Abstract
Mitral regurgitation (MR) is a frequent valvular disease among patients deemed too high risk for surgery. Echocardiography along with CT is the primary diagnostic tool for MR and offers a comprehensive 3D assessment in patient selection and screening for the optimal treatment method. The direct percutaneous mitral annuloplasty addresses the underlying mechanisms of functional MR with a less invasive, catheter-based approach. The here-described techniques proved a sufficient safety profile, delivered significant MR reduction in most of the cases, and were associated with a notable improvement of symptoms. Although long-term outcome assessment is needed to support these early reports, the percutaneous mitral annuloplasty is likely to set a new standard of treatment in the forthcoming future.
Highlights
Mitral regurgitation (MR) is the most frequent valve disease in developed countries [1]
In previously conducted studies, based on surgical experience, the investigators demonstrated that the combination of leaflet repair with surgical annuloplasty has a potential for a lower rate of MR recurrence [35]
The percutaneous annuloplasty devices are primarily intended for the stand-alone treatment of functional mitral regurgitation (FMR), the simultaneous usage of two therapies may become an alternative strategy for some subgroups [36]
Summary
Mitral regurgitation (MR) is the most frequent valve disease in developed countries [1]. Referred to as secondary or as functional mitral regurgitation (FMR), it is caused by sustained left ventricle injury in the course of myocardial infarction or certain forms of cardiomyopathy, leading to left ventricle remodeling. Building on the years of experience with mitral valve replacement and repair procedures, together with a desire for a less invasive approach, multiple percutaneous technologies have emerged as a feasible and convenient therapeutic option for patients with MR. They can be classified depending on the anatomical and pathophysiological grounds: the indirect and direct annuloplasty, left ventricle (LV) remodeling devices, and leaflet and chordal repair procedures. This review aims to summarize current principles for patient selection and pre-procedural planning for direct transcatheter annuloplasty followed by the procedural know-how
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