Analysis of Procedural Effects of Percutaneous Edge-to-Edge Mitral Valve Repair by 2D and 3D Echocardiography
- 1 November 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Cardiovascular Imaging
- Vol. 5 (6), 748-755
- https://doi.org/10.1161/circimaging.112.974691
Abstract
Background—: Analysis of procedural effects in patients undergoing percutaneous mitral valve repair (PMVR) using the edge-to-edge technique is complex, and common methods to define mitral regurgitation severity based on 2-dimensional (2D) echocardiography are not validated for postprocedural double-orifice mitral valve. This study used 3D transesophageal echocardiography (TEE) to determine the functional and morphological effects of PMVR. Methods and Results—: In 39 high-risk surgical patients with moderate to severe functional mitral valve regurgitation, 3D TEE with and without color Doppler as well as 2D transthoracic and TEE was performed before and after PMVR (MitraClip device). Mitral valve regurgitant volume by color Doppler 3D TEE was determined as the product of vena contracta areas defined by direct planimetry and velocity time integral using continuous-wave Doppler. Regurgitant volume was reduced from 84.1±38.3 mL preintervention to 35.6±25.6 mL postintervention. Patients in whom vena contracta area could be reduced >50% had a smaller preprocedural mitral annulus area compared with patients with ≤50% reduction (11.9±3.9 versus 16.1±8.5 cm 2 , respectively; P =0.036) and tended to have a smaller mitral annulus circumference (13.0±2.0 versus 14.8±4.1 cm, respectively; P =0.112). At 6 months follow-up, left atrial and left ventricular end-diastolic volumes were significantly more reduced in patients in whom regurgitant vena contracta area was reduced by >50% compared with those with less reduction (−11.4±5.2 versus −4.8±7.7%; P =0.005, and −11.0±7.2 versus −4.5±9.3%; P =0.028). The maximum diastolic mitral valve area decreased from 6.0±2.0 to 2.9±0.9 cm 2 ( P <0.0001). Conclusions—: Three dimensional TEE demonstrates significant reduction of regurgitant volume after PMVR. The unique visualization of the mitral valve by 3D TEE allows improved understanding of the morphological and functional changes induced by PMVR.Keywords
This publication has 26 references indexed in Scilit:
- Comparison of Accuracy of Mitral Valve Regurgitation Volume Determined by Three-Dimensional Transesophageal Echocardiography Versus Cardiac Magnetic Resonance ImagingThe American Journal of Cardiology, 2012
- Comparison of Direct Planimetry of Mitral Valve Regurgitation Orifice Area by Three-Dimensional Transesophageal Echocardiography to Effective Regurgitant Orifice Area Obtained by Proximal Flow Convergence Method and Vena Contracta Area Determined by Color Doppler EchocardiographyThe American Journal of Cardiology, 2011
- Quantitative Assessment of Mitral RegurgitationCirculation: Cardiovascular Imaging, 2010
- Direct Measurement of Vena Contracta Area by Real-Time 3-Dimensional Echocardiography for Assessing Severity of Mitral RegurgitationThe American Journal of Cardiology, 2009
- Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Vena Contracta Area in Mitral Regurgitation: In Vitro Validation and Clinical ExperienceJACC: Cardiovascular Imaging, 2008
- Quantitative Assessment of Severity of Mitral Regurgitation by Serial Echocardiography in a Multicenter Clinical Trial of Percutaneous Mitral Valve RepairThe American Journal of Cardiology, 2007
- Effects of Annular Size, Transmitral Pressure, and Mitral Flow Rate on the Edge-To-Edge Repair: An In Vitro StudyThe Annals of Thoracic Surgery, 2006
- ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart DiseaseCirculation, 2006
- Instrumentation and physical factors related to visualization of stenotic and regurgitant jets by Doppler color flow mappingJournal of the American College of Cardiology, 1988
- STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENTThe Lancet, 1986