3.1 Echocardiographic measurements before and after TMVI (Table
3)
At baseline, LV dimensions and basal septum wall thickness were in
normal range. However, on average LV volumes were larger and ejection
fraction was lower compared to those in normal range.
There were 19 patients (44%)
with LV dysfunction (LVEF <50%), while 6 patients (14%) had
hyperdynamic LV motion (LVEF >70%). There was no patient
with LVOT obstruction, but there were 2 patients with post aortic valve
replacement and elevated peak velocity; one had peak PG of 55 mm Hg due
to moderate to severe prosthetic valve stenosis, and the other had peak
PG of 46 mm Hg due to aortic valve prosthesis-patient mismatch.
After the procedure, LV end-diastolic volume and LVEF decreased, while
LVESV was not changed. LVOT gradient was significantly increased after
TMVI (Figure 3) despite a significant increase in AM angle.
One patient with SAM and severe
LVOT obstruction had the smallest LVOT area of 0.3 cm2and increased LVOT gradient of 88 mm Hg, while pre-procedure LVOT
gradient was only 8 mm Hg without any evidence of SAM.