TY - JOUR
T1 - Impact of transcatheter aortic valve replacement on hemodynamic status in patients with aortic stenosis and mitral stenosis
T2 - Doppler echocardiographic study
AU - Kato, Nahoko
AU - Shibayama, Kentaro
AU - Omori, Nami
AU - Hoshina, Mizuho
AU - Makihara, Yu
AU - Okumura, Hiroshi
AU - Tabata, Minoru
AU - Obunai, Kotaro
AU - Hirao, Kenzo
AU - Pellikka, Patricia A.
AU - Watanabe, Hiroyuki
N1 - Funding Information:
The results of this study have already been presented at the 82nd Annual Scientific Meeting of the Japan Circulation Society on March 25, 2018.
Publisher Copyright:
© 2019 Japanese College of Cardiology
PY - 2019/12
Y1 - 2019/12
N2 - Background: Mitral stenosis (MS) is often concomitant with aortic stenosis (AS). However, little is known about the functional status following transcatheter aortic valve replacement (TAVR) alone in patients with severe AS and MS and the impact of TAVR for AS on MS hemodynamics. Methods: We enrolled 11 patients (age 83.6 ± 4.7 years, eight women) with severe AS and MS who underwent TAVR. We compared New York Heart Association (NYHA) functional class and mean transmitral pressure gradient (MPG), mitral valve area (MVA), and stroke volume (SV) measured by transthoracic Doppler echocardiography between baseline and after TAVR. We also examined the calcification of the mitral annulus and mitral leaflet opening. Results: NYHA functional class improved after TAVR in all 11 patients. As SV increased after TAVR (52 ± 12 mL to 63 ± 18 mL, p = 0.041), MPG decreased and MVA increased (6.9 ± 3.8 mmHg to 5.1 ± 2.5 mmHg, p = 0.011 for MPG and 1.12 ± 0.25 cm2 to 1.49 ± 0.43 cm2, p = 0.035 for MVA). However, MPG increased in one patient in whom calcification extended into the entire anterior mitral leaflet (AML) and AML mobility was severely reduced. Conclusions: NYHA functional class and hemodynamic status of MS improved after TAVR in patients with severe AS and MS. TAVR might provide therapeutic efficacy for selected symptomatic severe AS patients with MS.
AB - Background: Mitral stenosis (MS) is often concomitant with aortic stenosis (AS). However, little is known about the functional status following transcatheter aortic valve replacement (TAVR) alone in patients with severe AS and MS and the impact of TAVR for AS on MS hemodynamics. Methods: We enrolled 11 patients (age 83.6 ± 4.7 years, eight women) with severe AS and MS who underwent TAVR. We compared New York Heart Association (NYHA) functional class and mean transmitral pressure gradient (MPG), mitral valve area (MVA), and stroke volume (SV) measured by transthoracic Doppler echocardiography between baseline and after TAVR. We also examined the calcification of the mitral annulus and mitral leaflet opening. Results: NYHA functional class improved after TAVR in all 11 patients. As SV increased after TAVR (52 ± 12 mL to 63 ± 18 mL, p = 0.041), MPG decreased and MVA increased (6.9 ± 3.8 mmHg to 5.1 ± 2.5 mmHg, p = 0.011 for MPG and 1.12 ± 0.25 cm2 to 1.49 ± 0.43 cm2, p = 0.035 for MVA). However, MPG increased in one patient in whom calcification extended into the entire anterior mitral leaflet (AML) and AML mobility was severely reduced. Conclusions: NYHA functional class and hemodynamic status of MS improved after TAVR in patients with severe AS and MS. TAVR might provide therapeutic efficacy for selected symptomatic severe AS patients with MS.
KW - Aortic stenosis
KW - Echocardiography
KW - Mitral stenosis
KW - Transcatheter aortic valve replacement
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U2 - 10.1016/j.jjcc.2019.05.010
DO - 10.1016/j.jjcc.2019.05.010
M3 - Article
C2 - 31256928
AN - SCOPUS:85067784361
VL - 74
SP - 532
EP - 538
JO - Journal of Cardiology
JF - Journal of Cardiology
SN - 0914-5087
IS - 6
ER -