title: A three-dimensional echocardiographic study on aortic-mitral coupling in transcatheter aortic valve replacement.
abstract: OBJECTIVE
  Normal aortic valve (AV) and mitral valve (MV) function in a reciprocal interdependent fashion. We hypothesized that MV function would be affected by severe aortic stenosis (AS) and that it would remain altered after transcatheter AV replacement (TAVR). Using three-dimensional (3D) echocardiography, we studied aortic-mitral coupling in patients with severe AS undergoing TAVR and compared them with controls.
  
  
  RESULTS
  Three-dimensional transoesophageal echocardiography (Philips iE33) was performed on 43 patients: 27 with severe AS studied pre- and post-TAVR and 16 controls. A custom software tracked the aortic annulus (AoA) and mitral annulus (MA), allowing dynamic automated measurements of AoA and MA morphology, angle, and motion. The AS pre-TAVR patients had significantly reduced MA displacement, MA area, and maximum AoA area compared with the controls. Post-TAVR, MA displacement, MA area, and AoA area remained reduced. End-systolic AoA-MA angle was significantly wider in the AS patients compared with the controls and remained wider post-TAVR. Pre-TAVR, there was no difference in MA or AoA dynamics between patients with mild vs. moderate-to-severe MA calcium; Edwards-Sapien vs. a Medtronic CoreValve valve; normal vs. reduced left ventricular systolic function whereas post-TAVR, MA dynamics were significantly reduced in those with moderate-to-severe MA calcium.
  
  
  CONCLUSIONS
  This is the first study to demonstrate that AS can affect a secondary 'unaffected' valve, the MV, due to the calcification in the aortic-mitral fibrous continuity. TAVR does not result in recovery of MV structure. These changes have implications in the future TAVR valve development and the possible need for MV assessment pre- and post-TAVR.
authors.affiliation: University of Chicago Medical Center, 5841 South Maryland Avenue, MC 5084, Chicago, IL 60637, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Tsang
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Meineri
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Hahn
authors.forename: Federico
authors.initials: F
authors.lastname: Veronesi
authors.forename: Atman P
authors.initials: AP
authors.lastname: Shah
authors.forename: Mark
authors.initials: M
authors.lastname: Osten
authors.forename: Sandeep
authors.initials: S
authors.lastname: Nathan
authors.forename: Mark
authors.initials: M
authors.lastname: Russo
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horlick
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D016022:Case-Control Studies; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: aortic stenosis; aortic–mitral coupling; three-dimensional echocardiography; transcatheter aortic valve replacement