- Email: [email protected]
Exhaustive echocardiographic phenotyping of mitral valve prolapse in a single center: ‘Severe myxomatous mitral valve disease’ as a specific entity?
52 Disclosure of interest peting interest.
Abstracts The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2018.10.111 396
Exhaustive echocardiographic phenotyping of mitral valve prolapse in a single center: ‘Severe myxomatous mitral valve disease’ as a specific entity? O. Torras ∗ , J. Hourdain , J.C. Deharo , G. Habib , J. Pradier , A.C. Casalta , N. Resseguier , J.F. Avierinos CHU La Timone, AP—HM, Marseille, France ∗ Corresponding author. E-mail address: [email protected] (O. Torras) Background A particular phenotype of mitral valve prolapse (MVP) was identified as linked to sudden-death (SD) associating myxomatous, bi-leaflet and prolapse with mitral annular disjunction (MAD), so called ‘severe myxomatous mitral valve disease’ (SMMVP). Purpose Description of the prevalence and the echocardiographic characteristics of SMMVP in a cohort of MVP patients. Methods From a single center echocardiographic database, patients with MVP were retrospectively enrolled from January 2016 to December 2017 and echocardiographic characteristics, based for all patients on reports and additional measurement, were reported. Results Among 101 patients included (female, n = 50; 59 ± 16 years), we reported 71 patients with myxomatous MVP and 30 patients with fibro-elastic deficiency (FED). All patients with MAD (n = 22/101) had myxomatous bi-leaflet MVP (i.e. SMMVP). Compared to FED, SMMVP patients were younger (52 ± 13 vs. 68 ± 13 years, P = 0.02), without flail leaflet (0 vs.7 patients, P < 0.0001), with lower left ventricle (LV) ejection fraction (65 ± 9% vs. 76 ± 5%, P = 0.002) and greater LV end-systolic diameter (31 ± 5 mm vs. 25 ± 5 mm, P = 0.005) as systolic mitral annulus diameter (43 ± 7 vs. 33 ± 4 mm, P = 0.0009). SMMVP patients had, compared to FED and Barlow groups, a deeper MVP (6.5 ± 2.1 mm vs. 3.8 ± 1.2 mm, P = 0.0096; vs. 4.4 ± 1.4 mm, P = 0.009) with thicker distal posterior mitral leaflet (5.5 ± 1.2 mm vs. 3.4 ± 0.8 mm, P 0.004; vs. 4.3 ± 1.6 mm, P = 0.01) and lower mitral regurgitation (MR) (3/22 vs. 22/30 vs. 24/49 patients with severe MR, P < 0.0001). Among 101 MVP, 5 had SD history, all had a SMMVP. SMMVP patients with SD had larger MAD (10.3 ± 1.5 vs. 6.9 ± 1.7 mm, P = 0.007), deeper MVP (8.8 ± 2. vs. 5.1 ± 1.9 mm, P = 0.04) and larger systolic annulus diameter (48 ± 2 vs. 40 ± 6 mm, P = 0.02) than the other SMMVP. Conclusion Among MVP population, SMMVP is an independent MVP entity. This phenotype is all the more specific because it is linked to SD, associating severe deep myxomatous bi-leaflet prolapse with large MAD. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.112 043
Silent thrombosis of a WATCHMAN device after Left Atrial Appendage ClosureDate from the RESET registry Guillaume Bonnet 1 , J. Pradier 2 , A.C. Casalta 2 , A. Jacquier 3 , J. Bonnet 1,∗ 1 Service de Cardiologie A 2 Service de Cardiologie B 3 Service de Radiologie, CHU Timone, Marseille, France ∗ Corresponding author. E-mail address: [email protected] (J. Bonnet)
Introduction Left atrial appendage (LAA) closure (LAAC) is recommended in patients (pts) with non-valvular atrial fibrillation (AF) and a contra indication (CI) to long-term oral anticoagulation (OAC).We sought to determine incidence and risk factors for WATCHMAN device (WM) thrombosis. Methods LAAC with a WM was done in 100 consecutive pts prospectively included in the monocentric RESET Registry. No thromboembolic event occurred. Transoesophageal echocardiography (TOE) was done in 57 pts at a median of 53 days (22—460) and Cardiac Computed Tomography Angiography (CCTA) in 62 at a median of 175 days (33—792). LAA thrombus against the device was detected by TOE or CCTA in 5 pts. We compared characteristics of the group with (DT) or without (NDT) device thrombosis. Results A major bleeding was the CI for OAC in 77 pts (96%) and only 8 received anticoagulation for 