Abstract 18591: Can the Clip Restore the Physiological Annular Morphology? Serial Quantitative 4d Echocardiographic Analysis

Abstract

Background: We sought to seek an answer for the question whether the transcatheter mitral valve edge-to-edge repair (TEER) without annuloplasty can induce chronic positive remodeling of the annulus and restore the physiological saddle-shape morphology after the procedure. Methods: We serially analyzed the 3D echocardiographic images in 20 patients who were successfully treated with MitraClip for symptomatic severe mitral regurgitation (MR) (16 functional, and 8 degenerative). Four patients who had the recurrence of MR greater than moderate at chronic phase (3 functional, and 1 degenerative) were also evaluated. 4D-volumetric transesophageal (TEE) and transthoracic echocardiography (TTE) data were assessed offline by dedicated software at 1) before, 2) 5-day and 3) 1-year after the clipping procedure. Results: Annulus shortened in anterior-posterior (AP) direction in early after the TEER procedure (5-day), with keeping anterolateral-posteromedial (AL-PM) diameter and annulus circumference. Following the initial A-P reshape of the annulus, annular diameters reduced both in AP and ML directions with restoring physiological saddle shape (annulus height/AL-PM diameter) in one-year after the valve leaflet intervention (see figure). Conclusions: Fixing leaflet coaptation by successful TEER could induce chronic positive remodeling of the entire mitral annulus, with restoring its physiological saddle shape. Our results show that simple reduction in MR burden can cause the beneficial restoration of the valve apparatus morphology. Progressive negative annular remodeling was found in patients with recurrent MR.