ABSTRACT
Mitral regurgitation [MR] is a frequent finding in patients with aortic stenosis [AS]. The objective of this study is to assess the change in MR severity following transcatheter aortic valve implantation [TAVI]. MR changes were assessed by comparing transthoracic echocardiography before and after the procedure. The prosthetic aortic valve was successfully implanted in 65 patients. The number of patients with pre-procedure MR was reduced from 58 [85.3%] to 43 [63.2%] [p < 0.001]. Vena contracta width was decreased from 0.47 +/- 0.28 to 0.25 +/- 0.21, [p = 0.043]. About 59.4% [19/32] of those who had moderate to severe MR and 85.7% [12/14] of those with severe MR experienced a significant improvement in MR after the procedure [p < 0.001]. Improvement in MR was independent of prosthetic valve type with 54.2% in CoreValve and 43.9% in Edwards SAPIEN, p = 0.424; valve sizes were 25.8 +/- 1.9 in those who improved vs. 25.0 +/- 1.9 mm in those who did not improve, p = 0.105; femoral approach was 51.2% and apical approach was 41.7%, p = 0.457; MR etiology was 48.1% in organic and 48.6% in functional, p = 0.968; and operative risk was 50.0% in EuroScore >20 and 48.6% in EuroScore <20, p = 0.356. TAVI is associated with a significant improvement in MR, especially in severe types. The lack of influence of MR improvement by the etiology of MR, the type of valve implanted, and the operative risk need to be confirmed in a larger multi-center study
ABSTRACT
BMV is an established treatment for rheumatic mitral valve stenosis. The procedure is historically guided by fluoroscopy, and the role of intracardiac echocardiogram [ICE] guidance is not well defined. We report our initial experience of using ICE to guide BMV procedures. During BMV procedure, ICE catheter was inserted into the right atrium from the right femoral vein, and the septal puncture was monitored by ICE, as well as positioning of the balloon in the mitral valve. Comparisons were made between ICE, transthoracic echocardiography [TTE], and catheterization derived hemodynamic measurements [cath]. Seventeen patients with mitral stenosis underwent the procedure. The mean age was 44.4 +/- 21 years. The mean MV area increased from 0.9 +/- 0.1 cm[2] to 1.7 +/- 0.2 cm[2], P < 0.0001 and the mean gradient decreased from 12.6 +/- 5.8 mmHg to 4.9 +/- 1.8 mmHg, P < 0.001. Atrial septum puncture and guidance of the balloon into the MV apparatus were obtained in all patients under ICE guidance. Severe MR developed in one patient and was readily detected by ICE. ICE derived gradient measurements were comparable to those obtained by TTE, and cath. ICE guidance of BMV is feasible, and useful in monitoring safe septal puncture, optimizing balloon positioning, and in detecting complications. The hemodynamic measurements obtained were comparable to those obtained by TTE, and cath