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Related Concept Videos

Mitral Valve Prolapse II: Assessment and Management01:22

Mitral Valve Prolapse II: Assessment and Management

IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular tachycardia.
Mitral Regurgitation I: Introduction01:20

Mitral Regurgitation I: Introduction

Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
Mitral Regurgitation III: Medical Management01:25

Mitral Regurgitation III: Medical Management

Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
Aortic Regurgitation I: Introduction01:15

Aortic Regurgitation I: Introduction

IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...

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Updated: May 7, 2026

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Commissural Alignment in SAPIEN 3 Valves: Impact on Gradient and Mortality at Follow-Up.

Leire Unzue1,2, Belén Díaz Antón2,3, Adrián Peláez Laderas2,4,5

  • 1Departamento de Cardiología Intervencionista, HM CIEC MADRID (Centro Integral de Enfermedades Cardiovasculares), HM Hospitales, Madrid, Spain.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|April 2, 2025
PubMed
Summary
This summary is machine-generated.

Commissural misalignment (CMA) occurs in 40% of SAPIEN 3 valve patients but does not impact long-term mortality or gradient increase. This study assessed CMA in SAPIEN 3 valves and found no significant association with adverse outcomes.

Keywords:
SAPIEN 3 valvesTAVRcommissural alignment

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Echocardiography

Background:

  • Commissural misalignment (CMA) in self-expandable valves can complicate future coronary access and is linked to leaflet thrombosis and increased valve gradients.
  • Understanding CMA in balloon-expandable valves is crucial for long-term outcomes.

Purpose of the Study:

  • To evaluate commissural alignment of the SAPIEN 3 valve.
  • To determine the impact of CMA on transvalvular gradient and mortality at 5-year follow-up.

Main Methods:

  • Transesophageal echocardiogram (TEE) was used to measure commissural alignment in 105 patients post-SAPIEN 3 valve deployment.
  • CMA was defined as a neocommissure deviation >30° compared to native commissures.
  • Echocardiographic gradients and clinical events were tracked for 5 years.

Main Results:

  • 40% of patients exhibited significant CMA (>30°).
  • Misaligned patients had smaller aortic annuli and received smaller valves.
  • A slight increase in mean transvalvular gradient was observed over time, but not significantly different between aligned and misaligned groups.
  • 5-year mortality was 49.5% and not associated with CMA.

Conclusions:

  • Significant commissural misalignment is common with SAPIEN 3 valves.
  • CMA did not correlate with increased transvalvular gradients or long-term mortality in this cohort.