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Transcatheter mitral valve replacement (TMVR) has emerged as a feasible alternative to surgical reoperation in failed bioprostheses and rings. Residual mitral regurgitation following TMVR can present as a valve?in?valve paravalvular leak (PVL) and is associated with increased morbidity and mortality. Current therapies for valve?in?valve PVL are limited. We present a case of a symptomatic patient with severe valve?in?valve PVL after TMVR for a previous surgical bioprosthesis leak, who then underwent a second TMVR as a valve?in?valve?in?valve implantation with a 29 mm Edwards? SAPIEN 3 valve via transseptal approach using three?dimensional (3D) echocardiography. This unique case highlights the complexity of this clinical entity and recognizes 3D transesophageal echocardiography as a valuable tool to guide valve?in?valve PVL closures.echocardiography
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The incidence of acute myocardial infarction (AMI) is increasing. Acute papillary muscle rupture is one of the serious and rare mechanical complications of AMI, which occurs mostly in inferior and posterior myocardial infarction. A patient with acute inferior myocardial infarction developed pulmonary edema and refractory shock, followed by cardiac arrest. After cardiopulmonary resuscitation (CPR), revascularization of criminal vessels was carried out by emergency percutaneous transluminal coronary angioplasty (PTCA) under the support of intra-aortic balloon pump (IABP) and extra corporeal membrane oxygenation (ECMO). Although the patient was given a chance for surgery, his family gave up treatment due to unsuccessful brain resuscitation. It reminds that mechanical complications such as acute papillary muscle rupture, valvular dysfunction and rupture of the heart should be highly suspected when cardiogenic pulmonary edema and cardiogenic shock are difficult to correct in acute inferior myocardial infarction. Echocardiogram and surgery should be put forward when revascularization of criminal vessels is available.
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Humans , Inferior Wall Myocardial Infarction/complications , Papillary Muscles/surgery , Pulmonary Edema , Myocardial Infarction/surgery , Shock, CardiogenicABSTRACT
@#As the indications for transcatheter aortic valve replacement (TAVR) expand, multi-valve lesions are becoming more common in clinical practice. Moderate to severe atrioventricular regurgitation, particularly when persistent after TAVR, significantly increases the risk of adverse events. Therefore, many studies have evaluated factors that contribute to the improvement of atrioventricular regurgitation. However, this field remains controversial due to the heterogeneity of retrospective studies and the lack of randomized controlled trials. Despite advances in atrioventricular valve intervention techniques, evidence for atrioventricular regurgitation intervention after TAVR is still scarce. The management decision for atrioventricular regurgitation in patients who underwent TAVR is complex and must take into account the severity of valve disease, anatomical characteristics, quality of life, and procedural complexity. We conducted a review of atrioventricular regurgitation in patients who have received TAVR in hope that it will help decision-making in clinical practice.
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@# Objective To analyze the efficacy of off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation. Methods The clinical data of patients aged≥70 years with coronary artery disease complicated with moderate mitral regurgitation, and undergoing OPCABG from January 2009 to January 2020 in Beijing Anzhen Hospital were retrospectively analyzed. The echocardiographic indicators of the patients were compared preoperatively, postoperatively before discharge and during the follow-up. Results Finally 239 patients were enrolled. There were 136 males and 103 females, aged 74.1±3.2 years. Before postoperative discharge, 49 (20.5%) patients had no mitral regurgitation, 144 (60.3%) mild regurgitation, 46 (19.2%) moderate regurgitation, and 0 severe regurgitation. The area of mitral regurgitation was significantly improved (2.5±1.8 cm2 vs. 5.6±1.0 cm2, P<0.001). There were 10 (4.2%) patients of hospital death, 23 (9.6%) of low cardiac output, 3 (1.3%) of myocardial infarction, and 8 (3.3%) of nervous system injury after operation. As a result, 208 (90.8%) patients were followed up and the mean follow-up time was 3.4 years (range 1-9 years). The cumulative survival rates at postoperative 2, 4, 6, and 8 years were 95.8%, 88.0%, 78.4%, and 73.1%, respectively. Postoperative follow-up showed significant improvements compared with those before surgery in the area of mitral regurgitation, left ventricular ejection fraction, left ventricular end-diastolic and left ventricular end-systolic diameters (all P<0.05). Duirng the follow-up, the major adverse cardiac and cerebrovascular events were all cause death in 22 (10.6%) patients, including cardiac death in 17 (8.2%) patients, myocardial infarction in 7 (3.4%) patients, heart failure in 24 (11.5%) patients, cerebrovascular events in 11 (5.3%) patients, re-hospitalization due to heart disease in 23 (11.1%) patients, and none of the patients with myocardial infarction were revascularized. Conclusion The mid- and long-term outcomes of OPCABG in the treatment for elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation is good.
