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Sauter R, Lin C, Magunia H, Schreieck J, Dürschmied D, Gawaz M, Patzelt J, Langer HF. Improved mid-term stability of MR reduction with an increased number of clips after percutaneous mitral valve repair in functional MR. Int J Cardiol Heart Vasc 2023; 45:101190. [PMID: 36941997 PMCID: PMC10024191 DOI: 10.1016/j.ijcha.2023.101190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023]
Abstract
Background Percutaneous mitral valve repair (PMVR) has evolved to be a standard procedure in suitable patients with mitral regurgitation (MR) not accessible for open surgery. Here, we analyzed the influence of the number and positioning of the clips implanted during the procedure on MR reduction analyzing also sub-collectives of functional and degenerative MR (DMR). Results We included 410 patients with severe MR undergoing PMVR using the MitraClip® System. MR and reduction of MR were analyzed by TEE at the beginning and at the end of the PMVR procedure. To specify the clip localization, we sub-divided segment 2 into 3 sub-segments using the segmental classification of the mitral valve. Results We found an enhanced reduction of MR predominantly in DMR patients who received more than one clip. Implantation of only one clip led to a higher MR reduction in patients with functional MR (FMR) in comparison to patients with DMR. No significant differences concerning pressure gradients could be observed in degenerative MR patients regardless of the number of clips implanted. A deterioration of half a grade of the achieved MR reduction was observed 6 months post-PMVR independent of the number of implanted clips with a better stability in FMR patients, who got 3 clips compared to patients with only one clip. Conclusions In patients with FMR, after 6 months the reduction of MR was more stable with an increased number of implanted clips, which suggests that this specific patient collective may benefit from a higher number of clips.
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Key Words
- CO, cardiac output
- COe, cardiac output echocardiographically determinded by combination of TTE and TEE parameters
- COi, invasively determined cardiac output
- Clips
- DMR, degenerative mitral regurgitation
- EDV, end-diastolic volume
- EF, ejection fraction
- ESV, end-systolic volume
- Echocardiography
- FMR, functional mitral regurgitation
- Heart failure
- Heart geometry
- Hemodynamics
- ICE, intracardiac echocardiography
- IVUS, intravascular ultrasound
- Interventional cardiology
- Interventional therapy
- LA, left atrium
- LV, left ventricle
- LVEDD, left ventricular end diastolic diameter
- MR, mitral regurgitation
- MRI, magnetic resonance imaging
- Mitral regurgitation
- NYHA, New York heart association
- PA, pulmonary artery
- PAP, pulmonary artery pressure
- PASP, pulmonary artery systolic pressure
- PCW, pulmonary capillary wedge
- PCWP, pulmonary capillary wedge pressure
- PHT, pulmonary hypertension
- PMVR
- PMVR, percutaneous mitral valve repair
- RV, right ventricle
- SD, standard deviation
- Structural heart disease
- Surgery
- TAVI, transcatheter aortic valve implantation
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
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Affiliation(s)
- Reinhard Sauter
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Chaolan Lin
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harry Magunia
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Juergen Schreieck
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Daniel Dürschmied
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Mannheim/Heidelberg, Germany
| | - Meinrad Gawaz
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Johannes Patzelt
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harald F. Langer
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Mannheim/Heidelberg, Germany
- Corresponding author at: Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, 68167 Mannheim, Germany.
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Chiew K, Akhtar M, McGarvey M, Browne S, Vazir A, Heng EL, Smith R. Paradoxical Left-to-Right Device Embolization Complicating Transcatheter Mitral Valve Edge-to-Edge Repair. JACC Case Rep 2023; 5:101692. [PMID: 36523951 PMCID: PMC9745655 DOI: 10.1016/j.jaccas.2022.101692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Abstract
We describe an unusual presentation of transcatheter mitral valve edge-to-edge repair device embolization into the left common femoral vein in a patient with primary degenerative mitral regurgitation. We hypothesize a possible mechanism for this phenomenon, factors that may increase the risk of this complication, and outline the patient's clinical course. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Kayla Chiew
- Address for correspondence: Dr Kayla Chiew, Royal Brompton Hospital, Sydney Street, SW3 6NP London, United Kingdom.
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Cagli K, Gursoy HT, Basyigit F, Koprucu E, Golbasi Z. 3-Dimensional Images of Mitral Annulus Perforation: An Alien's Mouth. JACC Case Rep 2022; 4:101681. [PMID: 36438889 PMCID: PMC9685358 DOI: 10.1016/j.jaccas.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
In this clinical vignette, we describe a case of a patient with windsock-like posterior mitral annulus perforation at the site of annular calcification caused by infective endocarditis. Three-dimensional transesophageal images of the perforation resembling an "alien's mouth" are very striking for how 3-dimensional imaging can improve visualization of anatomy of the heart. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Kumral Cagli
- University of Health Sciences, Gulhane Faculty of Medicine, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | | | - Funda Basyigit
- Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | - Etga Koprucu
- Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | - Zehra Golbasi
- Yildirim Beyazit University, Faculty of Medicine, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
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4
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Hosoba S, Ito T, Mori M, Kato R, Kobayashi M, Nakai Y, Morishita Y. Midterm results after seamless patch mitral reconstruction. JTCVS Tech 2022; 16:35-42. [PMID: 36510531 PMCID: PMC9737040 DOI: 10.1016/j.xjtc.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/18/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Some pathologies, including infective endocarditis or sclerotic changes of the mitral leaflet, make the conventional mitral valve repair challenging. Our previously described technique for reconstruction with a seamless pericardial patch makes the repair feasible in some of such difficult pathologies. However, the extent of mitral leaflet segments that could be safely repaired using this technique remains unknown. We investigated the association between the midterm outcome and the extent of mitral leaflet segments replaced by a pericardial patch. Methods From January 2009 to January 2022, patients who underwent mitral valve repair with the seamless 1-patch reconstruction technique were included. The glutaraldehyde-treated pericardium was trimmed and anchored at the papillary muscle. The edge was sewn to the leaflet and the annulus. Results A total of 49 patients (aged 60 ± 15 years) underwent mitral valve repair with this technique. The totally endoscopic approach was used in 27 patients (55%). No patient's repair was converted to valve replacement. No operative mortality or disabling stroke was observed during the early postoperative period. In the midterm follow-up, redo surgery was required in 9 patients (18%). Freedom from mitral valve reintervention rates at 1, 5, and 10 years were 84%, 82%, and 82% for all patients, respectively. Freedom from reoperation at 5 years was 100%, 92%, and 46% for commissural lesion, 1- to 2-segment involvement, and 3-segment involvement, respectively. There was a significant difference among the 3 groups with regard to mitral valve reoperation rate (P = .002). Conclusions Mitral valve seamless patch reconstruction provides excellent midterm results if applied to commissural lesions or lesions involving up to 2 segments.
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Affiliation(s)
- Soh Hosoba
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
- Address for reprints: Soh Hosoba, MD, PhD, Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita, Nakamura, Nagoya 453-8511, Japan.
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Makoto Mori
- Division of Cardiothoracic Surgery, Yale School of Medicine, New Haven, Conn
| | - Riku Kato
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Masaaki Kobayashi
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yuji Nakai
- Department of Clinical Engineering, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yoshihiro Morishita
- Department of Cardiology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
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Farooq W, Iyer V. Hemoperitoneum, Hepatic Laceration, and Hepatic Artery Pseudoaneurysm as a Complication of Emergent Pericardiocentesis. JACC Case Rep 2022; 5:101686. [PMID: 36523950 PMCID: PMC9745653 DOI: 10.1016/j.jaccas.2022.101686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/10/2022] [Accepted: 10/21/2022] [Indexed: 12/02/2022]
Abstract
Emergent pericardiocentesis is a potentially life-saving therapeutic procedure. We report a case of hemoperitoneum, a rare but known complication of pericardiocentesis; due to hepatic artery laceration and hepatic artery pseudoaneurysm formation resulting in delayed hemorrhagic shock as a complication of emergent pericardiocentesis. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Waseem Farooq
- Address for correspondence: Dr. Waseem Farooq, University at Buffalo, 2780 Main Street, Rear Upper Carriage House, Buffalo, New York 14214, USA. @waseemfarooqmd
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Tozzi P, Locca D, Siniscalchi G, Ait-Tigrine S. Percutaneous reduction of septal-to-lateral mitral annular distance to increase mitral leaflet coaptation length: Preclinical study results. JTCVS Tech 2022; 17:65-72. [PMID: 36820354 PMCID: PMC9938367 DOI: 10.1016/j.xjtc.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/15/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives Percutaneous indirect annuloplasty has emerged as a treatment strategy for functional/ischemic mitral regurgitation. This study sought to evaluate the feasibility of percutaneous indirect annuloplasty technique using a new device. Methods The device has 3 components: the "saddle" inserted into the great cardiac vein, the "plug" positioned in the left ventricular outflow tract, and the "bridge," a transatrial suture connecting the 2 holding elements. The aim was to shorten the septal-to-lateral distance of the mitral annulus by pulling on the saddle element. The procedure was performed through venous access in healthy adult sheep. A dedicated catheter holding a needle was used to deploy the saddle into the great cardiac vein and pierce its wall toward the left atrium to deploy the expanded polytetrafluoroethylene suture that is part of the bridge. A catheter for transseptal puncture was inserted for crossing the interatrial septum and piercing the aortic-mitral curtain, thereby allowing the plug to be deployed. The plug was held in place by the second part of the expanded polytetrafluoroethylene bridge. The 2 parts of the bridge were then joined to reduce the septal-to-lateral mitral annular distance. The septal-to-lateral distance and the coaptation length at P2 level were measured before and after the procedure using echocardiography. Results Overall, 10 animals were treated, 7 successfully. The mean procedure duration was 110 ± 81 minutes. Septal-to-lateral distance decreased from 3.8 mm to 2.6 mm (30%), and maximum increase of mitral leaflet coaptation was 4 mm. Conclusions This new approach seems promising for percutaneous treatment of functional mitral regurgitation.
