Transcatheter Mitral Valve Implantation: Implications of Interventional Technique and 3D Echocardiography for Complex Valve?in?Valve Paravalvular Leak

Transcatheter mitral valve replacement (TMVR) has emerged as a feasible alternative to surgical reoperation in failed bioprostheses and rings. Residual mitral regurgitation following TMVR can present as a valve?in?valve paravalvular leak (PVL) and is associated with increased morbidity and mortality. Current therapies for valve?in?valve PVL are limited. We present a case of a symptomatic patient with severe valve?in?valve PVL after TMVR for a previous surgical bioprosthesis leak, who then underwent a second TMVR as a valve?in?valve?in?valve implantation with a 29 mm Edwards? SAPIEN 3 valve via transseptal approach using three?dimensional (3D) echocardiography. This unique case highlights the complexity of this clinical entity and recognizes 3D transesophageal echocardiography as a valuable tool to guide valve?in?valve PVL closures.echocardiography

Annual progress of transcatheter mitral valve intervention in 2022 / 中国胸心血管外科临床杂志

@#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.

Interpretation of updated version 2020 of expert consensus decision pathway on the management of mitral regurgitation / 中国胸心血管外科临床杂志

@#American College of Cardiology (ACC) issued the updated expert consensus decision pathway on the management of mitral regurgitation in April 2020. The whole process in caring patients with mitral valve regurgitation from patient evaluation to treatment choice was discussed in the consensus. The main change from the 2017 version is the confirmation of the effect of transcatheter mitral valve repair on secondary mitral regurgitation. It standardized the process in this field. In this paper, we aimed to introduce the focus update of this consensus.

Role of real-time three-dimensional epicardial echocardiography in a novel transcatheter treatment techniques of mitral regurgitation:an acute in vivo animal study / 中华超声影像学杂志

Objective To evaluate the usefulness of real-time three-dimensional intraoperative epicardial echocardiography ( RT-3D IEE) in the process of transapical mitral valve repair and a new device's efficacy in an animal model . Methods Acute mitral regurgitation ( MR) was induced in 18 anesthetized domestic pigs as MR group by cutting chordae supporting the segment of the leaflet ( A2 , n = 9 ; P2 , n = 8 ;P3 , n = 1) ,while 15 pigs received no cutting chordae were chosed as normal mitral valve ( NMV ) group . The ValveClamp procedures were then transapically performed either on the prolapsing segment ( MR group) or A2/ P2 segment ( NMV group ) respectively solely under 3D epicardial echocardiographic guidance . Epicardial echocardiography was obtained before and after transcatheter interventions . Thirty days later all pigs were humanely killed to verify the location of implanted devices . Results In normal group , the preoperative max and mean mitral valve pressure gradient was higher than postoperative those ( P < 0 .0001) ,and no significant difference was found in other echocardiographic parameters . In MR group , the preoperative echocardiography showed that cutting the leaflet chordae caused severe ( n = 15 ) or moderate( n = 3) MR ,while postoperative immediate echo observed overt MR area reduction( P < 0 .0001) with 8 cases to slight ,5 cases to mild and 1 case eliminated .Furthermore ,the mean postoperative and max mitral valve pressure gradient significantly increased both in two groups ( P < 0 .0001 ) ,whereas no complications or other structural changes were observed ( P > 0 .05) .The autopsy report demonstrated that all ValveClamp devices were precisely placed to clamp either the prolapsing segments (MR group) of mitral valve or A2/P2 segments (NMV group) ,respectively .Conclusions Real-time three-dimensional epicardial echocardiography can independently monitor the new transcatheter mitral repair technique-ValveClamp , facilitating the overall procedure . Transapical implantation of ValveClamp device under epicardial echocardiographic guidance is effective in reducing acutely induced mitral regurgitation .