Hemodynamics rounds: Hemodynamics of mitral valve interventions

Abstract

Mitral valvulopathy presents as regurgitation, stenosis, or mixed disease and can occur in both native and prosthetic valves. Such disease develops in conjunction with pathophysiologic changes in the left atrium (LA) and drives changes in LA compliance, pressure, and thus clinical syndromes. With advances in the understanding and treatment of structural heart disease and in the setting of higher‐risk patient populations, less‐invasive transcatheter approaches have become increasingly commonplace in the treatment of mitral valve disease. Over time, transcatheter mitral valve interventions have evolved to include paravalvular leak closure, mitral valve repair, and mitral valve replacement. Parallel to this evolution, advances in invasive intracardiac pressure monitoring, particularly at the level of the LA, have also occurred. These advances emphasize the unique interplay between mitral valve disease and LA function; account for limitations of noninvasive assessment; and guide beneficial outcomes in each area of transcatheter mitral valve intervention. As a result, continuous transseptal LA pressure monitoring has developed into an indispensable instrument in successful percutaneous mitral valve intervention, complementing traditional noninvasive assessment.

Symptomatic Response to Transcatheter Mitral Valve Repair According to Baseline Left Atrial Pressure

“…During ventricular systole, it fills with blood returning from the pulmonary venous circuit until the onset of ventricular diastole, when it delivers pre-load to the LV through passive filling and atrial contraction. 14 The presence of mitral valve regurgitation disrupts this normal process and leads to the development of changes in the LA structure and compliance in order to overcome these barriers. Owing to this close relationship, invasive hemodynamic assessment of LA parameters has become a critical tool in the evaluation of mitral valve disorders.…”

“…The advent of continuous LAP monitoring during TMVr has proven to be an invaluable addition to intra-procedural TEE, which is often limited by eccentric jets and shadowing from prosthetic material. 14 It allows for real-time assessment of pressure changes after device deployment and can be used to minimize post-procedural valvular leak and maximize clinical outcomes. The degree of left atrial V-wave reduction during TMVr predicts improvement in 6-minute walk distance and elevations in LAP following TMVr are associated with adverse clinical outcomes.…”

Hemodynamics in mitral regurgitation – before and after correction with MitraClip

“…Lloyd и кол. [10] демонстрират непосредствения ефект върху хемодинамиката на лявото предсърдие на три типа транскатетърни интервенции по повод митрална инсуфициенция. Първият представен пациент е с тотална сърдечна недостатъчност и високостепенна парапротезна митрална клапна инсуфициенция.…”