Transcatheter Mitral Valve Implantation in Degenerated Bioprosthetic Valves

Mankad, Sunil; Aldea, Gabriel S.; Ho, Natalie; Mankad, Rekha; Pislaru, Sorin V.; Rodriguez, L. Leonardo; Whisenant, Brian; Zimmerman, Karen G.

doi:10.1016/j.echo.2018.03.008

Cited by 5 publications

(6 citation statements)

References 34 publications

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“…More importantly, TMVI cannot be performed without real time 2D and 3D TEE as it provides guidance for transseptal puncture and crossing, alignment of the delivery system using either a 3D en face surgical view or a simultaneous multiplane (orthogonal) 2D view, and assessment for perivalvular leakage and LVOT obstruction after TMVI. 7,8,21 Furthermore, analysis of newly created LVOT area by real time 3D TEE just after deployment of the stent valve in the catheterization-lab not only confirms the success of TMVI but also may predict future LVOT obstruction.…”

Section: The Role Of 3d Tee Compared To Mdctmentioning

confidence: 87%

“…Recent valvular heart disease guidelines and literature have recognized the importance of advanced cardiovascular imaging, especially 3D TEE and cardiac CT. 7,8,19 Multidetector computed tomography provides a 3D dataset with good to excellent visualization of anatomic details of the MV and LVOT, enabling us to analyze the AM angle and predicted neo-LVOT area, which seems to contribute to the assessment of LVOT obstruction risk as well as patient selection, planning, and valve sizing for TMVI procedure. 9,20 On the other hand, echocardiography including 3D TEE could be an alternative to MDCT in such patients as those with unstable clinical status, known allergy to iodinated contrast, kidney disease, tachycardia, and unable to hold their breath.…”

Section: The Role Of 3d Tee Compared To Mdctmentioning

confidence: 99%

“…Therefore, a comprehensive approach or planning to prevent these complications is required. 7,8 Left ventricular outflow tract obstruction following transseptal TMVI in bioprosthetic valves [valve-in-valve (ViV)], surgical MV annuloplasty rings [valve-in-ring (ViR)], and native MV [valve-in-native valve (ViN)] has been recognized early in the development of this technique and increases mortality in these patients. 3,9 The TMVI device elongates the preexisting native outflow tract toward the LV apex and creates a new LVOT (neo-LVOT) surrounded by surgical valve leaflet or native mitral anterior leaflet and inter-ventricular septum.…”

Section: Introductionmentioning

confidence: 99%

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Left ventricular outflow tract area after percutaneous transseptal transcatheter mitral valve implantation: A three‐dimensional transesophageal echocardiography study

et al. 2021

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Background: Left ventricular (LV) outflow tract (LVOT) obstruction increases mortality in patients undergoing transcatheter mitral valve implantation (TMVI) in degenerated bioprostheses, annuloplasty rings, and native mitral valves. We aimed to evaluate the LVOT area after TMVI using 3-dimensional (3D) transesophageal echocardiography (TEE) and to investigate the preprocedural cardiac geometry that affects the LVOT area after TMVI. Methods:We retrospectively reviewed echocardiography data in 43 patients who had TMVI. A change in pressure gradient across LVOT from before to after TMVI (∆PG) and postprocedure 3D LVOT cross-sectional area at the level of the most distal portion of the mitral valve stent that was closest to the LV apex were assessed as evidence of LVOT narrowing.Results: Transcatheter mitral valve implantation with the use of balloon-expandable valve system was performed for 24 bioprostheses, 7 annuloplasty rings, and 12 native valves. Compared to patients without increase in LVOT gradient (∆PG <10 mm Hg; n = 33), patients with increase in LVOT gradient (∆PG ≥10 mm Hg; n = 10) had smaller LV end-systolic volume (LVESV), greater LV ejection fraction (LVEF), and smaller aorto-mitral (AM) angle. The LVOT area at the valve stent distal edge showed strong association with ∆PG (r = −.68, P < .0001). Only a small AM angle was associated with a small LVOT area at the valve stent distal edge on multivariable analysis, independent of LVESV and LVEF. Conclusion:Small LV size, preserved LVEF, and small AM angle were associated with LVOT narrowing. 3D-derived AM angle might be independently associated with LVOT narrowing in patients undergoing transcatheter mitral valve-in-valve, valve-inring, and valve-in-native valve implantation, independent of LVESV and LVEF.

