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Mitral and Tricuspid Valve Disease and Imaging Techniques
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Mitral and Tricuspid Valve Disease and Imaging Techniques

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (20 March 2023) | Viewed by 13538

Special Issue Editors

Dr. Valeria Cammalleri

E-Mail Website
Guest Editor
Unit of Cardiac Sciences, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
Interests: heart valve disease; tricuspid valve; mitral valve; echocardiography; computed tomography; structural heart disease interventions; multimodality imaging
Special Issues, Collections and Topics in MDPI journals
Dr. Atsushi Sugiura

E-Mail Website
Guest Editor
Heart Center Bonn, Department of Medicine II, University Hospital Bonn, 53127 Bonn, Germany
Interests: heart valve disease; tricuspid valve; mitral valve; echocardiography; computed tomography; structural heart disease interventions; multimodality imaging

Special Issue Information

Dear Colleagues,

With the advent of new transcatheter treatment options, the therapeutic spectrum for patients with valvular heart disease has expanded considerably in recent years. While transcatheter aortic valve implantation is now established as the standard of care in high-risk aortic stenosis patients, mitral and tricuspid disease has proven to be more challenging. Interventional treatment of the mitral and tricuspid valves requires an individualized and multidimensional approach due to the different etiologies of valve dysfunction and the complex anatomy of the atrioventricular valves. Rigorous patient selection, availability of safe and effective devices, and a careful research approach are essential to direct these developments toward meeting patients’ unmet clinical needs. Undoubtedly, significant advances have recently been achieved in the diagnosis of valvular heart disease, including echocardiography, computed tomography, and magnetic resonance imaging. Nevertheless, challenges remain in detecting valve disease early, tailoring correct and timely intervention, and finally identifying an adequate imaging protocol for each transcatheter procedure, intending to state the anatomical feasibility and predict the procedural success.

The current issue aims to provide to the readers an overview of the latest discoveries and new findings, analysis of previously published data, and new opinions and perspectives, on imaging techniques for mitral and tricuspid valve disease.

Dr. Valeria Cammalleri
Dr. Atsushi Sugiura
Guest Editors

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • mitral regurgitation
  • tricuspid regurgitation
  • imaging
  • mitral valve disease
  • tricuspid valve disease
  • computed tomography
  • echocardiography
  • cardiac magnetic resonance imaging

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Published Papers (6 papers)

