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EuroIntervention : Journal of EuroPCR... Jan 2023Mitral regurgitation (MR) is the most prevalent valvular heart disease and, when left untreated, results in reduced quality of life, heart failure, and increased...
Mitral regurgitation (MR) is the most prevalent valvular heart disease and, when left untreated, results in reduced quality of life, heart failure, and increased mortality. Mitral valve transcatheter edge-to-edge repair (M-TEER) has matured considerably as a non-surgical treatment option since its commercial introduction in Europe in 2008. As a result of major device and interventional improvements, as well as the accumulation of experience by the interventional cardiologists, M-TEER has emerged as an important therapeutic strategy for patients with severe and symptomatic MR in the current European and American guidelines. Herein, we provide a comprehensive up-do-date overview of M-TEER. We define preprocedural patient evaluation and highlight key aspects for decision-making. We describe the currently available M-TEER systems and summarise the evidence for M-TEER in both primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR). In addition, we provide recommendations for device selection, intraprocedural imaging and guiding, M-TEER optimisation and management of recurrent MR. Finally, we provide information on major unsolved questions and "grey areas" in M-TEER.
Topics: Humans; Mitral Valve; Mitral Valve Insufficiency; Quality of Life; Cardiac Surgical Procedures; Heart Failure; Heart Valve Prosthesis Implantation; Treatment Outcome
PubMed: 36688459
DOI: 10.4244/EIJ-D-22-00725 -
Hellenic Journal of Cardiology : HJC =... 2021
Topics: Humans; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Stenosis
PubMed: 33771729
DOI: 10.1016/j.hjc.2021.03.002 -
Journal of Veterinary Internal Medicine May 2021There is no commonly shared severity score for myxomatous mitral valve disease (MMVD) based on routinely acquired echocardiographic variables.
BACKGROUND
There is no commonly shared severity score for myxomatous mitral valve disease (MMVD) based on routinely acquired echocardiographic variables.
HYPOTHESIS/OBJECTIVES
To propose an easy-to-use echocardiographic classification of severity of MMVD in dogs.
ANIMALS
Five hundred and sixty dogs with MMVD.
METHODS
This was a retrospective, multicenter, observational study. The proposed Mitral INsufficiency Echocardiographic (MINE) score was based on 4 echocardiographic variables: left atrium-to-aorta ratio, left ventricular end-diastolic diameter normalized for body weight, fractional shortening, and E-wave transmitral peak velocity. Specific echocardiographic cutoffs were defined based on previous prognostic studies on MMVD, and severity scores were assigned as follows: mild (score: 4-5), moderate (score: 6-7), severe (score: 8-12), late stage (score: 13-14).
RESULTS
Median survival time was significantly different (P < .05) between the proposed severity classes: mild (2344 days, 95% confidence interval [CI] 1877-2810 days), moderate (1882 days, 95% CI 1341-2434 days), severe (623 days, 95% CI 432-710 days), and late stage (157 days, 95% CI 53-257 days). A MINE score >8 was predictive of cardiac death (area under the curve = 0.85; P < .0001; sensitivity 87%, specificity 73%). In the multivariable analysis, all the echocardiographic variables of the MINE score were independent predictors of death because of heart disease (P < .001).
CONCLUSIONS AND CLINICAL IMPORTANCE
The MINE score is a new easy-to-use echocardiographic classification of severity of MMVD, which has been proven to be clinically effective as it is associated with survival. This classification provides prognostic information and could be useful for an objective echocardiographic assessment of MMVD.
Topics: Animals; Dog Diseases; Dogs; Echocardiography; Mitral Valve; Mitral Valve Insufficiency; Retrospective Studies
PubMed: 33951235
DOI: 10.1111/jvim.16131 -
Methodist DeBakey Cardiovascular Journal 2022Despite improvements and advancements in surgical technique, paravalvular leaks (PVL) continue to present a challenge when caring for patients with prosthetic valve...
Despite improvements and advancements in surgical technique, paravalvular leaks (PVL) continue to present a challenge when caring for patients with prosthetic valve disease. Paravalvular leaks result from dehiscence of the surgical ring from the mitral annulus. Some theories suggest that uneven distribution of collagen fibers in the mitral annulus leaves the posterior mitral annulus without a well-formed fibrous structure, which may predispose it to recurrent mechanical injury that leads to PVL. The reported incidence of PVL is 2.2%. Risk factors associated with PVL include the presence of mitral annular calcification, infective endocarditis, active steroid use, and continuous surgical suturing, which poses a greater risk than an interrupted surgical approach. Risk of PVL varies by prosthesis type, with mechanical prostheses carrying a higher risk of PVL than bioprosthetic valves. Below are images of a 70-year-old male with severe mitral stenosis and pulmonary hypertension who had previously undergone mitral valve commissurotomy and subsequent mitral valve replacement with a bioprosthetic mitral valve. He presented to the hospital with pulmonary edema. Initial transthoracic echocardiogram showed depressed biventricular function with a dehiscence of the bioprosthetic mitral valve and a large eccentric posterior PVL, severe tricuspid regurgitation, and severe pulmonary hypertension. Transesophageal images in illustrate a significant posterior PVL with dehiscence of the prosthetic valve from the mitral annulus. The patient underwent closure of the paravalvular leak with two 18-mm Amplatzer ventricular septal defect occluders (Abbott) with excellent results and trace residual mitral regurgitation post closure ( ).
Topics: Aged; Cardiac Catheterization; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Hypertension, Pulmonary; Male; Mitral Valve; Mitral Valve Insufficiency; Prosthesis Failure; Treatment Outcome
PubMed: 35432730
DOI: 10.14797/mdcvj.1096 -
JACC. Cardiovascular Interventions Oct 2021
Topics: Heart Valve Prosthesis; Humans; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 34600872
DOI: 10.1016/j.jcin.2021.08.040 -
The Journal of Thoracic and... Jul 2021
Topics: Humans; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency
PubMed: 32111426
DOI: 10.1016/j.jtcvs.2020.02.001 -
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 -
International Heart Journal 2021Functional mitral regurgitation (FMR) frequently coexists with left ventricular systolic dysfunction and advanced heart failure, and typically has poor clinical... (Review)
Review
Functional mitral regurgitation (FMR) frequently coexists with left ventricular systolic dysfunction and advanced heart failure, and typically has poor clinical outcomes. Although various therapeutic options including cardiac resynchronization therapy and surgical mitral intervention, have been proposed, an optimal treatment strategy for functional mitral regurgitation has not yet been established. Over the last decade, transcatheter mitral valve repair using MitraClip has emerged as a novel alternative therapeutic option for functional mitral regurgitation. In 2018, the COAPT trial demonstrated that MitraClip treatment reduced rehospitalization due to heart failure and all-cause death in patients with functional mitral regurgitation and heart failure. As a consequence, the MitraClip has become a very promising potential treatment for functional mitral regurgitation. In this review, we discuss and summarize the current status and future perspectives of the treatment for functional mitral regurgitation and heart failure.
Topics: Endovascular Procedures; Heart Failure; Humans; Mitral Valve Annuloplasty; Mitral Valve Insufficiency
PubMed: 33518664
DOI: 10.1536/ihj.20-712 -
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 -
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