Diastolic transmitral valve pressure gradients in patients with severe calcific aortic stenosis

Yong, Gerald; Ali, Aman; Feldman, Ted

doi:10.1002/ccd.22195

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…A recent catheterisation study reported that a significant transmitral valve gradient is commonly seen in patients with severe calcific AS who underwent balloon aortic valvuloplasty. 8 However, no morphological data of the mitral valve were mentioned regarding the underlying mechanism of this transmitral valve pressure gradient in these patients. Thus, MAC is associated with calcific aortic valve diseases, but its adverse impact on mitral valve geometry and function in patients with degenerative AS has not been established.…”

Section: Discussionmentioning

confidence: 95%

“… 6 Although degenerative AS is known to involve both the aortic valves and systemic arteries, 2 3 7 there have been only a few reports describing associated mitral valve apparatus pathology. 8 Yong et al 8 have described the increase in the diastolic transmitral valve pressure gradient in patients with degenerative AS. However, the underlying mechanism of this phenomenon has yet to be defined.…”

Section: Introductionmentioning

confidence: 99%

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Calcific extension towards the mitral valve causes non-rheumatic mitral stenosis in degenerative aortic stenosis: real-time 3D transoesophageal echocardiography study

et al. 2014

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ObjectiveMitral annular/leaflet calcification (MALC) is frequently observed in patients with degenerative aortic stenosis (AS). However, the impact of MALC on mitral valve function has not been established. We aimed to investigate whether MALC reduces mitral annular area and restricts leaflet opening, resulting in non-rheumatic mitral stenosis.MethodsReal-time three-dimensional transoesophageal images of the mitral valve were acquired in 101 patients with degenerative AS and 26 control participants. The outer and inner borders of the mitral annular area (MAA) and the maximal leaflet opening angle were measured at early diastole. The mitral valve area (MVA) was calculated as the left ventricular stroke volume divided by the velocity time integral of the transmitral flow velocity.ResultsAlthough the outer MAA was significantly larger in patients with AS compared to control participants (8.2±1.3 vs 7.3±0.9 cm2, p<0.001), the inner MAA was significantly smaller (4.5±1.1 vs 5.9±0.9 cm2, p<0.001), resulting in an average decrease of 45% in the effective MAA. The maximal anterior and posterior leaflet opening angle was also significantly smaller in patients with AS (64±10 vs 72±8°, p<0.001, 71±12 vs 87±7°, p<0.001). Thus, MVA was significantly smaller in patients with AS (2.5±1.0 vs 3.8±0.8 cm2, p<0.001). Twenty-four (24%) patients with AS showed MVA <1.5 cm2. Multivariate regression analysis including parameters for mitral valve geometry revealed that a decrease in effective MAA and a reduced posterior leaflet opening angle were independent predictors for MVA.ConclusionsCalcific extension to the mitral valve in patients with AS reduced effective MAA and the leaflet opening, resulting in a significant non-rheumatic mitral stenosis in one-fourth of the patients.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Calcific extension towards the mitral valve causes non-rheumatic mitral stenosis in degenerative aortic stenosis: real-time 3D transoesophageal echocardiography study

et al. 2014

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Section: Introductionmentioning

confidence: 99%

“…Although the vast majority of mitral stenosis (MS) in the world results from rheumatic heart disease, senile degenerative MS is common in the elderly population [1,2]. Especially, in elderly patients with symptomatic severe calcific aortic stenosis (AS), there is a high prevalence of MS [2][3][4]. Mitral annular calcification (MAC), which is reported to exist in about 50% of severe AS patients [5][6][7], can be a cause of MS in senile calcific aortic stenosis [1,8].…”

Section: Introductionmentioning

confidence: 99%

Impact of transcatheter aortic valve replacement on hemodynamic status in patients with aortic stenosis and mitral stenosis: Doppler echocardiographic study

Kato

Shibayama²,

Omori³

et al. 2019

Journal of Cardiology

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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 AE 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 AE 12 mL to 63 AE 18 mL, p = 0.041), MPG decreased and MVA increased (6.9 AE 3.8 mmHg to 5.1 AE 2.5 mmHg, p = 0.011 for MPG and 1.12 AE 0.25 cm 2 to 1.49 AE 0.43 cm 2 , 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.

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“…Some of such patients show increased transmitral valve pressure gradient (i.e. mitral stenosis (MS)) due to the extension of calcification to the mitral valve leaflets, which is variously termed calcific MS, non-rheumatic MS, or degenerative MS (DMS) [4][5][6][7][8][9][10][11][12]. DMS is often found in patients with cardiovascular risk factors [6].…”

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confidence: 99%

Prevalence and clinical characteristics of degenerative mitral stenosis

Ukita¹,

Yuda

Sugio³

et al. 2016

Journal of Cardiology

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Diastolic transmitral valve pressure gradients in patients with severe calcific aortic stenosis

Abstract: A significant MVG is commonly seen in patients with severe calcific aortic stenosis and is associated with higher pulmonary arterial and left atrial pressures.

Cited by 8 publications

References 17 publications

Calcific extension towards the mitral valve causes non-rheumatic mitral stenosis in degenerative aortic stenosis: real-time 3D transoesophageal echocardiography study

Calcific extension towards the mitral valve causes non-rheumatic mitral stenosis in degenerative aortic stenosis: real-time 3D transoesophageal echocardiography study

Impact of transcatheter aortic valve replacement on hemodynamic status in patients with aortic stenosis and mitral stenosis: Doppler echocardiographic study

Prevalence and clinical characteristics of degenerative mitral stenosis

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