Heart Valve Center, NYU Langone Health, New York, New York, USA.
Heart Valve Center, NYU Langone Health, New York, New York, USA.
JACC Cardiovasc Interv. 2021 Oct 25;14(20):2215-2227. doi: 10.1016/j.jcin.2021.06.030. Epub 2021 Sep 29.
The aim of this study was to clarify the dynamics of the mitral annulus throughout the cardiac cycle and its relevance to transcatheter mitral valve replacement (TMVR) sizing and case selection.
Limited data are available regarding the relevance of mitral annular (MA) and neo-left ventricular outflow tract (LVOT) dynamics in the overall population presenting with significant mitral valve disease.
Patients attending a combined surgical-transcatheter heart valve clinic for severe symptomatic mitral valve disease were assessed using multiphase computed tomography. The relative influence of MA and neo-LVOT dynamics to TMVR case selection was studied.
A total of 476 patients with significant mitral valve disease were evaluated. In 99 consecutive patients with severe mitral regurgitation, a 10-phase assessment showed that the mitral annulus was on average largest in late systole. On comparing maximal MA dimension with late systolic dimension, TMVR size assignment changed in 24.2% of patients. If the average MA perimeter was used to determine sizing, 48.5% were excluded because of MA dimension being too large; in a multiphase assessment of the neo-LVOT, an additional 16.2% were excluded on the basis of neo-LVOT dimension. In an expanded series of 312 consecutive patients, selection protocol influenced anatomical exclusion: a manufacturer-proposed early systolic approach excluded 69.2% of patients, whereas a late systolic approach excluded 82.7% of patients, the vast majority because of large mitral annuli.
Contemporary TMVR can treat only a minority of patients with severe mitral regurgitation, principally because of limitations of large MA dimension.
本研究旨在阐明整个心动周期二尖瓣环的动力学及其与经导管二尖瓣置换术（TMVR）的大小选择和病例选择的相关性。
关于在患有严重二尖瓣疾病的人群中，二尖瓣环（MA）和新左心室流出道（LVOT）动力学的相关性，相关数据有限。
对因严重症状性二尖瓣疾病而参加联合外科经导管心脏瓣膜诊所的患者进行多相位计算机断层扫描评估。研究了 MA 和新 LVOT 动力学对 TMVR 病例选择的相对影响。
共评估了 476 例患有严重二尖瓣疾病的患者。在 99 例连续的严重二尖瓣反流患者中，10 相评估显示二尖瓣环平均在收缩晚期最大。将最大 MA 直径与收缩晚期直径进行比较，24.2%的患者 TMVR 大小分配发生变化。如果使用 MA 平均周长来确定大小，则 48.5%的患者因 MA 尺寸过大而被排除在外；在新 LVOT 的多相评估中，根据新 LVOT 尺寸，另外 16.2%的患者被排除在外。在 312 例连续患者的扩展系列中，选择方案影响解剖排除：制造商提出的早期收缩方法排除了 69.2%的患者，而晚期收缩方法排除了 82.7%的患者，绝大多数是因为 MA 过大。
当代 TMVR 只能治疗少数严重二尖瓣反流患者，主要是因为 MA 尺寸过大的限制。