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@#Mitral regurgitation is the most common heart valvular disease at present. In the past, mitral regurgitation was mainly treated by surgical mitral valve repair or replacement. However, with the progress of transcatheter interventional techniques and instruments in recent years, transcatheter mitral valve interventional therapy has gradually shown its advantages and benefited patients. The purpose of this article is to review the progress of transcatheter mitral valve intervention in this year, and to provide prospects for the future of transcatheter mitral valve treatment.
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Objective:To study the influence of Mei mini maze procedure for atrial functional mitral regurgitation.Methods:The data of 33 patients with atrial fibrillation and atrial functional mitral regurgitation from January 2017 to June 2020 were retrospectively analyzed. All patients received Mei mini maze procedure for atrial fibrillation. The procedure is carried out thoracoscopically through the left thoracic approach. The ablation of atrial fibrillation includes bilateral circumferential pulmonary vein ablation, isolation of the left atrium posterior wall, left atrial appendage resection, ablation of Marshall's ligament and autonomic ganglion, etc. Follow-up was conducted by outpatient follow-up and telephone. Postoperative heart rhythm was recorded by the patient's symptoms, electrocardiogram, 24 h holter and other examinations. Postoperative mitral valve lesions were obtained by echocardiography.Results:33 patients successfully completed the operation. There was no conversion to thoracotomy and no perioperative death. Thirty patients(90.9%) maintained sinus rhythm at discharge. Before discharge, 16 patients had no mitral regurgitation in echocardiography, 8 patients had mild mitral regurgitation, and 9 patients had moderate mitral regurgitation. Follow-up was 1-4 years after discharge, with a mean of(2.6±1.1) years. Sinus rhythm was maintained in 23 patients(69.7%). 17 patients had no mitral regurgitation, 9 had mild mitral regurgitation, 6 had moderate, and 1 had severe mitral regurgitation. The degree of regurgitation in 25 patients was reduced compared with pre-operation, 5 patients remained unchanged, and 3 patients mitral regurgitation aggravated. Unreduced atrial functional mitral regurgitation was associated with recurrence of atrial fibrillation by Cox multivariate analysis.Conclusion:This study found a close relationship between atrial fibrillation rhythm and atrial functional mitral regurgitation. Most moderate atrial functional mitral regurgitation can be alleviated by effective treatment for atrial fibrillation. It is not recommended that patients with severe atrial functional mitral regurgitation only receive treatment for atrial fibrillation.
