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Napoli F, Vella C, Ferri L, Ancona MB, Bellini B, Russo F, Agricola E, Esposito A, Montorfano M. Rheumatic and Degenerative Mitral Stenosis: From an Iconic Clinical Case to the Literature Review. J Cardiovasc Dev Dis 2024; 11:153. [PMID: 38786975 PMCID: PMC11122136 DOI: 10.3390/jcdd11050153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/05/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
Mitral stenosis (MS) poses significant challenges in diagnosis and management due to its varied etiologies, such as rheumatic mitral stenosis (RMS) and degenerative mitral stenosis (DMS). While rheumatic fever-induced RMS has declined in prevalence, DMS is rising with aging populations and comorbidities. Starting from a complex clinical case of DMS, the aim of this paper is to review the literature on mitral stenosis by analyzing the available tools and the differences in terms of diagnosis and treatment for rheumatic and degenerative stenosis. Emerging transcatheter techniques, such as transcatheter mitral valve replacement (TMVR) and lithotripsy-facilitated percutaneous mitral commissurotomy (PMC), represent promising alternatives for DMS patients deemed unfit for surgery. In particular, intravascular lithotripsy (IVL) has shown potential in facilitating percutaneous interventions by fracturing calcific deposits and enabling subsequent interventions. However, larger prospective studies are warranted to validate these findings and establish IVL's role in DMS management. To further enhance this technique, research could focus on investigating the long-term outcomes and durability of mitral lithotripsy, as well as exploring its potential in combination with PMC or TMVR.
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Affiliation(s)
- Francesca Napoli
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Ciro Vella
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Luca Ferri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Marco B. Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Barbara Bellini
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
- School of Medicine, Vita Salute San Raffaele University, 20132 Milan, Italy;
| | - Antonio Esposito
- School of Medicine, Vita Salute San Raffaele University, 20132 Milan, Italy;
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
- School of Medicine, Vita Salute San Raffaele University, 20132 Milan, Italy;
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Eng MH, Zahr F. Orthotopic Transcatheter Mitral Valve Replacement. Interv Cardiol Clin 2024; 13:227-235. [PMID: 38432765 DOI: 10.1016/j.iccl.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Mitral valve dysfunction is prevalent amongst older patients. Of those not suitable for surgical therapy, mitral transcatheter edge-to-edge repair (TEER) can treat as large proportion of patients, many are not suitable TEER candidates. As such, orthotopic transcatheter mitral valve replacement (TMVR) is an important innovation but it faces significant challenges. Orthotopic TMVR requires a prosthesis with stable anchoring, adequate sealing, minimal footprint in the left ventricle and long term durability. Multidisciplinary expertise in advanced imaging, surgery, heart failure are needed for success.
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Affiliation(s)
- Marvin H Eng
- Structural Heart Program, Division of Cardiology, University of Arizona, Banner University Medical Center, 755 East McDowell Road, Phoenix, AZ 85006, USA.
| | - Firas Zahr
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
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Kargoli F, Al Qaraghuli AK, Fang HK, Eng MH. Postsurgical Transcatheter Mitral Valve Replacement. Interv Cardiol Clin 2024; 13:207-216. [PMID: 38432763 DOI: 10.1016/j.iccl.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Reintervention is commonly required postsurgical mitral valve replacement (SMVR) or repair due to bioprosthetic valve and annuloplasty ring degeneration. However, redo SMVR is associated with a high risk of morbidity and mortality. Postsurgical transcatheter mitral valve replacement (TMVR) is a safe and less-invasive alternative that has repeatedly been shown to be associated with improved survival and lower rates of complications compared with redo SMVR. Comprehensive patient evaluation and thorough procedural planning are key to successful TMVR.
