Long-term Echocardiographic Follow-up Research Articles

Echocardiographic Strain Evaluation Shows Persistent Echocardiographic Changes at 1 Year after Diagnosis of Multisystem Inflammatory Syndrome in Children.

Coronavirus disease (COVID-19) is a global pandemic causing multisystem inflammatory syndrome in children (MIS-C). This study evaluated the long-term echocardiographic impact of MIS-C on patients and compared it with that in a healthy control group. Data from 22 children with MIS-C admitted to Jeonbuk National University Hospital and 22 healthy children (control group) were retrospectively analyzed. Echocardiographic data were compared at two distinct time points: diagnosis and 1-year follow-up. At diagnosis, the MIS-C cohort exhibited significantly reduced left ventricular ejection fraction (LVEF), longitudinal strain across the apical 4- and 2-chamber views, and global longitudinal strain (GLS). At 1-year follow-up, the reduced LVEF in the apical 4-chamber, overall longitudinal strain in the apical 4-chamber, and GLS persisted. However, the right ventricular free wall and global strain remained diminished compared with those in the control group. Despite significant changes over time, the LVEF and longitudinal strain in the apical 4-chamber and z-scores of all coronary arteries were normal at baseline and 1-year follow-up. Persistent cardiac alterations were observed in patients with MIS-C, particularly in both ventricular functions. Therefore, middle- to long-term echocardiographic follow-up may help improve understanding and management of long-term echocardiographic implications in patients with post-COVID-19 syndrome.

Abstract 15841: Echocardiographic Parameters Are Correlated With Initial Infection Severity in Long-Term Post Covid-19 Patients

Introduction: COVID-19 acutely affects the cardiovascular system leading to various cardiac complications. Major concerns are on the less understood long-term cardiovascular consequences of COVID-19. Hypothesis: Post COVID-19 cardiac dysfunctions could be long lasting and vary by severity of initial infection. Methods: This is an on-going prospective observational study from a multidisciplinary Post COVID-19 Research Clinic. Inclusion criteria included both RT-PCR confirmed and recovered COVID-19 patients and control subjects. After IRB approval and informed consents, 83 participants received serial transthoracic echocardiography at 3, 6 or >12 months after initial infection. Pearson’s correlation coefficients, Fisher's exact test and one-way ANOVA was conducted to examine the association between variables, across follow-up time and severity of initial infection. Results: Proximal RVOT diastolic diameter was significantly larger at >12 months’ compared to earlier time points post COVID-19 (2.92±0.55 cm at 3 months, 2.81±0.57 cm at 6 months and 3.15±0.52 cm at >12 months). The posterior wall was significantly thicker in post COVID-19 patients with moderate or severe infection compared to patients with mild infection. The left atrium diameter was significantly larger as the initial infection severity increased. Pulmonary artery acceleration time was significantly shorter as initial infection severity increased indicating higher pulmonary arterial pressure although no significant relationship was found with follow-up time. There were no left ventricular ejection fraction, E/E’ (index of diastolic function) or valvular abnormality differences by either follow-up time or severity. Furthermore, 77% patients with severe infection had grade 1 diastolic dysfunction compared to mild (28.57%) or moderate (33.33%) patients. Conclusions: Long-term echocardiographic follow-up showed increased RV size after COVID-19 over time. Posterior wall thickness, left atrium size and pulmonary artery acceleration time, and diastolic dysfunction were correlated with initial infection severity in long-term post COVID-19 patients suggestive of possible structural changes in recovered patients from COVID-19.

Mid to Long-Term Echocardiographic Follow-up of Patients Undergoing Transcatheter Tricuspid Valve-in-Valve Replacement for Degenerated Bioprosthetic Valves: First Single-Center Report from Iran.

