Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
EuroIntervention. 2016 Apr 20;11(13):1554-61. doi: 10.4244/EIJY15M09_09.
Our aim was to evaluate the acute effects of transcatheter edge-to-edge mitral valve repair using the MitraClip device on mitral valve geometry in patients with functional mitral regurgitation (FMR).
Forty-two patients (age 73 years [IQ range 66.1-78.0], 55% men, 62% ischaemic FMR) with moderate-to-severe and severe FMR treated with the MitraClip were included. Three-dimensional transoesophageal echocardiography was performed prior to and immediately after MitraClip implantation. Acute changes of mitral annular and leaflet geometry were assessed with dedicated mitral modelling software. FMR less than moderate grade was achieved in 36 (86%) patients. After MitraClip implantation, the mitral annulus became more elliptical (ellipticity from 122±17% to 129±18%; p=0.04) with a non-significant reduction in anteroposterior diameter (33±6 to 32±5 mm, p=0.08). The coaptation area increased from 350 mm2 (IQ range 289-493 mm2) to 434 mm2 (IQ range 328-523 mm2, p=0.008). In particular, a larger part of the anterior mitral leaflet was included in the coaptation, leaving a smaller exposed anterior leaflet length of the A2 segment (from 27±6 mm to 25±5 mm, p<0.05) while the exposed length of the posterior leaflet (P2 level) remained unchanged (12±4 mm pre- vs. 13±4 mm post-repair, p=0.15). There was no change in total leaflet area (1,811±582 mm2 pre- vs. 1,870±506 mm2 post-repair, p=0.18). Annular height to intercommissural width ratio and tenting volume remained unchanged, suggesting no increase in leaflet stress.
The MitraClip device affects MV geometry in FMR patients by increasing mitral annular ellipticity and coaptation area.
我们旨在评估经导管缘对缘二尖瓣修复术（MitraClip 装置）对功能性二尖瓣反流（FMR）患者二尖瓣几何形状的急性影响。
共纳入 42 例接受 MitraClip 治疗的中重度和重度 FMR 患者（年龄 73 岁[IQ 范围 66.1-78.0]，55%为男性，62%为缺血性 FMR）。在 MitraClip 植入术前和即刻进行三维经食管超声心动图检查。使用专用的二尖瓣建模软件评估二尖瓣环和瓣叶几何形状的急性变化。36 例（86%）患者的 FMR 降至中度以下。MitraClip 植入后，二尖瓣环变得更椭圆（从 122±17%变为 129±18%；p=0.04），前后直径虽略有减小（从 33±6 变为 32±5 mm，p=0.08）。对合面积从 350 mm2（IQ 范围 289-493 mm2）增加至 434 mm2（IQ 范围 328-523 mm2，p=0.008）。特别是，前二尖瓣瓣叶的较大部分被包含在对合中，留下较小的前瓣叶 A2 段暴露长度（从 27±6 变为 25±5 mm，p<0.05），而后瓣叶（P2 水平）的暴露长度保持不变（修复前 12±4 mm 与修复后 13±4 mm，p=0.15）。总瓣叶面积无变化（修复前 1811±582 mm2 与修复后 1870±506 mm2，p=0.18）。瓣环高度与瓣间距离比值和膨出容积保持不变，表明瓣叶应力无增加。
MitraClip 装置通过增加二尖瓣环的椭圆度和对合面积来影响 FMR 患者的 MV 几何形状。
