Left atrial pressure is associated with iatrogenic atrial septal defect after mitral valve clip

Heart ◽  
2018 ◽  
Vol 105 (11) ◽  
pp. 864-872 ◽  
Author(s):  
Hiroki Ikenaga ◽  
Atsushi Hayashi ◽  
Takafumi Nagaura ◽  
Satoshi Yamaguchi ◽  
Jun Yoshida ◽  
...  
Keyword(s):  
New York ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Heart Association ◽  
Functional Class ◽  
Systolic Pulmonary Artery Pressure ◽  
New York Heart Association ◽  
Iatrogenic Atrial Septal Defect

ObjectivesMitral valve (MV) clip procedure requires interatrial trans-septal puncture to access the left atrium (LA). Iatrogenic atrial septal defect (iASD) is not uncommon and may remain for a while. However, haemodynamic and echocardiographic determinants of persistent iASD are not well investigated. We sought to find haemodynamic and echocardiographic determinants of iASD after MV clip.MethodsA total of 131 patients with grades 3 to 4+ mitral regurgitation who underwent MitraClip and completed invasive haemodynamic measurement, baseline, 1 month and approximately 12 months of transthoracic echocardiography (TTE) follow-up were retrospectively reviewed.ResultsTTE at 1 month showed persistent iASD in 57% (1M-iASD). Mean LA pressure after clip was significantly higher in patients with 1M-iASD than patients without 1M-iASD (17±6 mm Hg vs 15±5 mm Hg, p=0.01). Among patients with 1M-iASD, 24 patients (35%) had persistent iASD at 12 months (12M-iASD). Mean LA pressure after clip was significantly higher in patients with 12M-iASD than patients without 12M-iASD (19±6 mm Hg vs 16±6 mm Hg, p=0.04). Patients with 12M-iASD did not significantly differ from patients without 12M-iASD in terms of right heart enlargement, estimated systolic pulmonary artery pressure, New York Heart Association functional class and brain natriuretic peptide at 12 months. Logistic regression analysis, however, showed that mean LA pressure after clip was significantly associated with persistent iASD at 12 months in patients with 1M-iASD even after adjustment for cardiac index after clip and the prevalence of mitral regurgitation ≥3+ at 12 months (OR 1.10 per 1 mm Hg, 95% CI 1.01 to 1.21, p=0.04).ConclusionsElevated LA pressure after MV clip was associated with persistent iASD.

scholarly journals Mitral Valve Repair for Functional Mitral Regurgitation in End-Stage Dilated Cardiomyopathy

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Michele De Bonis ◽  
Elisabetta Lapenna ◽  
Giovanni La Canna ◽  
Eleonora Ficarra ◽  
Marco Pagliaro ◽  
...  
Keyword(s):  
New York ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Hospital Mortality ◽  
Heart Association ◽  
Functional Mitral Regurgitation ◽  
York Heart Association Class ◽  
Association Class ◽  
New York Heart Association ◽  
End Stage

Background— The aim of this study was to assess the results of mitral valve (MV) repair in functional mitral regurgitation because of end-stage dilated cardiomyopathy (DCM). Methods and Results— Seventy-seven patients with end-stage idiopathic (26 patients) or ischemic (51 patients) DCM underwent MV repair for functional mitral regurgitation (3 to 4+/4+). Fifty-eight patients (75.3%) were in New York Heart Association class III, and 19 (24.6%) were in IV. In 23 patients (29.8%) with a coaptation depth <1 cm, an isolated undersized annuloplasty was used. In the remaining 54 (70.1%), with a coaptation depth ≥1 cm, the “edge-to-edge” technique was associated with the annuloplasty. In most of the cases (88.3%), a complete rigid/semirigid ring was used. Concomitant coronary artery bypass graft was performed in 39 patients (50.6%). Hospital mortality was 3.8% (3 of 77). Actuarial survival was 90.7±3.64%, and freedom from cardiac events was 81.8±7.96% at 2.7 years. At a mean follow-up of 18.4±9.8 months (range, 1 month to 5 years) New York Heart Association class improved from 3.4±0.4 to 1.4±0.6 ( P <0.0001). Mitral repair failure (recurrence of MR ≥3+/4+) was documented in 7 patients (9%): 2 in the edge-to-edge (2 of 54, 3.7%) and 5 in the isolated annuloplasty group (5 of 23, 21.7%) ( P =0.03). Freedom from repair failure at 1.5 years was 95.0±3.4% and 77±12.1%, respectively ( P =0.04). The absence of the edge-to-edge was the only predictor of repair failure ( P =0.03). When residual MR was absent or mild, a reverse left ventricular remodeling was clearly documented. Conclusions— In patients with end-stage DCM, MV repair is feasible with low hospital mortality and important symptomatic improvement. The association of the edge-to-edge technique to the undersized annuloplasty can significantly improve the durability of the repair.