Transcatheter tricuspid valve-in-valve (TTViV) replacement has become an alternative treatment in high-risk patients with bioprosthetic valve degeneration. This is the first report on the mid to long-term echocardiographic findings of patients who underwent TTViV replacement in a cardiac referral center in Iran. Data of 12 patients, consisting of 11 women and 1 man, who underwent TTViV replacement between 2015 and 2021 were reviewed retrospectively. The patients underwent echocardiography before the procedure and at a mean follow-up time of 3.17±1.75 years. All the patients had New York Heart Association (NYHA) function class III/IV before TTViV. Six patients had tricuspid regurgitation, 1 had tricuspid stenosis, and 5 had both. All the patients had successful TTViV. The mean time from the initial valve surgery to TTViV was 6.25±2.45 years. At follow-up, 2 patients had died: 1 due to COVID-19 pneumonia and 1 without a known cause. The remaining 10 patients experienced improvements in the NYHA functional class. Echocardiographic measures showed significant improvements. Transvalvular mean gradient pressure decreased from 7.08±1.98 mm Hg to 5.29±1.63 mm Hg (P=0.028), tricuspid valve pressure half time decreased from 245.00±49.46 ms to 158.64±57.41 ms (P=0.011), tricuspid regurgitation gradient decreased from 39.91±7.31 mm Hg to 26.72±8.99 mm Hg, and left ventricular ejection fraction increased from 47.71±4.70% to 49.79±4.58% (P=0.046). There was no significant paravalvular or transvalvular leakage at follow-up. This is a single-center report on the mid and long-term echocardiographic follow-up of patients after TTViV replacement. Our study showed that TTViV was a safe and efficient method in treating high-risk patients with degenerated bioprosthetic tricuspid valves and had favorable echocardiographic and clinical results.

Robotic Mitral Valve Repair: A Decade of Experience With Echocardiographic Follow-up

BackgroundSurgical approaches for mitral valve (MV) disease have evolved with the aim of developing minimally invasive techniques. Although the safety of robotic procedures has been documented, there are limited data on long-term echocardiographic follow-up. This review demonstrates outcomes of 11 years of robotic MV repair at a single, tertiary institution. MethodsFrom 2008 to 2019, 843 patients underwent robotic MV repair at Mayo Clinic in Rochester, Minnesota. Repeated measures generalized least squares (GLS) modeling was used to assess the echocardiographic changes over time. ResultsThe median age was 58 years (interquartile range, 50.8, 65.5 years), and 591 were male (70.1%). The mechanism of mitral regurgitation was posterior leaflet prolapse in 479 (56.8%) patients, bileaflet prolapse in 325 (38.6%), and anterior leaflet prolapse in 36 (4.3%). There were 3 early deaths (0.4%) and 24 early reoperations (2.8%). Echocardiographic follow-up demonstrated left ventricular end-systolic and end-diastolic dimensions, left atrial volume index, and pulmonary pressure all continuously improved up to 2 years postoperatively. Ejection fraction immediately declined postoperatively but then gradually improved to near normal over 2 years. Survival and freedom from reoperation at 10 years were 93% and 92.6%, respectively. When patients were surveyed after dismissal, 93.4% reported their activity level at or above their peers, and 93.3% reported no activity limitation from cardiac symptoms. ConclusionsRobotic MV repair is safe and effective with excellent long-term results, including echocardiographic data that demonstrated early improvement in cardiac chamber size and maintenance of postoperative cardiac function. Exceedingly low mortality rates and freedom from reoperation are comparable to those of the standard open repair.

Outcome of consistent guideline-based tricuspid management in patients undergoing degenerative mitral regurgitation correction

ObjectivesDespite coherent guidelines, management of functional tricuspid regurgitation (FTR) consequences on outcome in the context of degenerative mitral regurgitation (DMR) remains controversial due to lacking series of large magnitude with rigorous application of tricuspid guidelines and strict long-term echocardiographic follow-up. Thus, we aimed at gathering such a cohort to examine outcomes of patients undergoing DMR surgery following tricuspid surgery guidelines. MethodsAll consecutive patients with isolated DMR 2005-2015 operated on with baseline FTR assessment and tricuspid annulus diameter measurement were identified. Operative complications, postoperative tricuspid regurgitation incidence, and survival were assessed overall and stratified by guideline-based tricuspid annuloplasty (TA) indication (severe FTR or tricuspid annulus diameter ≥40 mm). ResultsAmong 441 patients with DMR undergoing mitral repair (66 ± 13 years, 30% female, ejection fraction 66 ± 10%, systolic pulmonary artery pressures 39 ± 12 mm Hg) followed 6 [3-9] years, patients with TA (n = 234, 53%) had generally similar presentation versus without TA (n = 207, 47%; all P ≥ .2) except for more atrial fibrillation and larger left ventricle (both P ≥ .0003). Patients with TA showed longer bypass time, more maze procedures (all P ≤ .001), but hospital stay, renal-failure, pacemaker implantation, and operative mortality (overall 0.9%) were comparable (all P ≥ .2). Postoperative incidence of moderate/severe FTR (0% at 1 year) became over time greater among patients without TA (5-year 8% [4%-13%] vs 3% [1%-11%] and 10-year 10% [6%-16%] vs 4% [1%-16%], P = .01). Survival (95% confidence interval) throughout follow-up was 85% (77%-89%) at 10 years, with hazard ratio 0.57 (0.29-1.10), P = .09. for patients with TA versus without. ConclusionsIn this large surgical DMR cohort, guideline-based FTR management was safe and effective. While long-term mortality did not reach significance, postoperative incidence of moderate/severe FTR, overall low, was nevertheless greater in patients who did not appear to require TA at surgery and linked to tricuspid annular dimension. Thus, future multicenter prospective cohorts with long-term follow-up are warranted to re-examine thresholds for TA performance and impact on survival.

