Percutaneous Treatment of Left Side Cardiac Valves: A Practical Guide for the Interventional Cardiologist

351 Pages·2012·41.394 MB·English

by  Corrado Tamburino, Gian Paolo Ussia (auth.)

Percutaneous Treatment
of Left Side Cardiac Valves
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--
Societa Italiana
Ferrarotto Hospital ETNA Foundution University of Catania di Cardiologia Invasiva
Corrado Tamburino • Gian Paolo Ussia
ercutaneous reatment
of eft Side Cardiac
Va yes
A Practical Guide for the
Interventional Cardiologist
Second Edition
In collaboration with
Davide Capodanno
Massimiliano Mule
~ Springer
Corrado Tamburino Gian Paolo Ussia
Full Professor of Cardiology, Director of lnterventional Cardiology
Postgraduate School of Cardiology Director Structural Heart Disease Program
Chief of Cardiothoracovascular Department Cardiology Division, Ferrarotto Hospital
Director of Cardiology Division and Catania, Italy
Interventional Cardiology
Ferrarotto Hospital, University of Catania
ETNA Foundation, Catania, Italy
In collaboration with
Davide Capodanno
Professor of Cardiology, Cardiology Division, Ferrarotto Hospital, University of Catania,
ETNA Foundation, Catania, Italy
Massimiliano Mule
Heart Failure Unit, Cardiology Division, Ferrarotto Hospital, University of Catania, ETNA
Foundation, Catania, Italy
The Authors thank the "Associazione Cuore e Ricerca" of Catania for the technical and
scientitic support in the realization of this volume
ISBN 978-88-470-2630-8 ISBN 978-88-470-2631-5 (eBook)
DOl 10.1007/978-88-470-2631-5
Springer Milan Dordrecht Heidelberg London New York
Library of Congress Control Number: 2012935777
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54321 2012 2013 2014 2015
Cover design: Simona Colombo, Milan, Italy
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This volume is dedicated to the real engine of research,
motivating force of passion and mental vivacity:
my students, young doctors and fellows
to whom I wish to say a sincere "thank you"
Corrado Tamburino
Preface to the Second Edition
At the time of publication ofthis handbook, percutaneous treatment of left side car
diac valves represented just an exciting and promising opportunity. The lack of out
come data at medium and long term, however, required some caution, since there
were still too many unknowns related to a minimally invasive treatment of valvular
heart disease, including durability of acute results, long-term impact of procedural
complications, patient selection and so on. After two years since our first publica
tion, the literature has produced substantial data supporting particularly tran
scatheter aortic valve implantation, in parallel with a considerable increase of the
procedures around the world, as well as operators' experience and procedural suc
cess. These data allow now to consider these procedures not only a promise for the
future, but a solid reality of our present. Not surprisingly, the enthusiasm for these
achievements has prompted the industry to continuously improve their own
devices. The scenario has therefore changed dramatically in recent years, necessi
tating a substantial update of the first edition of this volume. Once again, the goal
ofthis practical handbook is to give interventional cardiologists an advanced under
standing and the current state of the art of the percutaneous treatment of left side
cardiac valves.
Catania, April 2012 Corrado Tamburino
Gian Paolo U ssia
vii
Preface to the First Edition
Transcatheter therapy of cardiac valve diseases is a rediscovery by interventional
cardiologists. Treating cardiac valve diseases with alternative techniques to car
diac surgery using prosthetic devices has rekindled interest in the field of hemo
dynamics, which has been neglected in recent years. Within this framework, two
sectors can be distinguished: valvuloplasty techniques using a balloon alone to
treat mitral, aortic, and pulmonary stenoses, and those using prosthetic heart
valves or repair devices. Valvuloplasty techniques should be considered as pallia
tive, as the duration of their effectiveness varies from just a few weeks, as in the
case of aortic valvuloplasty for degenerative stenoses, to years, as in the case of
mitral and pulmonary valvuloplasty. By contrast, transcatheter implantation of
biological prosthetic valves, or repair techniques using dedicated devices aim to
provide a definitive therapeutic solution or at least a solution offering results that
are equal to or just as good as those of cardiac surgery. The advent of devices for
the percutaneous treatment of left chamber valve diseases is one of the greatest
breakthroughs in interventional cardiology. The goal of this handbook is to give
interventional cardiologists the means to understand the context of the percuta
neous treatment of valve diseases and the state of the art of the techniques and pro
cedures currently available.
Catania, April 2010 Corrado Tamburino
Gian Paolo U ssia
ix
Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XV
Abbreviations .................................................. XIX
1 Anatomy ................................................. .
1.1 Mitral Valve Anatomy ................................ .
1.1.1 Mitral Leatlets ....................................... 2
1.1.2 Annulus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.1.3 Papillary Muscles and Chordae Tendineae . . . . . . . . . . . . . . . . . 6
1.2 Aortic Valve Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.2.1 Annulus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.2.2 Leatl ets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.2.3 Commissures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.2.4 Interleatlet Triangles .................................. 10
1.2.5 Sinuses of Valsalva ................................... 11
1.2.6 Sinotubular Junction .................................. 11
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 12
2 Mitral Valve Diseases ....................................... 15
2.1 Mitral Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 15
2.1.1 Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 15
2.1.2 Pathophysiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 16
