Author + information
- Received February 24, 2014
- Accepted March 13, 2014
- Published online September 1, 2014.
- Michael Huntgeburth, MD∗∗ (, )
- Jochen Müller-Ehmsen, MD∗,
- Christine Brase, MD†,
- Stephan Baldus, MD∗ and
- Volker Rudolph, MD∗
- ∗Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
- †Department of Anesthesiology, University Hospital Cologne, Cologne, Germany
- ↵∗Reprint requests and correspondence:
Dr. Michael Huntgeburth, Department of Cardiology, Heart Center, University Hospital Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
Percutaneous mitral valve repair is increasingly used to improve mitral regurgitation in patients who are considered not suitable for surgery, without significant thrombus-related complications (1,2). We report, for the first time, an acute thrombus formation on the right atrial side of the atrial septum adjacent to the MitraClip steerable guide catheter ([SGC]; Abbott Vascular, Santa Clara, California), which was successfully recovered. An 86-year-old woman with a clinically relevant severe, functional mitral regurgitation was referred to our clinic for percutaneous mitral valve repair. One MitraClip was successfully placed, resulting in a significant improvement and acceptable result with mild to moderate remaining mitral regurgitation. Repeated doses of heparin were applied, leading to an activated clotting time of 356 s. In preparation to retract the delivery system, a highly mobile thrombus was detected by transesophageal echocardiography, which appeared to be attached to the right side of the atrial septum next to the SGC. The thrombus had a polyplike shape with an oval body (7 × 5 mm) and a hairlike appendix of 15 mm in length (Figure 1A, Online Video 1). To our concern, a cardiac cycle–dependent prolapse on the left atrial side was noted through the iatrogenic atrial septum defect at the SGC puncture site, posing a threat for left-sided embolism (Figure 1B, Online Video 2). The thrombus was recovered by thrombus aspiration through the slowly retracted SGC (Online Video 2) after a possible systemic embolization was prevented by increasing left atrial pressure (via increasing systemic pressure by norepinephrine infusion) and reducing right atrial pressure (by decreasing pulmonary resistance via the increase of inspiratory oxygen concentration to 100%). The retrieved blood volume was flushed through a filter, displaying a thrombus resembling the echocardiographic features (Figure 2, Online Video 3). No residual thrombus was found by transesophageal echocardiography, and no post-procedural embolic events became evident.
In summary, thrombus formation on the MitraClip system can occur despite an effective anticoagulant regimen. We therefore urge careful screening for thrombus formation during and at the end of any MitraClip procedure.
For accompanying videos, and their legends, please see the online version of this article.
Dr. Baldus has received speaking fees from Abbott Vascular. Dr. Rudolph has received an unrestricted research grant from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 24, 2014.
- Accepted March 13, 2014.
- American College of Cardiology Foundation
- Mauri L.,
- Foster E.,
- Glower D.D.,
- et al.,
- for the EVEREST II Investigators