Author + information
- Received October 12, 2015
- Accepted October 22, 2015
- Published online February 8, 2016.
- aKlinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
- bKlinik und Poliklinik für Herz-, Thorax-, und Herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg, Germany
- ↵∗Reprint requests and correspondence:
PD Dr. Med. Stefan Buchner, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
- Alfieri stitch
- mitral regurgitation
- mitral valve repair
- percutaneous edge-to-edge mitral valve
A 75-year-old woman underwent a surgical correction of severe mitral regurgitation (MR). The valve morphology was characterized by chordae rupture (P2), prolapse (A2), and an unusual small anterior valve area with a restrictive posterior leaflet. The correction comprised chordae replacement P2/A2 without annuloplasty due to a tight annulus. Finally, an Alfieri stitch was performed.
Four weeks later, the patient presented with dyspnea. Echocardiography revealed a rupture of the Alfieri stitch (Figures 1A and 1B, Online Videos 1 and 2) with severe MR (Figure 1C, Online Video 3) and a mitral valve area of 2.47 cm2 (Figure 1D). The patient did not prefer to undergo a reoperation, and the heart team’s consensus was an interventional strategy with an “edge-to-edge” repair.
To prevent significant mitral stenosis, we performed a thorough hemodynamic monitoring by simultaneous measurements with 1 pigtail catheter in the left atrium and 1 in left ventricle (Figure 1E). The initial transvalvular gradient was 6 mm Hg (Figure 1F). Using 3-dimensional echocardiography, the clip was positioned and the grasp was done (Figure 1G, Online Video 4). Before final detachment of the clip, simultaneous measurements showed a decrease of the v-wave (63 to 30 mm Hg) and a mean gradient of 8 mm Hg (Figure 1H). Thus, the clip was released. Three-dimensional echocardiography confirmed a significant reduction in MR and the mitral valve area of 1.8 cm2 (7 mm Hg) (Figures 1I, 1J, and 1K, Online Videos 5 and 6). On follow-up, the patient is doing well.
This case highlights the feasibility and efficacy of MitraClip therapy as a bail-out strategy after failure of a surgical “edge-to-edge” repair.
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 October 12, 2015.
- Accepted October 22, 2015.
- 2016 American College of Cardiology Foundation