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Mitral and Aortic Valve Repair and Replacement: Yesterday, Today, and Tomorrow

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 17944

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Prof. Dr. Johannes M. Albes

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Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School “Theodor Fontane”, Neuruppin, Germany
Interests: heart valve repair and replacement; aortic surgery; endovascular prosthesis; myocyte function; valve hemodynamics; development of new valve types and repair strategies and devices
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Dear Colleagues,

Since Hufnagel implanted the first heart valve into the descending aorta in 1952 and Gibbon developed the heart-lung machine soon thereafter, valve replacement and repair have significantly improved. Mechanical and biological prostheses were developed, while repair strategies for the mitral valve were invented in parallel. A steady evolutionary process ensued, resulting in robust, reliable, biological and mechanical prostheses that have been implanted by millions worldwide. Mitral valve repair became a viable option for insufficient valves, and somewhat later in the late 1980s, repair strategies were even developed for the aortic valve. Despite all efforts, the surgical burden remained, especially putting the most vulnerable patients, the elderly and frail, at risk. Despite the continuous improvement in reducing this burden through facilitated implantation techniques and minimally invasive approaches, it always remained. Then, two crucial changes occurred: surgical repair and replacement strategies were challenged by the emerging expandable transcatheter valves (TAVI) and the interventional mitral valve edge-to-edge repair, the MitraClip, both of which entered the market in the mid-2010s and were so successful that their worldwide prevalence rapidly increased, driven by demographic change and the resulting sharp increase in patient demand. The particular success of the TAVI procedure has led to a steady decline in the number of surgically implanted aortic valves over the last 20 years. The MitraClip was somewhat less successful in terms of substituting surgical mitral valve repair due to the more palliative nature of this procedure. Although the indications for both procedures were significantly expanded to include intermediate-risk, and later, even low-risk groups for TAVI, and almost all elderly patients were anatomically eligible for MitraClip. It then became clear that a significant proportion of patients still required surgical valve replacement and especially repair. This Special Issue addresses the current state of the art in valve repair and replacement, looking to the future but also highlighting the many obstacles we currently face in selecting and providing the best option for our patients.

Prof. Dr. Johannes M. Albes
Guest Editor

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Keywords

aortic valve
mitral valve
valve repair
valve replacement
TAVI
MitraClip
endocarditis

Published Papers (10 papers)

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11 pages, 657 KiB

Open AccessArticle

An Analysis of Early Results after Valve Replacement in Isolated Aortic Valve Stenosis by Using Sutureless vs. Stented Bioprostheses: A Single-Center Middle-Income Country Experience

by Marko Kaitovic, Slobodan Micovic, Ivan Nesic, Tatjana Raickovic, Jelena Dotlic, Ivan Stojanovic and Tatjana Gazibara

Medicina 2023, 59(6), 1032; https://doi.org/10.3390/medicina59061032 - 26 May 2023

Viewed by 1154

Abstract

Background and Objectives: There is a lack of data about the survival of patients after the implantation of sutureless relative to stented bioprostheses in middle-income settings. The objective of this study was to compare the survival of people with isolated severe aortic stenosis after the implantation of sutureless and stented bioprostheses in a tertiary referral center in Serbia. Materials and Methods: This retrospective cohort study included all people treated for isolated severe aortic stenosis with sutureless and stented bioprostheses from 1 January 2018 to 1 July 2021 at the Institute for Cardiovascular Diseases “Dedinje”. Demographic, clinical, perioperative and postoperative data were extracted from the medical records. The follow-up lasted for a median of 2 years. Results: The study sample comprised a total of 238 people with a stented (conventional) bioprosthesis and 101 people with a sutureless bioprosthesis (Perceval). Over the follow-up, 13.9% of people who received the conventional and 10.9% of people who received the Perceval valve died (p = 0.400). No difference in the overall survival was observed (p = 0.797). The multivariate Cox proportional hazard model suggested that being older, having a higher preoperative EuroScore II, having a stroke over the follow-up period and having valve-related complications were independently associated with all-cause mortality over a median of 2 years after the bioprosthesis implantation. Conclusions: This research conducted in a middle-income country supports previous findings in high-income countries regarding the survival of people with sutureless and stented valves. Survival after bioprosthesis implantation should be monitored long-term to ensure optimum postoperative outcomes. Full article

(This article belongs to the Special Issue Mitral and Aortic Valve Repair and Replacement: Yesterday, Today, and Tomorrow)

