Author + information
- Received December 12, 2016
- Accepted December 29, 2016
- Published online March 20, 2017.
- aVictor Chang Cardiac Research Institute, Sydney, Australia
- bCardiology Department, Liverpool Hospital, Sydney, Australia
- cCardiology Department, St Vincent’s Hospital, Sydney, Australia
- ↵∗Address for correspondence:
Dr. David W.M. Muller, Cardiology Department, St Vincent’s Hospital, Darlinghurst, Sydney 2010, Australia.
A 76-year-old man with a background of hypertension, type 2 diabetes, hyperlipidemia, cigarette smoking, chronic airways limitation, and chronic renal impairment (estimated glomerular filtration rate 35 ml/min/1.73 m2) was referred for management of severe symptomatic mitral regurgitation. He had had an inferolateral myocardial infarction and subsequent coronary bypass surgery 20 years previously, and developed severe secondary mitral regurgitation due to chordal shortening and tethering of the posterior mitral leaflet. Diagnostic angiography showed patent grafts. The left ventricular ejection fraction was 35% to 40% and the pulmonary artery systolic pressure was 55 mm Hg. He was considered a poor candidate for surgical valve repair or replacement due to his comorbidities, and was not well suited anatomically for transcatheter mitral valve repair because of the degree of leaflet tethering. He was enrolled in the Tendyne Global Feasibility Trial (1), and underwent transcatheter mitral valve implantation using a Tendyne Mitral Valve System (Tendyne Holdings, Roseville, Minnesota).
The device was implanted using a transapical approach through a left lateral minithoracotomy. It was advanced through a 34-F delivery sheath, partially unsheathed in the left atrium, retracted and fully deployed within the mitral annulus, and then tethered to an epicardial pad at the apex. The post-procedural course was uncomplicated. The patient was discharged home 7 days post-operatively.
Thirty days post-implantation, a wide-volume functional cardiac computed tomography was performed. The entire cardiac volume was captured within a single R-R interval, and images were reconstructed at 5% phase intervals. Four-dimensional image processing was then performed (PhyZiodyamics and InVivo, Ziosoft, Tokyo, Japan) to reduce image noise by combining signal information over multiple time points. High-quality rendered images of the beating heart were created with the assistance of a dedicated graphics processing unit (GPU) accelerator (Figures 1A to 1F, Online Videos 1, 2, 3, 4, 5, and 6). Computed tomography and echocardiography demonstrated normal function of the implanted valve with no left ventricular outflow tract gradient.
For supplemental videos and their legends, please see the online version of this article.
Dr. Otton has reported that he has no relationships relevant to the contents of this paper to disclose. Dr. Muller has served on the advisory board and as a consultant to Medtronic, Boston Scientific, and Edwards Lifesciences; has received research grant support from Tendyne, Abbott Vascular, and Medtronic; has served as a proctor for Medtronic and Abbott Vascular; and has served as a consultant to Tendyne.
- Received December 12, 2016.
- Accepted December 29, 2016.
- 2017 American College of Cardiology Foundation