2.1.3 Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 18
2.1.3.1 Noninvasive Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 18
2.1.3.2 Invasive Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 31
2.1.4 Timing of Intervention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 33
2.1.5 Percutaneous Therapy ................................. 36
2.l.5.1 Patient Selection ..................................... 38
2.l.5.2 Procedure and Technical Aspects ........................ 39
2.l.5.3 Complications ....................................... 43
xi
xii Contents
2.l.5.4 Results..................... ................... ..... 44
2.2. Mitral Regurgitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 45
2.2.1 Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 45
2.2.2 Pathophysiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 45
2.2.2.1 Degenerative Mitral Regurgitation ............. ..... ..... 47
2.2.2.2 Secondary or Functional Mitral Regurgitation .............. 49
2.2.3 Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 51
2.2.3.1 Noninvasive Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 51
2.2.3.2 Invasive Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 72
2.2.4 Timing ofIntervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 75
2.2.5 Percutaneous Therapy .... ..... ..... .............. ..... 78
2.2.5.1 Leaflet Repair ....................................... 79
2.2.5.2 Indirect Annuloplasty
(Trans catheter Coronary Sinus Techniques) ................ 108
2.2.5.3 Direct Annuloplasty .............................. ..... 113
2.2.5.4 Chamber and Annular Remodeling ....................... 117
2.2.5.5 Transcatheter Mitral Valve Replacement. . . . . . . . . . . . . . . . . .. 119
2.2.5.6 Percutaneous Neochordal Implantation .................... 120
2.2.6 Mitral Regurgitation Post-Cardiac Resynchronization Therapy .. 120
References ................................................. 123
3 Aortic Valve Disease ........................................ 137
3.1 Aortic Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 137
3.1.1 Epidemiology ........................................ 137
3.1.2 Pathophysiology ...................................... 139
3.1.3 Diagnosis ........................................... 139
3.1.3.1 NoninvasiveDiagnosis ................................. 139
3.1.3.2 Invasive Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 151
3.1.4 Timing of Interventions ................................ 152
3.1.4.1 Symptomatic Patients ................................. 154
3.1.4.2 Asymptomatic Patients ................................ 154
3.1.5 Percutaneous Treatment of Aortic Stenosis. . . . . . . . . . . . . . . .. 157
3.1.5.1 Aortic Valvuloplasty .................................. 157
3.1.5.2 Percutaneous Aortic Valve Implantation . . . . . . . . . . . . . . . . . .. 163
3.1.5.3 Edwards-SAPIEN XT Transcatheter Heart Valve ............ 176
3.1.5.4 Core Valve Revalving System Device ..................... 198
3.1.5.5 Echocardiographic Guidance during TAVI ................. 213
3.1.5.6 Essential Reading ..................................... 215
3.1.5.7 Other Devices ........................................ 223
3.1.5.8 Potential Periprocedural Complications ................... 231
3.2 Aortic Regurgitation .................................. 245
3.2.1 Epidemiology ........................................ 245
3.2.2 Pathophysiology ...................................... 245
3.2.3 Diagnosis ........................................... 246
Contents xiii
3.2.3.1 Noninvasive Diagnosis ................................. 246
3.2.3.2 Invasive Diagnosis .................................... 251
3.2.4 Timing ofInterventions ................................ 251
3.2.5 Patient Selection ..................................... 253
3.2.6 Percutaneous Therapy .................. ..... ..... ..... 254
3.3 Transcatheter Aortic Valve Implantation
for Degenerated Surgical Bioprosthesis ................... 254
3.3.1 Basics of Surgical Biological Devices ..................... 255
References ............................................ ..... 257
4 Tips and Tricks and Complication Management in Valvular
Interventional Cardiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
4.1 Patient Selection ..................................... 270
4.1.1 Anatomical Typing ............................... ..... 270
4.1.2 Valve and Heart Anatomy .............................. 270
4.1.3 Vascular Anatomy ..................... ..... .......... 272
4.1.3.1 Femoral Arteries ..................................... 272
4.1.3.2 Iliac Arteries ........................................ 273
4.1.3.3 Abdominal Aorta ..................................... 274
4.1.3.4 Thoracic Aorta ....................................... 275
4.2 Procedure ........................................... 275
4.2.1 Vascular Accesses .................................... 276
4.2.2 Choosing the Introducer ............................... 280
4.2.3 Passing the Aortic Valve ............................... 283
4.2.4 Valvuloplasty ........................................ 288
4.2.5 Percutaneous Heart Valve Delivery and Implantation ......... 289
4.2.5.1 Check of Implantation ................................. 294
4.2.6 Closing the Arterial Breach with Prostar Device ............ 298
4.2.7 Miscellaneous ....................................... 300
4.2.7.1 Difficult Navigation of the Delivery Catheter
in the Aortic Arch .................................... 300
4.2.7.2 Recovery of Catheter Fragments ......................... 301
4.2.7.3 Balloon Valvuloplasty Trapping ......................... 301
4.2.7.4 Management of Vascular Complications ................... 302
4.3 Mitraclip ............................................ 305
4.3.1 Device and Technique ................................. 305
4.3.2 Procedure ........................................... 305
Reference .................................................. 312
5 Transcatheter Valve Treatment: Periprocedural Management ..... 313
5.1 Preprocedural Care ................................... 315
5.2 Postprocedural Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316
5.2.1 ICU Care ........................................... 316