaptation device a considerable tractive force is applied on the leaflets, which might have an effect on the valve ring. Aim of the study was to examine the impact of device implantation on tricuspid ring dimensions. Methods During pTVR 3D zoom loops of tricuspid valve were acquired before and after clip placement using transoesophageal echocardiography. Measurements of TV ring dimensions included the following parameters: ring area (TV area), maximal diameter, minimal diameter, eccentricity index (Figure 1). Tenting area was derived from a four-chamber view of the valve. In addition, regurgitation severity was graded from 1+ to 5+ by measuring vena contracta area (VCA3D) in 3D full volume colour Doppler loop using multiplanar reconstruction. Right atrial (RA) and ventricular volumes (RVVd3D, RVVs3D) and function (RVEF3D) were assessed in a 3D full volume loop. Results The study population comprised 97 patients (age 78±6 years, 47 male), who underwent pTVR at our hospital. As expected cavity dimension correlated with TV area size (for RVVd3D r=0.51, p<0.001 and for RA volume r=0.71, p<0.001). The mean TV ring area was significantly reduced (ring area 8.53±2.23 cm2/m2BSA vs. 7.55±2.18 cm2/m2BSA, p<0.001) and the ring shape became more oval (Eccentricity index 1.2±0.15 vs. 1.29±0.17, p<0.001) after pTVR. The reduction of ring area (12±7%, range 0.7–28%) showed an only modest correlation to the number of implanted coaptation devices (r=0.30, p<0.001) and percentage reduction of VCA3D (r=0.36, p<0.001). In the patient group with a ring area change ≥12% a reduction to TR grade ≤2+ by pTVR was achieved in 83% of cases, whereas only 62% of patients reached moderate TR when area change was below 12%. Conclusion pTVR using coaptation devices reduces the ring area. This effect is related to the number of devices implanted. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals 145 Prognostic value of three-dimensional echocardiographic assessment of tricuspid valve geometry in atrial and ventricular functional tricuspid regurgitation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesca Heilbron ◽  
Mara Gavazzoni ◽  
Diana Florescu ◽  
Roberto Ochoa ◽  
Michele Tomaselli ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Major Axis ◽  
Right Atrial ◽  
Vena Contracta ◽  
Functional Tricuspid Regurgitation ◽  
Significant Difference ◽  
History Of ◽  
The Difference

Abstract Aims Atrial and ventricular functional tricuspid regurgitation (A-FTR and V-FTR) have recently emerged as different phenotypes of FTR. Given the difference in mechanisms that are postulated to be underlying these two entities, a different remodelling of tricuspid valve (TV) apparatus can occur and therefore also a specific quantitative approach could be deemed. Moreover, considered the known limitation of the two-dimensional flow convergence method (2D-PISA) for quantifying FTR in advanced valve apparatus remodelling with irregular effective valve orifice (ERO) morphology, it would be expected that also the parameters of severity of FTR can be different in these two types of FTR. The aim of this study was to investigate the TV apparatus remodelling in the two different phenotypes of FTR: ventricular (V-FTR) and atrial (A-FTR) and the role of echocardiographic parameters of TV remodelling and TR severity to predict clinical outcomes. Methods and results The present retrospective study included consecutive patients with moderate to severe functional tricuspid regurgitation (FTR) referred for echocardiography in two Italian centres. The composite endpoint of death for any cause and heart failure (HF) hospitalization was used as primary outcome of this analysis. According to more recent guidelines, patients were considered having A-FTR if having history of long-standing atrial fibrillation, without history of pulmonary hypertension and left side heart disease. A total of 180 patients were included. Despite the right atrial volume (RAV) was not different in the two groups, in A-FTR tethering height was significantly lower (11.7 ± 4.8 mm vs. 15.0 ± 5.5 in V-FTR. P < 0.01) and the 3D-derived tricuspid annulus (TA) diameters were larger both in end-diastolic and mid-systolic phase (3D-TA-End diastolic-major axis: 45.2 ± 6.2 mm in A-FTR vs. 42.8 ± 5.4 in V-FTR. P = 0.04; 3D-TA mid systolic major axis: 41.7 ± 6.4 mm in A-FTR vs. 37.9 ± 5.1 in V-FTR, P < 0.01). 3D-TA-End diastolic-minor axis: 39.7 ± 6.8 vs. 37.1 ± 5.2. P = 0.03. Regarding the parameters of severity of FTR, patients with V-FTR had larger vena contracta (VC), either when 2D estimated or 3D (2D-VC-average: 5.3 ± 2.8 mm in A-FTR vs. 6.6 ± 3.7 in V-FTR. P = 0.02; 3D-VCA: 0.9 ± 0.4 cm2 vs. 1.3 ± 1.1 cm2, P = 0.02); conversely the value of 2D-ERO and regurgitant volume estimated with 2D-PISA method did not show significant difference between the two groups. After a median follow-up of 24 months (IQR: 2–48) 72 patients (40%) reached the primary endpoint and 64 (36%) hospitalized for HF. Different predictors of combined endpoint were found in the two groups: tenting height. 2D-VC. 3D-VCA and regurgitant fraction were prognostic correlates in V-FTR; TA dimensions as well as all the parameters of severe TR, including EROA with PISA method were related to the prognosis in A-FTR. Conclusions Different TV remodelling occurs in patients with A- and V-FTR, having the second more pronounce tethering of TV leaflets; the prognostic role of quantitative parameters of FTR in these two groups is different, thus reaffirming: (1) the limitation of PISA method without correction in case of more pronounced tenting of leaflets; (2) the difference in underlying pathogenic mechanisms; and (3) the needing for a more specific diagnostic approach and prognostic stratification in these two FTR phenotypes.

