Objectives The aim of this study was to evaluate the outcome of transcatheter mitral valve repair (TMVr) in patients with cardiogenic shock and significant mitral regurgitation (MR).
The aim of this study was to evaluate whether fulfilling COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) criteria identifies patients with better outcomes after MitraClip treatment for secondary mitral regurgitation (SMR).
Objectives This study was designed to assess hemodynamic changes in response to transcatheter tricuspid valve edge-to-edge repair (TTVR) and to identify hemodynamic predictors associated with mortality.
Objectives The study reports for the first time the 30-day outcomes of the first U.S. study with the Cardioband tricuspid valve reconstruction system for the treatment of functional tricuspid regurgitation (TR).
Objectives The study sought to assess the acute hemodynamic effects of iatrogenic atrial septal defect (iASD) closure following transcatheter mitral valve edge-to-edge repair (TMVR).
Objectives This study sought to investigate clinical outcomes associated with left atrial appendage occlusion (LAAO) versus direct oral anticoagulants (DOACs) in patients with high-risk atrial fibrillation (AF).
Objectives This study aimed to investigate cardiac computed tomography (CT) and transesophageal echocardiography (TEE) peridevice leak (PDL) assessments, and the clinical relevance of PDL.
An 80-year-old woman had severe atrial functional mitral regurgitation (MR) and multiple admissions for heart failure. Computed tomography demonstrated severe mitral annular calcification (MAC) involving more than two-thirds of the annulus (Figure 1A, yellow arrows). Transesophageal echocardiography showed bulky calcification protruding from the posterior annulus (Figure 1B, yellow arrows). The posterior mitral leaflet was restricted but not calcified severely (Figure 1B, blue arrows). Because of very high surgical risk, the patient was offered MitraClip therapy (MitraClip NT, Abbott Vascular, Santa Clara, California). A clip arm was opened at an angle of almost 180° to insert the arm between the posterior leaflet and protruding MAC (Figure 1Ca). The grasp was performed centrally with careful attention to grasp both leaflets adequately and avoid leaflet tear (Figure 1Cb). Insertion length of the posterior leaflet was 6 mm. With a single clip, MR was reduced from severe to mild (Figure 1Cc, Video 1). Post-procedure, pulmonary vein flow was improved from diastolic wave dominant to systolic wave dominant (Figure 1Cd). The patient’s status improved, and echocardiography 1 month after the procedure showed mild to moderate MR.
An 87-year-old woman with symptomatic severe aortic stenosis underwent transcatheter aortic valve replacement with a 23-mm LOTUS Edge (Boston Scientific, Natick, Massachusetts) (Video 1). At discharge, she was asymptomatic, and device success was achieved (mean pressure gradient 12.6 mm Hg, no paravalvular regurgitation); she was prescribed only oral aspirin 100 mg. After initial improvement, the patient became breathless (New York Heart Association [NYHA] functional class III) at 30-day follow-up with a prolonged ejection systolic murmur. Transthoracic echocardiography (TTE) showed a considerable rise in aortic transvalvular gradient (45.9 mm Hg). Multidetector computed tomography demonstrated hypoattenuated leaflet thickening (HALT) of all 3 cusps with severely reduced leaflet motion (RELM) of all 3 leaflets (Figures 1A to 1D). Therefore, the patient was diagnosed with clinical valve thrombosis. After hospitalization, systematic anticoagulation (intravenous heparin, activated partial thromboplastin time 45 to 60 s, followed by oral vitamin K antagonist [VKA], international normalized ratio 2.5 to 3.0) was immediately initiated. Fourteen days after anticoagulation therapy, TTE showed improved hemodynamic status (mean pressure gradient 20.3 mm Hg) with significant resolution of HALT and RELM on multidetector computed tomography (Figures 1E to 1H). The patient was discharged from the hospital on an oral VKA with NYHA functional class II symptoms. At 60-day follow-up, her shortness of breath had improved to NYHA functional class I, and imaging examinations revealed normal function of the LOTUS Edge valve (mean pressure gradient 13.0 mm Hg) without trileaflet HALT and RELM (Figures 1I to 1L). During this treatment period, no signs of thrombus embolization was observed. Regular follow-up was planned every 3 months with TTE as needed, with permanent VKA therapy.
