Author + information
- Received June 12, 2014
- Revision received July 9, 2014
- Accepted July 10, 2014
- Published online January 1, 2015.
- Vera E. Bottari, MD∗∗ (, )
- Gloria Tamborini, MD∗,
- Antonio L. Bartorelli, MD∗,†,
- Francesco Alamanni, MD∗,† and
- Mauro Pepi, MD∗
- ∗Centro Cardiologico Monzino, Instituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- †Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
- ↵∗Reprint requests and correspondence:
Dr. Vera Elena Bottari, Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milan, Italy.
Percutaneous mitral valve repair (PMVR) with MitraClip (Abbott Laboratories, Abbott Park, Illinois) has emerged as a therapeutic option for severe mitral regurgitation (MR) in high surgical risk patients (1). Echocardiography is fundamental in patient selection, in guiding MitraClip implantation procedure, and in assessing procedural results (2). Previous cases of PMVR, after failure of surgical mitral valve (MV) annuloplasty (3,4) have been reported. To our knowledge, this is the first case of clip implantation in a patient with severe MR after a surgical repair with the edge-to-edge technique.
A 76-year-old man was referred to our hospital for symptomatic (New York Heart Association functional class III) severe MR. Eight years ago, he underwent surgical MV edge-to-edge repair, with stitching at the posteromedial commissure and between A3-P3 scallops, without annuloplasty. Assessment of the mechanism of recurrent MR and its quantification was performed by transthoracic and transesophageal echocardiography. Transthoracic echocardiography confirmed severe MR (vena contracta 8 mm), mean gradient was 2 mm Hg, and MV orifice area 5.3 cm2. Transesophageal echocardiography showed a large prolapse of P3, extended to P2, due to a partial detachment of the Alfieri stitch. The stitch detachment did not involve posteromedial commissure and a regurgitant jet originated from the central peristitch orifice (Figure 1). He has been deemed at prohibitive surgical risk for redo surgery, and PMVR was proposed. The complexity of the case required the implantation of 2 clips. The first clip was implanted close to the posteromedial commissure and the second in a more lateral position to obtain a better leaflet stabilization without functional stenosis (postoperative mean gradient 3 mm Hg) and significant MR reduction (vena contracta 2 mm) (Figure 2).
Three-dimensional transesophageal echocardiography played a key role in the guidance of the MitraClip implantation. Accurate echocardiographic patient selection and procedure guidance makes PMVR feasible, even in a patient with previous edge-to-edge surgical repair.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 12, 2014.
- Revision received July 9, 2014.
- Accepted July 10, 2014.
- American College of Cardiology Foundation