Steps Toward the Percutaneous Replacement of Atrioventricular Valves

Boudjemline, Younès; Agnoletti, Gabriella; Bonnet, Damien; Behr, L.; Borenstein, Nicolas; Sidi, Daniel; Bonhoeffer, Philipp

doi:10.1016/j.jacc.2005.01.063

Cited by 109 publications

(41 citation statements)

References 9 publications

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“…5,7,11,12 The present study offers mechanistic insights that can potentially be applied to improve repair for functional TR in both operative and newly emerging percutaneous approaches. 37 In the present study, we demonstrated that changes in the 3D annular shape also predicted functional TR, not just annular area alone, and hence, achievement of a saddle shape may be an important therapeutic goal beyond that of annular reduction alone. Ideally, annular remodeling with tricuspid annuloplasty should take into account the geometric changes that occur with TR, namely, increased circularity and planarity, and restore the normal bimodal-elliptical shape of the tricuspid annulus to reduce leaflet tethering and leaflet stress.…”

Section: Ton-nu Et Al Geometric Determinants Of Functional Tr 147mentioning

confidence: 50%

Geometric Determinants of Functional Tricuspid Regurgitation

et al. 2006

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Background-Tricuspid regurgitation (TR) is an important predictor of morbidity and mortality in heart failure. We aimed to examine the 3D geometry of the tricuspid valve annulus (TVA) in patients with functional TR, comparing them with patients with normal tricuspid valve function and relating annular geometric changes to functional TR. Methods and Results-TVA shape was examined by real-time 3D echocardiography in 75 patients: 35 with functional TR and 40 with normal tricuspid valve function (referent group). The 3D shape of the TVA was reconstructed from rotated 2D planes, and the annular plane was computed by least-squares fitting. Annular area and mediolateral, anteroposterior, and high (superior)-low (inferior) distances were calculated. TR was assessed by vena contracta width. The normal TVA has a bimodal pattern (high-low distanceϭ7.23Ϯ1.05 mm). High points were located anteroposteriorly, and low points were located mediolaterally. With moderate or greater TR (vena contracta width 5.80Ϯ2.62 mm), the TVA became dilated (17.24Ϯ4.75 versus 9.83Ϯ2.18 cm 2 , PϽ0.0001, TR versus referent), more planar with decreased high-low distance (4.14Ϯ1.05 mm), and more circular with decreased ratio of mediolateral/anteroposterior (1.11Ϯ0.09 versus 1.32Ϯ0.09, PϽ0.0001, TR versus referent). Conclusions-The normal TVA has a bimodal shape with distinct high points located anteroposteriorly and low points located mediolaterally. With functional TR, the annulus becomes larger, more planar, and circular. These changes in annular shape with TR have potentially important mechanistic and therapeutic implications for tricuspid valve repair.

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Section: Ton-nu Et Al Geometric Determinants Of Functional Tr 147mentioning

confidence: 50%

Geometric Determinants of Functional Tricuspid Regurgitation

et al. 2006

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“…In 2005, Boudjemline et al 45 described a novel percutaneous tricuspid valve consisting of a bovine jugular venous valve mounted to a self-expanding nitinol frame consisting of 2 disks. The device was deployed through an 18F sheath in the right internal jugular vein, with right ventricular and right atrial disks deployed sequentially to sandwich the native tricuspid valve ( Figure 6).…”

Section: Relevance In the Percutaneous Eramentioning

confidence: 99%

The Tricuspid Valve

2009

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Abstract-Cardiovascular specialists have entered an era of renewed interest and enthusiasm surrounding the diagnosis and treatment of valvular heart disease, driven in part by emerging percutaneous therapies for the treatment of aortic, pulmonic, and mitral valve disease. Despite this wave of investigation, little or no attention has been given to the treatment of tricuspid valve disease. Tricuspid regurgitation (TR) occurs mainly from tricuspid annular dilation, which can result from left-sided heart failure from myocardial or valvular causes, right ventricular volume and pressure overload, or dilation of cardiac chambers. If untreated at the time of surgical mitral valve repair, significant residual TR negatively impacts perioperative outcomes, functional class, and survival. TR does not reliably resolve after successful mitral valve surgery. If present at the time of mitral valve surgery, TR can usually be effectively addressed with ring annuloplasty. Because reoperations for recurrent TR carry high mortality rates, few patients are offered reoperation for redo tricuspid repair or replacement. As transcatheter therapies for mitral regurgitation arise, parallel percutaneous approaches for TR may be necessary. In this article, we review the anatomy, pathophysiology, and value of mechanical correction of TR, including potential transcatheter therapies for TR.

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“…As demonstrated by Boudjemline et al, 2 orthotopic valve replacement is possible but carries a risk of injury and paravalvular leakage. The vicinity to the endocardium is likely to contribute to ventricular arrhythmia.…”

Section: To the Editormentioning

confidence: 96%