45 days after LAAC. Thereafter, 58 received aspirin (73%), 20 no treatment (25%) and 2 an OAC. LAA thrombus was detected in 2 pts by TOE (51 and 98 days) and 3 by CCTA (178, 183 and 447 day) and resolved on OAC. Incidence at 1 year was 5.1% (4/78). No significant difference was observed between the 2 groups. Although DT had a tendency of higher CHA2DS2-VASc (5 ± 1.6 vs. 4.6 ± 1.4) or HAS-BLED (4.6 ± 0.5 vs. 4.4 ± 1) scores, permanent AF (60% vs. 48%), intracranial haemorrhage (80% vs. 48%), no difference in term of history of stroke/TIA (60% vs. 70%) or antiplatelet treatment (80% vs. 60%) was noted. Morphology of LAA was in all cases a non-chicken-wing (vs. 67%). Conclusion Although LAAC is limited to patients with multiple comorbidities that are reluctant to TOE, incidence of LAA thrombosis after WM implantation is high enough to strongly recommend device surveillance. Nevertheless, the optimal timing for imaging remains unclear and repetitive studies could be necessary in specific conditions. Medical history and morphologic characteristics of LAA are of limited help to identify high-risk patients. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.113 488
Preliminary data from ‘LAA-Print French registry’: A large national multi-centric prospective registry evaluating a new preoperative approach based on 3D printed simulation in LAAC procedures V. Ciobotaru 1,∗ , E. Marijon 2 , Julien Ternacle 3 , Xavier Iriart 4 , N. Combes 5 , Meyer Elbaz 6 , A. Lepillier 7 , G. Bonnet 8 , S. Armero 9 , S. Hascoët 10 , E. Cheneau 11 1 Cardiologie, hôpital Privé Les Franciscaines, Nîmes 2 Cardiology, HEGP, Paris 3 CHU Henri-Mondor, Creteil 4 CHU de Bordeaux, Bordeaux 5 Clinique Pasteur 6 CHU Rangueil, Toulouse 7 Centre Cardiologique du Nord, Paris 8 CHU de Timone 9 Hôpital européen de Marseille, Marseille 10 Hôpital Marie-Lannelongue, Le Plessis-Robinson 11 Centre hospitalier Privé Clairval, Marseille, France ∗ Corresponding author. E-mail address: [email protected] (V. Ciobotaru) Introduction 3D-printing have demonstrated improving in LAAC device sizing, a reduce procedure time and number of prostheses
Abstracts The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2018.10.111 396
Exhaustive echocardiographic phenotyping of mitral valve prolapse in a single center: ‘Severe myxomatous mitral valve disease’ as a specific entity? O. Torras ∗ , J. Hourdain , J.C. Deharo , G. Habib , J. Pradier , A.C. Casalta , N. Resseguier , J.F. Avierinos CHU La Timone, AP—HM, Marseille, France ∗ Corresponding author. E-mail address: [email protected] (O. Torras) Background A particular phenotype of mitral valve prolapse (MVP) was identified as linked to sudden-death (SD) associating myxomatous, bi-leaflet and prolapse with mitral annular disjunction (MAD), so called ‘severe myxomatous mitral valve disease’ (SMMVP). Purpose Description of the prevalence and the echocardiographic characteristics of SMMVP in a cohort of MVP patients. Methods From a single center echocardiographic database, patients with MVP were retrospectively enrolled from January 2016 to December 2017 and echocardiographic characteristics, based for all patients on reports and additional measurement, were reported. Results Among 101 patients included (female, n = 50; 59 ± 16 years), we reported 71 patients with myxomatous MVP and 30 patients with fibro-elastic deficiency (FED). All patients with MAD (n = 22/101) had myxomatous bi-leaflet MVP (i.e. SMMVP). Compared to FED, SMMVP patients were younger (52 ± 13 vs. 68 ± 13 years, P = 0.02), without flail leaflet (0 vs.7 patients, P < 0.0001), with lower left ventricle (LV) ejection fraction (65 ± 9% vs. 76 ± 5%, P = 0.002) and greater LV end-systolic diameter (31 ± 5 mm vs. 25 ± 5 mm, P = 0.005) as systolic mitral annulus diameter (43 ± 7 vs. 33 ± 4 mm, P = 0.0009). SMMVP patients had, compared to FED and Barlow groups, a deeper MVP (6.5 ± 2.1 mm vs. 3.8 ± 1.2 mm, P = 0.0096; vs. 4.4 ± 1.4 mm, P = 0.009) with thicker distal posterior mitral leaflet (5.5 ± 1.2 mm vs. 3.4 ± 0.8 mm, P 