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9 pages, 1319 KiB

Open AccessArticle

Simple and Safe: Inverse Plication of the Posterior Mitral Leaflet in Everyday Mitral Valve Reconstruction with and without Concomitant Procedures

by Roya Ostovar, Farnoosh Motazedian, Martin Hartrumpf, Filip Schröter and Johannes Maximilian Albes

Medicina 2023, 59(2), 218; https://doi.org/10.3390/medicina59020218 - 23 Jan 2023

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Abstract

Objective: Cardiosurgical mitral valve repair (MVR) cannot be easily replaced by other interventional procedures due to the complexity of mitral valve regurgitation as well as physiologic and anatomic repair techniques. A wide variety of techniques have been adopted for proper reconstruction of posterior leaflet prolapse. We investigated the long-term results of quadrangular resections and compared them with a simplified reconstruction maneuver, the inverse plication. Methods: We retrospectively collected data from 1977 patients after mitral valve repair between 2004 and 2022. After considering inclusion and exclusion criteria, we analyzed data from 180 patients after MVR with and without concomitant procedures such as CABG and/or aortic valve replacement (AVR). All MVRs were performed with a semi-rigid annuloplasty ring. A total of 180 patients received quadrangular resection (QuadRes, N = 120)) or inverse plication (InvPlic, N = 60) of the posterior leaflet, among other measures. Demographic data, risk factors, procedure times, hospitalization time, early and long-term mortality as well as Kaplan–Meier survival were analyzed. Results: Age (65.3 vs. 63.1 years) and sex (28.8% female vs. 337.5% female) did not differ significantly, and the EuroSCORE was significantly higher in the InvPlic group (6.46 ± 2.75) than in the QuadRes group (5.68 ± 3.1). Procedural times did not differ for cardiopulmonary bypass, and were as follows: InvPlic 136 ± 44 min; QuadRes 140 ± 48 min; X-Clamp: InvPlic 91 ± 31 min; QuadRes 90 ± 32 min. Hospitalization time was slightly but insignificantly lower in the InvPlic group (15.5 days) than in the QuadRes group (16.1 days). Early mortality (5.08% vs. 8.33%) and re-do procedures (1.69% InvPlic; 6.67% QuadRes) did not differ significantly. However, long-term mortality was significantly lower in the InvPlic group (15.25% vs. 32.32%, p = 0.029). Conclusions: Among the surgical measures for the posterior leaflet, inverse plication appears to be non-inferior to quadrangular resection in unselected all-comer patients. Long-term results and absence of re-do procedures indicate very good stability. Thus, inverse plication not only allows correction of PML, but is also completely safe in the long term and can replace quadrangular resection, especially in patients where a reduction in technical challenges and procedure duration is desired. Full article

(This article belongs to the Special Issue Mitral and Aortic Valve Repair and Replacement: Yesterday, Today, and Tomorrow)

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14 pages, 3873 KiB

Open AccessArticle

Safety and Efficacy of the Transaxillary Access for Minimally Invasive Mitral Valve Surgery—A Propensity Matched Competitive Analysis

by Ali Taghizadeh-Waghefi, Sebastian Arzt, Veronica De Angelis, Jana Schiffarth, Asen Petrov, Matuš Tomko, Konstantin Alexiou, Klaus Matschke, Utz Kappert and Manuel Wilbring

Medicina 2022, 58(12), 1850; https://doi.org/10.3390/medicina58121850 - 15 Dec 2022