scholarly journals Outcomes after the MitraClip Procedure in Patients at Very High Risk for Conventional Mitral Valve Surgery

2018 ◽  
Vol 13 (6) ◽  
pp. 433-437
Author(s):  
Joshua L. Manghelli ◽  
Daniel I. Carter ◽  
Ali J. Khiabani ◽  
Hersh S. Maniar ◽  
Ralph J. Damiano ◽  
...  
Keyword(s):  
New York ◽  
High Risk ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Heart Association ◽  
Mitral Valve Surgery ◽  
Risk Of Mortality ◽  
New York Heart Association ◽  
Predicted Risk

Objective Approximately 50% of patients with severe symptomatic mitral regurgitation are deemed too high risk for surgery. The MitraClip procedure is a viable option for this population. Our goal was to assess outcomes and survival of patients who underwent the MitraClip procedure at an institution where mitral valve surgery is routinely performed. Methods A retrospective study of patients undergoing the MitraClip procedure was performed. Baseline characteristics, perioperative outcomes, and follow-up echocardiographic and clinical outcomes were examined. Primary end point was survival. Secondary end points included technical failure (residual 3/4+ mitral regurgitation), reoperation, New York Heart Association symptoms, 30-day mortality, and other clinical outcomes. Predictors of mortality were determined using multivariable regression analysis. Results Fifty consecutive patients underwent the MitraClip procedure during the 4-year period. The average age was 83, the Society of Thoracic Surgeons predicted risk of mortality mean was 9.4%, 88% (44/50) had New York Heart Association III/IV symptoms, 86% (43/50) had 4+ mitral regurgitation, and 72% (36/50) had degenerative mitral disease etiology. Echocardiographic data (median [interquartile range] follow-up = 43 [26–392]) showed that 86% (43/50) of patients had 2+ or less mitral regurgitation. Sixty percent (24/40) had New York Heart Association I/II symptoms at last follow-up. Predictors of mortality were higher Society of Thoracic Surgeons predicted risk of mortality ( P = 0.042, hazard ratio = 1.098) and previous cardiac surgery ( P = 0.013, hazard ratio = 3.848). Survival at 1 and 2 years was 75% and 63%, respectively. Conclusions Many patients with mitral valve regurgitation who are high risk for open surgery can be treated with the MitraClip procedure. In our study, most patients (86%) had a technically successful operation and postoperative outcomes including survival were acceptable.

scholarly journals Severe mitral regurgitation from Libman–Sacks endocarditis treated with MitraClip: a case report

2021 ◽  
Vol 5 (10) ◽  
Author(s):  
Wong Ningyan ◽  
Ignasius Aditya Jappar ◽  
Ewe See Hooi ◽  
Yeo Khung Keong
Keyword(s):  
New York ◽  
Mitral Regurgitation ◽  
Heart Association ◽  
Class Ii ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Severe Mitral Regurgitation ◽  
Nyha Functional Class ◽  
New York Heart Association

Abstract Background  Systemic lupus erythematosus (SLE) valvulopathy can manifest as a spectrum of pathologies and treatment of severe valvular dysfunction thus far has been surgical. However, surgery in patients with SLE is frequently associated with high morbidity and mortality due to the presence of significant co-morbidities. Case summary  We report the case of a 41-year-old woman with SLE and anti-phospholipid syndrome with extensive co-morbidities including lupus nephritis, pancytopaenia, cerebrovascular accident, and severe airway obstruction from ipsilateral lung collapse and bronchiectasis. She had severe mitral regurgitation (MR) from Libman–Sacks endocarditis and in recent months developed heart failure with progressive exertional dyspnoea from New York Heart Association (NYHA) functional Class from New York Heart Association (NYHA) functional class II to III. In addition, there was progressive left ventricular dilatation and reduction in left ventricular ejection fraction. In view of the high surgical risk, she underwent transcatheter edge-to-edge repair (TEER) of the mitral valve with the MitraClip system. At 1-month follow-up, she was back to NYHA functional Class II with mild MR. Discussion Our case demonstrates that in select patient with suitable anatomy, TEER is a potential treatment option for severe MR from SLE valvulopathy.

