ABSTRACT
Functional mitral regurgitation (FMR) is frequent in left ventricular (LV) dilatation/dysfunction. Echocardiographic predictors of FMR are known. However, cardiac magnetic resonance (CMR) predictors of FMR have not been fully addressed. The aim of the study was to evaluate CMR mitral valve (MV) parameters associated with FMR in ischemic and non ischemic LV dysfunction. 80 patients with LV ejection fraction below 45% and/or left ventricular dilatation of ischemic and non ischemic etiology were included. Cine-MR images (steady state free-precession) were acquired in a short-axis and 4 chambers views where MV evaluation was performed. Delayed enhancement was performed as well. Significant FMR was established as more than mild MR according to the echocardiographic report. Mean age was 59 years, males 79%. FMR was detected in 20 patients (25%) Significant differences were noted in LV functional parameters and in most MV parameters according to the presence of significant FMR. However, differences were noted between ischemic and non ischemic groups. In the first, differences in most MV parameters remained significant while in the non ischemic, only systolic and diastolic interpapillary muscle distance (1.60 vs. 2.19 cm, P = 0.001; 2. 51 vs. 3.04, P = 0.008) were predictors of FMR. FMR is associated with a more severe LV dilatation/dysfunction in the overall population. CMR MV parameters are associated with the presence of significant FMR and are different between ischemic and non ischemic patients. CMR evaluation of these patients may help in risk stratification as well as in surgical candidate selection.
Subject(s)
Magnetic Resonance Imaging, Cine , Mitral Valve Insufficiency/diagnosis , Myocardial Ischemia/complications , Ventricular Dysfunction, Left/diagnosis , Aged , Female , Humans , Image Interpretation, Computer-Assisted , Male , Middle Aged , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/physiopathology , Predictive Value of Tests , Spain , Stroke Volume , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, LeftABSTRACT
Degenerative aortic stenosis is the most common valvulopathy in Europe. In symptomatic patients, aortic valve replacement with a prosthesis substantially improves prognosis. However, a high percentage of candidates for valve replacement surgery are rejected because of the high risk of serious complications. In recent years, percutaneous and minimally invasive surgical techniques have been developed for the transcatheter implantation of prosthetic aortic valves. These developments could lead to an increase in the number of interventions carried out in high-risk patients as the positive effect of treatment on prognosis would be retained while the complication rate would be reduced. We describe the use of transesophageal echocardiography (TEE) for intraoperative monitoring in 21 patients who underwent transcatheter aortic valve replacement using an transapical approach, and report morphologic findings, hemodynamic results, and complications observed. We propose a standard approach to imaging, in which real-time three-dimensional TEE is used to provide additional information during intraoperative monitoring of transapical transcatheter aortic valve replacement.
Subject(s)
Aortic Valve/surgery , Echocardiography, Transesophageal , Heart Valve Prosthesis Implantation , Monitoring, Intraoperative/methods , Aged , Aged, 80 and over , Computer Systems , HumansABSTRACT
La estenosis aórtica degenerativa es la valvulopatía más frecuente en Europa. En pacientes sintomáticos, la sustitución valvular aórtica por una prótesis mejora su pronóstico. Un elevado porcentaje de candidatos a cirugía de reemplazo valvular son desestimados por elevado riesgo de complicaciones graves. En los últimos años, se han desarrollado técnicas percutáneas o quirúrgicas mínimamente invasivas de implantación de prótesis valvular aórtica transcatéter (PATC), que persiguen elevar la tasa de intervención en pacientes de alto riesgo manteniendo los beneficios en el pronóstico y disminuyendo las complicaciones. Describimos el protocolo de supervisión intraoperatoria con ecocardiografía transesofágica (ETE), hallazgos morfológicos, resultados hemodinámicos y complicaciones detectadas en 21 pacientes sometidos a la implantación de PATC por abordaje transapical. Proponemos una estandarización de la exploración, en la que la ETE tridimensional en tiempo real aportaría información adicional en la supervisión intraoperatoria de implantación por vía transapical de la PATC (AU)
Degenerative aortic stenosis is the most common valvulopathy in Europe. In symptomatic patients, aortic valve replacement with a prosthesis substantially improves prognosis. However, a high percentage of candidates for valve replacement surgery are rejected because of the high risk of serious complications. In recent years, percutaneous and minimally invasive surgical techniques have been developed for the transcatheter implantation of prosthetic aortic valves. These developments could lead to an increase in the number of interventions carried out in high-risk patients as the positive effect of treatment on prognosis would be retained while the complication rate would be reduced. We describe the use of transesophageal echocardiography (TEE) for intraoperative monitoring in 21 patients who underwent transcatheter aortic valve replacement using an transapical approach, and report morphologic findings, hemodynamic results, and complications observed. We propose a standard approach to imaging, in which realtime three-dimensional TEE is used to provide additional information during intraoperative monitoring of transapical transcatheter aortic valve replacement (AU)