Cited by 3 | Viewed by 2574

Abstract

Background and Objectives: Transaxillary access is a straightforward “single incision—direct vision” concept, based on a 5 cm skin incision in the right anterior axillary line. It is suitable for aortic, mitral and tricuspid surgery. The present study evaluates the hospital outcomes of the transaxillary access for isolated mitral valve surgery compared with full sternotomy. Patients and Methods: The final study group included 480 patients. A total of 160 consecutive transaxillary patients served as treatment group (MICS-MITRAL). Based on a multivariate logistic regression model including age, sex, body-mass-index, EuroScore II and LVEF, a 1:2 propensity matched control-group (n = 320) was generated out of 980 consecutive sternotomy patients. Redo surgeries, endocarditis or combined procedures were excluded. The mean age was 66.6 ± 10.6 years, 48.6% (n = 234) were female. EuroSCORE II averaged 1.98 ± 1.4%. Results: MICS-MITRAL had longer perfusion (88.7 ± 26.6 min vs. 68.7 ± 32.7 min; p < 0.01) and cross-clamp (64.4 ± 22.3 min vs. 49.7 ± 22.4 min; p < 0.01) times. This did not translate into longer procedure times (132 ± 31 min vs. 131 ± 46 min; p = 0.76). Both groups showed low rates of failed repair (MICS-MITRAL: n = 6/160; 3.75%; Sternotomy: n = 10/320; 3.1%; p = 0.31). MICS-MITRAL had lower transfusion rates (p ≤ 0.001), less re-exploration for bleeding (p = 0.04), shorter ventilation times (p = 0.02), shorter ICU-stay (p = 0.05), less postoperative hemofiltration (p < 0.01) compared to sternotomy patients. No difference was seen in the incidence of stroke (p = 0.47) and postoperative delirium (p = 0.89). Hospital mortality was significantly lower in MICS-MITRAL patients (0.0% vs. 3.4%; p = 0.02). Conclusions: The transaxillary access for MICS-MITRAL provides superior cosmetics and excellent clinical outcomes. It can be performed at least as safely and in the same time frame as conventional mitral surgery by sternotomy. Full article

(This article belongs to the Special Issue Mitral and Aortic Valve Repair and Replacement: Yesterday, Today, and Tomorrow)

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14 pages, 1479 KiB

Open AccessArticle

Diastolic versus Systolic Left Ventricular Dysfunction as Independent Predictors for Unfavorable Postoperative Evolution in Patients with Aortic Regurgitation Undergoing Aortic Valve Replacement

by Luminita Iliuta, Andreea Gabriella Andronesi, Camelia Cristina Diaconu, Horatiu Moldovan, Marius Rac-Albu and Madalina-Elena Rac-Albu

Medicina 2022, 58(11), 1676; https://doi.org/10.3390/medicina58111676 - 19 Nov 2022

Cited by 9 | Viewed by 1703

Abstract

Background and Objectives: Chronic severe aortic valve disease is associated with important changes in left ventricle (LV) performance associated with eccentric or concentric LV hypertrophy. We aimed to assess the immediate prognostic implications of the type of the LV diastolic filling pattern (LVDFP) compared with LV systolic performance in patients with severe aortic regurgitation (AR) undergoing aortic valve replacement (AVR) and to define the independent echographic predictors for the immediate and long-term prognoses. Materials and Methods: We performed a prospective study enrolling 332 AR patients undergoing AVR, divided into two groups: Group A—201 pts with normal LV systolic function, divided into two subgroups (A1: 129 pts with a nonrestrictive LVDFP and A2: 72 pts with restrictive LVDFP), and Group B—131 pts with LV systolic dysfunction (LV ejection fraction LVEF < 50%), divided into two subgroups (B1: 83 pts with a nonrestrictive LVDFP and B2: 48 pts with restrictive LVDFP). Results: The early postoperative mortality rate was higher in patients with a restrictive LVDFP (11.12% in A2 and 12.5% in B2) compared with normal LV filling (2.32% in A1 and 7.63% in B1, p < 0.0001), regardless of the LVEF. The restrictive LVDFP—defined by at least one of the following echographic parameters: an E/A > 2 with an E wave deceleration time (EDt) < 100 ms; an isovolumetric relaxation time (IVRT) < 60 ms; or an S/D ratio < 1 in the pulmonary vein flow—was an independent predictor for early postoperative mortality, increasing the relative risk by 8.2-fold. Other independent factors associated with early poor prognosis were an LV end-systolic diameter (LVESD) > 58 mm, an age > 75 years, and the presence of comorbidities (chronic obstructive pulmonary disease-COPD or diabetes mellitus). On a medium-term, an unfavorable evolution was associated with: an age > 75 years (RR = 8.1), an LV end-systolic volume (LVESV) > 95 cm³ (RR = 6.7), a restrictive LVDFP (RR = 9.8, p < 0.0002), and pulmonary hypertension (RR = 8.2). Conclusions: The presence of a restrictive LVDFP in patients with AR undergoing AVR is associated with both increased early and medium-term mortality rates. The LV diastolic function is a more reliable parameter for prognosis than LV systolic performance (RR 9.2 versus 2.1). Other independent predictors for increased early postoperative mortality rate were: an age > 75 years, an LVESD > 58 mm, and comorbidities (diabetes mellitus, COPD), and for unfavorable evolution at 2 years postoperatively: an age > 75 years, an LVESV > 95 cm³, and severe pulmonary hypertension. Full article

(This article belongs to the Special Issue Mitral and Aortic Valve Repair and Replacement: Yesterday, Today, and Tomorrow)