Congenital Mitral Valve Regurgitation in Adult Patients

2011 ◽  
Vol 14 (2) ◽  
pp. 114 ◽  
Author(s):  
ShengLi Jiang ◽  
ChangQing Gao ◽  
BoJun Li ◽  
ChongLei Ren ◽  
Yao Wang ◽  
...  
Keyword(s):  
New York ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Heart Association ◽  
Mitral Valve Regurgitation ◽  
Atrioventricular Septal Defect ◽  
Functional Class ◽  
Valve Regurgitation ◽  
Valve Repair ◽  
New York Heart Association

Objective: Congenital mitral valve regurgitation (MVR) is a rare disease found in adults. We report on our 5-year surgical experience with congenital MVR in adults.Methods: We reviewed the data for 48 consecutive patients (26 men), aged >18 years (median, 42 years; range, 18-78 years) who underwent operations for severe congenital MVR between June 2005 and May 2010. Patients with atrioventricular septal defect were excluded.Results: Congenital MVR was preoperatively diagnosed in 28 cases (58%). The lesions consisted of annular dilation (100%), valvular cleft (58%), prolapsed leaflet (40%), papillary muscle abnormality (5%), commissure fusion (2%), and leaflet deficiency (2%). Mitral valve repair was performed in 42 cases (88%) by means of Carpentier techniques. The other 6 patients underwent mitral valve replacement; one of these patients died of ventricular fibrillation 2 days after surgery. There were no other hospital deaths or late mortality. At the last follow-up (median, 38 months; range, 2-50 months), all 47 patients were in New York Heart Association functional class I or II. Echocardiography evaluations for the 42 patients who underwent the repairs revealed that 32 (76%) of the patients had no or trivial MVR and 10 patients (24%) had mild MVR. No patient underwent reoperation.Conclusion: Congenital MVR is rare and often misdiagnosed in adults. Mitral valve repair is feasible in the majority of patients, with excellent immediate and medium-term results.

scholarly journals Outcome after percutaneous edge-to-edge mitral repair for functional and degenerative mitral regurgitation: a systematic review and meta-analysis

Heart ◽  
2017 ◽  
Vol 104 (4) ◽  
pp. 306-312 ◽  
Author(s):  
Mauro Chiarito ◽  
Matteo Pagnesi ◽  
Enrico Antonio Martino ◽  
Michele Pighi ◽  
Andrea Scotti ◽  
...  
Keyword(s):  
Systematic Review ◽  
New York ◽  
Mitral Regurgitation ◽  
Meta Analysis ◽  
Heart Association ◽  
Class Iii ◽  
Term Outcome ◽  
Mitral Repair ◽  
New York Heart Association ◽  
One Year

ObjectivesDifferences in terms of safety and efficacy of percutaneous edge-to-edge mitral repair between patients with functional and degenerative mitral regurgitation (MR) are not well established. We performed a systematic review and meta-analysis to clarify these differences.MethodsPubMed, EMBASE, Google scholar database and international meeting abstracts were searched for all studies about MitraClip. Studies with <25 patients or where 1-year results were not delineated between MR aetiology were excluded. This study is registered with PROSPERO.ResultsA total of nine studies investigating the mid-term outcome of percutaneous edge-to-edge repair in patients with functional versus degenerative MR were included in the meta-analysis (n=2615). At 1 year, there were not significant differences among groups in terms of patients with MR grade≤2 (719/1304 vs 295/504; 58% vs 54%; risk ratio (RR) 1.12; 95% CI: 0.86 to 1.47; p=0.40), while there was a significantly lower rate of mitral valve re-intervention in patients with functional MR compared with those with degenerative MR (77/1770 vs 80/818; 4% vs 10%; RR 0.60; 95% CI: 0.38 to 0.97; p=0.04). One-year mortality rate was 16% (408/2498) and similar among groups (RR 1.26; 95% CI: 0.90 to 1.77; p=0.18). Functional MR group showed significantly higher percentage of patients in New York Heart Association class III/IV (234/1480 vs 49/583; 16% vs 8%; p<0.01) and re-hospitalisation for heart failure (137/605 vs 31/220; 23% vs 14%; p=0.03). No differences were found in terms of single leaflet device attachment (25/969 vs 20/464; 3% vs 4%; p=0.81) and device embolisation (no events reported in both groups) at 1 year.ConclusionsThis meta-analysis suggests that percutaneous edge-to-edge repair is likely to be an efficacious and safe option in patients with both functional and degenerative MR. Large, randomised studies are ongoing and awaited to fully assess the clinical impact of the procedure in these two different MR aetiologies.

