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Alec Vahanian - One of the best experts on this subject based on the ideXlab platform.

  • relationship between valve calcification and long term results of percutaneous Mitral commissurotomy for rheumatic Mitral Stenosis
    Circulation-cardiovascular Interventions, 2014
    Co-Authors: Claire Bouleti, Bertrand Cormier, Bernard Iung, Dominique Himbert, Eric Brochet, David Messikazeitoun, Eric Garbarz, Alec Vahanian
    Abstract:

    BACKGROUND: Indications of percutaneous Mitral commissurotomy (PMC) remain debated in calcific Mitral Stenosis. We analyzed long-term results of PMC for calcific Mitral Stenosis and the factors associated with late functional results. METHODS AND RESULTS: We compared the characteristics and outcome of 314 patients undergoing PMC for calcific Mitral Stenosis with 710 patients with noncalcified valves followed up to 20 years. Calcification was defined by fluoroscopy, and its extent was graded from 1 to 4. Good immediate results (valve area ≥ 1.5 cm(2) with Mitral regurgitation ≤ 2/4) were obtained in 251 patients (80%) with calcified valves and 661 (93%) with noncalcified valves (P < 0.001). The hazard ratio for good functional results (survival without cardiovascular death, without Mitral reintervention, and in New York Heart Association class I or II) was 2.5 (95% confidence interval [2.1-2.9]; P < 0.0001) in patients with calcified valves (12 ± 3% at 20 years) relative to the noncalcified group (38 ± 2% at 20 years). In the 251 patients with calcified valves who had good immediate results, 15-year rates of good functional results were 35 ± 4% for minor (grade 1) calcification, 24 ± 6% for grade 2, and 10 ± 6% for severe (grades 3-4) calcification. Factors associated with poor late functional results on multivariable analysis were calcification extent, older age, higher New York Heart Association class, atrial fibrillation, and higher mean gradient after PMC. CONCLUSIONS: Although late results of PMC are less satisfying in calcific Mitral Stenosis, long-term functional outcome depends on calcification extent, patient characteristics, and immediate results of PMC. These findings support the use of PMC as first-line treatment in selected patients with calcific Mitral Stenosis.

  • transseptal transcatheter Mitral valve implantation for severely calcified Mitral Stenosis
    Jacc-cardiovascular Interventions, 2014
    Co-Authors: Amirali Fassa, Dominique Himbert, Eric Brochet, Jeanpol Depoix, Adrian P Cheong, Soleiman Alkhoder, Patrick Nataf, Alec Vahanian
    Abstract:

    A 72-year-old woman, with prior aortic valve replacement and tricuspid annuloplasty, was referred for heart failure. Echocardiography showed Mitral Stenosis (mean gradient 12 mm Hg, area 0.8 cm2) with severe Mitral annular calcification (MAC) ([Fig. 1][1]A). Computed tomography demonstrated a

  • relationship between valve calcification and long term results of percutaneous Mitral commissurotomy for rheumatic Mitral Stenosis
    Circulation-cardiovascular Interventions, 2014
    Co-Authors: Claire Bouleti, Bertrand Cormier, Bernard Iung, Dominique Himbert, Eric Brochet, David Messikazeitoun, Eric Garbarz, Alec Vahanian
    Abstract:

    Background—Indications of percutaneous Mitral commissurotomy (PMC) remain debated in calcific Mitral Stenosis. We analyzed long-term results of PMC for calcific Mitral Stenosis and the factors associated with late functional results. Methods and Results—We compared the characteristics and outcome of 314 patients undergoing PMC for calcific Mitral Stenosis with 710 patients with noncalcified valves followed up to 20 years. Calcification was defined by fluoroscopy, and its extent was graded from 1 to 4. Good immediate results (valve area ≥1.5 cm2 with Mitral regurgitation ≤2/4) were obtained in 251 patients (80%) with calcified valves and 661 (93%) with noncalcified valves (P<0.001). The hazard ratio for good functional results (survival without cardiovascular death, without Mitral reintervention, and in New York Heart Association class I or II) was 2.5 (95% confidence interval [2.1–2.9]; P<0.0001) in patients with calcified valves (12±3% at 20 years) relative to the noncalcified group (38±2% at 20 years). ...

