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@#Transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) is known as M-TEER. Its strengths include: precise targets and fewer implants; simple and clear principles for catheterization; originating from dependable medical concepts and broad applicability. Furthermore, TEER offers advantages in real-time hemodynamic and effectiveness measurement throughout the procedure over surgical edge-to-edge repair (SEER). When it comes to patients with degenerative mitral regurgitation , M-TEER should aim to deliver more optimum procedural outcomes. In functional mitral regurgitation, a modest transvalvular gradients or moderate residual shunt can be tolerated with M-TEER, which reduces the risk of problems and has no bearing on the patient's prognosis.
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@#Objective To summarize and analyze the preliminary clinical outcomes of the KokaclipTM transcatheter edge-to-edge mitral valve repair system for severe degenerative mitral regurgitation (DMR). Methods This study was a single-arm, prospective, single-group target value clinical trial that enrolled patients who underwent the KokaclipTM transcatheter edge-to-edge repair (TEER) system for DMR in the Department of Heart Surgery of Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute from June 2022 to January 2023. Differences in the grade of mitral regurgitation (MR) during the perioperative and follow-up periods were compared, and the incidences of adverse events such as all-cause death, thoracotomy conversion, reoperation, and severe recurrence of MR during the study period were investigated. Results The enrolled patient population consisted of 14 (50.0%) females with a mean age of 70.9±5.4 years. Twenty-eight (100.0%) patients were preoperatively diagnosed with typeⅡ DMR, with a prolapse width of 12.5 (11.0, 16.1) mm, a degree of regurgitation 4+ leading to pulmonary venous reflux, and a New York Heart Association cardiac function class≥Ⅲ. All patients completed the TEER procedure successfully, with immediate postoperative improvement of MR to 0, 1+, and 2+ grade in 2 (7.1%), 21 (75.0%), and 5 (17.9%) patients, respectively. Mitral valve gradient was 2.5 (2.0, 3.0) mm Hg. Deaths, thoracotomy conversion, or device complications such as unileaflet clamping, clip dislodgement, or leaflet injury were negative. Twenty-eight (100.0%) patients completed at least 3-month postoperative follow-up with a median follow-up time of 5.9 (3.6, 6.8) months, during which patients had a mean MR grade of 1.0+ (1.0+, 2.0+) grade and a significant improvement from preoperative values (P<0.001). There was no recurrence of ≥3+ regurgitation, pulmonary venous reflux, reoperation, new-onset mitral stenosis, or major adverse cardiovascular events. Twenty-two (78.6%) patients’ cardiac function improved to classⅠorⅡ. Conclusion The domestic KokaclipTM TEER system has shown excellent preliminary clinical results in selected DMR patients with a high safety profile and significant improvement in MR. Additional large sample volume, prospective, multicenter studies, and long-term follow-up are expected to validate the effectiveness of this system in the future.
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Tricuspid regurgitation(TR)is a common heart valve disease.According to the pathogenesis,TR can be divided into primary(organic)and secondary(functional)regurgitation,of which functional TR accounts for more than 90%.Patients with severe TR have poor prognosis and poor drug treatment,and surgery(valvuloplasty)is the main treatment.At present,transcatheter edge-to-edge tricuspid valve repair(T-TEER)has become an essential program of transcatheter treatment for TR,providing minimally invasive treatment for TR patients who cannot undergo surgery or are at high risk of surgery.T-TEER reduces the degree of regurgitation by clamping leaflets,and is currently in the early stage of research and development exploration and clinical validation,mainly for functional TR.T-TEER devices have also made significant progress(TriClip,PASCAL),and Chinese-made novel-designed T-TEER devices are also undergoing clinical trials(DragonFly-TTM,SQ-Kyrin-TTM,NeoBlazarTM).This paper reviews the current applications and research progress of T-TEER.
