@article{DietlPrieschenkEckertetal.2018,
  author    = {Dietl, Alexander and Prieschenk, Christine and Eckert, Franziska and Birner, Christoph and Luchner, Andreas and Maier, Lars S. and Buchner, Stefan},
  title     = {3D vena contracta area after MitraClip© procedure: precise quantification of residual mitral regurgitation and identification of prognostic information},
  series = {Cardiovascular Ultrasound},
  volume    = {16},
  journal   = {Cardiovascular Ultrasound},
  doi       = {10.1186/s12947-017-0120-9},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-225318},
  year      = {2018},
  abstract  = {Background Percutaneous mitral valve repair (PMVR) is increasingly performed in patients with severe mitral regurgitation (MR). Post-procedural MR grading is challenging and an unsettled issue. We hypothesised that the direct planimetry of vena contracta area (VCA) by 3D-transoesophageal echocardiography allows quantifying post-procedural MR and implies further prognostic relevance missed by the usual ordinal scale (grade I-IV). Methods Based on a single-centre PMVR registry containing 102 patients, the association of VCA reduction and patients' functional capacity measured as six-minute walk distance (6 MW) was evaluated. 3D-colour-Doppler datasets were available before, during and 4 weeks after PMVR. Results Twenty nine patients (age 77.0 ± 5.8 years) with advanced heart failure (75.9\% NYHA III/IV) and severe degenerative (34\%) or functional (66\%) MR were eligible. VCA was reduced in all patients by PMVR (0.99 ± 0.46 cm\(^2\) vs. 0.22 ± 0.15 cm\(^2\), p < 0.0001). It remained stable after median time of 33 days (p = 0.999). 6 MW improved after the procedure (257.5 ± 82.5 m vs. 295.7 ± 96.3 m, p < 0.01). Patients with a decrease in VCA less than the median VCA reduction showed a more distinct improvement in 6 MW than patients with better technical result (p < 0.05). This paradoxical finding was driven by inferior results in very large functional MR. Conclusions VCA improves the evaluation of small residual MR. Its post-procedural values remain stable during a short-term follow-up and imply prognostic information for the patients' physical improvement. VCA might contribute to a more substantiated estimation of treatment success in the heterogeneous functional MR group.},
  language  = {en}
}