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Affiliation(s)
- Piergiorgio Tozzi
- Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland,Address for reprints: Piergiorgio Tozzi, MD, Cardiac Surgery Department, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Didier Locca
- Centre Cardiovasculaire Grand Chêne, Lausanne, Switzerland
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Gaignard S, Babaliaros V, Perdoncin E, Gleason P, Xie J, Jokhadar M. Transcatheter Mitral Valve Repair in a Tricuspid Atresia Patient With Potts and Glenn Shunts. JACC Case Rep 2022; 4:1379-1383. [PMID: 36299650 PMCID: PMC9588587 DOI: 10.1016/j.jaccas.2022.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
Abstract
Our patient was a 50-year-old woman with tricuspid atresia who had undergone palliation with a Potts shunt to the left pulmonary artery as an infant and a classic Glenn shunt to the right pulmonary artery as a young child. Under general anesthesia, she underwent transcatheter edge-to-edge repair of the mitral valve for severe symptomatic mitral regurgitation. (Level of Difficulty: Advanced.)
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Key Words
- ASD, atrial septal defect
- EROA, effective regurgitant orifice area
- LPA, left pulmonary artery
- LV, left ventricular
- MC, MitraClip
- MR, mitral regurgitation
- PEEP, positive end-expiratory pressure
- RPA, right pulmonary artery
- TEE, transesophageal echocardiography
- TEER, transcatheter edge-to-edge repair
- congenital heart disease
- cyanotic heart disease
- echocardiography
- mitral valve
- pulmonary circulation
- systolic heart failure
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Affiliation(s)
- Scott Gaignard
- Address for correspondence: Dr Scott Gaignard, Emory University School of Medicine, Emory Faculty Office Building, 49 Jesse Hill Jr Drive Southeast, Atlanta, Georgia 30303, USA.
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8
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Rajotte K, Shalen E, Song HK, Golwala H, Cigarroa J, Burch G, Zahr F, Chadderdon SM. Severe MR With Prior Alfieri Stitch Treated With Transcatheter Edge-to-Edge Repair and a Vascular Plug. JACC Case Rep 2022; 4:1314-1318. [PMID: 36406907 PMCID: PMC9666753 DOI: 10.1016/j.jaccas.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 06/16/2023]
Abstract
We present a case of a high-risk surgical patient with prior surgical Alfieri stitch and recurrent severe mitral regurgitation. In cases with suitable anatomy, mitral valve transcatheter edge-to-edge repair and vascular plug closure of a small regurgitant orifice can be used with excellent results. (Level of Difficulty: Advanced.).
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Affiliation(s)
| | | | | | | | | | | | | | - Scott M. Chadderdon
- Address for correspondence: Dr Scott M. Chadderdon, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, USA.
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Ravipati H, Sabouni MA, Kodavaluru T, Alkhawam H, Ahmed MI. Venous-Left Atrial Extracorporeal Membrane Oxygenation Configuration Use in Right Ventricular Failure and Tricuspid Ring. JACC Case Rep 2022; 4:1263-1266. [PMID: 36406909 PMCID: PMC9666754 DOI: 10.1016/j.jaccas.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/08/2022] [Indexed: 06/16/2023]
Abstract
Mechanical circulatory support devices are used to support the heart in cardiogenic shock. We present a case of demonstrating the feasible use of left ventricular assistive device with reverse configuration to support severe right ventricular failure in a patient with recent tricuspid annuloplasty ring.
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Key Words
- AS, aortic stenosis
- LVEF, left ventricular ejection fraction
- MR, mitral regurgitation
- PA, pulmonary artery
- RA, right atrial
- RV, right ventricular
- RVAD, right ventricular assistive device
- TEE, transesophageal echocardiogram
- TH, tandem heart
- TR, tricuspid regurgitation
- TV, tricuspid valve
- VA ECMO, veno-arterial extracorporeal membrane oxygenation
- cardiac assist devices
- right ventricle
- tricuspid valve
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Affiliation(s)
- Harish Ravipati
- Section of Advanced Heart Failure, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mouhamed Amr Sabouni
- Division of Interventional and Structural Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Hassan Alkhawam
- Division of Interventional and Structural Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mustafa I. Ahmed
- Division of Interventional and Structural Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Arbona MA, David TE, David CM, Rao V. Results of mitral valve reconstruction using substitute extracellular matrix. JTCVS Tech 2022; 16:43-48. [PMID: 36510520 PMCID: PMC9735417 DOI: 10.1016/j.xjtc.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/14/2022] [Accepted: 09/11/2022] [Indexed: 12/12/2022] Open
Abstract
Background During the ongoing search for an ideal patch material for reconstructive heart surgery, several versions of extracellular matrix (ECM) have been used. However, long-term performance in different cardiac positions is unknown. Methods We performed a retrospective review of outcomes after mitral valve surgery using ECM in 29 patients from 2011 to 2014. Clinical and echocardiographic follow-up was reviewed (mean time, 6.3 ± 2.8 years). Results ECM was used to reconstruct the posterior mitral annulus in 69% and to repair the mitral leaflet in 65% of the patients. The most prevalent etiology was dystrophic calcification of the annulus (80%) versus endocarditis for leaflet repair (60%). Fifty-five percent of the patients who required annular reconstruction received a mitral valve replacement (MVR). There were 2 perioperative deaths (7%). Long-term data were analyzed according to surgical technique; namely, isolated leaflet repair compared with annular reconstruction with or without MVR. There were 3 late deaths (1 per group). Overall survival was 83% at 7 years. Ninety percent of cases with mitral valve repair with or without annular reconstruction were free from more than mild mitral regurgitation, compared with 45% in the MVR and annular reconstruction group. The mechanism of failure was patch degeneration creating a severe paravalvular leak due to prosthesis dehiscence. Conclusions ECM used to repair the mitral valve leaflets with or without annular reconstruction offers acceptable results. However, caution should be taken with the use of ECM adjacent to prosthetic valve material because of a high rate of failure associated with patch degeneration.
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Affiliation(s)
| | | | | | - Vivek Rao
- Address for reprints: Vivek Rao, MD, PhD, Division of Cardiovascular Surgery, Toronto General Hospital, 200 Elizabeth St, 4N464, Toronto, Ontario M5G 2C4, Canada.
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11
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Simonian NT, Liu H, Pouch AM, Gorman JH, Gorman RC, Sacks MS. Quantitative in vivo assessment of human mitral valve coaptation area after undersized ring annuloplasty repair for ischemic mitral regurgitation. JTCVS Tech 2022; 16:49-59. [PMID: 36510522 PMCID: PMC9735426 DOI: 10.1016/j.xjtc.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives Long-term outcomes of mitral valve repair procedures to correct ischemic mitral regurgitation remain unpredictable, due to an incomplete understanding of the disease process and the inability to reliably quantify the coaptation zone using echocardiography. Our objective was to quantify patient-specific mitral valve coaptation behavior from clinical echocardiographic images obtained before and after repair to assess coaptation restoration and its relationship with long-term repair durability. Methods To circumvent the limitations of clinical imaging, we applied a simulation-based shape-matching technique that allowed high-fidelity reconstructions of the complete mitral valve in the systolic configuration. We then applied this method to an extant database of human regurgitant mitral valves before and after undersized ring annuloplasty to quantify the effect of the repair on mitral valve coaptation geometry. Results Our method was able to successfully resolve the coaptation zone into distinct contacting and redundant regions. Results indicated that in patients whose regurgitation recurred 6 months postrepair, both the contacting and redundant regions were larger immediately postrepair compared with patients with no recurrence (P < .05), even when normalized to account for generally larger recurrent valves. Conclusions Although increasing leaflet coaptation area is an intuitively obvious way to improve long-term repair durability, this study has implied that this may not be a reliable target for mitral valve repair. This study underscores the importance of a rigorous understanding of the consequences of repair techniques on mitral valve behavior, as well as a patient-specific approach to ischemic mitral regurgitation treatment within the context of mitral valve and left ventricle function.
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Key Words
- CMF, chordal mimicking force
- ED, end-diastolic
- ES, end-systolic
- FE, finite element
- IMR, ischemic mitral regurgitation
- LV, left ventricle
- MR, mitral regurgitation
- MV, mitral valve
- MVTa, mitral valve tenting area
- URA, undersized ring annuloplasty
- mitral valve imaging
- mitral valve mechanics
- mitral valve regurgitation
- mitral valve repair
- myocardial infarction
- rt-3DE, real-time 3-dimensional echocardiography
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Affiliation(s)
- Natalie T. Simonian
- James T. Willerson Center for Cardiovascular Modeling and Simulation, The Oden Institute for Computational Engineering and Sciences and the Department of Biomedical Engineering, The University of Texas at Austin, Austin, Tex
| | - Hao Liu
- James T. Willerson Center for Cardiovascular Modeling and Simulation, The Oden Institute for Computational Engineering and Sciences and the Department of Biomedical Engineering, The University of Texas at Austin, Austin, Tex
| | - Alison M. Pouch
- Departments of Radiology and Bioengineering, University of Pennsylvania, Philadelphia, Pa
| | - Joseph H. Gorman
- Department of Surgery, Smilow Center for Translational Research, Gorman Cardiovascular Research Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Robert C. Gorman
- Department of Surgery, Smilow Center for Translational Research, Gorman Cardiovascular Research Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Michael S. Sacks
- James T. Willerson Center for Cardiovascular Modeling and Simulation, The Oden Institute for Computational Engineering and Sciences and the Department of Biomedical Engineering, The University of Texas at Austin, Austin, Tex,Address for reprints: Michael S. Sacks, PhD, Department of Biomedical Engineering, The Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, 201 East 24th St, Stop C0200, Austin, TX 78712-1229.
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Liu X, Chen M, Han Y, Pu Z, Lin X, Feng Y, Xu K, Lam YY, Lim DS, Wang J. First-in-Human Study of the Novel Transcatheter Mitral Valve Repair System for Mitral Regurgitation. JACC Asia 2022; 2:390-394. [PMID: 36338402 PMCID: PMC9627920 DOI: 10.1016/j.jacasi.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 06/16/2023]
Abstract
Transcatheter mitral valve intervention treatment is a promising alternative therapy for patients with severe mitral regurgitation (MR). This is a multicenter, prospective, first-in-human study of transcatheter edge-to-edge repair (TEER) using a novel device for severe MR. Safety and efficacy were assessed immediately after the procedure and at 30-day follow-up. Twenty-three patients (age 70.0 ± 5.2 years) who were at high/prohibitive surgical risk underwent successful procedures without major periprocedural complications. All patients achieved residual MR ≤2+ at discharge, with 73.9% with 1+ residual MR. The left ventricular end-systolic diameter improved from 4.1 cm at baseline to 3.4 cm at 30-day follow-up. New York Heart Association functional class I/II after TEER was achieved in 87% of patients. This study demonstrated that TEER with the device was feasible and safe for the treatment of patients with severe MR. (Dragonfly-M Transcatheter Mitral Valve Repair System Early Feasibility Study; NCT04528576).
