title: Non invasive evaluation of cardiomechanics in patients undergoing MitrClip procedure.
abstract: BACKGROUND
  In the last recent years a new percutaneous procedure, the MitraClip, has been validated for the treatment of mitral regurgitation. MitraClip procedure is a promising alternative for patients unsuitable for surgery as it reduces the risk of death related to surgery ensuring a similar result. Few data are present in literature about the variation of hemodynamic parameters and ventricular coupling after Mitraclip implantation.
  
  
  METHODS
  Hemodynamic data of 18 patients enrolled for MitraClip procedure were retrospectively reviewed and analyzed. Echocardiographic measurements were obtained the day before the procedure (T0) and 21 ± 3 days after the procedure (T1), including evaluation of Ejection Fraction, mitral valve regurgitation severity and mechanism, forward Stroke Volume, left atrial volume, estimated systolic pulmonary pressure, non invasive echocardiographic estimation of single beat ventricular elastance (Es(sb)), arterial elastance (Ea) measured as systolic pressure • 0.9/ Stroke Volume, ventricular arterial coupling (Ea/Es(sb) ratio). Data were expressed as median and interquartile range. Measures obtained before and after the procedure were compared using Wilcoxon non parametric test for paired samples.
  
  
  RESULTS
  Mitraclip procedure was effective in reducing regurgitation. We observed an amelioration of echocardiographic parameters with a reduction of estimated systolic pulmonary pressure (45 to 37,5 p = 0,0002) and left atrial volume (110 to 93 p = 0,0001). Despite a few cases decreasing in ejection fraction (37 to 35 p = 0,035), the maintained ventricular arterial coupling after the procedure (P = 0,67) was associated with an increasing in forward stroke volume (60,3 to 78 p = 0,05).
  
  
  CONCLUSIONS
  MitraClip is effective in reducing mitral valve regurgitation and determines an amelioration of hemodynamic parameters with preservation of ventricular arterial coupling.
authors: Department of Cardiothoracic Anesthesia and Intensive Care Medicine, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56123, Italy. fabiodoc64@hotmail.com
authors: Fabio
authors: F
authors: Guarracino
authors: Baldassare
authors: B
authors: Ferro
authors: Rubia
authors: R
authors: Baldassarri
authors: Pietro
authors: P
authors: Bertini
authors: Francesco
authors: F
authors: Forfori
authors: Cristina
authors: C
authors: Giannini
authors: Vitantonio
authors: V
authors: Di Bello
authors: Anna S
authors: AS
authors: Petronio
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D057234:Preoperative Period; D011446:Prospective Studies; D011474:Prosthesis Design; D015203:Reproducibility of Results; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology*
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