Quantification of mitral regurgitation during percutaneous mitral valve repair: added value of simultaneous hemodynamic and 3D echocardiographic assessment

  • Ilonka Rohm
  • Tudor C. Poerner
  • Ali Hamadanchi
  • Sylvia Otto
  • Torsten Doenst
  • Christian Jung
  • P. Christian Schulze
  • Björn Goebel
Original Paper


The objective of this study was to investigate the usefulness of intraprocedural hemodynamic monitoring for MR evaluation during pMRV. Assessment of mitral regurgitation (MR) during percutaneous mitral valve repair (pMVR) procedure is challenging. 3D color Doppler allows exact quantification of MR, but is technically demanding. Sixty patients with moderate to severe MR (14 with structural and 46 functional MR) were included in the study. Intraprocedural pressure curves were continuously obtained in the left atrium (LA) and left ventricle (LV). Transesophageal echocardiography was performed using 3D color Doppler derived mean vena contracta area (VCAmean) and mitral regurgitation volume (RegVol) to quantify MR severity before and after each clip implantation. In the entire patient group, strongest correlations were observed firstly between VCA and the raise of the ascending limb of the left atrial V pressure wave (Vascend; r = 0.58, p < 0.001) and secondly between the difference of peak V wave pressure and mean LA pressure divided by systolic LV pressure [(Vpeak − LAmean) − LVsystole; r = 0.53, p < 0.001]. In patients with structural MR, the highest area under the ROC curve for prediction of mild MR (VCAmean < 0.2 cm² and RegVol < 30 ml) after clip implantation was found for Vascend (AUC 0.89, p < 0.001) whereas in functional MR calculation of (Vpeak − LAmean) − LVsystole showed the highest predictive value (AUC 0.69, p = 0.003). Invasive pressure monitoring can give a direct feedback with regard to the success of clip placement during pMVR.


Mitral regurgitation Vena contracta area 3D color Doppler echocardiography Invasive pressure monitoring V wave 



Body mass index


Degenerative mitral regurgitation


Functional mitral regurgitation


Left atrium


LA compliance


Mean LA pressure


Left ventricle


Area under the pressure–time curve derived from the LV


Left ventricular end diastolic pressure


Peak systolic left ventricular pressure


Mitral regurgitation


Regurgitation volume measured by VCA method


Diastolic blood pressure


Systolic blood pressure


Vena contracta area derived by 3D color Doppler echocardiography


Peak pressure value of the left atrial V wave


Area under the pressure–time curve of the left atrial V wave


Velocity of pressure rise of the left atrial V wave



Björn Goebel and Ali Hamadanchi have received a travel grant by Abbott Vascular to attend EuroEcho-Imaging congress 2015. The authors have full control of all primary data and agree to allow the journal to review the data if requested.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.


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Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Divisions of Cardiology, Angiology, Pneumology, and Intensive Medical Care, Department of Internal Medicine 1Friedrich-Schiller-University of JenaJenaGermany
  2. 2.Department of Cardiothoracic SurgeryJena University Hospital-Friedrich Schiller University of JenaJenaGermany
  3. 3.Department of Medicine, Division of Cardiology, Pulmonary Diseases and Vascular MedicineUniversity Hospital DüsseldorfDüsseldorfGermany

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