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Cardiovascular Images
February 8, 2021

Right Ventricular Pressure–Volume Analysis Before and After Transcatheter Leaflet Approximation for Severe Mitral Regurgitation

Author Affiliations
  • 1Division of Cardiology, Columbia University Irving Medical Center, New York, New York
  • 2Cardiovascular Research Foundation, New York, New York
  • 3Division of Cardiology, Mayo Clinic, Rochester, Minnesota
  • 4Princeton Heart and Thoracic, Brookwood Baptist Health, Birmingham, Alabama
JAMA Cardiol. 2021;6(2):e207209. doi:10.1001/jamacardio.2020.7209

What is the right ventricular response to transcatheter edge-to-edge repair for mitral regurgitation? Biventricular pressure-volume (PV) analysis was performed with a conductance catheter (CD Leycom) in a patient in their 80s with severe primary mitral regurgitation (MR), before and after transcatheter leaflet approximation (Figure). MitraClip deployment resulted in decreased left atrial pressure (LAP) (24 to 16 mm Hg) and V-wave amplitude (47 to 21 mm Hg). The RV PV loops illustrate a marked reduction in afterload, or effective arterial elastance (Ea), which is represented by the slope of the dashed line connecting end-diastolic volume with the end-systolic PV point. When indexing RV Ea in this manner,1 Ea reflects both pulmonary arterial properties and LAP. MitraClip does not alter pulmonary arterial properties in the short term, but it did reduce LAP and V-wave amplitude dramatically in this patient. Consequently, RV Ea declined after MitraClip implantation, illustrating the pivotal role of left-sided filling pressures in RV afterload. This finding explains the observed improvements in RV function following transcatheter leaflet approximation2 and complements previous reports characterizing LV function after MitraClip implantation.3,4

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