  • assessment of the Mitral valve area in patients with Mitral Stenosis by multislice computed tomography
    Journal of the American College of Cardiology, 2006
    Co-Authors: David Messikazeitoun, Bernard Iung, Eric Brochet, Jean Michel Serfaty, Jean Pierre Laissy, Mohammed Berhili, Alec Vahanian
    Abstract:

    To the Editor: Management of Mitral Stenosis (MS) relies on accurate assessment of the Mitral valve orifice area (MVA). Planimetry measured by Doppler echocardiography is considered the reference method, but must be precisely performed at the tips of the leaflet on a well-oriented plane and

  • usefulness of percutaneous balloon commissurotomy for Mitral Stenosis during pregnancy
    American Journal of Cardiology, 1994
    Co-Authors: Bernard Iung, Bertrand Cormier, Jean Marc Porte, O Nallet, P L Michel, Joseph Elias, S Sananes, Serge Uzan, Alec Vahanian, J Acar
    Abstract:

    Abstract Since its introduction in 1984, percutaneous Mitral commissurotomy (PMC) has steadily gained ground as an alternative to surgical commissurotomy in the treatment of Mitral Stenosis. 1,2 Pregnancy is a promising field for the application of PMC, given that surgery carries a high risk to the fetus, especially when an open-heart procedure is required. 3 Despite this, experience to date is limited and the few published series mainly concentrate on the repercussions of the procedure on the mother. The interest of the present series is that in addition to the efficacy of the procedure it also takes into account fetal tolerance.

Bijoy K Khandheria - One of the best experts on this subject based on the ideXlab platform.

  • native Mitral Stenosis treated with transcatheter Mitral valve replacement
    The Annals of Thoracic Surgery, 2016
    Co-Authors: Renuka Jain, Bijoy K Khandheria, Mohamed F Algahim, Tanvir Bajwa, Daniel Ohair
    Abstract:

    Surgical treatment of Mitral Stenosis with extreme calcification remains a challenge. Recently, the balloon-expandable valve prosthesis, anchored by radial force, offers a new option for these patients. We present 2 cases of transcatheter Mitral valve replacement in patients with severe native Mitral valve Stenosis and annular calcification deemed too extensive for conventional surgical techniques.

  • effects of percutaneous Mitral commissurotomy on longitudinal left ventricular dynamics in Mitral Stenosis quantitative assessment by tissue velocity imaging
    Journal of The American Society of Echocardiography, 2004
    Co-Authors: J C Mohan, Vimal Mehta, U A Kaul, Vijay Trehan, R. Arora, Bijoy K Khandheria
    Abstract:

    Abstract Objective We hypothesized that Mitral annular velocities would improve immediately after relief of Mitral Stenosis and that serial assessment could be used as an index for quantifying functional changes after percutaneous Mitral commissurotomy (PMC). Methods Longitudinal left ventricular annular velocities were quantified by spectral pulsed wave Doppler tissue velocity imaging in 25 patients (16 women; mean age [±SD], 29.2 ± 8.6 years) who had isolated Mitral Stenosis and were in sinus rhythm, and were compared with 30 age- and sex-matched control subjects. Echocardiography was performed 1 to 24 hours before PMC and 48 to 72 hours after, and changes in velocities from the lateral and septal corners of the Mitral annulus in early diastole, late diastole, isovolumic contraction, and ejection were recorded. Results Systolic and diastolic Mitral annular velocities were significantly less in patients with Mitral Stenosis than in control subjects. After PMC, peak annular velocity of systolic excursion in ejection and peak annular velocity in early diastole showed significant improvement. The change in peak annular velocity in early diastole in the lateral wall correlated well with improvement in the Mitral valve orifice area by planimetry (ratio of Mitral valve orifice area, 1.92 ± 0.42; ratio of peak annular velocity in early diastole, 1.36 ± 0.22; r = 0.65; P Conclusion Serial evaluation of changes in Mitral annular velocities by Doppler tissue imaging aids clinical assessment of immediate improvement in left ventricular function after PMC.

