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LV outflow obstruction predicts increase in systolic pressure gradients and blood residence time after TMVR

Philips CT Clinical Science Philips Healthcare • USA

De Vecchi A, Marlevi D, Nordsletten DA, Ntalas I, Leipsic J, Bapat V, Rajani R, Niederer SA.


* This article originally appeared in the October 2018 edition of Scientific Reports.

Left ventricular outflow tract (LVOT) obstruction is a relatively common consequence of transcatheter mitral valve replacement (TMVR). Although LVOT obstruction is associated with heart failure and adverse remodeling, its effects upon left ventricular hemodynamics remain poorly characterized. This study uses validated computational models to identify the LVOT obstruction degree that causes significant changes in ventricular hemodynamics after TMVR. Seven TMVR patients underwent personalized flow simulations based on pre-procedural imaging data. Different virtual valve configurations were simulated in each case, for a total of 32 simulations, and the resulting obstruction degree was correlated with pressure gradients and flow residence times. These simulations identified a threshold LVOT obstruction degree of 35%, beyond which significant deterioration of systolic function was observed. The mean increase from baseline (pre-TMVR) in the peak systolic pressure gradient rose from 5.7% to 30.1% above this threshold value. The average blood volume staying inside the ventricle for more than two cycles also increased from 4.4% to 57.5% for obstruction degrees above 35%, while the flow entering and leaving the ventricle within one cycle decreased by 13.9%. These results demonstrate the unique ability of modelling to predict the hemodynamic consequences of TMVR and to assist in the clinical decision-making process.
For more information about this publication, check out the PubMed listing for this article.

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Jun 29, 2019

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Cardiac, Interventional, left ventricle

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