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Objective:To quantitatively evaluate and compare the morphology and dynamics parameters of mitral valve devices in patients with atrial functional mitral regurgitation (AFMR) and ventricular functional mitral regurgitation (VFMR) by real-time three-dimensional ultrasound, in order to provide theoretical basis for diagnosis and clinical treatments of the two types of regurgitation patients.Methods:A retrospective study was conducted on 20 AFMR patients (AFMR group) and 20 VFMR patients (VFMR group) who underwent transesophageal echocardiography at Wuhan University People′s Hospital from May to November 2022. Additionally, 20 patients who underwent transesophageal echocardiography at our hospital during the same period due to patent foramen ovale or non cardiac surgery monitoring were selected as the control group. All subjects were measured mitral annulus anteroposterior diameter (AP diameter), anterolateral posteromedial diameter (ALPM diameter), anteroposterior diameter/anterolateral posteromedial diameter (AP/ALPM), commissural width (CW), annular area (AA), annular circumference (AC), annular height (AH), coaptation depth (CD), tenting volume (TV), non-planar angle (NPA) and posterior leaflet angle at isovolumic relaxation time, early diastole, mid diastole, late diastole, isovolumic contraction time, early systole, mid systole, and late systole. The total change rate and systolic change rate of the above parameters were calculated, the differences in structure and dynamic changes of the mitral valve device among three groups were compared, and the correlations between the change rate of mitral annular parameters and left ventricular long axis strain (GLS) were analyzed.Results:①The GLS of three groups were as follows: control group>AFMR group>VFMR group, and the differences between the groups were statistically significant (all P<0.05). ②Static structure: The AP diameter, ALPM diameter, AA, AC, and total leaflet area (TLA) of the AFMR group and VFMR group were significantly larger than those of the control group (all P<0.05), but there was no statistically significant difference between the AFMR group and VFMR group (all P>0.05). Compared with the other two groups, the TV, CD, and posterior leaflet angle of the VFMR group were significantly increased, exhibiting the mitral valve tethering; the control group had the largest AH/CW and the deepest saddle shape; the AFMR group had the smallest TLA/AA and the least mitral valve remodeling; there was no statistically significant difference in the junction area among the three groups (all P>0.05). ③Dynamic changes: AP diameter, ALPM diameter, AA and AC in the control group showed regular changes throughout the cardiac cycle, gradually decreased from isovolumic relaxation time to late diastole, and gradually increased from isovolumic contraction time to late systole; The changes in the above parameters in the AFMR and VFMR groups appeared more disordered. In addition, compared with the control group, the total change rate and systolic change rate of AP diameter in the AFMR group were significantly reduced, but the total change rate of ALPM diameter was significantly increased (all P<0.05). ④The total change rate of AA, ALPM diameter and AP diameter were moderately correlated with GLS ( r=0.353, P=0.006; r=-0.304, P=0.018; r=0.300, P=0.020), while the systolic change rate of posterior leaflet angle was weakly correlated with GLS ( r=0.267, P=0.039). Conclusions:There are differences in the morphology and dynamics parameters of mitral valve device in patients with AFMR and VFMR.Different clinical strategies can be used for the two kinds of functional mitral regurgitation.
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Objective:To investigate the effect of instantaneous flow rate on the consistency of diagnostic accuracy of severe degenerative mitral regurgitation (DMR) using proximal isovelocity surface area (PISA).Methods:From June 2019 to June 2021, 75 patients with DMR who underwent echocardiography in Department of Echocardiography of Zhongshan Hospital, Fudan University were prospectively enrolled. The instantaneous flow rate of DMR during the systolic phase was calculated using M-mode PISA(PISA M-mode), and a time-integrated curve was plotted. Regurgitant volume (RVol) and effective regurgitant orifice area (EROA) were calculated by traditional PISA (PISA max), pair PISA (PISA pair), and PISA M-mode, respectively. RVol acquired from cardiac magnetic resonance (CMR) volumetric method in 22 patients of the enrolled patients. The correlation and consistency of RVol acquired between the three PISA methods and CMR were compared. Agreement of diagnostic accuracy of severe mitral regurgitation (sMR) acquired between the three PISA methods and multi-parameter algorithm by American Society of Echocardiography (ASE) was analyzed using Cohen′s Kappa analysis. Results:The curve of instantaneous flow rate of DMR showed unimodal pattern with the peak at mid-late systolic phase. The correlation of RVol acquired between PISA methods and CMR was moderate for PISA max and PISA pair ( r=0.77, 0.80, both P<0.001), whereas PISA M-mode presented strong correlation with CMR ( r=0.87, P<0.001). RVol acquired from PISA max was larger than that of CMR[(69.1±37.1) ml vs (49.0±29.0)ml, P=0.002]. Both PISA max and PISA pair were shown moderate agreement of diagnostic accuracy of sMR with ASE multi-parameters algorithm (RVol: κ=0.496, 0.525, both P<0.001; EROA: κ=0.570, 0.578, both P<0.001), while PISA M-mode presented strong agreement (RVol: κ=0.867 and EROA: κ=0.802, both P<0.001). Conclusions:Based on the unimodal pattern of instantaneous flow rate in patients with DMR, PISA max may significantly overestimate RVol, exposing a significant proportion of patients with DMR to unnecessary MR surgery. PISA M-mode presents better correlation and consistency with CMR on the quantification of RVol compared with PISA max and PISA pair, and may improve the diagnostic accuracy of quantification of sMR using PISA.