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Objective To establish a method for testing isolated mitral valve in vitro and quantitatively evaluate the effect of transcatheter edge-to-edge repair technology(TEER)on functional mitral regurgitation(FMR)(non-A2-P2 regurgitation).Methods In this study,an FMR(non-A2-P2 regurgitation)model was developed by dilating the annulus orifice and displacing the papillary muscle in isolated porcine mitral valve.The hydrodynamics characteristics of 6 valves were tested by a pulsatile flow testing system under different physiological and pathological conditions before and after TEER.Results The results show that the valve regurgitation improved from moderate-severe[regurgitant fraction(60.2±17.5)％]to mild-moderate[regurgitant fraction(34.7±12.0)％]by repair(P＜0.001).The EOA[(3.8±1.6)cm2 vs.(2.2±0.5)cm2,P＜0.001]and the forward cross valve pressure difference[(1.8±1.3)mmHg vs.(3.8± 1.8)mmHg,P＜0.001],which characterize the forward flow performance of the valve,were compared before and after repair,and the differences were statistically significant.At the same time,the repair caused valve stenosis(the effective orifice area decreased by 40％and the positive differential pressure increased by 110％),but the valves was still within the normal physiological range,and no iatrogenic stenosis was caused.Conclusions It can be seen that TEER has an effect on FMR.This study provides validation and evaluation methods in vitro for expanding indications and improving TEER,and reference for developing standards of transcatheter valve repair testing in vitro.
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Objectives:To evaluate the valvular and cardiac function,cardiac reverse remodeling at 6-month after transcatheter edge-to-edge repair(TEER)for patients with functional and degenerative mitral valve regurgitation,and summarize the experience of echocardiography application. Methods:The clinical data of 93 patients with moderate to severe mitral regurgitation(MR)treated with TEER and completed 6-month follow-up in Yunnan Fuwai Cardiovascular Hospital from July 2022 to February 2023 were retrospectively analyzed.Patients were divided into functional mitral regurgitation(FMR)and degenerative mitral regurgitation(DMR)groups according to MR etiology.The valve characteristic parameters,as well as valvular function,chamber volume and cardiac functional parameters before and at 6 months after operation were compared.The key points of echocardiography application were summarized. Results:Among all patients,71 were FMR and 22 were DMR.There were differences in valve structure between the two groups.Mitral TEER were successfully accomplished and all patients completed 6-month follow-up.The key points of echocardiography application included:valve structure analysis,atrial septal puncture location,device delivery process monitoring and image optimization during clamping process.The mitral regurgitation grade and NYHA grade were significantly improved in all patients at 6 months after TEER(P<0.05),and the mean mitral valve pressure gradient was higher than that before operation(P<0.05).Left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)and left atrial volume index in FMR group were significantly decreased(P<0.05),while left ventricular and left atrial volume in DMR group remained unchanged(P>0.05).There were no significant changes in left ventricular ejection fraction and left ventricular global strain in both groups during the observation period(P>0.05).The changes of LVEDV and LVESV before and after operation were more significant in FMR group than those in DMR group(P<0.05). Conclusions:Mitral TEER can reduce the degree of regurgitation and improve cardiac function in the early postoperative period for moderate and severe MR patients with different etiologies.There are differences in preoperative valve structure and postoperative cardiac reverse remodeling between FMR and DMR patients.Echocardiography is an important imaging technique for the evaluation and monitoring process before,during and post mitral TEER.
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La insuficiencia mitral (IM) es una enfermedad frecuente. La degeneración mixomatosa es la principal causa de IM primaria en los países desarrollados. Si no se corrige, conduce a la disfunción ventricular y a la insuficiencia cardíaca congestiva, con elevada morbimortalidad. La cirugía de reparación valvular es el tratamiento recomendado en la IM primaria severa y sintomática. En los pacientes con alto riesgo quirúrgico las opciones terapéuticas son limitadas. El surgimiento de la reparación percutánea borde a borde ha permitido ofrecer alternativas terapéuticas para estos pacientes, y se han demostrado buenos resultados. Se presenta el caso clínico de un paciente añoso con IM primaria severa. Por su elevado riesgo quirúrgico se optó por realizar reparación percutánea con técnica borde a borde, con excelentes resultados clínicos y ecocardiográficos. Se trata del primer reporte de caso de estas características en nuestro país.
Mitral regurgitation (MR) is a common disease. Myxomatous degeneration is the main cause of primary MR in developed countries. If not corrected, it leads to ventricular dysfunction and congestive heart failure, with high morbidity and mortality. Valve repair surgery is the recommended treatment for severe and symptomatic primary MR. In patients with high surgical risk, therapeutic options are limited. The emergence of edge-to-edge percutaneous repair has made it possible to offer therapeutic alternatives for these patients, and good results have been demonstrated. We present the clinical case of an elderly patient with severe primary MR. Due to his high surgical risk, it was decided to perform percutaneous repair with edge-to-edge technique, with excellent clinical and echocardiographic results. It is the first case report of these characteristics in our country.
