Volker Rudolph

Background: Transcatheter tricuspid edge‐to‐edge repair (T‐TEER) has developed as a treatment option for patients experiencing severe tricuspid regurgitation. T‐TEER consistently reduces tricuspid regurgitation, but data on subsequent right heart remodeling remain limited. The aim of this study was to evaluate changes in right heart dimension and function after T‐TEER using extended echocardiographic follow‐up. Methods: The study was based on the international EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation), including patients undergoing T‐TEER between 2016 and 2024 at 18 European centers. Eligible were patients with available baseline and follow‐up (≥90 days postprocedure) echocardiographic assessment. Results: A total of 699 patients (mean age, 78±8 years; 56% women) were included in the analysis. Echocardiographic follow‐up was performed at a median of 407 days (interquartile range, 205–801 days). Right heart dimensions significantly decreased: right ventricular (RV) midventricular diameter from 40.2±8.9 to 37.1±8.4 mm ( P 2 ( P P P <0.001) was observed. Conclusions: In the subset of surviving patients with available echocardiographic follow‐up, treatment with T‐TEER led to favorable long‐term changes with reduced RV dimension, associated with procedural success. RV function modestly decreased, likely reflecting normalization after volume unloading.

BACKGROUND: Studies on mitral transcatheter edge-to-edge repair for atrial functional mitral regurgitation (AFMR) and ventricular functional mitral regurgitation (VFMR) are limited. METHODS: We report 1-year outcomes of mitral transcatheter edge-to-edge repair for AFMR and VFMR using the PASCAL transcatheter valve repair system in the MiCLASP (Transcatheter Repair of Mitral Regurgitation With Edwards Pascal Transcatheter Valve Repair System) multicenter European postmarket clinical follow-up study. RESULTS: Analysis included 295 patients with FMR (75.5±9.93 years old, 59.3% male) from the first 600 enrolled in the MiCLASP study, with AFMR in 17.6% (52) and VFMR in 82.4% (243). Patients with AFMR were older (79.7±6.67 versus 74.6±10.30 years), majority female (75.0% versus 33.3%), and had higher rates of hypertension (98.1% versus 82.3%) and atrial fibrillation (82.7% versus 60.1%) than patients with VFMR (all P P P P =0.661), and patients with AFMR had shorter procedure duration (73.5 versus 85.5 minutes; P =0.044). One-year Kaplan-Meier estimate of freedom from all-cause mortality or heart failure hospitalization was 79.3% in AFMR and 70.9% in VFMR ( P =0.267). Both AFMR and VFMR groups demonstrated significant mitral regurgitation reduction (mitral regurgitation ≤1+, 93.1% and 81.3%), low mean transmitral gradients (3.5 and 3.1 mm Hg), significant proportional reductions in left ventricular end-diastolic volume (−12.9% and −16.4%) and left atrial volume (−9.6% and −10.9%), high proportions at New York Heart Association class I/II (76.5% and 64.6%), and significant increases in Kansas City Cardiomyopathy Questionnaire Overall Summary score (+18.0 and +11.6 points), respectively (all P <0.05 from baseline). CONCLUSIONS: One-year MiCLASP results support the safety of mitral transcatheter edge-to-edge repair with the PASCAL system in both AFMR and VFMR, with comparable echocardiographic, functional, and quality-of-life changes, despite baseline differences in clinical presentation. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04430075.

Background: Acute Anrep effect describes transient afterload-dependent increase in myocardial contractility with the aim of maintaining a stroke volume during physical exertion. Sustained activation of the Anrep effect has recently been identified as a compensatory mechanism in afterload-driven diseases, such as hypertrophic obstructive cardiomyopathy or aortic stenosis. The aim of this case presentation was to show whether the Anrep effect can also be chronically activated and reversed in the right heart in a patient with pulmonary stenosis. Case summary: A 30-year-old female patient with chronic exertional dyspnoea (New York heart association II) and suspected supravalvular pulmonary stenosis was referred to our hospital for further diagnosis and treatment. Echocardiography revealed a borderline hypertrophied right ventricle with a gradient of more than 100 mmHg across the pulmonary valve. However, it was not possible to distinguish between valvular and supravalvular stenosis. Pulmonary stenosis with characteristic bulging of the valve could finally be diagnosed by transoesophageal echocardiography. Subsequently, a successful balloon valvuloplasty of the pulmonary valve was performed, which significantly reduced the maximum pressure gradient from 70 to 19 mmHg. Detailed pressure–volume analyses demonstrated distinctive increased contractility (end-systolic elastance = 1.47 mmHg/mL), increased afterload effective arterial elastance, prolonged systole duration (480 ms), and increased stroke work prior to valvuloplasty consistent with the Anrep effect. After successful intervention, the Anrep effect abruptly reversed characterized by reduction of afterload, contractility, and systolic duration. Conclusion: This case report of severe pulmonary stenosis identified a possible contribution of the chronic Anrep effect as a regulator of right ventricular contractility and energy expenditure before and after successful pulmonary valve implantation.

Zusammenfassung: Herzklappenerkrankungen stellen eine der häufigsten strukturellen kardiovaskulären Pathologien bei Schwangeren dar. Während regurgitierende Vitien meist gut toleriert werden, bergen stenosierende Klappenvitien und mechanische Herzklappenprothesen ein relevantes maternales und fetales Risiko, insbesondere im Peripartum. Die physiologische Steigerung des Herzzeitvolumens, Volumenverschiebungen unter der Geburt sowie das hyperkoagulatorische Milieu im Wochenbett können zur kardialen Dekompensation oder zu Klappenthrombosen führen. Das peripartale Management erfordert daher eine klappenspezifische Risikostratifikation, eine individualisierte Antikoagulationsstrategie sowie eine strukturierte Geburtsplanung im interdisziplinären Setting. Dieser Beitrag fasst die aktuellen evidenzbasierten Strategien für das Management von Klappenvitien sowie prothetischen Klappen im Peripartum zusammen.

Background: Tricuspid regurgitation (TR) and right ventricular (RV) remodelling are closely related. Recent European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on valvular heart disease propose adjusted reference values for RV size and function. Aims: To determine the predictive value of the proposed RV dilatation and dysfunction thresholds in a real-world interventional cohort. Methods and Results: Echocardiographic thresholds were evaluated retrospectively in 651 patients, who underwent transcatheter tricuspid valve repair (TTVr) at two tertiary centres. The primary endpoint was 2-year survival [Kaplan–Meier estimate: 78.6% (74.9–81.9)]. RV strain was the most frequent marker of dysfunction at baseline [free walls strain (FWS) 21 mm/m2), and tricuspid annular (TA) diameters (>21 mm/m2) were associated with survival (P = .04, <.01, and <.01). Tricuspid annular plane systolic excursion 21 mm/m2 [hazard ratio (HR) 2.85 (1.41–5.76); P < .01] and FWS <11% [HR 1.91 (1.07–3.38); P = .03] independently predicted survival. Mortality risk increased for each additional pathological parameter [HR per parameter 1.33 (1.14–1.57); P < .01]. After effective TR reduction (residual TR ≤I; n = 341, 52%), no RV cut-off remained associated with survival. Conclusions: TTVr is often performed at an advanced disease stage, and adverse RV remodelling is strongly associated with survival. Nevertheless, effective TR reduction attenuated this prognostic value.