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Objective:To explore the value of transapical catheter of mitral valve repair (MVR) with Memoclip device in the management of moderate to severe and severe mitral regurgitation (MR) guided by transesophageal echocardiography (TEE).Methods:Fifteen patients with moderate to severe and severe MR in Hefei High-tech Cardiovascular Hospital from December 2021 to October 2022 were prospectively selected. Mitral valve morphology and length, regurgitation severity, left ventricular ejection fraction and pulmonary venous Doppler spectra were carefully evaluated before MVR by TEE.Intraprocedural TEE was performed to guide the MVR including transseptal catheterization, alignment of the clip delivery system, assessment of leaflet capture, clip deployment, post-clip deployment assessment, and withdrawal of the clip delivery system. The position and coaptation length of the clips, the mitral orifice morphology, residual mitral valve regurgitation and pressure gradient were evaluated after MVR.Meanwhile, the complications were monitored throughout the procedure.Results:Among the 15 patients, 12 were implanted with 1 clip and 3 were implanted with 2 clips, respectively. No complications occurred. There were 13 patients with mild regurgitation and 2 showed to moderate mitral regurgitation 1 month later after MVR, and 13 remained mild and 2 maintained moderate regurgitation 3 months later. Significant differences were found in maximal MR area (MRA-max), maximal and mean mitral valve pressure gradient (MVPG-max, MVPG-mean) and mitral valve area (MVA) among the 5 observation time points (all P<0.05). MRA-max, MVA and MVPG-mean were significantly decreased immediately and 3 months after the procedure ( P<0.001). No significant stenosis was found in mitral valve after MVR. Conclusions:MVR with Memoclip is safe, effective, easy to operate in treating patients with moderate to severe and severe MR. TEE plays a key role in perioperative MVR with Memoclip through apical catheterization.
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Resumen La regurgitación valvular mitral funcional es el resultado de la desestructuración tridimensional de la válvula mitral debido a disfunción ventricular izquierda. La técnica quirúrgica de "borde a borde" ha dado lugar a la técnica transcatéter "borde a borde" percutánea (TEER) para tratar la regurgitación valvular mitral funcional; sin embargo, la falta de un anillo protésico por anuloplastia hace a la TEER solo parcialmente efectiva con resultados inciertos a largo plazo. Los estudios MITRA-FR (Multicentre Randomized Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients with Severe Secondary Mitral Regurgitation) y COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation), en los cuales están basadas las recomendaciones actuales de la TEER, muestran resultados contradictorios. El posible sesgo de los resultados del COAPT ha influido en las recomendaciones actuales emitidas en las guías de práctica clínica a favor de la TEER en regurgitación valvular mitral funcional.
Abstract Functional mitral regurgitation (FMR) is the result of three-dimensional structural disruption of the mitral valve due to left ventricular dysfunction. The "edge-to-edge" surgical technique has given rise to the percutaneous transcatheter edge-to-edge repair (TEER) technique to treat FMR; however, the lack of a mitral annuloplasty ring makes TEER only partially effective, with uncertain long-term results. The MITRA-FR and COAPT trials, on which current TEER recommendations are based, show conflicting results. COAPT results possible bias has influenced current recommendations issued by clinical practice guidelines in favor of TEER in FMR.