A regurgitação mitral (RM) é uma doença frequente. A degeneração mixomatosa é a principal causa de RM primária em países desenvolvidos. Se não for corrigido, leva à disfunção ventricular e insuficiência cardíaca congestiva, com alta morbimortalidade. A cirurgia de reparo valvular é o tratamento recomendado na RM primária grave. Em pacientes com alto risco cirúrgico, as opções terapêuticas são limitadas. O surgimento do reparo percutâneo com plicatura dos segmentos é uma opção terapêutica alternativa, com bons resultados demonstrados. Apresentamos o caso clínico de um paciente doente por RM primária grave. Devido ao seu alto risco cirúrgico, optou-se pela correção percutânea com técnica "edge-to-edge", com excelentes resultados clínicos e ecocardiográficos. Este é o primeiro caso publicado com a técnica em Uruguai.
Subject(s)
Humans , Male , Aged, 80 and over , Percutaneous Coronary Intervention/methods , Mitral Valve Insufficiency/surgery , OctogenariansABSTRACT
@#Transcatheter mitral valve edge-to-edge repair (TEER) has become an important treatment opinion for patients with severe mitral regurgitation (MR) at high risk for surgery. The devices and procedural techniques of TEER are complex and require excellent team cooperation. However, there is still a lack of standardized clinical pathways in China. Based on the latest evidence, the expert group wrote this clinical pathway to guide and optimize TEER therapy in clinical practice. It demonstrates the following key issues of clinical concern: (1) TEER team building; (2) preoperative clinical evaluation of TEER patients; (3) imaging assessment before TEER procedure; (4) standardized procedures for TEER; (5) TEER for complex MR; (6) the standard process of perioperative comprehensive management; and (7) full life-cycle rehabilitation and follow-up. This clinical pathway might be helpful to facilitate the standardized development of TEER therapy and application, and promote the improvement of management and life quality for patients with MR.
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Objective:To investigate short-term safety, efficacy and the learning curve of this self-developed novel transcatheter valve repair system (Neonova?) in patients with mitral regurgitation, and explore the role of perioperative echocardiography.Methods:Ten patients who visited the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from June 2021 to March 2022 and met the inclusive criteria were prospectively enrolled. All the patients were at high risk of surgery with moderate to severe or severe mitral regurgitation (MR). Clamps of Neonova? were implanted under guidance of transesophageal echocardiography and digital subtraction angiography. Clinical outcomes, echocardiography indexes and learning curves of this technique were evaluated immediately after intervention, 7 d, 1 month and 3 months post-intervention.Results:The technical success rate was 100% with MR relieved in all patients immediately after intervention. The device and procedural success rates were both 90.0% with 1 patient received surgical replacement at 37 days post-intervention while the others′ reduced to mild (8/9) and moderate (1/9) MR. New York Heart Association class and the Kansas City Cardiomyopathy Questionnaire improved significantly (all P<0.001). Mean mitral valve pressure gradient didn′t increase significantly after intervention when compared with that before intervention( P=0.324), and no mitral stenosis was observed. Left ventricular end-diastolic diameter decreased significantly ( P=0.008) during follow up.Procedure duration ranged from 60 to 300 (175.8±75.2)minutes. The simple linear regression model between procedure volume and duration showed that procedure duration decreased significantly with the increase of procedure volume ( F=15.857, P=0.004). Conclusions:Neonova? implantation can improve MR severity and clinical symptoms safely and effectively. Transthoracic echocardiography and transesophageal echocardiography are essential for perioperative management of transcatheter mitral valve repair.
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@#Mitral regurgitation is the most common heart valvular disease at present. In the past, mitral regurgitation was mainly treated by surgical mitral valve repair or replacement. However, with the progress of transcatheter interventional techniques and instruments in recent years, transcatheter mitral valve interventional therapy has gradually shown its advantages and benefited patients. The purpose of this article is to review the progress of transcatheter mitral valve intervention in this year, and to provide prospects for the future of transcatheter mitral valve treatment.
