Chronic ischemic mitral regurgitation

peer reviewe

Mitral regurgitation in patients with systolic heart failure: more than a bystander

Peer reviewe

The Conundrum of Tricuspid Regurgitation Grading

Findings from early percutaneous tricuspid intervention trials have shown that the severity of tricuspid regurgitation (TR) far exceeded the current definition of severe TR. Also, the improvement in the amount of TR following tricuspid intervention is not accounted for by the current definition of TR as different degrees of severity at the severe end was grouped under the same umbrella term of “severe.” There has been a recent call to expand the TR grading system, encompassing two more grades, namely “massive” and “torrential” TR, in the order of increasing severity. This seems appropriate as the patients enrolled in tricuspid intervention trials were found to have TR severity up to 2 grades above the current severe thresholds of effective regurgitant orifice area (EROA) 40 mm2, regurgitant volume (R Vol) 45 ml and vena contracta (VC) width 7 mm. The proposed grade of “massive” is defined by EROA 60–79 mm2, R Vol 60–74 ml and VC 14–20 mm, while “torrential” is defined by EROA ≥80 mm2, R Vol ≥75 ml, and VC ≥21 mm. The grading of TR requires a comprehensive, multi-parametric approach. In particular, quantitative assessment of TR should be performed in patients who require serial monitoring and quantification of treatment effect

How I look at the regurgitant mitral valve-a stepwise echocardiographic assessment.

peer reviewe

Role of Imaging in Left Atrial Appendage Occlusion

Percutaneous left atrial appendage (LAA) occlusion is now a valid alternative to long-term oral anticoagulation in patients with non-valvular atrial fibrillation at high thrombo-embolism risk, especially for patients who are considered ineligible for anticoagulation. The most frequently used occluders worldwide include the WATCHAMN (Boston Scientific, Natick, MA, USA) and the Amplatzer Cardiac Plug or Amulet (St. Jude Medical/Abbott, St Paul, MN, USA) devices. Multimodality imaging is key in the understanding of 3D aspects of the LAA and surrounding structures anatomy. Imaging is essential for procedural planning, during each step of the procedure and for device surveillance after implantation. Multimodality imaging, including 2D/3D echocardiography, fluoroscopy, and cardiac computed tomography can increase the safety and efficacy of the procedure

Amylose cardiaque à transthyrétine de type sénile et sténose aortique - ne manquez pas le diagnostic !

peer reviewe

Layer-specific longitudinal strain predicts left ventricular maximum wall thickness in patients with hypertrophic cardiomyopathy.

peer reviewedAIMS: The aim of this study was (a) to clarify the detailed mechanisms of structural and functional abnormalities of myocardial tissue in hypertrophic cardiomyopathy (HCM) using layer-specific strain (LSS) and compare it with healthy subjects (b) to investigate the diagnostic accuracy of LSS for HCM. METHODS AND RESULTS: Forty-one patients with HCM and preserved left ventricular ejection fraction (LVEF; 66% male, 52 ± 18 years, LVEF 62.9% ± 3.7%) and 41 controls matched for age and sex (66% male, 52 ± 20 years, LVEF 63.5% ± 8.2%) underwent 2D-speckle tracking echocardiography. Absolute values of LSS were globally lower and the ratio of endocardial/epicardial layer (End/Epi ratio) was higher in HCM. LSS gradually increased from the epicardial toward the endocardial layer at all chamber views and at all levels of the LV. LSS and End/Epi ratio at the apex were higher than those at the middle or basal level of the LV. End/Epi ratio was correlated with LV maximal wall thickness both controls (r = .35, P = .03) and HCM (r = .81, P < .001). End/Epi ratio was an independent factor associated with LV maximal wall thickness (β = 0.96, P < .001). A higher End/Epi ratio (≥1.31) was associated with diagnostic criteria for HCM (sensitivity 98%, specificity 95%, area under the curve 0.99, P < .001). CONCLUSION: LSS has the potential for unraveling the mechanism of impaired LV wall motion in HCM and to accurately detect HCM