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Anomalous left atrial chorda is associated with mitral regurgitation. A young woman presenting for mitral valve repair with the diagnosis of mid?segment (A2) of anterior mitral leaflet prolapse causing severe mitral regurgitation. Transesophageal echocardiography examination in pre?bypass period showed an anomalous chorda attaching A2 to the left atrial roof, tethering the anterior mitral leaflet toward the atrial wall. Surgical findings confirmed the abnormally attached chordae and an absence of normal chorda of A2 segment. The anomalous chorda was resected and neo?chordae placed between the A2 segment and papillary muscles and annulus strengthened with an annuloplasty ring
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Resumen Se han publicado ya las nuevas guías 2020 de recomendación clínica de la AHA/ACC para el tratamiento de pacientes con valvulopatía. Luego de un análisis profundo, con base en los más grandes estudios clínicos y en la situación en los países de Latinoamérica, la Latinoamerican Association of Cardiac & Endovascular Surgery (LACES) redactó una declaración en relación con algunas de las nuevas recomendaciones.
Abstract The new clinical guidelines of the AHA/ACC for the treatment of patients with Valvulopathy 2020 have been published. After an in-depth analysis, based on the largest clinical trials and taking into account the situation in our countries in Latin America, the Latinoamerican Association of Cardiac & Endovascular Surgery (LACES) drafting a statement on some of the new recommendations.
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Objective:To explore the morbidity, clinical features and mortality of unilateral pulmonary edema (PE) in the intensive care unit (ICU).Methods:Clinical data of PE patients in ICU between January 2018 and January 2021 were retrospectively collected. All patients were divided into the bilateral PE and unilateral PE groups according to imaging manifestations. Etilogy, clinical performance, cardiac ultrasound parameters, complications, treatment and prognosis were compared between the two groups. Binary logistic regression analysis was used to screen out the risk factors of death.Results:Of the 314 PE patients, 14 (4.5%) were unilateral PE patients , and 11 (78.5%) were right-sided unilateral PE. There were no differences in age, gender, heart rate, respiratory rate and left ventricular eject fraction between the unilateral and bilateral PE groups. Compared with the bilateral PE group, systolic and diastolic blood pressure were significantly lower in the unilateral PE group [128 (102.7-138) mmHg vs. 135 (116-166) mmHg, 72 (54-88.2) mmHg vs. 82 (69-97.7)mmHg, respectively]. The incidence of cardiac arrest and hospital mortality were higher in the unilateral PE group [28.6% vs. 8.0%, 42.9% vs. 10%, all P<0.05]. Binary logistic regression analysis showed that age, unilateral PE, and use of vasoactive agent were associated with poor prognosis. Odds ratio of unilateral PE and use of vasoactive agent were 17.78 and 11.67, respectively. Conclusions:Unilateral PE is not rare, which is an independent risk factors for mortality and should be promptly recognized to avoid delays in treatment.
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Resumen INTRODUCCIÓN: En Estados Unidos, las cardiopatías periparto se registran en 1 de cada 4000 pacientes. Se consideran idiopáticas y se asocian con enfermedades genéticas, problemas inmunológicos y malformaciones cardiacas, sin que se tenga certeza del origen real de este tipo de enfermedades. La miocardiopatía periparto se asocia con el embarazo y el puerperio; los criterios diagnósticos incluyen: a) insuficiencia cardiaca en las últimas cuatro semanas del embarazo o en los cinco meses siguientes al parto, b) ausencia de causas identificables de insuficiencia cardiaca, c) ausencia de enfermedad cardiaca demostrable antes de las últimas cuatro semanas del embarazo y alteración de la función del ventrículo izquierdo (fracción de eyección del ventrículo izquierdo, menor del 45%). La presentación del caso ayudará a que se tenga conocimiento de este problema. CASO CLINICO: Paciente de 26 años, en curso de las 35.4 semanas de embarazo, con inicio abrupto de signos de cardiopatía congestiva: tos, edema, taquicardia e hipertensión arterial. El embarazo finalizó por cesárea, con traslado inmediato a la unidad de cuidados intensivos. La ecocardiografía reportó una valvulopatía no conocida, insuficiencia ventricular izquierda y disminución de la fracción de eyección del ventrículo izquierdo; con lo anterior se integró el diagnóstico de miocardiopatía periparto. CONCLUSIONES: Las cardiopatías periperiparto son alteraciones excepcionales, con cuadros clínicos debidamente definidos y diagnóstico complejo. Las valvulopatías son el último diagnóstico diferencial de cardiopatía congestiva peripuerperal y se han descrito pocos casos asociados con miocardiopatía periparto.