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Research

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11 pages, 1666 KiB  
Article
Safety and Effectiveness of Concomitant Mitral Transcatheter Edge-to-Edge Repair and Left Atrial Appendage Closure
by Marco Frazzetto, Claudio Sanfilippo, Giuliano Costa, Salvatore Scandura, Giuseppe Castania, Jessica De Santis, Maria Sanfilippo, Maria Elena Di Salvo, Salvatore Uccello, Gerardo Rugiano, Sofia Rizzo, Chiara Barbera, Corrado Tamburino, Marco Barbanti and Carmelo Grasso
J. Clin. Med. 2023, 12(14), 4742; https://doi.org/10.3390/jcm12144742 - 18 Jul 2023
Cited by 5 | Viewed by 1547
Abstract
Background: Concomitant mitral transcatheter edge-to-edge repair (M-TEER) and left atrial appendage closure (LAAC) showed to be a feasible approach to optimize the treatment of patients eligible for both procedures, but mid-term outcomes are unclear. Methods: We retrospectively analyzed consecutive patients undergoing M-TEER and [...] Read more.
Background: Concomitant mitral transcatheter edge-to-edge repair (M-TEER) and left atrial appendage closure (LAAC) showed to be a feasible approach to optimize the treatment of patients eligible for both procedures, but mid-term outcomes are unclear. Methods: We retrospectively analyzed consecutive patients undergoing M-TEER and enrolled in the local prospective Getting Reduction of Mitral Insufficiency by Percutaneous Clip Implantation (GRASP) registry. We compared patients undergoing isolated M-TEER (n = 58, 58.5%) with those undergoing concomitant M-TEER and LAAC (n = 41, 41.5%) from January 2018 to December 2022. The primary endpoint was a composite of all-cause death, stroke or systemic embolism, hospitalization for heart failure, and bleeding at 1 year. The co-primary endpoint was procedural success. Results: The primary endpoint was similar between patients undergoing concomitant M-TEER+LAAC or isolated M-TEER (Kaplan Meier (KM) estimates 36.6% vs. 44.8%; plog-rank = 0.75). Procedural success was also similar (92.7% vs. 94.8%; p = 0.69). At 1- year, minor bleeds were lower in patients undergoing concomitant M-TEER and LAAC (KM estimates 0.0% vs. 18.9%; plog-rank < 0.01). Conclusion: In patients with concomitant MR and AF and eligible for M-TEER and LAAC treatment, a combined approach of M-TEER and LAAC was as safe as an M-TEER-alone strategy and associated with lower minor bleeding at 1 year. Full article
(This article belongs to the Special Issue Mitral and Tricuspid Valve Disease and Imaging Techniques)
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17 pages, 2701 KiB  
Article
Contemporary Treatment and Outcomes of High Surgical Risk Mitral Regurgitation
by Mitsumasa Sudo, Vivian Vij, Nihal Wilde, Tetsu Tanaka, Johanna Vogelhuber, Miriam Silaschi, Marcel Weber, Farhad Bakhtiary, Georg Nickenig, Sebastian Zimmer and Atsushi Sugiura
J. Clin. Med. 2023, 12(8), 2978; https://doi.org/10.3390/jcm12082978 - 19 Apr 2023
Cited by 2 | Viewed by 1709
Abstract
Before the development of transcatheter interventions, patients with mitral regurgitation (MR) and high surgical risk were often conservatively treated and subject to poor prognoses. We aimed to assess the therapeutic approaches and outcomes in the contemporary era. The study participants were consecutive high-risk [...] Read more.
Before the development of transcatheter interventions, patients with mitral regurgitation (MR) and high surgical risk were often conservatively treated and subject to poor prognoses. We aimed to assess the therapeutic approaches and outcomes in the contemporary era. The study participants were consecutive high-risk MR patients from April 2019 to October 2021. Among the 305 patients analyzed, 274 (89.8%) underwent mitral valve interventions, whereas 31 (10.2%) received medical therapy alone. Of the interventions, transcatheter edge-to-edge mitral repair (TEER) was the most frequent (82.0% of overall), followed by transcatheter mitral valve replacement (TMVR) (4.6%). In patients treated with medical therapy alone, non-optimal morphologies for TEER and TMVR were shown in 87.1% and 65.0%, respectively. Patients undergoing mitral valve interventions experienced less frequent heart failure (HF) rehospitalization compared to those with medical therapy alone (18.2% vs. 42.0%, p < 0.01). Mitral valve intervention was associated with a lower risk of HF rehospitalization (HR 0.36 [0.18–0.74]) and an improved New York Heart Association class (p < 0.01). Most high-risk MR patients can be treated with mitral valve interventions. However, approximately 10% remained on medical therapy alone and were considered as unsuitable for current transcatheter technologies. Mitral valve intervention was associated with a lower risk of HF rehospitalization and improved functional status. Full article
(This article belongs to the Special Issue Mitral and Tricuspid Valve Disease and Imaging Techniques)
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Review

