Definition of atrial functional mitral regurgitation and feasibility of percutaneous edge-to-edge mitral valve repair in atrial functional mitral regurgitation_West China Medical Journal

Authors：

PAN Wenzhi , JIN Qinchun ,  ZHOU Daxin

Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China;

Corresponding author：

ZHOU Daxin, Email: zhou.daxin@zs-hospital.sh.cn

Keywords：

Atrial fibrillation; Functional mitral regurgitation; Transcatheter mitral valve repair

DOI：

10.7507/1002-0179.202108063

Video：

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Abstract Full text Figures/Tables Video References Cited by

Atrial functional mitral regurgitation has been referred to patients with atrial fibrillation related functional mitral regurgitation without left ventricular dysfunction and it has nowadays received remarked attention in structural heart disease field. Significant dilation of mitral annulus and left atrium, insufficient leaflet remodeling, iatrogenic leaflet tethering, reduced annular contractility and increased valve stress by flattened saddle shape of the annulus might be important triggers of atrial functional mitral regurgitation. Recently, several studies indicated that transcatheter edge-to-edge mitral valve repair could be an effective strategy for atrial functional mitral regurgitation. In this review, the definition, mechanism together with efficacy and safety of transcatheter edge-to-edge mitral valve repair in atrial functional mitral regurgitation are discussed.

Citation： PAN Wenzhi, JIN Qinchun, ZHOU Daxin. Definition of atrial functional mitral regurgitation and feasibility of percutaneous edge-to-edge mitral valve repair in atrial functional mitral regurgitation. West China Medical Journal, 2021, 36(9): 1172-1176. doi: 10.7507/1002-0179.202108063 Copy

