Author + information
- Received June 26, 2015
- Accepted July 16, 2015
- Published online December 21, 2015.
- Christophe Caussin, MD∗,
- Christelle Diakov, MD∗,
- Patrice Dervanian, MD† and
- Nicolas Amabile, MD, PhD∗∗ ()
- ∗Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
- †Department of Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France
- ↵∗Reprint requests and correspondence:
Dr. Nicolas Amabile, Department of Cardiology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France.
A 70-year-old man with severe mitral regurgitation (MR) was referred to our institution for percutaneous mitral valve repair. A Mitraclip (Abbott Vascular, Santa Clara, California) was implanted but did not correctly tether the posterior leaflet and was solely attached to the anterior leaflet. A second clip was thus implanted to stabilize the first clip. However, a residual severe eccentric MR was still present on final transesophageal echocardiographic control, after full retraction of the delivery system (Figures 1A and 1B).
Although the patient was asymptomatic, transthoracic echocardiography revealed dislodgment of clip 1 on day 2. A computed tomography scan without contrast revealed the device’s presence within the right renal hilum (Figure 1C). Selective renal arteriography and phlebography localized the detached clip in the right ostial renal vein (Figures 1D and 1E, Online Videos 1 and 2). The device was successfully retrieved using a double-snare technique through an 18-F sheath (Figures 1F1 to 1F3, Online Videos 3 and 4).
The patient underwent surgical MR correction. Periprocedural analysis revealed a large interatrial defect, a diffuse hematoma on the anterior leaflet, and a tear on the initial clip tethering zone (Figures 1G1 and 1G2). The patient benefited from a bioprosthesis implantation with a subsequent uneventful clinical course. The most plausible hypothesis explaining this case is a primary leaflet tear induced by the clip, followed by its migration toward the right atrium through the transseptal puncture orifice and, finally, backward migration within the inferior vena cava.
For supplemental videos, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 26, 2015.
- Accepted July 16, 2015.
- American College of Cardiology Foundation