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Affiliation(s)
- Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhaoxia Pu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinping Lin
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kai Xu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yat-Yin Lam
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
- Centre Medical Hong Kong, Hong Kong SAR, China
| | - D. Scott Lim
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jian’an Wang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Medicine, Zhejiang University School of Medicine, Hangzhou, China
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13
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Suetani Y, Arita Y, Tanaka K, Okada M, Ogasawara N. Multiple Cardiac Calcified Amorphous Tumors. JACC Case Rep 2022; 4:91-93. [PMID: 35106491 PMCID: PMC8784721 DOI: 10.1016/j.jaccas.2021.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/10/2021] [Accepted: 08/26/2021] [Indexed: 06/14/2023]
Abstract
A 61-year-old woman who underwent hemodialysis presented with heart failure. Echocardiography revealed multiple mobile masses in the left atrium. The masses were excised, and histopathologic examination revealed calcified amorphous tumors. Here, we present several echocardiography images, including 3-dimensional transesophageal echocardiography, demonstrating the revolving masses in the left atrium. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Yuto Suetani
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Yoh Arita
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Kenji Tanaka
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Masako Okada
- Clinical Laboratory, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Nobuyuki Ogasawara
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
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14
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Paulsen MJ, Cuartas MM, Imbrie-Moore A, Wang H, Wilkerson R, Farry J, Zhu Y, Ma M, MacArthur JW, Woo YJ. Biomechanical engineering comparison of four leaflet repair techniques for mitral regurgitation using a novel 3-dimensional-printed left heart simulator. JTCVS Tech 2021; 10:244-51. [PMID: 34977730 DOI: 10.1016/j.xjtc.2021.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 01/05/2023] Open
Abstract
Objective Mitral valve repair is the gold standard treatment for degenerative mitral regurgitation; however, a multitude of repair techniques exist with little quantitative data comparing these approaches. Using a novel ex vivo model, we sought to evaluate biomechanical differences between repair techniques. Methods Using porcine mitral valves mounted within a custom 3-dimensional-printed left heart simulator, we induced mitral regurgitation using an isolated P2 prolapse model by cutting primary chordae. Next, we repaired the valves in series using the edge-to-edge technique, neochordoplasty, nonresectional remodeling, and classic leaflet resection. Hemodynamic data and chordae forces were measured and analyzed using an incomplete counterbalanced repeated measures design with the healthy pre-prolapse valve as a control. Results With the exception of the edge-to-edge technique, all repair methods effectively corrected mitral regurgitation, returning regurgitant fraction to baseline levels (baseline 11.9% ± 3.7%, edge-to-edge 22.5% ± 6.9%, nonresectional remodeling 12.3% ± 3.0%, neochordal 13.4% ± 4.8%, resection 14.7% ± 5.5%, P < 0.01). Forces on the primary chordae were minimized using the neochordal and nonresectional techniques whereas the edge-to-edge and resectional techniques resulted in significantly elevated primary forces. Secondary chordae forces also followed this pattern, with edge-to-edge repair generating significantly higher secondary forces and leaflet resection trending higher than the nonresectional and neochord repairs. Conclusions Although multiple methods of degenerative mitral valve repair are used clinically, their biomechanical properties vary significantly. Nonresectional techniques, including leaflet remodeling and neochordal techniques, appear to result in lower chordal forces in this ex vivo technical engineering model.
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15
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Budra M, Janušauskas V, Zorinas A, Zakarkaitė D, Aidietis A, Samalavičius R, Ručinskas K. Rescue transventricular off-pump mitral valve repair with artificial neochords for acute mitral regurgitation due to postinfarction papillary muscle rupture. JTCVS Tech 2022; 10:231-242. [PMID: 34977729 PMCID: PMC8691823 DOI: 10.1016/j.xjtc.2021.09.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/27/2021] [Indexed: 12/18/2022] Open
Abstract
Background We report 3 cases of rescue transventricular off-pump mitral valve (MV) repair in high-risk patients with acute mitral regurgitation (MR) due to post–myocardial infarction (MI) papillary muscle rupture (PMR). Methods The 3 patients presented with acute inferior ST elevation myocardial infarction, cardiogenic shock, and pulmonary edema. Their preoperative peak troponin I levels were 1909 ng/L, 16,963 ng/L, and 8299 ng/L. All 3 patients underwent successful percutaneous intervention to the culprit coronary artery, and antiplatelet therapy was initiated. All patients required inotropic support and had an intra-aortic balloon pump inserted preoperatively. Transesophageal echocardiography (TEE) demonstrated severe eccentric MR due to the leaflet prolapse secondary to PMR. The patients’ estimated EuroSCORE II scores were 16.03%, 16.68%, and 7.81%, and their Society of Thoracic Surgeons scores were 14.77%, 18.24%, and 9.8%, respectively. All 3 patients underwent urgent transventricular off-pump MV repair using artificial chords, with 2 or 3 three neochords implanted. The duration of operation was <2 hours, and intraoperative and postoperative drainage was minimal in all cases. MV function was assessed by qualitative and semiquantitative TEE. Results Intraoperative MR reduction to a mild level was achieved in all 3 patients. All patients had moderate MR at discharge, likely due to left ventricular remodeling. Severe MR recurred in all patients, at 5, 4, and 2 months of follow-up, respectively. All 3 patients underwent an elective MV reoperation via conventional approach. Conclusions Off-pump transventricular MV repair may offer a safe and feasible alternative to stabilize high-risk patients with acute MR due to post-MI PMR. Although early MR recurrence is concerning, urgent transventricular MV repair may serve as a bridge to conventional surgery in such unstable patients.
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Key Words
- AF, atrial fibrillation
- ECG, electrocardiography
- IABP, intra-aortic balloon pump
- LAD, left anterior descending artery
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MI, myocardial infarction
- MR, mitral regurgitation
- MV, mitral valve
- PCI, percutaneous coronary intervention
- PMR, papillary muscle rupture
- RCA, right coronary artery
- STEMI, ST elevation myocardial infarction
- STS, Society of Thoracic Surgeons
- TEE, transesophageal echocardiography
- TR, tricuspid regurgitation
- acute mitral regurgitation
- artificial chords
- cardiogenic shock
- minimally invasive
- mitral valve
- off-pump
- papillary muscle rupture
- transventricular mitral repair
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Affiliation(s)
- Mindaugas Budra
- Centre of Cardiac and Thoracic Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Vilius Janušauskas
- Centre of Cardiac and Thoracic Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Aleksejus Zorinas
- Centre of Cardiac and Thoracic Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Diana Zakarkaitė
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Audrius Aidietis
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Robertas Samalavičius
- II Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Kęstutis Ručinskas
- Centre of Cardiac and Thoracic Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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16
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Abstract
BACKGROUND Cirrhotic cardiomyopathy refers to the structural and functional changes in the heart leading to either impaired systolic, diastolic, electrocardiographic, and neurohormonal changes associated with cirrhosis and portal hypertension. Cirrhotic cardiomyopathy is present in 50% of patients with cirrhosis and is clinically seen as impaired contractility, diastolic dysfunction, hyperdynamic circulation, and electromechanical desynchrony such as QT prolongation. In this review, we will discuss the cardiac physiology principles underlying cirrhotic cardiomyopathy, imaging techniques such as cardiac magnetic resonance imaging and scintigraphy, cardiac biomarkers, and newer echocardiographic techniques such as tissue Doppler imaging and speckle tracking, and emerging treatments to improve outcomes. METHODS We reviewed available literature from MEDLINE for randomized controlled trials, cohort studies, cross-sectional studies, and real-world outcomes using the search terms "cirrhotic cardiomyopathy," "left ventricular diastolic dysfunction," "heart failure in cirrhosis," "liver transplantation," and "coronary artery disease". RESULTS Cirrhotic cardiomyopathy is associated with increased risk of complications such as hepatorenal syndrome, refractory ascites, impaired response to stressors including sepsis, bleeding or transplantation, poor health-related quality of life and increased morbidity and mortality. The evaluation of cirrhotic cardiomyopathy should also guide the feasibility of procedures such as transjugular intrahepatic portosystemic shunt, dose titration protocol of betablockers, and liver transplantation. The use of targeted heart rate reduction is of interest to improve cardiac filling and improve the cardiac output using repurposed heart failure drugs such as ivabradine. Liver transplantation may also reverse the cirrhotic cardiomyopathy; however, careful cardiac evaluation is necessary to rule out coronary artery disease and improve cardiac outcomes in the perioperative period. CONCLUSION More data are needed on the new diagnostic criteria, molecular and biochemical changes, and repurposed drugs in cirrhotic cardiomyopathy. The use of advanced imaging techniques should be incorporated in clinical practice.
