Immediate effect of the MitraClip® procedure on mitral ring geometry in primary and secondary mitral regurgitation
Immediate effect of the MitraClip® procedure on mitral ring geometry in primary and secondary mitral regurgitation
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DOI：
10.1093/ehjci/jes293
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发表时间：
2013-09-01
影响因子：
6.2
通讯作者：
Warnholtz, Ascan
中科院分区：
文献类型：
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作者：
Schmidt, Frank Patrick;von Bardeleben, Ralph Stephan;Warnholtz, Ascan
目的 经皮治疗二尖瓣反流 (MR) 已被证明可以降低 MR 严重程度并改善功能结果。 MR 的手术治疗通常包括二尖瓣环缩小术。 MitraClip (R) 对环空几何形状的影响尚不清楚。我们想要调查手术本身是否会减小瓣环直径，以及二次或功能性 (SMR) 与初次 (PMR) MR 之间是否可能存在差异。方法和结果我们回顾性评估了 55 名患者在手术过程中在夹子放置前后不久获得的 3D 超声心动图 (3D-TEE) 数据，以了解瓣环直径和面积的变化。测量是使用 QLAB 软件完成的。患者被分类为 SMR (n = 41) 或 PMR (n = 14)。在 SMR 中，我们能够证明环面积（平均 Delta 1.30 +/- 1.44 cm(2)；P < 0.001）、前后 (AP) 直径（平均 Delta 0.28 +/- 0.32 cm；P < 0.001）、隆起面积（平均 Delta 0.39 +/- 0.49 cm(2)；P < 0.001）显着减小。 0.001）。外侧内侧 (LM) 直径没有发现显着变化。相比之下，我们无法证明 PMR 患者的上述任何参数有显着变化。 结论 使用 MitraClip (R) 装置进行经皮治疗可以立即减小 SMR 中的二尖瓣环尺寸，这可能支持手术的成功。它还可以减少隆起，这可能具有预后意义。相反，这些对二尖瓣几何形状的影响无法在 PMR 中得到证明。了解 SMR 和 PMR 之间的差异对于改进程序策略可能很重要。
Aims Percutaneous treatment of mitral regurgitation (MR) has been shown to reduce MR severity and improve functional outcomes. Surgical treatment of MR usually includes mitral annulus reduction. The influence of the MitraClip (R) on annulus geometry is not clear. We wanted to investigate whether the procedure itself reduces annulus diameter and if there may be differences between secondary or functional (SMR) and primary (PMR) MR.Methods and results We retrospectively assessed 3D echocardiography (3D-TEE) data of 55 patients acquired during the procedure shortly before and after clip placement for changes in annulus diameter and area. Measurements were done with QLAB software. Patients were categorized as having either SMR (n = 41) or PMR (n = 14). In SMR, we were able to demonstrate a significant reduction in annulus area (mean Delta 1.30 +/- 1.44 cm(2); P < 0.001), anterior-posterior (AP)-diameter (mean Delta 0.28 +/- 0.32 cm; P < 0.001), tenting area (mean Delta 0.39 +/- 0.49 cm(2); P < 0.001). No significant change could be found for latero-medial (LM)-diameter. In contrast, we could not demonstrate significant changes in any of the parameters described above in patients with PMR.Conclusion Percutaneous treatment with the MitraClip (R) device can produce immediate reductions in mitral annulus size in SMR, probably supporting procedural success. It also reduces tenting, which may have prognostic implications. In contrast, these effects on mitral geometry cannot be demonstrated in PMR. Knowledge of this difference between SMR and PMR may be important to improve procedural strategies.