Abstract
Mitral regurgitation is associated with a worsened prognosis in dilated cardiomyopathy. First standard therapy consists of a mitral valve reconstruction through heart surgery including heart lung machine. In patients with high co-morbidity, catheter-based techniques, have been developed. In the Evolution I study the MONARC-system which was implanted in the coronary sinus in the functional mitral regurgitation. A reduction in regurgitation by over 1 grade was documented in 50% of patients. MitraClip is an alternative, edge-to-edge technique, which joined the posterior and anterior leaflet by implanting a clip. It can be used for both functional and degenerativ mitral regurgitation. We reported a case of MitraClip procedure with the use of two clips and a reduction of mitral regurgitation to grade 0-1 after implanting a MONARC-device four years ago with missing relevant reduction in mitral regurgitation. With this report we illustrated the management of Mitraclip in a patient with implanted MONARC-device and technical difficulties through the bowing of the posterior anulus.
Highlights
Mitral regurgitation in dilated cardiomyopathy is often a functional reason of either ischemic or idiopathic origin
We reported a case of MitraClip procedure with the use of two clips and a reduction of mitral regurgitation to grade 0–1 after implanting a MONARC device four years ago with missing relevant reduction in mitral regurgitation
In the Evolution I study, a patient with functional mitral regurgitation between 2+ and 4+ revealed at 12 months a reduction by >1 grade in 50%, that is less than what it obtained with surgical mitral valve repair
Summary
Mitral regurgitation in dilated cardiomyopathy is often a functional reason of either ischemic or idiopathic origin. In the Evolution I study, the MONARC system was implanted in the coronary sinus in the functional mitral regurgitation. A reduction in regurgitation by >1 grade was documented in 50% of the patients. MitraClip is an alternative, edge-to-edge technique, which joined the posterior and anterior leaflet by implanting a clip.
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