Dynamic mitral regurgitation and acute pulmonary edema

peer reviewedWe report the case of a 61-year old patient with signs and symptoms of heart failure with mid-range left ventricular ejection fraction and moderate mitral regurgitation of mixed etiology (rheumatic heart disease, toxic and ischemic). The dynamic behaviour of the mitral regurgitation was revealed by an acute episode of pulmonary edema in the context of an abrupt elevation of blood pressure inducing an increase in left ventricular afterload. Dynamic mitral regurgitation must be considered in any patient with exercise dyspnea who has a moderate mitral regurgitation in resting conditions or in patients with repeated acute pulmonary edema without an obvious cause. Exercise stress echocardiography is the best diagnostic test to explore the dynamic behaviour of the mitral regurgitation. Surgery or percutaneous treatment may be proposed in severe cases

Caseous calcification of the mitral annulus: an uncommon cause of acute mitral regurgitation.

peer reviewe

Tricuspid regurgitation: transcatheter treatment by TriClip®.

editorial reviewedTricuspid regurgitation (TR) is not rare and has been associated with poor clinical outcomes when severe. The etiology of TR is functional in most cases and is usually associated with left-sided valvular heart disease. Severe TR is responsible for right heart failure and may evolve to global heart failure. Current echocardiographic classification includes several grades (trivial, moderate, severe, massive, torrential TR) which influence patients' prognosis in an incremental manner. Management of patients with severe TR is discussed in Heart Team after evaluation of surgical risk. The TRI-SCORE may be used to evaluate the intra-hospital mortality risk in case of isolated tricuspid surgery. Isolated TR surgery is rarely performed as surgical risk outweighs expected clinical benefits. Transcatheter treatment of severe TR may be considered in highly selected cases. Transcatheter edge-to-edge repair (TEER) restores leaflets coaptation. First tricuspid TEER procedures were performed with the MitraClip® (Abbott, Santa Clara, CA, USA) device, but a specific device has been developed: the TriClip® (Abbott). The prospective multicenter TRILUMINATE trial evaluated the TriClip® procedure in patients with symptomatic moderate to severe TR and high surgical risk. The results show a good efficacy with reduction of post-procedural TR grade and increase in NYHA functional class, 6-minute walking test distance, right ventricular function, and quality of life at 1 year. Other devices are currently being evaluated or in development (i.e., transcatheter tricuspid implantation). Non-surgical TR management is likely to evolve and improve significantly soon.L’insuffisance tricuspide (IT) est une valvulopathie assez fréquente dans la population et qui est associée à un mauvais pronostic lorsqu’elle est modérée à sévère. Elle est le plus souvent fonctionnelle et liée à une valvulopathie du cœur gauche. Cliniquement, elle se marque par le développement de signes d’insuffisance cardiaque droite avec évolution vers une décompensation cardiaque globale. La classification échocardiographique actuelle distingue plusieurs stades (IT minime, modérée, sévère, massive et torrentielle) qui influencent le pronostic de façon incrémentielle. La prise en charge est discutée de manière collégiale après stratification du risque opératoire, dont l’évaluation est facilitée par le TRI-SCORE (risque de mortalité intra-hospitalière post-opératoire de chirurgie isolée de la valve tricuspide). La prise en charge chirurgicale d’une IT isolée est rarement pratiquée en raison d’un risque opératoire souvent élevé. Une prise en charge percutanée peut être envisagée dans certains cas, selon les limitations anatomiques. La technique de réparation bord à bord au niveau tricuspidien permet de restaurer une coaptation valvulaire par accolement des feuillets. Initialement réalisée à l’aide du système MitraClip® (Abbott, Santa Clara, CA, USA), il existe maintenant un système dédié spécifiquement à la tricuspide : le TriClip® (Abbott), dont la dernière génération existe en quatre tailles. Le TriClip® a été évalué dans l’étude prospective multicentrique TRILUMINATE chez des patients avec IT modérée à sévère symptomatique à haut risque chirurgical. La procédure a montré une efficacité avec réduction rapide du grade d’IT et amélioration de la classe fonctionnelle NYHA, de la distance de marche à 6 minutes, de la fonction ventriculaire droite et de la qualité de vie à un an. D’autres dispositifs sont en cours d’étude ou en développement (implantation tricuspide percutanée). La prise en charge non chirurgicale de l’IT devrait se développer de manière significative dans le futur