  • effects of percutaneous Mitral commissurotomy on longitudinal left ventricular dynamics in Mitral Stenosis quantitative assessment by tissue velocity imaging
    Journal of The American Society of Echocardiography, 2004
    Co-Authors: Partho P Sengupta, J C Mohan, Vimal Mehta, U A Kaul, Vijay Trehan, R. Arora, Bijoy K Khandheria
    Abstract:

    Abstract Objective We hypothesized that Mitral annular velocities would improve immediately after relief of Mitral Stenosis and that serial assessment could be used as an index for quantifying functional changes after percutaneous Mitral commissurotomy (PMC). Methods Longitudinal left ventricular annular velocities were quantified by spectral pulsed wave Doppler tissue velocity imaging in 25 patients (16 women; mean age [±SD], 29.2 ± 8.6 years) who had isolated Mitral Stenosis and were in sinus rhythm, and were compared with 30 age- and sex-matched control subjects. Echocardiography was performed 1 to 24 hours before PMC and 48 to 72 hours after, and changes in velocities from the lateral and septal corners of the Mitral annulus in early diastole, late diastole, isovolumic contraction, and ejection were recorded. Results Systolic and diastolic Mitral annular velocities were significantly less in patients with Mitral Stenosis than in control subjects. After PMC, peak annular velocity of systolic excursion in ejection and peak annular velocity in early diastole showed significant improvement. The change in peak annular velocity in early diastole in the lateral wall correlated well with improvement in the Mitral valve orifice area by planimetry (ratio of Mitral valve orifice area, 1.92 ± 0.42; ratio of peak annular velocity in early diastole, 1.36 ± 0.22; r = 0.65; P Conclusion Serial evaluation of changes in Mitral annular velocities by Doppler tissue imaging aids clinical assessment of immediate improvement in left ventricular function after PMC.

Bernard Iung - One of the best experts on this subject based on the ideXlab platform.

  • relationship between valve calcification and long term results of percutaneous Mitral commissurotomy for rheumatic Mitral Stenosis
    Circulation-cardiovascular Interventions, 2014
    Co-Authors: Claire Bouleti, Bertrand Cormier, Bernard Iung, Dominique Himbert, Eric Brochet, David Messikazeitoun, Eric Garbarz, Alec Vahanian
    Abstract:

    Background—Indications of percutaneous Mitral commissurotomy (PMC) remain debated in calcific Mitral Stenosis. We analyzed long-term results of PMC for calcific Mitral Stenosis and the factors associated with late functional results. Methods and Results—We compared the characteristics and outcome of 314 patients undergoing PMC for calcific Mitral Stenosis with 710 patients with noncalcified valves followed up to 20 years. Calcification was defined by fluoroscopy, and its extent was graded from 1 to 4. Good immediate results (valve area ≥1.5 cm2 with Mitral regurgitation ≤2/4) were obtained in 251 patients (80%) with calcified valves and 661 (93%) with noncalcified valves (P<0.001). The hazard ratio for good functional results (survival without cardiovascular death, without Mitral reintervention, and in New York Heart Association class I or II) was 2.5 (95% confidence interval [2.1–2.9]; P<0.0001) in patients with calcified valves (12±3% at 20 years) relative to the noncalcified group (38±2% at 20 years). ...

  • relationship between valve calcification and long term results of percutaneous Mitral commissurotomy for rheumatic Mitral Stenosis
    Circulation-cardiovascular Interventions, 2014
    Co-Authors: Claire Bouleti, Bertrand Cormier, Bernard Iung, Dominique Himbert, Eric Brochet, David Messikazeitoun, Eric Garbarz, Alec Vahanian
    Abstract:

