title: Change in mitral annular size and geometry after MitraClip® implantation in patients with functional and degenerative mitral regurgitation.
abstract: BACKGROUND
  MitraClip® therapy is an alternative to conventional surgery. The aim was to characterize the mitral annular geometry pre- and postrepair with the MitraClip® taking into account the regurgitation mechanism.
  
  
  METHODS
  We retrospectively collected pre- and postprocedural transesophageal echocardiography data in 46 patients. Patients were categorized as having isolated degenerative (DMR, n = 18), isolated functional (FMR, n = 9) or a combination of both functional and degenerative mitral regurgitation (MMR, n = 19).
  
  
  RESULTS
  A significant reduction in septolateral (SL) diameters in all patients occurred. Noteworthy, in those with DMR, there was no significant change in intercommissural (IC) diameters whereas in those with FMR and MMR, it increased significantly in systole (FMR: +2.8 ± 3.4 mm, P = 0.03, MMR: +2.1 ± 2.6 mm, P = 0.002). In DMR, a significant reduction in mitral annular areas post-procedure was observed (-1.8 ± 2.3 cm(2), P = 0.001 in diast., -0.8 ± 1.0 cm(2), P = 0.004 in syst.). In patients with FMR and MMR, though the SL diameter decreased, this occurred at the expense of an increase in IC diameter causing a change in annular shape but leaving the annular area unchanged. Nevertheless, a comparable reduction in regurgitant severity (DMR: P = <0.001; FMR: P = 0.003; MMR: P = <0.001) and improvement in functional class occurred regardless of regurgitant mechanism.
  
  
  CONCLUSIONS
  Though changes in mitral annular geometry after MitraClip® repair differ depending on regurgitant mechanism, this does not appear to have an impact on residual regurgitation or clinical status in the short-term.
authors.affiliation: CardioVascular Center CVC Frankfurt, Frankfurt, Germany.
authors.forename: Talea
authors.initials: T
authors.lastname: Remy
authors.forename: Stefan C
authors.initials: SC
authors.lastname: Bertog
authors.forename: Nina
authors.initials: N
authors.lastname: Wunderlich
authors.forename: Laura
authors.initials: L
authors.lastname: Vaskelyte
authors.forename: Ilona
authors.initials: I
authors.lastname: Hofmann
authors.forename: Sameer
authors.initials: S
authors.lastname: Gafoor
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058385:Cardiac Valve Annuloplasty / Q000295:instrumentation*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D012189:Retrospective Studies