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Affiliation(s)
- Faraj Kargoli
- Division of Cardiology, University of Arizona, Banner University Medical Center, 1111 East McDowell Road, Phoenix, AZ 85006, USA
| | - Abdullah K Al Qaraghuli
- MedStar Health Research Institute, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Hao Kenith Fang
- Division of Cardiothoracic Surgery, Banner University Medical Center, 1111 East McDowell Road, Phoenix, AZ 85006, USA
| | - Marvin H Eng
- Structural Heart Program, University of Arizona, Banner University Medical Center, 755 East McDowell Road, Phoenix, AZ 85006, USA.
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Nkomo VT, El-Am EA. The Complex Treatment of Postradiation Valvular Heart Disease. JACC Case Rep 2022; 8:101652. [PMID: 36860566 PMCID: PMC9969542 DOI: 10.1016/j.jaccas.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vuyisile T. Nkomo
- Address for correspondence: Dr Vuyisile T. Nkomo, Mayo Clinic, Department of Cardiovascular Medicine, 200 First Street SW, Rochester, Minnesota 55905, USA.
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Turi ZG. The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100087. [PMID: 37288059 PMCID: PMC10242581 DOI: 10.1016/j.shj.2022.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/09/2023]
Abstract
Percutaneous balloon mitral valvuloplasty (PBMV), once the most complex of percutaneous cardiac procedures and essentially the first adult structural heart intervention, set the stage for a host of new technologies. Randomized studies comparing PBMV to surgery were the first to provide a high-level evidence base in structural heart. The devices used have changed little in 40 years, but the advent of improved imaging and the expertise gained in interventional cardiology has provided some additional procedural safety. However, with the decline in rheumatic heart disease, PBMV is being performed in fewer patients in industrialized nations; in turn, these patients have more comorbidities, less favorable anatomy, and thus a higher rate of procedure-related complications. There remain relatively few experienced operators, and the procedure is distinct enough from the rest of the structural heart intervention world that it has its own steep learning curve. This article reviews the use of PBMV in a variety of clinical settings, the influence of anatomic and physiologic factors on outcomes, the changes in the guidelines, and alternative approaches. PBMV remains the procedure of choice in patients with mitral stenosis with ideal anatomy and a useful tool in patients with less than ideal anatomy who are poor surgical candidates. In the 40 years since its first performance, PBMV has revolutionized the care of mitral stenosis patients in developing countries and remains an important option for suitable patients in industrialized nations.
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Affiliation(s)
- Zoltan G. Turi
- Address correspondence to: Zoltan G. Turi, MD, Structural and Congenital Heart Center, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ 07601.
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Transcatheter Mitral Valve Replacement in Failed Bioprosthetic Surgical Valves and Surgical Annuloplasty Rings. Curr Cardiol Rep 2022; 24:1417-1424. [PMID: 35980565 DOI: 10.1007/s11886-022-01761-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Repeat surgery for failed mitral valve prostheses and repairs are fraught with high rates of morbidity and mortality. Therefore, clinicians have evolved transcatheter technology as an alternative therapy. This review serves as an update as the field has moved out of the early learning curve of treating postsurgical mitral valve failures. RECENT FINDINGS Mitral valve-in-valve procedures have higher rates of technical success and better in-hospital and 1-year mortality rates than mitral valve-in-ring cases. The higher rates of complications, including left ventricular outflow tract obstruction, paravalvular leak, valve embolization, and need for a 2nd valve, may explain these outcomes. Mitral valve-in-ring procedures have attenuated outcomes as compared to valve-in-valve. Clinicians should be cognizant of the nuanced complexities and the potential for suboptimal outcomes in using balloon-expandable valves for mitral valve-in-ring procedures.
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Eng MH, Fang HK. TMVR: Early benefits, late questions. Catheter Cardiovasc Interv 2022; 99:1666-1667. [PMID: 35476288 DOI: 10.1002/ccd.30208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Marvin H Eng
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - H Kenith Fang
- Division of Cardiothoracic Surgery, Banner University Medical Center, Phoenix, Arizona, USA
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