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14 pages, 1237 KiB

Open AccessArticle

Additional Prognostic Value of Tissue Doppler Evaluation in Patients with Aortic Stenosis and Left-Ventricular Systolic Dysfunction Undergoing Aortic Valve Replacement

by Luminita Iliuta, Andreea Gabriella Andronesi, Camelia Cristina Diaconu, Eugenia Panaitescu and Georgiana Camburu

Medicina 2022, 58(10), 1410; https://doi.org/10.3390/medicina58101410 - 7 Oct 2022

Cited by 6 | Viewed by 2139

Abstract

Background and Objectives: Patients with surgical aortic stenosis (AS) show impaired diastolic filling, which is a risk factor for early and late mortality after aortic valve replacement (AVR). There is a paucity of information concerning the impact of restrictive diastolic filling and the evolution of diastolic dysfunction in the early and medium terms post-AVR. We aimed to determine the prognostic value of the presence of a restrictive left-ventricular (LV) diastolic filling pattern (LVDFP) and dilated left atrium (LA) in patients with AS and LV systolic dysfunction (LVEF < 40%) who underwent AVR, and to define the independent predictors for immediate and long-term prognosis and their value for preoperative risk estimation. Materials and Methods: The study was prospective and included 197 patients with surgical AS and LVEF <40% who underwent AVR. Preoperative echocardiographic examinations were repeated at day 10, at 1, 3 and 6 months, and at 1 and 2 years after surgery, with evaluation of LVEF, diastolic function and LA dimension index (mm/m²). Depending on LV systolic performance, patients were classified as Group A (LVEF: 30–40%) or Group B (LVEF < 30%). Results: The main echographic independent parameters for early and late postoperative death were: restrictive LVDFP, significant pulmonary hypertension, LV end-systolic diameter (LVESD) >55 mm and the presence of second-degree mitral regurgitation. Restrictive LVDFP and LA dimension >30 mm/m² were independent predictors for fatal outcome (p = 0.0017). Conclusions: Assessment of diastolic function and LA dimension are reliable parameters in predicting fatal outcome and hospitalization for heart failure, having an independent and incremental prognostic value in patients with surgical AS. Complete evaluation of LVDFP with all the echographic measurements (including TDI) should routinely be part of the preoperative assessment of patients with LV systolic dysfunction undergoing AVR. Full article

(This article belongs to the Special Issue Mitral and Aortic Valve Repair and Replacement: Yesterday, Today, and Tomorrow)

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10 pages, 3662 KiB

Open AccessArticle

Do Not Withhold Mitral Surgery from Patients with Poor Left Ventricular Function

by Roya Ostovar, Max Schmidt, Filip Schroeter, Ralf-Uwe Kuehnel, Jacqueline Rashvand, Martin Hartrumpf and Johannes Maximilian Albes

Medicina 2022, 58(9), 1220; https://doi.org/10.3390/medicina58091220 - 5 Sep 2022

Cited by 1 | Viewed by 1275

Abstract

Background and Objectives: Increasing reluctance to perform surgical mitral valve repair or replacement particularly in high-risk patients with poor left-ventricular function is trending. These patients are increasingly treated interventionally, e.g., by MitraClip, but often show only low to moderate improvement. The primary objective of the study was to investigate whether left ventricular ejection fraction (LVEF) influences postoperative mortality. Materials and Methods: The study included 903 patients undergoing mitral valve repair or replacement between 2009 and 2021. Statistical comparison was performed between patients with LVEF ≤ 30% and LVEF > 30%. Finally, statistical analysis was performed according to propensity score matching (1:3 PS matching). Results: No significant difference in in-hospital mortality was found before and after matching regarding LVEF ≤ 30% and LVEF > 30% (Pre: 10.8% vs. 15.1%, p = 0.241, after: 11.6% vs. 18.1%, p = 0.142). After PS matching, the 112 patients with LVEF ≤ 30% compared with 336 patients with LVEF > 30% showed a significantly higher preoperative NT-proBNP (p < 0.001), larger diameters at preoperative left ventricle and atrium (p < 0.001), lower preoperative TAPSE (p = 0.003) and PAP (p = 0.003), and more dilated cardiomyopathy and chronic kidney disease (p < 0.001, p = 0.045). Conclusions: The results of this study demonstrate that poor preoperative LVEF alone does not play a significant role in postoperative outcome and long-term mortality. Prognosis appears to be multifactorial. Poor preoperative LVEF is not a contraindication for surgery and does not justify primary interventional treatment accepting inferior hemodynamic results impeding outcome. Full article