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Section: The Role Of 3d Tee Compared To Mdctmentioning

confidence: 87%

Section: The Role Of 3d Tee Compared To Mdctmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Left ventricular outflow tract area after percutaneous transseptal transcatheter mitral valve implantation: A three‐dimensional transesophageal echocardiography study

et al. 2021

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show abstract

“…Recent valvular heart disease guidelines and literature have recognized the importance of advanced cardiovascular imaging, especially 3D TEE and cardiac CT. 7,8,19 MDCT provides a 3D dataset with good to excellent visualization of anatomic details of the MV and LVOT, enabling us to analyze the AM angle and predicted neo-LVOT area, which seems to contribute to the assessment of LVOT obstruction risk as well as patient selection, planning, and valve sizing for TMVI procedure. 9,20 On the other hand, echocardiography including 3D TEE could be an alternative to MDCT in such patients as those with unstable clinical status, known allergy to iodinated contrast, kidney disease, tachycardia, and unable to hold their breath.…”

Section: The Role Of 3d Tee Compared To Mdctmentioning

confidence: 99%

“…Therefore, a comprehensive approach or planning to prevent these complications is required. 7,8 LVOT obstruction following transseptal TMVI in bioprosthetic valves [valve-in-valve (ViV)], surgical MV annuloplasty rings [valve-in-ring (ViR)], and native MV [valve-in-native valve (ViN)] has been recognized early in the development of this technique and increases mortality in these patients. 3,9 The TMVI device elongates the pre-existing native outflow tract toward the LV apex and creates a new LVOT (neo-LVOT) surrounded by surgical valve leaflet or native mitral anterior leaflet and interventricular septum.…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Outflow Tract Area After Percutaneous Transseptal Transcatheter Mitral Valve Implantation; A Three-dimensional Transesophageal Echocardiography Study

Hayashi¹,

Ikenaga²,

Nagaura³

et al. 2021

Preprint

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Background: Left ventricular (LV) outflow tract (LVOT) obstruction increases mortality in patients undergoing transcatheter mitral valve implantation (TMVI) in degenerated bioprostheses, annuloplasty rings, and native mitral valves. We aimed to evaluate the left ventricular outflow tract area after TMVI using 3-diensional (3D) transesophageal echocardiography (TEE) and to investigate the pre-procedural cardiac geometry affects the LVOT area after TMVI. Methods: We retrospectively reviewed echocardiography data in 43 patients who had TMVI. A change in pressure gradient across LVOT from before to after TMVI (∆PG) and post-procedure 3D cross sectional area (CSA) at the level of the most distal portion of the mitral valve stent that was closest to the LV apex were assessed as evidence of LVOT narrowing. Results: TMVI with the use of balloon-expandable valve system was performed for 24 bioprostheses, 7 annuloplasty rings, and 12 native valves. Compared to patients without increase in LVOT gradient (∆PG <10 mmHg; n=33), patients with increase in LVOT gradient (∆PG ≥10 mmHg; n=10) had smaller LV end-systolic volume (LVESV), greater LV ejection fraction (LVEF) and smaller aorto-mitral (AM) angle. CSA at the valve stent distal edge showed strong association with ∆PG (r=-0.68, P<0.0001). Only small AM angle was associated with small CSA at the valve stent ventricular edge on multivariable analysis, independent of LVESV and LVEF. Conclusion: Pre-procedural AM angle as well as LVESV and LVEF were associated with LVOT narrowing in patients undergoing transcatheter mitral valve-in-valve, valve-in-ring, and valve-in-native valve implantation. These data may be useful for preprocedural planning.

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Other Applications, Including the Critical Care Setting

Jone

Younoszai

2021

Transesophageal Echocardiography for Pediatric and Congenital Heart Disease

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Transcatheter Mitral Valve Implantation in Degenerated Bioprosthetic Valves

Cited by 5 publications

References 34 publications

Left ventricular outflow tract area after percutaneous transseptal transcatheter mitral valve implantation: A three‐dimensional transesophageal echocardiography study

Left ventricular outflow tract area after percutaneous transseptal transcatheter mitral valve implantation: A three‐dimensional transesophageal echocardiography study

Left Ventricular Outflow Tract Area After Percutaneous Transseptal Transcatheter Mitral Valve Implantation; A Three-dimensional Transesophageal Echocardiography Study

Other Applications, Including the Critical Care Setting

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