NDLI: Effect of transcatheter aortic valve replacement on the mitral valve apparatus and mitral regurgitation: real-time three-dimensional transesophageal echocardiography study.

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Year: 2014 Volume: 7 Issue: 1

Effect of transcatheter aortic valve replacement on the mitral valve apparatus and mitral regurgitation: real-time three-dimensional transesophageal echocardiography study.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Shibayama, Kentaro Harada, Kenji Berdejo, Javier Mihara, Hirotsugu Tanaka, Jun Gurudevan, Swaminatha V. Siegel, Robert Jilaihawi, Hasan Makkar, Raj R. Shiota, Takahiro
Description	Country affiliation: Canada Author Affiliation: Shibayama K ( Cedars-Sinai Heart Institute, Los Angeles, CA.)
Abstract	BACKGROUND: The effect of transcatheter aortic valve replacement (TAVR) on the mitral valve apparatus and factors influencing the reduction of mitral regurgitation with or without mitral leaflet tethering after TAVR are poorly understood. The present 3-dimensional (3D) transesophageal echocardiography study aimed to elucidate early changes further in the structure and function of the mitral valve apparatus after TAVR. METHODS AND RESULTS: We analyzed 90 patients (nontenting group, 56 patients and tenting group, 34 patients) who underwent TAVR using the Edwards SAPIEN and had intraprocedural 3D transesophageal echocardiography evaluation of the mitral valve. Of all patients, mitral regurgitation improved in 54%, remained the same in 38%, and worsened in 8% 1 day after TAVR. There were no statistically significant differences in mitral annular 3D parameters before and after TAVR in both groups. In the tenting group, tenting area (P<0.01) and tenting height (P<0.01) were decreased, and coaptation length was increased (P<0.05) after TAVR. In a multivariable analysis, the predictors of improved mitral regurgitation were the decrease of tenting area (odds ratio, 8.15; 95% confidence interval, 1.31-50.7; P<0.05) and the decrease of valvuloarterial impedance (odds ratio, 7.57; 95% confidence interval, 1.15-49.9; P<0.05) in the tenting group and the decrease of valvuloarterial impedance (odds ratio, 6.96; 95% confidence interval, 1.24-39.2; P<0.05) in the nontenting group. CONCLUSIONS: Mitral leaflet tethering was improved immediately by TAVR in patients with mitral leaflet tenting regardless of mitral annular geometry. Acute improvement in mitral regurgitation after TAVR is predominantly related to global left ventricular hemodynamics and mitral leaflet tethering change.
File Format	HTM / HTML
ISSN	19419651
e-ISSN	19420080
Journal	Circulation: Cardiovascular Imaging
Issue Number	2
Volume Number	7
Language	English
Publisher	American Heart Association
Publisher Date	2014-03-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Diagnostic Imaging Discipline Cardiology Aortic Valve Stenosis Surgery Aortic Valve Cardiac Catheterization Echocardiography, Three-dimensional Echocardiography, Transesophageal Heart Valve Prosthesis Implantation Mitral Valve Insufficiency Physiopathology Intraoperative Period Reproducibility Of Results Retrospective Studies Time Factors
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Cardiology and Cardiovascular Medicine

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