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Mitral regurgitation is one of the most common valvular heart diseases,with a incidence rate of about 10％in the population,most of which are functional regurgitation.V-FMR patients are caused by weakened left ventricular systolic function combined with left ventricular enlargement,resulting in valve ring enlargement and relative tendon tethering.Due to poor cardiac function and basic condition,the surgical risk and prognosis of these patients are not as good as those with conventional mitral regurgitation.In recent years,transcatheter mitral valve edge-to-edge repair has gradually developed into a mature mitral regurgitation intervention technique,achieving good clinical results in V-FMR patients and providing new options for the treatment of V-FMR.
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Mitral regurgitation(MR)is a common valvular heart disease in China,the prevalence of which increases with age,and most patients present with a wide range of cardiac or non-cardiac comorbidities.Transcatheter mitral valve edge-to-edge repair(TEER)has become a guideline-recommended,safe and effective treatment option for patients with severe primary or secondary mitral regurgitation.With the rapid development of TEER technology in China,relevant devices have been developed and approved for clinical trials,including the self-designed and manufactured JensClip system,which adopts a unique slider locking design to realize the innovation of mitral clip locking mode.Here we reported a case of JensClip device in treatment of a patient with degenerative mitral regurgitation(DMR).
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@#Objective To investigate the early clinical results of MitraClip system in domestic patients. Methods We retrospectively analyzed the clinical data of 36 patients who underwent transcatheter edge-to-edge repair procedure using MitraClip system in Beijing Fuwai Hospital, Shenzhen Fuwai Hospital and Fuwai Yunnan Cardiovascular Hospital between January and June 2021. There were 24 males and 12 females, with a median age of 70 (47-86) years. Ten (27.8%) patients had 3+ mitral regurgitation (MR) and 26 (72.2%) patients had 4+ MR preoperatively. Results All procedures were successfully performed. The reduction in MR was 2+ at least immediately after surgery, and 91.7% of patients had MR≤2+ at 3 days postoperatively. There was no statistical difference in left ventricular ejection fraction change postoperatively. Forward velocity and peak gradient of mitral valve were increased after the procedure. Mean gradient of mitral valve were increased at 3 days postoperatively than immediately after surgery (P<0.001). Two patients had acute pericardial effusion intraoperatively, and received pericardial puncture and drainage immediately. Conclusion MitraClip system has been applied well in domestic patients and can significantly improve MR. This sutdy has a good consistency with foreign studies, and the early results are satisfactory.
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@#Transcatheter edge-to-edge repair (TEER) originated from surgical edge-to-edge repair. MitraClip is the first mature TEER device, and the TEER based on MitraClip is far ahead of many transcatheter mitral valve repair (TMVr) technologies in terms of safety, effectiveness and popularity, so it is named separately in the latest guidelines. The TEER has the following advantages: consistent with basic medical principles, few implants, precise target, less invasive and repeatable. However, there are also some shortcomings, such as the relatively complex design of transfemoral device, target single and relatively narrow indications. At present, the main clinical data of TEER are mainly from the clinical practice of MitraClip. Based on the three-year outcomes of COAPT study, both 2020 ACC/AHA guideline and 2020 ACC expert consensus decision pathway on the management of mitral regurgitation recommend in patients with chronic heart failure with left ventricular dysfunction and severe mitral regurgitation in nonresponders to medicine treatment. Edward's PASCAL, another TEER device, has two models. Among the domestic TEER devices, the ValveClamp of Hanyu medical technology has many distinct advantages, such as simple operation, large clamping area, high clamping efficiency and no need of X-ray. DragonFly, another domestic TEER device, has also completed its feasibility study. There are five trends of TEER in the future: further expansion of indications, combination with other interventional techniques, repeatable operations, transcatheter mitral valve replacement after TEER, and continuous improvement and innovation of equipment.