Superior Long-term Survival After Aortic Valve-sparing Root Surgery in Patients with Connective Tissue Disorder

Objective: Most patients with connective tissue disorder present with aortic root dilatation that may require surgical intervention. In many specialized centres, aortic valve-sparing root surgeries have become the preferred surgical procedure to treat aortic root aneurysm in patients with connective tissue disorder. Methods: A total of 313 patients underwent aortic valve-sparing root surgery at our institution between 1997 and August 2019. Out of these, 83 patients had a connective tissue disorder and were included into further analysis. Follow-up protocol included clinical interview using a structured questionnaire and long-term echocardiographic follow-up. Time-to-event analyses were calculated using the Kaplan-Meier method. Primary endpoint was actual freedom from aortic valve (AV) re-intervention, secondary endpoints were survival and freedom from major adverse cardiac and cerebrovascular events (MACCE). Results: Mean age of the study cohort was 35.4 ± 12.4 years and 60% were male. Marfan syndrome was present in 95.2% and Loeys-Dietz syndrome in 4.8% of the patients. Reimplantation technique of the aortic valve was performed in 72 and remodeling technique of the aortic root in 11 patients. In-hospital and 30-day mortality was 0%. Mean follow-up was 69.6 ± 51.1 (range: 2 - 185 months). Overall survival was 92.1%, 77.5%, and 77.5% at 5, 10 and 15 years. Freedom from AV re-intervention at 5, 10 and 15 years was 92.8%, 78.5 and 78.5%, respectively. No further MACCE (e.g. endocarditis, stroke) occurred in this study cohort during follow-up. Conclusions: In specialized heart centers, aortic valve-sparing root surgery is a safe procedure with very low in-hospital mortality and favorable long-term results in patients with connective tissue disorder.

Mid-term outcome of surgical treatment in patients with aorto-left ventricular tunnel.

The purpose of this study was to review the outcomes of surgical treatment in patients with aorto-left ventricular tunnel and to investigate what kind of patient cohort is more likely to have adverse events. Twenty-one patients with a median age of 6.58 [interquartile range (IQR) 4.17-24.50] years who received surgical treatment of aorto-left ventricular tunnel from March 2002 to December 2019 were reviewed. The median follow-up time was 64.50 (IQR 25.15-120.50) months. Clinical characteristics, surgical methods and follow-up outcomes were summarized in separate groups of patients with or without preoperative aortic valve (AoV) issues. Composite adverse events were defined as death or requirement of reoperation. Time-related analysis of freedom from death and requirement of reoperation was performed with the Kaplan-Meier method. The average tunnel size was 8.68 (standard deviation: 3.62) mm. The most common and the most important associated lesions were AoV lesions. Tunnels in 20 patients were closed with direct sutures or a patch. For 1 patient with an irreparable AoV, the tunnel was cut open simultaneously with aortic valve replacement and aortic root plasty. In the group of patients with preoperative AoV issues, 4 patients received aortic valve replacement with mechanical prosthetic valves and 6 patients received aortic valvuloplasty repair. The follow-up outcomes differed significantly between groups (the incidence of death was 15.38% and the incidence of requiring a reoperation was 46.15% in patients with preoperative AoV issues). In the group without preoperative AoV issues, there were no deaths and no reoperations (Fisher's exact test; P = 0.018). The probability of freedom from death and of the requirement for reoperation between the 2 groups was not significantly different (log-rank, P = 0.09). Overall, the estimated probability of freedom from death and requirement of reoperation was 77.30% (standard error: 10.20%) [95% confidence interval (CI): 49.53-91.00] at 5 years, 67.64% (standard error: 12.70%) (95% CI: 36.71-85.84) at 10 years. Patients with aorto-left ventricular tunnel with preoperative AoV issues are more prone to die or to require a reoperation. In contrast, patients without preoperative AoV issues can be free from death or reoperation for a longer period of time. Patients with preoperative AoV issues need much stricter postoperative long-term echocardiographic follow-up.

