Department of Cardiology, Angiology and Intensive Care, Medical Clinic I, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
Sci Rep. 2021 Jun 16;11(1):12700. doi: 10.1038/s41598-021-92255-3.
Percutaneous mitral valve repair (PMVR) requires transseptal puncture and results in iatrogenic atrial septal defect (iASD). The impact of persistent iASD was previously investigated. However, data were diverse and inconclusive. 53 patients who underwent MITRACLIP were retrospectively included. Based on the presence of iASD in transesophageal echocardiography (TEE) after 6 months, patients were divided in two groups (iASD group vs. non-iASD group). Impact of iASD on outcome at 6 months and at two years was evaluated. Persistent iASD was detected in 62% of patients. Independent predictors for persistent iASD were female gender and reduced left ventricular ejection fraction. At 6-month follow-up, there was no difference in reduction of NYHA class (ΔNYHA = 1.3 ± 1 in iASD group vs. 0.9 ± 1 in non-iASD group, p = 0.171). There was a significant difference in right ventricular end diastolic diameter (RVEDd) (42 ± 8 mm in iASD-group vs. 39 ± 4 mm in non-iASD group, p = 0.047). However, right ventricular systolic function (TAPSE) (14 ± 7 mm in iASD group vs. 16 ± 8 mm in non-iASD group, p = 0.176) and right ventricular systolic pressure (RVSP) (40 ± 12 mmHg in iASD group vs. 35 ± 10 mmHg in non-iASD group, p = 0.136) were still comparable between both groups. At 2 years follow-up, there was no significant difference regarding rate of rehospitalization (24% vs 15%, p = 0.425) or mortality (12% vs 10%, p = 0.941) between both groups. Incidence of persistent iASD after MITRACLIP is markedly high. Despite the increase in right ventricular diameter in patients with persistent iASD, these patients were not clinically compromised compared to patients without persistent iASD.
经皮二尖瓣修复术（PMVR）需要经房间隔穿刺，导致医源性房间隔缺损（iASD）。先前已经研究了持续性 iASD 的影响。然而，数据各不相同，结论也不一致。回顾性纳入了 53 名接受 MITRACLIP 治疗的患者。根据 6 个月后经食管超声心动图（TEE）是否存在 iASD，将患者分为两组（iASD 组与非 iASD 组）。评估 iASD 对 6 个月和 2 年时结局的影响。62%的患者存在持续性 iASD。持续性 iASD 的独立预测因素为女性和左心室射血分数降低。在 6 个月随访时，NYHA 分级的降低无差异（iASD 组为 1.3±1，非 iASD 组为 0.9±1，p=0.171）。右心室舒张末期直径（RVEDd）存在显著差异（iASD 组为 42±8mm，非 iASD 组为 39±4mm，p=0.047）。然而，右心室收缩功能（TAPSE）（iASD 组为 14±7mm，非 iASD 组为 16±8mm，p=0.176）和右心室收缩压（RVSP）（iASD 组为 40±12mmHg，非 iASD 组为 35±10mmHg，p=0.136）在两组之间仍相似。2 年随访时，两组再住院率（24% vs 15%，p=0.425）或死亡率（12% vs 10%，p=0.941）均无显著差异。MITRACLIP 后持续性 iASD 的发生率明显较高。尽管持续性 iASD 患者的右心室直径增加，但与无持续性 iASD 的患者相比，这些患者并未出现临床并发症。
