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Mechanism and Severity of Mitral Regurgitation by Transesophageal Echocardiography in Patients Referred for Percutaneous Valve Repair

Percutaneous mitral valve repair with the MitraClip has been shown to decrease mitral regurgitation (MR) severity, left ventricular volumes, and functional class in patients with severe (3+ or 4+) MR. Determination of which patients are optimal candidates for MitraClip therapy versus surgery has not... Full description

Journal Title: The American journal of cardiology 2011, Vol.108 (6), p.882-887
Main Author: Grayburn, Paul A., MD
Other Authors: Roberts, Bradley J., RDCS , Aston, Susan, RN , Anwar, Azam, MD , Hebeler, Robert F., MD , Brown, David L., MD , Mack, Michael J., MD
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: New York, NY: Elsevier Inc
ID: ISSN: 0002-9149
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title: Mechanism and Severity of Mitral Regurgitation by Transesophageal Echocardiography in Patients Referred for Percutaneous Valve Repair
format: Article
creator:
  • Grayburn, Paul A., MD
  • Roberts, Bradley J., RDCS
  • Aston, Susan, RN
  • Anwar, Azam, MD
  • Hebeler, Robert F., MD
  • Brown, David L., MD
  • Mack, Michael J., MD
subjects:
  • Abridged Index Medicus
  • Aged
  • Biological and medical sciences
  • Cardiology
  • Cardiology. Vascular system
  • Cardiovascular
  • Cardiovascular disease
  • Cardiovascular system
  • Echocardiography
  • Echocardiography, Three-Dimensional
  • Echocardiography, Transesophageal
  • Endocardial and cardiac valvular diseases
  • Female
  • Heart
  • Heart surgery
  • Humans
  • Investigative techniques, diagnostic techniques (general aspects)
  • Male
  • Medical sciences
  • Mitral Valve - diagnostic imaging
  • Mitral Valve - physiopathology
  • Mitral Valve - surgery
  • Mitral valve insufficiency
  • Mitral Valve Insufficiency - diagnostic imaging
  • Mitral Valve Insufficiency - physiopathology
  • Mitral Valve Insufficiency - surgery
  • Patient Selection
  • Prospective Studies
  • Registries
  • Severity of Illness Index
  • Therapy
  • Treatment Outcome
  • Ultrasonic imaging
  • Ultrasonic investigative techniques
ispartof: The American journal of cardiology, 2011, Vol.108 (6), p.882-887
description: Percutaneous mitral valve repair with the MitraClip has been shown to decrease mitral regurgitation (MR) severity, left ventricular volumes, and functional class in patients with severe (3+ or 4+) MR. Determination of which patients are optimal candidates for MitraClip therapy versus surgery has not been rigorously evaluated. Transesophageal echocardiography was prospectively performed in 113 consecutive patients referred for potential MitraClip therapy under the REALISM continued access registry. MR severity was assessed quantitatively in all patients. Mitral valve anatomy and feasibility of MitraClip placement were assessed by transesophageal echocardiography and clinical parameters. MR was degenerative (mitral valve prolapse) in 60 patients (53%), functional (anatomically normal) in 44 (39%), and thickened with restricted motion (Carpentier IIIB classification) in 9 (8%). MR was mild in 19 patients (17%), moderate in 27 (24%), and severe (3 to 4+) in 67 (59%) by Transesophageal echocardiography. MitraClip placement was performed in only 17 of 113 patients (15%); all were successful. Surgical mitral valve repair was performed in 25 patients (22%), mitral valve replacement in 12 (11%). Most patients (59 of 113, 52%) were treated medically, usually because MR was not severe enough to warrant intervention. In conclusion, most patients referred for MitraClip therapy do not have severe enough MR to warrant intervention. Of those with clinical need for intervention, surgery is more often recommended for anatomic or clinical reasons. Three-dimensional transesophageal echocardiography with quantitative assessment of MR severity is helpful in evaluating these patients.
language: eng
source:
identifier: ISSN: 0002-9149
fulltext: no_fulltext
issn:
  • 0002-9149
  • 1879-1913
url: Link