Prevalence, Predictors and Prognostic Value of Left Ventricular Reverse Remodeling and Relapse in Patients Hospitalized with Dilated Cardiomyopathy with Long-term Echocardiographic Follow-up

Objectives to investigate prevalence, predictors, prognostic value of left ventricular reverse remodeling (LVRR) and relapse in patients hospitalized with dilated cardiomyopathy (DCM) from the initial center of heart failure (HF) in China. Methods Patients hospitalized in Heart Failure Care Unit, Fuwai Hospital from January 2009 to December 2013 with left ventricular ejection fraction (LVEF) 55 mm on admission were enrolled and followed up until June 2019 or death, heart transplantation, implantation of left ventricular assist device (LVAD). LVRR was defined as an absolute increase in LVEF ≥ 10% to a final level of ≥ 50% and an absolute decrease in LVEDD ≥ 5 mm to a final level of ≤ 55 mm during follow-up without symptoms of HF. Relapse was defined by a reduction in LVEF to 55 mm again after initial LVRR. Results A total of 448 patients were enrolled. After a median follow-up with repeat echocardiograms of 52 (24, 77) months, 126 patients (28.1%) have achieved LVRR, showing a significant increase in LVEF from 30.3±6.2 % at baseline to 56.1±4.6 % at initial LVRR, accompanied by a significant decrease in LVEDD from 65.5±6.9 mm to 50.9±3.1 mm (both P 6 months, odds ratio (OR) 2.433, 95% confidence interval (CI) 1.393-4.252, P = 0.002], systolic blood pressure at discharge (per 10 mmHg increase, OR 1.404, 95% CI 1.158-1.702, P = 0.001), LVEDD at baseline (per 5 mm increase, OR 0.665, 95% CI 0.569-0.778, P 13.7%, OR 2.268, 95% CI 1.231-4.179, P = 0.009) and NT-proBNP levels on admission (≤ 905.7 fmol/ml vs. > 905.7 fmol/ml, OR 2.189, 95% CI 1.175-4.080, P = 0.014) were significantly independent baseline predictors of LVRR. After a median clinical follow-up of 70 (43, 89) months, patients with LVRR showed a significantly lower occurrence of cardiovascular events than those without LVRR (4.8% vs. 30.9%, P Conclusions Based on current optimal medical and device therapy, about 30% patients with DCM in China can achieve LVRR which is associated with better prognosis. Some baseline parameters can predict the occurrence of LVRR. However, some patients, especially those discontinuing medications may suffer from relapse after initial LVRR.

P1781 Cardio-protective role of dexrazoxane co-administered with anthracyclines: long-term echocardiographic follow-up in adult survivors of pediatric cancer

Abstract Background Cardiovascular disease is a well-recognized cause of increased late morbidity and mortality among survivors of childhood cancer treated with anthracyclines. A decrease in left ventricular (LV) ejection fraction (LVEF) and fractional shortening may be observed during follow-up. Previous studies reported non-negligible prevalence of subclinical systolic dysfunction assessed with deformation imaging at short-, mid- and long-term follow up. Co-administration of Dexrazoxane has been shown to significantly reduce short-term and mid-term cardiotoxicity. The usefulness of dexrazoxane in preventing late (>10 years) anthracycline cardiotoxicity remains under discussion. Purpose Aim of this study was to assess cardiac function in long-term (>10 years) survivors of childhood tumors treated with dexrazoxane/anthracycline association. Methods Twenty cancer survivors previously treated with co-administration of anthracyclines and dexrazoxane for childhood renal tumors or sarcoma and a control group of 20 healthy non-athletic subjects matched for age, sex and body surface area were enrolled in the study. Echocardiographic measurements included 3D LVEF and LV and right ventricular (RV) global longitudinal strain (GLS). Cancer survivors were evaluated at median follow-up time of 21.5 years (range 10-26). Results No evidence of cardiac toxicity, as defined by current guidelines, was reported in all survivors. None of survivors presented LVEF < 50% or abnormal longitudinal strain, defined as a value >2 SDs below the mean using sex-specific and age-specific strain values. No significant differences in standard and deformation imaging parameters were observed between survivors and controls (3D LVEF 58 ± 3 % vs 60 ± 5 % p = NS; LV GLS -21 ± 1 % vs - 21 ± 2 % p= NS; RV GLS - 23 ± 2 % vs - 23 ± 5 % p= NS). Moreover, considering subjects who received a cumulative dose of anthracyclines above the median (doxorubicin-equivalent dose ≥208 mg/m2) no significant differences were found as compared to the group receiving a lower dose. Conclusions No evidence of cardiac toxicity was detected in all survivors. Our findings support the cardio-protective role of dexrazoxane in children undergoing anthracycline-based treatment. Parameters Cancer survivors (n= 20) Controls (n= 20) P 3D LVEF (%) 58 ± 3 60 ± 5 NS LV GLS (%) -21 ± 1 -21 ± 2 NS RV GLS (%) -23 ± 2 -23 ± 5 NS 3 D LVEF: Three-Dimensional Left Ventricular Ejection Fraction, LV GLS: Left Ventricular Global Longitudinal Strain; LV; RV GLS: Right Ventricular Global Longitudinal Strain. Abstract P1781 Figure. LV strain analysis in a survivor