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Key Words
- 2-AG, 2-arachidonylglycerol
- 2D, two-dimensional
- AEA, Anandamide
- ANP, Atrial Natriuretic Peptide
- ASE, the American Society of Echocardiography
- AUC, area under the curve
- BA, bile acid
- BNP, Brain natriuretic peptide
- CAD, coronary artery disease
- CB-1, cannabinoid −1
- CCM, Cirrhotic Cardiomyopathy
- CMR, cardiovascular magnetic resonance imaging
- CO, cardiac output
- CT, computed tomography
- CTP, Child–Turcotte–Pugh
- CVP, central venous pressure
- DT, deceleration Time
- ECG, electrocardiogram
- ECV, extracellular volume
- EF, Ejection fraction
- EMD, electromechanical desynchrony
- ESLD, end-stage liver disease
- FXR, Farnesoid X receptor
- GI, gastrointestinal
- GLS, Global Longitudinal strain
- HCN, Hyperpolarization-activated cyclic nucleotide–gated
- HE, hepatic encephalopathy
- HF, heart failure
- HO, Heme oxygenase
- HPS, hepatopulmonary syndrome
- HR, heart rate
- HRS, hepatorenal syndrome
- HVPG, hepatic venous pressure gradient
- HfmrEF, heart failure with mid-range ejection fraction
- HfrEF, heart failure with reduced ejection fraction
- IVC, Inferior Vena Cava
- IVCD, IVC Diameter
- IVS, intravascular volume status
- L-NAME, NG-nitro-L-arginine methyl ester
- LA, left atrium
- LAVI, LA volume index
- LGE, late gadolinium enhancement
- LT, liver transplant
- LV, left ventricle
- LVDD, left ventricular diastolic dysfunction
- LVEDP, left ventricular end-diastolic pressure
- LVEDV, LV end diastolic volume
- LVEF, left ventricular ejection fraction
- LVESV, LV end systolic volume
- LVOT, left ventricular outflow tract
- MAP, mean arterial pressure
- MELD, Model for End-Stage Liver Disease
- MR, mitral regurgitation
- MRI, Magnetic resonance imaging
- MV, mitral valve
- NAFLD, Nonalcoholic fatty liver disease
- NO, nitric oxide
- NOS, Nitric oxide synthases
- NTProBNP, N-terminal proBNP
- PAP, pulmonary artery pressure
- PCWP, pulmonary capillary wedged pressure
- PHT, portal hypertension
- PWD, Pulsed-wave Doppler
- RV, right ventricle
- RVOT, right ventricular outflow tract
- SA, sinoatrial
- SD, standard deviation
- SV, stroke volume
- SVR, Systemic vascular resistance
- TDI, tissue Doppler imaging
- TIPS, transjugular intrahepatic portosystemic shunt
- TR, Tricuspid valve
- TRPV1, transient receptor potential cation channel subfamily V member 1
- TTE, transthoracic echocardiography
- USG, ultrasonography
- VTI, velocity time integral
- beta blocker
- cirrhotic cardiomyopathy
- hemodynamics in cirrhosis
- left ventricular diastolic dysfunction
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Affiliation(s)
| | - Madhumita Premkumar
- Address for correspondence: Dr. Madhumita Premkumar, M.D., D.M., Department of Hepatology, Postgraduate Institute of Medical Education and Research, 60012, Chandigarh, India. Tel.: ++91-9540951061 (mobile)
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17
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Ingraham BS, Chareonthaitawee P, Reddy YNV. Exercise-Induced Left Bundle Branch Block Resulting in Severe Mitral Regurgitation. JACC Case Rep 2021; 3:1287-90. [PMID: 34471879 DOI: 10.1016/j.jaccas.2021.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/26/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022]
Abstract
Exercise hemodynamic catheterization is helpful to evaluate exertional symptoms when noninvasive investigations fail to provide an explanation in non-ischemic cardiomyopathy. In this case, a rate-related left bundle branch block resulted in severe dynamic mitral regurgitation and acute increase in pulmonary capillary wedge pressure. Cardiac resynchronization therapy resolved her symptoms. (Level of Difficulty: Intermediate.).
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Key Words
- AO, aorta
- BMI, body mass index
- CRT, cardiac resynchronization therapy
- LA, left atrium
- LBBB, left bundle branch block
- MR, mitral regurgitation
- PA, pulmonary artery
- PCWP, pulmonary capillary wedge
- TTE, transthoracic echocardiogram
- Vo2, oxygen consumption
- cardiac resynchronization therapy
- exercise
- hemodynamics
- mitral valve
- right-sided catheterization
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18
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Batnyam U, Tuluca A, Witzke CF, Greenspan AM, Mainigi SK. Failure of Complete Endothelialization of a Watchman Device 3 Years Post-Implantation. JACC Case Rep 2021; 3:319-321. [PMID: 34317527 PMCID: PMC8310938 DOI: 10.1016/j.jaccas.2020.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/09/2020] [Accepted: 09/20/2020] [Indexed: 11/29/2022]
Abstract
We report an unusual case of incomplete endothelialization of the Watchman device >3 years after its implantation. Animal data suggest that device endothelialization occurs ∼45 days post-implantation; however, data on humans are lacking. Guidelines on anticoagulation are based on expectation from animal studies. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Uyanga Batnyam
- Division of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Alexandra Tuluca
- Division of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christian F Witzke
- Division of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Allan M Greenspan
- Division of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Sumeet K Mainigi
- Division of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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19
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Shetty M, Lampert MB, Levisay J, Erwin JP, Ricciardi MJ. Iatrogenic Atrial Septal Defect Closure Following Mitral Transcatheter Edge-to-Edge Repair: When Do You Close? JACC Case Rep 2021; 3:357-360. [PMID: 34317536 PMCID: PMC8311052 DOI: 10.1016/j.jaccas.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 12/02/2022]
Abstract
Transcatheter edge-to-edge repair has revolutionized the management of mitral regurgitation in the high surgical-risk population. Iatrogenic atrial septal defects (iASDs) are an obligatory consequence of the procedure. The long-term sequelae of persistent iASDs are unknown but are believed to be dependent on their size, directionality of flow, and underlying hemodynamics. We discuss an uncommon scenario of a post–transcatheter edge-to-edge repair iASD that required immediate closure. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Mrinali Shetty
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago Illinois, USA
| | - Mark B Lampert
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago Illinois, USA
| | - Justin Levisay
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago Illinois, USA
| | - John P Erwin
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago Illinois, USA
| | - Mark J Ricciardi
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA
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20
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Pirzada A, Mokhtar AT, Stewart R, Styles K, Ramer S. Blown Wide Open: An Unusual Case of Torrential Mitral Regurgitation Resolving With a Cough. JACC Case Rep 2021; 3:668-671. [PMID: 34317600 PMCID: PMC8302803 DOI: 10.1016/j.jaccas.2021.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/22/2021] [Accepted: 02/28/2021] [Indexed: 11/04/2022]
Abstract
Mitral regurgitation can have varying hemodynamic parameters dependent on factors such as pressure gradients, exercise, and/or provocative maneuvers. We present a case of unusual dynamic mitral regurgitation resolved by coughing in a patient with hypertrophic cardiomyopathy. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Ashar Pirzada
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ahmed T Mokhtar
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Robbie Stewart
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kim Styles
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Ramer
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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21
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Shah MA, Dalak FA, Alsamadi F, Shah SH, Qattea MB. Complications Following Percutaneous Mitral Valve Edge-to-Edge Repair Using MitraClip. JACC Case Rep 2021; 3:370-376. [PMID: 34317539 PMCID: PMC8311053 DOI: 10.1016/j.jaccas.2020.12.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/17/2022]
Abstract
Percutaneous mitral valve edge-to-edge repair with MitraClip (Abbott, Abbott Park, Illinois) has emerged as an effective and safe treatment for symptomatic mitral regurgitation in suitable patients. The safety of the MitraClip procedure is well established, and the rate of major complications is 4.35%. We present 4 cases of mitral regurgitation in patients who had complications following the MitraClip procedure. (Level of Difficulty: Intermediate.)
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22
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Erinne I, Theertham AK, Maleki K, Chen C, Russo M, Hakeem A. Complete Atrioventricular Block: A Rare Complication of MitraClip Implantation. JACC Case Rep 2021; 3:772-777. [PMID: 34317623 PMCID: PMC8311180 DOI: 10.1016/j.jaccas.2021.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 10/25/2022]
Abstract
MitraClip (Abbott Vascular, Inc., Santa Clara, California) has emerged as a viable alternative for treatment of symptomatic severe mitral regurgitation. Conduction abnormalities are not a known complication of this procedure. We report a case of complete heart block without a ventricular escape rhythm immediately following MitraClip placement near the medial leaflets (A3-P3) in a patient with underlying trifascicular block. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Ikenna Erinne
- Division of Cardiovascular Diseases and Cardiovascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Arjun K Theertham
- Division of Cardiovascular Diseases and Cardiovascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kataneh Maleki
- Department of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Chunguang Chen
- Division of Cardiovascular Diseases and Cardiovascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Mark Russo
- Division of Cardiovascular Diseases and Cardiovascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Abdul Hakeem
- Division of Cardiovascular Diseases and Cardiovascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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23
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Takahashi K, Sasaki D, Sakaue T, Enomoto D, Uemura S, Okura T, Ikeda S, Yamamoto D, Kono T, Yamamura N. Extracardiac Accumulation of Technetium-99m-Pyrophosphate in Transthyretin Cardiac Amyloidosis. JACC Case Rep 2021; 3:1069-1074. [PMID: 34317686 PMCID: PMC8311377 DOI: 10.1016/j.jaccas.2021.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/11/2021] [Accepted: 02/17/2021] [Indexed: 11/03/2022]
Abstract
This report presents a rare case of acute decompensated heart failure with technetium-99m-pyrophosphate accumulation in extracardiac sites, such as chest and abdominal walls, in addition to intense myocardial uptake of the tracer. Subsequently, an abdominal fat pad fine-needle aspiration biopsy, which provided positive findings for transthyretin amyloidosis, was performed. (Level of Difficulty: Advanced.)
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Key Words
- 99mTc, technetium-99m
- ADHF, acute decompensated heart failure
- ATTR-CM, transthyretin cardiac amyloidosis
- CT, computed tomography
- DPD, 3,3-diphosphono-1,2-propanedicarboxylic acid
- HMDP, hydroxymethylene diphosphonate
- LV, left ventricle
- MR, mitral regurgitation
- PYP, pyrophosphate
- SPECT, single photon emission computed tomography
- abdominal fat
- amyloidosis
- bone-avid radiotracer
- heart failure
- transthyretin
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Affiliation(s)
- Koji Takahashi
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan.,Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Daisuke Sasaki
- Department of Radiology, Yawatahama City General Hospital, Ehime, Japan
| | - Tomoki Sakaue
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan.,Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Daijiro Enomoto
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Shigeki Uemura
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Takafumi Okura
- Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Shuntaro Ikeda
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan.,Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan
| | - Daichi Yamamoto
- Department of Radiology, Yawatahama City General Hospital, Ehime, Japan
| | - Taizo Kono
- Department of Radiology, Yawatahama City General Hospital, Ehime, Japan
| | - Nobuhisa Yamamura
- Department of Clinical Pathology, Yawatahama City General Hospital, Ehime, Japan
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24
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Tan TS, Akbulut IM, Kozluca V, Durdu MS, Dincer I. Severe Intermittent Transvalvular Mitral Valve Regurgitation: Serious Complication of Mitral Valve Replacement With Subvalvular Preservation. JACC Case Rep 2021; 3:663-667. [PMID: 34317599 PMCID: PMC8302801 DOI: 10.1016/j.jaccas.2021.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/24/2021] [Accepted: 02/28/2021] [Indexed: 11/30/2022]
Abstract
Mitral valve replacement with subvalvular preservation is a favorable technique to protect left ventricular function and improve long-term survival. However, complications of the procedure should be considered. We report the case of a patient with a history of prosthetic mitral valve replacement with severe intermittent transvalvular mitral regurgitation and reduced ejection fraction. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Turkan Seda Tan
- Department of Cardiovascular Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Irem Muge Akbulut
- Department of Cardiovascular Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Volkan Kozluca
- Department of Cardiovascular Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Serkan Durdu
- Department of Cardiovascular Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Irem Dincer
- Department of Cardiovascular Medicine, Ankara University School of Medicine, Ankara, Turkey
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25
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Tsianaka T, Matziris I, Kobe A, Euler A, Kuzo N, Erhart L, Leschka S, Manka R, Kasel AM, Tanner FC, Alkadhi H, Eberhard M. Mitral annular disjunction in patients with severe aortic stenosis: Extent and reproducibility of measurements with computed tomography. Eur J Radiol Open 2021; 8:100335. [PMID: 33748350 PMCID: PMC7960936 DOI: 10.1016/j.ejro.2021.100335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 01/08/2023] Open
Abstract
Mitral annulus disjunction (MAD) is frequent in patients with severe aortic stenosis. Computed tomography enables a highly reproducible assessment of MAD. MAD patients significantly more often have mitral valve prolapse.
