Author + information
- Received September 19, 2012
- Accepted September 27, 2012
- Published online March 1, 2013.
- Karl K. Poon, MBBS⁎ (, )
- Robert D. Safian, MD and
- George S. Hanzel, MD
- ↵⁎Reprint requests and correspondence:
Dr. Karl K. Poon, Department of Cardiology, William Beaumont Hospital, 3601 13W Mile Road, Royal Oak, Michigan 48073
A 66-year-old man was referred for percutaneous mitral edge-to-edge repair for New York Heart Association (NYHA) functional class III heart failure and severe mitral regurgitation. He underwent coronary bypass surgery for a large anterior myocardial infarct 8 years prior, resulting in a severe ischemic cardiomyopathy with a left ventricular ejection fraction of 25% despite resynchronization therapy. He also received a Greenfield permanent inferior vena cava (IVC) filter (Boston Scientific, Natick, Massachusetts) several years prior for recurrent pulmonary embolism. He had now been deemed prohibitive surgical risk for mitral valve surgery, and the MitraClip procedure (Abbott Vascular, Menlo Park, California) was proposed. A 23-cm 8-F venous sheath was placed in the right femoral vein, and a venogram excluded presence of thrombi on the filter. The IVC filter was then traversed carefully with a 0.032-inch guidewire under fluoroscopic guidance. The transeptal sheath and its dilator were advanced over the wire, eventually allowing Brokenbrough needle to access the left atrium. This sheath was removed under fluoroscopy, and the 24-F MitraClip guiding catheter advanced into the left atrium without much resistance or undue movement from the IVC filter (Fig. 1A,Online Video 1). Two MitraClips were ultimately deployed (Figs. 1B and 1C) with reduction of mitral regurgitation from 4/4 to 1/4. The MitraClip guiding catheter was removed under fluoroscopy, and the tension exerted on the IVC filter could be seen relieved as the sheath was removed (Online Video 2). One-month follow-up revealed NYHA functional class I symptoms. The largest reported sheath through an IVC filter had been a 21-F sheath (1). With careful maneuvering and appreciation of IVC dimensions, even a 24-F sheath seems to be safe. The design characteristics of an IVC filter make them reasonably stable, particularly one implanted years ago. With the increase in transcatheter structural heart disease interventions, the safety of interventions through IVC filter might be particularly relevant.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 19, 2012.
- Accepted September 27, 2012.
- American College of Cardiology Foundation