Long-Term Outcomes Comparing Minimally Invasive Mitral Valve Repair versus Conventional Mitral Valve Surgery

Objectives: To compare the long term outcomes between minimally invasive mitral valve repair (MiMVR) and conventional surgery. Current retrospective comparisons between the techniques frequently report echocardiographical (echo) outcomes early after surgery and rarely report them later. Methods: Patients were selected for MiMVR by the surgical multi-disciplinary meeting from June 2008-March 2013. Patients included had at least two transthoracic post-operative echocardiograms. Echocardiographic parameters including left ventricular size and systolic function, degree of mitral regurgitation (MR) and mean mitral valve gradient were recorded. Clinical outcomes including all-cause mortality, re-operation, recurrence of at least moderate MR and elevated mean mitral valve gradients > 5 mmHg were recorded and compared using Kaplan-Meier survival analysis. Results: 223 patients were screened, 96 (43%) met the criteria and were included. Thirty-seven patients underwent conventional surgery and 59 underwent MiMVR. Mean clinical follow-up was 6.3 years and echo follow up was 3.2 years. There was a significantly higher recurrence of moderate MR in the conventional group (38% (n = 19) versus 17% (n = 10)). The mean LV end-diastolic diameter was 4.8 cm (conventional) versus 5.0 cm (MiMVR). The incidence of elevated PG was 26% (n = 13, conventional) and 23% (n = 14, MiMVR). There was no significant difference in incidence in re-operation (conventional 12% (n = 6), MiMVR 8.3% (n = 5)). Long-term mortality was higher in the conventional group (1.7% vs. 18% p = 0.004) although the logistic Euroscore was significantly higher 6.8% ± 5.4 vs. 3.6% ± 1.6. Conclusions: Minimally invasive mitral valve surgery is safe and feasible in selected patients with good medium and long-term echocardiographic follow-up.

Long-term echocardiographic follow-up of untreated 2+ functional tricuspid regurgitation in patients undergoing mitral valve surgery.

Concomitant tricuspid valve surgery with mitral valve surgery is recommended for patients with severe functional tricuspid regurgitation (TR). However, the treatment for 2+ TR (mild TR) remains controversial. Here, we evaluated the long-term results of untreated 2+ TR in patients undergoing mitral valve surgery. We retrospectively reviewed the records of 96 patients with untreated 2+ TR among 885 patients who underwent mitral valve surgery from 2003 to 2010. Exclusion criteria were tricuspid valve surgery (TVS), emergency surgery, primary TR and pacemaker lead through the tricuspid valve. We assessed survival and freedom from heart failure. The freedom from 3+ (moderate) or 4+ (severe) TR was investigated by echocardiographic data at pre- and postoperative week 1, then at 1, 3, 5, 7 and 10 postoperative years, which were compared with those in patients who had 2+ TR preoperatively and underwent concomitant TVS in the same period (n = 47). The mean follow-up was 7.1 ± 2.7 years. There was no 30-day mortality. The survival rate was 97.5% at 5 years and 87.5% at 10 years. The independent risk factors for mortality were age (OR 1.2, P = 0.03) and left ventricular ejection fraction (OR 0.9, P = 0.03). Untreated 2+ TR improved transiently within the first postoperative year (P < 0.001), but progressed again in the mid- to long term. Freedom from ≥3+ TR was 64.2% at 5 years and 46.7% at 10 years, which was significantly lower than that from ≥3+ TR in patients who underwent concomitant TVS (P = 0.006). The independent risk factors for TR progression (≥3 + TR) were age (OR 1.1, P = 0.005), atrial fibrillation (OR 2.2, P = 0.04) and tricuspid annular diameter (TAD) index (mm/m(2); OR 1.1, P = 0.02). Receiver operating characteristic curves showed that the optimal TAD index cut-off value was 21.0 for long-term survival [area under the curve (AUC) = 0.72] and 21.2 for TR progression (AUC = 0.64). Although untreated, 2+ TR significantly improved after mitral valve surgery, it then progressed again in the mid- to long term. Therefore, concomitant TVS should be considered in patients with 2+ TR who have dilated tricuspid annulus or atrial fibrillation, if feasible.