0.004; vs. 4.3 ± 1.6 mm, P = 0.01) and lower mitral regurgitation (MR) (3/22 vs. 22/30 vs. 24/49 patients with severe MR, P < 0.0001). Among 101 MVP, 5 had SD history, all had a SMMVP. SMMVP patients with SD had larger MAD (10.3 ± 1.5 vs. 6.9 ± 1.7 mm, P = 0.007), deeper MVP (8.8 ± 2. vs. 5.1 ± 1.9 mm, P = 0.04) and larger systolic annulus diameter (48 ± 2 vs. 40 ± 6 mm, P = 0.02) than the other SMMVP. Conclusion Among MVP population, SMMVP is an independent MVP entity. This phenotype is all the more specific because it is linked to SD, associating severe deep myxomatous bi-leaflet prolapse with large MAD. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.112 043
Silent thrombosis of a WATCHMAN device after Left Atrial Appendage ClosureDate from the RESET registry Guillaume Bonnet 1 , J. Pradier 2 , A.C. Casalta 2 , A. Jacquier 3 , J. Bonnet 1,∗ 1 Service de Cardiologie A 2 Service de Cardiologie B 3 Service de Radiologie, CHU Timone, Marseille, France ∗ Corresponding author. E-mail address: [email protected] (J. Bonnet)
Introduction Left atrial appendage (LAA) closure (LAAC) is recommended in patients (pts) with non-valvular atrial fibrillation (AF) and a contra indication (CI) to long-term oral anticoagulation (OAC).We sought to determine incidence and risk factors for WATCHMAN device (WM) thrombosis. Methods LAAC with a WM was done in 100 consecutive pts prospectively included in the monocentric RESET Registry. No thromboembolic event occurred. Transoesophageal echocardiography (TOE) was done in 57 pts at a median of 53 days (22—460) and Cardiac Computed Tomography Angiography (CCTA) in 62 at a median of 175 days (33—792). LAA thrombus against the device was detected by TOE or CCTA in 5 pts. We compared characteristics of the group with (DT) or without (NDT) device thrombosis. Results A major bleeding was the CI for OAC in 77 pts (96%) and only 8 received anticoagulation for 45 days after LAAC. Thereafter, 58 received aspirin (73%), 20 no treatment (25%) and 2 an OAC. LAA thrombus was detected in 2 pts by TOE (51 and 98 days) and 3 by CCTA (178, 183 and 447 day) and resolved on OAC. Incidence at 1 year was 5.1% (4/78). No significant difference was observed between the 2 groups. Although DT had a tendency of higher CHA2DS2-VASc (5 ± 1.6 vs. 4.6 ± 1.4) or HAS-BLED (4.6 ± 0.5 vs. 4.4 ± 1) scores, permanent AF (60% vs. 48%), intracranial haemorrhage (80% vs. 48%), no difference in term of history of stroke/TIA (60% vs. 70%) or antiplatelet treatment (80% vs. 60%) was noted. Morphology of LAA was in all cases a non-chicken-wing (vs. 67%). Conclusion Although LAAC is limited to patients with multiple comorbidities that are reluctant to TOE, incidence of LAA thrombosis after WM implantation is high enough to strongly recommend device surveillance. Nevertheless, the optimal timing for imaging remains unclear and repetitive studies could be necessary in specific conditions. Medical history and morphologic characteristics of LAA are of limited help to identify high-risk patients. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2018.10.113 488
Preliminary data from ‘LAA-Print French registry’: A large national multi-centric prospective registry evaluating a new preoperative approach based on 3D printed simulation in LAAC procedures V. Ciobotaru 1,∗ , E. Marijon 2 , Julien Ternacle 3 , Xavier Iriart 4 , N. Combes 5 , Meyer Elbaz 6 , A. Lepillier 7 , G. Bonnet 8 , S. Armero 9 , S. Hascoët 10 , E. Cheneau 11 1 Cardiologie, hôpital Privé Les Franciscaines, Nîmes 2 Cardiology, HEGP, Paris 3 CHU Henri-Mondor, Creteil 4 CHU de Bordeaux, Bordeaux 5 Clinique Pasteur 6 CHU Rangueil, Toulouse 7 Centre Cardiologique du Nord, Paris 8 CHU de Timone 9 Hôpital européen de Marseille, Marseille 10 Hôpital Marie-Lannelongue, Le Plessis-Robinson 11 Centre hospitalier Privé Clairval, Marseille, France ∗ Corresponding author. E-mail address: [email protected] (V. Ciobotaru) Introduction 3D-printing have demonstrated improving in LAAC device sizing, a reduce procedure time and number of prostheses