Itabashi Yuji, Utsunomiya Hiroto, Kubo Shunsuke, Mizutani Yukiko, Mihara Hirotsugu, Murata Mitsushige, Siegel Robert J, Kar Saibal, Fukuda Keiichi, Shiota Takahiro
Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
J Cardiol. 2018 Apr;71(4):336-345. doi: 10.1016/j.jjcc.2017.10.023. Epub 2017 Dec 6.
Postprocedural mitral stenosis (MS) is a main limitation for MitraClip™ (Abbot Vascular, Inc., Santa Clara, CA, USA) procedure. The purpose of this study was to detect the preprocedural predictors of high transmitral pressure gradient (TMPG) after MitraClip™ implantation, which indicated postprocedural mitral stenosis (MS).
We studied 79 patients who were implanted with MitraClip™ in our institute. Before the procedure, mitral valve orifice area (MVOA), and anterior-posterior (AP) and medial-lateral (ML) mitral annular diameters were measured at diastole using three-dimensional (3D) transesophageal echocardiography (TEE) data set. After the procedure, the mean TMPG was assessed using continuous-wave (CW) Doppler by periprocedural TEE.
Preprocedural MVOA, and AP and ML diameter of left ventricular (LV) inflow orifices were larger in patients with mean TMPG ≤4mmHg than in patients with TMPG >4mmHg after 1-and 2-clip implantation. The large MVOA and ML diameter of LV inflow orifice strongly correlated with the low TMPG after 1- and 2-clip implantation. As a result of the receiver operating characteristic curve analysis, the preprocedural MVOA predicted the low postprocedural TMPG more accurately than the ML diameter of LV inflow orifice after 1-clip implantation either in the degenerative or functional mitral regurgitation (MR) patients. After 2-clip implantation, however, the preprocedural ML diameter of LV inflow orifice predicted it more accurately than the MVOA in the degenerative and functional MR patients.
3D TEE derived MVOA predicts the postprocedural MS after 1-clip implantation, however, preprocedural ML diameter of LV inflow orifice is more useful to predict after 2-clip implantation.
二尖瓣夹合术（MitraClip™，美国加利福尼亚州圣克拉拉市雅培血管公司）术后二尖瓣狭窄（MS）是该手术的主要限制因素。本研究的目的是检测二尖瓣夹合术（MitraClip™）植入术后高跨二尖瓣压力阶差（TMPG）的术前预测因素，高跨二尖瓣压力阶差提示术后二尖瓣狭窄（MS）。
我们研究了在我院接受二尖瓣夹合术（MitraClip™）的79例患者。术前，使用三维（3D）经食管超声心动图（TEE）数据集在舒张期测量二尖瓣口面积（MVOA）以及二尖瓣前后（AP）和内外（ML）瓣环直径。术后，通过围手术期TEE使用连续波（CW）多普勒评估平均TMPG。
在植入1枚和2枚夹子后，平均TMPG≤4mmHg的患者术前MVOA以及左心室（LV）流入道开口的AP和ML直径大于TMPG>4mmHg的患者。LV流入道开口的大MVOA和ML直径与植入1枚和2枚夹子后的低TMPG密切相关。经受试者工作特征曲线分析，在退行性或功能性二尖瓣反流（MR）患者中，植入1枚夹子后，术前MVOA比LV流入道开口的ML直径更准确地预测术后低TMPG。然而，植入2枚夹子后，在退行性和功能性MR患者中，LV流入道开口的术前ML直径比MVOA更准确地预测术后低TMPG。
3D TEE得出的MVOA可预测植入1枚夹子后的术后MS，然而，LV流入道开口的术前ML直径在植入2枚夹子后更有助于预测。
