Immediate Closure of Iatrogenic ASD After MitraClip Procedure Prompted by Acute Right Ventricular Dysfunction (original) (raw)
Related papers
Catheterization and Cardiovascular Interventions, 2012
Objectives: Review the prevalence, echocardiographic features and potential predictors of iatrogenic ASD (iASD) created with the MitraClip guiding catheter. Background: Catheter-based repair of mitral regurgitation (MR) with the MitraClip device (Abbott Vascular, Menlo Park, CA), is performed through a 22-French transseptal guiding catheter. The echocardiographic prevalence of iASDs after the MitraClip procedure has not been reported. Methods: Thirty subjects undergoing MitraClip repair during the roll-in phase of the EVEREST II randomized trial who had baseline, 30 day, 6 and 12 month transthoracic echocardiograms (TTEs) available for review were included. Patients who underwent surgery for MR within the first 12 months were excluded. Residual iASD size, right ventricular (RV) size, left atrial (LA) volume, and tricuspid/MR grade were quantified. Results: iASDs were found at 12 months in 8 patients (27%) with a mean diameter of 6.6 6 3.1 mm. Subjects with iASD at 12 months had more residual MR, increased TR and a trend toward larger LA volumes than non-iASD patients. 83% of non-ASD patients were free from MR > 21 at 12 mos. vs. 38% of those with iASD (p50.016). There were no other significant associations between clinical and echocardiographic variables and the persistence of iASD. Conclusions: After MitraClip repair, persistent iASDs occur at a rate comparable to reports after other transseptal interventional procedures and do not appear hemodynamically significant. Patients with persistent iASDs had less MR reduction at 12-months and a trend toward larger LA volumes, suggesting that increased LA pressure may be a mechanism for persistent iASD.
World Journal of Cardiovascular Diseases
Percutaneous mitral valve repair has shown to be a less-invasive treatment option for patients with symptomatic severe mitral regurgitation (MR) with multiple comorbidities. We describe a case of improved mitral regurgitation due to improved atrial fibrillation secondary to left atrial pressure relief after the inter-atrial defect created during an unsuccessful mitraclip placement attempt. Transthoracic Echocardiogram that was performed on admission showed severe mitral valve regurgitation. She was not a surgical candidate due to multiple co-morbidities. Patient was then medically optimized and a percutaneous MitraClip placement (PMCP) was attempted but was unsuccessful due to excessive trans-mitral gradient and the procedure was aborted. However, left atrial pressure decreased, likely secondary to inter-atrial septal defect created by the procedure. Transesophageal echocardiogram performed post-op showed moderate and improved mitral regurgitation and sinus rhythm. Attempts to convert atrial fibrillation to sinus rhythm to improve mitral regurgitation had to be made before continuing with a mitral clip placement procedure in our case. In our case, the procedure itself did not help patient's symptoms, but the resulting acute atrial pressure relief improved mitral regurgitation overall due to left to right shunt from iASD, which also helped the rhythm.
Development of mitral stenosis after single mitraclip insertion for severe mitral regurgitation
Catheterization and Cardiovascular Interventions, 2014
We report the first case of mitral stenosis following Mitra-Clip insertion in a patient with symptomatic NYHA IV heart failure, secondary to severe mitral regurgitation (MR). A 79year-old female with a history of prior aortic valve replacement underwent percutaneous mitral valve (MV) repair. A single clip was advanced coaxially down onto the MV under TOE guidance, with the anterior and posterior leaflets clipped together between A2 and P2. TOE confirmed a significant reduction in MR (grade 4 to grade 1). Despite initial symptomatic relief, she represented 3 months later with similar symptoms. Repeat TOE confirmed a well positioned Mitra-Clip with mild residual MR. However, the possibility of significant mitral stenosis was raised due to the presence of significant turbulence through the bi-orifice valve, with a peak gradient of 25 mm Hg. In addition there was evidence of severe functional tricuspid valve (TV) regurgitation with elevated pulmonary artery pressures (PAP 90 mm Hg), confirmed on subsequent right heart catheterization. After repeated heart team discussions and a failure of optimal medical therapy, and despite a logistic EuroScore of 35.5, minimally invasive surgical replacement of the MV and simultaneous TV repair was undertaken via a right thoracotomy. Despite procedural success and initial good postoperative response, the patient died subsequently from a combination of hospital-acquired pneumonia and significant gastrointestinal bleeding (post operative day 35). Mitra-Clip is a promising novel approach to MV repair. The establishment of further clinical and echocardiographic based selection criteria will help identify the correct patients for this treatment. V C 2013 Wiley Periodicals, Inc.
