Successful MitraClip Implantation in a Barlow's Valve: A Feasible Alternative?
Ontology highlight
ABSTRACT:
SUBMITTER: Kelley BP
PROVIDER: S-EPMC7887515 | biostudies-literature | 2021 Feb
REPOSITORIES: biostudies-literature
Publications
Successful MitraClip Implantation in a Barlow's Valve: A Feasible Alternative?
Kelley Brian P BP Gazda Casey C Sivak Joseph A JA Vavalle John P JP Weickert Thelsa T TT
CASE (Philadelphia, Pa.) 20201121 1
Similar Datasets
Project description:Untreated tricuspid valve regurgitation (TR) is associated with increased rates of mortality, morbidity, and hospitalization. Current pharmacological and surgical treatment options for TR are limited. MitraClip (MC), an edge-to-edge percutaneous intervention, has been reported to be effective for treatment of TR. The goal of this study was to examine the effects of MC position on TR, using a multiphysics fluid-structure-interaction (FSI) analysis. The computational set up included the tricuspid valve (TV), the chordae tendineae, the blood particles, and a tube that surrounded the leaflets and blood particles. The leaflets and chordae were modeled as hyperelastic materials, and blood was modeled using smoothed particle hydrodynamics. FSI analysis was conducted for blood flow through the closed valve for multiple simulations that account for normal, diseased, and treated conditions of the TV. To simulate the diseased TV, a group of chordae between septal and pulmonary leaflets were removed from the normal TV, which produced increased regurgitation. Four MC treated scenarios were considered: i) one MC near the annulus, ii) one MC approximately midway between the annulus and leaflet tip, iii) one MC near the leaflet tip, iv) two MCs: one approximately midway between the annulus and leaflet tip, and one close to the leaflet tip. The TR increased in diseased TV (7.5%) compared to normal TV (2.5%). All MC treated scenarios decreased TR. The MC located near the midway point between the annulus and leaflet tip led to largest decrease in TR (75.2% compared to the untreated condition). The MC located near the leaflet tip was associated with lowest reduction in TR (2.2% compared to the untreated condition). When two MCs were used, reduction in TR was relatively high (68.7%), but TR was not improved compared to the optimal single MC. MC caused high stresses in the vicinity of the clipping area in all conditions; the highest occurred when the MC was near the leaflet tips. Using a quantitative computational approach, we confirm previous clinical reports on the efficacy of MC for treatment of TR. The results of this study could lead to the design of more efficient MC interventions for TR.
| S-EPMC6706066 | biostudies-literature
Project description:Transcatheter tricuspid valve-in-valve implantation is a critical option in high risk bioprosthetic tricuspid valve dysfunction. In this case report, balloon-expandable transcatheter heart valve was implanted successfully into the tricuspid valve and early thrombosis was managed successfully. (Level of Difficulty: Intermediate.) Central Illustration
| S-EPMC9830461 | biostudies-literature
Project description:Purpose of reviewTo provide a detailed overview of complications associated with MitraClip therapy and its development over time with the aim to alert physicians for early recognition of complications and to offer treatment strategies for each complication, if possible.Recent findingsThe MitraClip system (MC) is the leading transcatheter technique to treat mitral regurgitation (MR) and has been established as a safe procedure with very low adverse event rates compared to mitral surgery at intermediate to high risk or in secondary MR. Lately, the fourth MC generation has been launched with novel technical features to facilitate device handling, decrease complication rates, and allow the treatment of even complex lesions. Although the complication rate is low, adverse events are associated with increased morbidity and mortality. The most common complications are bleeding, acute kidney failure, procedure-induced mitral stenosis, and an iatrogenic atrial septal defect with unknown clinical impact.