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16 pages, 324 KiB  
Review
Perioperative Right Ventricular Dysfunction and Abnormalities of the Tricuspid Valve Apparatus in Patients Undergoing Cardiac Surgery
by Alessia Mattei, Alessandro Strumia, Maria Benedetto, Antonio Nenna, Lorenzo Schiavoni, Raffaele Barbato, Ciro Mastroianni, Omar Giacinto, Mario Lusini, Massimo Chello and Massimiliano Carassiti
J. Clin. Med. 2023, 12(22), 7152; https://doi.org/10.3390/jcm12227152 - 17 Nov 2023
Cited by 7 | Viewed by 1680
Abstract
Right ventricular (RV) dysfunction frequently occurs after cardiac surgery and is linked to adverse postoperative outcomes, including mortality, reintubation, stroke, and prolonged ICU stays. While various criteria using echocardiography and hemodynamic parameters have been proposed, a consensus remains elusive. Distinctive RV anatomical features [...] Read more.
Right ventricular (RV) dysfunction frequently occurs after cardiac surgery and is linked to adverse postoperative outcomes, including mortality, reintubation, stroke, and prolonged ICU stays. While various criteria using echocardiography and hemodynamic parameters have been proposed, a consensus remains elusive. Distinctive RV anatomical features include its thin wall, which presents a triangular shape in a lateral view and a crescent shape in a cross-sectional view. Principal causes of RV dysfunction after cardiac surgery encompass ischemic reperfusion injury, prolonged ischemic time, choice of cardioplegia and its administration, cardiopulmonary bypass weaning characteristics, and preoperative risk factors. Post-left ventricular assist device (LVAD) implantation RV dysfunction is common but often transient, with a favorable prognosis upon resolution. There is an ongoing debate regarding the benefits of concomitant surgical repair of the RV in the presence of regurgitation. According to the literature, the gold standard techniques for assessing RV function are cardiac magnetic resonance imaging and hemodynamic assessment using thermodilution. Echocardiography is widely favored for perioperative RV function evaluation due to its accessibility, reproducibility, non-invasiveness, and cost-effectiveness. Although other techniques exist for RV function assessment, they are less common in clinical practice. Clinical management strategies focus on early detection and include intravenous drugs (inotropes and vasodilators), inhalation drugs (pulmonary vasodilators), ventilator strategies, volume management, and mechanical support. Bridging research gaps in this field is crucial to improving clinical outcomes associated with RV dysfunction in the near future. Full article
(This article belongs to the Special Issue Mitral and Tricuspid Valve Disease and Imaging Techniques)
13 pages, 1412 KiB  
Review
Cellular and Molecular Mechanisms Underlying Tricuspid Valve Development and Disease
by Nadia Salerno, Giuseppe Panuccio, Jolanda Sabatino, Isabella Leo, Michele Torella, Sabato Sorrentino, Salvatore De Rosa and Daniele Torella
J. Clin. Med. 2023, 12(10), 3454; https://doi.org/10.3390/jcm12103454 - 14 May 2023
Cited by 2 | Viewed by 1951
Abstract
Tricuspid valve (TV) disease is highly prevalent in the general population. For ages considered “the forgotten valve” because of the predominant interest in left-side valve disease, the TV has now received significant attention in recent years, with significant improvement both in diagnosis and [...] Read more.
Tricuspid valve (TV) disease is highly prevalent in the general population. For ages considered “the forgotten valve” because of the predominant interest in left-side valve disease, the TV has now received significant attention in recent years, with significant improvement both in diagnosis and in management of tricuspid disease. TV is characterized by complex anatomy, physiology, and pathophysiology, in which the right ventricle plays a fundamental role. Comprehensive knowledge of molecular and cellular mechanisms underlying TV development, TV disease, and tricuspid regurgitation-related right-ventricle cardiomyopathy is necessary to enhance TV disease understanding to improve the ability to risk stratify TR patients, while also predicting valve dysfunction and/or response to tricuspid regurgitation treatment. Scientific efforts are still needed to eventually decipher the complete picture describing the etiopathogenesis of TV and TV-associated cardiomyopathy, and future advances to this aim may be achieved by combining emerging diagnostic imaging modalities with molecular and cellular studies. Overall, basic science studies could help to streamline a new coherent hypothesis underlying both the development of TV during embryogenesis and TV-associated disease and its complications in adult life, providing the conceptual basis for the ultimate and innovative field of valve repair and regeneration using tissue-engineered heart valves. Full article
(This article belongs to the Special Issue Mitral and Tricuspid Valve Disease and Imaging Techniques)
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24 pages, 28192 KiB  
Review
Advances in Imaging for Tricuspid Transcatheter Edge-to-Edge Repair: Lessons Learned and Future Perspectives
by Francesca Romana Prandi, Stamatios Lerakis, Martina Belli, Federica Illuminato, Davide Margonato, Lucy Barone, Saverio Muscoli, Marcello Chiocchi, Mario Laudazi, Massimo Marchei, Marco Di Luozzo, Annapoorna Kini, Francesco Romeo and Francesco Barillà
J. Clin. Med. 2023, 12(10), 3384; https://doi.org/10.3390/jcm12103384 - 10 May 2023
Cited by 3 | Viewed by 3517
Abstract
Severe tricuspid valve (TV) regurgitation (TR) has been associated with adverse long-term outcomes in several natural history studies, but isolated TV surgery presents high mortality and morbidity rates. Transcatheter tricuspid valve interventions (TTVI) therefore represent a promising field and may currently be considered [...] Read more.
Severe tricuspid valve (TV) regurgitation (TR) has been associated with adverse long-term outcomes in several natural history studies, but isolated TV surgery presents high mortality and morbidity rates. Transcatheter tricuspid valve interventions (TTVI) therefore represent a promising field and may currently be considered in patients with severe secondary TR that have a prohibitive surgical risk. Tricuspid transcatheter edge-to-edge repair (T-TEER) represents one of the most frequently used TTVI options. Accurate imaging of the tricuspid valve (TV) apparatus is crucial for T-TEER preprocedural planning, in order to select the right candidates, and is also fundamental for intraprocedural guidance and post-procedural follow-up. Although transesophageal echocardiography represents the main imaging modality, we describe the utility and additional value of other imaging modalities such as cardiac CT and MRI, intracardiac echocardiography, fluoroscopy, and fusion imaging to assist T-TEER. Developments in the field of 3D printing, computational models, and artificial intelligence hold great promise in improving the assessment and management of patients with valvular heart disease. Full article
(This article belongs to the Special Issue Mitral and Tricuspid Valve Disease and Imaging Techniques)
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Other

