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Advances in Surgery Sep 2020
Review
Topics: Cardiac Catheterization; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Mitral Valve Stenosis; Sternotomy; Thoracotomy
PubMed: 32713426
DOI: 10.1016/j.yasu.2020.05.011 -
Mayo Clinic Proceedings Jan 2021To investigate the clinical presentation, pathophysiology, and treatment for "paroxysmal severe mitral regurgitation" (MR), which is an underappreciated cause of heart...
OBJECTIVE
To investigate the clinical presentation, pathophysiology, and treatment for "paroxysmal severe mitral regurgitation" (MR), which is an underappreciated cause of heart failure with preserved left ventricular ejection fraction.
METHODS
We retrospectively reviewed cases of transient severe MR that were evaluated at Mayo Clinic in Rochester, Minnesota, between January 1, 2006, and December 31, 2019. Paroxysmal severe MR was defined as the appearance of transient severe MR in patients with mild MR at rest, normal left ventricle (LV) size, left ventricular ejection fraction greater than 40%, and absence of obstructive coronary artery disease.
RESULTS
We identified 6 patients (5 women) with a median age of 68 years. There were 3 distinct mechanisms of paroxysmal severe MR, which we labeled types 1, 2, and 3. Type 1 MR was caused by LV dyssynchrony from a rate-dependent left bundle branch block, which led to apical leaflet tenting and incomplete coaptation. Type 2 MR occurred from mitral annular dilatation during maneuvers that increased left-sided volume. Type 3 MR was caused by coronary artery vasospasm with apical leaflet tenting. Treatments varied depending on the underlying cause and included cardiac resynchronization therapy for type 1, surgical valve replacement for type 2, and medical therapy for type 3.
CONCLUSION
Paroxysmal severe MR is a rare cause of heart failure in patients with preserved LV function. We have identified 3 distinct mechanisms that can lead to this dynamic process, with treatments varying based on the underlying cause.
Topics: Acute Disease; Aged; Aged, 80 and over; Echocardiography, Doppler; Female; Heart Failure; Heart Ventricles; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Retrospective Studies; Stroke Volume; Ventricular Function
PubMed: 33413838
DOI: 10.1016/j.mayocp.2020.06.001 -
Archives of Cardiovascular Diseases Dec 2022
Topics: Humans; Mitral Valve; Heart Valve Diseases; Calcinosis; Heart Defects, Congenital; Mitral Valve Stenosis; Mitral Valve Insufficiency
PubMed: 36347773
DOI: 10.1016/j.acvd.2022.09.005 -
Current Opinion in Cardiology Nov 2021Optimal timing of intervention for ischemic mitral regurgitation remains to be elucidated. This review summarizes the data on the management of ischemic mitral... (Review)
Review
PURPOSE OF REVIEW
Optimal timing of intervention for ischemic mitral regurgitation remains to be elucidated. This review summarizes the data on the management of ischemic mitral regurgitation, and their implications on current practice and future research.
RECENT FINDINGS
Mechanistically, ischemic mitral regurgitation can present as Type I, Type IIIb or mixed Type I and IIIb disease. Severity of mitral regurgitation is typically quantified with echocardiography, either transthoracic or transesophageal echocardiography, but may also be assessed via cardiac MRI. In patients with moderate ischemic mitral regurgitation, revascularization can lead to left ventricular reverse remodeling in some. In patients with severe ischemic mitral regurgitation, mitral valve replacement may be associated with fewer adverse events related to heart failure and cardiovascular readmissions, compared with valve repair, although reverse remodeling may be better in patients following successful mitral repair. Transcatheter edge-to-edge repair also further complements the treatment of ischemic mitral regurgitation.
SUMMARY
A tailored approach to patients should be considered for each patient presenting with ischemic mitral regurgitation.
Topics: Echocardiography; Heart Failure; Humans; Mitral Valve; Mitral Valve Insufficiency; Ventricular Remodeling
PubMed: 34535004
DOI: 10.1097/HCO.0000000000000916 -
The Journal of Invasive Cardiology Feb 2023To the best of our knowledge, this case represents the first patient with Mitraclip, Amplatzer, and TricValve devices with a profound clinical improvement and long-term...
