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Open AccessArticle

Structural and Functional Characteristics of Mitral Paravalvular Leakage Identified by Multimodal Imaging and Their Implication on Clinical Presentation

1
Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea
2
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
3
Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
4
Division of Cardiology, Department of Internal Medicine, Donguk University Gyeongju Hospital, Gyeongju 38067, Korea
5
Department of Cardiothoracic Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
*
Authors to whom correspondence should be addressed.
These authors contributed equally to this work as first authors.
These authors contributed equally to this work as senior authors.
J. Clin. Med. 2021, 10(2), 222; https://doi.org/10.3390/jcm10020222
Received: 19 December 2020 / Revised: 27 December 2020 / Accepted: 7 January 2021 / Published: 10 January 2021
(This article belongs to the Section Cardiology)
Objective: Clinical presentation of patients with mitral paravalvular leakage (PVL) varies from asymptomatic to heart failure related with hemolytic anemia or pulmonary hypertension. We aimed to investigate the structural and functional characteristics of mitral PVL by multimodal imaging and their association with the severity of hemolysis and hemodynamic significance. Methods: A total of 74 patients with mitral PVL who underwent both cardiac computed tomography (CT) and echocardiography from March 2010 to December 2017 was investigated. Location and size of PVL, degree of left atrial (LA) calcification as measured by CT, and hemodynamic variables as measured by echocardiography were comprehensively analyzed. To investigate the degree of hemolysis and pulmonary hypertension, level of lactate dehydrogenase (LDH) and Doppler estimated systolic pulmonary artery pressure (SPAP) were used respectively. Results: Level of LDH was not related to PVL perimeter and was variable, especially in patients with a small PVL. However, it was positively correlated with mean mitral regurgitation velocity. Additionally, SPAP was significantly correlated with PVL perimeter and LA calcium score. In multivariable analysis, mean mitral regurgitation velocity was significantly correlated with levels of LDH (β = 0.345; p = 0.016), and PVL perimeter and LA calcium score were independently associated with SPAP (β = 0.249; p = 0.036 and β = 0.467; p < 0.001, respectively). Conclusions: Characteristics of mitral PVL and adjacent structures are associated with the severity of hemolysis and pulmonary hypertension. Evaluating the structural and functional characteristics of mitral PVL by complementary multimodal imaging would be important for understanding the clinical presentation and deciding optimal treatments for individual patients. View Full-Text
Keywords: mitral paravalvular leakage; hemolysis; pulmonary hypertension; heart failure; multimodal imaging mitral paravalvular leakage; hemolysis; pulmonary hypertension; heart failure; multimodal imaging
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MDPI and ACS Style

Choi, J.Y.; Suh, Y.J.; Seo, J.; Choi, K.-U.; Hong, G.-R.; Lee, S.; Lee, S.-H.; Ha, J.-W.; Kim, Y.J.; Shim, C.Y. Structural and Functional Characteristics of Mitral Paravalvular Leakage Identified by Multimodal Imaging and Their Implication on Clinical Presentation. J. Clin. Med. 2021, 10, 222. https://doi.org/10.3390/jcm10020222

AMA Style

Choi JY, Suh YJ, Seo J, Choi K-U, Hong G-R, Lee S, Lee S-H, Ha J-W, Kim YJ, Shim CY. Structural and Functional Characteristics of Mitral Paravalvular Leakage Identified by Multimodal Imaging and Their Implication on Clinical Presentation. Journal of Clinical Medicine. 2021; 10(2):222. https://doi.org/10.3390/jcm10020222

Chicago/Turabian Style

Choi, Jah Y.; Suh, Young J.; Seo, Jiwon; Choi, Kang-Un; Hong, Geu-Ru; Lee, Sak; Lee, Seung-Hyun; Ha, Jong-Won; Kim, Young J.; Shim, Chi Y. 2021. "Structural and Functional Characteristics of Mitral Paravalvular Leakage Identified by Multimodal Imaging and Their Implication on Clinical Presentation" J. Clin. Med. 10, no. 2: 222. https://doi.org/10.3390/jcm10020222

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