Different indicators for postprocedural mitral stenosis caused by single- or multiple-clip implantation after percutaneous mitral valve repair.

Abstract:

BACKGROUND:Postprocedural mitral stenosis (MS) is a main limitation for MitraClip™ (Abbot Vascular, Inc., Santa Clara, CA, USA) procedure. The purpose of this study was to detect the preprocedural predictors of high transmitral pressure gradient (TMPG) after MitraClip™ implantation, which indicated postprocedural mitral stenosis (MS). METHODS:We studied 79 patients who were implanted with MitraClip™ in our institute. Before the procedure, mitral valve orifice area (MVOA), and anterior-posterior (AP) and medial-lateral (ML) mitral annular diameters were measured at diastole using three-dimensional (3D) transesophageal echocardiography (TEE) data set. After the procedure, the mean TMPG was assessed using continuous-wave (CW) Doppler by periprocedural TEE. RESULTS:Preprocedural MVOA, and AP and ML diameter of left ventricular (LV) inflow orifices were larger in patients with mean TMPG ≤4mmHg than in patients with TMPG >4mmHg after 1-and 2-clip implantation. The large MVOA and ML diameter of LV inflow orifice strongly correlated with the low TMPG after 1- and 2-clip implantation. As a result of the receiver operating characteristic curve analysis, the preprocedural MVOA predicted the low postprocedural TMPG more accurately than the ML diameter of LV inflow orifice after 1-clip implantation either in the degenerative or functional mitral regurgitation (MR) patients. After 2-clip implantation, however, the preprocedural ML diameter of LV inflow orifice predicted it more accurately than the MVOA in the degenerative and functional MR patients. CONCLUSIONS:3D TEE derived MVOA predicts the postprocedural MS after 1-clip implantation, however, preprocedural ML diameter of LV inflow orifice is more useful to predict after 2-clip implantation.

journal_name

J Cardiol

journal_title

Journal of cardiology

authors

Itabashi Y,Utsunomiya H,Kubo S,Mizutani Y,Mihara H,Murata M,Siegel RJ,Kar S,Fukuda K,Shiota T

doi

10.1016/j.jjcc.2017.10.023

subject

Has Abstract

pub_date

2018-04-01 00:00:00

pages

336-345

issue

4

eissn

0914-5087

issn

1876-4738

pii

S0914-5087(17)30318-0

journal_volume

71

pub_type

杂志文章