Objectives To determine with CT the prevalence and extent of mitral annular disjunction (MAD) in patients undergoing transcatheter aortic valve replacement (TAVR) and its association with mitral valve disease and arrhythmia. Methods We retrospectively evaluated 408 patients (median age, 82 years; 186 females) with severe aortic stenosis undergoing ECG-gated cardiac CT with end-systolic data acquisition. Baseline and follow-up data were collected in the context of a national registry. Two blinded, independent observers evaluated the presence of MAD on multi-planar reformations. Maximum MAD distance (left atrial wall-mitral leaflet junction to left ventricular myocardium) and circumferential extent of MAD were assessed on CT using dedicated post-processing software. Associated mitral valve disease was determined with echocardiography. Results 7.8 % (32/408) of patients with severe aortic stenosis had MAD. The maximum MAD was 3.5 mm (interquartile range: 3.0–4.0 mm). The circumferential extent of MAD comprised 34 ± 15 % of the posterior and 26 ± 12 % of the entire mitral annulus. Intra- and interobserver agreement for the detection of MAD on CT were excellent (kappa: 0.90 ± 0.02 and 0.92 ± 0.02). Mitral regurgitation (p = 1.00) and severe mitral annular calcification (p = 0.29) were similarly prevalent in MAD and non-MAD patients. Significantly more patients with MAD (6/32; 19 %) had mitral valve prolapse compared to those without (6/376; 2 %; p < 0.001). MAD was not associated with arrhythmia before and after TAVR (p > 0.05). Conclusions Using CT, MAD was found in 7.8 % of patients with severe aortic stenosis, with a higher prevalence in patients with mitral valve prolapse. We found no association of MAD with arrhythmia before or after TAVR.
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Affiliation(s)
- T Tsianaka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - I Matziris
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - A Kobe
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - A Euler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - N Kuzo
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - L Erhart
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - S Leschka
- Division of Radiology and Nuclear Medicine, Kantonsspital St.Gallen, Switzerland
| | - R Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland.,Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - A M Kasel
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - F C Tanner
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - H Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - M Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
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26
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Weber LA, Geirsson A, Prescher L. Early Mitral Valve Repair Failure in the Setting of Endocarditis: When to Reoperate? JACC Case Rep 2021; 3:707-711. [PMID: 34317610 PMCID: PMC8311157 DOI: 10.1016/j.jaccas.2020.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022]
Abstract
Surgery is recommended for endocarditis complicated by annular abscess or destruction of the native valve. Guidelines also recommend valvular repair over replacement for endocarditis when feasible. Guidance on management of early repair failure is not well described. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Lauren A Weber
- Walter Reed National Military Medical Center, Department of Cardiology, Bethesda, Maryland, USA
| | - Arnar Geirsson
- Yale New Haven Hospital, Department of Cardiac Surgery, New Haven, Connecticut, USA
| | - Lindsey Prescher
- Walter Reed National Military Medical Center, Department of Cardiothoracic Surgery, Bethesda, Maryland, USA
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27
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Caniato F, Andrei V, Bernardo P, Agostini C, Cappelli F, Stefano PL, Olivotto I, Pieroni M, Bolognese L, Di Mario C. Cardiogenic Shock in Obstructive Hypertrophic Cardiomyopathy Plus Apical Ballooning: Management With VA-ECMO and Myectomy. JACC Case Rep 2021; 3:433-437. [PMID: 34317552 PMCID: PMC8311032 DOI: 10.1016/j.jaccas.2020.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 04/28/2023]
Abstract
A patient with known obstructive hypertrophic cardiomyopathy developed worsening left ventricular outflow tract obstruction, severe mitral regurgitation, and apical ballooning leading to cardiogenic shock, a combination in which treatment of each component could worsen the others. Emergency veno-arterial extracorporeal membrane oxygenation, levosimendan, and noradrenaline transiently restored adequate systemic perfusion and gas exchange. Surgical myectomy offered a more definitive solution. (Level of Difficulty: Intermediate.).
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Key Words
- AF, atrial fibrillation
- CS, cardiogenic shock
- EF, ejection fraction
- HCM, hypertrophic cardiomyopathy
- HF, heart failure
- LVOTO, left ventricular outflow tract obstruction
- MR, mitral regurgitation
- SAM, systolic anterior movement
- TTE, transthoracic echocardiography
- VA-ECMO, veno-arterial extracorporeal membrane oxygenation
- acute heart failure
- cardiac assist devices
- cardiomyopathy
- inotropes
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Affiliation(s)
- Flavia Caniato
- Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy
- Address for correspondence: Dr. Flavia Caniato, Cardiac Intensive Care Unit, Careggi University Hospital, Largo G. Alessandro Brambilla, 3, 50134 Florence, Italy.
| | - Valentina Andrei
- Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Pasquale Bernardo
- Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Cecilia Agostini
- Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | | | | | - Carlo Di Mario
- Cardiac Intensive Care Unit, Careggi University Hospital, Florence, Italy
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28
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Maisano F. Prevent, Identify, and Manage Complications to Keep Percutaneous Mitral Repair Procedures Safe. JACC Case Rep 2021; 3:377-379. [PMID: 34317540 PMCID: PMC8311008 DOI: 10.1016/j.jaccas.2021.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Francesco Maisano
- Department of Cardiac Surgery, University of Zurich, Zurich, Switzerland
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29
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Blossom J, Lowe C, Ashley KE, Kogon BE, Lee SB, Long RC, Moore CK, Lennep BW, Papadimitriou L, Hernandez GA. Torrential Mitral Regurgitation After Transcatheter Edge-to-Edge Mitral Valve Repair. JACC Case Rep 2021; 3:69-73. [PMID: 34317471 DOI: 10.1016/j.jaccas.2020.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/03/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022]
Abstract
A patient with severe mitral regurgitation and chronic systolic heart failure taking inotropic support at home presents for transcatheter edge-to-edge mitral valve repair, complicated by torrential mitral regurgitation from damaged mitral leaflets requiring escalating mechanical circulatory support and ultimately expedited orthotopic heart transplantation. (Level of Difficulty: Intermediate.).
