title: Immediate effect of the MitraClip procedure on mitral ring geometry in primary and secondary mitral regurgitation.
abstract: OBJECTIVE
  Percutaneous treatment of mitral regurgitation (MR) has been shown to reduce MR severity and improve functional outcomes. Surgical treatment of MR usually includes mitral annulus reduction. The influence of the MitraClip on annulus geometry is not clear. We wanted to investigate whether the procedure itself reduces annulus diameter and if there may be differences between secondary or functional (SMR) and primary (PMR) MR.
  
  
  RESULTS
  We retrospectively assessed 3D echocardiography (3D-TEE) data of 55 patients acquired during the procedure shortly before and after clip placement for changes in annulus diameter and area. Measurements were done with QLAB software. Patients were categorized as having either SMR (n = 41) or PMR (n = 14). In SMR, we were able to demonstrate a significant reduction in annulus area (meanΔ 1.30 ± 1.44 cm2; P < 0.001), anterior-posterior (AP)-diameter (meanΔ 0.28 ± 0.32 cm; P < 0.001), tenting area (meanΔ 0.39 ± 0.49 cm2; P < 0.001). No significant change could be found for latero-medial (LM)-diameter. In contrast, we could not demonstrate significant changes in any of the parameters described above in patients with PMR.
  
  
  CONCLUSIONS
  Percutaneous treatment with the MitraClip device can produce immediate reductions in mitral annulus size in SMR, probably supporting procedural success. It also reduces tenting, which may have prognostic implications. In contrast, these effects on mitral geometry cannot be demonstrated in PMR. Knowledge of this difference between SMR and PMR may be important to improve procedural strategies.
authors.affiliation: Department of Medicine II, University Medical Center of Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz 55131, Germany. frank.schmidt@unimedizin-mainz.de
authors.forename: Frank Patrick
authors.initials: FP
authors.lastname: Schmidt
authors.forename: Ralph Stephan
authors.initials: RS
authors.lastname: von Bardeleben
authors.forename: Philipp
authors.initials: P
authors.lastname: Nikolai
authors.forename: Alexander
authors.initials: A
authors.lastname: Jabs
authors.forename: Nina
authors.initials: N
authors.lastname: Wunderlich
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hink
authors.forename: Ascan
authors.initials: A
authors.lastname: Warnholtz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D012984:Software; D016896:Treatment Outcome
keywords: 3D echocardiography; MitraClip®; Mitral regurgitation; Mitral valve geometry