Transcatheter mitral valve interventions

2021 ◽  
pp. 337-360
Author(s):  
Nina C. Wunderlich ◽  
Robert J. Siegel ◽  
Ronak Rajani ◽  
Nir Flint
Keyword(s):  
Mitral Valve ◽  
Surgical Techniques ◽  
Transoesophageal Echocardiography ◽  
Fusion Imaging ◽  
Comparable Efficacy ◽  
Device Development ◽  
Percutaneous Procedures ◽  
Procedural Guidance ◽  
Secondary Mr ◽  
New Devices

The past decade has been a revolution in the use of percutaneous procedures for mitral valve (MV) therapy, and currently there are several devices in different stages of development. The enhanced imaging with 3D transoesophageal echocardiography (TEE), as well as computed tomography (CT) and fusion imaging, has led to better understanding of MV anatomy, which in turn helped promote the development of new devices, as well as being crucial for procedural guidance and effective valve repair or replacement. In addition to the new devices, fusion imaging promises to result in even better outcomes in the future by enhancing device deployment. While initially device development for the MV focused on degenerative mitral regurgitation (MR), more recent studies have demonstrated that reducing the severity of secondary MR with transcatheter techniques may provide symptomatic benefit with regards to cardiac heart failure and improved survival. Percutaneous therapies for the MV, as they are less invasive, have many advantages that may supplant surgical techniques, provided that they reduce morbidity and mortality and have comparable efficacy. In this chapter we review transcatheter MV interventions for mitral stenosis (MS) and MR.

Mechanisms of mitral regurgitation after percutaneous mitral valve repair with the MitraClip

2019 ◽  
Vol 21 (10) ◽  
pp. 1131-1143 ◽  
Author(s):  
Hiroki Ikenaga ◽  
Moody Makar ◽  
Florian Rader ◽  
Robert J Siegel ◽  
Saibal Kar ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Morphological Changes ◽  
Transoesophageal Echocardiography ◽  
Left Ventricular ◽  
Index Procedure ◽  
End Diastolic Volume ◽  
Percutaneous Mitral Valve Repair ◽  
Secondary Mr ◽  
Leaflet Prolapse

Abstract Aims We sought to find the morphological mechanisms of recurrent mitral regurgitation (MR) after MitraClip procedure using 3D transoesophageal echocardiography (TOE). Methods and results Of 478 consecutive patients treated with the initial MitraClip procedure, 41 patients who underwent repeat mitral valve (MV) transcatheter or surgical intervention for recurrent MR were retrospectively reviewed. Using 3D-TOE, we investigated morphological changes of MV leading to repeat MV intervention. Aetiology of MR at the index intervention was primary in 24 (59%) and secondary in 17 (41%) patients. In the primary MR group, worsening leaflet prolapse at the clip site caused recurrent MR in 12 (50%) patients, while 7 (29%) patients had a leaflet tear at the clip site. Acute single leaflet device detachment was seen in four patients and one patient had recurrent MR between the plug and the clip. In secondary MR, left ventricular (LV)/left atrial dilation caused recurrent MR in 13 (76%) patients. Significant increase in the LV end-diastolic volume and tenting height were observed from post-index procedure to repeat intervention (LV end-diastolic volume; from 205 to 237 ml, P < 0.001, tenting height; from 0.8 to 1.3 cm, P < 0.001). New emergent leaflet prolapse/flail was seen in 3 (18%) patients, suggesting iatrogenic MR. Conclusion Mechanisms of recurrent MR after MitraClip procedure varied and depended on the underlying MV pathology: in primary MR, worsening mitral leaflet prolapse and in secondary MR, progressive LV dilation with worsening tenting were the main causes of recurrent MR.

A Complex Mitral Valve Reconstruction: A Case Report

2005 ◽  
Vol 6 (2) ◽  
pp. 27
Author(s):  
Dimitrios Buklas ◽  
Massimo Massetti ◽  
Eric Saloux ◽  
Eugenio Neri ◽  
Olivier LePage ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Surgical Techniques ◽  
Mitral Valve Insufficiency ◽  
Left Ventricular ◽  
Mitral Valve Reconstruction ◽  
Mitral Repair ◽  
Valve Reconstruction ◽  
Valve Insufficiency ◽  
Valve Function ◽  
Valvular Function

Several techniques are currently in use for mitral valve reconstruction. We report a mitral repair case in which the use of a combination of different surgical techniques resulted in the necessary correction. A 47-year-old woman underwent surgical intervention to treat severe mitral valve insufficiency due to A1/A2/A3 and P2 prolapsed valve tissue. A combination of quadrangular resection, sliding leaflet, single chordal transposition, "flip-over" leaflet, and ring annuloplasty techniques were applied, and postsurgical correct valve function was documented by results of a left ventricular saline filling test and transesophageal echocardiography control. Complex mitral valve repairing techniques can be combined to reestablish valvular function.

scholarly journals Utility of 3-dimensional transoesophageal echocardiography for mitral annular sizing in transcatheter mitral valve replacement procedures: a cardiac computed tomography comparative study