MitraClip detachment after electrical cardioversion: a case report
European Heart Journal - Case Reports
Background Transcatheter edge-to-edge repair (TEER) repair is a minimally invasive procedure used for patients with severe mitral regurgitation (MR). Cardioversion is indicated for haemodynamically unstable patients with narrow complex tachycardia and is generally considered safe post-mitral clip. We present a patient who underwent cardioversion post-TEER with a single leaflet detachment (SLD). Case summary An 86-year-old female with severe MR underwent TEER with a MitraClip that reduced MR severity to mild. During the procedure, the patient experienced tachycardia, and cardioversion was performed successfully. However, immediately after the cardioversion, the operators noticed recurrent severe MR with a posterior leaflet clip detachment. Deployment of a new clip adjacent to the detached one was obtained. Discussion Transcatheter edge-to-edge repair is a well-established method for treating severe MR in patients who are not suitable for surgical intervention. However, complications ...
Utility of Intraoperative Transesophageal Echocardiography in an Atrial Septal Defect Operation
Journal of Cardiothoracic and Vascular Anesthesia, 2006
T RANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) aids in intraoperative management and improves outcome in patients undergoing cardiac valve repairs, complex congenital heart corrections, and in high-risk patients undergoing coronary artery bypass surgery. 1 For the aforementioned reasons, TEE has become a standard monitor in many cardiac operating rooms. 1 As far as its clinical impact and cost-saving profile are discussed, there are numerous reports regarding its benefits for many conditions. [2] In the present case, there was complex congenital heart disease and TEE was inserted at the onset of the operation. After the repair of the atrial septal defect (ASD), TEE facilitated immediate diagnosis of faulty patch placement and a small left atrium. The correct and immediate diagnosis by TEE prevented the possible mortality and provided a good prognosis.
Echocardiography, 2008
Background: Little attention is given to development of mitral regurgitation (MR) in adults with atrial septal defect (ASD). The aim of the study was to determine the associated factors of MR in ASD adults before surgical repair and the fate of moderate to severe MR after surgery. Methods: We examined 71 consecutive patients with secundum ASD (47 ± 16 years) who underwent surgical repair. Clinical and echocardiographic variables including size of left and right heart systems and severity of MR and tricuspid regurgitation (TR) were investigated before and early after surgery. Results: Before ASD closure, 14 patients (20%) had moderate to severe MR and 25 patients (35%) showed mitral valve (MV) prolapse. The ASD patients with moderate to severe MR showed worse cardiovascular symptoms, increased occurrence of atrial fibrillation and MV prolapse, and greater left ventricular (LV) end-diastolic volume, left atrial area, and TR severity than those with none to mild MR (all P < 0.05). Among preoperative variables, TR severity, left atrial area, LV end-diastolic volume, and MV prolapse were associated with preoperative MR severity in all the patients (all P < 0.03). Isolated ASD closure (n = 46) decreased MV prolapse (P = 0.008). Preoperative moderate to severe MR decreased after ASD closure with and without MV surgery (n = 9 and 5, respectively; both P < 0.05). Conclusions: Preoperative MR severity was associated with TR severity, dilated left heart chambers, and MV prolapse. MR decreased after ASD closure with and even without MV surgery. (ECHOCARDIOGRAPHY, Volume 25, November 2008) atrial septal defect, mitral regurgitation, mitral valve prolapse, tricuspid regurgitation
Use of four MitraClip devices in a patient with ischemic cardiomyopathy and mitral regurgitation
Catheterization and Cardiovascular Interventions, 2012
Severe mitral regurgitation (MR) as a consequence of underlying left ventricular dysfunction substantially contributes to morbidity and mortality. A variety of percutaneous treatment options for mitral valve repair have been developed; however, most of these techniques are still at an early stage of clinical evaluation. Today, percutaneous edgeto-edge mitral valve repair using the MitraClip V R system is the only endovascular approach that demonstrated noninferiority when compared with standard surgical repair in a randomized trial. However, a considerable number of patients with functional MR will present with extensive annulus dilatation and minimal vertical leaflet coaptation that potentially preclude them from this beneficial technology for anatomical reasons. In this report, we portray a 72-year-old man presenting with end-stage systolic heart failure and severe functional MR as a consequence of long-standing coronary artery disease. Recently, his clinical course was complicated by intractable hemodynamic instability and recurrent pulmonary edema. High predicted mortality and progressive physical decay rendered this moribund patient a candidate for salvage percutaneous mitral valve repair. During the endovascular procedure, a central systolic coaptation gap of 7 mm proved to be too wide for adequate simultaneous grasping of both leaflets. Consideration was given to an alternative approach by means of our novel ''zipping technique.'' Through the trans-septal route, medial to lateral approximation of the tethered leaflets was successfully achieved by intentional deployment of four MitraClip V R devices. With the first in-human application of four mechanical implants, a profound reduction of MR grade has been accomplished by the creation of a lateral neo-orifice with apparent acute clinical success. However, it needs to be determined whether successful application of the zipping technique leads to sustained reverse ventricular remodeling and will translate into an improved long-term prognosis. V C 2011 Wiley Periodicals, Inc.