Short Term Failure after Residual Intra Mitraclips Regurgitation Treated with Transcatheter Implantation of an Amplatzer Ventricular Septal Defect Device

Luigi Biasco,Pedrazzini Giovanni,Daniel Surder,Elena Pasotti,Tiziano Moccetti,Marco Moccetti,Francesco Petracca

doi:10.17987/jatamis.v2i0.364

Luigi Biasco, Pedrazzini Giovanni + Show 5 more

Open Access

https://doi.org/10.17987/jatamis.v2i0.364

Copy DOI

Abstract

<p>We here report the case of a patient with significant recurrent “intraclip” mitral regurgitation following the implant two Mitraclips for a functional mitral incontinence. An AMPLATZER Vascular Plug II deployed between the two clips with acute procedural success with post-procedural trans-esophageal echocardiography (TEE) showing a mild residual mitral regurgitation with trivial trans-valvuar gradients. Few months after the procedure, the patient was newly admitted for acute heart failure due to recurrent MR with a partial detachment of both clips and of the vascular plug forcing a surgical solution for the case.</p>

Highlights

A 74 years old male with known chronic obstructive pulmonary disease, permanent atrial fibrillation with previous stroke and ischemic heart disease treated with by-pass surgery ( LIMA to the LAD; and saphenous vein grafts to the right and circumflex artery) and a previous percutaneous management of a severe mitral regurgitation treated with 2 mitraclips placed between scallops A1-P1 and A2-P2 (Figure 1, panel A and panel C) was acutely admitted for recurrent heart failure
A prominent, central, intra clip regurgitation and a second, medial jet originating from A1-P1 scallops (Figure 2, panel B)
Following the description of the first in man First-in-man report of residual “intra-clip” regurgitation between two mitraclips treated with implantation of an Amplatzer Vascular Plug II that showed this approach to be feasible [1], we decided to attempt the implant of an occlusive device in between the two previously implanted clips

Summary

Introduction

A 74 years old male with known chronic obstructive pulmonary disease, permanent atrial fibrillation with previous stroke and ischemic heart disease treated with by-pass surgery ( LIMA to the LAD; and saphenous vein grafts to the right and circumflex artery) and a previous percutaneous management of a severe mitral regurgitation treated with 2 mitraclips placed between scallops A1-P1 and A2-P2 (Figure 1, panel A and panel C) was acutely admitted for recurrent heart failure. Trans-esophageal echocardiography (TEE) showed a significant residual mitral regurgitation with two distinct jets. A prominent, central, intra clip regurgitation and a second, medial jet originating from A1-P1 scallops (Figure 2, panel B).

Results

Conclusion