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30
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McCauley BD, Herrmann HC, Chen T, Anwaruddin S. MitraClip for Secondary Mitral Regurgitation: Approach to the 2020 ACC/AHA Valvular Heart Disease Guidelines. JACC Case Rep 2020; 3:361-365. [PMID: 34317537 PMCID: PMC8311014 DOI: 10.1016/j.jaccas.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/02/2022]
Abstract
We describe the case of an 83-year-old man with a history of ischemic cardiomyopathy and severe secondary mitral regurgitation. This case highlights the role of transcatheter edge-to-edge repair with the MitraClip in the management of symptomatic functional mitral regurgitation in a surgically unfavorable patient. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Brian D McCauley
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Howard C Herrmann
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tiffany Chen
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saif Anwaruddin
- Division of Cardiology, St. Vincent's Hospital/Tenet Healthcare, Worcester, Massachusetts, USA
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31
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Labrada L, Patil A, Kumar J, Kolman S, Iftikhar O, Keane M, Minakata K, Van Decker W, Lakhter V, Whitman I. Papillary Muscle Rupture Complicating Acute Myocardial Infarction: A Tale of Teamwork. JACC Case Rep 2020; 2:2283-2288. [PMID: 34317156 PMCID: PMC8304571 DOI: 10.1016/j.jaccas.2020.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022]
Abstract
A 52-year-old man presented with acute onset of chest pain and was found to have an inferolateral ST-segment elevation myocardial infarction and acute mitral regurgitation due to papillary muscle rupture. This case describes a rare, potentially fatal mechanical complication of acute myocardial infarction. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Lyana Labrada
- Lewis Katz School of Medicine Temple Heart and Vascular Institute, Philadelphia, Pennsylvania, USA
| | - Aadhar Patil
- Lewis Katz School of Medicine Temple Heart and Vascular Institute, Philadelphia, Pennsylvania, USA
| | - Jeevan Kumar
- Lewis Katz School of Medicine Temple Heart and Vascular Institute, Philadelphia, Pennsylvania, USA
| | - Samuel Kolman
- Lewis Katz School of Medicine Temple Heart and Vascular Institute, Philadelphia, Pennsylvania, USA
| | - Omer Iftikhar
- Section of Interventional Cardiology, Lewis Katz School of Medicine Temple Heart and Vascular Institute, Philadelphia, Pennsylvania, USA
| | - Martin Keane
- Lewis Katz School of Medicine Temple Heart and Vascular Institute, Philadelphia, Pennsylvania, USA
| | - Kenji Minakata
- Department of Surgery, Section of Cardiovascular Surgery, Lewis Katz School of Medicine Temple Heart and Vascular Institute, Philadelphia, Pennsylvania, USA
| | - William Van Decker
- Lewis Katz School of Medicine Temple Heart and Vascular Institute, Philadelphia, Pennsylvania, USA
| | - Vladimir Lakhter
- Section of Interventional Cardiology, Lewis Katz School of Medicine Temple Heart and Vascular Institute, Philadelphia, Pennsylvania, USA
| | - Isaac Whitman
- Section of Cardiac Electrophysiology, Lewis Katz School of Medicine Temple Heart and Vascular Institute, Philadelphia, Pennsylvania, USA
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32
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Sharma M, Gorstein S, Aldrich ML, Hsu DT, Choueiter NF. Reversible Myocardial Injury Associated With SARS-CoV-2 in an Infant. JACC Case Rep 2020; 2:2348-2352. [PMID: 33073245 PMCID: PMC7550045 DOI: 10.1016/j.jaccas.2020.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/29/2020] [Accepted: 09/22/2020] [Indexed: 01/07/2023]
Abstract
Coronavirus disease-2019 is caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and has been associated with myocardial dysfunction and heart failure in adult patients. We report a case of reversible myocardial injury and heart failure in an infant with SARS-CoV-2 infection. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Madhu Sharma
- Division of Pediatric Cardiology, Department of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, New York, USA
| | - Samuel Gorstein
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, New York, USA
| | - Margaret L. Aldrich
- Division of Pediatric Infectious Disease, Department of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, New York, USA
| | - Daphne T. Hsu
- Division of Pediatric Cardiology, Department of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, New York, USA
| | - Nadine F. Choueiter
- Division of Pediatric Cardiology, Department of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, New York, USA
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33
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Russo MJ, Garg A, Okoh A, Chaudhary A, Hakeem A, Lee LY, Chen C. MitraClip Implantation in a Patient With Post-Surgical Repair of Primum Atrial Septal Defect and Residual Mitral Cleft. JACC Case Rep 2020; 2:2027-2029. [PMID: 34317100 PMCID: PMC8299242 DOI: 10.1016/j.jaccas.2020.07.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/01/2020] [Accepted: 07/16/2020] [Indexed: 10/26/2022]
Abstract
This paper presents the case of a 67-year-old female with primum atrial septal defect and congenital mitral cleft status-post surgical repair 40 years previously who was recently found to have severe mitral regurgitation. Percutaneous mitral valve repair was successfully performed using implantation of 2 MitraClips with mild residual mitral regurgitation. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Mark J Russo
- Division of Cardiac Surgery and Structural Heart Disease, Robert Wood Johnson Medical School, Rutgers, New Jersey
| | - Aakash Garg
- Cardiovascular Institute, Robert Wood Johnson Medical School, Rutgers, New Jersey
| | - Alexis Okoh
- Division of Cardiac Surgery and Structural Heart Disease, Robert Wood Johnson Medical School, Rutgers, New Jersey
| | - Ashok Chaudhary
- Division of Cardiology, Robert Wood Johnson Medical School, Rutgers, New Jersey
| | - Abdul Hakeem
- Division of Cardiology, Robert Wood Johnson Medical School, Rutgers, New Jersey
| | - Leonard Y Lee
- Division of Cardiac Surgery and Structural Heart Disease, Robert Wood Johnson Medical School, Rutgers, New Jersey
| | - Chunguang Chen
- Advanced Cardiac Imaging, Robert Wood Johnson Medical School, Rutgers, New Jersey
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34
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Ekanem E, Gattani R, Bakhshi H, Tehrani B, Batchelor W. Combined Venoarterial ECMO and Impella-CP Circulatory Support for Cardiogenic Shock Due to Papillary Muscle Rupture. JACC Case Rep 2020; 2:2169-2172. [PMID: 34317131 PMCID: PMC8299848 DOI: 10.1016/j.jaccas.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022]
Abstract
Papillary muscle rupture (PMR) is a catastrophic complication of acute myocardial infarction (AMI). We report on 3 consecutive patients with AMI cardiogenic shock due to PMR, treated with combined venoarterial extracorporeal membrane oxygenation and Impella-CP axial flow circulatory support as a bridge to definitive surgery. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Emmanuel Ekanem
- Department of Medicine, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Raghav Gattani
- Department of Medicine, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Hooman Bakhshi
- Department of Medicine, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Behnam Tehrani
- Department of Medicine, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Wayne Batchelor
- Department of Medicine, Inova Heart and Vascular Institute, Falls Church, Virginia
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35
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Ticar JM, Gaidulis G, Veith K, Rath C, Jarman J, Mohl W. Mitral Butterfly: Preclinical Experience of a Novel Chordal Repair Device Using an Artificial Papillary Muscle. ACTA ACUST UNITED AC 2020; 5:1002-1014. [PMID: 33145463 PMCID: PMC7591935 DOI: 10.1016/j.jacbts.2020.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 01/08/2023]
Abstract
Transcatheter mitral repair is based on the principle of artificial monochordal repair. In this paper, the authors show an alternative, based on the realization of an artificial papillary muscle concept that avoids multiple chordal replacements and fixation in the myocardium. Unlike the interposition of artificial chordae between the free edge of the leaflet and the myocardium, the so-called Mitral Butterfly device collects a multitude of chordae in a matrix connected to a swing arm, stabilizing prolapsing forces with a broad atrial support. Device testing in chronic animal models and in silico substantiated the underlying device concept and performance after 90 days.
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Affiliation(s)
| | - Gediminas Gaidulis
- Department of Biomechanical Engineering, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | | | - Claus Rath
- Department of Anatomy, Medical University of Vienna, Vienna, Austria
| | | | - Werner Mohl
- AVVie GmbH, Vienna, Austria
- Department of Surgery, Medical University of Vienna, Vienna, Austria
- Address for correspondence: Dr. Werner Mohl, Medical University of Vienna, AVVie GmbH, Lazarettgasse 12/1, 1090 Vienna, Austria.
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36
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Caballero A, McKay R, Sun W. Computer simulations of transapical mitral valve repair with neochordae implantation: Clinical implications. JTCVS Open 2020; 3:27-44. [PMID: 36003874 PMCID: PMC9390497 DOI: 10.1016/j.xjon.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Transapical beating heart neochordae implantation is an innovative mitral valve repair technique that has demonstrated promising clinical results in patients with primary mitral regurgitation. However, as clinical experience continues to increase, neochordae implantation criteria have not been fully standardized. The aim of this study was to investigate the biomechanical effects of selecting an antero-lateral apical access site compared with a postero-lateral site, and suboptimal neochordae length compared with optimal suture length, on restoring physiologic left heart dynamics. METHODS Transapical neochordae implantation using 3 and 4 sutures was computer simulated under 3 posterior mitral leaflet prolapse conditions: isolated P2, multiscallop P2/P3 and multiscallop P2/P1. Physiologic, pre- and postrepair left heart dynamics were evaluated using a fluid-structure interaction modeling framework. RESULTS Despite the absence of residual mitral regurgitation in all postrepair models with optimal neochordae length, selecting an antero-lateral apical entry site for the treatment of P2/P3 prolapse generated a significant increase (>80%) in neochordae tension and P2 peak stress, with respect to a postero-lateral entry site. During isolated P2 prolapse repair, although neochordae overtension by 5% led to minimal hemodynamic changes in the regurgitant volume compared with using an optimal suture length, a significant increase in systolic and diastolic neochordae tension (>300%) and posterior leaflet average stress (70%-460%) was quantified. On the other hand, neochordae undertension by 5% led to worsening of regurgitation severity. CONCLUSIONS This parametric computer study represents a further step toward an improved understanding of the biomechanical outcomes of transapical neochordae technologies.
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Key Words
- AL-NC, antero-lateral neochordae
- AML, anterior mitral leaflet
- AV, aortic valve
- FSI, fluid-structure interaction
- LV, left ventricle
- MR, mitral regurgitation
- MV, mitral valve
- NC, neochordae
- PL-NC, postero-lateral neochordae
- PM, papillary muscle
- PML, posterior mitral leaflet
- beating heart mitral valve repair
- ePTFE suture
- ePTFE, expanded polytetrafluoroethylene
- fluid-structure interaction FSI
- primary mitral regurgitation
- transapical neochord
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Affiliation(s)
- Andrés Caballero
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Raymond McKay
- Division of Cardiology, The Hartford Hospital, Hartford, Conn
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
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37
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Miura S, Yamashita T, Murata M, Iwano H, Ohkawa Y. An Unusual Case of Bioprosthetic Mitral Valve Failure. JACC Case Rep 2020; 2:1572-1574. [PMID: 34317020 PMCID: PMC8302175 DOI: 10.1016/j.jaccas.2020.05.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 11/17/2022]
Abstract
We report a case of sudden-onset pulmonary edema due to failure of a bioprosthetic mitral valve. Gross inspection revealed a leaflet tear at a stent post without calcification or pannus formation and no evidence of sutures. This case highlights the mechanical failure of a bioprosthetic mitral valve associated with missing sutures. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Shiro Miura
- Department of Cardiology, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
- Address for correspondence: Dr. Shiro Miura, Department of Cardiology, Hokkaido Ohno Memorial Hospital, 2-1-16-1 Miyanosawa, Nishi-ku, Sapporo 063-0052, Japan.
| | - Takehiro Yamashita
- Department of Cardiology, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Masaki Murata
- Department of Surgical Pathology, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Youhei Ohkawa
- Department of Thoracic and Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
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38
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Tagliari AP, Gavazzoni M, Miura M, Taramasso M, Maisano F. SAM and Severe Mitral Regurgitation Post-Acute Type A Aortic Dissection Surgery Treated With MitraClip. JACC Case Rep 2020; 2:1582-6. [PMID: 34317023 DOI: 10.1016/j.jaccas.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 11/27/2022]
Abstract
Post-operative systolic anterior motion associated with mitral regurgitation can be a challenging combination. We present the case of a 64-year-old male patient managed by MitraClip (Abbott Laboratories, Abbott Park, Illinois) implantation for systolic anterior motion and severe mitral regurgitation in the early post-operative period after aortic dissection surgery. This is the first description of MitraClip use post–aortic dissection. (Level of Difficulty: Intermediate.)
