Our Summary

This research paper discusses the impact of a specific heart valve repair procedure, known as percutaneous mitral valve repair (PMVR), on the right side of the heart. The authors note that problems with the right ventricle (RV) and a condition called tricuspid regurgitation (TR) can lead to negative outcomes for patients undergoing this procedure. However, there isn’t much data available on how the right heart responds to PMVR, and how this might impact the patient’s prognosis.

The researchers highlight certain measures that can predict a poor outcome following PMVR. They recommend that these should be considered when selecting patients for the procedure. These include a preprocedural measurement of the movement of the tricuspid annulus (part of the heart) of less than 15 mm, a specific Doppler measurement less than 9.5 cm/sec, and moderate or severe TR.

Interestingly, they also found that PMVR could have benefits for the right heart, not just the left heart. It could lead to improved RV function and reduce the severity of TR. This is mainly observed in patients who had RV dysfunction to begin with.

However, if there is a high pressure gradient across the mitral valve after the procedure, this seems to be linked with a lack of improvement in the RV. The authors call for more research to better understand when to intervene with mitral valve repair in relation to RV impairment, and to identify predictors of improvement in RV function after PMVR.

FAQs

  1. What is the role of right ventricular function and tricuspid regurgitation in patients undergoing percutaneous mitral valve repair?
  2. How does percutaneous mitral valve repair influence right heart function and prognosis?
  3. What are the predictors of adverse outcome after percutaneous mitral valve repair?

Doctor’s Tip

One helpful tip a doctor might tell a patient about mitral valve repair is to carefully monitor and evaluate right ventricular function and tricuspid regurgitation before and after the procedure. Preprocedural factors such as tricuspid annular plane systolic excursion, tricuspid annular tissue Doppler S’ velocity, and degree of tricuspid regurgitation can be predictors of outcomes after mitral valve repair. Additionally, emerging data suggest that mitral valve repair may also have positive effects on right ventricular function and tricuspid regurgitation. Patients with baseline right ventricular dysfunction may experience improvements in function and reduction in tricuspid regurgitation after the procedure. It is important for patients to follow up with their healthcare provider regularly to monitor these factors and ensure optimal outcomes.

Suitable For

Patients who are typically recommended for mitral valve repair are those with right ventricular dysfunction and tricuspid regurgitation. Specifically, patients with preprocedural tricuspid annular plane systolic excursion less than 15 mm, tricuspid annular tissue Doppler S’ velocity less than 9.5 cm/sec, and moderate or severe TR are considered at higher risk for adverse outcomes after PMVR and should be carefully evaluated for patient selection. Additionally, patients with RV dysfunction at baseline may benefit from PMVR as it has been shown to improve RV function and reduce TR severity in this subgroup. Further studies are needed to determine the timing of mitral intervention with respect to RV impairment and predictors of RV reverse remodeling after PMVR.

Timeline

  • Pre-procedure: Patients with mitral valve disease may experience symptoms such as shortness of breath, fatigue, and chest pain. They will undergo various diagnostic tests to evaluate their condition, including echocardiograms and cardiac catheterization. Once it is determined that they are candidates for mitral valve repair, they will undergo preoperative preparation and counseling.

  • Procedure: During the mitral valve repair procedure, a catheter is inserted into the heart through a blood vessel in the leg or arm. The mitral valve is repaired using techniques such as the placement of an annuloplasty ring or the use of a clip to improve valve function.

  • Post-procedure: Following mitral valve repair, patients will be closely monitored in the hospital for any complications. They may need to take medications to manage symptoms and prevent blood clots. Cardiac rehabilitation may be recommended to help with recovery and improve overall heart health.

  • Long-term: Patients who undergo successful mitral valve repair can experience significant improvements in their symptoms and quality of life. Regular follow-up appointments with their healthcare provider will be necessary to monitor their heart function and ensure the long-term success of the procedure.

What to Ask Your Doctor

  1. How does my right ventricular function and tricuspid regurgitation impact my prognosis and outcomes with mitral valve repair?
  2. What criteria do you use to determine if I am a good candidate for mitral valve repair based on my right heart function?
  3. What are the potential risks and complications related to my right heart function and tricuspid regurgitation during and after the mitral valve repair procedure?
  4. Will the mitral valve repair have any impact on improving my right ventricular function or reducing the severity of my tricuspid regurgitation?
  5. How will you monitor and assess my right heart function and tricuspid regurgitation post-mitral valve repair?

Reference

Authors: Italia L, Adamo M, Lupi L, Scodro M, Curello S, Metra M. Journal: J Am Soc Echocardiogr. 2021 Oct;34(10):1038-1045. doi: 10.1016/j.echo.2021.05.013. Epub 2021 May 27. PMID: 34052316