    BACKGROUND: Indications of percutaneous Mitral commissurotomy (PMC) remain debated in calcific Mitral Stenosis. We analyzed long-term results of PMC for calcific Mitral Stenosis and the factors associated with late functional results. METHODS AND RESULTS: We compared the characteristics and outcome of 314 patients undergoing PMC for calcific Mitral Stenosis with 710 patients with noncalcified valves followed up to 20 years. Calcification was defined by fluoroscopy, and its extent was graded from 1 to 4. Good immediate results (valve area ≥ 1.5 cm(2) with Mitral regurgitation ≤ 2/4) were obtained in 251 patients (80%) with calcified valves and 661 (93%) with noncalcified valves (P < 0.001). The hazard ratio for good functional results (survival without cardiovascular death, without Mitral reintervention, and in New York Heart Association class I or II) was 2.5 (95% confidence interval [2.1-2.9]; P < 0.0001) in patients with calcified valves (12 ± 3% at 20 years) relative to the noncalcified group (38 ± 2% at 20 years). In the 251 patients with calcified valves who had good immediate results, 15-year rates of good functional results were 35 ± 4% for minor (grade 1) calcification, 24 ± 6% for grade 2, and 10 ± 6% for severe (grades 3-4) calcification. Factors associated with poor late functional results on multivariable analysis were calcification extent, older age, higher New York Heart Association class, atrial fibrillation, and higher mean gradient after PMC. CONCLUSIONS: Although late results of PMC are less satisfying in calcific Mitral Stenosis, long-term functional outcome depends on calcification extent, patient characteristics, and immediate results of PMC. These findings support the use of PMC as first-line treatment in selected patients with calcific Mitral Stenosis.

  • assessment of the Mitral valve area in patients with Mitral Stenosis by multislice computed tomography
    Journal of the American College of Cardiology, 2006
    Co-Authors: David Messikazeitoun, Bernard Iung, Eric Brochet, Jean Michel Serfaty, Jean Pierre Laissy, Mohammed Berhili, Alec Vahanian
    Abstract:

    To the Editor: Management of Mitral Stenosis (MS) relies on accurate assessment of the Mitral valve orifice area (MVA). Planimetry measured by Doppler echocardiography is considered the reference method, but must be precisely performed at the tips of the leaflet on a well-oriented plane and

  • late results of percutaneous Mitral commissurotomy for calcific Mitral Stenosis
    American Journal of Cardiology, 2000
    Co-Authors: Bernard Iung, P L Michel, Eric Garbarz, Luc Doutrelant, Patricia Berdah, Pierre Michaud, Bruno Farah, Mourad Mokhtari, Yasuhiro Makita, P Luxereau
    Abstract:

    Abstract The aim of this study was to assess late results of percutaneous Mitral commissurotomy (PMC) in calcific Mitral Stenosis and to identify predictors to improve patient selection. We analyzed 422 patients who underwent PMC for calcific Mitral Stenosis. The extent of calcium was graded from 1 to 4 by fluoroscopy: 227 patients (53%) were graded 1, 125 (30%) graded 2, 55 graded 3 (13%), and 15 graded 4 (4%). The procedure failed in 15 patients, used a single balloon in 11, a double balloon in 126, and the Inoue balloon in 270. In-hospital mortality was 1.2%. Good immediate results (valve area ≥1.5 cm2 without Mitral regurgitation >2/4), were obtained in 321 patients (76%). Multivariate analysis identified 5 predictors of good immediate results: a younger age (p = 0.0004), a lesser degree of Stenosis (p = 0.0005), a smaller extent of calcium (p = 0.04), the use of the Inoue balloon (p = 0.015), and a larger effective balloon dilating area (p = 0.006). Good functional results, defined as survival with no further intervention and in New York Heart Association class I or II, were 36 ± 4% at 8 years. The predictors of good functional results after good immediate results were a younger age (p = 0.04), a lower pre-PMC New York Heart Association class (p

  • usefulness of percutaneous balloon commissurotomy for Mitral Stenosis during pregnancy
    American Journal of Cardiology, 1994
    Co-Authors: Bernard Iung, Bertrand Cormier, Jean Marc Porte, O Nallet, P L Michel, Joseph Elias, S Sananes, Serge Uzan, Alec Vahanian, J Acar
    Abstract:

    Abstract Since its introduction in 1984, percutaneous Mitral commissurotomy (PMC) has steadily gained ground as an alternative to surgical commissurotomy in the treatment of Mitral Stenosis. 1,2 Pregnancy is a promising field for the application of PMC, given that surgery carries a high risk to the fetus, especially when an open-heart procedure is required. 3 Despite this, experience to date is limited and the few published series mainly concentrate on the repercussions of the procedure on the mother. The interest of the present series is that in addition to the efficacy of the procedure it also takes into account fetal tolerance.

