Anatomy of the Mitral Valvular Complex and its Implications for Transcatheter Interventions for Mitral Regurgitation

J Am Coll Cardiol. 2010; 56(8):617-626

Van Mieghem NM, Piazza N, Anderson RH, Tzikas A, Nieman K, De Laat LE, McGhie JS, Geleijnse ML, Feldman T, Serruys PW, de Jaegere PP

Mitral regurgitation (MR) poses a significant clinical burden in the adult population, which is expected to increase even more with the ever prolonging life expectancies in developed countries. New technology has brought MR, once exclusively the arena of cardiac surgeons, to the attention of interventional cardiologists. A variety of device-oriented transcatheter strategies have evolved in recent years. A comprehensive understanding of mitral valvular anatomy is crucial for the selection of patients, the implementation of devices, and further refinements of these transcatheter techniques if they are eventually to produce procedural and clinical success. The aim of this review is to elucidate the morphology of the mitral valvular complex, integrating key anatomical features into the developing transcatheter options for the treatment of MR.

PMID: 20705218

2 Responses

  1. Paul Schoenhagen  on September 4th, 2010

    Li W, Han W, Yu C, Zhang C, Tu Z, Wu S, Huber CH, Ma L.

    Severe mitral valve insufficiency after transcatheter atrial septal defect closure with the amplatzer septal occluder: a device-related complication.

    J Card Surg. 2009 Nov-Dec;24(6):672-4.

    Abstract

    Atrial septal defect (ASD) is the one of the most common congenital cardiac diseases. Percutaneous device closure of the ASD has developed as an alternative to traditional surgical closure with a similar outcome, decreased surgical trauma, and shorter hospital stay. However, several complications have been reported. We now report a rare complication of late severe mitral insufficiency (MI) after a successful closure of a secundum ASD with an Amplatzer device. The potential mechanisms may be the continual traction of the oversized mismatched device on the root of the mitral annulus and the insufficient rim to the mitral annulus. The patient was sent for a surgical operation to remove the device, and the defect was closed. No MI was found at the one-year follow-up.

    PMID: 20078713

  2. Jacobo Kirsch  on September 15th, 2010

    This paper gives a very nice review highlighting the key anatomical landmarks and dimensions relevant to these newer percutaneous techniques, including the clips for prolapse.


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