Cardiovascular magnetic resonance (CMR) imaging in patients with hypertrophic cardiomyopathy (HCM) enables the assessment of not only left ventricular (LV) hypertrophy and scarring but also the severity of mitral regurgitation. CMR assessment of mitral regurgitation is primarily based on the difference between LV stroke volume (LVSV) and aortic forward flow (Ao) measured using the phase-contrast (PC) technique. However, LV outflow tract (LVOT) obstruction causing turbulent, non-laminar flow in the ascending aorta may impact the accuracy of aortic flow quantification, leading to false conclusions regarding mitral regurgitation severity. Thus, we decided to quantify mitral regurgitation in patients with HCM using Ao or, alternatively, main pulmonary artery forward flow (MPA) for mitral regurgitation volume (MRvol) calculations. The analysis included 143 prospectively recruited subjects with HCM and 15 controls. MRvol was calculated as the difference between LVSV computed with either the inclusion (LVSVincl) or exclusion (LVSVexcl) of papillary muscles and trabeculations from the blood pool and either Ao (MRvolAoi or MRvolAoe) or MPA (MRvolMPAi or MRvolMPAe). The presence or absence of LVOT obstruction was determined based on Doppler echocardiography findings. MRvolAoi was higher than MRvolMPAi in HCM patients with LVOT obstruction [47.0 ml, interquartile range (IQR) = 31.5–60.0 vs. 35.5 ml, IQR = 26.0–51.0; p < 0.0001] but not in non-obstructive HCM patients (23.0 ml, IQR = 16.0–32.0 vs. 24.0 ml, IQR = 15.3–32.0; p = 0.26) or controls (18.0 ml, IQR = 14.3–21.8 vs. 20.0 ml, IQR = 14.3–22.0; p = 0.89). In contrast to controls and HCM patients without LVOT obstruction, in HCM patients with LVOT obstruction, aortic flow-based MRvol (MRvolAoi) was higher than pulmonary-based findings (MRvolMPAi) (bias = 9.5 ml; limits of agreement: −11.7–30.7 with a difference of 47 ml in the extreme case). The differences between aortic-based and pulmonary-based MRvol values calculated using LVSVexcl mirrored those derived using LVSVincl. However, MRvol values calculated using LVSVexcl were lower in all the groups analyzed (HCM with LVOT obstruction, HCM without LVOT obstruction, and controls) and with all methods of MRvol quantification used (p ≤ 0.0001 for all comparisons). In HCM patients, LVOT obstruction significantly affects the estimation of aortic flow, leading to its underestimation and, consequently, to higher MRvol values than those obtained with MPA-based MRvol calculations.

Background: Tricuspid regurgitation (TR) is a common valvular heart disease that often causes disabling symptoms. Caval valve implantation with the TricValve system is one of the transcatheter treatment options proposed for TR symptom reduction. With this prospective registry, we aim to summarize our early experience with TricValve system implantation. Methods: Registry participants, selected out of patients who were referred for TR treatment but who were not eligible for the transcatheter tricuspid edge-to-edge valve repair (T-TEER), were qualified for the caval valve implantation following a HeartTeam discussion. Results: Four patients (four women; median age 71 years; 67.5–77 years) in whom a one-year follow-up was completed were included in the study. The patients were highly symptomatic in the NYHA class III despite intensive diuretic treatment; all of them were considered a high-mortality risk during conventional cardiac surgery. The TricValve system was successfully implanted in all patients. At 6-month follow-up, we observed a reduction in symptoms in three out of four patients. Up to 12 months, only one patient survived, with a reduction in symptoms of NYHA class II; two patients died because of heart failure; one died due to a progression in neoplastic disease. Conclusions: In highly symptomatic TR patients who were not eligible for the T-TEER and who had a prohibitive risk of cardiac surgery, TricValve implantation led to a reduction in symptoms in a 6-month perspective. Long-term survival was limited mainly by heart failure progression and severe concomitant disorders. Further studies are needed to fully elucidate the role of caval valve implantation in the treatment of TR patients.

A 81-year woman was admitted to our institution due to worsening chronic heart failure. The patient presented herself with severe aortic valve stenosis and mitral valve insufficiency. Due to estimated high operative risk a TAVI approach was chosen. Following the fist TAVI implantation (Sapien XT™ 26 mm) a big paravalvular leakage was diagnosed. Hence, in order to close the paravalular leakage, a second TAVI procedure with a Core Valve™ 26 mm was performed. A following CT scan showed signs of aortic ring rupture. We therefore decided to perform open heart surgery. After removal of both TAVI prosthesis, native valve excision a 21 mm sized aortic homograft was implanted. Additionally, a mitral valve annuloplasty with CE Physio™ 28 mm ring was performed. In the postoperative period the patient remained for three weeks in the ICU, followed by two weeks on general ward. The patient was discharged home in good condition, with good left ventricular function and regular homograft function in the aortic position. The open heart surgery should have had been performed primarily. Nevertheless, the decision on the treatment strategy is always difficult in case of borderline patients.

Hypertrophic cardiomyopathy (HCM) is the most common congenital disease increasing the risk of sudden cardiac death. For many years, HCM patients were excluded from exercise training. However, there are data showing that patients with HCM undergoing supervised exercise training could improve physical performance without serious adverse events. A project was designed as a randomized clinical trial to assess the effectiveness and safety of hybrid cardiac rehabilitation (HCR)—a combination of hospital-based cardiac rehabilitation (1 month) with a new form of home-based telemonitored cardiac rehabilitation (2 months) in HCM patients without left ventricular (LV) outflow tract obstruction and preserved systolic function. Sixty patients who fulfil the inclusion criteria have been randomly assigned (1:1) to either HCR plus usual care (training group) or usual care only (control group). The primary endpoint is a functional capacity evaluated by peak oxygen uptake (pVO₂). Secondary endpoints include workload time during the cardiopulmonary exercise testing, a six-minute walk test distance, NT-pro BNP level, echocardiographic parameters of the left ventricular diastolic function (E/A, E/e’, myocardial strain rate), right ventricular systolic pressure, a gradient in the LV outflow tract, and quality of life. The tertiary analysis includes safety, acceptance and adherence to the HCR program. Our research will provide innovative data on the effectiveness and safety of hybrid cardiac rehabilitation in HCM patients without LV outflow tract obstruction and preserved systolic function. Clinical trials registry: ClinicalTrials.gov Identifier NCT03178357.