Regression of left ventricular mass after implantation of the sutureless 3f Enable aortic bioprosthesis.

Left ventricular hypertrophy in aortic stenosis is considered a compensatory response for the maintenance of systolic function but a risk factor for cardiac morbidity and death. We investigated the degree of left ventricular mass regression after implantation of the sutureless Medtronic 3f Enable Aortic Bioprosthesis. We studied 19 patients who, from May 2010 through July 2011, underwent isolated aortic valve replacement with the 3f Enable bioprosthetic valve, with clinical and echocardiographic follow-up at 6 months. The mean age was 77.1 ± 5.1 years (range, 68-86 yr); 14 patients were women (73.7%); and the mean logistic EuroSCORE was 15.4% ± 11.8%. Echocardiography was performed preoperatively, at discharge, and at 6 months' follow-up. The left ventricular mass was calculated by means of the Devereux formula and indexed to body surface area. The left ventricular mass index decreased from 146.1 ± 47.6 g/m(2) at baseline to 118.1 ± 39.8 g/m(2) at follow-up (P=0.003). The left ventricular ejection fraction did not change significantly. The mean transaortic gradient decreased from 57.3 ± 14.2 mmHg at baseline to 12.3 ± 4.6 mmHg at discharge and 12.2 ± 5.3 mmHg at follow-up (P <0.001), and these decreases were accompanied by substantial clinical improvement. No moderate or severe paravalvular leakage was present at discharge or at follow-up. In isolated aortic stenosis, aortic valve replacement with the 3f Enable bioprosthesis results in significant regression of left ventricular mass at 6 months' follow-up. However, this regression needs to be verified by long-term echocardiographic follow-up.

Percutaneous Mitral Valve Edge-to-Edge Repair: In-Hospital Results and 1-Year Follow-Up of 628 Patients of the 2011–2012 Pilot European Sentinel Registry

BackgroundThe use of transcatheter mitral valve repair (TMVR) has gained widespread acceptance in Europe, but data on immediate success, safety, and long-term echocardiographic follow-up in real-world patients are still limited. ObjectivesThe aim of this multinational registry is to present a real-world overview of TMVR use in Europe. MethodsThe Transcatheter Valve Treatment Sentinel Pilot Registry is a prospective, independent, consecutive collection of individual patient data. ResultsA total of 628 patients (mean age 74.2 ± 9.7 years, 63.1% men) underwent TMVR between January 2011 and December 2012 in 25 centers in 8 European countries. The prevalent pathogenesis was functional mitral regurgitation (FMR) (n = 452 [72.0%]). The majority of patients (85.5%) were highly symptomatic (New York Heart Association functional class III or higher), with a high logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) (20.4 ± 16.7%). Acute procedural success was high (95.4%) and similar in FMR and degenerative mitral regurgitation (p = 0.662). One clip was implanted in 61.4% of patients. In-hospital mortality was low (2.9%), without significant differences between groups. The estimated 1-year mortality was 15.3%, which was similar for FMR and degenerative mitral regurgitation. The estimated 1-year rate of rehospitalization because of heart failure was 22.8%, significantly higher in the FMR group (25.8% vs. 12.0%, p[log-rank] = 0.009). Paired echocardiographic data from the 1-year follow-up, available for 368 consecutive patients in 15 centers, showed a persistent reduction in the degree of mitral regurgitation at 1 year (6.0% of patients with severe mitral regurgitation). ConclusionsThis independent, contemporary registry shows that TMVR is associated with high immediate success, low complication rates, and sustained 1-year reduction of the severity of mitral regurgitation and improvement of clinical symptoms.