To the best of our knowledge, this case represents the first patient with Mitraclip, Amplatzer, and TricValve devices with a profound clinical improvement and long-term follow-up. In addition, this case illustrates how the treatment of high-risk patients with polyvalvular disease has changed in the last few years.
Topics: Humans; Mitral Valve; Mitral Valve Insufficiency; Cardiac Catheterization; Heart Valve Prosthesis Implantation; Treatment Outcome
PubMed: 36735872
DOI: 10.25270/jic/22.00152 -
Circulation. Cardiovascular Imaging May 2023
Topics: Humans; Mitral Valve Insufficiency; Atrial Fibrillation; Heart Atria; Catheter Ablation
PubMed: 37158074
DOI: 10.1161/CIRCIMAGING.123.015396 -
Journal of Cardiothoracic and Vascular... Jun 2022
Topics: Humans; Mitral Valve; Mitral Valve Insufficiency
PubMed: 35221221
DOI: 10.1053/j.jvca.2022.01.040 -
F1000Research 2019Interest in the mitral valve has increased over the past few years with the development of new technologies that allow intervention in patients previously deemed too ill... (Review)
Review
Interest in the mitral valve has increased over the past few years with the development of new technologies that allow intervention in patients previously deemed too ill for treatment. This increased attention has resulted in a significant increase in publications on the mitral valve, the majority of which focus on mitral regurgitation and mitral valve surgery/intervention. The focus of this review is on publications in the past few years that offer additional insights into our understanding and management of mitral valve disease and specifically mitral regurgitation. It will discuss mitral valve anatomy, epidemiology of mitral valve disease, changes in the 2017 management guidelines, management of mitral bioprosthetic valves, transcatheter mitral valve procedures and the repair of rheumatic valves.
Topics: Cardiac Surgical Procedures; Heart Valve Diseases; Humans; Mitral Valve; Mitral Valve Insufficiency
PubMed: 31588355
DOI: 10.12688/f1000research.16066.1 -
The Journal of Invasive Cardiology Nov 2023Transcatheter edge-to-edge repair (TEER) using the MitraClip (Abbott Vascular) system has emerged as a standard treatment for patients with symptomatic severe secondary... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Transcatheter edge-to-edge repair (TEER) using the MitraClip (Abbott Vascular) system has emerged as a standard treatment for patients with symptomatic severe secondary or inoperable primary mitral regurgitation (MR). The relatively recent approval of the PASCAL Transcatheter Valve Repair System (Edwards Lifesciences) has expanded the options of TEER devices. However, evidence comparing PASCAL with MitraClip systems is still limited.
METHODS
We conducted a systematic literature research and meta-analysis in PubMed, Medline, and EMBASE databases for studies comparing PASCAL and MitraClip systems.
RESULTS
Four observational studies and 1 randomized controlled trial, involving 1315 patients total, were eligible for inclusion. All patients exhibited symptomatic (NYHA II-IV) MR grades 3+ or 4+. Baseline characteristics were comparable across all included studies. The clinical outcomes were assessed according to the Mitral Valve Academic Research Consortium consensus. The procedural success rates for the 2 devices were comparable in terms of achieving post-procedural MR grades of less than or equal to 2+ and less than or equal to 1+. Furthermore, most patients improved their clinical status, with no significant differences between patients treated with PASCAL and those treated with MitraClip. In terms of safety, both procedures exhibited low overall mortality rates and occurrence of major adverse events (MAE), without significant difference between the 2 devices. These findings remained consistent in both short- and long-term follow-up assessments.
CONCLUSIONS
Our study revealed similar effectiveness and safety profiles between the PASCAL and MitraClip devices in patients experiencing significant symptomatic MR.
Topics: Humans; Cardiac Catheterization; Cardiac Surgical Procedures; Catheters; Heart Valve Prosthesis Implantation; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 37992330
DOI: 10.25270/jic/23.00218 -
Circulation. Cardiovascular Imaging Dec 2020
Topics: Echocardiography, Three-Dimensional; Humans; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Prolapse; Myocardial Infarction
PubMed: 33317331
DOI: 10.1161/CIRCIMAGING.120.012130