| S-EPMC8363549 | biostudies-literature
Project description:An 80-year-old male underwent a transcatheter aortic valve implantation (TAVI) for severe senile aortic stenosis. Six weeks after the surgery, he was readmitted to our institution because of a high-grade fever. Transesophageal echocardiography revealed thickening of all three leaflets of the aortic prosthesis and mobile mass on the leaflet, and Streptococcus sanguis was identified from his blood culture. Therefore, he was diagnosed with prosthetic valve endocarditis (PVE) and received intensive intravenous antibiotic therapy. Because he did not respond to the pharmacological therapy, surgical aortic valve replacement (AVR) was indicated although it was considered a relatively high-risk procedure. Herein, we report on the successful surgical AVR in this patient using a pericardial valve after removal of the infected prosthetic valve, and discuss some issues related to this rare complication after TAVI. <Learning objective: Transcatheter aortic valve implantation (TAVI) is a highly effective procedure for patients with symptomatic severe aortic stenosis who are at high risk or deemed inoperable. Because it only requires limited surgical invasiveness, the risk of prosthetic valve endocarditis (PVE) after TAVI is thought to be low. However, PVE can occur even early after TAVI. We present our recent such case and discuss some issues related to this rare complication.>.
| S-EPMC6279805 | biostudies-literature
Project description: Not available
| S-EPMC10242568 | biostudies-literature
Project description: Not available
| S-EPMC10580168 | biostudies-literature
Project description:Duchenne muscular dystrophy (DMD) is a congenital X-linked muscular dystrophy, and cardiomyopathy typically develops in the second decade of life. In those patients with severe heart failure, the use of mechanical circulatory support is considered one of the treatment options, however, the decision to implant the assist device should be made after gauging the inherent risks and potential benefits. Transcatheter mitral valve repair (TMVr) is performed in adults with heart failure due to severe mitral regurgitation (MR) refractory to guideline-directed medical therapies. Data on MitraClip-based treatment (Abbott Vascular, Menlo Park, CA, USA) of young patients with cardiomyopathy-associated severe heart failure remain limited. We present the first report on the safety and effectiveness of TMVr with the MitraClip in an 18-year-old man with DMD and severe MR who was at a prohibitive risk for mitral valve surgery or left ventricular assist device therapy due to comorbidities. He was discharged without complications and, is now asymptomatic at one year after TMVr.Learning objectiveReaders will be able to:Understand the mechanism of mitral regurgitationUnderstand the less invasiveness and usefulness of this procedure.Discuss the indication of transcatheter mitral valve repair in young patients with severe heart failure.
| S-EPMC9214854 | biostudies-literature
Project description: Not available
| S-EPMC10507450 | biostudies-literature
Project description:BackgroundFailed mitral bioprosthesis has conventionally been treated with redo surgical mitral valve replacement (SMVR). Transcatheter mitral valve-in-valve implantation (TM-VIVI) is emerging as an alternative to SMVR in high-risk patients. We report our experience with transapical TM-VIVI using the J-Valve system.MethodsFrom May 2020 to January 2021, 21 patients with a failed mitral bioprosthesis underwent transapical TM-VIVI without concomitant procedures at Guangdong Provincial People's hospital. The mean age was 74.62 years. All patients were heavily symptomatic with severe mitral regurgitation and increased trans-prosthetic gradient. The Society of Thoracic Surgeons predicted risk of mortality (STS PROM) and European System for Cardiac Operative Risk Evaluation II (EuroScore II) scores were used and predicted high mortality (STS PROM, 12.91%±9.94%; EuroScore II, 12.04%±10.5%). All the procedures were performed in a hybrid room.ResultsThe success rate was 100% with no conversion to median sternotomy and no intraprocedural death. The mean ventilation time and intensive care unit (ICU) stay were 25±21.44 minutes and 4.14±7.08 days, respectively. No major postoperative complications were observed, except 1 patient suffered pneumonia and required tracheostomy. All patients recovered well. Postoperative echocardiography revealed excellent hemodynamics with no residual mitral regurgitation in 19 patients and mild regurgitation in 2 patients. In a subgroup analysis, no significant differences among procedural and postoperative outcomes were detected in patients with previous aortic-mitral double valve replacement (DVR) compared to other patients.ConclusionsOur results demonstrate the safety and feasibility of transapical TM-VIVI using the J-Valve system, even in patients following DVR.
| S-EPMC8411171 | biostudies-literature
Project description: Not available
| S-EPMC8443204 | biostudies-literature