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titleMechanism and Severity of Mitral Regurgitation by Transesophageal Echocardiography in Patients Referred for Percutaneous Valve Repair
creatorGrayburn, Paul A., MD ; Roberts, Bradley J., RDCS ; Aston, Susan, RN ; Anwar, Azam, MD ; Hebeler, Robert F., MD ; Brown, David L., MD ; Mack, Michael J., MD
creatorcontribGrayburn, Paul A., MD ; Roberts, Bradley J., RDCS ; Aston, Susan, RN ; Anwar, Azam, MD ; Hebeler, Robert F., MD ; Brown, David L., MD ; Mack, Michael J., MD
descriptionPercutaneous mitral valve repair with the MitraClip has been shown to decrease mitral regurgitation (MR) severity, left ventricular volumes, and functional class in patients with severe (3+ or 4+) MR. Determination of which patients are optimal candidates for MitraClip therapy versus surgery has not been rigorously evaluated. Transesophageal echocardiography was prospectively performed in 113 consecutive patients referred for potential MitraClip therapy under the REALISM continued access registry. MR severity was assessed quantitatively in all patients. Mitral valve anatomy and feasibility of MitraClip placement were assessed by transesophageal echocardiography and clinical parameters. MR was degenerative (mitral valve prolapse) in 60 patients (53%), functional (anatomically normal) in 44 (39%), and thickened with restricted motion (Carpentier IIIB classification) in 9 (8%). MR was mild in 19 patients (17%), moderate in 27 (24%), and severe (3 to 4+) in 67 (59%) by Transesophageal echocardiography. MitraClip placement was performed in only 17 of 113 patients (15%); all were successful. Surgical mitral valve repair was performed in 25 patients (22%), mitral valve replacement in 12 (11%). Most patients (59 of 113, 52%) were treated medically, usually because MR was not severe enough to warrant intervention. In conclusion, most patients referred for MitraClip therapy do not have severe enough MR to warrant intervention. Of those with clinical need for intervention, surgery is more often recommended for anatomic or clinical reasons. Three-dimensional transesophageal echocardiography with quantitative assessment of MR severity is helpful in evaluating these patients.
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subjectAbridged Index Medicus ; Aged ; Biological and medical sciences ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular disease ; Cardiovascular system ; Echocardiography ; Echocardiography, Three-Dimensional ; Echocardiography, Transesophageal ; Endocardial and cardiac valvular diseases ; Female ; Heart ; Heart surgery ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Mitral Valve - diagnostic imaging ; Mitral Valve - physiopathology ; Mitral Valve - surgery ; Mitral valve insufficiency ; Mitral Valve Insufficiency - diagnostic imaging ; Mitral Valve Insufficiency - physiopathology ; Mitral Valve Insufficiency - surgery ; Patient Selection ; Prospective Studies ; Registries ; Severity of Illness Index ; Therapy ; Treatment Outcome ; Ultrasonic imaging ; Ultrasonic investigative techniques
ispartofThe American journal of cardiology, 2011, Vol.108 (6), p.882-887
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descriptionPercutaneous mitral valve repair with the MitraClip has been shown to decrease mitral regurgitation (MR) severity, left ventricular volumes, and functional class in patients with severe (3+ or 4+) MR. Determination of which patients are optimal candidates for MitraClip therapy versus surgery has not been rigorously evaluated. Transesophageal echocardiography was prospectively performed in 113 consecutive patients referred for potential MitraClip therapy under the REALISM continued access registry. MR severity was assessed quantitatively in all patients. Mitral valve anatomy and feasibility of MitraClip placement were assessed by transesophageal echocardiography and clinical parameters. MR was degenerative (mitral valve prolapse) in 60 patients (53%), functional (anatomically normal) in 44 (39%), and thickened with restricted motion (Carpentier IIIB classification) in 9 (8%). MR was mild in 19 patients (17%), moderate in 27 (24%), and severe (3 to 4+) in 67 (59%) by Transesophageal echocardiography. MitraClip placement was performed in only 17 of 113 patients (15%); all were successful. Surgical mitral valve repair was performed in 25 patients (22%), mitral valve replacement in 12 (11%). Most patients (59 of 113, 52%) were treated medically, usually because MR was not severe enough to warrant intervention. In conclusion, most patients referred for MitraClip therapy do not have severe enough MR to warrant intervention. Of those with clinical need for intervention, surgery is more often recommended for anatomic or clinical reasons. Three-dimensional transesophageal echocardiography with quantitative assessment of MR severity is helpful in evaluating these patients.
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2Biological and medical sciences
3Cardiology
4Cardiology. Vascular system
5Cardiovascular
6Cardiovascular disease
7Cardiovascular system
8Echocardiography
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10Echocardiography, Transesophageal
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22Mitral valve insufficiency
23Mitral Valve Insufficiency - diagnostic imaging
24Mitral Valve Insufficiency - physiopathology
25Mitral Valve Insufficiency - surgery
26Patient Selection
27Prospective Studies
28Registries
29Severity of Illness Index
30Therapy
31Treatment Outcome
32Ultrasonic imaging
33Ultrasonic investigative techniques
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titleMechanism and Severity of Mitral Regurgitation by Transesophageal Echocardiography in Patients Referred for Percutaneous Valve Repair
authorGrayburn, Paul A., MD ; Roberts, Bradley J., RDCS ; Aston, Susan, RN ; Anwar, Azam, MD ; Hebeler, Robert F., MD ; Brown, David L., MD ; Mack, Michael J., MD
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abstractPercutaneous mitral valve repair with the MitraClip has been shown to decrease mitral regurgitation (MR) severity, left ventricular volumes, and functional class in patients with severe (3+ or 4+) MR. Determination of which patients are optimal candidates for MitraClip therapy versus surgery has not been rigorously evaluated. Transesophageal echocardiography was prospectively performed in 113 consecutive patients referred for potential MitraClip therapy under the REALISM continued access registry. MR severity was assessed quantitatively in all patients. Mitral valve anatomy and feasibility of MitraClip placement were assessed by transesophageal echocardiography and clinical parameters. MR was degenerative (mitral valve prolapse) in 60 patients (53%), functional (anatomically normal) in 44 (39%), and thickened with restricted motion (Carpentier IIIB classification) in 9 (8%). MR was mild in 19 patients (17%), moderate in 27 (24%), and severe (3 to 4+) in 67 (59%) by Transesophageal echocardiography. MitraClip placement was performed in only 17 of 113 patients (15%); all were successful. Surgical mitral valve repair was performed in 25 patients (22%), mitral valve replacement in 12 (11%). Most patients (59 of 113, 52%) were treated medically, usually because MR was not severe enough to warrant intervention. In conclusion, most patients referred for MitraClip therapy do not have severe enough MR to warrant intervention. Of those with clinical need for intervention, surgery is more often recommended for anatomic or clinical reasons. Three-dimensional transesophageal echocardiography with quantitative assessment of MR severity is helpful in evaluating these patients.
copNew York, NY
pubElsevier Inc
pmid21741608
doi10.1016/j.amjcard.2011.05.013