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@#Objective To explore the effect and safety of surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM) with mitral regurgitation (MR) through right mini-thoracotomy. Methods From January 2008 to June 2018, 54 patients with HOCM and moderate-to-severe MR underwent modified Morrow procedure and edge-to-edge mitral valvuloplasty through right mini-thoracotomy, including 31 males and 23 females, with an average age of 47.1±12.6 years. All patients had systolic anterior motion (SAM) phenomenon. Preoperative left ventricular outflow tract pressure gradient (LVOTPG) was 93.6±32.8 mm Hg, interventricular septum thickness (IVST) was 24.8±2.8 mm. Results Surgeries in all patients were completed successfully. No early death or interventricular septal perforation occurred. One (1.9%) patient received permanent pacemaker implantation due to the complete atrial-ventricular block. At discharge, postoperative LVOTPG (18.1±6.2 mm Hg) and IVST (14.5±2.1 mm) were significantly decreased compared with the preoperative values (P<0.05). No MR or SAM was observed in all patients. The follow-up time was 6-132 months, and during this period, no death, MR or SAM occurred. The average LVOTPG was 19.4±5.7 mm Hg, and the average IVST was 14.2±1.5 mm. Conclusion Morrow procedure and edge-to-edge mitral valvuloplasty through right mini-thoracotomy is a safe and effective method for treatment of HOCM with moderate-to-severe MR.
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RESUMEN Objetivos: Reportar y analizar los resultados iniciales de una serie de pacientes con insuficiencia mitral (IM) grave sintomática y alto riesgo para cirugía que recibieron reparación percutánea de la válvula mitral (RPVM) con MitraClip®. Material y métodos: Entre marzo de 2016 y octubre de 2018 recibieron RPVM con MitraClip® en forma consecutiva 12 sujetos con IM grave sintomática, con alto riesgo o contraindicación para cirugía. Se consideró "éxito del implante" (EI) el correcto agarre de las valvas con el clip que dejó una IM residual leve o moderada al finalizar el procedimiento, y "éxito del procedimiento (EP) a 30 días" el EI en ausencia de eventos adversos mayores (MACE), los que incluyeron muerte, infarto agudo de miocardio (IAM), accidente cerebrovascular (ACV), necesidad de cirugía valvular, derrame pericárdico, taponamiento o sangrado mayor. Datos basales y antecedentes de los pacientes: la media de edad fue de 74,1 ± 8,9 años; 7 eran hombres; 3, diabéticos; 10 eran hipertensos y dislipidémicos; 4 eran tabaquistas, 5 tenían fibrilación auricular, 2 portaban marcapasos definitivo, 3 documentaban IAM previo, 2 habían sido sometidos antes a ATC y 4 a cirugía cardíaca. La tasa de filtración glomerular estimada (eGFR) fue de 73,8 ± 34,8 ml/m2, 2 tenían < 60 ml/m2 y uno se encontraba en diálisis. Todos los pacientes estaban en clase funcional (CF) III-IV, con antecedentes de internaciones por insuficiencia cardíaca (IC). Características ecográficas: diámetro diastólico del ventrículo izquierdo (DDVI): 61,8 ± 6,4 mm; diámetro sistólico (DSVI): 46,3±2,1 mm; fracción de eyección del ventrículo izquierdo (FEVI): 47,5±13,4% (rango: 25-60%). La causa de la IM era degenerativa en 7 pacientes y funcional en 5. La evaluación del riesgo mostró un EuroSCORElog de 9,6±6,8; el STS score de mortalidad fue 16,1 ±1 3,5 y el de morbimortalidad 22,8 ± 17,7. Resultados: Se obtuvo EI en todos los pacientes; en 7 enfermos se implantó 1 solo clip y en los otros 5 se colocaron 2 clips; el gradiente residual medio posimplante fue 3,6 ± 0,2 mmHg. La IM posprocedimiento fue leve en 11 y mínima en 1. La estadía hospitalaria media fue de 1,9 ± 0,8 días (rango: 1-3 días). A los 30 días, todos los sujetos se encontraban en CF I-II; ningún paciente presentó eventos mayores o reinternación por IC. El seguimiento abarcó a todos los pacientes y se extendió por un tiempo medio de 8,8 ± 6,7 meses (rango: 1-30 meses). Dos pacientes fallecieron: 1 de neumonía a los 14 meses y otro a los 30 meses por IC refractaria luego de un reemplazo valvular aórtico por cateterismo (TAVI), manteniendo IM leve. No hubo otras complicaciones. Todos se encontraban en CF I-II, 1 requirió reinternación por IC (a los 7 meses). El eco-Doppler cardíaco de seguimiento demostró IM leve en 11 pacientes y moderada a grave en 1. Hubo una mejoría en la calidad de vida en todos los casos. Conclusiones: En esta serie inicial de un solo centro y que incluye la curva de aprendizaje, la RPVM con MitraClip® en pacientes con IM grave sintomática y alto riesgo quirúrgico fue segura y efectiva, con una mejoría clínica significativa y también en la calidad de vida en el seguimiento.
