Showing papers by "Patric Biaggi published in 2012"

Acute haemodynamic changes after percutaneous mitral valve repair: relation to mid-term outcomes

Abstract: Background Percutaneous mitral valve repair (MVR) using the Evalve MitraClip has been recently introduced as a potential alternative to surgical MVR. Objective To assess immediate haemodynamic changes after percutaneous MVR using right heart catheterisation. Design Single-centre longitudinal cohort study. Setting Tertiary referral centre. Patients Fifty consecutive non-surgical patients (age 74±14 years, EuroSCORE 26±14) with moderate to severe (3+) and severe (4+) mitral regurgitation (MR) due to functional (56%), degenerative (30%) or mixed (14%) disease were selected. Interventions MitraClip implantation was performed under general anaesthesia with fluoroscopy and echocardiographic guidance. Haemodynamic variables were obtained before and after MVR using standard right heart catheterisation and oximetry. Main outcome measures Haemodynamic changes immediately before and after MVR. Results Acute procedural success (reduction in MR to grade 2+ or less) was achieved in 46 (92%) patients. Mitral valve clipping reduced mean pulmonary capillary wedge pressure (mPCWP) (from 17±7 to 12±5 mm Hg), PCWP v-wave (from 24±11 to 16±7 mm Hg) and mean pulmonary artery pressure (mPAP) (from 29±12 to 24±6 mm Hg), and increased the cardiac index (CI) (from 3.1±1.0 to 3.9±1.1 l/min/m 2 ) (all p Conclusion In a heterogeneous population with predominantly functional MR, percutaneous MVR with the Evalve MitraClip system lowers mPCWP, PCWP v-wave and mPAP by 20%, 20% and 8%, respectively, and increases the CI by 32%.

Quantification of mitral valve anatomy by three-dimensional transesophageal echocardiography in mitral valve prolapse predicts surgical anatomy and the complexity of mitral valve repair.

Abstract: Background Three-dimensional (3D) transesophageal echocardiography (TEE) is more accurate than two-dimensional (2D) TEE in the qualitative assessment of mitral valve (MV) prolapse (MVP). However, the accuracy of 3D TEE in quantifying MV anatomy is less well studied, and its clinical relevance for MV repair is unknown. Methods The number of prolapsed segments, leaflet heights, and annular dimensions were assessed using 2D and 3D TEE and compared with surgical measurements in 50 patients (mean age, 61 ± 11 years) who underwent MV repair for mainly advanced MVP. Results Three-dimensional TEE was more accurate (92%–100%) than 2D TEE (80%–96%) in identifying prolapsed segments. Three-dimensional TEE and intraoperative measurements of leaflet height did not differ significantly, while 2D TEE significantly overestimated the height of the posterior segment P1 and the anterior segment A2. Three-dimensional TEE quantitative MV measurements were related to surgical technique: patients with more complex MVP (one vs two to four vs five or more prolapsed segments) showed progressive enlargement of annular anteroposterior (31 ± 5 vs 34 ± 4 vs 37 ± 6 mm, respectively, P = .02) and commissural diameters (40 ± 6 vs 44 ± 5 vs 50 ± 10 mm, respectively, P = .04) and needed increasingly complex MV repair with larger annuloplasty bands (60 ± 13 vs 67 ± 9 vs 72 ± 10 mm, P = .02) and more neochordae (7 ± 3 vs 12 ± 5 vs 26 ± 6, P Conclusions Measurements of MV anatomy on 3D TEE are accurate compared with surgical measurements. Quantitative MV characteristics, as assessed by 3D TEE, determined the complexity of MV repair.

Reduced left ventricular compacta thickness: a novel echocardiographic criterion for non-compaction cardiomyopathy.

Abstract: Background Left ventricular noncompaction (LVNC) is characterized by a two-layered myocardium consisting of a noncompacted inner and a compacted outer layer. The ratio of the thicknesses of these two layers is a major diagnostic criterion, which is, however, often difficult to apply in clinical practice. Methods Transthoracic echocardiography was performed in 41 patients with LVNC, 41 patients with moderate or severe aortic valve stenosis (AVS), and 41 age-matched normal controls. The maximal systolic thicknesses of "noncompacta" and "compacta" were measured in standard short-axis views at the apical or midventricular level, in the segment with most prominent recesses (in patients with LVNC) or trabeculation (in patients with AVS and controls). Results The mean maximal systolic thickness of noncompacta was 1.8 ± 0.4 cm in patients with LVNC compared with 0.2 ± 0.1 cm in controls and 0.6 ± 0.02 cm in patients with AVS ( P P P 8.1 mm ( P 8.1 mm in patients with AVS ( P 2 in patients with LVNC compared to ≤0.62/m 2 in controls and ≤0.96/m 2 in patients with AVS. Conclusions Maximal systolic compacta thickness

