Percutaneous Treatment of Left Side Cardiac Valves (eBook)

Corrado Tamburino is Professor of Cardiology and Director of both the Cardiology Institute and Cardiovascular Dept. and the Post-graduate School of Cardiology at the University of Catania. He is also Chief of the Cardiovascular Dept. at Ferrarotto Hospital, Catania. At present he is also President of the Italian Society of Invasive Cardiology (GISE).He introduced the technique of endomyocardial biopsy and mitral valvuloplasty to Sicily and has performed more than 12,000 interventional procedures of coronary angioplasty and coronary stent implantation. Prof. Tamburino was the first interventional cardiologist in Italy to implant a percutaneous aortic valve on patients who cannot undergo surgical interventions and the first who treated percuteneously mitral regurgitation.An interesting recent article published in CIRCULATION presents Prof. Tamburrino's career and experiences in detail (Circulation 2008; 118; f63-f66).

Title Page 2
Copyright Page 3
Preface 5
Table of contents 6
List of Authors and Contributors 10
Abbreviations 13
1 Anatomy 17
1.1 Mitral Valve Anatomy 17
1.1.1 Mitral Leaflets and the Dynamics of Their Movement 18
1.1.2 The Annulus 21
1.1.3 The Chordae Tendineae and Papillary Muscles 22
1.2 Aortic Valve Anatomy 23
1.2.1 The Annulus 25
1.2.2 The Leaflets 25
1.2.3 The Commissures 26
1.2.4 The Interleaflet Triangles 26
1.2.5 The Sinuses of Valsalva 27
1.2.6 The Sinotubular Junction 28
References 28
2 Mitral Valve Disease 30
2.1 Mitral Stenosis 30
2.1.1 The Pathophysiology of Mitral Stenosis 30
2.1.2 Diagnosis 32
2.1.2.1 Non-invasive Diagnosis 32
2.1.2.2 Invasive Diagnosis 41
2.1.3 Timing of Interventions 43
2.1.4 Patient Selection 45
2.1.5 Percutaneous Therapy 47
2.1.5.1 Procedure and Technical Aspects 50
2.1.5.2 Mitral Valvuloplasty Outcomes 52
2.1.5.3 Complications 54
2.2 Mitral Regurgitation 54
2.2.1 The Pathophysiology of Mitral Regurgitation Physiopathology 54
2.2.2 Diagnosis 57
2.2.2.1 Non-invasive Diagnosis 57
2.2.2.1.1 Parameters Derived from the Regurgitation Jet 63
2.2.2.1.2 Proximal Isovelocity Surface Area (PISA) Method 64
2.2.2.1.3 Vena Contracta 65
2.2.2.1.4 Regurgitant Jet Analysis 65
2.2.2.1.5 Parameters Not Derived from the Regurgitation Jet 68
2.2.2.1.6 Transesophageal Echocardiography in Assessing Mitral Regurgitation Severity 71
2.2.2.2 Invasive Diagnosis 71
2.2.2.2.1 Hemodynamic Assessment 71
2.2.2.2.2 Angiographic Assessment 73
2.2.3 Timing of Interventions 75
2.2.4 Patient Selection 77
2.2.4.1 Anatomical and Functional Assessment of the Mitral Valve 80
2.2.4.2 Assessment of Regurgitation Etiopathogenesis 82
2.2.4.3 Selection of Patients for Implantation 88
2.2.5 Percutaneous Therapy 92
2.2.5.1 Leaflets Repair 93
2.2.5.1.1 MitraClip® 94
2.2.5.1.2 Other Devices 115
2.2.5.2 Transcatheter Coronary Sinus Techniques 116
2.2.5.2.1 MONARC™ 117
2.2.5.2.2 CARILLON 120
2.2.5.2.3 PTMA Device 121
2.2.5.3 Annuloplasty Techniques 123
2.2.5.3.1 Mitralign 123
2.2.5.3.2 QuantumCor™ 125
2.2.5.3.3 AccuCinch™ 125
2.2.5.4 Chamber and Annular Remodeling 126
2.2.5.4.1 Coapsys 126
2.2.5.4.2 PS3 System™ 127
2.2.5.5 A Glimpse into the Future 128
2.2.5.5.1 Transcatheter Mitral Valve Replacement 128
2.2.5.5.2 Percutaneous Neochordal Implantation 129
References 130
3 Aortic Valve Disease 140
3.1 Aortic Stenosis 140
3.1.1 The Pathophysiology of Aortic Stenosis 140
3.1.2 Diagnosis 142
3.1.2.1 Non-invasive Diagnosis 142
