One stone hits two birds: transcatheter mitral valve edge-to-edge repair for hypertrophic obstructive cardiomyopathy and severe mitral regurgitation.

Abstract

A 68-year-old woman presented with dyspnoea on exertion and intermittent palpitation followed by near fainting. The transthoracic echocardiography (TTE) revealed asymmetric myocardial hypertrophy with an interventricular septal wall thickness of 15.2 mm at diastole, and elongated anterior leaflet (Panel B) with systolic anterior motion (SAM; Panels A and C, right). Left ventricular outflow tract (LVOT) obstruction with a peak flow velocity (Vp) of 5.18 m/s and a peak pressure gradient (PPG) of 107 mmHg (Panel D) and severe eccentric mitral regurgitation (MR) were observed (Panel E). The transoesophageal echocardiography (TEE) showed MR mostly originated from A2 and A3 (Panel F). The patient was finally diagnosed as hypertrophic cardiomyopathy (HCM). After the Heart Team discussion and share decision-making, the patient then received transcatheter mitral valve edge-to-edge repair (TEER) with MitraClip system and a single XTR clip. The intraoperative TEE displayed residual trace MR (Panel J and TTE Panel I), abolishment of SAM phenomenon (Panel G, right), and an LVOT Vp of 1.84 m/s and PPG of 13 mmHg (Panel H). After the procedure, the left ventricular global longitudinal strain and circumferential strain also increased (pre-operation Panel C, left; post-operation Panel G, left). The patient got rid of prior symptoms immediately after the procedure, and she was then safely discharged home within a week.