Long-Term Functional and Clinical Follow-Up of Patients With Heart Failure With Recovered Left Ventricular Ejection Fraction After β-Blocker Therapy

Background— Some patients with left ventricular systolic dysfunction (LVSD) have a dramatic improvement in left ventricular ejection fraction (LVEF) after β-blockade. No study has analyzed the long-term echocardiographic and clinical follow-up of this subgroup of patients. Methods and Results— We included in this analysis 174 consecutive patients with LVSD who had an LVEF≥45% after β-blockade. We performed a long-term echocardiographic follow-up (median 7.7 [4–9.9] years) and clinical follow-up (median 9.2 [7.2–10.8] years). LVEF improved from 33±8% to 54±6% after β-blockade ( P &lt;0.0001). At the last echocardiographic evaluation, 26% of the patients had an LVEF&lt;45% (mean±SD: 34±6%), whereas 74% still had an LVEF≥45% (mean±SD: 54±6%). Independent predictors of LVEF deterioration were a low LVEF, a high left ventricular end-diastolic diameter and a low heart rate after β-blockade, and the presence of a complete left bundle–branch block. In the overall study population, survival rates were 90% at 5 years and 75% at 10 years. Cardiovascular death rate was 9%, noncardiovascular death rate was 11%, and unknown death rate was 3%. Patients with subsequent LVEF deterioration had a higher cardiovascular mortality compared with patients with sustained recovered LVEF (22% versus 4%). Conclusions— The long-term survival of patients with LVSD and with near-normal LVEF after β-blockade is good. However, a quarter of these patients may experience a subsequent degradation of LVEF. These patients are at higher risk of cardiovascular mortality.

Outcomes following repair of bileaflet prolapse due to myxomatous disease of the mitral valve

Myxomatous disease represents the most common cause of MR due to bileaflet prolapse. Mitral valve repair of mitral regurgitation (MR) due to bileaflet prolapse poses many technical challenges. In addition, late outcomes following repair are not well characterized in this population. Published series have included mixed patient cohorts and/or lacked long-term echocardiographic follow-up. And thus constitutes the focus of the current study. One-hundred thirty six patients (mean age 57.3 ± 17.5 years) underwent mitral valve repair of bileaflet prolapse due to myxomatous disease from 2002–2010. Concomitant CABG was performed in 16 (12%) patients. All patients were followed by a dedicated mitral valve clinic with a follow-up interval that extended up to 6.6 years. There were no hospital deaths. Ring annuloplasty was used for all patients. Additional mitral valve repair techniques included chordal transfer ( N = 67 ), polytetrafluoroethylene neochords ( N = 22 ), edge-to-edge repair, including lateral edge-to-edge repair towards either commissure ( N = 30 ), or use of the hybrid-flip over technique ( N = 23 ). Prolapse involving more than one scallop of the posterior leaflet was observed in 32 (24%) patients whereas prolapse of more than one scallop of the anterior leaflet was observed in 56 (41%) patients. At follow-up, 3 patients had MR ⩾ 2+, and no patients required subsequent mitral valve re-intervention. Five-year survival and freedom from recurrent ( ⩾ 2+) MR were 81.9 ± 2.7% and 95.8 ± 2.7%, respectively. Mitral valve repair of bileaflet prolapse due to myxomatous disease is safe and durable. Successful repair often requires a combination of surgical repair techniques.

Severe Aortic Regurgitation, Aortic Valve Preserving Procedures: A Viable Alternative to Prosthetic AVR

Severe Aortic Regurgitation, Aortic Valve Preserving Procedures: A Viable Alternative to Prosthetic AVR

A frequently found rare tumor at high altitude: Atrial Myxoma; Kashmir experience

