title: Analysis of procedural effects of percutaneous edge-to-edge mitral valve repair by 2D and 3D echocardiography.
abstract: BACKGROUND
  Analysis of procedural effects in patients undergoing percutaneous mitral valve repair (PMVR) using the edge-to-edge technique is complex, and common methods to define mitral regurgitation severity based on 2-dimensional (2D) echocardiography are not validated for postprocedural double-orifice mitral valve. This study used 3D transesophageal echocardiography (TEE) to determine the functional and morphological effects of PMVR.
  
  
  RESULTS
  In 39 high-risk surgical patients with moderate to severe functional mitral valve regurgitation, 3D TEE with and without color Doppler as well as 2D transthoracic and TEE was performed before and after PMVR (MitraClip device). Mitral valve regurgitant volume by color Doppler 3D TEE was determined as the product of vena contracta areas defined by direct planimetry and velocity time integral using continuous-wave Doppler. Regurgitant volume was reduced from 84.1±38.3 mL preintervention to 35.6±25.6 mL postintervention. Patients in whom vena contracta area could be reduced >50% had a smaller preprocedural mitral annulus area compared with patients with ≤50% reduction (11.9±3.9 versus 16.1±8.5 cm(2), respectively; P=0.036) and tended to have a smaller mitral annulus circumference (13.0±2.0 versus 14.8±4.1 cm, respectively; P=0.112). At 6 months follow-up, left atrial and left ventricular end-diastolic volumes were significantly more reduced in patients in whom regurgitant vena contracta area was reduced by >50% compared with those with less reduction (-11.4±5.2 versus -4.8±7.7%; P=0.005, and -11.0±7.2 versus -4.5±9.3%; P=0.028). The maximum diastolic mitral valve area decreased from 6.0±2.0 to 2.9±0.9 cm(2) (P<0.0001).
  
  
  CONCLUSIONS
  Three dimensional TEE demonstrates significant reduction of regurgitant volume after PMVR. The unique visualization of the mitral valve by 3D TEE allows improved understanding of the morphological and functional changes induced by PMVR.
authors.affiliation: Department of Cardiology, Pneumology, Angiology, Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Ertunc
authors.initials: E
authors.lastname: Altiok
authors.forename: Sandra
authors.initials: S
authors.lastname: Hamada
authors.forename: Kathrin
authors.initials: K
authors.lastname: Brehmer
authors.forename: Kathrin
authors.initials: K
authors.lastname: Kuhr
authors.forename: Sebastian
authors.initials: S
authors.lastname: Reith
authors.forename: Michael
authors.initials: M
authors.lastname: Becker
authors.forename: Jörg
authors.initials: J
authors.lastname: Schröder
authors.forename: Mohammad
authors.initials: M
authors.lastname: Almalla
authors.forename: Walter
authors.initials: W
authors.lastname: Lehmacher
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D009200:Myocardial Contraction / Q000502:physiology; D015203:Reproducibility of Results; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*