scholarly journals Impact of the implantation of one MitraClip on the mitral valve anatomy: NTR vs. XTR

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Kassar
Keyword(s):  
Mitral Valve ◽  
Vena Contracta ◽  
Funding Sources ◽  
Mitral Repair ◽  
Before And After ◽  
Vena Contracta Area ◽  
The Impact ◽  
Device Size ◽  
Valve Area ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Percutaneous mitral repair using MitraClips (MC) for severe symptomatic regurgitation (MR) has emerge as an alternative treatment for selected high risk surgical patients. Despite the high number of cases treated with both iterations of the MC, the small NTR and the big XTR, the impact of the device size on the mitral valve area (MVA), the morphology of the annulus, the severity of the MR and the use of multiple device is still unknown. Methods High quality volume focused on the MV were acquired during each intervention. Using a dedicated 3-D analysis software the dimensions of the annulus, the MVA and the 3-D vena contracta area (VCA) were evaluated before and after clipping. After implantation, the area of both orifices were measured independently and summed. Results A total of 120 patients were included, 63 received a NTR and 57 a XTR. Before clipping, XTR cases had bigger MVA (5.9+/-1.7 vs. 4.9+/-1.3 cm2, p .001), a trend toward bigger VCA (0.56+/-0.7 vs. 0.51+/-0.9 cm2, p .073) and no difference in the anteroposterior (AP, 3.5 [3.1-4] vs. 3.5 [3.3-3.8] cm, p .47) and the lateromedial (LM, 4.2 [3.8-4.5] vs. 4.3 [4.0-4.5] cm) diameter of the annulus compared to NTR cases. One MC implantation produced a significant decrease of all these parameters but only MVA was significantly more reduce by XTR (Figure 1). The patients receiving a NTR as first MC did not need more often a second clip (31/63 vs. 26/57, p .072). Conclusions On average, both devices produce a MVA reduction of more than 50% and an indirect annuloplasty mainly in the anteroposterior direction. The use of an XTR as first MC do not decrease the probability of the necessity of a second one. All these parameters should be carefully taken into account when defining the implantation strategy. Abstract Figure.

Changes of tricuspid valve geometry after interventional implantation of an anuloplasty band

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Landendinger ◽  
S Smolka ◽  
J Haug ◽  
M Troebs ◽  
F Ammon ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Clinical Results ◽  
Vena Contracta ◽  
Functional Tricuspid Regurgitation ◽  
Area Reduction ◽  
Before And After ◽  
Grade Scale ◽  
New Treatment ◽  
Lateral Diameter