Background: Myxomas are the most common type of cardiac tumors in all age groups, and symptoms are produced by mechanical interference with cardiac function or embolization. This study comprises the clinical profile, surgical approach, morbidity, mortality and recurrence rate of atrial myxomas in the Kashmir valley. Patients and Methods: The study was retrospective from January 1991 to July 2005 and prospective from August 2005 to December 2007. All patients admitted with the diagnosis of atrial myxomas were included in the study. Results: The study included 30 patients with a mean age of 52 ± 4.8 years. Females outnumbered males, with a ratio of 2.9:1. Dyspnea was the most common symptom on presentation, with majority of the patients belonging to New York Heart Association Class III (56.6%). Pre-operative diagnosis was established in all patients by echocardiography. Majority of myxomas, i.e. 22 (88%), arose from interatrial septum. Wide excision of tumor with polytetrafluorethylene (PTFE)/pericardial patch closure was the most common surgical procedure performed. Both early and late mortalities were 6.6%. In addition to clinical examination, periodic echocardiography was done on follow-up to detect recurrence, which was seen in one (3.3%) patient. Conclusions: Surgical management is curative with minimal early and late morbidity and mortality. Extensive resection of the myxoma attached to the atrial septum or atrial wall can reduce the likelihood of recurrence to a great extent, and long-term clinical and echocardiographic follow-up is mandatory.

Aortic valve-sparing reimplantation technique (David-procedure) in different pathologies: Long-term clinical and echocardiographic follow-up in 170 patients. A single-center experience

Aortic valve-sparing reimplantation technique (David-procedure) in different pathologies: Long-term clinical and echocardiographic follow-up in 170 patients. A single-center experience

Long-Term Echocardiographic Follow-up after Posterior Mitral Annuloplasty Using a Vascular Strip for Ischemic Mitral Regurgitation: Ten-Years of Experience at a Single Center

Management of ischemic mitral regurgitation (MR) is challenging. The aim of this study was to investigate long-term clinical and echocardiographic results of restrictive mitral annuloplasty for ischemic MR. From 2001 through 2010, 96 patients who underwent myocardial revascularization with restrictive mitral annuloplasty using a vascular strip for ischemic MR were analyzed. Patients were stratified into two groups based on left ventricular ejection fraction (LVEF): group I, n = 50, with LVEF > 35% and group II, n = 46, with LVEF ≤ 35%. The early mortality rate was 2.1% (2/96) and the late cardiac mortality rate was 11.5% (11/96). MR grade was reduced at discharge (0.8 ± 0.7) but increased during follow-up (1.1 ± 0.8, P = 0.001). There was no intergroup difference in terms of freedom from recurrent MR ≥ moderate eight years after surgery (94.1% ± 5.7%, group I vs 87.8% ± 7.2%, group II; P = 0.575). NYHA functional class (odds ratio [OR], 2.2; P = 0.044) and early postoperative residual MR ≥ mild (OR, 25.4; P < 0.001) were independent predictors of recurrent MR. Restrictive mitral annuloplasty using a vascular strip is effective in ischemic MR. It is important to avoid early postoperative residual MR.

Anderson-Fabry disease: long-term echocardiographic follow-up under enzyme replacement therapy

Anderson-Fabry disease affects various organ systems due to glycosphingolipid accumulation. Enzyme replacement therapy (ERT) has been reported to decrease left ventricular wall thickening (LVWT) and to improve diastolic dysfunction. This prospective study included 29 patients (patients; mean age 37 +/- 13 years) with genetically, enzymatically and/or biopsy-proven Anderson-Fabry disease and long-time ERT. Data on symptoms, cardiac medications and history of hypertension were collected and all patients had comprehensive echocardiographic examination prior to ERT and at follow-up. Disease was at an early stage with a total mean Mainz severity score index of only 18.6 +/- 13.0. Prior to ERT, 79% of patients reported acroparesthesia. The median creatinine level was 121 +/- 108 mcmol/L and LVWT was present in nine patients (31%). Binary appearance of the interventricular septum was found in 20% and posterobasal fibrosis in 83%. At median follow-up of 37 months, acroparesthesia decreased to 55% (P = 0.016). There was no change in creatinine levels. The incidence of LVWT was unchanged, only an increase in interventricular septal wall thickness from 11.7 +/- 0.4 to 12.5 +/- 0.5 was observed (P = 0.009). Left atrial size and the percentage of patients with binary appearance and posterobasal fibrosis were unchanged. There was a small improvement in diastolic function (29% decrease of E/Ea; P < 0.002). Our Anderson-Fabry cohort had successful long-time ERT with impressive amelioration of subjective symptoms. Although there was not much improvement in cardiac changes apart from a slight improvement of diastolic function, at least, there was no progression of cardiac disease. For complete reversibility of cardiac changes in Anderson-Fabry disease, ERT might have to be started earlier in life and/or prescribed for a longer time.