Comparison of mitral valve geometrical effect of percutaneous edge-to-edge repair between central and eccentric functional mitral regurgitation: clinical implications
Comparison of mitral valve geometrical effect of percutaneous edge-to-edge repair between central and eccentric functional mitral regurgitation: clinical implications
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经皮边对边修复术对中心型和偏心型功能性二尖瓣反流的二尖瓣几何效果比较：临床意义
DOI：
10.1093/ehjci/jey117
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Shiota Takahiro
中科院分区：
文献类型：
--
作者：
Utsunomiya Hiroto;Itabashi Yuji;Kobayashi Sayuki;Yoshida Jun;Ikenaga Hiroki;Rader Florian;Hussaini Asma;Makar Moody;Trento Alfredo;Siegel Robert J;Kar Saibal;Shiota Takahiro
目的经皮缘对缘修复术改变功能性二尖瓣返流（FMR）中二尖瓣（MV）的几何形状。我们试图表征MV形态与中央和偏心FMR患者，比较几何效应的二尖瓣夹系统治疗，并阐明不同的MR改善机制，根据FMR subtypes.Methods和resultsSeventy-six级症状性患者3至4+ FMR（中央，n= 39;偏心，n= 37）进行三维经食管超声心动图在二尖瓣夹系统植入术。我们将手术成功定义为二尖瓣返流减少≥1级，残余二尖瓣返流（MR）≤ 2+级。中心和偏心FMR的手术成功率相似（77% vs. 78%，P =0.55）。二尖瓣夹系统术后，FMR亚型之间前后径的减小没有差异，但偏心性FMR患者的平均栓系角差减小更大（P<0.001），帐篷体积和高度减小更小（均P <0.001）。在多变量分析中，在中央FMR中，二尖瓣夹术后二尖瓣返流减少与前后径缩短[系数0.388，95%置信区间（CI）0.216-0.561;P<0.001]和接合面积增加相关（系数0.117，95%CI 0.039-0.194;P=0.004），而偏心FMR的MR减少主要与平均栓系角差的减少相关（系数0.050，95%CI 0.021-0.078;P=0.001）结论二尖瓣几何效应及其与二尖瓣返流改善的相关性因FMR亚型而异。我们的研究结果表明，MR射流方向和瓣叶系留模式可以考虑在FMR的经皮治疗策略。
AimsPercutaneous edge-to-edge repair alters mitral valve (MV) geometry in functional mitral regurgitation (FMR). We sought to characterize MV morphology in patients with central and eccentric FMR, compare the geometrical effect of MitraClip therapy, and elucidate different mechanisms of MR improvement according to FMR subtypes.Methods and resultsSeventy-six symptomatic patients with Grade 3 to 4+ FMR (central,n= 39; eccentric,n= 37) underwent three-dimensional transoesophageal echocardiography during MitraClip implantation. We defined procedural success as a reduction of MR by ≥1 grade with having a residual mitral regurgitation (MR) of ≤ grade 2+. Procedural success rate was similar between central and eccentric FMR (77% vs. 78%,P=0.55). After MitraClip, the reduction in anterior-posterior diameter did not differ between FMR subtypes, but patients with eccentric FMR had a greater reduction in the averaged tethering angle difference (P<0.001) with less reduction in tenting volume and height (bothP<0.001) than did patients with central FMR. On multivariable analysis, in central FMR, MR reduction post-clip was associated with shortening in anterior-posterior diameter [coefficient 0.388, 95% confidence interval (CI) 0.216–0.561;P<0.001] and an increase in coaptation area (coefficient 0.117, 95% CI 0.039–0.194;P=0.004), whereas in eccentric FMR MR reduction was mainly associated with a decrease in the averaged tethering angle difference (coefficient 0.050, 95% CI 0.021–0.078;P=0.001).ConclusionMV geometrical effect and its association with MR improvement after MitraClip therapy differ according to FMR subtypes. Our results indicate the MR jet direction and the leaflet tethering pattern may be considered in the strategy for percutaneous treatment for FMR.
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影响因子：
6.2
作者：
Schmidt, Frank Patrick;von Bardeleben, Ralph Stephan;Warnholtz, Ascan
通讯作者：
Warnholtz, Ascan
影响因子：
39.3
作者：
Puls M;Lubos E;Boekstegers P;von Bardeleben RS;Ouarrak T;Butter C;Zuern CS;Bekeredjian R;Sievert H;Nickenig G;Eggebrecht H;Senges J;Schillinger W
通讯作者：
Schillinger W
缺血性二尖瓣反流的不对称与对称栓系模式：三维经食管超声心动图的几何差异。
DOI：
10.1016/j.echo.2014.01.006
发表时间：
2014
期刊：
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
影响因子：
--
作者：
Zeng,Xin;Nunes,MariaCarmoP;Dent,John;Gillam,Linda;Mathew,JosephP;Gammie,JamesS;Ascheim,DeborahD;Moquete,Ellen;Hung,Judy
通讯作者：
Hung,Judy
DOI：
10.1016/j.echo.2014.10.003
发表时间：
2015-01-01
影响因子：
6.5
作者：
Lang, Roberto M.;Badano, Luigi P.;Voigt, Jens-Uwe
通讯作者：
Voigt, Jens-Uwe
DOI：
10.1016/j.euje.2004.03.001
发表时间：
2004-10-01
期刊：
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology
影响因子：
--
作者：
Agricola, Eustachio;Oppizzi, Michele;Alfieri, Ottavio
通讯作者：
Alfieri, Ottavio