Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
J Am Soc Echocardiogr. 2021 Jun;34(6):595-603.e2. doi: 10.1016/j.echo.2021.01.018. Epub 2021 Jan 29.
Iatrogenic mitral stenosis is a known limitation of transcatheter edge-to-edge mitral valve repair (TMVr), but determinants of increased postprocedural mean diastolic gradient (MG) are not well defined. The aim of this study was to determine correlates of increased post-TMVr MG or aborted clip implantation due to increased MG.
Procedural three-dimensional transesophageal echocardiographic (TEE) data sets of 112 patients who underwent TMVr were retrospectively analyzed. Three-dimensional TEE mitral valve area (MVA) planimetry and mitral annular calcification (MAC) were quantified using multiplanar reconstruction. When MAC extension into the mitral leaflets was present, MAC with leaflet calcification (MAC-LC) length was recorded as the maximum distance from the mitral annulus to the most distal leaflet calcification. Increased MG after TMVr, measured on intraprocedural TEE imaging, was defined as ≥5 mm Hg or aborted clip implantation due to increased MG.
Baseline MVA was 5.9 ± 1.7 cm, baseline MG was 2.1 ± 1.2 mm Hg, and MAC-LC length was 4.0 ± 4.5 mm. Thirty-two patients (29%) had increased post-TMVr MG. Risk for increased post-TMVr MG was 86%, 28%, and 14% in patients with baseline MVA < 4.0, 4.0 to 6.0, and >6.0 cm, respectively (P < .001). In patients with baseline MVA 4.0 to 6.0 cm, concurrent baseline MG ≥ 4 mm Hg or MAC-LC ≥ 6 mm was associated with higher risk for increased post-TMVr MG (53% vs 12%, P = .002). In patients with baseline MVA < 4.0 and >6.0 cm, the risk for increased post-TMVr MG was similar in the presence or absence of baseline MG ≥ 4 mm Hg or MAC-LC ≥ 6 mm (P > .05 for both).
Patients with baseline three-dimensional TEE MVA < 4.0 cm are at high risk for increased post-TMVr MG. Additionally, patients with borderline MVA (4.0-6.0 cm) and concurrent MAC-LC length ≥ 6 mm or baseline MG ≥ 4 mm Hg are at moderate risk for increased MG after TMVr.
经导管缘对缘二尖瓣修复术（TMVr）后发生医源性二尖瓣狭窄是已知的局限性，但导致术后平均舒张期梯度（MG）增加的决定因素尚未明确。本研究旨在确定与 TMVr 术后 MG 增加或因 MG 增加而导致夹闭器植入失败相关的因素。
回顾性分析了 112 例行 TMVr 的患者的经食管三维超声心动图（TEE）的程序三维数据集。使用多平面重建量化了三维 TEE 二尖瓣瓣口面积（MVA）平面图和二尖瓣环钙化（MAC）。当 MAC 延伸到二尖瓣叶时，记录有瓣叶钙化的 MAC（MAC-LC）长度为从二尖瓣环到最远端瓣叶钙化的最大距离。TMVr 后即刻 TEE 成像上测量的 MG 增加定义为≥5mmHg 或因 MG 增加而导致夹闭器植入失败。
基线 MVA 为 5.9±1.7cm，基线 MG 为 2.1±1.2mmHg，MAC-LC 长度为 4.0±4.5mm。32 名患者（29%）术后 MG 增加。在基线 MVA<4.0cm、4.0cm 至 6.0cm 和>6.0cm 的患者中，TMVr 后 MG 增加的风险分别为 86%、28%和 14%（P<0.001）。在基线 MVA 为 4.0cm 至 6.0cm 的患者中，基线 MG≥4mmHg 或 MAC-LC≥6mm 与 TMVr 后 MG 增加的风险增加相关（53%比 12%，P=0.002）。在基线 MVA<4.0cm 和>6.0cm 的患者中，在基线 MG≥4mmHg 或 MAC-LC≥6mm 存在或不存在的情况下，TMVr 后 MG 增加的风险相似（两者均 P>0.05）。
基线三维 TEE MVA<4.0cm 的患者 TMVr 后发生 MG 增加的风险较高。此外，基线 MVA（4.0cm 至 6.0cm）且同时存在 MAC-LC 长度≥6mm 或基线 MG≥4mmHg 的患者 TMVr 后发生 MG 增加的风险中等。