Abstract BACKGROUND: Peripartum heart disease occurs in 1 out of 4000 cases in the United States; currently, its exact origin is unknown, which is why they are called idiopathic. Genetic diseases, immunological problems and heart malformations have been associated, without being certain about the real origin of these pathologies. Peripartum cardiomyopathy is a rare pathology associated with pregnancy and the puerperium, the diagnosis criteria includes: a) Development of heart failure in the last month of pregnancy or in the 5 months after delivery, b) absence of identifiable causes of heart failure, c) absence of demonstrable heart disease prior to the last month of pregnancy and impaired left ventricular function (FEVI less than 45%). The presentation of the case will help to raise awareness about this problem. CLINICAL CASE: A 26-year-old female patient coursing second gestation in the 35.4 pregnancy week, who debuts abruptly with signs of congestive heart disease such as cough, edema, tachycardia and arterial hypertension. The pregnancy was solved by cesarean section with a subsequent stay in Intensive Care Unit, an unknown valvular disease was identified by echocardiography, as well as left ventricular failure and decreased FEVI. Finally, a definitive diagnosis of peripartum cardiomyopathy was integrated. CONCLUSIONS: Peripartum heart disease is a rare occurrence, with well-defined clinical pictures, but difficult to approach and diagnose. Where valvular heart disease is the last differential diagnosis for peripuerperal congestive heart disease, and few cases associated with peripartum cardiomyopathy have been described.
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Introdução: A valvuloplastia é indicada para o tratamento de regurgitação mitral grave, sendo a técnica transcateter uma opção à toracotomia. Testou-se o dispositivo MitraClip para reparo percutâneo da valva mitral em dois ensaios clínicos randomizados com resultados antagônicos: MITRA-FR e COAPT. Objetivo: Analisar as variáveis metodológicas apresentadas pelos ensaios. Método: Revisão crítico-comparativa entre MITRA-FR e COAPT. Resultados: COAPT apresentou taxa de sucesso de 98% e redução na taxa de hospitalização por IC. Já MITRA-FR não demonstrou redução da taxa de mortalidade ou da hospitalização não planejada por IC em um ano. Discussão: A seleção de participantes em COAPT mostrou-se mais criteriosa. Embora COAPT tenha utilizado maior número de clipes por operação, o desfecho primário nos dois ensaios foi semelhante. No COAPT, o acompanhamento medicamentoso foi estabelecido por um comitê, sendo relatado aumento expressivo do uso de betabloqueadores no grupo experimental. Ademais, interesses financeiros podem ter corroborado para os resultados encontrados no COAPT. Conclusão: Os resultados conflitantes de MITRA-FR e COAPT são explicados por diferenças metodológicas, mas o resultado positivo apresentado por COAPT possui maior risco de viés. [au]
Introduction: Valvuloplasty is indicated as treatment for severe mitral regurgitation and the transcatheter technique is an option to thoracotomy. The MitraClip device for percutaneous mitral valve repair has been tested in two randomized clinical trials with conflicting results: MITRA-FR and COAPT. Objective: Analyze the methodological varieties presented by the trials. Method: Critical-comparative review between MITRA-FR and COAPT. Results: COAPT presented a 98% success rate and a reduction of the hospitalization rate for heart failure. Contrarily, the MITRA-FR trial did not present any benefits in the reduction of the mortality