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Coisne ◽  
F Pontana ◽  
S Aghezzaf ◽  
S Mouton ◽  
H Ridon ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Cardiac Computed Tomography ◽  
Transoesophageal Echocardiography ◽  
3 Dimensional ◽  
Ct Measurements ◽  
Good Ability ◽  
Transcatheter Mitral Valve Replacement

Abstract Funding Acknowledgements Type of funding sources: None. Background.  3-dimensional transoesophageal echocardiography (3D-TEE) is frequently used as an initial screening tool in the evaluation of patients who are candidates to Transcatheter Mitral Valve Replacement (TMVR). However, little is known about the imaging correlation with the gold-standard computed tomography (CT) imaging. We aimed at testing the quantitative differences between these two modalities and finding the best 3D-TEE parameters for TMVR screening. Methods. We included 57 patients referred to our Heart Valve Clinic for TMVR with prostheses specifically designed for the mitral valve. Mitral annulus (MA) analyses were performed using commercially available software in 3D-TEE and CT. Results. 3D-TEE was feasible in 52 patients (91%). Although 3D-TEE measurements were slightly lower than in CT, both measurements of projected MA area and perimeter showed excellent correlation with small differences between the two modalities (r = 0.88 and r = 0.92 respectively, p < 0.0001). Correlations were significant but lower for MA diameters (r = 0.68 to 0.72, p < 0.0001) and mitro-aortic angle (r = 0.53, p = 0.0001). ROC curve analyses showed that 3D-TEE had a good ability to predict TMVR screening success defined by constructors based on CT measurements with a range of 12.9 to 15cm² for MA area (AUC = 0.88-0.91, p < 0.0001), 128 to 139mm for MA perimeter (AUC = 0.85-0.91, p < 0.0001), 35 to 39mm for anteroposterior diameter (AUC = 0.79-0.84 p < 0.0001) and 37 to 42mm for posteromedial-anterolateral diameter (AUC = 0.81-0.89, p < 0.0001) (Figure 1). Conclusion. 3D-TEE measurements of MA dimensions display strong correlation with CT measurements in patients undergoing TMVR screening process. 3D-TEE should be proposed as a reasonable alternative to CT in this vulnerable population. Abstract Figure.

scholarly journals Echocardiographic-fluoroscopic fusion imaging for transcatheter mitral valve repair guidance

2018 ◽  
Vol 19 (7) ◽  
pp. 715-726 ◽  
Author(s):  
Francesco F Faletra ◽  
Alberto Pozzoli ◽  
Eustachio Agricola ◽  
Andrea Guidotti ◽  
Luigi Biasco ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Fusion Imaging ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair

scholarly journals Four-dimensional modelling of the mitral valve by real-time 3D transoesophageal echocardiography: proof of concept

2014 ◽  
Vol 20 (2) ◽  
pp. 200-208 ◽  
Author(s):  
Thilo Noack ◽  
Chirojit Mukherjee ◽  
Philipp Kiefer ◽  
Fabian Emrich ◽  
Marcel Vollroth ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Real Time ◽  
Transoesophageal Echocardiography ◽  
Proof Of Concept

Transcatheter mitral valve interventions: pre-procedural planning and intra-procedural guidance

2021 ◽  
Author(s):  
Antonio Boccellino ◽  
Francesco Melillo ◽  
Francesco Ancona ◽  
Antonio Napolano ◽  
Giacomo Ingallina ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Procedural Guidance ◽  
Procedural Planning

scholarly journals Acute and Short-Term Outcomes of Percutaneous Transcatheter Mitral Valve Replacement in Children

2021 ◽  
Author(s):  
Nicola Maschietto ◽  
Ashwin Prakash ◽  
Pedro del Nido ◽  
Diego Porras
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Pediatric Patients ◽  
Surgical Techniques ◽  
Postoperative Mortality ◽  
Surgical Risk ◽  
Transcatheter Mitral Valve Replacement ◽  
High Surgical Risk ◽  
Valve In Valve

Background: Despite the improvement of surgical techniques for mitral valve (MV) repair in children, mitral valve replacement (MVR) is sometimes still necessary. MVR and redo-MVR continue to be burdened by early postoperative mortality and long-term morbidity with only about 75% of these patients being alive or transplant-free 10 years after the initial MVR. Although transcatheter MVR (TMVR) is a well-established intervention in high surgical risk adults, only a few pediatric valve-in-valve case reports have been published. The purpose of this study was to describe our initial experience with the off-label use of the Sapien S3 valve for TMVR in a highly selected pediatric patient population. Methods: We conducted a retrospective analysis of pediatric patients who underwent TMVR at Boston Children’s Hospital between October 2018 and July 2020. Results: Eight consecutive high surgical risk pediatric patients (median age, 9 years; range, 8–15) underwent TMVR (7 as valve-in-valve, 1 in a native MV). Each patient previously underwent multiple MV surgeries or MVR (median 4, range 2–5) and was highly symptomatic (Ross functional class 3 or 4). The indication for TMVR was mitral stenosis in 4 patients, regurgitation in 1, and mixed disease in 3. TMVR was successful in each patient, effectively reduced the left atrium and pulmonary hypertension ( P =0.012 and 0.043 respectively), and was carried out without significant complications. Conclusions: TMVR is an attractive alternative to MVR in high surgical risk patients. In this small series, TMVR was acutely effective and safe, with very encouraging early results.

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