Eric Brochet - One of the best experts on this subject based on the ideXlab platform.

  • transseptal transcatheter Mitral valve implantation for severely calcified Mitral Stenosis
    Jacc-cardiovascular Interventions, 2014
    Co-Authors: Amirali Fassa, Dominique Himbert, Eric Brochet, Jeanpol Depoix, Adrian P Cheong, Soleiman Alkhoder, Patrick Nataf, Alec Vahanian
    Abstract:

    A 72-year-old woman, with prior aortic valve replacement and tricuspid annuloplasty, was referred for heart failure. Echocardiography showed Mitral Stenosis (mean gradient 12 mm Hg, area 0.8 cm2) with severe Mitral annular calcification (MAC) ([Fig. 1][1]A). Computed tomography demonstrated a

  • relationship between valve calcification and long term results of percutaneous Mitral commissurotomy for rheumatic Mitral Stenosis
    Circulation-cardiovascular Interventions, 2014
    Co-Authors: Claire Bouleti, Bertrand Cormier, Bernard Iung, Dominique Himbert, Eric Brochet, David Messikazeitoun, Eric Garbarz, Alec Vahanian
    Abstract:

    BACKGROUND: Indications of percutaneous Mitral commissurotomy (PMC) remain debated in calcific Mitral Stenosis. We analyzed long-term results of PMC for calcific Mitral Stenosis and the factors associated with late functional results. METHODS AND RESULTS: We compared the characteristics and outcome of 314 patients undergoing PMC for calcific Mitral Stenosis with 710 patients with noncalcified valves followed up to 20 years. Calcification was defined by fluoroscopy, and its extent was graded from 1 to 4. Good immediate results (valve area ≥ 1.5 cm(2) with Mitral regurgitation ≤ 2/4) were obtained in 251 patients (80%) with calcified valves and 661 (93%) with noncalcified valves (P < 0.001). The hazard ratio for good functional results (survival without cardiovascular death, without Mitral reintervention, and in New York Heart Association class I or II) was 2.5 (95% confidence interval [2.1-2.9]; P < 0.0001) in patients with calcified valves (12 ± 3% at 20 years) relative to the noncalcified group (38 ± 2% at 20 years). In the 251 patients with calcified valves who had good immediate results, 15-year rates of good functional results were 35 ± 4% for minor (grade 1) calcification, 24 ± 6% for grade 2, and 10 ± 6% for severe (grades 3-4) calcification. Factors associated with poor late functional results on multivariable analysis were calcification extent, older age, higher New York Heart Association class, atrial fibrillation, and higher mean gradient after PMC. CONCLUSIONS: Although late results of PMC are less satisfying in calcific Mitral Stenosis, long-term functional outcome depends on calcification extent, patient characteristics, and immediate results of PMC. These findings support the use of PMC as first-line treatment in selected patients with calcific Mitral Stenosis.

  • relationship between valve calcification and long term results of percutaneous Mitral commissurotomy for rheumatic Mitral Stenosis
    Circulation-cardiovascular Interventions, 2014
    Co-Authors: Claire Bouleti, Bertrand Cormier, Bernard Iung, Dominique Himbert, Eric Brochet, David Messikazeitoun, Eric Garbarz, Alec Vahanian
    Abstract:

    Background—Indications of percutaneous Mitral commissurotomy (PMC) remain debated in calcific Mitral Stenosis. We analyzed long-term results of PMC for calcific Mitral Stenosis and the factors associated with late functional results. Methods and Results—We compared the characteristics and outcome of 314 patients undergoing PMC for calcific Mitral Stenosis with 710 patients with noncalcified valves followed up to 20 years. Calcification was defined by fluoroscopy, and its extent was graded from 1 to 4. Good immediate results (valve area ≥1.5 cm2 with Mitral regurgitation ≤2/4) were obtained in 251 patients (80%) with calcified valves and 661 (93%) with noncalcified valves (P<0.001). The hazard ratio for good functional results (survival without cardiovascular death, without Mitral reintervention, and in New York Heart Association class I or II) was 2.5 (95% confidence interval [2.1–2.9]; P<0.0001) in patients with calcified valves (12±3% at 20 years) relative to the noncalcified group (38±2% at 20 years). ...

