{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T08:16:49Z","timestamp":1782202609575,"version":"3.54.5"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Several studies have evaluated preprocedural imaging predictors of left ventricular outflow tract obstruction (LVOTO) after transcatheter mitral valve replacement. The patient cohorts in these studies were heterogeneous and included patients with transcatheter mitral valve replacement in failed bioprostheses, annuloplasty rings, and severe mitral annular calcification (MAC). The goal of this study was to evaluate predictors of LVOTO specific to patients undergoing valve-in-MAC.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>This study included patients with severe MAC who underwent valve-in-MAC and had optimal quality preprocedural multidetector row computed tomography scans eligible for retrospective analysis. Baseline demographic, echocardiographic, and procedural data on these patients were collected. multidetector row computed tomography parameters were analyzed for association with LVOTO, defined as increase in mean LVOT gradient by \u226510 mm\u2009Hg with accompanying hemodynamic instability.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Seventy-one patients with optimal preprocedural computed tomography scans were included in this study (mean age, 72.5\u00b113.5 years), 9 of which developed LVOTO (all female). Baseline mean LVOT area, neo-LVOT area (145.3 versus 270.9 mm\n              <jats:sup>2<\/jats:sup>\n              ;\n              <jats:italic>P<\/jats:italic>\n              =0.006), indexed neo-LVOT area (90.1 versus 157.4;\n              <jats:italic>P<\/jats:italic>\n              =0.05), and virtual transcatheter heart valve to septum distance (3.1 versus 6.9 mm;\n              <jats:italic>P<\/jats:italic>\n              =0.002) were lower in the LVOTO group. Expected % LVOT area reduction was higher in the latter group (58.3 versus 42.7%;\n              <jats:italic>P<\/jats:italic>\n              =0.008). In the univariable analysis, the baseline mean LVOT area, neo-LVOT area, indexed neo-LVOT area, and valve to septum distance were all significantly associated with LVOTO.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>The systolic mean LVOT area, neo-LVOT area, indexed neo-LVOT, expected percentage LVOT area reduction, and the valve to septum distance were associated with LVOTO after valve-in-MAC.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.121.010854","type":"journal-article","created":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T18:26:02Z","timestamp":1634667962000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Predictors of Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Replacement in Severe Mitral Annular Calcification: An Analysis of the Transcatheter Mitral Valve Replacement in Mitral Annular Calcification Global Registry"],"prefix":"10.1161","volume":"14","author":[{"given":"Abdallah","family":"El Sabbagh","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (A.E.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9572-7688","authenticated-orcid":true,"given":"Mohammed","family":"Al-Hijji","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Heart Hospital, Hamad Medical Corporation, Doha, Qatar (M.A.-H)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dee Dee","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Henry Ford Hospital, Detroit, MI (D.D.W., W.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6082-5379","authenticated-orcid":true,"given":"Mackram","family":"Eleid","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.E., C.R., M.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Urena","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bichat Hospital, Paris, France (M.U., D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0336-0058","authenticated-orcid":true,"given":"Dominique","family":"Himbert","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bichat Hospital, Paris, France (M.U., D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun","family":"Chakravarty","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, CA (T.C., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Holzhey","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Leipzig Heart Center, Germany (D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Pershad","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Chandler Regional and Mercy Gilbert Medical Center, AZ (A.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. Kenith","family":"Fang","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Banner University Medical Center, Phoenix, AZ (H.K.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1096-1537","authenticated-orcid":true,"given":"Mohammed","family":"Nejjari","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Centre Cardiologique du Nord, St. Denis, France (M.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firas","family":"Zahr","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Oregon Health &amp; Science University, Portland, OR (F.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4461-9089","authenticated-orcid":true,"given":"Danny","family":"Dvir","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington, Seattle (D.D.)"},{"name":"Jesselson Integrated Heart Center, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel (D.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Rizwan","family":"Sardar","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Northeast Ohio Medical University, Rootstown, OH (M.R.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asim N.","family":"Cheema","sequence":"additional","affiliation":[{"name":"Division of Cardiology, St. Michael\u2019s Hospital, Toronto, Canada (A.N.C., S.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami","family":"Alnasser","sequence":"additional","affiliation":[{"name":"Division of Cardiology, St. Michael\u2019s Hospital, Toronto, Canada (A.N.C., S.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay","family":"Iyer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Buffalo General Medical Center, Buffalo, NY (V.I.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georges","family":"Kaddissi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cooper University Hospital, Camden, NJ (G.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Webb","sequence":"additional","affiliation":[{"name":"Division of Cardiology, St. Paul\u2019s Hospital, Vancouver, Canada (J.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj","family":"Makkar","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, CA (T.C., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alec","family":"Vahanian","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Paris, Paris, France (A.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"O\u2019Neill","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Henry Ford Hospital, Detroit, MI (D.D.W., W.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charanjit","family":"Rihal","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.E., C.R., M.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9151-8096","authenticated-orcid":true,"given":"Mayra","family":"Guerrero","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.E., C.R., M.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.08.872"},{"key":"e_1_3_4_3_2","first-page":"297","article-title":"Rupture of the posterior wall of the left heart at the atrio-ventricular groove following mitral valve replacement","volume":"76","author":"Casarotto D","year":"1977","unstructured":"Casarotto, D, Bortolotti, U, Thiene, G, Gallucci, V, Cevese, PG. 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