rate or in the unplanned hospitalization for heart failure. Discussion: The selection of participants in COAPT was more rigorous. Although COAPT used a higher number of clips per operation, the primary outcome in both trials was similar. In COAPT, medication follow-up was established by a committee, with a significant increase in the use of beta-blockers in the experimental group being reported. Furthermore, financial interests may have corroborated the results found in COAPT. Conclusion: The conflicting results presented by MITRA-FR and COAPT are explained by methodological differences, but the positive result presented by COAPT had more risk of bias [au]
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@#Objective To evaluate the impact of different surgical strategies for moderate functional mitral regurgitation (FMR) at the time of aortic valve replacement (AVR) on patients' prognosis. Methods A total of 118 AVR patients, including 84 males and 34 females, aged 58.1±12.4 years, who were complicated with moderate FMR were retrospectively recruited. Patients were divided into three groups according to the treatment strategy of mitral valve: a group A (no intervention, n=11), a group B (mitral valve repair, n=51) and a group C (mitral valve replacement, n=56). The primary endpoint was the early and mid-term survival of the patients, and the secondary endpoint was the improvement of FMR. Results The median follow-up time was 29.5 months. Five patients died perioperatively, all of whom were from the group C. Early postoperative FMR improvement rates in the group A and group B were 90.9% and 94.1% (P=0.694). The mid-term mortality in the three groups were 0.0%, 5.9% and 3.9%, respectively (P=0.264), while the incidences of major cardiovascular and cerebrovascular events were 0.0%, 9.8% and 17.7%, respectively (P=0.230). Improvements of FMR in the group A and group B were 100.0% and 94.3% at the mid-term follow-up (P>0.05). Conclusion For patients receiving AVR with moderate FMR, conservative treatment or concurrent repair of mitral valve may be more reasonable, while mitral valve replacement may increase the incidence of early and mid-term adverse events.
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@#Objective To evaluate the safety and efficacy of transapical mitral valve repair with moderate-to-severe or severe mitral regurgitation (MR) by using LifeClip system. Methods We retrospectively analyzed the clinical data of 7 symptomatic patients with moderate-to-severe or severe MR who received transapical mitral valve repair by using the LifeClip system in our hospital from July to November 2021. There were 5 males and 2 females with an average age of 76.0±7.5 years. Results There were 2 patients with degenerative MR and 5 patients with functional MR. All of the procedures were successful and 6 patients received 1 LifeClip while the other one patient received 2. The operation time was 135.7±46.9 min, the mechanical ventilation time was 12 (3, 14) h, and the hospital stay time was 18.1±4.1 d. No serious complications or death occurred during the perioperative or follow-up period. MR reduction by ≥ grades was achieved in all the patients at the one-month follow-up. The classification of cardiac function was improved in varying degrees. Conclusion Transapical mitral valve repair using the LifeClip system shows good safety and efficacy for severe MR patients, and MR degree is significantly improved at early follow-up. However, the benefit of LifeClip should be validated in a larger sample size of Chinese population and through long-term follow-up.
