P980Mitral inflow patterns in rest and during exercise following MitraClip implantation

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Background: Due to the implantation of one or more MitraClips in patients with mitral valve regurgitation, a decrease in mitral valve area (MVA) is created, which has not been shown to result in clinical significant mitral stenosis. However mitral inflow patterns were only measured in these patients during resting conditions. Therefore we aimed to investigate the effect of MitraClip implantation on mitral valve pressure gradient (MVPG) after exercise.Methods: In a single center prospective observational study, we included 17 patients (age 72±10 years, 9 male) with severe mitral valve regurgitation, who underwent MitraClip implantation with placement of one or more clips. Transthoracic echocardiography was performed before and 1 month after MitraClip implantation to measure the mean and maximum MVPG with continuous wave Doppler (in rest and directly after exercise). Other clinical data were collected from the medical history.Results: Following MitraClip implantation the mean MVPG increased from 1.8±1.1 mmHg at baseline to 3.8±1.3 mmHg at 1 month (P<0.001). During exercise at follow-up the mean MVPG increased from 3.8± 1.3 to 6.1±3.0 mmHg (P=0.001). The maximum MVPG is also significantly increased at one month follow up from 6.1±3.4 mmHg at baseline to 9.9±3.3 mmHg (P=0.002) and after exercise from 9.9±3.3mmHg to 12.8±5.8mmHg (P= 0.032). The pulmonary artery pressure decreased from 45.1±8.2 mmHg at baseline to 38.6 ±9.3mmHg at follow up (P=0.016). NYHA class was significantly decreased from a median of III at baseline to II at 1 month follow up (P<0.001).Conclusion: MitraClip implantation results in an expected increase of mean and maximum transmitral pressure gradient during exercise, however with no evidence of clinically significant mitral stenosis.

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