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8 pages, 6823 KiB  
Opinion
Novel 3D Echocardiographic Technique for Mitral Calcium Mapping
by Francesca Romana Prandi, Francesco Romeo, Francesco Barillà, Samin Sharma, Annapoorna Kini and Stamatios Lerakis
J. Clin. Med. 2023, 12(4), 1470; https://doi.org/10.3390/jcm12041470 - 12 Feb 2023
Cited by 1 | Viewed by 1908
Abstract
Mitral annular calcification (MAC) is a common chronic degenerative process of the mitral valve fibrous support ring. MAC increases the risk of mitral valve dysfunction, all-cause and cardiovascular mortality, and worse outcomes in cardiac interventions. Echocardiography represents the first imaging modality for MAC [...] Read more.
Mitral annular calcification (MAC) is a common chronic degenerative process of the mitral valve fibrous support ring. MAC increases the risk of mitral valve dysfunction, all-cause and cardiovascular mortality, and worse outcomes in cardiac interventions. Echocardiography represents the first imaging modality for MAC assessment, but it has low specificity compared to cardiac CT in terms of distinguishing between calcium and dense collagen. Novel three-dimensional transesophageal maximal intensity projection (MIP) mapping allows for the real-time MAC distribution and depth visualization of the cardiac anatomy and represents a useful and promising tool for pre-procedural assessment and intra-procedural guidance of cardiac interventions. Full article
(This article belongs to the Special Issue Mitral and Tricuspid Valve Disease and Imaging Techniques)
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