Percutaneous Transluminal Mitral Valve Repair (Mitraclip): A First Successful Case in the Philippines

Abstract

INTRODUCTION: Mitral regurgitation (MR) is a common valvular disease. The major causes of MR include mitral valve prolapse (MVP), rheumatic heart disease, infective endocarditis, annular calcification, cardiomyopathy and ischemic heart disease. MR is classified as primary MR (or degenerative), which is caused by intrinsic disease of the mitral leaflets, and secondary MR which is caused by diseases of the left ventricle and/or mitral annulus. Surgical treatment should be considered for patients with functional disability and/or for patients with no symptoms or only mild symptoms but with progressively deteriorating left ventricular (LV) function or progressively increasing LV dimensions. Without surgical treatment, the prognosis for patients with MR and heart failure is poor, so mitral valve repair or replacement is indicated for symptomatic patients. However, in patients with MR due to primary abnormality of the mitral apparatus (degenerative MR) who are deemed high risk for mitral valve surgery, MitraClip Clip Delivery System provides an alternative option in reducing significant symptomatic MR (MR ≥ 3+). THE CASE: We present the case of a 59-year-old female, hypertensive, with a history of progressive easy fatigability. Echocardiography revealed the presence of MVP with severe MR. The patient was initially offered surgical treatment but she refused and opted for percutaneous mitral valve repair (Mitraclip). The patient underwent minimally invasive percutaneous mitral valve repair which resulted in a marked reduction of mitral regurgitation. Two months after the treatment, the patient had significant clinical improvement. CONCLUSION: Percutaneous mitral valve repair using the Mitraclip Delivery System provides a novel and promising approach to select patients with severe MR as an alternative to open heart surgery. This paper describes a patient with MVP with severe MR who was treated successfully with this latest technique.