Pulmonary Vein Flow Morphology After Transcatheter Mitral Valve Edge-to-Edge Repair as Predictor of Survival

Ahmed El Shaer, MBBS, Alejandra A. Chavez Ponce, MD, Mays T. Ali, MD, Didem Oguz, MD, Sorin V. Pislaru, MD, PhD, Vuyisile T. Nkomo, MD, MPH, Ratnasari Padang, MBBS, PhD, Mackram F. Eleid, MD, Mayra Guerrero, MD, Guy S. Reeder, MD, Charanjit S. Rihal, MD, Mohamad Alkhouli, MD, and Jeremy J. Thaden, MD

Mitral valve (MV) transcatheter edge-to-edge repair (TEER; MV-TEER) is an established therapy for primary mitral regurgitation (MR) in patients at high risk for MV surgery or for secondary MR for patients who remain symptomatic despite maximally tolerated guideline-directed medical treatment.1,2 Real-time intraprocedural transesophageal echocardiography (TEE) is important for procedural guidance and postprocedural assessment and can be complemented by real-time invasive hemodynamic assessment.3,4 Although residual MR is well recognized to yield prognostic outcomes, quantitative assessment is frequently limited due to the presence of multiple jets, eccentric jets, and acoustic shadowing from the prosthetic mate-rial. 5 Pulsed-wave Doppler interrogation of pulmonary venous flow (PVF) is a fast and simple method that is widely utilized to assess the severity of MR. 6 The utility of PVF was previously demonstrated as an adjunct tool to TEE post MV-TEER, but data on its prognostic value remain limited. 7,8 We sought to assess the prognostic value of the post-MV-TEER PVF morphology on clinical outcomes.

Accreditation Statement: 

The American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Society of Echocardiography designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program, the American Board of Pediatrics (ABP) MOC program, and/or the American Board of Anesthesiology’s (ABA) Maintenance of Certification in Anesthesiology Program® or MOCA 2.0®. It is ASE’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM and ABP MOC points and/or ABA MOCA 2.0®.   Physicians will earn MOC and/or MOCA 2.0 points equivalent to the amount of CME credits claimed for the activity.

ARDMS and CCI recognize ASE’s certificates and have agreed to honor the CME credit hours toward their registry requirements for sonographers.

• Release Date: May 1, 2024
• Expiration Date May 1, 2025 - CME/MOC must be claimed by this date.

Learning Objectives:

1. Apply PW Doppler of PVF to assess the hemodynamic burden of residual MR post TEER
2. Correlate PVF with all cause mortality post TEER
3. Design a protocol for recording of pre and post procedure PVF
4. Consider that abnormal PVF is an independent marker of mortality post TEER after correction for residual MR

Accreditation Statement: 

The American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Society of Echocardiography designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program, the American Board of Pediatrics (ABP) MOC program, and/or the American Board of Anesthesiology’s (ABA) Maintenance of Certification in Anesthesiology Program® or MOCA 2.0®. It is ASE’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM and ABP MOC points and/or ABA MOCA 2.0®.   Physicians will earn MOC and/or MOCA 2.0 points equivalent to the amount of CME credits claimed for the activity.

ARDMS and CCI recognize ASE’s certificates and have agreed to honor the CME credit hours toward their registry requirements for sonographers.

• Release Date: May 1, 2024
• Expiration Date May 1, 2025 - CME/MOC must be claimed by this date.

Disclosures:

ASE is committed to ensuring that its educational mission, and all accredited continuing educational programs provide a protected space to learn, teach, and engage in scientific discourse free from influence from organizations that may have an incentive to insert commercial bias into education.

While a monetary or professional affiliation with an ineligible company does not necessarily influence a speaker’s presentation, the Standards for Integrity and Independence in Accredited Continuing Education and policies of the ACCME require that all financial relationships with ineligible companies* be identified and mitigated prior to engaging in an accredited CE activity. In accordance with these policies, ASE actively identified relevant financial relationships between faculty in control of this accredited CE activity and ineligible companies and implemented mitigation strategies to eliminate any potential influence from persons or organizations that may have an incentive to insert commercial bias in this activity. (*Companies that are ineligible to be accredited in the ACCME System (“ineligible companies”) are those whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.)

At the time this article was published, the authors reported no actual or potential conflict of interest relative to the content.

Members of the ASE CME Committee members (not serving as faculty) do not have any financial relationships with ineligible companies.  Click here for a list of these members.

None of the ASE staff who were involved in the planning and implementation of this educational activity have relevant financial relationship(s) to disclose with ineligible companies.  Click here for a list of ASE staff members.

No commercial support was provided for this activity.

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