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Young Investigator Award session: Basic Science, European Heart Journal - Cardiovascular Imaging, Volume 17, Issue suppl_2, December 2016, Pages ii53–ii54, https://doi.org/10.1093/ehjci/jew238
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Background: Percutaneous Mitral valve repair using MitraClip implantation has become a valid alternative for patients with severe mitral regurgitation (MR) and high surgical risk. After mitral valve (MV) replacement with mechanical prosthesis, vortex reversal flow and increase in energy dissipation was observed by Echo-PIV analysis. Aim of the present study was to evaluate if the revised valve anatomy with a generated double or multi-orifice configuration after MitraClip implantation may alter intraventricular flow patterns during diastole. Methods: From May 2015 to April 2016, 13 consecutive patients with severe MR undergoing MitraClip implantation were enrolled. All pts underwent contrast echocardiography before and after the procedure (2±1 days) for Echo-PIV analysis and vortex quantification. Acute procedural success (APS) was defined as successful clip implantation with residual MR grade ≤2+. Following parameters were evaluated by 2D/3D echocardiography: the etiology of MR (functional, ischemic and degenerative), MV anatomic characteristics, tricuspid regurgitation (TR) and pulmonary artery systolic pressure (PASP), LV dimension and function. Following parameters were evaluated by Echo-PIV analysis: vortex area, intensity and geometry, energy dissipation, flow force momentum (ϕ) and flow force dispersion. Results: Study population was divided in two groups according to the success of the procedure (APS in 7 and failure in 6 pts). No difference in MR etiology and severity, leaflets’ length and valve area was found. Patients with APS presented with a less pre-interventional PASP (28±6 vs 53±11 mmHg, p=0.005). By comparing vortex data before and after the procedure, in all patients vortex area and intensity were significantly lower after MitraClip implantation (0.39±0.07 vs 0.32±0.11; p=0.006 and -0.53±0.1 vs-0.30±0.34; p=0.009), confirmed in both sub-groups analysis. Contrary to what observed after MV replacement with mechanical prosthesis, vortex reversal flow was not detected. Finally, only in APS subgroup, a significant flow force dispersion reduction (50±3.4 vs 45±5; p=0.01) was found. Conclusion: The results of this study showed significant changes in intraventricular flow patterns following MitraClip implantation with different characteristics as compared to patients undergoing surgical MV replacement. A significant reduction of flow turbulence (flow force dispersion) in APS group was found. Further longitudinal studies are necessary to assess the impact of these intraventricular flow patterns on functional outcome.
