Author + information
- Received February 4, 2016
- Accepted February 11, 2016
- Published online May 9, 2016.
- Stephen H. Little, MD∗ (, )
- Marija Vukicevic, PhD,
- Eleonora Avenatti, MD,
- Mahesh Ramchandani, MD and
- Colin M. Barker, MD
- ↵∗Reprint requests and correspondence:
Dr. Stephen H. Little, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, SM-677, Houston, Texas 77030.
A 62-year-old man with peripheral vascular disease, chronic kidney disease (glomerular filtration rate <30 ml/min), previous coronary artery bypass grafting, and recent treatment for bacterial endocarditis was referred for refractory decompensated congestive heart failure (New York Heart Association functional class IV). Echocardiography demonstrated severe mitral valve regurgitation with restricted leaflet coaptation and a perforation of the posterior leaflet (Figure 1, Online Videos 1 and 2). His predicted risk for surgical mitral valve intervention was high (Society of Thoracic Surgeons Predicted Risk of Mortality, 22%), so a catheter-based mitral valve repair was considered. We previously described catheter-based intervention for mitral leaflet perforation (1).
Cardiac computed tomography was performed to better assess the size and location of the leaflet perforation. A 3-dimensional (3D) printed multimaterial model of the mitral valve leaflets and subvalvular calcium deposition was created (Figure 2) to facilitate selection and sizing of an occluder device for the posterior leaflet perforation. An AMPLATZER Duct Occluder (ADO) II (St. Jude Medical, St. Paul, Minnesota) with a waist of 6 mm, a length of 4 mm, and a disk diameter of 12 mm was selected based on its deployed geometry within the 3D printed model (Figure 3). This occluder provided complete coverage of the perforation and minimal interaction with modeled subvalvular calcification.
Under general anesthesia and 3-D transesophageal guidance, the patient underwent transseptal placement of a MitraClip (Abbott Laboratories, Abbott Park, Illinois) device across the middle scallops of the anterior and posterior leaflet. The MitraClip device reduced mitral regurgitation severity as well as the mobility of the posterior leaflet. A single ADO occluder was deployed within the posterior leaflet perforation (Figure 4, Online Video 3) with an immediate reduction of mitral regurgitation severity to mild (Online Video 4). He was discharged home the following day and continues to report improved functional status (New York Heart Association functional class II) 2 months later.
For supplemental videos, please see the online version of this article.
Dr. Barker is on the Advisory Board of Medtronic and Boston Scientific and on the Speakers’ Bureau of Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 4, 2016.
- Accepted February 11, 2016.
- American College of Cardiology Foundation