(This article belongs to the Special Issue Mitral and Aortic Valve Repair and Replacement: Yesterday, Today, and Tomorrow)

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13 pages, 754 KiB

Open AccessArticle

The Evolution of Pulmonary Hypertension and Its Prognostic Implications Post-TAVI—Single Center Experience

by Luiza Cristina Dumitrof, Igor Nedelciuc, Mihai Roca, Radu Crișan-Dabija, Traian Mihăescu and Grigore Tinică

Medicina 2022, 58(9), 1182; https://doi.org/10.3390/medicina58091182 - 30 Aug 2022

Cited by 2 | Viewed by 2271

Abstract

Background and Objectives: Since the first transcatheter aortic valve implantation (TAVI) procedure was performed in 2002, advances in technology and refinement of the method have led to its widespread use in patients with severe aortic stenosis (AS) and high surgical risk. We aim to identify the impact of TAVI on the clinical and functional status of patients with severe AS at the one-month follow-up and to identify potential predictors associated with the evolution of pulmonary hypertension (PH) in this category of patients. Materials and Methods: We conducted a prospective study which included 86 patients diagnosed with severe AS undergoing TAVI treatment. We analyzed demographics, clinical and echocardiographic parameters associated with AS and PH both at enrolment and at the 30-day follow-up. Results: In our study, the decrease of EUROSCORE II score (p < 0.001), improvement of angina (p < 0.001) and fatigue (p < 0.001) as clinical benefits as well as a reduction in NYHA functional class in patients with heart failure (p < 0.001) are prognostic predictors with statistical value. Regression of left ventricular hypertrophy (p = 0.001), increase in the left ventricle ejection fraction (p = 0.007) and improvement of diastolic dysfunction (p < 0.001) are echocardiographic parameters with a prognostic role in patients with severe AS undergoing TAVI. The pulmonary artery acceleration time (PAAT) (p < 0.001), tricuspid annular plane systolic excursion (TAPSE) (p = 0.020), pulmonary arterial systolic pressure (PASP) (p < 0.001) and the TAPSE/PASP ratio (p < 0.001) are statistically significant echocardiographic parameters in our study that assess both PH and its associated prognosis in patients undergoing TAVI. Conclusions: PAAT, TAPSE, PASP and the TAPSE/PASP ratio are independent predictors that allow the assessment of PH and its prognostic implications post-TAVI. Full article

(This article belongs to the Special Issue Mitral and Aortic Valve Repair and Replacement: Yesterday, Today, and Tomorrow)

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10 pages, 4154 KiB

Open AccessArticle

How Strong Can We Pull? Critical Thresholds for Traction Forces on the Aortic Annulus: Measurements on Fresh Porcine Hearts

by Martin Hartrumpf, Josephine Sterner, Filip Schroeter, Ralf-Uwe Kuehnel, Roya Ostovar and Johannes M. Albes

Medicina 2022, 58(8), 1055; https://doi.org/10.3390/medicina58081055 - 4 Aug 2022

Cited by 2 | Viewed by 1381

Abstract

Background and Objectives: Friable or infected tissue remains a challenge in surgical aortic valve replacement. We recently described the “Caput medusae” method, in which circumferential tourniquets temporarily secure the prosthesis and are then gently knotted. Tourniquets have been shown to develop significantly less force than knots. The current study investigates the critical threshold forces for tissue damage to the aortic annulus. Materials and Methods: In 14 fresh porcine hearts, the aortic valve leaflets were removed and several pledgeted sutures were placed along the annulus at defined locations. The hearts were mounted in a self-constructed device. Incremental traction force was applied to every suture and continuously recorded. The movement of each Teflon pledget was filmed with a high-speed camera. Forces at the moment of pledget “cut-in” as well as complete “tear-out” were determined from the recordings. Results: The average threshold force was determined 9.31 ± 6.04 N for cut-in and 20.41 ± 10.02 N for tear-out. Detailed analysis showed that the right coronary region had lower threshold forces than the other regions (4.77 ± 3.28 N (range, 1.67–12.75 N) vs. 10.67 ± 6.04 N (1.62–26.00 N) for cut-in and 10.67 ± 4.04 N (5.40–18.64 N) vs. 23.33 ± 9.42 N (9.22–51.23 N) for tear-out). The findings are discussed in conjunction with the knot and tourniquet forces from our previous study. Conclusions: Even in healthy tissue, moderate forces can reach a critical level at which a Teflon pledget will cut into the annulus, while a complete tear-out is unlikely. The right coronary portion is more susceptible to damage than the remaining regions. When compared to previous data, forces during manual knotting may exceed the critical cut-in level, while rubber tourniquets may provide a higher safety margin against tissue rupture. Full article