1.	Dziadzko V, Dziadzko M, Medina-Inojosa JR, et al. Causes and mechanisms of isolated mitral regurgitation in the community: clinical context and outcome. Eur Heart J, 2019, 40(27): 2194-2202.
2.	Samad Z, Shaw LK, Phelan M, et al. Long-term outcomes of mitral regurgitation by type and severity. Am Heart J, 2018, 203: 39-48.
3.	Abe Y, Takahashi Y, Shibata T. Functional mitral regurgitation, updated: ventricular or atrial?. J Echocardiogr, 2020, 18(1): 1-8.
4.	El Sabbagh A, Reddy YNV, Nishimura RA. Mitral valve regurgitation in the contemporary era: insights into diagnosis, management, and future directions. JACC Cardiovasc Imaging, 2018, 11(4): 628-643.
5.	Yoshida J, Ikenaga H, Nagaura T, et al. Impact of percutaneous edge-to-edge repair in patients with atrial functional mitral regurgitation. Circ J, 2021, 85(7): 1001-1010.
6.	潘文志, 周达新, 葛均波. 二尖瓣反流机制的新认识及其应用. 中国医学前沿杂志(电子版), 2017, 9(10): 43-46.
7.	Machino-Ohtsuka T, Seo Y, Ishizu T, et al. Novel mechanistic insights into atrial functional mitral regurgitation- 3-dimensional echocardiographic study. Circ J, 2016, 80(10): 2240-2248.
8.	Kagiyama N, Hayashida A, Toki M, et al. Insufficient leaflet remodeling in patients with atrial fibrillation: association with the severity of mitral regurgitation. Circ Cardiovasc Imaging, 2017, 10(3): e005451.
9.	Itabashi Y, Mihara H, Berdejo J, et al. Distant position of chordae from coaptation causes mitral regurgitation in patients with atrial fibrillation. J Heart Valve Dis, 2016, 25(3): 323-331.
10.	Sharma S, Lardizabal J, Monterroso M, et al. Clinically unrecognized mitral regurgitation is prevalent in lone atrial fibrillation. World J Cardiol, 2012, 4(5): 183-187.
11.	Abe Y, Akamatsu K, Ito K, et al. Prevalence and prognostic significance of functional mitral and tricuspid regurgitation despite preserved left ventricular ejection fraction in atrial fibrillation patients. Circ J, 2018, 82(5): 1451-1458.
12.	Cong T, Gu J, Lee AP, et al. Quantitative analysis of mitral valve morphology in atrial functional mitral regurgitation using real-time 3-dimensional echocardiography atrial functional mitral regurgitation. Cardiovasc Ultrasound, 2018, 16(1): 13.
13.	Dal-Bianco JP, Aikawa E, Bischoff J, et al. Active adaptation of the tethered mitral valve: insights into a compensatory mechanism for functional mitral regurgitation. Circulation, 2009, 120(4): 334-342.
14.	Chaput M, Handschumacher MD, Tournoux F, et al. Mitral leaflet adaptation to ventricular remodeling: occurrence and adequacy in patients with functional mitral regurgitation. Circulation, 2008, 118(8): 845-852.
15.	Kim DH, Heo R, Handschumacher MD, et al. Mitral valve adaptation to isolated annular dilation: insights into the mechanism of atrial functional mitral regurgitation. JACC Cardiovasc Imaging, 2019, 12(4): 665-677.
16.	Silbiger JJ. Does left atrial enlargement contribute to mitral leaflet tethering in patients with functional mitral regurgitation? Proposed role of atriogenic leaflet tethering. Echocardiography, 2014, 31(10): 1310-1311.
17.	Salgo IS, Gorman JH 3rd, Gorman RC, et al. Effect of annular shape on leaflet curvature in reducing mitral leaflet stress. Circulation, 2002, 106(6): 711-717.
18.	Caiani EG, Fusini L, Veronesi F, et al. Quantification of mitral annulus dynamic morphology in patients with mitral valve prolapse undergoing repair and annuloplasty during a 6-month follow-up. Eur J Echocardiogr, 2011, 12(5): 375-383.
19.	Yoon YE, Kim HJ, Kim SA, et al. Left atrial mechanical function and stiffness in patients with paroxysmal atrial fibrillation. J Cardiovasc Ultrasound, 2012, 20(3): 140-145.
20.	Mack MJ, Lindenfeld J, Abraham WT, et al. 3-year outcomes of transcatheter mitral valve repair in patients with heart failure. J Am Coll Cardiol, 2021, 77(8): 1029-1040.
21.	Gertz ZM, Herrmann HC, Lim DS, et al. Implications of atrial fibrillation on the mechanisms of mitral regurgitation and response to MitraClip in the COAPT Trial. Circ Cardiovasc Interv, 2021, 14(4): e010300.
22.	Godino C, Sisinni A, Pivato CA, et al. Prognostic value of pre-operative atrial fibrillation in patients with secondary mitral regurgitation undergoing MitraClip implantation. Am J Cardiol, 2021, 143: 51-59.
23.	Kaur S, Sadana D, Patel J, et al. Atrial fibrillation and transcatheter repair of functional mitral regurgitation: evidence from a meta-regression. JACC Cardiovasc Interv, 2020, 13(20): 2374-2384.
24.	Ikenaga H, Higashihara T, Itakura K, et al. Successful MitraClip therapy for atrial functional mitral regurgitation with severe mitral annular calcification. JACC Cardiovasc Interv, 2021, 14(1): 101-102.
25.	Tabata N, Weber M, Sugiura A, et al. Impact of the leaflet-to-annulus index on residual mitral regurgitation in patients undergoing edge-to-edge mitral repair. JACC Cardiovasc Interv, 2019, 12(24): 2462-2472.
26.	Ben-Shoshan J, Overtchook P, Buithieu J, et al. Predictors of outcomes following transcatheter edge-to-edge mitral valve repair. JACC Cardiovasc Interv, 2020, 13(15): 1733-1748.
27.	Pan W, Zhou D, Wu Y, et al. First-in-human results of a novel user-friendly transcatheter edge-to-edge mitral valve repair device. JACC Cardiovasc Interv, 2019, 12(23): 2441-2443.

