Comprehensive Assessment of Mitral Valve Geometry and Cardiac Remodeling With 3-Dimensional Echocardiography After Percutaneous Mitral Valve Repair

Published: 16-09-2019| Version 1 | DOI: 10.17632/w7r8zn5t8b.1
Contributors:
Valentina Mantegazza,
Laura Fusini,
Manuela Muratori,
Paola Gripari,
Sarah Ghulam Ali,
Carlo Vignati,
Antonio Luca Bartorelli,
Cristina Ferrari,
Francesco Alamanni,
Mauro Pepi,
Gloria Tamborini

Description

MitraClip is a validated treatment for significant mitral regurgitation (MR) in high risk patients. Aims of the study were to evaluate immediate changes in mitral valve (MV) geometry induced by MitraClip and correlations between baseline geometry and cardiac remodeling. Eighty patients undergoing MitraClip for primary (48%) or secondary (52%) MR were enrolled. Intraoperative transesophageal echocardiographic 3D images were acquired immediately before and after the procedure for MV annulus (MVA) morphology analysis. Transthoracic 3D echocardiography was performed pre-operatively and at 6 months follow-up (6MFU). Patients were classified on the basis of MR reduction (ΔMR) at 6MFU as Optimal (ΔMR≥2) or Suboptimal (ΔMR<2). An optimal result was reached in 60 (75%) patients, whereas 20 subjects showed a ΔMR<2 at 6MFU. The Optimal showed significantly smaller baseline MVA (antero-posterior diameter 4.05±0.59 vs. 4.43±0.68cm; anterolateral-posteromedial diameter 4.38±0.56 vs. 4.70±0.73cm; MVA circumference 14.1±1.7 vs. 15.1±2.3cm and 3D area 14.8±3.9 vs. 17.4±5.3cm2), lower sphericity index and non-planar angle compared to Suboptimal. A value of antero-posterior diameter ≥4.44 cm was identified (ROC curve) as a possible cut-off for pre-operative identification of Suboptimal patients. Post-operatively, MitraClip reduced MVA flattening (non-planar angle), sphericity index and size (as expressed by antero-posterior diameter, MVA circumference and area). At 6MFU the Optimal showed significant decrease in left ventricular volumes and pulmonary artery systolic pressure. In conclusion, MitraClip induces remarkable changes in MVA geometry and favorable LV remodeling is detected in patients with optimal mid-term outcome. A pre-procedural antero-posterior diameter <4.44cm seems to be a potential predictor of mid-term optimal result.

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