Author + information
- Received September 20, 2016
- Revision received November 22, 2016
- Accepted November 30, 2016
- Published online March 6, 2017.
- Mohamad Alkhouli, MDa,∗ (, )
- Stanley Wolfe, BSb,
- Fahad Alqahtani, MDa,
- Sami Aljohani, MDa,
- James Mills, MDa,
- Stephen Gnegy, PA-Ca and
- Vinay Badhwar, MDa
- aWest Virginia University Heart and Vascular Institute, Morgantown, West Virginia
- bWest Virginia University School of Medicine, Morgantown, West Virginia
- ↵∗Address for correspondence:
Dr. Mohamad Alkhouli, West Virginia University Heart & Vascular Institute, 1 Medical Drive, Morgantown, West Virginia 26505.
- acute myocardial infarction
- mechanical circulatory support
- mitral regurgitation
- percutaneous mitral valve repair
Transcatheter edge-to-edge mitral valve repair with MitraClip (Abbott Vascular, Santa Clara, California) is an effective therapy for patients with severe degenerative mitral regurgitation (MR) who are at high-risk for surgery (1). Experience with using the MitraClip in patients with acute MR complicating myocardial infarction is limited (2).
A 77-year-old man with hypertension and emphysema presented with chest pain, dyspnea, and cough. On presentation, he was normotensive (118/77 mm Hg), tachypnic, and hypoxemic (oxygen saturation, 92%). A 4/6 holosystolic apical murmur and bibasilar crackles were heard on auscultation. Chest radiograph showed pulmonary edema. Electrocardiogram revealed sinus rhythm, right bundle branch block, and lateral ST depression. Troponin-I was 5,190 ng/l. Heparin was started and cardiac catheterization was planned. Over the next 24 h, the patient developed hypotension and worsening hypoxemia. Coronary angiography and left ventriculography revealed 99% right coronary artery stenosis, mild left anterior descending artery stenosis, severe inferior wall hypokinesis, and severe MR (Figures 1A and 1B, Online Video 1). The right coronary artery was stented with a 3.0 × 18 mm drug-eluting stent (Figure 1C). Aortic pressure was 77/49 mm Hg, right atrial pressure was 24 mm Hg, mean pulmonary artery pressure was 34 mm Hg, and cardiac index was 1.6 l/min/m2. Mean left atrial pressure measured via a retrograde approach was 38 mm Hg (V-wave, 74 mm Hg) (Figure 1D). An Impella-CP (Abiomed, Danvers, Massachusetts) device was inserted and provided 3.3 l/min flow support. Over the next 48 h, the patient remained dependent on circulatory support. Following a heart team discussion, it was decided to proceed with MitraClip implantation. After the MitraClip guide was advanced into the left atrium, the Impella-CP device was pulled into the aorta and left at performance level 1 (Figures 2A and 2B). Two Mitraclips were implanted reducing MR to trivial and left atrial pressure from 38 mm Hg to 20 mm Hg (Figure 2C). Real-time three-dimensional transesophageal echocardiography showed adequate grasping of the flail A2 segment and near resolution of MR (Figure 3, Online Videos 2 and 3). The patient was discharged home on post-operative Day 6, and remained asymptomatic at 45 days follow-up. This case illustrates the feasibility and the effectiveness of MitraClip in the management of acute ischemic MR.
For supplemental videos and their legends, please see the online version of this article.
Dr. Badhwar has an uncompensated position on the Advisory Board of Abbott CardioVascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 20, 2016.
- Revision received November 22, 2016.
- Accepted November 30, 2016.
- American College of Cardiology Foundation
- ↵Sorajja P, Mack M, Vemulapalli S, et al. Initial experience with commercial transcatheter mitral valve repair in the United States. J Am Coll Cardiol 2016;67:1129–40.
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