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39
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Atreya AR, Kawamoto K, Yelavarthy P, Arain MA, Cohen DG, Wanamaker BL, El Ela AA, Romano MA, Grossman PM. Acute Myocardial Infarction and Papillary Muscle Rupture in the COVID-19 Era. JACC Case Rep 2020; 2:1637-1641. [PMID: 32839759 PMCID: PMC7438054 DOI: 10.1016/j.jaccas.2020.06.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/26/2020] [Indexed: 11/26/2022]
Abstract
Mechanical complications of acute myocardial infarction are infrequent in the modern era of primary percutaneous coronary intervention, but they are associated with high mortality rates. Papillary muscle rupture with acute severe mitral regurgitation is one such life-threatening complication that requires early detection and urgent surgical intervention. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Auras R Atreya
- Division of Cardiovascular Medicine and Cardiac Surgery, Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kris Kawamoto
- Division of Cardiovascular Medicine and Cardiac Surgery, Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Prasanthi Yelavarthy
- Division of Cardiovascular Medicine and Cardiac Surgery, Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mansoor A Arain
- Division of Cardiovascular Medicine and Cardiac Surgery, Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - David G Cohen
- Division of Cardiovascular Medicine and Cardiac Surgery, Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Brett L Wanamaker
- Division of Cardiovascular Medicine and Cardiac Surgery, Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ashraf Abou El Ela
- Division of Cardiovascular Medicine and Cardiac Surgery, Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Matthew A Romano
- Division of Cardiovascular Medicine and Cardiac Surgery, Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Paul M Grossman
- Division of Cardiovascular Medicine and Cardiac Surgery, Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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Gong FF, Peters AC, Malaisrie SC, Davidson CJ, Flaherty JD, Mehlman DJ, Narang A, Puthumana JJ. Optimal Imaging Guidance During Transcatheter Mitral Valve-in-Valve Replacement in Bioprostheses With Radiolucent Sewing Rings. JACC Case Rep 2020; 2:1129-1134. [PMID: 34317432 PMCID: PMC8311896 DOI: 10.1016/j.jaccas.2020.05.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 11/18/2022]
Abstract
Transcatheter mitral valve-in-valve replacement (TMVR) offers a less invasive strategy for managing bioprosthetic mitral valve dysfunction. TMVR positioning is challenging in the setting of a radiolucent bioprosthetic sewing ring. We present 2 cases demonstrating the roles of fluoroscopy and echocardiography in guiding TMVR placement within bioprostheses with radiolucent sewing rings. (Level of Difficulty: Intermediate.).
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Key Words
- LV, left ventricle
- LVOT, left-ventricular outflow tract
- MPR, multiplanar reconstruction
- MR, mitral regurgitation
- MV, mitral valve
- Medtronic Mosaic
- RV, right ventricle
- S3, Edwards SAPIEN 3 valve
- TEE, transesophageal echocardiography
- TMVR, transcatheter mitral valve-in-valve replacement
- TTE, transthoracic echocardiography
- bioprosthetic valve dysfunction
- mitral valve
- transcatheter valve replacement
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Affiliation(s)
- Fei Fei Gong
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Address for correspondence: Dr. Fei Fei Gong, Division of Cardiology, Northwestern Medicine, 676 North St. Clair Street, Suite 600, Chicago, Illinois 60611.
| | - Andrew C. Peters
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S. Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles J. Davidson
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James D. Flaherty
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David J. Mehlman
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Akhil Narang
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jyothy J. Puthumana
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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41
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Wang TKM, Miyasaka R, Reed G, Krishnaswamy A, Kapadia SR, Harb SC. Be Prepared for the Unexpected: Importance of Careful Intraprocedural Transesophageal Echocardiography Assessment During MitraClip. JACC Case Rep 2020; 2:549-554. [PMID: 34317292 PMCID: PMC8298544 DOI: 10.1016/j.jaccas.2019.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/12/2019] [Accepted: 12/28/2019] [Indexed: 06/13/2023]
Abstract
Transesophageal echocardiography plays a central role in the evaluation and guidance of mitral valve interventions. Our case highlights the importance of thorough intraprocedural valve evaluation using 3-dimensional and multiplanar reconstruction transesophageal echocardiography, discovering an unexpected mechanism for mitral regurgitation, to guide an alternative intervention strategy by an experienced interventional team. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Tom Kai Ming Wang
- Department of Cardiovascular Medicine, Cardiovascular Imaging Section, Cleveland Clinic, Cleveland, Ohio
| | - Rhonda Miyasaka
- Department of Cardiovascular Medicine, Cardiovascular Imaging Section, Cleveland Clinic, Cleveland, Ohio
| | - Grant Reed
- Department of Cardiovascular Medicine, Cardiovascular Interventional Section, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Cardiovascular Interventional Section, Cleveland Clinic, Cleveland, Ohio
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Cardiovascular Interventional Section, Cleveland Clinic, Cleveland, Ohio
| | - Serge C. Harb
- Department of Cardiovascular Medicine, Cardiovascular Imaging Section, Cleveland Clinic, Cleveland, Ohio
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Kunimasa K, Kamada R, Oka T, Oboshi M, Kimura M, Inoue T, Tamiya M, Nishikawa T, Yasui T, Shioyama W, Nishino K, Imamura F, Kumagai T, Fujita M. Cardiac Adverse Events in EGFR-Mutated Non-Small Cell Lung Cancer Treated With Osimertinib. JACC CardioOncol 2020; 2:1-10. [PMID: 34396203 PMCID: PMC8352275 DOI: 10.1016/j.jaccao.2020.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess osimertinib-associated cardiac adverse events (AEs) in a real-world setting, using a retrospective single-center cohort study in Japan. BACKGROUND Cases of osimertinib-associated cardiac AEs have been reported but remain poorly understood. METHODS A total of 123 cases of advanced non-small cell lung cancer (NSCLC) with confirmed EGFR mutations who received osimertinib monotherapy from 2014 to 2019 at the Osaka International Cancer Institute (Osaka, Japan) were evaluated. Cardiac AEs were defined according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Changes in left ventricular ejection fraction (LVEF) and rates of cancer therapeutics-related cardiac dysfunction (CTRCD), defined as a ≥10 % absolute decline in LVEF from baseline to a value of <53%, were further assessed in 36 patients in whom serial measurements of LVEF were obtained before and during osimertinib treatment. RESULTS Severe cardiac AEs (CTCAE grade 3 or higher) occurred in 6 patients (4.9%) after osimertinib administration. These AEs included acute myocardial infarction (n = 1), heart failure with reduced LVEF (n = 3), and valvular heart disease (n = 2). Five of the 6 patients had a history of cardiovascular risk factors or disease. Myocardial biopsies in 2 of the patients showed cardiomyocyte hypertrophy and lipofuscin deposition. In 36 patients assessed with serial LVEF, LVEF declined from 69.4 ± 4.2% to 63.4 ± 10.5% with osimertinib therapy (p < 0.001). CTRCD occurred in 4 patients with a nadir LVEF of 40.3 ± 9.1% with osimertinib. CONCLUSIONS In this retrospective cohort analysis, the incidence of cardiac AEs in patients treated with osimertinib was 4.9%. Additional prospective data collected from patients with NSCLC treated with osimertinib will be important in understanding the incidence, pathophysiology, and management of cardiac AEs with osimertinib.
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Key Words
- ACE, angiotensin-converting enzyme
- AE, adverse event
- ARB, angiotensin II receptor blocker
- CTCAE, common terminology criteria for adverse event
- CTRCD, cancer therapeutics-related cardiac dysfunction
- EGFR mutations
- EGRF, epidermal growth factor receptor
- HER, human epidermal growth factor receptor
- LVEF, left ventricular ejection fraction
- LVIDd, left ventricular internal end-diastolic diameter
- LVIDs, left ventricular internal end-systolic diameter
- MR, mitral regurgitation
- NSCLC, non–small cell lung cancer
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- PASP, pulmonary artery systolic pressure
- TKI, tyrosine kinase inhibitor
- TR, tricuspid regurgitation
- VEGF, vascular endothelial growth factor
- cardiac adverse events
- cardiac dysfunction
- myocardial biopsy
- non–small cell lung cancer
- osimertinib
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Affiliation(s)
- Kei Kunimasa
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Risa Kamada
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Toru Oka
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Makiko Oboshi
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Madoka Kimura
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takako Inoue
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Motohiro Tamiya
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tatsuya Nishikawa
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Taku Yasui
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Wataru Shioyama
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazumi Nishino
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Fumio Imamura
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Toru Kumagai
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masashi Fujita
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
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Butts B, Ahmed MI, Bajaj NS, Cox Powell P, Pat B, Litovsky S, Gupta H, Lloyd SG, Denney TS, Zhang X, Aban I, Sadayappan S, McNamara JW, Watson MJ, Ferrario CM, Collawn JF, Lewis C, Davies JE, Dell'Italia LJ. Reduced Left Atrial Emptying Fraction and Chymase Activation in Pathophysiology of Primary Mitral Regurgitation. JACC Basic Transl Sci 2020; 5:109-122. [PMID: 32140620 PMCID: PMC7046515 DOI: 10.1016/j.jacbts.2019.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 11/17/2022]
Abstract
Increasing left atrial (LA) size predicts outcomes in patients with isolated mitral regurgitation (MR). Chymase is plentiful in the human heart and affects extracellular matrix remodeling. Chymase activation correlates to LA fibrosis, LA enlargement, and a decreased total LA emptying fraction in addition to having a potential intracellular role in mediating myofibrillar breakdown in LA myocytes. Because of the unreliability of the left ventricular ejection fraction in predicting outcomes in MR, LA size and the total LA emptying fraction may be more suitable indicators for timing of surgical intervention.