A 66-year-old man presented with recurrent heart failure (New York Heart Association functional class III) and severe mitral regurgitation (MR) in the setting of previous surgical repair involving P2 resection and placement of a 38-mm Cosgrove Edwards annuloplasty ring. We present a case of a MitraClip (Abbott Vascular, Santa Clara, California) affixing the native anterior leaflet to the annuloplasty ring under 2-dimensional and real-time 3-dimensional (3D) multiplanar reconstruction (MPR) with transesophageal echocardiography.
An 81-year-old patient with multivalvular heart disease presented with symptomatic severe secondary mitral regurgitation 18 years after mechanical aortic valve replacement. Due to age and previous open-heart surgery, the patient was considered at increased risk for reoperation on multiple valves (EuroSCORE II 7.2%). He underwent uneventful implantation of 2 MitraClips (Abbott Laboratories, Abbott Park, Illinois) in the mitral position with sustained reduction of mitral regurgitation to grade 2+. Two years later, symptoms of right heart failure and worsening dyspnea (New York Heart Association [NYHA] functional class III) ensued owing to severe secondary tricuspid regurgitation (TR) (Figures 1A and 1B, Videos 1 and 2). Due to the predominant anteroseptal jet localization, bicuspidization of the valve by means of implantation of 2 MitraClip XTR was performed with reduction of TR to grade 2+ (Figures 1C to 1E, Videos 3 and 4). After initial clinical improvement, symptoms of worsening dyspnea (NYHA functional class III) and peripheral edema recurred 10 months later. Transesophageal echocardiography revealed recurrent severe central TR related to progressive tricuspid annulus dilatation (4.9 to 5.4 cm) (Figure 2A, Videos 5 and 6) despite good clip attachment. Several reasons may explain the observed disease progression, including elevated pulmonary vascular resistance, persisting volume overload (residual TR) or further decrease of the right ventricular function in the context of past cardiotomy. After assessment of anatomic eligibility, transcatheter tricuspid annuloplasty using the Cardioband system (Edwards Lifesciences, Irvine, California) was selected due to its ability to reverse annular dilatation and was performed 12 months after tricuspid edge-to-edge repair (Figures 2B and 2C). The tricuspid annulus area was cinched from 22.3 cm2 to 18.3 cm2 with subsequent TR reduction to mild (Figure 2D, Video 7). No adverse events occurred, and the patient was discharged home 2 days after the procedure.
A 60-year-old patient presented with symptomatic residual severe mitral valve regurgitation (MR). An emergent percutaneous mitral valve repair with a MitraClip (Abbott Vascular, Santa Clara, California) in the context of acute papillary muscle rupture after ST-segment elevation myocardial infarction had been performed 1 year before. In the initial procedure, 2 central MitraClip NTR devices were implanted; residual MR seemed to be moderate but was difficult to assess because of rapid ventricular response to atrial fibrillation. Considering the critical clinical situation, the relevant reduction of MR (from massive to moderate), and the challenging anatomy, no additional clips were implanted. After the intervention, the patient was discharged from the hospital, but progressive clinical worsening with 3 hospital admissions for heart failure occurred within 1 year. Control echocardiography showed severe residual MR (Figure 1, Videos 1 and 2) with a regurgitant jet originating between the two implanted clips. As shown in Figure 1, Video 3, both clips described a triangular area, as the posterior prolapsing leaflet was short at this level and could not be grasped. After a heart team discussion, a new percutaneous mitral valve repair was proposed. The initial strategy was the implantation of a third clip between the previous 2 clips, but insufficient space at the level of the anterior leaflet precluded this approach (Figure 1). Given the triangular shape of the residual orifice, an Amplatzer Vascular Plug (AVP) III (14 × 5 mm; Abbott Vascular) (Videos 4, 5, 6, and 7) was implanted, effectively reducing the MR to mild. At 3 months, the patient had no congestive signs and mild residual MR.
Objectives Whether there are prognostic links between coronary morphologies and coronary functional abnormalities was examined in ischemia and nonobstructive coronary artery disease (INOCA) patients.
Objectives The aim of this study was to determine the impact of invasive approaches and revascularization in patients with cocaine-associated non–ST-segment elevation myocardial infarction (NSTEMI).
Objectives The aim of this study was to investigate the safety and efficacy of biodegradable-polymer sirolimus-eluting stents (BP-SES) compared with durable-polymer everolimus-eluting stents (DP-EES) in patients with ST-segment elevation myocardial infarction (STEMI).
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