Title: Unexpected mechanism of mitral regurgitation in a patient post ALCAPA repair: added value of three-dimensional echocardiography Authors: Oleksandr Danylenko1, Elena Surkova1, Roxy Senior1, Wei Li1 Institution: 1 - Royal Brompton and Harefield NHS Foundation Trust, Royal Brompton Hospital, London UK

Background: The sustainability of the results of mitraclip procedures is a source of concern. Aims: To investigate risk factors of severe mitral regurgitation (MR) recurrence after Mitraclip in primary MR. Methods and results: Eighty-three patients undergoing successful Mitraclip procedures were retrospectively included. Valve anatomy and Mitraclips placement were comprehensively analyzed by post-processing 3D echocardiographic acquisition. The primary composite endpoint was the recurrence of severe MR. Mean age was 83±7 years-old, 37 (44%) were female. Median follow-up was 381 days (IQR 195-717) and 17 (20%) patients reached the primary endpoint. Main causes of recurrence of severe MR were relapse of a prolapse (64%) and single leaflet detachment (23%). Posterior coaptation line length (HR 1.06 95%CI 1.01-1.12 p=0.02), poor imaging quality (HR 3.84, 95%CI1.12-13.19; p=0.03), and inter-clip distance (HR 1.60, 95%CI 1.27-2.02; p<0.01) were associated with the occurrence of the primary endpoint. Conclusions: Recurrence of severe MR after a MitraClip procedure for primary MR is common and results from a complex interplay between anatomical (tissue excess) and procedural criteria (quality of ultrasound guidance and MitraClips spacing).

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Three-dimensional Echocardiography Is Not Essential for Intraoperative Assessment of Mitral Regurgitation

Circulation ◽

10.1161/circulationaha.112.120519 ◽

2013 ◽

Vol 128 (6) ◽

pp. 653-658 ◽

Cited By ~ 7

Author(s):

Patrick M. McCarthy

Keyword(s):

Mitral Regurgitation ◽

Three Dimensional ◽

Intraoperative Assessment ◽

Dimensional Echocardiography ◽

Three Dimensional Echocardiography

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Cardiac magnetic resonance imaging for assessment of mitral stenosis before and after percutaneous balloon valvuloplasty in comparison to two- and three-dimensional echocardiography

Acta Radiologica ◽

10.1177/0284185119897368 ◽

2020 ◽

Vol 61 (9) ◽

pp. 1176-1185

Author(s):

Hanaa MM Abdelaziz ◽

Ahmed M Tawfik ◽

Ayman A Abd-Elsamad ◽

Sherif A Sakr ◽

Abdulsalam M Algamal

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Mitral Regurgitation ◽

Mitral Stenosis ◽

Three Dimensional ◽

Percutaneous Balloon ◽

Before And After ◽

Dimensional Echocardiography ◽

Three Dimensional Echocardiography ◽

2D And 3D

Background The experience with cardiac magnetic resonance (CMR) in mitral stenosis (MS) is limited in contrast to mitral regurgitation. Purpose To compare CMR versus 2D and 3D transthoracic (TTE) and 3D transesophgeal (TEE) echocardiography in assessment of rheumatic MS before and after percutaneous balloon mitral valvuloplasty (PBMV). Material and Methods Twenty consecutive symptomatic patients with MS were evaluated prospectively and independently by CMR, TTE, and TEE pre-PBMV, and by CMR and TTE post-PBMV. Mitral valve area (MVA) was assessed by CMR planimetry, TTE and TEE planimetry, and pressure half time (PHT). Further assessment included trans-mitral velocity, mitral regurgitation (MR), and left atrial (LA) volume. Results PBMV was successful in 18 patients and failed in two patients (one with MVA <1.5 cm2, one developed severe MR). Pre-PBMV and MVA by CMR, 2D TTE, biplane, 3D TTE, 3D TEE, and PHT were 1.16, 1.16, 1.10, 1.02, 1.05, and 0.99 cm2, respectively. Post-PBMV, a significant increase in MVA was observed (2.15, 2.06, 2.07, 2.04, and 2.03 cm2, respectively). High agreement was observed between CMR and echocardiography before and after PBMV, except for PHT method. CMR significantly underestimated trans-mitral velocity and gradients compared to echocardiography (P<0.001). Before PBMV, mild MR was observed in 11, 12, and 19 patients by 2D TTE, 3D TTE, and CMR. After PBMV, MR was observed in all patients (19 mild, one severe) by all modalities. Echocardiography significantly underestimated LA volume compared to CMR (P<0.001). LA volume decreased significantly after PBMV (P<0.001). Conclusion CMR provides comprehensive assessment of several parameters in MS patients before and after intervention. Agreement with echocardiography is acceptable.

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