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Eur Heart J Cardiovasc Imaging 2021 May 13. Epub 2021 May 13.

Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland.

Secondary mitral regurgitation (MR) is the most common and undertreated form of MR, whose contribution to poor prognosis and indications to correction remains under discussion. MR has been characterized into 'proportionate' or 'disproportionate', based on left ventricle (LV) and regurgitant volumes, whereas 'tertiary' MR identifies conditions, in which regurgitation is pathologic per se and actively contributes to LV dysfunction. Echocardiographic and anatomo-pathological studies revealed that secondary MR prompts subtle leaflet maladaptive changes, actively contributing to the dynamic progression of secondary MR. Read More

J Interv Cardiol 2021 21;2021:6659261. Epub 2021 Apr 21.

Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.

MitraClip edge-to-edge (E2E) repair system is the only transcatheter device recommended in the current guidelines for treating mitral regurgitation (MR). The percutaneous femoral venous transseptal access of MitraClip requires a complex steerable delivery system and may thus be technically complex to optimally position and deploy the clip onto the mitral valve. A transapical approach for E2E repair has been devised to treat MR for the ease of operation (ValveClamp system, Hanyu Medical Technology, Shanghai). Read More

Kyobu Geka 2021 Feb;74(2):152-155

Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan.

A 78-year-old man with mitral regurgitation incidentally diagnosed with aneurysm of the left internal thoracic artery(LITA) and several internal thoracic artery-pulmonary artery( ITA-PA) fistulas originating from the aneurysm. To prevent rupture of the aneurysm, ITA ligation was performed during surgery for the mitral valve. Because of the complex anatomy surrounding the aneurysm, the main duct of the ITA was ligated at the peripheral and center of the aneurysm, then arterial fistulae were resected as many as possible. Read More

Circ Cardiovasc Imaging 2021 May 4:CIRCIMAGING121012656. Epub 2021 May 4.

Division of Cardiology, Department of Medicine, Washington University, St Louis, MO. (J.D.M., R.G.B., S.C.M., S.C.).

Minerva Cardiol Angiol 2021 May 4. Epub 2021 May 4.

Cardiovascular Imaging Unit, San Raffaele Hospital, Milan, Italy -

Mitral regurgitation is the most prevalent valve disease worldwide. Percutaneous mitral valve interventions are emerging as alternative options for high-risk patients with severe mitral regurgitation not eligible for conventional surgery. Accurate patient selection is based on a detailed pre-procedural multimodality imaging evaluation. Read More

Quant Imaging Med Surg 2021 May;11(5):1899-1908

Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Background: Hemodialysis (HD) can influence end-stage renal disease (ESRD) patients' circulatory system. The present study aimed to evaluate the effect of volume depletion on left ventricular (LV) and left atrial (LA) function and determine the volume-independent parameters before and after HD in patients with ESRD.

Methods: Between January 2018 and January 2019, we recruited long-term HD patients (n=40, 51. Read More

PLoS One 2021 29;16(4):e0248862. Epub 2021 Apr 29.

Department of Paediatric Cardiology and General Paediatrics, Medical University of Warsaw, Warsaw, Poland.

Aims: The aim of the study was to evaluate left ventricular (LV) remodeling and systolic function using two-dimensional speckle tracking echocardiographic (2D STE) imaging in children at a long-term (more than 36 months, 107.5±57.8 months) after balloon valvuloplasty for aortic stenosis (BAV). Read More

Int J Cardiovasc Imaging 2021 Apr 25. Epub 2021 Apr 25.

Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy.

Patients with mitral valve prolapse (MVP), undergoing early surgery for severe regurgitation, are usually characterized by a low degree of right chambers' remodeling. In this selected population, the mechanisms leading to tricuspid annular (TA) dilatation (TAD) are not well understood. In this setting, we aimed to evaluate, using three-dimensional echocardiography (3DE), how right chambers affect TA size and might contribute to functional tricuspid regurgitation (FTR) progression. Read More

J Vet Cardiol 2021 Mar 24;35:90-100. Epub 2021 Mar 24.

Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, 24061, USA.

