Long or redundant leaflet complicating transcatheter mitral valve replacement: Case vignettes that advocate for removal or reduction of the anterior mitral leaflet.
Catheter Cardiovasc Interv
; 92(3): 627-632, 2018 09 01.
Article
em En
| MEDLINE
| ID: mdl-28471059
ABSTRACT
Transcatheter mitral valve replacement (TMVR) procedures can be an alternative to surgical valve replacement for high surgical risk patients with bioprosthetic mitral valves, annuloplasty rings, or severe mitral annular calcification (MAC). TMVR can trigger acute left ventricular outflow tract (LVOT) obstruction from permanent displacement of the native anterior mitral leaflet toward the left ventricular septum, more often among patients undergoing valve-in-ring and valve-in-MAC procedures. Although acute LVOT obstruction is well described in the literature, there are important additional complications of TMVR related to the length and/or redundancy of the anterior mitral valve that have been recognized after mitral valve surgery and have not been previously reported in the setting of TMVR. These additional complications include acute mitral regurgitation secondary to prolapsing native leaflet through the TMVR, frozen TMVR leaflet secondary to overhanging native leaflet and late LVOT obstruction in the neo-LVOT secondary to long native leaflet. Preprocedural planning with imaging (echocardiography and computed tomography) and measurement of anterior mitral leaflet length is critical important in understanding the risk for these complications. As transcatheter mitral valve technology proliferates, interactions with the anterior mitral leaflet after TMVR may be more frequent than initially anticipated. We believe that there is no advantage to an intact anterior leaflet and advocate removal or reduction of the leaflet prior to TMVR. © 2017 Wiley Periodicals, Inc.
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Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Obstrução do Fluxo Ventricular Externo
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Cateterismo Cardíaco
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Implante de Prótese de Valva Cardíaca
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Valva Mitral
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Insuficiência da Valva Mitral
Tipo de estudo:
Etiology_studies
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Risk_factors_studies
Limite:
Aged
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Humans
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Male
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article