ABSTRACT Objective: To analyze and report our initial outcomes of Percutaneous Mitral Valve Repair (PMVR) with MitraClip® for patients with severe symptomatic Mitral Regurgitation (MR) and high surgical risk. Methods: Between March 2016 and October 2018 twelve consecutive PMVR with MitraClip® were performed in patients with severe symptomatic MR and contraindication or high surgical risk. Implantation Success (IS) was defined as adequate leaflets grasping, leaving < moderate residual MR at the end of the procedure and 30-day Procedural Success when IS was achieved without any Major Adverse Cardiovascular Event (MACE: death, AMI, Stroke, need of valvular surgery, pericardial effusion, tamponade or major bleeding). Results: Mean age was 74.1±8.9 years, all of them had hypertension and Dyslipemia 7 were men, 3 diabetics, 4 smokers, 5 had previous atrial fibrillation, 2 permanent pacemakers, 3 previous AMI, 2 of them had received PCI and 4 cardiac surgery. The eGFR was 73.8±34.8 ml/m2, 2 had <60 ml/m2 and one on dialysis. All Ptes were in FC III-IV and history of previous hospitalizations because heart failure. Echocardiographic findings: Left Ventricle End Diastolic Diameter (LVEDD) 61.8±6.4, End Systolic Diameter (LVESD) 46.3±2.1; left ventricular ejection fraction (LVEF) 47.5±13.4 (25-60). MI were degenerative in 7 Ptes and functional in 5. Risk Scores: EuroSCORE log was 9.6±6.8, STS for mortality 16.1±13.5 and the STS for morbimortality of 22.8±17.7 EI was achieved in all Ptes; 1 Single Clip was implanted in 7 Pts and 2 Clips in 5; Mean residual post-implantation gradient was 3.6±0.2 mmHg. IS was achieved in all; post-procedural MR was mild in 11 and trivial in one. Mean length of hospital stay was 1.9±0.8 (1-3) days. At 30 days all were in FC 0-II, no one presented MACE or rehospitalization because heart failure. Follow-Up was performed in all Ptes with an average time of 8.8±6.7 (1-30) months. Two patients died (1 from pneumonia at 14 months and another at 30 months due to refractory cardiac failure after TAVI, maintaining mild MR.) There were no other complications, all were in FC I-II, one required rehospitalization due to heart failure (at 7 month). Echo Doppler at follow-Up showed that 11 Ptes had <2 MR and 1 had >2 MR. The QOL improved during the follow-up Conclusion: In this initial series, from a single center that includes the learning curve of the team, PMVR with MitraClip® in Ptes with severe mitral regurgitation and high surgical risk was safe and effective, with a significant clinical improvement at follow-up
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Objective To summarize the safety and effect of modified surgery for hypertrophic obstructive cardiomyopathy ( HOCM) with concomitantly significant mitral regurgitation( MR) through a single transaortic approach. Methods From Jan-uary 2008 to June 2018, 93 patients with HOCM and significant MR underwent modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. Preoperative left ventricular outflow tract pressure gradient( LVOT-PG) was 51-199 mmHg(1 mmHg=0. 133 kPa). Preoperative interventricular septum thickness(IVST) was 17 -30 mm. All patients had significant MR with SAM phenomenon. The modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach was performed under cardiopulmonary bypass and aortic crossclamp. Results All patients successfully underwent the surgery of modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. No early death and interventricular septal perforation were occurred. In the early postoperative period, two patient(2. 15％) received permanent pacemaker implantation due to the complete atrial-ventricular block. At discharge, postoperative LVOTPG(7-31 mmHg) and IVST(11 -19 mm) were significantly decreased compared with the preoperative values(P<0. 05). All patients had none or trivial MR. The mitral valve pressure gradient(MVPG) was 0-6 mmHg. SAM phenomenon disappeared in all patients. At a mean follow-up of(40. 53 ± 27. 11) months, no patient had significant residual left ventricular outflow tract obstruction. All patients had none or trivial MR. No SAM phenomenon occurred. Conclusion Modified surgery of Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach could be safely and effectively applied for patients with HOCM and concomitantly significant MR.