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Affiliation(s)
- Brittany Butts
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mustafa I Ahmed
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Navkaranbir S Bajaj
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pamela Cox Powell
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Betty Pat
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Silvio Litovsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Himanshu Gupta
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Veterans Affairs Medical Center, Birmingham, Alabama
- Department of Cardiology, Valley Health System, Paramus, New Jersey
| | - Steven G Lloyd
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Veterans Affairs Medical Center, Birmingham, Alabama
| | - Thomas S Denney
- Department of Electrical and Computer Engineering, Auburn University School of Engineering, Auburn, Alabama
| | - Xiaoxia Zhang
- Department of Electrical and Computer Engineering, Auburn University School of Engineering, Auburn, Alabama
| | - Inmaculada Aban
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sakthivel Sadayappan
- Division of Cardiovascular Disease, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James W McNamara
- Division of Cardiovascular Disease, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael J Watson
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Carlos M Ferrario
- Department of Surgery, Wake Forest University Health Science Center, Winston-Salem, North Carolina
| | - James F Collawn
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Clifton Lewis
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - James E Davies
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Louis J Dell'Italia
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Veterans Affairs Medical Center, Birmingham, Alabama
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Panaich SS, Qazi AH, Horwitz PA, Staffey K, Rossen JD. Transcatheter Repair of Anterior Mitral Leaflet Perforation: Deploy, Retrieve, Redeploy. JACC Case Rep 2019; 1:689-693. [PMID: 34316910 PMCID: PMC8288573 DOI: 10.1016/j.jaccas.2019.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 12/04/2022]
Abstract
We describe a case of anterior mitral leaflet perforation successfully treated with the Amplatzer Cribriform device, with resultant hemolytic anemia. The device was retrieved, and perforation occluded with the GORE CARDIOFORM device with resolution of hemolysis. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Sidakpal S Panaich
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Abdul H Qazi
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Phillip A Horwitz
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Kimberly Staffey
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - James D Rossen
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Mahadevan K, Strange JW. Case-Based Review of the Current Global Evidence Supporting Impella-Facilitated Complex and Complete Revascularization. JACC Case Rep 2019; 1:869-72. [PMID: 34316948 DOI: 10.1016/j.jaccas.2019.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 11/24/2022]
Abstract
A 74-year-old male patient who was admitted with non–ST-segment elevation myocardial infarction, severe left ventricular impairment, severe mitral regurgitation, and full viability who was turned down for surgery underwent high-risk and indicated multivessel stenting with Impella (Abiomed) support. At 6-month follow-up he was angina free, with complete resolution of the mitral regurgitation. (Level of Difficulty: Intermediate.)
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Key Words
- AMICS, acute myocardial infarction with cardiogenic shock
- CTO, chronic total occlusion
- HR-PCI, high-risk percutaneous coronary intervention
- IABP, intra-aortic balloon pump
- LAD, left anterior descending
- LMS, left main stem
- LV, left ventricular
- MCS, mechanical circulatory support
- MR, mitral regurgitation
- OM, obtuse marginal
- PCI, percutaneous coronary intervention
- RCA, right coronary artery
- RCT, randomized controlled trial
- myocardial ischemia
- myocardial revascularization
- percutaneous coronary intervention
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46
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Sauter RJ, Patzelt J, Mezger M, Nording H, Reil JC, Saad M, Seizer P, Schreieck J, Rosenberger P, Langer HF, Magunia H. Conventional echocardiographic parameters or three-dimensional echocardiography to evaluate right ventricular function in percutaneous edge-to-edge mitral valve repair (PMVR). Int J Cardiol Heart Vasc 2019; 24:100413. [PMID: 31508480 PMCID: PMC6723083 DOI: 10.1016/j.ijcha.2019.100413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
Abstract
Introduction In this study, we evaluated right ventricular (RV) function before and after percutaneous mitral valve repair (PMVR) using conventional echocardiographic parameters and novel 3DE data sets acquired prior to and directly after the procedure. Patients and methods Observational study on 45 patients undergoing PMVR at an university hospital. Results In the overall collective, the 3D RV-EF before and after PMVR showed no significant change (p = 0.16). While there was a significant increase of the fractional area change (FAC, from 23 [19–29] % to 28 [24–33] %, p = 0.001), no significant change of the tricuspid annular plane systolic excursion (TAPSE, from 17 ± 6 mm to 18 ± 5 mm (standard deviation), p = 0.33) was observed. Regarding patients with a reduced RV-EF (< 35%), a significant RV-EF improvement was observed (from 27 [23–34] % to 32.5 [30–39] % (p = 0.001). 71.4% of patients had an improved clinical outcome (improvement in 6-minute walk test and/or improvement in NYHA class of more than one grade), whereas clinical outcome did not improve in 28.6% of patients. Using univariate logistic regression analysis, the post-PMVR RV-EF (OR 1.15: 95% CI 1.02–1.29; p = 0.02) and the change in RV-EF (OR 1.13: 95% CI 1.02–1.25; p = 0.02) were significant predictors for improved clinical outcome at 6 months follow up. Conclusion Thus, RV function may be an important non-invasive parameter to add to the predictive parameters indicating a potential clinical benefit from treatment of severe mitral regurgitation using PMVR.
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Key Words
- 3D-echocardiography
- 3DE, 3D-echocardiography
- ACE, angiotensin converting enzyme
- DMR, degenerative mitral regurgitation
- EDV, end-diastolic volume
- EF, ejection fraction
- ESV, end-systolic volume
- Echocardiography
- FAC, fractional area change
- FMR, functional mitral regurgitation
- LA, left atrium
- LV, left ventricle
- LVOT, left ventricular outflow tract
- MR, mitral regurgitation
- MRI, magnetic resonance imaging
- Mitral regurgitation
- NYHA, New York heart association functional classification
- Outcome
- PAMP, pulmonary artery mean pressure
- PASP, pulmonary artery systolic pressure
- PCWP, pulmonary capillary wedge pressure
- PMVR, percutaneous mitral valve repair
- Percutaneous mitral valve repair
- RV function
- RV, right ventricle
- TAPSE, tricuspid annular plane systolic excursion
- TAVR, transcatheter aortic valve replacement
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
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Affiliation(s)
- Reinhard J Sauter
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Johannes Patzelt
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Matthias Mezger
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Henry Nording
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Jan-Christian Reil
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Mohammed Saad
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Peter Seizer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Juergen Schreieck
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Peter Rosenberger
- University Hospital, Department of Anaesthesiology and Intensive Care Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Harald F Langer
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Harry Magunia
- University Hospital, Department of Anaesthesiology and Intensive Care Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
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Laudari S, Tiwari KK, Pazdernik M, Sharma SK. Rheumatic Heart Disease Screening Among School Children in Central Nepal. JACC Case Rep 2019; 1:218-220. [PMID: 34316788 PMCID: PMC8301538 DOI: 10.1016/j.jaccas.2019.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/19/2019] [Accepted: 06/27/2019] [Indexed: 11/17/2022]
Abstract
Rheumatic heart disease is the most common heart disease in developing countries. This Global Health Report uses the results of screening 28,050 school children clinically with 2-dimensional echocardiography. A total of 1,739 students had cardiac murmur, with the most dominant lesion being rheumatic mitral regurgitation. This report concluded that the burden of rheumatic heart disease is decreasing, but it is still significant in Nepal. That is why echocardiographic screening is important in early diagnosis and management. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Shankar Laudari
- Department of Cardiology, College of Medical Sciences Teaching Hospital, Bharatpur, Nepal
| | - Kaushal K Tiwari
- Department of Cardiothoracic and Vascular Surgery, College of Medical Sciences Teaching Hospital, Bharatpur, Nepal
| | - Michal Pazdernik
- Department of Cardiology, Institute for Clinical and Experimental Medicine Prague, Czech Republic
| | - Sanjib K Sharma
- Department of Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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48
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Fatima B, Sohail MR, Schaff HV. Lyme Disease-An Unusual Cause of a Mitral Valve Endocarditis. Mayo Clin Proc Innov Qual Outcomes 2018; 2:398-401. [PMID: 30560244 PMCID: PMC6260468 DOI: 10.1016/j.mayocpiqo.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/31/2018] [Accepted: 09/14/2018] [Indexed: 11/02/2022] Open
Abstract
Lyme disease is a tick-borne infection caused by Borrelia burgdorferi. Cardiac manifestations are rare, occurring in 0.5% to 10% of patients. Lyme carditis and atrioventricular block are established manifestations of Lyme disease. Endocarditis caused by Borrelia has been reported only twice previously, and in both cases, these were species (Borrelia afzelii and Borrelia bissettii) not present in North America. We report a unique case of mitral valve endocarditis caused by B burgdorferi.
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Affiliation(s)
- Benish Fatima
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - M Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
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49
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DeVecchi F, Facchini E, Degiovanni A, Sartori C, Cavallino C, Santagostino M, Di Ruocco V, Magnani A, Occhetta E, Marino PN. Acute contractile recovery extent during biventricular pacing is not associated with follow-up in patients undergoing resynchronization. Int J Cardiol Heart Vasc 2016; 11:66-73. [PMID: 28616528 PMCID: PMC5441335 DOI: 10.1016/j.ijcha.2016.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/16/2016] [Accepted: 03/19/2016] [Indexed: 11/18/2022]
Abstract
Background It has been reported that contractility, as assessed using dobutamine infusion, is independently associated with reverse remodeling after CRT. Controversy, however, exists about the capacity of this approach to predict a long-term clinical response. This study's purpose was to assess whether long-term CRT clinical effects can be predicted according to acute inotropic response induced by biventricular stimulation (CRT on), as compared with AAI–VVI right stimulation pacing mode (CRT off), quantified at the time of implantation. Methods In 98 patients (ejection fraction 29 ± 10%), acute changes in left ventricular (LV) elastance (Ees), arterial elastance (Ea), and Ees/Ea, as assessed from slope changes of the force–frequency relation obtained when the heart rate increased, and also assessed while measuring triplane LV volumes and continuous noninvasive blood pressure, were related to death or rehospitalization during a 3-year follow-up. Other covariances tested were age, gender, disease etiology, QRS duration, amount of mitral regurgitation, LV diastolic volume, ejection fraction, and the degree of asynchrony and longitudinal strain at baseline. Results There was a marked increment in the Ees slope with CRT (interaction P = 0.004), no Ea change, and modest Ees/Ea increase (interaction P < 0.05). In Cox analysis, however, neither slope changes nor baseline values of Ees, Ea, and Ees/Ea were associated with long-term follow-up. Only ventricular diastolic volume (direct relation P = 0.002) and QRS duration (inverse relation P = 0.009) predicted death/rehospitalization. Conclusions Acute contractile recovery in CRT patients is not associated with 3 years prognosis. Instead, death or rehospitalization can be predicted from QRS duration and LV diastolic volume at baseline.
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Key Words
- CRT, biventricular stimulation
- Congestive heart failure
- DYS, dyssynchrony
- Dyssynchrony
- EDV, end-diastolic volume
- EF, ejection fraction
- Ea, arterial elastance
- Ees, ventricular elastance
- FFR, force–frequency relation
- Force–frequency relation
- HR, hazard ratio
- LV, left ventricle
- MR, mitral regurgitation
- Resynchronization
- Speckle-tracking echocardiography
- TUS, temporal uniformity of strain
- r2, adjusted r squared
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