An Early Canadian Experience with the Correx Automated Coring and Apical Connector Device for Aortic Valve Bypass

2016 ◽  
Vol 11 (6) ◽  
pp. 434-438
Author(s):  
Hussein A. Al-Amodi ◽  
Christopher L. Tarola ◽  
Hamad F. Alhabib ◽  
Corey Adams ◽  
Linrui Ray Guo ◽  
...  
Keyword(s):  
New York ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
New York Heart Association ◽  
Apical Connector ◽  
Aortic Valve Bypass

Objective Aortic valve replacement is the standard of care for severe, symptomatic aortic valve stenosis (AS); however, anatomy or preexisting comorbidities may preclude conventional or alternative transcatheter approaches. Aortic valve bypass (AVB) may be performed as a salvage procedure for the relief of symptomatic aortic stenosis in patients who are not suitable candidates for aortic valve replacement. Methods At our institution, seven patients underwent AVB using the Correx automated coring and apical connector system. All patients had severe AS with New York Heart Association functional class 3 symptoms and were not candidates for conventional or transcatheter approaches. Via a left anterolateral thoracotomy to access the descending aorta and left ventricular apex, we used the Correx system (Correx, Waltham, MA USA) to anastomose a valve conduit to the left ventricular apex proximally and the descending aorta distally. Three patients required cardiopulmonary bypass. Results In all seven patients, the automated coring and apical connector was successfully deployed. There were two in-hospital deaths in this series. Immediately postoperatively and at 3 months, there was a significant reduction in mean and peak valve gradients, and all surviving patients performed at New York Heart Association functional class 1. Conclusions Aortic valve bypass seems to be an acceptable alternative for the treatment of severe AS in high-risk patients who are not candidates for aortic valve replacement. The Correx automated system may improve the clinical applicability and surgical repro-ducibility of AVB in appropriately selected patients in which conventional or transcatheter aortic valve replacement is not a feasible options.

scholarly journals Marfan syndrome with unileaflet mitral valve, moderate mitral regurgitation and atrial septal defect. An uncommon association

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Nilda Espinola-Zavaleta ◽  
Rodrigo Escalante-Armenta ◽  
Dana Leyla Rei-Cassab ◽  
Luis Javier Castellanos-Vizcaíno ◽  
Erick Alexanderson-Rosas
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Atrial Septal Defect ◽  
Marfan Syndrome ◽  
Septal Defect

Subtotal Pericardiectomy via Sternotomy for Constrictive Pericarditis

2000 ◽  
Vol 8 (2) ◽  
pp. 134-136 ◽  
Author(s):  
Ashok K Srivastava ◽  
Anoop K Ganjoo ◽  
Bashist Misra ◽  
Tapas Chaterjee ◽  
Aditya Kapoor ◽  
...  
Keyword(s):  
New York ◽  
Constrictive Pericarditis ◽  
Left Atrial ◽  
Heart Association ◽  
Functional Class ◽  
Left Atrial Size ◽  
Univariate Logistic Regression Analysis ◽  
Atrial Size ◽  
New York Heart Association ◽  
Pericardial Calcification

Records of 103 patients with constrictive pericarditis who underwent subtotal pericardiectomy from January 1990 to December 1997 were retrospectively analyzed. The etiology of pericardial constriction was unknown in 63, tuberculous in 30, pyogenic in 7, and miscellaneous in 3 patients. Adequate pericardiectomy could be accomplished in 85 (82.5%) patients. Eleven patients (10.68%) died within 30 days of surgery. The 92 survivors were followed up for 47.21 ± 30.7 months; functional status improved in all cases. Of 15 variables examined by univariate logistic regression analysis, preoperative New York Heart Association functional class IV, atrial fibrillation, left atrial size > 40 mm·m−2, mild to moderate mitral regurgitation, tricuspid regurgitation, pericardial calcification, and inadequate pericardiectomy were found to be significant predictors of poor outcome. Adequate pericardiectomy via sternotomy was considered to carry low operative risk and provide excellent improvement in functional capacity.

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