Our Summary

This research paper discusses the important role of imaging in a new heart procedure called transcatheter native mitral valve replacement (TMVR). The procedure is used to treat mitral regurgitation, a condition where the heart’s mitral valve doesn’t close tightly, allowing blood to flow backward in your heart.

The paper highlights the need for a new professional role, an “interventional imager”, who has specialized knowledge in heart disease procedures. This person would use different types of imaging technologies during the TMVR procedure.

The imaging helps in several ways: it can determine if a patient is a good candidate for the procedure based on their heart’s structure; it can help measure the valve size; it can help plan the best way to insert the catheter and position the new valve; it can predict the likelihood of success and potential complications.

The paper also outlines how echocardiography, a test that uses sound waves to produce images of your heart, is used during the procedure. It helps in assessing the access point for the catheter, guiding its placement and trajectory, positioning the valve, assessing the functioning of the heart after the procedure, detecting any leakage around the valve, and checking for any obstruction in the heart’s main pumping chamber.

The authors conclude that the knowledge of using different imaging methods is essential for the “interventional imager” and is key to the success of the TMVR procedure.

FAQs

  1. What is the role of the “interventional imager” in a transcatheter native mitral valve replacement (TMVR) procedure?
  2. What are the key steps of procedural imaging in TMVR using the Tendyne mitral valve system?
  3. How does pre-procedure cardiac multi-modality imaging screening and planning for TMVR help in determining patient eligibility and predicting the risks of potential procedural complications?

Doctor’s Tip

One helpful tip a doctor might tell a patient about mitral valve replacement is to follow all pre-procedure imaging screening and planning recommendations closely. This includes undergoing various imaging tests to determine eligibility for the procedure, provide measurements for proper valve sizing, and plan the access site and valve positioning. Following these steps can help ensure a successful outcome for the mitral valve replacement procedure.

Suitable For

Patients who are typically recommended for mitral valve replacement are those with severe mitral regurgitation or stenosis that is causing symptoms such as shortness of breath, fatigue, and fluid retention. These patients may have failed conservative management or are not suitable candidates for mitral valve repair. Patients with certain anatomical features such as a dilated left ventricle, severe valve calcification, or abnormal valve leaflet morphology may also be recommended for mitral valve replacement. Additionally, patients who are at high risk for traditional open-heart surgery may be considered for transcatheter mitral valve replacement as a less invasive alternative.

Timeline

Before mitral valve replacement:

  1. Patient presents with symptoms of mitral valve disease, such as shortness of breath, fatigue, and palpitations.
  2. Patient undergoes diagnostic tests, such as echocardiogram, to confirm the diagnosis of mitral regurgitation.
  3. Multidisciplinary heart team evaluates the patient’s condition and determines the need for mitral valve replacement.
  4. Pre-operative imaging studies, such as cardiac MRI and CT scans, are performed to assess the anatomy of the mitral valve and surrounding structures.
  5. Patient undergoes pre-operative preparation, including medication management and education about the procedure.

After mitral valve replacement:

  1. Patient undergoes transcatheter native mitral valve replacement (TMVR) procedure with the Tendyne mitral valve system.
  2. Interventional imager assists in guiding the procedure using echocardiography to assess access, catheter/sheath positioning, valve deployment, and post-procedural complications.
  3. Post-procedure imaging is performed to assess the success of the valve replacement and detect any complications, such as perivalvular leakage or left ventricular outlet tract obstruction.
  4. Patient is monitored in the hospital for recovery and potential complications.
  5. Patient undergoes follow-up imaging studies to assess the long-term function of the replaced mitral valve and overall cardiac health.

What to Ask Your Doctor

  1. What is the reason for recommending mitral valve replacement?
  2. What are the different types of mitral valve replacement options available?
  3. What are the potential risks and complications associated with mitral valve replacement surgery?
  4. How long is the recovery period after mitral valve replacement surgery?
  5. Will I need to take medication after the procedure? If so, what kind and for how long?
  6. How often will I need follow-up appointments after the procedure?
  7. What lifestyle changes or restrictions will I need to follow after mitral valve replacement?
  8. How long can I expect the mitral valve replacement to last?
  9. Are there any specific activities that I should avoid after the procedure?
  10. What are the signs or symptoms that I should watch out for and report to my doctor after the procedure?

Reference

Authors: Al Sergani H, Moreo A, Bossone E, Vriz O, Alenazy A, Alshehri A, Al Amri M, Alhamshari A, Alamro B, Galzerano D. Journal: Monaldi Arch Chest Dis. 2022 Sep 7;93(2). doi: 10.4081/monaldi.2022.2404. PMID: 36069642