Biventricular Physiology of Iatrogenic Atrial Septal Defects Following Transcatheter Mitral Valve Edge-to-Edge Repair.
iatrogenic atrial septal defect
physiology
pressure-volume loops
transcatheter mitral valve repair
Journal
JACC. Cardiovascular interventions
ISSN: 1876-7605
Titre abrégé: JACC Cardiovasc Interv
Pays: United States
ID NLM: 101467004
Informations de publication
Date de publication:
11 01 2021
11 01 2021
Historique:
received:
12
08
2020
revised:
09
10
2020
accepted:
20
10
2020
entrez:
8
1
2021
pubmed:
9
1
2021
medline:
28
7
2021
Statut:
ppublish
Résumé
The study sought to assess the acute hemodynamic effects of iatrogenic atrial septal defect (iASD) closure following transcatheter mitral valve edge-to-edge repair (TMVR). The potential hemodynamic and clinical consequences of an iASD following TMVR are currently subject to controversial debates. In 21 patients with relevant left-to-right shunt flow (50% [IQR: 38% to 60%] of systemic perfusion volume) across an iASD following TMVR, interventional closure was performed with recordings of left ventricular (LV) and right ventricular (RV) pressure-volume loops during iASD occlusion. iASD occlusion led to a volume shift from the RV (RV end-diastolic volume index: pre 102 [IQR: 80 to 120] ml/m iASD closure following TMVR leads to a volume shift from the RV to the LV with reduced pulmonary but increased systemic cardiac index and with favorable biventricular interaction at maintained LV filling pressure, resulting in a decline in heart failure symptoms at 1-month follow-up.
Sections du résumé
OBJECTIVES
The study sought to assess the acute hemodynamic effects of iatrogenic atrial septal defect (iASD) closure following transcatheter mitral valve edge-to-edge repair (TMVR).
BACKGROUND
The potential hemodynamic and clinical consequences of an iASD following TMVR are currently subject to controversial debates.
METHODS
In 21 patients with relevant left-to-right shunt flow (50% [IQR: 38% to 60%] of systemic perfusion volume) across an iASD following TMVR, interventional closure was performed with recordings of left ventricular (LV) and right ventricular (RV) pressure-volume loops during iASD occlusion.
RESULTS
iASD occlusion led to a volume shift from the RV (RV end-diastolic volume index: pre 102 [IQR: 80 to 120] ml/m
CONCLUSIONS
iASD closure following TMVR leads to a volume shift from the RV to the LV with reduced pulmonary but increased systemic cardiac index and with favorable biventricular interaction at maintained LV filling pressure, resulting in a decline in heart failure symptoms at 1-month follow-up.
Identifiants
pubmed: 33413865
pii: S1936-8798(20)32164-6
doi: 10.1016/j.jcin.2020.10.032
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
54-66Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Author Disclosures Dr. Lurz has received institutional fees and research grants from Abbott Vascular, Edwards, Lifesciences, Medtronic, ReCor, and Occlutech. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.