(This article belongs to the Special Issue Mitral and Aortic Valve Repair and Replacement: Yesterday, Today, and Tomorrow)

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Review

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13 pages, 2321 KiB

Open AccessReview

Combined Bentall and Modified Ravitch Procedures: A Case Report and Systematic Review of the Evidence

by Ali Taghizadeh Waghefi, Asen Petrov, Manuel Wilbring, Zuzana Fajfrova, Guido Fitze, Klaus Matschke and Utz Kappert

Medicina 2022, 58(12), 1774; https://doi.org/10.3390/medicina58121774 - 30 Nov 2022

Viewed by 1712

Abstract

Background and Objectives: Marfan syndrome (MS) is a genetic disorder with autosomal dominant inheritance that affects the connective tissue and consequently many organ systems. The cardiovascular manifestations of MS are notorious and include aortic root dilatation or acute aortic dissection, which can cause morbidity and early mortality. However, surgical treatment of aortic pathology may be complicated by musculoskeletal deformity of the chest wall, as in pectus excavatum. In this regard, single-stage combined Bentall and Ravitch surgery is an extreme rarity that has also been scarcely reported in the literature. Patients and Methods: We present the medical history and single-stage Bentall and modified Ravitch surgical treatment of an 18-year-old male MS patient with symptomatic and severe pectus excavatum (PEX) in conjunction with a pear-shaped aortic root aneurysm. To discuss our case in the context of a synopsis of similar published cases, we present a systematic review of combined Bentall surgical aortic aneurysm repair and Ravitch correction of PEX. Results: A total of four studies (one case series and three case reports) and a case from our institution describing a single-stage combined Bentall and Ravitch operation were included. Patients were 22 ± 5.9 years of age (median = 22.5 years) and predominantly male (60%). All cases reported a midline vertical skin incision over the sternum. The most common surgical approach was midsternotomy (80%). In all cases metal struts were used to reinforce the corrected chest wall. Postoperative mortality was zero. Conclusions: Single-stage combined Bentall and Ravitch surgery is an underutilized surgical approach. Its use in MS patients with concomitant PEX and ascending aortic aneurysm that require surgical treatment warrants further investigation. Midsternotomy seems to be a viable access route that provides sufficient exposure in the single-stage surgical setting. Although operative time is long, the intraoperative and postoperative risks appear to be low and manageable. Full article

(This article belongs to the Special Issue Mitral and Aortic Valve Repair and Replacement: Yesterday, Today, and Tomorrow)

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Other

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6 pages, 1284 KiB

Open AccessCase Report

Change in Lung Fluid Volume during Exercise in Patients with Exercise-Induced Mitral Regurgitation

by Teruhiko Imamura, Masakazu Hori, Shuhei Tanaka, Nikhil Narang and Koichiro Kinugawa

Medicina 2022, 58(6), 724; https://doi.org/10.3390/medicina58060724 - 28 May 2022

Cited by 1 | Viewed by 1499

Abstract

Exercise-induced mitral regurgitation (MR) can be diagnosed during stress echocardiography testing. Remote dielectric sensing (ReDS^TM) is a noninvasive electromagnetic-based modality to measure lung fluid levels. The change in lung fluid levels in patients with MR during stress echocardiography remains unknown. Patients with symptomatic MR at baseline and suspected worsening exercise-induced MR underwent stress echocardiography. ReDS values were measured before and after the tests. A total of four patients (ages ranging between 74 and 84 years old, three women) underwent stress echocardiography testing using a bicycle ergometer. In patient A, MR effective regurgitant orifice area (EROA) remained unchanged and ReDS values decreased. EROA increased significantly with a small incremental change in ReDS values in patient B and patient C, who underwent valve repair with MitraClip later. Patient D had a mild increase in MR EROA but a considerable increase in ReDS values (from 22% to 32%), and eventually received valve repair with MitraClip. The ReDS system may be a complementary tool to conventional stress echocardiography in the evaluation of clinically significant MR and considering mitral valve intervention. Full article

(This article belongs to the Special Issue Mitral and Aortic Valve Repair and Replacement: Yesterday, Today, and Tomorrow)

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