Author + information
- Received February 20, 2018
- Accepted February 27, 2018
- Published online June 18, 2018.
- Tilak K.R. Pasala, MD,
- Lucy M. Safi, MD,
- Vladimir Jelnin, MD and
- Carlos E. Ruiz, MD, PhD∗ ()
- Structural and Congenital Heart Center, Hackensack University Medical Center, Hackensack, New Jersey
- ↵∗Address for correspondence:
Dr. Carlos E. Ruiz, Hackensack University Medical Center and The Joseph M. Sanzari Children’s Hospital, 30 Prospect Avenue, 5 Main, Room 5640, Hackensack, New Jersey 07601.
An 86-year-old woman presented with New York Heart Association functional class III symptoms and a large mitral valve prolapse involving the P2 and P3 segments (white arrows, Figure 1A) with severe mitral regurgitation. A MitraClip (Abbott Vascular, Santa Clara, California) was placed at the A2-P2 segments first (Figure 1B). Transesophageal echocardiogram imaging showed residual mitral regurgitation on both sides of the initial MitraClip. A second MitraClip was placed medially to the first one, but the grasp was challenging. The anterior leaflet was easily grasped, but the posterior leaflet remained elusive (Figure 1C), despite the use of adenosine (12 mg). After multiple attempts, adequate grasp of both leaflets was determined and the second MitraClip was released. Immediately after deployment, the MitraClip partially detached (Figure 1D, Online Video 1) and after several heartbeats, a complete detachment occurred (white arrow, Figure 1D). The MitraClip appeared freely mobile in the left atrium, traversed briefly into the left ventricle, and embolized back into the left atrium (red arrow, Figure 1D, Online Video 1). Cardiothoracic surgery was called, and while awaiting their arrival, a percutaneous attempt to retrieve the MitraClip was made. A 6-F JR4 guide catheter and 18-30 En Snare (Merit Medical, South Jordan, Utah) was advanced through the same guide delivery system into the left atrium. Using fine maneuvering, the MitraClip was caught at the nose of the clip. Subtle adjustments were made to align the clip coaxial to the sheath, and the MitraClip was retrieved into the guide delivery system (Figure 1E, Online Video 1). Subsequently, a new MitraClip was placed at the A1-P1 portions of the mitral valve leaflets stabilizing the first MitraClip and reducing the overall mitral regurgitation from 4+ to 2+ (Figure 1F).
Grasping the mitral valve leaflets in patients with significant mitral valve prolapse can be challenging, and in the setting of hypermobile prolapsing leaflets, there is a potential for complete detachment. Previously embolized MitraClips required surgical removal. However, we report the successful percutaneous retrieval of a completely detached MitraClip free-flying in the left atrium.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 20, 2018.
- Accepted February 27, 2018.
- 2018 American College of Cardiology Foundation