Introduction: Echocardiographically identified pulmonary hypertension is an independent predictor of poor outcome in dogs affected by myxomatous valvular degeneration (MMVD). Systolic pulmonary arterial pressure is routinely estimated based on its relationship with the Doppler-determined velocity of tricuspid regurgitation as defined by the simplified Bernoulli equation (sPAP_D). Experimental studies suggest that the method is imperfect, but its accuracy in dogs with MMVD is not known. Read More

Cardiol Clin 2021 May;39(2):267-280

Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.

Transcatheter edge-to-edge mitral valve repair is a minimally invasive treatment option for selected patients with moderate to severe or severe mitral regurgitation. Although transcatheter edge-to-edge mitral valve repair offers a significant step forward in the management of mitral regurgitation, the rate of procedural-related complications is not trivial. High-quality periprocedural imaging is important for optimal patient selection and procedural success. Read More

Open Heart 2021 04;8(1)

Cardiology, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland.

JACC Cardiovasc Interv 2021 Apr;14(8):890-891

Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.

JACC Cardiovasc Interv 2021 Apr;14(8):879-889

Cardiovascular Research Foundation, New York, New York, USA; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: https://twitter.com/GreggWStone.

Objectives: The authors sought to evaluate the association between mean mitral valve gradient (MVG) and clinical outcomes among patients who underwent MitraClip treatment for secondary mitral regurgitation (SMR) in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial.

Background: In the COAPT trial, patients with heart failure (HF) and severe SMR who remained symptomatic despite guideline-directed medical therapy had marked 2-year reductions in mortality and HF hospitalizations after treatment with MitraClip.

Methods: MitraClip-treated patients were divided into quartiles (Q) based on discharge echocardiographic MVG (n = 250). Read More

JACC Cardiovasc Interv 2021 Apr;14(8):830-845

Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA.

Objectives: The aim of this study was to evaluate 1-year outcomes of valve-in-mitral annular calcification (ViMAC) in the MITRAL (Mitral Implantation of Transcatheter Valves) trial.

Background: The MITRAL trial is the first prospective study evaluating the feasibility of ViMAC using balloon-expandable aortic transcatheter heart valves.

Methods: A multicenter prospective study was conducted, enrolling high-risk surgical patients with severe mitral annular calcification and symptomatic severe mitral valve dysfunction at 13 U. Read More

EuroIntervention 2021 Apr;16(17):1386-1387

Heart Valve Center, NYU Langone Health, New York, NY, USA.

EuroIntervention 2021 Apr;16(17):1384-1385

Service Médico-Chirurgical, Valvulopathies - Chirurgie Cardiaque - Cardiologie Interventionnelle Structurelle, Hôpital Cardiologique de Haut Lévèque, Bordeaux, France.

J Am Soc Echocardiogr 2021 Apr 16. Epub 2021 Apr 16.

Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. Electronic address:

Transcatheter edge-to-edge mitral valve repair has revolutionized the treatment of primary and secondary mitral regurgitation. The landmark EVEREST (Endovascular Valve Edge-to-Edge Repair Study) and COAPT (Clinical Outcomes Assessment of the MitraClip Percutaneous Therapy for High Surgical Risk Patients) trials included only clinically stable patients with favorable mitral valve anatomy for edge-to-edge repair. However, since its initial commercial approval in the US, growing operator experience, device iterations, and improvements in intraprocedural imaging have led to an expansion in the utilization of transcatheter edge-to-edge repair to more complex mitral valve pathologies and clinical scenarios, many of which were previously considered a contraindication for the procedure. Read More

Front Physiol 2021 1;12:639761. Epub 2021 Apr 1.

Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.

Introduction: Pulmonary artery pressure (PAP) is increased and right ventricular (RV) function is well preserved in healthy subjects upon exposure to high altitude (HA). An increase in PAP may trigger notching of the right ventricular outflow tract Doppler flow velocity envelope (RVOT notch), which is associated with impaired RV function in patients with pulmonary hypertension. However, whether HA exposure can induce RVOT notch formation and the subsequent impact on cardiac function in healthy subjects remains unclear. Read More

JACC Cardiovasc Imaging 2021 Apr 7. Epub 2021 Apr 7.

