Green Morphology Research Articles

Impact of mitral valve anatomy suitability in echocardiographic and clinical evolution in patients referred for percutaneous edge-to-edge repair

Abstract Background Percutaneous edge-to-edge mitral repair has become an effective therapeutic alternative to surgery in high-risk patients with moderate-to-severe mitral regurgitation (MR). A traffic light system has been proposed to evaluate echocardiographic suitability for this therapy. However, few data is available regarding prognostic impact of these criteria. Purpose To study the impact of imaging eligibility classification in echocardiographic and clinical evolution. Methods We evaluated all the consecutive patients who underwent percutaneous mitral repair with the MitraClip system between 2010 and 2020 in our tertiary university hospital, excluding the redo procedures (n=1). Imaging eligibility classification was blindly made by two experts in structural heart disease. Pre and posprocedural echocardiographic measurements were reassessed and clinical events were collected from medical records. Results 87 patients (65.5% males) with a mean age of 76±10 years were finally included. Regarding mitral valve disease, 13 (14.9%) was graded as moderate-to-severe whereas 74 (85.1%) was considered severe. MR etiology was: functional 44.8%, organic 34.5% and mixed 20.7%. Prior to the procedure the NYHA class was III or higher in 88.5% and LVEF was 44.4±15.4%. Eligibility criteria was: green (44, 50.6%), yellow (39, 44.8%) and red (4, 4.6%). The later patients, with theorical contraindication for the procedure, were excluded from analysis. Although less number of clips were needed in green morphology (1.14 vs 1.46; p=0.01), pulmonary vein flow improved more markedly (Table) in these patients. This resulted only in a slightly greater reduction in MR grade at 6 months (−2.5 vs −1.9; p=0.008). No differences were noted in follow up absolute MR grade or changes in ventricular volumes, LVEF or pulmonary artery systolic pressure. Moreover, there was no impact in MACE during the evolution. Conclusion Excluding contraindicated group, no relevant echocardiographic or clinical impact was noted regarding eligibility criteria for percutaneous edge-to-edge mitral repair. Thus, suboptimal patients may equally benefit from this therapy even in moderate-volume centers. Funding Acknowledgement Type of funding sources: None. Table 1. Postprocedural pulmonary vein flow pattern in relation with eligibility criteria

Temperature and Spatiotemporal Variability of Salicylihalamide A in the Sponge Haliclona sp.

The production of salicylihalamide A by the marine sponge Haliclona sp. was investigated. Samples of the two morphologies (green and brown) were collected from four locations covering approximately 1,200 km of coastline. Temporal variation between winter and summer was also examined at Bremer Bay. Chemical profiling by using liquid chromatography coupled with ultra violet detection and mass spectrometry showed that salicylihalamide A was produced only by the green morphology. Salicylihalamide A concentration was significantly correlated to water temperature but not to the size or depth of the sponge. Salicylihalamide A concentration was found to differ significantly among locations (Bremer Bay 13.5 microg g(-1), Hamelin Bay 11 microg g(-1), Rottnest Island 9.9 microg g(-1), and Jurien Bay 8.5 microg g(-1)) partially accounted for by the influence of water temperature. A difference between seasons was also observed in Bremer Bay (summer concentration of 13.5 microg g(-1) vs. winter concentration of 8.2 microg g(-1)). Environmental and physiological factors appear to be important in the production of salicylihalamide A by the green morphology. Additionally, the brown morphology does not produce salicylihalamide A, thus adding to the evidence that this morphology may be a different species.