1. Dziadzko V, Dziadzko M, Medina-Inojosa JR, et al. Causes and mechanisms of isolated mitral regurgitation in the community: clinical context and outcome. Eur Heart J, 2019, 40(27): 2194-2202.
2. Samad Z, Shaw LK, Phelan M, et al. Long-term outcomes of mitral regurgitation by type and severity. Am Heart J, 2018, 203: 39-48.
3. Abe Y, Takahashi Y, Shibata T. Functional mitral regurgitation, updated: ventricular or atrial?. J Echocardiogr, 2020, 18(1): 1-8.
4. El Sabbagh A, Reddy YNV, Nishimura RA. Mitral valve regurgitation in the contemporary era: insights into diagnosis, management, and future directions. JACC Cardiovasc Imaging, 2018, 11(4): 628-643.
5. Yoshida J, Ikenaga H, Nagaura T, et al. Impact of percutaneous edge-to-edge repair in patients with atrial functional mitral regurgitation. Circ J, 2021, 85(7): 1001-1010.
6. 潘文志, 周达新, 葛均波. 二尖瓣反流机制的新认识及其应用. 中国医学前沿杂志(电子版), 2017, 9(10): 43-46.
7. Machino-Ohtsuka T, Seo Y, Ishizu T, et al. Novel mechanistic insights into atrial functional mitral regurgitation- 3-dimensional echocardiographic study. Circ J, 2016, 80(10): 2240-2248.
8. Kagiyama N, Hayashida A, Toki M, et al. Insufficient leaflet remodeling in patients with atrial fibrillation: association with the severity of mitral regurgitation. Circ Cardiovasc Imaging, 2017, 10(3): e005451.
9. Itabashi Y, Mihara H, Berdejo J, et al. Distant position of chordae from coaptation causes mitral regurgitation in patients with atrial fibrillation. J Heart Valve Dis, 2016, 25(3): 323-331.
10. Sharma S, Lardizabal J, Monterroso M, et al. Clinically unrecognized mitral regurgitation is prevalent in lone atrial fibrillation. World J Cardiol, 2012, 4(5): 183-187.
11. Abe Y, Akamatsu K, Ito K, et al. Prevalence and prognostic significance of functional mitral and tricuspid regurgitation despite preserved left ventricular ejection fraction in atrial fibrillation patients. Circ J, 2018, 82(5): 1451-1458.
12. Cong T, Gu J, Lee AP, et al. Quantitative analysis of mitral valve morphology in atrial functional mitral regurgitation using real-time 3-dimensional echocardiography atrial functional mitral regurgitation. Cardiovasc Ultrasound, 2018, 16(1): 13.
13. Dal-Bianco JP, Aikawa E, Bischoff J, et al. Active adaptation of the tethered mitral valve: insights into a compensatory mechanism for functional mitral regurgitation. Circulation, 2009, 120(4): 334-342.
14. Chaput M, Handschumacher MD, Tournoux F, et al. Mitral leaflet adaptation to ventricular remodeling: occurrence and adequacy in patients with functional mitral regurgitation. Circulation, 2008, 118(8): 845-852.
15. Kim DH, Heo R, Handschumacher MD, et al. Mitral valve adaptation to isolated annular dilation: insights into the mechanism of atrial functional mitral regurgitation. JACC Cardiovasc Imaging, 2019, 12(4): 665-677.
16. Silbiger JJ. Does left atrial enlargement contribute to mitral leaflet tethering in patients with functional mitral regurgitation? Proposed role of atriogenic leaflet tethering. Echocardiography, 2014, 31(10): 1310-1311.
17. Salgo IS, Gorman JH 3rd, Gorman RC, et al. Effect of annular shape on leaflet curvature in reducing mitral leaflet stress. Circulation, 2002, 106(6): 711-717.
18. Caiani EG, Fusini L, Veronesi F, et al. Quantification of mitral annulus dynamic morphology in patients with mitral valve prolapse undergoing repair and annuloplasty during a 6-month follow-up. Eur J Echocardiogr, 2011, 12(5): 375-383.
19. Yoon YE, Kim HJ, Kim SA, et al. Left atrial mechanical function and stiffness in patients with paroxysmal atrial fibrillation. J Cardiovasc Ultrasound, 2012, 20(3): 140-145.
20. Mack MJ, Lindenfeld J, Abraham WT, et al. 3-year outcomes of transcatheter mitral valve repair in patients with heart failure. J Am Coll Cardiol, 2021, 77(8): 1029-1040.
21. Gertz ZM, Herrmann HC, Lim DS, et al. Implications of atrial fibrillation on the mechanisms of mitral regurgitation and response to MitraClip in the COAPT Trial. Circ Cardiovasc Interv, 2021, 14(4): e010300.
22. Godino C, Sisinni A, Pivato CA, et al. Prognostic value of pre-operative atrial fibrillation in patients with secondary mitral regurgitation undergoing MitraClip implantation. Am J Cardiol, 2021, 143: 51-59.
23. Kaur S, Sadana D, Patel J, et al. Atrial fibrillation and transcatheter repair of functional mitral regurgitation: evidence from a meta-regression. JACC Cardiovasc Interv, 2020, 13(20): 2374-2384.
24. Ikenaga H, Higashihara T, Itakura K, et al. Successful MitraClip therapy for atrial functional mitral regurgitation with severe mitral annular calcification. JACC Cardiovasc Interv, 2021, 14(1): 101-102.
25. Tabata N, Weber M, Sugiura A, et al. Impact of the leaflet-to-annulus index on residual mitral regurgitation in patients undergoing edge-to-edge mitral repair. JACC Cardiovasc Interv, 2019, 12(24): 2462-2472.
26. Ben-Shoshan J, Overtchook P, Buithieu J, et al. Predictors of outcomes following transcatheter edge-to-edge mitral valve repair. JACC Cardiovasc Interv, 2020, 13(15): 1733-1748.
27. Pan W, Zhou D, Wu Y, et al. First-in-human results of a novel user-friendly transcatheter edge-to-edge mitral valve repair device. JACC Cardiovasc Interv, 2019, 12(23): 2441-2443.

West China Medical Journal

Definition of atrial functional mitral regurgitation and feasibility of percutaneous edge-to-edge mitral valve repair in atrial functional mitral regurgitation

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