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Objective:To quantitatively analyze the static geometric structure and dynamic changes of the mitral annulus(MA) in patients with degenerative mitral regurgitation (DMR) by three-dimensional transthoracic echocardiography.Methods:Thirty-five patients with DMR (both mitral valve prolapse and Barlow) were collected as DMR group in Yunnan Fuwai Cardiovascular Disease Hospital from August 2019 to March 2021, and 42 healthy volunteers were selected as control group during the same period. The mitral annulus area (MAA), mitral annulus perimeter (MAP), mitral annulus anterolateral-posteromedial diameter (DALPM), anteroposterior diameter (DAP), non-planar angle (NPA), mitral annulus height (AH), and the ratio of height to intercommissural diameter (AHCWR) were measured during the late-diastole, early-systole, mid-systole and late-systole, and the systolic change fractions of the above parameters were calculated. The differences of static structure and dynamic change of MA between the two groups were compared, and the characteristics of dynamic change of MA in the whole cardiac cycle were analyzed.Results:Static structure: MAA, MAP, DAP and DALPM in DMR group were higher than those in control group during the whole cardiac cycle, and the differences were statistically significant (all P<0.05). Compared with the control group, the saddle structure in DMR group were flattened in the middle and late contraction stages (AHCWR: 0.17±0.01 vs 0.21±0.01 and 0.15±0.01 vs 0.23±0.01, both P<0.05), while the saddle structure was relatively preserved in the rest of the contraction stage. Dynamic changes: Presystole contraction (MAA, MAP, DAP, DALPM decreased, all P<0.05) were appeared durng the late-diastole and early-systole in the control group, and saddle shape deepened (NPA decreased, AH and AHCWR increased, all P<0.05). Compared with the control group, presystole MA contraction and saddle deepening disappeared in DMR group (there were no significant differences in all MA parameters between late-diastole and early-systole, all P>0.05). The systolic dynamic changes were weaker and impaired when compared with the control group, which showed that the systolic change scores of DALPM, NPA and AHCWR were lower than those of the control group (all P<0.05). There were no statistical differences in the 4 time phases of MA parameters except DAP (all P>0.05). Conclusions:The saddle-shape structure of MA in normal subjects is obvious, and the dynamic change of MA in the cardiac cycle is significant, with obvious contraction before contraction and saddle-shape deepening. The saddle structure of DMR patient is flattened in the middle and late systolic period, and the MA kinetic energy of DMR patient is weakened throughout the cardiac cycle, the contraction phenomenon disappeared before contraction, and the dynamic change of systolic period is impaired to varying degrees.
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@#Objective To investigate the early clinical results of MitraClip system in domestic patients. Methods We retrospectively analyzed the clinical data of 36 patients who underwent transcatheter edge-to-edge repair procedure using MitraClip system in Beijing Fuwai Hospital, Shenzhen Fuwai Hospital and Fuwai Yunnan Cardiovascular Hospital between January and June 2021. There were 24 males and 12 females, with a median age of 70 (47-86) years. Ten (27.8%) patients had 3+ mitral regurgitation (MR) and 26 (72.2%) patients had 4+ MR preoperatively. Results All procedures were successfully performed. The reduction in MR was 2+ at least immediately after surgery, and 91.7% of patients had MR≤2+ at 3 days postoperatively. There was no statistical difference in left ventricular ejection fraction change postoperatively. Forward velocity and peak gradient of mitral valve were increased after the procedure. Mean gradient of mitral valve were increased at 3 days postoperatively than immediately after surgery (P<0.001). Two patients had acute pericardial effusion intraoperatively, and received pericardial puncture and drainage immediately. Conclusion MitraClip system has been applied well in domestic patients and can significantly improve MR. This sutdy has a good consistency with foreign studies, and the early results are satisfactory.
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@#Transcatheter edge-to-edge repair (TEER) originated from surgical edge-to-edge repair. MitraClip is the first mature TEER device, and the TEER based on MitraClip is far ahead of many transcatheter mitral valve repair (TMVr) technologies in terms of safety, effectiveness and popularity, so it is named separately in the latest guidelines. The TEER has the following advantages: consistent with basic medical principles, few implants, precise target, less invasive and repeatable. However, there are also some shortcomings, such as the relatively complex design of transfemoral device, target single and relatively narrow indications. At present, the main clinical data of TEER are mainly from the clinical practice of MitraClip. Based on the three-year outcomes of COAPT study, both 2020 ACC/AHA guideline and 2020 ACC expert consensus decision pathway on the management of mitral regurgitation recommend in patients with chronic heart failure with left ventricular dysfunction and severe mitral regurgitation in nonresponders to medicine treatment. Edward's PASCAL, another TEER device, has two models. Among the domestic TEER devices, the ValveClamp of Hanyu medical technology has many distinct advantages, such as simple operation, large clamping area, high clamping efficiency and no need of X-ray. DragonFly, another domestic TEER device, has also completed its feasibility study. There are five trends of TEER in the future: further expansion of indications, combination with other interventional techniques, repeatable operations, transcatheter mitral valve replacement after TEER, and continuous improvement and innovation of equipment.