Related Experiment Video
Updated: Oct 1, 2025

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Flow adjusted transmitral pressure gradient as a modified indicator of functional mitral stenosis after repair for
Arudo Hiraoka1, Akihiro Hayashida2, Toshinori Totusgawa1
1Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Background And Aim:
After repair of degenerative mitral regurgitation (DMR), the focus is on functional mitral stenosis (FMS) when there is a decline of mitral hemodynamics. Yet, the clinical impacts and a standardized definition are still undecided. Since common mitral hemodynamic parameters are influenced by transmitral flow, the aim of this study is to seek the impact of flow adjusted transmitral pressure gradient (TMPG) by left ventricular stroke volume (LVSV) on the midterm outcomes.
Methods:
Three hundred one patients who had undergone isolated mitral valve repair for degenerative lesions with annuloplasty prosthesis between October 2012 and June 2019 were included. Postoperative adverse events occurred in 20 patients (6.6%). Flow adjusted TMPG was defined as TMPG/LVSV.
Results:
Common mitral hemodynamic parameters were not associated with adverse events. By multivariable analysis, patients' age, left ventricular ejection fraction (LVEF) and mean TMPG/LVSV were isolated as independent predictors (adjusted hazard ratio: 1.05, 0.95, and 1.16; p = .037, .005, and .035). Flow adjusted TMPG was significantly higher in the full ring group compared to the partial band group (0.051 mmHg/ml, [0.038-0.068] vs. 0.041 mmHg/ml, [0.031-0.056]; p < .001) and had a significantly negative correlation with the size of the annuloplasty prosthesis (r = -0.37, p < .001).
Conclusions:
Conventional mitral hemodynamic parameters were not associated with adverse cardiac events after repair for DMR. Adjustment by flow has a potential to advance pressure gradient to a more sensitive indicator of FMS associated with clinical outcomes.
More Related Videos
04:48Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
07:42An Image Guided Transapical Mitral Valve Leaflet Puncture Model of Controlled Volume Overload from Mitral Regurgitation in the Rat
Published on: May 19, 2020
Related Concept Videos
Mitral Stenosis II: Clinical features and Diagnostic Tests
Mitral Regurgitation IV: Nursing Management
Mitral Regurgitation II: Clinical Features and Diagnostic Tests
Mitral Regurgitation III: Medical Management
Mitral Valve Prolapse II: Assessment and Management
Mitral Regurgitation I: Introduction