Comprehensive evaluation of cardiac valve complex based on three-dimensional imaging for newly developed transcatheter heart valve treatment

2019 Fiscal Year Final Research Report

• Project/Area Number: 17K16008
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: Cardiovascular medicine
• Research Institution: Hiroshima University
• Principal Investigator: Utsunomiya Hiroto 広島大学, 病院(医), 助教 (10778492)
• Project Period (FY): 2017-04-01 – 2020-03-31
• Keywords: 心臓弁膜症 / 三次元経食道心エコー / 経皮的治療 / 大動脈弁狭窄症 / 僧帽弁閉鎖不全症 / 三尖弁閉鎖不全症

Outline of Final Research Achievements

①Reduced leaflet motion (RELM) after transcatheter aortic valve implantation (TAVI) may affect valve durability. However, its peri-procedural determinants remain unknown. Using intraprocedural 3D echocardiography data, insufficient valve expansion defined as a low post-TAVI annular area/pre-TAVI annular area ratio was independently associated with the incidence of post-TAVI RELM.
②MitraClip therapy may alter mitral valve (MV) geometry in functional mitral regurgitation (MR). Significant reduction in anterior-posterior MV diameter was observed post-Clip. On multivariable analysis, MR reduction post-Clip was associated with shortening in anterior-posterior diameter and a decrease in the averaged tethering angle difference.
③Three-dimensional vena contracta area has independent and incremental diagnostic value for evaluating severe tricuspid regurgitation (TR). Comprehensive evaluation of TR location and severity using 3D vena contracta analysis may help in treatment selection for TR.

Free Research Field

循環器内科学

Academic Significance and Societal Importance of the Research Achievements

従来，心臓弁膜症の治療は外科的治療に負うところが大きかったが，高齢や併存疾患のために外科治療がためらわれるような症例が増加しており，より低侵襲な治療方法が望まれてきた。心臓弁膜症に対する経皮的治療は欧米で先行され，本邦でも今後導入と適応拡大が行われる可能性が高い。
経皮的治療を行うに当たっては，従来の外科手術のように直視下で弁複合体を評価するわけではないため，術前の三次元的画像診断が極めて重要である。本研究では，経皮的治療時代を見据え，大動脈弁，僧帽弁，三尖弁の三次元的評価方法の提唱を行った。十分な術前評価によって，この低侵襲治療の効果が十分に引き出されることが期待される。