Dale E. Fowler

Progressive Mitral Stenosis After MitraClip Implantation in a Patient With Systemic Inflammatory Disease.

We describe a patient at high surgical risk who was successfully treated with a MitraClip (Abbott Vascular, Menlo Park, CA) without transmitral gradient. She received corticosteroid therapy for systemic lupus erythematosus, and progressive mitral stenosis developed late after MitraClip implantation. It gradually increased and reached 23 mm Hg at 28 months after the procedure; during the same period, her dose of prednisone had to be increased owing to lupus flare. Systemic inflammatory disease has the potential to result in mitral valve inflammation and fibrosis, ultimately causing thickening of the tissue bridge and worsening of the mitral valve obstruction. Preprocedural counseling regarding durability may help in this population.

6‐Minute walk test predicts prolonged hospitalization in patients undergoing transcatheter mitral valve repair by MitraClip

The 6‐minute walk test (6MWT) is a simple functional test that can predict exercise capacity and is widely employed to assess treatment outcomes. Although mortality with transcatheter mitral valve repair (TMVr) using the MitraClip (Abbott Vascular, Menlo Park, CA) is significantly less than for open mitral valve surgery in high‐risk patients, identifying which patient will benefit the most from TMVr remains a concern. There are limited prognostic metrics guiding patient selection and, no studies have reported relationship between prolonged hospitalization and 6MWT. This study aimed to determine if the 6MWT can predict prolonged hospitalization in patients undergoing TMVr by MitraClip.

Intracardiac echocardiography during transcatheter tricuspid valve-in-valve implantation

A 49-year-old woman with history of implantation of pacemaker with surgical epicardial lead placement due to complete heart block followed by upgrade to cardiac resynchronization therapy, four previous surgical tricuspid valve replacements due to degenerative valve failure and endocarditis, left ventricular ejection fraction of 20%, and heart failure due to long history of right ventricular pacing, atrial flatter, and possible inadequate myocardial protection in several cardiac surgeries presented with moderate-tosevere regurgitation of the 25-mm Mosaic bioprosthetic valve. Based on computed tomography, actual measurement of inner diameter of 25-mm Mosaic bioprosthetic valve was measured manually (and also Valve-in-Valve app; http://www.ubqo.com/ViV is helpful), and a 23-mm SAPIEN 3 valve was planned with the heart team approach. Procedure was performed via the percutaneous, transvenous femoral approach under general anesthesia and with ICE guidance. The 8-Fr AcuNav catheter was placed into right atrium (RA). The SAPIEN 3 valve was then deployed by slow balloon inflation under fluoroscopy and with ICE guidance (Fig. 1a, b; Online Video 1). Preand postprocedural valve functions including paravalvular leak were evaluated using the ICE catheter (Fig. 1c, d; Online Video 2, 3). She was discharged on the 9th postoperative days after paracentesis and readjustment of diuretics. This is the first report that demonstrates the utility of ICE imaging in patients undergoing the ViV procedure in tricuspid position [1]. ICE provided excellent visualization during ViV, and was very helpful for positioning of the transcatheter valve due to the Mosaic bioprostheses lacking a clearly visible fluoroscopic sewing ring marker. With improvement in transcatheter valves and delivery systems, many centers have advocated for angiographic-based minimalist approach without general anesthesia with intermittent transthoracic echocardiography. Ideally, in this case, it must be transcatheter tricuspid valve-in-valve implantation under ICE guidance without intubation in terms of minimalist approach. Due to lack of experience and immature heart team, patient was intubated just in case ICE is suboptimal for this procedure. Nonetheless, clearly, better resolution imaging with continuous monitoring can be obtained when ICE is utilized compared with transthoracic echocardiography alone. Moreover, ICE can be an acceptable alternative to transesophageal echocardiography (TEE) and a much less invasive option in the tricuspid ViV procedure, because general anesthesia will not be required [2]. ICE can obtain the optimal perpendicular imaging plane easily for preand postprocedural assessment such as device positioning, paravalvular leak, and transvalvular gradient, which provides the information to decide if additional interventions are required. In this case, as shown in Fig. 1d, there was no paravalvular leak postprocedure. She already had mean gradient of 9 mmHg just after the surgical tricuspid valve replacement in 2013, even though valve leaflets open well. After ViV procedure at this time, she had mean gradient of 6 mmHg on invasive measurement. Her valve area was 1.6 cm (index 0.93 cm/BSA). Electronic supplementary material The online version of this article (doi:10.1007/s12928-017-0469-6) contains supplementary material, which is available to authorized users.

TCT-632 Predictive Value of Age-Adjusted Charlson Comorbidity Index for 1-Year, 3-Year and 5-Year Mortality in Patients Following Transcatheter Mitral Valve Repair

This study aimed to determine if age-adjusted Charlson comorbidity index could predict mortality in patients undergoing transcatheter mitral valve repair (TMVR), and to assess its discriminatory performance in long-term outcomes. Comorbidity increases markedly with aging, and they often negatively