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Figure 1: TTE apical RV chamber view and sample assessment worksheet.
Abbreviations: LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle; RVFAC = right ventricular fractional area change; S’= RV longitudinal myocardial velocity; TAPSE = tricuspid annular plane systolic excursion; TTE = transthoracic echocardiogram.
Figure 2: TTE and cardiac CT images of Tendyne TMVI.
Top: (Left) TTE four-chamber view demonstrating Tendyne TMVI and apical tether; (Right) cardiac CT four-chamber view demonstrating Tendyne TMVI and apical tether.
Bottom: (Left) TTE parasternal long axis view demonstrating Tendyne TMVI and apical tether; (Right) cardiac CT apical two-chamber view demonstrating Tendyne TMVI and apical tether. CT images courtesy of Dr James Otton.
Abbreviations: CT = computed tomography; TTE = transthoracic echocardiogram; TMVI = transcatheter mitral valve implantation.
Figure 3: RV hemodynamics and remodeling.
  1. Improvement in RVSWI post-device deployment.
  2. Change in RVFAC from baseline to pre-discharge and 3-months.
  3. Decrease in pulmonary artery systolic pressure to 3-months.
Abbreviations: RVFAC = right ventricular fractional area change; RVSWI = right ventricular stroke work index.
Figure 4: Comparison of pre- and post- operative MR and TR.
Figure 4 (top): Bar chart comparison of pre- and post-operative MR following TMVI. All patients had ≥3+MR pre-operatively. There was a significant reduction in MR pre-discharge (p<0.001) and at 3 months (p<0.001).
Figure 4 (bottom): Bar chart comparison of pre- and post-operative TR following TMVI. There was an increase in patients with nil/mild TR post-operatively from 65% to 89% post-operatively and at 3 months(p<0.001).
Abbreviations: MR = mitral regurgitation; TMVI = transcatheter mitral valve implantation; TR = tricuspid regurgitation.
Figure 5: Comparison of pre- and post-operative LV volumes.
Comparison of LVEDVI and LVESVI pre- and post-TMVI. There was an immediate reduction in both values.
Abbreviations: LVEDVI = left ventricular end diastolic volume indexed; LVESVI = left ventricular end systolic volume indexed; LV = left ventricular; MR = mitral regurgitation; TMVI = transcatheter mitral valve implantation.
Figure 6: Graphical Abstract
Graphical abstract: (Top Left) TTE demonstrating a dilated LV. (Top Middle) 3D TOE of a MV coaptation defect at end-systole. (Middle Left) CT image of Tendyne TMVI. (Left lower) TTE with colour Doppler showing correction of MR following Tendyne TMVI.
Abbreviations: AV = aortic valve; MR = mitral regurgitation; MV = mitral valve; PASP = pulmonary artery systolic pressure; RV = right ventricular; RVSWI = right ventricular stroke work index; TOE = transesophageal echocardiogram; TTE = transthoracic echocardiogram; TMVI = transcatheter mitral valve implantation.