Abstract Background Implantation of an anuloplasty band (Cardioband, Edwards Lifesciences) is a new treatment option for patients with functional tricuspid regurgitation (TR). The initial clinical results are promising. Nevertheless very few details about the mechanism of reducing TR beyond the basic principle of reducing the annular perimeter are known. Therefore we sought to study the changes of the tricuspid valve geometry after Cardioband implantation. Methods In all patients, that were treated by Cardioband implantation for tricuspid valve implantation at our institution, fluoroscopic images of the implant were optained at an angle, which would correspond to an echocardiographic “enface” view of the tricuspid valve. In these images the area enclosed by the implant, the perimeter of this area, the septal to lateral diameter, the anterior to posterior diameter and the length of the implant before and after contracting the band was measured. In all patients an echocardiographic evaluation of the tricuspid regurgitation before and after cardioband implantation was performed. These clinical finding were correlated to changes of the above mentioned dimension in the fluoroscopic images. Results Between October 2018 und January 2019 17 patients with severe tricuspid regurgitation were treated by Cardioband implantation. In one patient the procedure had to be aborted due to extensive movement of the tricuspid annulus. In the remaining 16 patients (mean age 78±8 years, 7 males) the procedure could be completed successfully and the required measurements were done. The mean severity grade (5 grade scale) of the TR was 3.5±0.6 before and 2±0.7 (p<0.0001) after the implantation, the corresponding mean vena contracta changed from 12±4 mm to 6±3 mm (p<0.000, 51% reduction). The area decreased after band contraction from 10.6±1.4 cm2 to 4.7±1.4 cm2 (p<0.0001; 56% reduction), the perimeter from 13.4±1.8 cm to 9.6±1.6 cm (p<0.0001; 28% reduction) the septal to lateral diameter from 2.8±0.5 cm to 1.6±0.2 cm (p<0.0001; 40% reduction), the anterior to posterior diameter from 4.8±0.9 cm to 3.8±1.0 cm (p<0.005; 19% reduction) and the measured device length from 8.6 cm±1.0 to 5.8±0.8 cm (p<0.0001; 32% reduction). The strongest correlation was seen between area reduction and reduction of the vena contracta (r=0.5), reduction of the septal to lateral dimension as well as the reduction of the device length had a weaker correlation (r=0.3 and r=0.2). The reduction of the anterior posterior diameter and perimeter reduction showed no relevant correlation with regard to TR reduction. Conclusion In our patient population Cardioband implantation lead to effective TR reduction. Area reduction and reduction of the septal to lateral diameter of the tricuspid valve seem to have the strongest impact. These findings may be considered when implantations techniques are being optimized or when new devices for TR treatment are developed. Funding Acknowledgement Type of funding source: None

Comparison of 24-Hour Electrocardiogram Parameters in Patients with Graves Disease Before and After Anti-Thyroid Therapy

2020 ◽  
Vol 20 ◽  
Author(s):  
Gamze Akkuş ◽  
Yeliz Sökmen ◽  
Mehmet Yılmaz ◽  
Özkan Bekler ◽  
Oğuz Akkuş
Keyword(s):  
Treatment Group ◽  
Medical Treatment ◽  
Surgical Therapy ◽  
Graves Disease ◽  
Before And After ◽  
Euthyroid Status ◽  
Ectopic Beats ◽  
Group 2 ◽  
Electrocardiographic Parameters ◽  
Group 1

Background: We aimed prospectively investigate the laboratory and electrocardiographic parameters (hearth rate, QRS, QT, QTc, Tpe, Tpe/QTc, arrhythmia prevalance) in patients with graves disease before and after antithyroid therapy. Methods: 71 patients (48 female, 23 male), age between 18-50 (mean±SD: 36.48±12.20 ) with GD were included into the study. Patients treated with antithyroid therapy (thionamids and/or surgical therapy) to maintain euthyroid status. Patients were examined in terms of electrocardiographic parameters before and after the treatment. Results: Mean TSH, free thyroxin (fT4) and tri-iodothyrionine (fT3) levels of all patients were 0.005±0.21, 3.27± 1.81, 11.42±7.44, respectively. While 9 patients (group 2) underwent surgical therapy, had suspicious of malignant nodule or large goiter and unresponsiveness to medical treatment; the other patients (n=62, group 1) were treated with medical therapy. Patients with surgical therapy had more increased serum fT4 (p=0.045), anti-thyroglobulin value (p=0.018) and more severe graves orbitopathy (n=0.051) before treatment when compared to medical therapy group. Baseline Tpe duration and baseline Tpe/QTc ratio and frequency of supraventricular ectopic beats were found to be significantly higher in group 2 when compared to group 1 (p=0.00, p=0.005). Otherwise baseline mean heart rate, QRS duration, QTc values of both groups were similar. Although the patients became their euthyroid status, group 2 patients had still suffered from more sustained supraventricular ectopics beats than group 1. Conclusion: Distinct from medical treatment group, surgical treatment group with euthyroidism at least 3 months had still suffered from an arrhythmia (Tpe, Tpe/QTc, supraventricular and ventricular ectopic beats).

Sign in / Sign up

Export Citation Format

Share Document