  • assessment of the Mitral valve area in patients with Mitral Stenosis by multislice computed tomography
    Journal of the American College of Cardiology, 2006
    Co-Authors: David Messikazeitoun, Bernard Iung, Eric Brochet, Jean Michel Serfaty, Jean Pierre Laissy, Mohammed Berhili, Alec Vahanian
    Abstract:

    To the Editor: Management of Mitral Stenosis (MS) relies on accurate assessment of the Mitral valve orifice area (MVA). Planimetry measured by Doppler echocardiography is considered the reference method, but must be precisely performed at the tips of the leaflet on a well-oriented plane and

Sorin V Pislaru - One of the best experts on this subject based on the ideXlab platform.

  • hemodynamic response to transseptal transcatheter Mitral valve replacement in patients with severe Mitral Stenosis due to severe Mitral annular calcification
    Catheterization and Cardiovascular Interventions, 2021
    Co-Authors: Naoki Misumida, Charanjit S Rihal, Mayra Guerrero, Sorin V Pislaru, Mohamad Alkhouli, Mackram F Eleid
    Abstract:

    Objectives We aimed to investigate the invasive hemodynamic changes with transcatheter Mitral valve replacement (TMVR) in patients with severe Mitral Stenosis due to severe Mitral annular calcification. Background The hemodynamic response to TMVR in patients with Mitral Stenosis related to degenerative Mitral annular calcification has not been fully elucidated. Methods We conducted retrospective review of patients who underwent successful transseptal TMVR with balloon-expandable valves for symptomatic severe Mitral Stenosis due to Mitral annular calcification at our institution between January 2014 and February 2020. Invasive hemodynamic measurements were obtained both before valve implantation (predeployment) and after (postdeployment). Results Eighteen patients (age 72 ± 10 years, 44% female) were included for the analysis. There was a significant reduction in mean left atrial pressure (23.7 ± 5.6 mmHg versus 20.6 ± 4.8 mmHg; p = .01), left atrial v-wave (mean 39.3 ± 10.2 mmHg versus 32.9 ± 9.9 mmHg; p = .01), and an increase in systemic mean blood pressure (72.6 mmHg ±11.2 versus 79.5 ± 9.9 mmHg; p = .02) postdeployment compared to predeployment. Patients who had symptom improvement at 30-day follow-up tended to have greater reduction in mean left atrial pressure (4.4 ± 4.4 mmHg versus 0.5 ± 5.2 mmHg; p = .16) and v-wave (8.6 ± 9.0 mmHg versus 0.7 ± 8.4 mmHg; p = .10) compared to those who did not experience improvement of symptoms. Conclusions Transseptal TMVR for severe Mitral Stenosis due to Mitral annular calcification is associated with reductions in mean left atrial pressure and left atrial v-wave, and an increase in systemic arterial pressure.

  • hemodynamics and prognostic impact of concomitant Mitral Stenosis in patients undergoing surgical or transcatheter aortic valve replacement for aortic Stenosis
    Circulation, 2019
    Co-Authors: Nahoko Kato, William R Miranda, Ratnasari Padang, Cristina Pislaru, Mizuho Hoshina, Kentaro Shibayama, Hiroyuki Watanabe, Christopher G Scott, Kevin L Greason, Sorin V Pislaru
    Abstract:

    Background: Mitral Stenosis frequently coexists in patients with severe aortic Stenosis. Mitral Stenosis severity evaluation is challenging in the setting of combined aortic Stenosis and Mitral ste...