Document Detail


Percutaneous mitral valve annuloplasty for functional mitral regurgitation: acute results of the first patient treated with the Viacor permanent device and future perspectives.
MedLine Citation:
PMID:  20934667     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: There is a need to develop less invasive techniques to manage moderate or severe functional mitral regurgitation in patients at high surgical risk.
OBJECTIVE: We report the acute results of the first patient treated with the permanent Viacor percutaneous transvenous mitral annuloplasty (PTMA) device in North America, introduce the PTOLEMY-2 protocol, and briefly discuss the current status of transvenous mitral valve techniques.
CASE REPORT: After several episodes of pulmonary edema, an 87-year-old woman was referred for hemodynamic evaluation. Angiography revealed normal coronary arteries and severe mitral regurgitation. Baseline echocardiography showed severe (4+) functional mitral regurgitation. The coronary sinus was cannulated with a 9.5-Fr introducer from a left subclavian approach. After distal positioning of a coronary wire, the 7-Fr PTMA Viacor catheter was advanced to the anterior interventricular vein. Two 130 g/cm rods were then inserted resulting in an acute and dramatic reduction in mitral regurgitation as assessed by continuous transoesophageal echocardiography and which was associated with a sudden rise in arterial blood pressure. The next day, transthoracic echocardiogram showed a significant reduction in effective regurgitant orifice area (EROA) from 41 to 10 mm(2). The patient was discharged home the day following the procedure without complication. In accordance with the PTOLEMY-2 protocol, she will undergo 3-D transthoracic echocardiograms, quality of life assessments, and 6-min walk tests at regular intervals for the next 5 years.
CONCLUSION: PTMA is a promising technique for the treatment of severe mitral regurgitation in selected patients. Further ongoing research will determine the predictors of success and long-term safety and performance of this technique.
Authors:
Olivier F Bertrand; François Philippon; André St Pierre; Can M Nguyen; Eric Larose; Sylvie Bilodeau; François Dagenais; Eric Charbonneau; Josep Rodés-Cabau; Mario Sénéchal
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiovascular revascularization medicine : including molecular interventions     Volume:  11     ISSN:  1878-0938     ISO Abbreviation:  Cardiovasc Revasc Med     Publication Date:    2010 Oct-Dec
Date Detail:
Created Date:  2010-10-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101238551     Medline TA:  Cardiovasc Revasc Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  265.e1-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Canada. olivier.bertrand@criucpq.ulaval.ca
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