Right Heart Assessment by Echocardiography: Gender and Body Size Matters

Abstract: Background Published reference values for echocardiographic measurements of right-heart dimensions and function do not stratify for gender and body size. The aim of this study was therefore to assess the impact of gender and biometric characteristics on right-heart dimensions and function. Methods From the echocardiography database at a tertiary care center, 1,625 subjects (mean age, 44 ± 14 years; 47% men) with normal echocardiographic findings between 2000 and 2009 were identified. Gender differences and association with body surface area were assessed retrospectively for right atrial long-axis and short-axis dimensions, right ventricular short-axis dimension, end-diastolic and end-systolic right ventricular area, right ventricular fractional area change, and tricuspid annular plane systolic excursion. The impact of normal values stratified for gender and body surface area was tested in 24 patients with moderate-sized to large atrial septal defects. Results All dimensional right-heart measurements were significantly lower in women. Differences became smaller when measurements were indexed for body surface area, but significant differences persisted, particularly for right ventricular end-diastolic area (7.9 ± 1.6 vs 8.7 ± 1.8 cm 2 /m 2 , P 2 /m 2 , P 2 , respectively, P P Conclusions Gender and body surface area are important determinants of right ventricular dimensions and systolic function as measured on two-dimensional echocardiography. The investigators thus propose the use of measurements indexed to body surface area, with upper and lower reference ranges stratified for gender.

Automatic Detection and Quantification of Mitral Regurgitation on TTE with Application to Assist Mitral Clip Planning and Evaluation

Abstract: Mitral regurgitation (MR), characterized by reverse blood flow during systole, is one of the most common valvular heart diseases. It typically requires treatment via surgical (mitral valve replacement or repair) or percutaneous approaches (e.g., MitraClip). To assist clinical diagnosis and assessment, we propose a learning-based framework to automatically detect and quantify mitral regurgitation from transthoracic echocardiography (TTE), which is usually the initial method to evaluate the cardiac and valve function. Our method leverages both anatomical (B-Mode) and hemodynamical (Color Doppler) information by extracting 3D features on multiple channels and selecting the most relevant ones by a boosting-based approach. Furthermore, the proposed framework provides an automatic modeling of mitral valve structures, such as the location of the regurgitant orifice, the mitral annulus, and the mitral valve closure line, which can be used to assist medical treatment or interventions. To demonstrate the performance of our method, we evaluate the system on a clinical dataset acquired from MR patients. Preliminary results agree well with clinical measurements in a quantitative manner.

Patientenspezifische Annuloplastieringe für die Mitralklappenrekonstruktion

Abstract: Es wird ein Verfahren zur Herstellung patientenspezifischer Annuloplastieringe vorgestellt. Der Mitralklappenannulus wird aus Computertomographiebildern modelliert. Eine optimale Ringgeometrie wird interaktiv erstellt. Die Ringe werden mittels Selective Laser Melting aus einer Titanlegierung hergestellt. Im Tierversuch wurde die Machbarkeit des Verfahrens uberpruft. Mit patientenspezifisch geformten Annuloplastieringe fur die Mitralklappenrekonstruktion konnten die chirurgische Therapie besser an die individuelle Anatomie und Pathologie angepasst werden.

Sichere Anwendbarkeit von 3D-Echokardiographie-Angiogrpahie Fusionstechnologie bei komplexen Mitralklappen Interventionen im Hybrid-Operationssaal

Abstract: Die Standardtherapie zur Behandlung der Mitralklappeninsuffizienz ist die chirurgische Rekonstruktion. Daneben gibt es für Hochrisikopatienten mit dem MitraClip (Abbott Vascular Inc. Menlo Park, CA, USA) eine katheterbasierte Alternative. Hierbei kann auf den Einsatz der Herzlungenmaschine und den Herzstillstand verzichtet werden. Die Positionierung des Clips ist komplex und abhängig von adäquater Bildgebung wie transoesophageale Echokardiographie und Angiographie. Der EchoNavigator, eine prototypische Software, fusioniert beide Verfahren und soll dadurch u.a. die Navigation des MitraClips und die transseptale Punktion erleichtern. Bei 20 Patienten wurde die Software eingesetzt. Allen Eingriffen konnten sicher und komplikationslos durchgeführt werden. Der Eingriff an sich wurde nicht durch den Einsatz des EchoNavigator beeinträchtigt. Zusammenfassend konnte die Software sicher eingesetzt werden und die Navigation des Katheters erleichtert werden. Schlüsselworte: EchoNavigator, MitraClip, Mitralklappenrekonstruktion