Mitral regurgitation outcomes after transcatheter atrial septal defect closure

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Worsening mitral regurgitation (MR) is a known complication following intervention for atrial septal defect (ASD).
• Limited understanding exists regarding mitral valve (MV) characteristics that predict this worsening MR.
• This study investigates MR outcomes and predictors after transcatheter ASD closure.

Purpose of the Study:

• To identify echocardiographic predictors of worsening mitral regurgitation (MR) after transcatheter atrial septal defect (ASD) closure.
• To elucidate the relationship between baseline MV characteristics and the development or progression of MR post-procedure.
• To improve patient selection and management strategies for transcatheter ASD closure.

Main Methods:

• Analysis of MR changes from baseline to 6-month follow-up in 238 patients undergoing transcatheter ASD closure.
• Baseline transthoracic echocardiography was used to assess MV characteristics and predict worsening MR.
• Worsening MR was defined by specific criteria including increase in moderate MR or vena contracta width.

Main Results:

• Worsening MR was observed in 12.2% of patients within 6 months post-procedure.
• Univariable analysis identified pseudoprolapse, hamstringing, stiffness, and mitral annulus dimensions as associated findings.
• Multivariable models combining leaflet findings (pseudoprolapse, hamstringing, anterior leaflet stiffness) with annular dimensions significantly predicted worsening MR (R²=0.393 and R²=0.385).

Conclusions:

• Mitral regurgitation worsening after transcatheter ASD closure is associated with specific mitral valve leaflet findings and annulus size.
• These echocardiographic parameters are valuable for predicting MR progression, particularly in patients with long-standing persistent atrial fibrillation.
• Further research may refine these predictors for improved clinical decision-making.