3.1.2.2 Invasive Diagnosis 150
3.1.3 Timing of Interventions 152
3.1.3.1 Symptomatic Patients 153
3.1.3.2 Asymptomatic Patients 153
3.1.4 Patient Selection 156
3.1.4.1 Valve Annulus 160
3.1.4.2 Sinuses of Valsalva (Width and Height) 162
3.1.4.3 Sinotubular Junction (STJ) 162
3.1.4.4 Left Ventricular Outflow Tract 162
3.1.4.5 Ascending Aorta 163
3.1.4.6 Iliac-femoral and Subclavian Artery 163
3.1.5 Percutaneous Therapy 165
3.1.5.1 Edwards-SAPIEN™ Valve 167
3.1.5.1.1 Device Description 167
3.1.5.1.2 Procedure and Technical Aspects 169
3.1.5.1.3 Essential Bibliography 182
3.1.5.2 CoreValve® ReValving System 183
3.1.5.2.1 Device Description 183
3.1.5.2.2 Procedure and Technical Aspects 190
3.1.5.2.3 Essential Bibliography 203
3.1.5.3 Other Devices 204
3.1.5.4 Procedural Complications 211
3.2 Aortic Regurgitation 212
3.2.1 The Pathophysiology of Aortic Regurgitation 212
3.2.2 Diagnosis 213
3.2.2.1 Non-invasive Diagnosis 213
3.2.2.2 Invasive Diagnosis 219
3.2.3 Timing of Interventions 220
3.2.4 Patient Selection 221
3.2.5 Percutaneous Therapy 222
References 224
4 Tips and Tricks and Management of Complications in Valvular Interventional Cardiology 230
4.1 Patient Selection and Work-up 231
4.1.1 Anatomical Typing 231
4.1.2 Valve and Heart Anatomy 232
4.1.3 Vascular Anatomy 233
4.1.3.1 Femoral Arteries 234
4.1.3.2 Iliac Arteries 235
4.1.3.3 Abdominal Aorta 236
4.1.3.4 Thoracic Aorta 237
4.2 Procedure 238
4.2.1 Vascular Access 238
4.2.2 Choosing the Introducer 241
4.2.3 Passing the Aortic Valve 244
4.2.4 Valvuloplasty 249
4.2.5 CoreValve® Revalving System Delivery and Implantation 249
4.2.5.1 Check on Implantation 252
4.2.6 Closing the Arterial Breach with the Prostar™ Device 255
4.2.7 Miscellaneous 256
4.2.7.1 Difficult Navigation of the Delivery Catheter in the Aortic Arch 257
4.2.7.2 Recovery of Catheter Fragments 258
4.2.7.3 Balloon Valvuloplasty Trapping 259
4.2.7.4 Cardiac Perforation 261
4.2.7.5 Introducer Replacement 261
4.3 The MitraClip® 262
4.3.1 Device and Technique 262
4.3.2 Procedure 263
Reference 269
5 Transcatheter Valve Treatment: Peri-procedural Management 270
5.1 Pre-procedural Care 272
5.2 Post-procedural Management 273
5.2.1 ICU Care 273
5.2.1.1 Laboratory Tests 274
5.2.1.2 Renal Function and Fluid Balance 275
5.2.1.3 Vascular Access 276
5.2.1.4 Rhythm Control 278
5.2.1.5 Transthoracic Echocardiogram 281
5.2.2 Medical Treatment and Physical Rehabilitation 283
5.2.3 Before Hospital Discharge 284
5.2.4 Medium-term Management (Out of Hospital) 284
References 286
6 Surgical Treatment of MitralRegurgitation and Aortic Stenosis 288
6.1 Treatment of Degenerative Mitral Regurgitation 288
6.1.1 Epidemiology and Natural History 288
6.1.2 Diagnosis and Quantification of Degenerative Mitral Regurgitation 290
6.1.3 Surgical Considerations 291
6.1.3.1 Types of Procedure 291
6.1.3.2 Surgical Indications 292
6.1.3.3 Principles of Mitral Repair Surgery 293
6.1.3.3.1 Posterior Leaflet Prolapse 293
6.1.3.3.2 Anterior Leaflet Prolapse 295
6.1.3.3.3 Remodeling of the Mitral Annulus by Means of Annuloplasty 300
6.1.3.3.4 Annular Calcifications 301
6.1.3.4 Results 302
6.2 Treatment of Functional Mitral Regurgitation 303
6.3 Treatment of Aortic Stenosis 311
6.3.1 Surgical Indications 311
6.3.2 Specific Issues 312
6.3.2.1 Mechanical or Tissue Valves 312
6.3.2.2 Prosthesis–Patient Mismatch 313
6.3.2.3 The Role of Transfemoral or Transapical Aortic Valve Replacement 313
References 314