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英文誌(2004-)

Journal of Medical Ultrasonics

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2016 - Vol.43

Vol.43 No.Supplement

特別プログラム 循環器
パネルディスカッション 循環器 Joint(JSUM・AFSUMB Joint Session)(English) Structural Heart Disease(SHD)のカテーテル治療における 心エコーの役割

(S287)

DMRおよびFMRにおいてMitraClip手技が僧帽弁形態に及ぼす影響

Effects of MitraClip procedure on the MV morphology in patients with degenerative and functional MR: A 3D transesophageal echocardiography study

板橋 裕史

Yuji ITABASHI

慶應義塾大学医学部循環器内科

Department of Cardiology, Keio University School of Medicine

キーワード :

【Background】
Although only DMR has been approved for the MitraClip procedure in the USA, 80%of patients treated with the MitraClip procedure had FMR according to the recent literatures from Europe. The influences of the MitraClip procedure on the mitral valve(MV)morphology in the patients with DMR and FMR have not been fully elucidated.
【Methods】
We studied 106 patients who underwent MitaClip procedure in our institute. Of these, 53 had DMR(anterior mitral leaflet(AML)prolapse/flail: 6,posterior mitral leaflet(PML)prolapse/flail: 38,both mitral leaflets prolapse/flail: 9)and 53 had FMR. The preprocedural and postprocedural examination of the two-dimensional(2D)transthoracic echocardiography(TTE)and the there-dimensional(3D)transesophageal echocardiography(TEE), and 2D TTE examination in the chronic phase(296.3±185.5 days after the procedure)were analyzed. The influences of MitraClip procedure on the morphology of the left ventricle(LV)and the MV were compared between the DMR and the FMR groups. Then, the decrease of left ventricular ejection fraction(LVEF)greater than 15%after the procedure was defined as”significant LVEF reduction”((postLVEF-preLVEF)/preLVEF x 100<-15%), and its incidence was investigated in both groups.
【Results】
In the FMR group, preprocedural left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV)were larger and left ventricular ejection fraction(LVEF)smaller than in the DMR group. In both groups, postprocedural LVEDV and LVEF decreased in the acute phase. In the DMR group, LVESD decreased and LVEF increased after the procedure while these two parameters did not changed in the FMR group. 3D TEE analysis demonstrated the mitral annular area decreased after the procedure in both groups. Although prolapse/flail volume above the mitral annulus decreased in the DMR group after the procedure, tenting volume below the mitral annulus decreased in the FMR group. The decrease of tenting volume was correlated with the decrease of MR jet area by TEE in the FMR group. There was no significant difference in the postprocedural transmitral pressure gradient(TMPG)as well as the incidence of the significant LVEF reduction after the procedure between these two groups.
【Conclusions】
Mitral annular area, LVEDV, and LVEF decreased in both DMR and FMR groups after the MitraClip procedure, and the postprocedural TMPG as well as the incidence of the significant LVEF reduction was comparable in both groups. However, 3D TEE revealed that the prolapse/flail volume decreased in the DMR group while tenting volume decreased in the FMR group. The reduction of MR grade was associated with the decrease of the tenting volume in FMR patients.