Cardiovascular Imaging Program (Departments of Medicine and Radiology), Brigham and Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA. Electronic address:

Objectives: This study sought to evaluate cardiac computed tomography (CCT) findings and their clinical impact among patients being considered for transcatheter mitral valve replacement (TMVR).

Background: CCT is used to evaluate whether patients are candidates for TMVR, but limited data exist on the yield of such tests.

Methods: Patients referred for pre-procedural CCT for TMVR planning in the context of failing mitral bioprosthetic valves, annuloplasty rings, and severe native valve disease with annular calcification were included in this study. Read More

JACC Cardiovasc Imaging 2021 Mar 17. Epub 2021 Mar 17.

Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands.

Catheter Cardiovasc Interv 2021 Apr 13. Epub 2021 Apr 13.

Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.

Objectives: We present our initial experience with the fourth-generation MitraClip™ (G4) system and propose preliminary criteria for device selection.

Background: The MitraClip™ G4 system recently underwent a "controlled release" for transcatheter edge-to-edge mitral valve repair. The four new devices include technical improvements such as controlled gripper actuation (independent leaflet capture) and continuous left atrial pressure monitoring. Read More

Future Cardiol 2021 Apr 12. Epub 2021 Apr 12.

University of South Florida, Tampa, FL 33612, USA.

Mitral valve regurgitation (MR) is due primarily to either primary degeneration of the mitral valve with Barlow's or fibroelastic disease or is secondary to ischemic or nonischemic cardiomyopathies. Echocardiography is essential to assess MR etiology and severity, the remodeling of cardiac chambers and to characterize longitudinal chamber changes to determine optimal therapies. Surgery is recommended for severe primary MR if persistent symptoms are present or if left ventricle dysfunction is present with an EF <60% or a left ventricle end-systolic diameter ≥40 mm. Read More

Ann Thorac Surg 2021 Apr 7. Epub 2021 Apr 7.

Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of medicine and surgery, University of Milano-Bicocca, Milan, Italy.

Background: Current mitral bioprostheses are akin to the aortic valve and therefore abolish the left ventricular (LV) physiological vortex. We evaluated the hemodynamic performance and the effects on intraventricular flow dynamics (IFD) of a novel mitral bioprosthesis that presents an innovative design, mimicking the native valve.

Methods: A D-shaped self-expandable stent-bovine pericardium monoleaflet valve was designed to provide physiological asymmetric intraventricular flow. Read More

JACC Cardiovasc Imaging 2021 Apr;14(4):879

Department of Internal Medicine, Division of Cardiology, Northwestern University Medical School, Chicago, Illinois, USA.

JACC Cardiovasc Imaging 2021 Apr;14(4):809-811

National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.

JACC Cardiovasc Imaging 2021 Apr;14(4):797-808

Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address:

Objectives: This study was designed to compare the clinical and echocardiographic characteristics, management, and outcomes of severe atrial functional mitral regurgitation (AFMR) to primary mitral regurgitation (PMR).

Background: AFMR remains poorly defined clinically.

Methods: Consecutive patients who underwent transesophageal echocardiography at our institution between 2011 and 2018 for severe mitral regurgitation with preserved left ventricular function were screened. Read More

JACC Cardiovasc Imaging 2021 Apr;14(4):794-796

Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

JACC Cardiovasc Imaging 2021 Apr;14(4):782-793

Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA. Electronic address:

Objectives: The aim of this study was to assess mitral valve (MV) remodeling and strain in patients with secondary mitral regurgitation (SMR) compared with primary MR (PMR) and normal valves.

Background: A paucity of data exists on MV strain during the cardiac cycle in humans. Real-time 3-dimensional (3D) echocardiography allows for dynamic MV imaging, enabling computerized modeling of MV function in normal and disease states. Read More

JACC Cardiovasc Imaging 2021 Apr;14(4):766-767

University of Montreal, Montreal, Quebec, Canada. Electronic address:

JACC Cardiovasc Imaging 2021 Apr;14(4):711-714