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Objective@#To summarize the safety and effect of modified surgery for hypertrophic obstructive cardiomyopathy(HOCM) with concomitantly significant mitral regurgitation(MR) through a single transaortic approach.@*Methods@#From January 2008 to June 2018, 93 patients with HOCM and significant MR underwent modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. Preoperative left ventricular outflow tract pressure gradient(LVOTPG) was 51-199 mmHg(1 mmHg=0.133 kPa). Preoperative interventricular septum thickness(IVST) was 17-30 mm. All patients had significant MR with SAM phenomenon. The modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach was performed under cardiopulmonary bypass and aortic crossclamp.@*Results@#All patients successfully underwent the surgery of modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. No early death and interventricular septal perforation were occurred. In the early postoperative period, two patient(2.15%) received permanent pacemaker implantation due to the complete atrial-ventricular block. At discharge, postoperative LVOTPG(7-31 mmHg) and IVST(11-19 mm) were significantly decreased compared with the preoperative values(P<0.05). All patients had none or trivial MR. The mitral valve pressure gradient(MVPG) was 0-6 mmHg. SAM phenomenon disappeared in all patients. At a mean follow-up of(40.53±27.11) months, no patient had significant residual left ventricular outflow tract obstruction. All patients had none or trivial MR. No SAM phenomenon occurred.@*Conclusion@#Modified surgery of Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach could be safely and effectively applied for patients with HOCM and concomitantly significant MR.
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Objective To introduce a kind of operative technique in repair for the prolapse of the anterior mitral valve leaflet.Methods From January 2004 to October 2010,the operation of chordal transfer based on theedge-to-edge technique was performed in 18 cases with serious mitral valve regurgitation because of prolapse of the anterior leaflet.First,the edge-to-edge suturing was performed at the free edge of the prolapsed anterior leaflet with corresponding posterior leaflet.After that,quadrangular resection was performed to transfer these segments of posterior leaflet with its attached chordae.At last,the posterior leaflet was repaired after a quadrangular resection which would be much easier for the surgeons.After the operation,echocardiography was performed in each patient before discharge and at the time of follow-up.Results All patients survived after the operation,1 case required the rnitral valve replacement because of anterior leaflet performation occurring 3 days after the operation,1 case with hemoglobinuria and 1 case with low cardiac output,who all got symptomatic treatment afterwards.All the other patients were well discharged.At the time of follow-up,all of the patients were in NYHA functional class I.In all these patients,pre-discharge and follow-up echocardiography showed neither stenosis nor significant regurgitation of the mitral valve:the cross-sectional area of the mitral valve was 2.8-4.8 (3.78 +0.52) cm2,the mean regurgitation area was (0.45 +0.22) cm２.At the same time,both dimension of left atrium and left ventricular reduced significantly [ left atrium diameter:pre-operation ( 48.26 + 11.12 ) mm,post-operation ( 37.57 ± 9.56) mm (P ＝ 0.028 );the end-diastolic diameter of the left ventricular:pre-operation(61.43 ± 8.24) mm,post-operation (42.35 ±10.79) mm (P＝0.008)].Conclusion Chordal transfer based on the edge-to-edge technique provides good results for repair of anterior leaflet prolapse.
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A 33-year-old man presented with respiratory distress and lower leg edema in April 2006. Atrial septal defect (ASD), complicated with moderate mitral regurgitation (MR), advanced tricuspid regurgitation (TR) and pulmonary hypertension (95/32mmHg), was diagnosed. Qp/Qs was 6.3 and L-R shunt ratio was 84.4%. An “edge-to-edge” mitral valve plasty for MR complication as well as closure of the septal defect and tricuspid annuloplasty was performed, and a good result was obtained. It is known that ASD has a tendency to be accompanied by MR, and the strategy for treatment course for MR is debatable. The mitral lesions of MR complicating ASD are often seen in the posteromedial side of the anterior mitral leaflet, and usually many of the tendinous cords and valve leaflets are in the normal range in length. There have been reports on the mid-term results of edge-to-edge repair of mitral regurgitation due to degenerative lesions but the mid- and long-term results for MR complicating ASD, such as this case are unknown. We need to carefully observe the time course of this case.