Multiphase Assessment of Mitral Annular Dynamics in Consecutive Patients With Significant Mitral Valve Disease
| Autor: | Cezar Staniloae, Michael Querijero, Chloe Kalish, Mathew R. Williams, Larry A. Latson, Hasan Jilaihawi, Muhamed Saric, Makoto Nakashima, Joseph Tovar, Homam Ibrahim, Kazuhiro Hisamoto, Illya Pushkar, Yuxin He, Alan F. Vainrib |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Cardiac Catheterization medicine.medical_treatment Population Ventricular Outflow Obstruction Mitral valve Internal medicine Medicine Ventricular outflow tract Humans cardiovascular diseases Heart valve Systole education Heart Valve Prosthesis Implantation Mitral regurgitation education.field_of_study Cardiac cycle business.industry Mitral valve replacement Mitral Valve Insufficiency medicine.anatomical_structure Treatment Outcome Heart Valve Prosthesis cardiovascular system Cardiology Mitral Valve Cardiology and Cardiovascular Medicine business |
| Zdroj: | JACC. Cardiovascular interventions. 14(20) |
| ISSN: | 1876-7605 |
| Popis: | Objectives The aim of this study was to clarify the dynamics of the mitral annulus throughout the cardiac cycle and its relevance to transcatheter mitral valve replacement (TMVR) sizing and case selection. Background Limited data are available regarding the relevance of mitral annular (MA) and neo–left ventricular outflow tract (LVOT) dynamics in the overall population presenting with significant mitral valve disease. Methods Patients attending a combined surgical-transcatheter heart valve clinic for severe symptomatic mitral valve disease were assessed using multiphase computed tomography. The relative influence of MA and neo-LVOT dynamics to TMVR case selection was studied. Results A total of 476 patients with significant mitral valve disease were evaluated. In 99 consecutive patients with severe mitral regurgitation, a 10-phase assessment showed that the mitral annulus was on average largest in late systole. On comparing maximal MA dimension with late systolic dimension, TMVR size assignment changed in 24.2% of patients. If the average MA perimeter was used to determine sizing, 48.5% were excluded because of MA dimension being too large; in a multiphase assessment of the neo-LVOT, an additional 16.2% were excluded on the basis of neo-LVOT dimension. In an expanded series of 312 consecutive patients, selection protocol influenced anatomical exclusion: a manufacturer-proposed early systolic approach excluded 69.2% of patients, whereas a late systolic approach excluded 82.7% of patients, the vast majority because of large mitral annuli. Conclusions Contemporary TMVR can treat only a minority of patients with severe mitral regurgitation, principally because of limitations of large MA dimension. |
| Databáze: | OpenAIRE |
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