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Left Ventricular Outflow Tract Area After Percutaneous Transseptal Transcatheter Mitral Valve Implantation; A Three-dimensional Transesophageal Echocardiography Study
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  • atsushi hayashi,
  • hiroki ikenaga,
  • takafumi nagaura,
  • Jun Yoshida,
  • Florian Rader,
  • moody makar,
  • Tarun Chakravarty,
  • Robert J. Siegel,
  • saibal kar,
  • Raj Makkar,
  • Takahiro Shiota
atsushi hayashi
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hiroki ikenaga
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takafumi nagaura
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Jun Yoshida
Cedars-Sinai Medical Center
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Florian Rader
Cedars-Sinai Medical Center
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moody makar
Cedars-Sinai Medical Center
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Tarun Chakravarty
Cedars Sinai Medical Center
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Robert J. Siegel
Cedars Sinai Med Ctr
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saibal kar
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Raj Makkar
Cedar Sinai Medical Center
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Takahiro Shiota
Cedars Sinai Medical Center
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Abstract

Background: Left ventricular (LV) outflow tract (LVOT) obstruction increases mortality in patients undergoing transcatheter mitral valve implantation (TMVI) in degenerated bioprostheses, annuloplasty rings, and native mitral valves. We aimed to evaluate the left ventricular outflow tract area after TMVI using 3-diensional (3D) transesophageal echocardiography (TEE) and to investigate the pre-procedural cardiac geometry affects the LVOT area after TMVI. Methods: We retrospectively reviewed echocardiography data in 43 patients who had TMVI. A change in pressure gradient across LVOT from before to after TMVI (∆PG) and post-procedure 3D cross sectional area (CSA) at the level of the most distal portion of the mitral valve stent that was closest to the LV apex were assessed as evidence of LVOT narrowing. Results: TMVI with the use of balloon-expandable valve system was performed for 24 bioprostheses, 7 annuloplasty rings, and 12 native valves. Compared to patients without increase in LVOT gradient (∆PG <10 mmHg; n=33), patients with increase in LVOT gradient (∆PG ≥10 mmHg; n=10) had smaller LV end-systolic volume (LVESV), greater LV ejection fraction (LVEF) and smaller aorto-mitral (AM) angle. CSA at the valve stent distal edge showed strong association with ∆PG (r=-0.68, P<0.0001). Only small AM angle was associated with small CSA at the valve stent ventricular edge on multivariable analysis, independent of LVESV and LVEF. Conclusion: Pre-procedural AM angle as well as LVESV and LVEF were associated with LVOT narrowing in patients undergoing transcatheter mitral valve-in-valve, valve-in-ring, and valve-in-native valve implantation. These data may be useful for preprocedural planning.

Peer review status:ACCEPTED

12 Jan 2021Submitted to Echocardiography
13 Jan 2021Submission Checks Completed
13 Jan 2021Assigned to Editor
18 Jan 2021Reviewer(s) Assigned
14 Feb 2021Review(s) Completed, Editorial Evaluation Pending
15 Feb 2021Editorial Decision: Revise Major
01 Apr 20211st Revision Received
03 Apr 2021Submission Checks Completed
03 Apr 2021Assigned to Editor
08 Apr 2021Reviewer(s) Assigned
09 Apr 2021Review(s) Completed, Editorial Evaluation Pending
24 Apr 2021Editorial Decision: Accept